Namaste Sorrel Ml, Aaron Grant J, Varadhan Ravi, Peerson Janet M, Suchdev Parminder S
Strengthening Partnerships, Results, and Innovations in Nutrition Globally, Arlington, VA;
Helen Keller International, Washington, DC.
Am J Clin Nutr. 2017 Jul;106(Suppl 1):333S-347S. doi: 10.3945/ajcn.116.142273. Epub 2017 Jun 14.
The Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project is a multiagency and multicountry collaboration that was formed to improve micronutrient assessment and to better characterize anemia. The aims of the project were to ) identify factors associated with inflammation, ) assess the relations between inflammation, malaria infection, and biomarkers of iron and vitamin A status and compare adjustment approaches, and ) assess risk factors for anemia in preschool children (PSC) and women of reproductive age (WRA). The BRINDA database inclusion criteria included surveys that ) were conducted after 2004, ) had target groups of PSC, WRA, or both, and ) used a similar laboratory methodology for the measurement of ≥1 biomarker of iron [ferritin or soluble transferrin receptor or vitamin A status (retinol-binding protein or retinol)] and ≥1 biomarker of inflammation (α-1-acid glycoprotein or C-reactive protein). Individual data sets were standardized and merged into a BRINDA database comprising 16 nationally and regionally representative surveys from 14 countries. Collectively, the database covered all 6 WHO geographic regions and contained ∼30,000 PSC and 27,000 WRA. Data were analyzed individually and combined with the use of a meta-analysis. The methods that were used to standardize the BRINDA database and the analytic approaches used to address the project's research questions are presented in this article. Three approaches to adjust micronutrient biomarker concentrations in the presence of inflammation and malaria infection are presented, along with an anemia conceptual framework that guided the BRINDA project's anemia analyses. The BRINDA project refines approaches to interpret iron and vitamin A biomarker values in settings of inflammation and malaria infection and suggests the use of a new regression approach as well as proposes an anemia framework to which real-world data can be applied. Findings can inform guidelines and strategies to prevent and control micronutrient deficiencies and anemia globally.
反映贫血炎症和营养决定因素的生物标志物（BRINDA）项目是一个多机构、多国合作项目，旨在改善微量营养素评估并更好地描述贫血特征。该项目的目标是：（1）确定与炎症相关的因素；（2）评估炎症、疟疾感染与铁和维生素A状态生物标志物之间的关系，并比较调整方法；（3）评估学龄前儿童（PSC）和育龄妇女（WRA）贫血的危险因素。BRINDA数据库纳入标准包括：（1）2004年后进行的调查；（2）目标群体为PSC、WRA或两者；（3）使用类似实验室方法测量≥1种铁生物标志物[铁蛋白或可溶性转铁蛋白受体或维生素A状态（视黄醇结合蛋白或视黄醇）]和≥1种炎症生物标志物（α-1-酸性糖蛋白或C反应蛋白）。个体数据集进行了标准化处理，并合并到一个BRINDA数据库中，该数据库包含来自14个国家的16项具有全国和区域代表性的调查。总体而言，该数据库覆盖了世界卫生组织所有6个地理区域，包含约30,000名PSC和27,000名WRA。数据单独进行了分析，并采用荟萃分析进行合并。本文介绍了用于标准化BRINDA数据库的方法以及用于解决该项目研究问题的分析方法。文中提出了三种在存在炎症和疟疾感染情况下调整微量营养素生物标志物浓度的方法，以及一个指导BRINDA项目贫血分析的贫血概念框架。BRINDA项目完善了在炎症和疟疾感染情况下解释铁和维生素A生物标志物值的方法，建议使用一种新的回归方法，并提出了一个可应用实际数据的贫血框架。研究结果可为全球预防和控制微量营养素缺乏及贫血的指南和策略提供参考。
