- Volume 5 Issue 1
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Effectiveness of zinc protoporphyrin/heme ratio for screening iron deficiency in preschool-aged children
- Yu, Kyeong-Hee (Department of Hotel Culinary Arts, Ulsan College)
- Received : 2010.07.02
- Accepted : 2011.02.01
- Published : 2011.02.28
Hemoglobin and zinc protoporphyrin (ZPP) tests are commonly used to screen for iron deficiency, but little research has been done to systematically evaluate the sensitivity and specificity of these two tests. The goal of this study was to evaluate the effectiveness of zinc protoporphyrin/heme (ZPP/H) ratio as a point-of-service screening test for iron deficiency among preschool-aged children by comparing the sensitivity and specificity of hemoglobin, ZPP/H ratio, and serum ferritin (SF). Also completed were assessments for the prevalence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) with indicators of ferritin models. This study was carried out with 95 children ages 3 to 6 y. Anthropometric measurements were assessed and blood samples were analyzed for hemoglobin, SF, transferrin saturation (TS), and ZPP. Anemia was common and the prevalences of anemia, ID, and IDA were 14.7%, 12.6%, and 5.2%, respectively. The ZPP/H ratio was strongly and significantly correlated with hemoglobin. And ZPP/H ratio was a more sensitive test for ID than hemoglobin or SF measurement, correctly identifying more than twice as many iron-deficient children (sensitivity of 91.7%, compared to 41.7% for hemoglobin and SF). However, ZPP/H ratio had lower specificity (60.2%, compared to 89.1% for hemoglobin or 96.4% for SF) and resulted in the false identification of more subjects who actually were not iron deficient than did hemoglobin or SF. Low hemoglobin concentration is a late-stage indicator of ID, but ZPP/H ratio can detect ID at early stages and can be performed easily at a relatively low cost. Therefore, ZPP/H ratio can serve as a potential screening test for pre-anemic iron deficiency in community pediatric practices.
- Crowell R, Ferris AM, Wood RJ, Joyce P, Slivka H. Comparative effectiveness of zinc protoporphyrin and hemoglobin concentrations in identifying iron deficiency in a group of low-income, preschoolaged children: practical implications of recent illness. Pediatrics 2006;118:224-32. https://doi.org/10.1542/peds.2006-0156
- Cook JD, Skikne BS, Baynes RD. Iron deficiency: the global perspective. Adv Exp Med Biol 1994;356:219-28.
- Halterman JS, Kaczorowski JM, Aligne A, Auinger P, Szilagyi PG. Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States. Pediatrics 2001; 107:1381-6. https://doi.org/10.1542/peds.107.6.1381
- Yehuda S, Youdim MB. Brain iron: a lesson for animal models. Am J Clin Nutr 1989;50:618-29.
- Lozoff B, Jimenez E, Wolf AW. Long-term developmental outcome of infants with iron deficiency. N Engl J Med 1991;325:687-94. https://doi.org/10.1056/NEJM199109053251004
- Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL. Prevalence of iron deficiency in the United States. JAMA 1997; 277:973-6. https://doi.org/10.1001/jama.1997.03540360041028
- Rettmer RL, Carlson TH, Origenes ML, Jack RM, Labb RF. Zinc protoporphyrin/heme ratio for diagnosis of preanemic iron deficiency. Pediatrics 1999;104:e37. https://doi.org/10.1542/peds.104.3.e37
- Labbe RF, Vreman HJ, Stevenson DK. Zinc protoporphyrin: a metabolite with a mission. Clin Chem 1999;45:2060-72.
- Yip R, Schwartz S, Deinard AS. Screening for iron deficiency with the erythrocyte protoporphyrin test. Pediatrics 1983;72: 214-9.
- Mei Z, Parvanta I, Cogswell ME, Gunter EW, Grummer-Strawn LM. Erythrocyte protoporphyrin or hemoglobin: which is a better screening test for iron deficiency in children and women? Am J Clin Nutr 2003;77:1229-33.
- Soldin OP, Miller M, Soldin SJ. Pediatric reference ranges for zinc protoporphyrin. Clin Biochem 2003;36:21-5. https://doi.org/10.1016/S0009-9120(02)00405-8
- Siegel RM, LaGrone DH. The use of zinc protoporphyrin in screening young children for iron deficiency. Clin Pediatr (Phila) 1994;33:473-9. https://doi.org/10.1177/000992289403300805
- Zimmermann MB, Molinari L, Staubli-Asobayire F, Hess SY, Chaouki N, Adou P, Hurrell RF. Serum transferrin receptor and zinc protoporphyrin as indicators of iron status in African children. Am J Clin Nutr 2005;81:615-23.
- Recommendations to prevent and control iron deficiency in the United States. Centers for Disease Control and Prevention. MMWR Recomm Rep 1998;47:1-29.
- Hastka J, Lasserre JJ, Schwarzbeck A, Reiter A, Hehlmann R. Laboratory tests of iron status: correlation or common sense? Clin Chem 1996;42:718-24.
- Schneider JM, Fujii ML, Lamp CL, Lonnerdal B, Dewey KG, Zidenberg-Cherr S. Anemia, iron deficiency, and iron deficiency anemia in 12-36-mo-old children from low-income families. Am J Clin Nutr 2005;82:1269-75.
- Gibson RS. Principles of nutritional assessment. New York: Oxford University Press; 1990.
- Stanton NV, Gunter EW, Parsons PJ, Field PH. Empirically determined lead- poisoning screening cutoff for the Protofluor-Z hematofluorometer. Clin Chem 1989;35:2104-7.
- Summary of a report on assessment of the iron nutritional status of the United States population. Expert Scientific Working Group. Am J Clin Nutr 1985;42:1318-30.
- Cogswell ME, Looker AC, Pfeiffer CM, Cook JD, Lacher DA, Beard JL, Lynch SR, Grummer-Strawn LM. Assessment of iron deficiency in US preschool children and nonpregnant females of childbearing age: National Health and nutrition Examination Survey 2003-2006. Am J Clin Nutr 2009;89:1334-42. https://doi.org/10.3945/ajcn.2008.27151
- WHO/UNICEF/UNU. Iron deficiency anemia: assessment, prevention, and control. A guide for program managers. Geneva: World Health Organization, 2001;1-114.
- Deinard AS, Schwartz S, Yip R. Developmental changes in serum ferritin and erythrocyte protoporphyrin in normal (nonanemic) children. Am J Clin Nutr 1983;38:71-6.
- American Academy of Pediatrics, Committee on Nutrition. Iron deficiency. In: Kleinman RE, ed. Pediatric Nutrition Handbook. 5th ed. ELK Grove Village, IL: American Academy of Pediatrics; 2003. p299-311.
- Hastka J, Lasserre JJ, Schwarzbeck A, Strauch M, Hehlmann R. Washing erythrocytes to remove interferents in measurements of zinc protoporphyrin by front-face hematofluorometry. Clin Chem 1992;38:2184-9.
- Ohlund I, Lind T, Hornell A, Hernell O. Predictors of iron status in well-nourished 4-y-old children. Am J Clin Nutr 2008;87:839-45.
- Gunnarsson BS, Thorsdottir I, Palsson G. Iron status in 6-y-old children: associations with growth and earlier iron status. Eur J Clin Nutr 2005;59:761-7. https://doi.org/10.1038/sj.ejcn.1602137
- Karr M, Alperstein G, Causer J, Mira M, Lammi A, Fett MJ. Iron status and anaemia in preschool children in Sydney. Aust N Z J Public Health 1996;20:618-22. https://doi.org/10.1111/j.1467-842X.1996.tb01076.x
- Serdar MA, Sarici SU, Kurt I, Alpay F, Okutan V, Kurnaz L, Kutluay T. The role of erythrocyte protoporphyrin in the diagnosis of iron deficiency anemia of children. J Trop Pediatr 2000;46:323-6. https://doi.org/10.1093/tropej/46.6.323