Community and International Nutrition

Estimation of the Effect of the Acute Phase Response on Indicators of 

Micronutrient Status in Indonesian Infants1 



Frank T. Wieringa,*† Marjoleine A. Dijkhuizen,*† Clive E. West,* **2 

Christine A. Northrop-Clewes‡ and Muhilal† 





*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 



ABSTRACT 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  -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)  g/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)  mol/L, and of zinc lower by 1.49 (P 

. 

0.01, raised AGP) to 1.89 (P . 

0.05, raised CRP and AGP)  mol/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. J. Nutr. 132: 

3061–3066, 2002. 

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