Malaria is a cause of iron deficiency in African children

John Muthii Muriuki; Alexander J Mentzer; Ruth Mitchell; Emily L. Webb; Anthony O Etyang; Catherine Kyobutungi; Alireza Morovat; Wandia Kimita; Francis M Ndungu; Alex W Macharia; Caroline J Ngetsa; Johnstone Makale; Swaib A Lule; Solomon K Musani; Laura M Raffield; Clare L Cutland; Sodiomon B Sirima; Amidou Diarra; Alfred B Tiono; Michal Fried; Moses Gwamaka; Seth Adu-Afarwuah; James P Wirth; Rita Wegmüller; Shabir A Madhi; Robert W. Snow; Adrian V S Hill; Kirk A. Rockett; Manjinder S Sandhu; Dominic P Kwiatkowski; Andrew M Prentice; Kendra A Byrd; Alex Ndjebayi; Christine P. Stewart; Reina Engle-Stone; Tim J Green; Crystal D Karakochuk; Parminder S Suchdev; Philip Bejon; Patrick E Duffy; George Davey Smith; Alison M Elliott; Thomas N Williams; Sarah H Atkinson

doi:10.1038/s41591-021-01238-4

Malaria is a cause of iron deficiency in African children

John Muthii Muriuki, Alexander J Mentzer, Ruth Mitchell, Emily L. Webb, Anthony O Etyang, Catherine Kyobutungi, Alireza Morovat, Wandia Kimita, Francis M Ndungu, Alex W Macharia, Caroline J Ngetsa, Johnstone Makale, Swaib A Lule, Solomon K Musani, Laura M Raffield, Clare L Cutland, Sodiomon B Sirima, Amidou Diarra, Alfred B Tiono, Michal FriedMoses Gwamaka, Seth Adu-Afarwuah, James P Wirth, Rita Wegmüller, Shabir A Madhi, Robert W. Snow, Adrian V S Hill, Kirk A. Rockett, Manjinder S Sandhu, Dominic P Kwiatkowski, Andrew M Prentice, Kendra A Byrd, Alex Ndjebayi, Christine P. Stewart, Reina Engle-Stone, Tim J Green, Crystal D Karakochuk, Parminder S Suchdev, Philip Bejon, Patrick E Duffy, George Davey Smith, Alison M Elliott, Thomas N Williams, Sarah H Atkinson

Research output: Contribution to journal › Article › peer-review

42 Citations (Scopus)

Abstract

Malaria and iron deficiency (ID) are common and interrelated public health problems in African children. Observational data suggest that interrupting malaria transmission reduces the prevalence of ID1. To test the hypothesis that malaria might cause ID, we used sickle cell trait (HbAS, rs334 ), a genetic variant that confers specific protection against malaria2, as an instrumental variable in Mendelian randomization analyses. HbAS was associated with a 30% reduction in ID among children living in malaria-endemic countries in Africa (n = 7,453), but not among individuals living in malaria-free areas (n = 3,818). Genetically predicted malaria risk was associated with an odds ratio of 2.65 for ID per unit increase in the log incidence rate of malaria. This suggests that an intervention that halves the risk of malaria episodes would reduce the prevalence of ID in African children by 49%.

Original language	English
Pages (from-to)	653–658
Number of pages	6
Journal	Nature Medicine
Volume	27
Issue number	4
DOIs	https://doi.org/10.1038/s41591-021-01238-4
Publication status	Published - Apr 2021
Externally published	Yes

Keywords

malaria
iron deficiency
African children
sickle cell trait (HbAS, rs334)
Mendelian randomization analysis
HbAS

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1038/s41591-021-01238-4Licence: In Copyright

https://rdcu.be/drGRkLicence: In Copyright

Cite this

Muriuki, J. M., Mentzer, A. J., Mitchell, R., Webb, E. L., Etyang, A. O., Kyobutungi, C., Morovat, A., Kimita, W., Ndungu, F. M., Macharia, A. W., Ngetsa, C. J., Makale, J., Lule, S. A., Musani, S. K., Raffield, L. M., Cutland, C. L., Sirima, S. B., Diarra, A., Tiono, A. B., ... Atkinson, S. H. (2021). Malaria is a cause of iron deficiency in African children. Nature Medicine, 27(4), 653–658. https://doi.org/10.1038/s41591-021-01238-4

@article{966f5a42ba1543fbbe5c6c2f88d6c6a4,

title = "Malaria is a cause of iron deficiency in African children",

abstract = "Malaria and iron deficiency (ID) are common and interrelated public health problems in African children. Observational data suggest that interrupting malaria transmission reduces the prevalence of ID1. To test the hypothesis that malaria might cause ID, we used sickle cell trait (HbAS, rs334 ), a genetic variant that confers specific protection against malaria2, as an instrumental variable in Mendelian randomization analyses. HbAS was associated with a 30% reduction in ID among children living in malaria-endemic countries in Africa (n = 7,453), but not among individuals living in malaria-free areas (n = 3,818). Genetically predicted malaria risk was associated with an odds ratio of 2.65 for ID per unit increase in the log incidence rate of malaria. This suggests that an intervention that halves the risk of malaria episodes would reduce the prevalence of ID in African children by 49%.",

keywords = "malaria, iron deficiency, African children, sickle cell trait (HbAS, rs334), Mendelian randomization analysis, HbAS",

author = "Muriuki, {John Muthii} and Mentzer, {Alexander J} and Ruth Mitchell and Webb, {Emily L.} and Etyang, {Anthony O} and Catherine Kyobutungi and Alireza Morovat and Wandia Kimita and Ndungu, {Francis M} and Macharia, {Alex W} and Ngetsa, {Caroline J} and Johnstone Makale and Lule, {Swaib A} and Musani, {Solomon K} and Raffield, {Laura M} and Cutland, {Clare L} and Sirima, {Sodiomon B} and Amidou Diarra and Tiono, {Alfred B} and Michal Fried and Moses Gwamaka and Seth Adu-Afarwuah and Wirth, {James P} and Rita Wegm{\"u}ller and Madhi, {Shabir A} and Snow, {Robert W.} and Hill, {Adrian V S} and Rockett, {Kirk A.} and Sandhu, {Manjinder S} and Kwiatkowski, {Dominic P} and Prentice, {Andrew M} and Byrd, {Kendra A} and Alex Ndjebayi and Stewart, {Christine P.} and Reina Engle-Stone and Green, {Tim J} and Karakochuk, {Crystal D} and Suchdev, {Parminder S} and Philip Bejon and Duffy, {Patrick E} and {Davey Smith}, George and Elliott, {Alison M} and Williams, {Thomas N} and Atkinson, {Sarah H}",

year = "2021",

month = apr,

doi = "10.1038/s41591-021-01238-4",

language = "English",

volume = "27",

pages = "653–658",

journal = "Nature Medicine",

issn = "1078-8956",

publisher = "Nature Publishing Group",

number = "4",

}

Muriuki, JM, Mentzer, AJ, Mitchell, R, Webb, EL, Etyang, AO, Kyobutungi, C, Morovat, A, Kimita, W, Ndungu, FM, Macharia, AW, Ngetsa, CJ, Makale, J, Lule, SA, Musani, SK, Raffield, LM, Cutland, CL, Sirima, SB, Diarra, A, Tiono, AB, Fried, M, Gwamaka, M, Adu-Afarwuah, S, Wirth, JP, Wegmüller, R, Madhi, SA, Snow, RW, Hill, AVS, Rockett, KA, Sandhu, MS, Kwiatkowski, DP, Prentice, AM, Byrd, KA, Ndjebayi, A, Stewart, CP, Engle-Stone, R, Green, TJ, Karakochuk, CD, Suchdev, PS, Bejon, P, Duffy, PE, Davey Smith, G, Elliott, AM, Williams, TN & Atkinson, SH 2021, 'Malaria is a cause of iron deficiency in African children', Nature Medicine, vol. 27, no. 4, pp. 653–658. https://doi.org/10.1038/s41591-021-01238-4

TY - JOUR

T1 - Malaria is a cause of iron deficiency in African children

AU - Muriuki, John Muthii

AU - Mentzer, Alexander J

AU - Mitchell, Ruth

AU - Webb, Emily L.

AU - Etyang, Anthony O

AU - Kyobutungi, Catherine

AU - Morovat, Alireza

AU - Kimita, Wandia

AU - Ndungu, Francis M

AU - Macharia, Alex W

AU - Ngetsa, Caroline J

AU - Makale, Johnstone

AU - Lule, Swaib A

AU - Musani, Solomon K

AU - Raffield, Laura M

AU - Cutland, Clare L

AU - Sirima, Sodiomon B

AU - Diarra, Amidou

AU - Tiono, Alfred B

AU - Fried, Michal

AU - Gwamaka, Moses

AU - Adu-Afarwuah, Seth

AU - Wirth, James P

AU - Wegmüller, Rita

AU - Madhi, Shabir A

AU - Snow, Robert W.

AU - Hill, Adrian V S

AU - Rockett, Kirk A.

AU - Sandhu, Manjinder S

AU - Kwiatkowski, Dominic P

AU - Prentice, Andrew M

AU - Byrd, Kendra A

AU - Ndjebayi, Alex

AU - Stewart, Christine P.

AU - Engle-Stone, Reina

AU - Green, Tim J

AU - Karakochuk, Crystal D

AU - Suchdev, Parminder S

AU - Bejon, Philip

AU - Duffy, Patrick E

AU - Davey Smith, George

AU - Elliott, Alison M

AU - Williams, Thomas N

AU - Atkinson, Sarah H

PY - 2021/4

Y1 - 2021/4

N2 - Malaria and iron deficiency (ID) are common and interrelated public health problems in African children. Observational data suggest that interrupting malaria transmission reduces the prevalence of ID1. To test the hypothesis that malaria might cause ID, we used sickle cell trait (HbAS, rs334 ), a genetic variant that confers specific protection against malaria2, as an instrumental variable in Mendelian randomization analyses. HbAS was associated with a 30% reduction in ID among children living in malaria-endemic countries in Africa (n = 7,453), but not among individuals living in malaria-free areas (n = 3,818). Genetically predicted malaria risk was associated with an odds ratio of 2.65 for ID per unit increase in the log incidence rate of malaria. This suggests that an intervention that halves the risk of malaria episodes would reduce the prevalence of ID in African children by 49%.

AB - Malaria and iron deficiency (ID) are common and interrelated public health problems in African children. Observational data suggest that interrupting malaria transmission reduces the prevalence of ID1. To test the hypothesis that malaria might cause ID, we used sickle cell trait (HbAS, rs334 ), a genetic variant that confers specific protection against malaria2, as an instrumental variable in Mendelian randomization analyses. HbAS was associated with a 30% reduction in ID among children living in malaria-endemic countries in Africa (n = 7,453), but not among individuals living in malaria-free areas (n = 3,818). Genetically predicted malaria risk was associated with an odds ratio of 2.65 for ID per unit increase in the log incidence rate of malaria. This suggests that an intervention that halves the risk of malaria episodes would reduce the prevalence of ID in African children by 49%.

KW - malaria

KW - iron deficiency

KW - African children

KW - sickle cell trait (HbAS, rs334)

KW - Mendelian randomization analysis

KW - HbAS

UR - http://www.scopus.com/inward/record.url?scp=85101198218&partnerID=8YFLogxK

U2 - 10.1038/s41591-021-01238-4

DO - 10.1038/s41591-021-01238-4

M3 - Article

SN - 1078-8956

VL - 27

SP - 653

EP - 658

JO - Nature Medicine

JF - Nature Medicine

IS - 4

ER -

Malaria is a cause of iron deficiency in African children

Abstract

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this