Respiratory infections drive hepcidin-mediated blockade of iron absorption leading to iron deficiency anemia in African children.

Prentice, AMORCID logo; Bah, A; Jallow, MWORCID logo; Jallow, ATORCID logo; Sanyang, S; Sise, EA; Ceesay, K; Danso, E; Armitage, AEORCID logo; Pasricha, SORCID logo; +5 more...Drakesmith, H; Wathuo, MORCID logo; Kessler, NORCID logo; Cerami, CORCID logo; Wegmüller, RORCID logo and (2019) Respiratory infections drive hepcidin-mediated blockade of iron absorption leading to iron deficiency anemia in African children. SCIENCE ADVANCES, 5 (3). eaav9020-. ISSN 2375-2548 DOI: 10.1126/sciadv.aav9020
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Iron deficiency anemia (IDA) is the most prevalent nutritional condition worldwide. We studied the contribution of hepcidin-mediated iron blockade to IDA in African children. We measured hepcidin and hemoglobin weekly, and hematological, inflammatory, and iron biomarkers at baseline, 7 weeks, and 12 weeks in 407 anemic (hemoglobin < 11 g/dl), otherwise healthy Gambian children (6 to 27 months). Each child maintained remarkably constant hepcidin levels (P < 0.0001 for between-child variance), with half consistently maintaining levels that indicate physiological blockade of iron absorption. Hepcidin was strongly predicted by nurse-ascribed adverse events with dominant signals from respiratory infections and fevers (all P < 0.0001). Diarrhea and fecal calprotectin were not associated with hepcidin. In multivariate analysis, C-reactive protein was the dominant predictor of hepcidin and contributed to iron blockade even at very low levels. We conclude that even low-grade inflammation, especially associated with respiratory infections, contributes to IDA in African children.


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