{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T01:03:59Z","timestamp":1760231039465,"version":"build-2065373602"},"reference-count":105,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T00:00:00Z","timestamp":1661385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007061","name":"Secretar\u00eda Nacional de Ciencia, Tecnolog\u00eda e Innovaci\u00f3n","doi-asserted-by":"publisher","award":["COL08-009","NIH-RO1HD096863-01A1"],"award-info":[{"award-number":["COL08-009","NIH-RO1HD096863-01A1"]}],"id":[{"id":"10.13039\/501100007061","id-type":"DOI","asserted-by":"publisher"}]},{"name":"McGill Vitamin Fund","award":["COL08-009","NIH-RO1HD096863-01A1"],"award-info":[{"award-number":["COL08-009","NIH-RO1HD096863-01A1"]}]},{"name":"National Institutes of Health (NIH)","award":["COL08-009","NIH-RO1HD096863-01A1"],"award-info":[{"award-number":["COL08-009","NIH-RO1HD096863-01A1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Maternal infections, nutrient deficiencies, and inflammation (MINDI) co-exist in lactating indigenous women in Panama, but their impact on maternal iron status and infant growth is unknown. For this secondary analysis of cross-sectional data of lactating mothers from our MINDI cohort, we investigated associations of MINDI variables with maternal anemia, elevated serum transferrin receptor (sTfR), low serum iron, hepcidin, ferritin, and infant weight-for-age (WAZ), length-for-age (LAZ), and head-circumference-for-age (HCAZ) Z-scores in 99 mother-infant dyads. A bootstrapping resampling procedure preselected covariates for inclusion in multivariable regressions models from chronic maternal infections and nutritional status [folate, vitamins A, D, retinol-binding protein (RBP), insulin-growth factor-1 (IGF-1)] and inflammation [C-reactive protein (CRP), cytokines, platelet indices] indicators. Anemia was prevalent (53.5%) but underestimated due to widespread low plasma volume (&lt;2.2 L, 79.9%) and was associated with indicators of malnutrition [lower IGF-1, body mass index (BMI), vitamin D, and intake of green\/leafy vegetables], but not inflammation. Higher CRP was associated with lower serum iron, and higher hepcidin and ferritin, whereas maternal platelets were associated with lower HCAZ (\u03b2 = \u22120.22), WAZ (\u03b2 = \u22120.17), and LAZ (\u03b2 = \u22120.17). Higher LAZ was also associated with maternal serum vitamin D (\u03b2 = 0.23), whereas maternal iron supplementation lowered LAZ (\u03b2 = \u22120.22). Assessment of iron status in this MINDI cohort is complex and supplementation strategies must consider consequences for both the mother and the infant.<\/jats:p>","DOI":"10.3390\/nu14173497","type":"journal-article","created":{"date-parts":[[2022,8,26]],"date-time":"2022-08-26T02:04:32Z","timestamp":1661479472000},"page":"3497","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Multiple Indicators of Undernutrition, Infection, and Inflammation in Lactating Women Are Associated with Maternal Iron Status and Infant Anthropometry in Panama: The MINDI Cohort"],"prefix":"10.3390","volume":"14","author":[{"given":"Doris","family":"Gonz\u00e1lez-Fern\u00e1ndez","sequence":"first","affiliation":[{"name":"School of Human Nutrition, McGill University, (Macdonald Campus), Ste-Anne de Bellevue, QC H9X 3V9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeta","family":"Nemeth","sequence":"additional","affiliation":[{"name":"Center for Iron Disorders, David Geffen School of Medicine, University of California, Los Angeles, CA 90089, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Em\u00e9rita del Carmen","family":"Pons","sequence":"additional","affiliation":[{"name":"Department of Nutritional Health, Panamanian Ministry of Health, Panama City, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Odalis Teresa","family":"Sinisterra","sequence":"additional","affiliation":[{"name":"\u201cPanam\u00e1 Norte\u201d Health Region, Panamanian Ministry of Health, Panama City, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Delfina","family":"Rueda","sequence":"additional","affiliation":[{"name":"\u201cComarca Ng\u00e4be-Bugl\u00e9\u201d Health Region, Panamanian Ministry of Health, Panama City, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Starr","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, University of Panama, Panama City, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veena","family":"Sangkhae","sequence":"additional","affiliation":[{"name":"Center for Iron Disorders, David Geffen School of Medicine, University of California, Los Angeles, CA 90089, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrique","family":"Murillo","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, University of Panama, Panama City, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3553-4550","authenticated-orcid":false,"given":"Marilyn E.","family":"Scott","sequence":"additional","affiliation":[{"name":"Institute of Parasitology, McGill University, (Macdonald Campus), Ste-Anne de Bellevue, QC H9X 3V9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristine G.","family":"Koski","sequence":"additional","affiliation":[{"name":"School of Human Nutrition, McGill University, (Macdonald Campus), Ste-Anne de Bellevue, QC H9X 3V9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1007\/s00277-011-1279-z","article-title":"Postpartum anemia I: Definition, prevalence, causes, and consequences","volume":"90","author":"Milman","year":"2011","journal-title":"Ann. Hematol."},{"key":"ref_2","first-page":"CD010647","article-title":"Supplementation with multiple micronutrients for breastfeeding women for improving outcomes for the mother and baby","volume":"2","author":"Abe","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2603","DOI":"10.1182\/blood-2016-10-569186","article-title":"Vitamin B12 deficiency from the perspective of a practicing hematologist","volume":"129","author":"Green","year":"2017","journal-title":"Blood"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4399","DOI":"10.3390\/nu5114399","article-title":"The influence of vitamin A supplementation on iron status","volume":"5","author":"Michelazzo","year":"2013","journal-title":"Nutrients"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"126","DOI":"10.4103\/2008-7802.195212","article-title":"Effects of iron on vitamin D metabolism: A systematic review","volume":"7","author":"Vafa","year":"2016","journal-title":"Int. J. Prev. Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Bern\u00e1t, I. (1983). Protein-Deficiency Anemia. Iron Metabolism, Springer US.","DOI":"10.1007\/978-1-4615-7308-1"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1093\/ajcn\/31.1.46","article-title":"Protein-energy malnutrition and anemia in Kivu","volume":"31","author":"Fondu","year":"1978","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"416s","DOI":"10.3945\/ajcn.116.143073","article-title":"Predictors of anemia in women of reproductive age: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project","volume":"106","author":"Wirth","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_9","unstructured":"Suskind, R.M., and Lewinter-Suskind, L. (1990). The Anemia of Malnutrition. The Malnourished Child, Vevey\/Raven Press, Ltd."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2263","DOI":"10.1182\/blood-2004-05-1812","article-title":"Prevalence of anemia in persons 65 years and older in the United States: Evidence for a high rate of unexplained anemia","volume":"104","author":"Guralnik","year":"2004","journal-title":"Blood"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/j.hoc.2014.04.005","article-title":"Anemia of inflammation","volume":"28","author":"Nemeth","year":"2014","journal-title":"Hematol. Oncol. Clin. N. Am."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"235re3","DOI":"10.1126\/scitranslmed.3008249","article-title":"Expression of the iron hormone hepcidin distinguishes different types of anemia in African children","volume":"6","author":"Pasricha","year":"2014","journal-title":"Sci. Transl. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e1564","DOI":"10.1016\/S2214-109X(19)30393-6","article-title":"Hepcidin-guided screen-and-treat interventions against iron-deficiency anaemia in pregnancy: A randomised controlled trial in The Gambia","volume":"7","author":"Bah","year":"2019","journal-title":"Lancet Glob. Health"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Gebreegziabher, T., Roice, T., and Stoecker, B.J. (2020). Chronic inflammation was a major predictor and determinant factor of anemia in lactating women in Sidama zone southern Ethiopia: A cross-sectional study. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0240254"},{"key":"ref_15","unstructured":"WHO, and CDC (2016, March 23). Assessing the Iron Status of Populations. Available online: Apps.who.int\/iris\/bitstream\/10665\/75368\/1\/9789241596107_eng.pdf?ua=1&ua=1."},{"key":"ref_16","first-page":"9394060","article-title":"Limitations of Serum Ferritin in Diagnosing Iron Deficiency in Inflammatory Conditions","volume":"2018","author":"Dignass","year":"2018","journal-title":"Int. J. Chronic Dis."},{"key":"ref_17","unstructured":"WHO (2022, January 15). C-Reactive Protein Concentrations as a Marker of Inflammation or Infection for Interpreting Biomarkers of Micronutrient Status. Available online: http:\/\/apps.who.int\/iris\/bitstream\/10665\/133708\/1\/WHO_NMH_NHD_EPG_14.7_eng.pdf?ua=1."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"333s","DOI":"10.3945\/ajcn.116.142273","article-title":"Methodologic approach for the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project","volume":"106","author":"Namaste","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_19","first-page":"1298","article-title":"Anemia among lactating mothers in Kokang, Myanmar","volume":"47","author":"Zhao","year":"2016","journal-title":"Southeast Asian J. Trop. Med. Public Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/s10354-016-0505-7","article-title":"Iron deficiency or anemia of inflammation? Differential diagnosis and mechanisms of anemia of inflammation","volume":"166","author":"Nairz","year":"2016","journal-title":"Wien Med. Wochenschr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/S0009-8981(03)00005-6","article-title":"Soluble transferrin receptor for the evaluation of erythropoiesis and iron status","volume":"329","author":"Beguin","year":"2003","journal-title":"Clin. Chim. Acta"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"372s","DOI":"10.3945\/ajcn.116.142232","article-title":"Adjusting soluble transferrin receptor concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project","volume":"106","author":"Rohner","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S119","DOI":"10.1177\/0379572115585775","article-title":"Prevalence of Anemia in Latin America and the Caribbean","volume":"36","author":"Brito","year":"2015","journal-title":"Food Nutr. Bull."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.4269\/ajtmh.14-0547","article-title":"Interactions among urogenital, intestinal, skin, and oral infections in pregnant and lactating panamanian Ng\u00e4be women: A neglected public health challenge","volume":"92","author":"Koski","year":"2015","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1186\/s40249-017-0307-1","article-title":"C-reactive protein is differentially modulated by co-existing infections, vitamin deficiencies and maternal factors in pregnant and lactating indigenous Panamanian women","volume":"6","author":"Pons","year":"2017","journal-title":"Infect. Dis. Poverty"},{"key":"ref_26","unstructured":"Ministerio de Salud de Panam\u00e1 (2016, July 13). Plan Nacional \u201cPrevenci\u00f3n y Control de las Deficiencias de Micronutrientes\u201d 2008\u20132015. Available online: http:\/\/es.wfp.org\/sites\/default\/files\/es\/file\/plan__nacional_prevencion_y_control_de_las_deficiencias_de_micronutrientes_2008_2015.pdf."},{"key":"ref_27","unstructured":"De Le\u00f3n, J., Barba, A., Sinisterra, O.T., and Atencio, A. (2021, March 21). II Nutritional Monitoring in MINSA Facilities, MONINUT 2017. Available online: https:\/\/www.google.com\/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjvjdzKpcLvAhXaEVkFHTjmDYQQFjABegQIAxAD&url=https%3A%2F%2Fnutricionistaspanama.com%2Fwp-content%2Fuploads%2Fpublicaciones%2FINFORME_MNINUT.pdf&usg=AOvVaw1RMKpMtoQXF1SdTy2wqs8f."},{"key":"ref_28","unstructured":"Panamanian Ministry of Health (2022, June 17). Sistema de Informaci\u00f3n Geogr\u00e1fico Interactivo de la Encuesta Nacional de Salud de Panam\u00e1 (ENSPA). Available online: http:\/\/www.gorgas.gob.pa\/SIGENSPA\/Grafica_deplecion_ferropriva_anemia_MEF.html."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/MCO.0000000000000557","article-title":"Interventions to prevent iron deficiency during the first 1000 days in low-income and middle-income countries: Recent advances and challenges","volume":"22","author":"Lewies","year":"2019","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Dessie, Z.B., Fentie, M., Abebe, Z., Ayele, T.A., and Muchie, K.F. (2019). Maternal characteristics and nutritional status among 6-59\u2009months of children in Ethiopia: Further analysis of demographic and health survey. BMC Pediatr., 20.","DOI":"10.1186\/s12887-019-1459-x"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2067","DOI":"10.3945\/jn.116.232223","article-title":"Minerals and Trace Elements in Human Breast Milk Are Associated with Guatemalan Infant Anthropometric Outcomes within the First 6 Months","volume":"146","author":"Li","year":"2016","journal-title":"J. Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"414","DOI":"10.3389\/fped.2018.00414","article-title":"Breast Milk Cytokines and Early Growth in Gambian Infants","volume":"6","author":"Saso","year":"2018","journal-title":"Front. Pediatr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1038\/pr.2016.220","article-title":"Subclinical mastitis occurs frequently in association with dramatic changes in inflammatory\/anti-inflammatory breast milk components","volume":"81","author":"Tuaillon","year":"2017","journal-title":"Pediatric Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"nzab086","DOI":"10.1093\/cdn\/nzab086","article-title":"Infant Anthropometry and Growth Velocity Before 6 Months are Associated with Breastfeeding Practices and the Presence of Subclinical Mastitis and Maternal Intestinal Protozoa in Indigenous Communities in Guatemala","volume":"5","author":"Solomons","year":"2021","journal-title":"Curr. Dev. Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Brannon, P.M., and Taylor, C.L. (2017). Iron Supplementation during Pregnancy and Infancy: Uncertainties and Implications for Research and Policy. Nutrients, 9.","DOI":"10.3390\/nu9121327"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"280","DOI":"10.4269\/ajtmh.2012.11-0289","article-title":"Prediction of child health by household density and asset-based indices in impoverished indigenous villages in rural Panama","volume":"86","author":"Halpenny","year":"2012","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Keller, U. (2019). Nutritional Laboratory Markers in Malnutrition. J. Clin. Med., 8.","DOI":"10.3390\/jcm8060775"},{"key":"ref_38","unstructured":"World Health Organization (2021, August 15). WHO Guideline on Use of Ferritin Concentrations to Assess Iron Status in Individuals and Populations. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/331505."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1097\/AOG.0b013e3181c2bde8","article-title":"Pregnancy and laboratory studies: A reference table for clinicians","volume":"114","author":"Greer","year":"2009","journal-title":"Obstet. Gynecol."},{"key":"ref_40","unstructured":"World Health Organization (2021, April 09). Iron Deficiency Anaemia: Assessment, Prevention and Control: A Guide for Programme Managers. Available online: https:\/\/www.who.int\/nutrition\/publications\/micronutrients\/anaemia_iron_deficiency\/WHO_NHD_01.3\/en\/."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"S238","DOI":"10.1177\/15648265080292S129","article-title":"Conclusions of a WHO Technical consultation on folate and vitamin B12 deficiencies","volume":"29","year":"2008","journal-title":"Food Nutr. Bull."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.1017\/jns.2015.10","article-title":"Recommended intakes of vitamin D to optimize health, associated circulating 25-hydroxyvitamin D concentrations, and dosing regimens to treat deficiency: Workshop report and overview of current literature","volume":"4","author":"Balvers","year":"2015","journal-title":"J. Nutr. Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3703","DOI":"10.1080\/10408398.2016.1160362","article-title":"The vicious cycle of vitamin A deficiency: A review","volume":"57","author":"Wiseman","year":"2016","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_44","unstructured":"Sinisterra, O.T., Pons, E.d.C., Fontes, F., Lagrutta, F., Carrasco, Y., and Olivares, M. (2012). Evaluaci\u00f3n del programa de suplementaci\u00f3n con hierro en Panam\u00e1. Avances de Investigaci\u00f3n en Seguridad Alimentaria y Nutricional (SAN), University of Costa Rica."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1159\/000241654","article-title":"Serum retinol and retinol-binding protein in mothers and infants at delivery","volume":"43","author":"Jansson","year":"1983","journal-title":"Biol. Neonate"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"217","DOI":"10.3945\/ajcn.2009.27569","article-title":"Assessment of the relative dose-response test based on serum retinol-binding protein instead of serum retinol in determining low hepatic vitamin A stores","volume":"90","author":"Fujita","year":"2009","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1093\/ajcn\/73.3.594","article-title":"Retinol binding protein as a surrogate measure for serum retinol: Studies in vitamin A-deficient children from the Republic of the Marshall Islands","volume":"73","author":"Gamble","year":"2001","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1002\/hep.20864","article-title":"Comparison of indices of vitamin A status in children with chronic liver disease","volume":"42","author":"Feranchak","year":"2005","journal-title":"Hepatology"},{"key":"ref_49","unstructured":"World Health Organization (2021, June 20). Report: Priorities in the Assessment of Vitamin A and Iron Status in Populations, Panama City, Panama, 15\u201317 September 2010. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/75334."},{"key":"ref_50","unstructured":"Panamanian Ministry of Health (2021, May 24). Normas t\u00e9cnicas y administrativas del programa de salud integral del ni\u00f1o y la ni\u00f1a desde el nacimiento a los 9 a\u00f1os de edad. Available online: https:\/\/siteal.iiep.unesco.org\/bdnp\/2447\/normas-tecnicas-administrativas-programa-salud-integral-nino-nina-desde-nacimiento-9-anos."},{"key":"ref_51","unstructured":"World Health Organization (2022, July 16). A Healthy Lifestyle-WHO Recommendations. Available online: https:\/\/www.who.int\/europe\/news-room\/fact-sheets\/item\/a-healthy-lifestyle---who-recommendations."},{"key":"ref_52","unstructured":"Stieglitz, E., and Huang, J. (2019, August 06). Plasmapheresis Technique. Available online: https:\/\/emedicine.medscape.com\/article\/1895577-technique."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.tmrv.2019.10.003","article-title":"Transfusion medicine equations made internet accessible","volume":"34","author":"Hauser","year":"2020","journal-title":"Transfus. Med. Rev."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/0028-2243(85)90014-0","article-title":"Maternal serum folacin levels during and after normal pregnancy","volume":"20","author":"Bruinse","year":"1985","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1177\/1536867X1301300211","article-title":"Standardizing anthropometric measures in children and adolescents with functions for egen: Update","volume":"13","author":"Vidmar","year":"2013","journal-title":"Stata J."},{"key":"ref_56","first-page":"239","article-title":"A practical Application of a simple bootstrapping method for assessing predictors selected for epidemiologic risk models using automated variable selection","volume":"7","author":"Mannan","year":"2017","journal-title":"Int. J. Stat. Appl."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1177\/1536867X1601600109","article-title":"mfpa: Extension of mfp using the ACD covariate transformation for enhanced parametric multivariable modeling","volume":"16","author":"Royston","year":"2016","journal-title":"Stata J."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Royston, P., and Sauerbrei, W. (2008). Multivariable Model-Building: A Pragmatic Approach to Regression Analysis based on Fractional Polynomials for Modelling Continuous Variables, John Wiley.","DOI":"10.1002\/9780470770771"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Hosmer, D.W., Lemeshow, S., and Sturdivant, R.X. (2013). Model-Building Strategies and Methods for Logistic Regression. Applied Logistic Regression, Wiley & Sons, Inc.","DOI":"10.1002\/9781118548387"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1207\/s15327906mbr2603_7","article-title":"How many subjects does it take to do a regression analysis","volume":"26","author":"Green","year":"1991","journal-title":"Multivariate Behav. Res."},{"key":"ref_61","unstructured":"Ludwig-Mayerhofer, W. (2021, June 03). Winsorizing and Trimming. Available online: https:\/\/wlm.userweb.mwn.de\/Stata\/wstatwin.htm."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1198\/000313007X188252","article-title":"Estimators of relative importance in linear regression based on variance decomposition","volume":"61","year":"2007","journal-title":"Am. Stat."},{"key":"ref_63","unstructured":"Nehring, S.M., Goyal, A., Bansal, P., and Patel, B.C. (2021). C Reactive Protein. StatPearls, StatPearls Publishing LLC."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1007\/s12016-015-8525-4","article-title":"The eosinophil in infection","volume":"50","author":"Ravin","year":"2016","journal-title":"Clin. Rev. Allergy Immunol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.3324\/haematol.2016.144055","article-title":"A score of low-grade inflammation and risk of mortality: Prospective findings from the Moli-sani study","volume":"101","author":"Bonaccio","year":"2016","journal-title":"Haematologica"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s12185-020-03025-2","article-title":"Platelet indices as a predictive marker in neonatal sepsis and respiratory distress in preterm prelabor rupture of membranes","volume":"113","author":"Mishra","year":"2021","journal-title":"Int. J. Hematol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"359S","DOI":"10.3945\/ajcn.116.141762","article-title":"Adjusting ferritin concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project","volume":"106","author":"Namaste","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1056\/NEJMra1804281","article-title":"Anemia of inflammation","volume":"381","author":"Ganz","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"401","DOI":"10.3945\/an.116.013847","article-title":"Perspective: What makes it so difficult to mitigate worldwide anemia prevalence?","volume":"8","author":"Schumann","year":"2017","journal-title":"Adv. Nutr."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1182\/blood-2018-06-856500","article-title":"Anemia of inflammation","volume":"133","author":"Weiss","year":"2019","journal-title":"Blood"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.3945\/jn.116.245803","article-title":"Plasma ferritin and hepcidin are lower at 4 months postpartum among women with elevated C-reactive protein or \u03b11-acid glycoprotein","volume":"147","author":"Jorgensen","year":"2017","journal-title":"J. Nutr."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1053\/j.gastro.2013.12.016","article-title":"Gluconeogenic signals regulate iron homeostasis via hepcidin in mice","volume":"146","author":"Vecchi","year":"2014","journal-title":"Gastroenterology"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1373\/clinchem.2012.186866","article-title":"Circulating human hepcidin-25 concentrations display a diurnal rhythm, increase with prolonged fasting, and are reduced by growth hormone administration","volume":"58","author":"Troutt","year":"2012","journal-title":"Clin. Chem."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1002\/ajh.21279","article-title":"Serum transferrin receptor","volume":"83","author":"Skikne","year":"2008","journal-title":"Am. J. Hematol."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Canete, A., Cano, E., Munoz-Chapuli, R., and Carmona, R. (2017). Role of vitamin A\/retinoic acid in regulation of embryonic and adult hematopoiesis. Nutrients, 9.","DOI":"10.3390\/nu9020159"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1093\/nutrit\/nux041","article-title":"Hematological alterations in protein malnutrition","volume":"75","author":"Santos","year":"2017","journal-title":"Nutr. Rev."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1816s","DOI":"10.3945\/jn.115.229708","article-title":"Biomarkers of Nutrition for Development (BOND)-Vitamin A Review","volume":"146","author":"Tanumihardjo","year":"2016","journal-title":"J. Nutr."},{"key":"ref_78","first-page":"191","article-title":"Malnutrition and iron deficiency in lactating women in urban slum communities from Addis Ababa, Ethiopia","volume":"80","author":"Haidar","year":"2003","journal-title":"East Afr. Med. J."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1038\/sj.ejcn.1601060","article-title":"Repeated measurements of energy intake, energy expenditure and energy balance in lactating Bangladeshi mothers","volume":"54","author":"Vinoy","year":"2000","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1016\/j.nut.2015.03.007","article-title":"Seasonal variation in nutritional status and anemia among lactating mothers in two agro-ecological zones of rural Ethiopia: A longitudinal study","volume":"31","author":"Roba","year":"2015","journal-title":"Nutrition"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1042\/CS20120663","article-title":"Insulin-like growth factor-I (IGF-I) and clinical nutrition","volume":"125","author":"Livingstone","year":"2013","journal-title":"Clin. Sci."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1160\/TH10-06-0379","article-title":"Low insulin-like growth factor-1 levels are associated with anaemia in adult non-diabetic subjects","volume":"105","author":"Succurro","year":"2011","journal-title":"Thromb. Haemost."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"e191054","DOI":"10.1001\/jamanetworkopen.2019.1054","article-title":"Assessment of myocardial function in Kenyan children with severe, acute malnutrition: The Cardiac Physiology in Malnutrition (CAPMAL) study","volume":"2","author":"Brent","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.nut.2004.08.022","article-title":"Sodium depletion and hemoconcentration: Overlooked complications in patients with anorexia nervosa?","volume":"21","author":"Caregaro","year":"2005","journal-title":"Nutrition"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"e07720","DOI":"10.1016\/j.heliyon.2021.e07720","article-title":"Poor haemoglobin-haematocrit agreement in apparently healthy adult population; a cross-sectional study in Cape Coast Metropolis, Ghana","volume":"7","author":"Zenile","year":"2021","journal-title":"Heliyon"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1159\/000462998","article-title":"Pregnant and breastfeeding women: Drinking for two?","volume":"70","author":"Bardosono","year":"2017","journal-title":"Ann. Nutr. Metab."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"e66","DOI":"10.1017\/jns.2021.54","article-title":"Estimates of fluid intake, urine output and hydration-levels in women from Somaliland: A cross-sectional study","volume":"10","author":"Heen","year":"2021","journal-title":"J. Nutr. Sci."},{"key":"ref_88","unstructured":"World Health Organization (2021, June 04). Guideline: Iron Supplementation in Postpartum Women. Available online: https:\/\/www.who.int\/nutrition\/publications\/micronutrients\/guidelines\/daily_iron_supp_postpartum_women\/en\/."},{"key":"ref_89","first-page":"283","article-title":"Iron deficiency in pregnancy and the rationality of iron supplements prescribed during pregnancy","volume":"10","author":"Gautam","year":"2008","journal-title":"Medscape J. Med."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1097\/MCO.0000000000000749","article-title":"Iron deficiency in infancy: Current insights","volume":"24","author":"Berglund","year":"2021","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1093\/advances\/nmz039","article-title":"Perspective: Should exclusive breastfeeding still be recommended for 6 months?","volume":"10","author":"Buccini","year":"2019","journal-title":"Adv. Nutr."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1547s","DOI":"10.3945\/ajcn.117.155747","article-title":"Introduction to workshop on iron screening and supplementation in iron-replete pregnant women and young children","volume":"106","author":"Taylor","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_93","first-page":"269","article-title":"Infections associated with iron administration","volume":"19","author":"Nairz","year":"2019","journal-title":"Met. Ions Life Sci."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1093\/ajcn\/61.6.1253","article-title":"Comparison of the modified relative dose response (MRDR) and the relative dose response (RDR) in the assessment of vitamin A status in malnourished children","volume":"61","author":"Wahed","year":"1995","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"nzab012","DOI":"10.1093\/cdn\/nzab012","article-title":"INTERGROWTH-21 identifies high prevalence of low symphysis-fundal height in indigenous pregnant women experiencing multiple infections, nutrient deficiencies and inflammation: The MINDI cohort","volume":"5","author":"Nemeth","year":"2021","journal-title":"Curr. Dev. Nutr."},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Asare, H., Rosi, A., Faber, M., Smuts, C.M., and Ricci, C. (2022). Animal-source foods as a suitable complementary food for improved physical growth in 6 to 24-month-old children in low- and middle-income countries: A systematic review and meta-analysis of randomised controlled trials. Br. J. Nutr., 1\u201311.","DOI":"10.1017\/S0007114522000290"},{"key":"ref_97","first-page":"133","article-title":"Evaluation on the Acceptability and Consumption of Nutricrema in the Republic of Panama","volume":"30","year":"2003","journal-title":"Rev. Chil. Nutr."},{"key":"ref_98","unstructured":"Panamanian Ministry of Health (2021, June 04). Pr\u00e1cticas de cuidado y alimentaci\u00f3n infantil en las Comarcas ind\u00edgenas de Kuna-Yala, Ng\u00f6be-Bugl\u00e9, Ember\u00e1-Wounaan y los distritos de Ca\u00f1azas y Las Palmas (Provincia de Veraguas). Available online: https:\/\/www.google.com\/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjY2qCokP_wAhXFc98KHYSSA1kQFjAHegQIDBAE&url=https%3A%2F%2Fwww.paho.org%2Fhq%2Findex.php%3Foption%3Dcom_docman%26view%3Ddownload%26category_slug%3Dexperiencias-ver-mas-sitio-web-ingles-4986%26alias%3D19856-2009-panama-856%26Itemid%3D270&usg=AOvVaw2_coNrI3xk0kgLJSK9ns5u."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1111\/nure.12049","article-title":"Influence of iron status on risk of maternal or neonatal infection and on neonatal mortality with an emphasis on developing countries","volume":"71","author":"Brabin","year":"2013","journal-title":"Nutr. Rev."},{"key":"ref_100","unstructured":"Sinisterra, O.F.F., Lagrutta, F., and Olivares, M. (2022, June 03). Situaci\u00f3n de deficiencia de hierro y anemia. Available online: https:\/\/www.unicef.org\/panama\/spanish\/Hierro.pdf."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1159\/000508422","article-title":"Early-life effects of vitamin D: A focus on pregnancy and lactation","volume":"76","author":"Wagner","year":"2020","journal-title":"Ann. Nutr. Metab."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"f1169","DOI":"10.1136\/bmj.f1169","article-title":"Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: Systematic review and meta-analysis of observational studies","volume":"346","author":"Aghajafari","year":"2013","journal-title":"BMJ"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1056\/NEJMoa1800927","article-title":"Vitamin D supplementation in pregnancy and lactation and infant growth","volume":"379","author":"Roth","year":"2018","journal-title":"NEJM"},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Dawodu, A., Salameh, K.M., Al-Janahi, N.S., Bener, A., and Elkum, N. (2019). The effect of high-dose postpartum maternal vitamin D supplementation alone compared with maternal plus infant vitamin D supplementation in breastfeeding infants in a high-risk population a randomized controlled trial. Nutrients, 11.","DOI":"10.3390\/nu11071632"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1038\/s41430-020-0564-0","article-title":"Targeted 25-hydroxyvitamin D concentration measurements and vitamin D supplementation can have important patient and public health benefits","volume":"74","author":"Grant","year":"2020","journal-title":"Eur. J. Clin. Nutr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/17\/3497\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:15:22Z","timestamp":1760141722000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/17\/3497"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,25]]},"references-count":105,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["nu14173497"],"URL":"https:\/\/doi.org\/10.3390\/nu14173497","relation":{},"ISSN":["2072-6643"],"issn-type":[{"type":"electronic","value":"2072-6643"}],"subject":[],"published":{"date-parts":[[2022,8,25]]}}}