(P26-16-26) Applying Inflammation Adjustment to Iron and Hemoglobin Biomarkers in Adolescents: Findings From the J1CFU Cohort, Bangladesh

Objectives: Inflammation complicates the assessment of iron deficiency and anemia by altering biomarker concentrations, potentially underestimating iron stores and overestimating iron-deficiency anemia. We examined the extent to which inflammation affects iron status and anemia estimates in Bangladeshi adolescents in a setting where anemia is common despite low iron deficiency prevalence.

Methods: We conducted a cross-sectional analysis of 9–14-year-old participants from the JiVitA-1 Cohort Follow-up (J1CFU; 2015–2017), using plasma measurements of Hb, ferritin, CRP, and AGP. Inflammation prevalence defined as CRP >5 mg/L, AGP >1 g/L, or both elevated is described. Ferritin, CRP, and AGP were log-transformed to normalize distributions. Associations of CRP, AGP, and both with ferritin and hemoglobin were examined with log-linear and linear regression, and inflammation-adjusted Hb and ferritin were generated. Iron deficiency was defined as ferritin < 15 µg/L, elevated iron as ferritin > 150 µg/L, and anemia as Hb < 12 g/dL.

Results: Of 988 participants who provided plasma samples, 938 were included in the analytic sample after excluding those with missing biomarker data. AGP >1 g/L was prevalent (37.8%) while CRP >5 mg/L was not (3.1%). After adjustment, ferritin remained high (94.2 ± 69.8 µg/L unadjusted vs. 85.5 ± 59.5 µg/L adjusted), estimated iron deficiency increased from just 0.5% to 0.7%, and elevated iron prevalence declined from 12.6% to 9.7%. Mean Hb increased from 12.87 ± 0.84 to 12.98 ± 0.85 g/dL and anemia prevalence declined from 7.1% to 6.0%.

Iron status did not explain hemoglobin variation (R²=0.4%) even with inflammation adjustments. Of 56 anemic adolescents, 55 (98.2%) had ferritin above the iron deficiency threshold after adjustment.

Conclusions: Despite associations between inflammatory biomarkers and both ferritin and hemoglobin, adjustments did not substantially alter iron status or anemia estimates, though modest shifts in ferritin support the use of inflammation correction in adolescent populations. As anemia persisted despite low iron deficiency after adjustment, other etiologies warrant exploration in this population.

Funding Sources: Bill & Melinda Gates Foundation