Ferritin, when corrected for inflammation, is associated with increased malaria incidence in rural Zambian children (392.6)

Abstract

Poor iron status, assessed by low serum ferritin (SF), may protect against malaria. We evaluated the association of SF, and SF corrected for inflammation and malaria status (SFcorr), with microscopy‐confirmed incident malaria in a cohort of 954 4‐8 y old Zambian children participating in a 6 mo trial to improve vitamin A status (August 2012 to March 2013). Analyses were stratified by age (<5 y and >5 y) to account for the age‐specific risk of malaria. Baseline SFcorr was determined by proportionately reducing SF based on categories of inflammation defined by AGP > 1g/L, CRP > 5 mg/L, and by concurrent malaria status assessed by microscopy, relative to SF observed in unaffected children. SF and SFcorr levels were classified as deficient, medium, and high using cutoffs of <12 or 15 ug/L (depending on age), up to 60 ug/L (but not deficient), and >60 ug/L, respectively. Malaria‐infected children were treated at baseline. Among children <5 y, having medium or high SFcorr resulted in relative risks for incident malaria after 6 mo of 1.61 (95%CI: 1.05‐2.50) and 1.67 (95%CI: 1.06‐2.61), respectively. This pattern was not observed with uncorrected SF. Our findings demonstrate the necessity of adjusting for inflammation and concurrent malaria infection when assessing the relationship between iron status and malaria, and are consistent with evidence that iron status modifies malaria risk, particularly in young children.Grant Funding Source: Supported by HarvestPlus and Canadian International Development Agency