Iron Status, Inflammation and Anemia in Bangladeshi Women

101 Pages·2014·0.95 MB·English

by  Joycelyn M. Faraj

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Masters Theses 1911 - February 2014
2011
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Joycelyn M. Faraj
University of Massachusetts Amherst
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Faraj, Joycelyn M., "Iron Status, Inflammation and Anemia in Bangladeshi Women Exposed to Arsenic"
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IRON STATUS, INFLAMMATION AND ANEMIA IN BANGLADESHI
WOMEN EXPOSED TO ARSENIC

A Thesis Presented

by

JOYCELYN M. FARAJ

Submitted to the Graduate School of the
University of Massachusetts Amherst in partial fulfillment
of the requirements for the degree of

MASTER OF SCIENCE

February 2011

Nutrition
© Copyright by Joycelyn M. Faraj 2011

All Rights Reserved
IRON STATUS, INFLAMMATION AND ANEMIA IN BANGLADESHI
WOMEN EXPOSED TO ARSENIC

A Thesis Presented

by

JOYCELYN M. FARAJ

Approved as to style and content by:

_____________________________________
Alayne Ronnenberg, Chair

_____________________________________
Richard Wood, Member

_____________________________________
J. Richard Pilsner, Member

_____________________________________
Carol Bigelow, Member

__________________________
Nancy Cohen, Department Head
Nutrition
DEDICATION

To my family for giving me their invaluable support.
ACKNOWLEDGEMENTS

I would like to thank my advisor, Dr. Alayne Ronneberg, for her indispensable
guidance, support and motivation throughout my academic career.
I would also like to thank my committee members: Dr. Richard Wood, Dr. Carol
Bigelow, Dr. Edward Calabrese for their guidance throughout my thesis.
Special thanks to Dr. J. Richard Pilsner for his participation in this process.

I thank all my friends and colleagues who were directly or indirectly involved in
the project.

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ABSTRACT

IRON STATUS, INFLAMMATION AND ANEMIA
IN BANGLADESHI WOMEN EXPOSED TO ARSENIC

FEBRUARY 2011
JOYCELYN FARAJ, B.S. UNIVERSITY OF MASSACHUSETTS AMHERST
M.S., UNIVERSITY OF MASSACHUSETTS AMHERST
Directed by: Dr. Alayne Ronnenberg

Iron depletion is the most common nutrient deficiency worldwide and is the
leading cause of anemia. The prevalence of anemia in Bangladeshi women has
been estimated by others at 45%, but the prevalence of iron depletion (ID) and
iron deficiency anemia (IDA) in these women remains unknown. Chronic arsenic
(As) exposure, which is a major public health problem in Bangladesh, is
associated with increased risk of anemia. Arsenic exposure also triggers
inflammatory responses that alter iron parameters, including serum ferritin,
rendering IDA assessment more challenging. We assessed the prevalence of ID
and IDA in 147 Bangladeshi women, ages 18-33 years, who participated in a
larger study of arsenic exposure and skin lesions. The current study includes 75
women with skin lesions (cases) and 72 women without lesions (controls). Blood
samples, anthropometric, sociodemographic and dietary data were collected at
enrollment. Hb, ferritin and hs-c-reactive protein (CRP) were measured in serum.
Overall, the prevalence of anemia (Hb < 120 g/L) was 18%. Although the
prevalence of ID (ferritin ≤12mcg/L) did not differ between cases and controls,
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the prevalence of anemia was almost three times higher among women with
arsenic-related skin lesions compared with controls (25% vs 10%, respectively;
p=0.02). Of the women with anemia, 27% (N=7) also had ID (Hb<120g/L and
ferritin ≤12 mcg/L), indicating IDA. Women with normal iron status had double the
concentration of toenail arsenic compared to iron-depleted women (2.9 vs 1.4 µg
As/g toenail; p=0.00). In addition, the arsenic concentration of their water source
was three-times higher than that of iron-depleted women (18.8 vs 6.2 µg As/L;
p=0.03). Mean CRP was higher in cases than controls (p=0.04) as well as in
those with serum ferritin >12mcg/L compared to those who were iron deplete
(p=0.02). In multivariable logistic regression,. the risk of ID was 84% lower in
women ages 29-33 compared to women ages 18-22 (OR=0.16, 95% CI=0.04,
0.56); every 1µg increase in toenail As level was associated with a 45% lower d
risk of ID (OR=0.55 , 95% CI=0.33, 0.94).The presence of inflammation
decreased the odds of being classified as ID by 80% (OR=0.20, 95% CI=0.04,
0.96). Much of the anemia in this cohort appears unrelated to iron deficiency, but
could be linked to other nutrients, such as folate and vitamin B , which are
12
involved in both hematopoiesis and arsenic metabolism. It is possible that
arsenic exposure in this cohort compromised folate and vitamin B status.
12
Because these vitamins are also important during pregnancy, additional studies
are needed to assess B-vitamin status in arsenic-exposed women and to
determine whether B-vitamin status influences reproductive outcomes in these
women.

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TABLE OF CONTENTS
Page

ACKNOWLEDGEMENTS ..................................................................................... V
ABSTRACT ......................................................................................................... VI
LIST OF TABLES ................................................................................................. X
LIST OF FIGURES .............................................................................................. XI
CHAPTER

1 INTRODUCTION ........................................................................................... 1
2 IRON ............................................................................................................ 4

2.1 Introduction and Biological Functions ................................................... 4

2.1.1 Iron-containing Proteins .............................................................. 5

2.2 Iron Absorption ..................................................................................... 9

2.2.1 Non-heme Iron Absorption .......................................................... 9
2.2.2 Heme Iron Absorption ................................................................ 11

2.3 Iron Stores and Mobilization ............................................................... 12

2.4 Iron Homeostasis ................................................................................. 13
2.5 Iron Deficiency ..................................................................................... 18

2.6 Assessment of Iron Status ................................................................... 19

3 IRON DEFICIENCY AS A PUBLIC HEALTH PROBLEM ........................... 23

3.1 Epidemiology of Iron Deficiency .......................................................... 24

3.2 Etiology of Iron Deficiency ................................................................... 25

3.3 Iron Deficiency and Reproductive Health ............................................. 25
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4 ARSENIC .................................................................................................... 27

4.1 Arsenic: Properties ............................................................................. 27

4.2 Arsenic Contamination ........................................................................ 28

4.3 Arsenic Metabolism ............................................................................ 28

4.4 Arsenic Toxicity and Carcinogenicity .................................................. 30

4.4.1 Possible Mechanisms of Arsenic Carcinogenesis ....................... 32
4.4.2 Animal Toxicity Studies .............................................................. 32
4.4.3 Dietary Influences on Arsenic Toxicity ....................................... 34

4.5 Effects of Arsenic on Human Health ................................................... 35

4.5.1 Effects of Arsenic on Femal Reproductive Health ....................... 37
4.5.2 Gender Differences in Arsenic Toxicity ....................................... 38

5 BANGLADESH ............................................................................................ 40

6 PURPOSE OF THE STUDY ....................................................................... 44

6.1 Hypotheses ......................................................................................... 45

6.2 Specific Aims ...................................................................................... 45

7 MATERIALS AND METHODS .................................................................... 47

7.1 Subjects .............................................................................................. 47

7.2 Data Collection ................................................................................... 48

7.2.1 Blood Sample Collection ............................................................. 48
7.2.2 Laboratory Measurements .......................................................... 48

7.3 Statistical Analysis .............................................................................. 50

8 RESULTS .................................................................................................... 51

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