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*
Division of Human Nutrition and Epidemiology, Wageningen University, The Netherlands;
Nutrition Research and Development Centre, Bogor, Indonesia;
**
Department of Gastroenterology, University Medical Centre Nijmegen, The Netherlands; and
Northern Ireland Centre of Diet and Health, University of Ulster, Coleraine, BT52 1SA, Northern Ireland, UK
2To whom correspondence should be addressed. E-mail: clive.west{at}staff.nutepi.wau.nl.
Many indicators of micronutrient status change during infection because of the acute phase response. In this study, relationships between the acute phase response, assessed by measuring concentrations of C-reactive protein (CRP), 
1-antichymotrypsin (ACT) and 1-acid glycoprotein (AGP), and indicators of micronutrient status were analyzed in 418 infants who completed a 6-mo randomized, double-blind, placebo-controlled, supplementation trial with iron, zinc and/or ß-carotene. The acute phase response, defined by raised CRP (plasma concentration >10 mg/L), raised AGP (>1.2 g/L), or both raised CRP and AGP, significantly affected indicators of iron, vitamin A and zinc status, independently of the effects of supplementation. Plasma ferritin concentrations were higher by 15.7 (raised AGP) to 21.2 (raised CRP and AGP) µg/L in infants with elevated acute phase proteins compared with infants without acute phase response (P < 0.001). In contrast, plasma concentrations of retinol were lower by 0.07 (P < 0.05, raised AGP) to 0.12 (P < 0.01, raised CRP) µmol/L, and of zinc lower by 1.49 (P < 0.01, raised AGP) to 1.89 (P < 0.05, raised CRP and AGP) µmol/L. Hemoglobin concentrations and the modified relative dose response were not affected. Consequently, the prevalence of iron deficiency anemia was underestimated in infants with raised acute phase proteins by >15%, whereas the prevalence of vitamin A deficiency was overestimated by >16% compared with infants without acute phase response. Hence, using indicators of micronutrient status without considering the effects of the acute phase response results in a distorted estimate of micronutrient deficiencies, whose extent depends on the prevalence of infection in the population.
KEY WORDS: • vitamin A • zinc • ferritin • hemoglobin • modified relative dose response • acute phase proteins
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