Abstract
OBJECTIVES: To conduct a biomarker survey to examine the burden of anemia, iron deficiency, and inflammation in women of reproductive age in Southern India. METHODS: Participants were women of reproductive age (15–40 y; n = 980) who were not pregnant or lactating and resided in households within the 50 km,(2) catchment area of our periconceptional surveillance program in Southern India. Venous blood samples were collected at enrollment by a trained laboratory technician at our research facility. Whole blood samples were analyzed for hemoglobin (Hb) using an automated Coulter counter. Plasma, serum, and red blood cells were separated by centrifugation, processed, and stored <−80°C until analysis. Serum ferritin (SF) was measured by electrochemiluminescence (E411, Roche Diagnostics Mannheim). Soluble transferrin receptor (sTfR), C-reactive protein (CRP), and alpha-1 acid glycoprotein (AGP) were analyzed via the Roche COBAS Integra 400 plus analyzer (Roche Diagnostics). Anemia and severe anemia were defined as hemoglobin <12.0 g/dL and <8.0 g/dL, respectively. Serum ferritin concentrations were adjusted for inflammation using BRINDA methods. Iron deficiency was defined as SF < 15.0 µg/L, and iron deficiency anemia was defined as Hb < 12.0 g/dL and SF < 15.0 µg/L. Inflammation was defined as elevated CRP or AGP concentrations, using established cut-offs (CRP > 5.0 mg/L, AGP > 1.0 g/L). RESULTS: A total of 41.1% of women were anemic and 2.9% had severe anemia. In the biomarker analyses, 53.8% of women were iron deficient (67.2% after BRINDA adjustment) and 29.1% had iron deficiency anemia (31.2% after BRINDA adjustment). A total of 14.7% of women had elevated CRP levels (>5.0 mg/L) and 24.4% had elevated AGP (>1.0 g/L) concentrations. CONCLUSIONS: The substantial burden of anemia and iron deficiency in this study population suggest an opportunity for prevention of anemia and micronutrient deficiencies. Findings from this biomarker survey will inform the development of a randomized efficacy trial for the prevention of anemia and birth defects in Southern India. FUNDING SOURCES: This study was supported by the Centers for Disease Control and Prevention (CDC), and the University of South Carolina's Disability Research and Dissemination Center through its cooperative agreement with the Centers for Disease Control and Prevention. AF was supported by the National Institutes of Health.