Associations between Zinc and Hemoglobin Concentrations in Preschool Children and Women of Reproductive Age: An Analysis of Representative Survey Data from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project

doi:10.1093/jn/nxaa444

The Journal of Nutrition

Volume 151, Issue 5, May 2021, Pages 1277-1285

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Abstract

Background

Anemia is a worldwide concern. Nutritional deficiencies and inflammation are considered main contributors, but zinc deficiency has only recently been associated with anemia.

Objectives

In this study we assessed associations between zinc status and hemoglobin (Hb) concentrations and anemia in preschool children 6–59 mo old (PSC) and nonpregnant women of reproductive age 15–49 y old (WRA) in population-based nutrition surveys.

Methods

Cross-sectional data from 13 (PSC) and 12 (WRA) countries within the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project were used. Multivariable linear models were constructed that included zinc status (plasma/serum zinc concentrations), Hb concentrations and anemia, iron status, age, sex, and inflammation (C-reactive protein and α-1-acid glycoprotein). Zinc was adjusted for inflammation in PSC according to the BRINDA algorithm.

Results

Data were available for 18,658 PSC and 22,633 WRA. Prevalence of anemia ranged from 7.5% to 73.7% and from 11.5% to 94.7% in PSC and WRA, respectively. Prevalence of zinc deficiency ranged from 9.2% to 78.4% in PSC and from 9.8% to 84.7% in WRA, with prevalence of zinc deficiency >20% in all countries except Azerbaijan (PSC), Ecuador (PSC), and the United Kingdom (WRA). Multivariable linear regression models showed that zinc concentrations were independently and positively associated with Hb concentrations in 7 of 13 countries for PSC and 5 of 12 countries for WRA. In the same models, ferritin concentration was also significantly associated with Hb among PSC and WRA in 9 and 10 countries, respectively. Zinc deficiency was significantly associated with anemia in PSC and WRA in 5 and 4 countries respectively.

Conclusions

Zinc deficiency was prevalent in most countries and associations between zinc and Hb in roughly half of the countries examined suggesting that strategies to combat zinc deficiency may help reduce anemia prevalence. More research on mechanisms by which zinc deficiency is associated with anemia and the reasons for the heterogeneity among countries is warranted.

Key words

anemia

zinc deficiency

inflammation

preschool children

women of reproductive age

Abbreviations

aPR

adjusted prevalence ratio

AGP

α-1 acid glycoprotein

BIS

body iron stores

BRINDA

Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia

CRP

C-reactive protein

hemoglobin

PSC

preschool children

sTfR

soluble transferrin receptor

WRA

women of reproductive age

Cited by (0)

: Supported by the Bill & Melinda Gates Foundation, the US Centers for Disease Control and Prevention, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the French National Research Institute for Sustainable Development (IRD).

: Author disclosures: The authors report no conflicts of interest. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.

: Supplemental Tables 1–6 are available from the “Online Supporting Material” link in the online posting of the article and from the same link in the online table of contents at http://jn.nutrition.org.

: Abbreviations used: aPR, adjusted prevalence ratio; AGP, α-1 acid glycoprotein; BIS, body iron stores; BRINDA, Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia; CRP, C-reactive protein; Hb, hemoglobin; PSC, preschool children; sTfR, soluble transferrin receptor; WRA, women of reproductive age.