Next Article in Journal
Selenium Deficiency Is Widespread and Spatially Dependent in Ethiopia
Previous Article in Journal
Discrimination of Isointense Bitter Stimuli in a Beer Model System
Article

Inflammation Adjustment by Two Methods Decreases the Estimated Prevalence of Zinc Deficiency in Malawi

1
Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
2
School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, Leicestershire LE12 5RD, UK
3
Department of Nutrition, HIV, and AIDS, Ministry of Health, Lilongwe 3, Malawi
4
Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
5
School of Public Health, University of the Witwatersrand, Johannesburg 2193, South Africa
*
Authors to whom correspondence should be addressed.
Nutrients 2020, 12(6), 1563; https://doi.org/10.3390/nu12061563
Received: 16 April 2020 / Revised: 14 May 2020 / Accepted: 21 May 2020 / Published: 27 May 2020
(This article belongs to the Section Nutrition and Public Health)
Serum zinc concentration (SZC) is used widely to assess population-level zinc status. Its concentration decreases during inflammatory responses, which can affect the interpretation of the results. This study aimed to re-estimate the prevalence of zinc deficiency in Malawi based on the 2015–2016 Malawi Micronutrient Survey (MNS) data, by adjusting SZC measures with markers of inflammation. SZC and inflammation data from 2760 participants were analysed. Adjustments were made using: (1) The Internal Correction Factor (ICF) method which used geometric means, and (2) The Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) method, which used linear regression. Mean SZC values increased significantly when adjustments were made by either ICF or BRINDA (p < 0.001). The national prevalence of zinc deficiency decreased from 62% to 59%, after ICF adjustment, and to 52% after BRINDA adjustment. ICF and BRINDA values of SZC were highly correlated (p < 0.001, r = 0.99), but a Bland–Altman plot showed a lack of agreement between the two methods (bias of 2.07 µg/dL). There was no association between the adjusted SZC and stunting, which is a proxy indicator for zinc deficiency. Inflammation adjustment of SZC, using ICF or BRINDA, produces lower estimates of zinc deficiency prevalence, but the lack of agreement between the adjustment methods warrants further research. Furthermore, the lack of association between SZC and stunting highlights the need to explore other biomarkers and proxies of population zinc assessment. This study demonstrates the importance of considering inflammatory confounders when reporting SZC, to ensure accuracy and to support policy decision making. View Full-Text
Keywords: zinc; biomarkers; inflammation; C-reactive protein (CRP); alpha 1-acid glycoprotein (AGP); children; women of reproductive age zinc; biomarkers; inflammation; C-reactive protein (CRP); alpha 1-acid glycoprotein (AGP); children; women of reproductive age
Show Figures

Figure 1

MDPI and ACS Style

Likoswe, B.H.; Phiri, F.P.; Broadley, M.R.; Joy, E.J.M.; Patson, N.; Maleta, K.M.; Phuka, J.C. Inflammation Adjustment by Two Methods Decreases the Estimated Prevalence of Zinc Deficiency in Malawi. Nutrients 2020, 12, 1563. https://doi.org/10.3390/nu12061563

AMA Style

Likoswe BH, Phiri FP, Broadley MR, Joy EJM, Patson N, Maleta KM, Phuka JC. Inflammation Adjustment by Two Methods Decreases the Estimated Prevalence of Zinc Deficiency in Malawi. Nutrients. 2020; 12(6):1563. https://doi.org/10.3390/nu12061563

Chicago/Turabian Style

Likoswe, Blessings H., Felix P. Phiri, Martin R. Broadley, Edward J.M. Joy, Noel Patson, Kenneth M. Maleta, and John C. Phuka 2020. "Inflammation Adjustment by Two Methods Decreases the Estimated Prevalence of Zinc Deficiency in Malawi" Nutrients 12, no. 6: 1563. https://doi.org/10.3390/nu12061563

Find Other Styles
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Back to TopTop