BACKGROUND Iron deficiency (ID) is a major public health burden in African children and accurate prevalence estimates are important for effective nutritional interventions. However, ID may be incorrectly estimated in Africa because most measures of iron status are altered by inflammation and infections such as malaria. Through the current study, we have assessed different approaches to the prediction of iron status and estimated the burden of ID in African children. METHODS We assayed iron and inflammatory biomarkers in 4853 children aged 0-8 years from Kenya, Uganda, Burkina Faso, South Africa, and The Gambia. We described iron status and its relationship with age, sex, inflammation, and malaria parasitemia. We defined ID using the WHO guideline (ferritin < 12 μg/L or < 30 μg/L in the presence of inflammation in children < 5 years old or < 15 μg/L in children ≥ 5 years old). We compared this with a recently proposed gold standard, which uses regression-correction for ferritin levels based on the relationship between ferritin levels, inflammatory markers, and malaria. We further investigated the utility of other iron biomarkers in predicting ID using the inflammation and malaria regression-corrected estimate as a gold standard. RESULTS The prevalence of ID was highest at 1 year of age and in male infants. Inflammation and malaria parasitemia were associated with all iron biomarkers, although transferrin saturation was least affected. Overall prevalence of WHO-defined ID was 34% compared to 52% using the inflammation and malaria regression-corrected estimate. This unidentified burden of ID increased with age and was highest in countries with high prevalence of inflammation and malaria, where up to a quarter of iron-deficient children were misclassified as iron replete. Transferrin saturation < 11% most closely predicted the prevalence of ID according to the regression-correction gold standard. CONCLUSIONS The prevalence of ID is underestimated in African children when defined using the WHO guidelines, especially in malaria-endemic populations, and the use of transferrin saturation may provide a more accurate approach. Further research is needed to identify the most accurate measures for determining the prevalence of ID in sub-Saharan Africa.

中文翻译：

---

估计非洲儿童缺铁的负担。

背景缺铁 (ID) 是非洲儿童的主要公共卫生负担，准确的患病率估计对于有效的营养干预很重要。然而，在非洲，ID 可能被错误地估计，因为大多数铁状态的衡量标准都会因炎症和感染（如疟疾）而改变。通过目前的研究，我们评估了预测铁状况的不同方法，并估计了非洲儿童的 ID 负担。方法 我们检测了来自肯尼亚、乌干达、布基纳法索、南非和冈比亚的 4853 名 0-8 岁儿童的铁和炎症生物标志物。我们描述了铁的状态及其与年龄、性别、炎症和疟原虫血症的关系。我们使用 WHO 指南定义 ID（铁蛋白 < 12 μg/L 或 < 30 μg/L 在儿童出现炎症时 < 5 岁或 ≥ 5 岁儿童 < 15 μg/L）。我们将此与最近提出的金标准进行了比较，该标准根据铁蛋白水平、炎症标志物和疟疾之间的关系对铁蛋白水平进行回归校正。我们进一步研究了其他铁生物标志物在使用炎症和疟疾回归校正估计作为金标准来预测 ID 中的效用。结果 ID 的患病率在 1 岁和男婴中最高。炎症和疟原虫血症与所有铁生物标志物相关，尽管转铁蛋白饱和度受到的影响最小。WHO 定义的 ID 的总体流行率为 34%，而使用炎症和疟疾回归校正估计为 52%。这种不明身份的 ID 负担随着年龄的增长而增加，并且在炎症和疟疾高发国家中最高，其中多达四分之一的缺铁儿童被错误地归类为缺铁儿童。根据回归校正金标准，转铁蛋白饱和度 < 11% 最接近预测 ID 的患病率。结论 当使用 WHO 指南定义时，非洲儿童的 ID 患病率被低估了，特别是在疟疾流行人群中，转铁蛋白饱和度的使用可能提供更准确的方法。需要进一步研究以确定确定撒哈拉以南非洲 ID 患病率的最准确措施。根据回归校正金标准，11% 最接近预测 ID 的患病率。结论 使用 WHO 指南定义时，非洲儿童的 ID 患病率被低估了，特别是在疟疾流行人群中，转铁蛋白饱和度的使用可能提供更准确的方法。需要进一步研究以确定确定撒哈拉以南非洲 ID 患病率的最准确措施。根据回归校正金标准，11% 最接近预测 ID 的患病率。结论 使用 WHO 指南定义时，非洲儿童的 ID 患病率被低估了，特别是在疟疾流行人群中，转铁蛋白饱和度的使用可能提供更准确的方法。需要进一步研究以确定确定撒哈拉以南非洲 ID 患病率的最准确措施。