Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi.
School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, Leicestershire LE12 5RD, UK.
Nutrients. 2020 May 27;12(6):1563. doi: 10.3390/nu12061563.
Serum zinc concentration (SZC) is used widely to assess population-level zinc status. Its concentration decreases during inflammatory responses, which can affect the interpretation of the results. This study aimed to re-estimate the prevalence of zinc deficiency in Malawi based on the 2015-2016 Malawi Micronutrient Survey (MNS) data, by adjusting SZC measures with markers of inflammation. SZC and inflammation data from 2760 participants were analysed. Adjustments were made using: (1) The Internal Correction Factor (ICF) method which used geometric means, and (2) The Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) method, which used linear regression. Mean SZC values increased significantly when adjustments were made by either ICF or BRINDA ( < 0.001). The national prevalence of zinc deficiency decreased from 62% to 59%, after ICF adjustment, and to 52% after BRINDA adjustment. ICF and BRINDA values of SZC were highly correlated ( < 0.001, r = 0.99), but a Bland-Altman plot showed a lack of agreement between the two methods (bias of 2.07 µg/dL). There was no association between the adjusted SZC and stunting, which is a proxy indicator for zinc deficiency. Inflammation adjustment of SZC, using ICF or BRINDA, produces lower estimates of zinc deficiency prevalence, but the lack of agreement between the adjustment methods warrants further research. Furthermore, the lack of association between SZC and stunting highlights the need to explore other biomarkers and proxies of population zinc assessment. This study demonstrates the importance of considering inflammatory confounders when reporting SZC, to ensure accuracy and to support policy decision making.
血清锌浓度（SZC）被广泛用于评估人群锌营养状况。在炎症反应期间，其浓度会下降，这可能会影响结果的解读。本研究旨在根据 2015-2016 年马拉维微量营养素调查（MNS）数据，通过用炎症标志物调整 SZC 测量值，重新估计马拉维锌缺乏症的流行率。对 2760 名参与者的 SZC 和炎症数据进行了分析。调整方法包括：（1）内部校正因子（ICF）方法，使用几何均数，以及（2）反映炎症和营养决定贫血的生物标志物（BRINDA）方法，使用线性回归。当使用 ICF 或 BRINDA 进行调整时，SZC 的平均浓度值显著增加（<0.001）。使用 ICF 调整后，全国锌缺乏症的流行率从 62%降至 59%，BRINDA 调整后降至 52%。ICF 和 BRINDA 法的 SZC 值高度相关（<0.001，r=0.99），但 Bland-Altman 图显示两种方法之间缺乏一致性（偏差为 2.07 µg/dL）。调整后的 SZC 与发育迟缓（锌缺乏的替代指标）之间没有关联。使用 ICF 或 BRINDA 对 SZC 进行炎症调整会产生较低的锌缺乏症流行率估计值，但调整方法之间缺乏一致性需要进一步研究。此外，SZC 与发育迟缓之间缺乏关联突出表明需要探索其他生物标志物和人群锌评估的替代指标。本研究表明，在报告 SZC 时考虑炎症混杂因素的重要性，以确保准确性并支持政策决策。
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