{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T04:57:19Z","timestamp":1790485039919,"version":"4.1.0"},"reference-count":67,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Iron deficiency (ID), with or without anemia, remains a major global public health challenge, particularly in populations exposed to inflammatory conditions. Accurate assessment of iron status is difficult because ferritin, the primary biomarker of iron stores, is also an acute-phase reactant that increases during inflammation, potentially masking underlying ID and leading to diagnostic misclassification. The Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) approach uses regression-based methods incorporating C-reactive protein (CRP) and \u03b11-acid glycoprotein (AGP) to adjust iron biomarkers for inflammation. However, its performance in settings characterized by chronic low-grade inflammation, obesity, altitude-related physiology, and environmental stressors remains insufficiently characterized. We propose a context-informed conceptual framework that complements established BRINDA adjustment by considering chronic low-grade inflammation, candidate composite inflammatory markers, and contextual modifiers that may influence the interpretation of iron status. This framework incorporates established and candidate biomarkers, including CRP, AGP, the systemic immune-inflammation index (SII), and the neutrophil-to-lymphocyte ratio (NLR), together with contextual factors such as altitude, metabolic status, and environmental exposures. We also discuss the complex interplay between inflammation and iron metabolism through hepcidin dysregulation and oxidative stress, which may complicate the interpretation of ferritin and other iron biomarkers. Using Peru as an illustrative setting of heterogeneous epidemiological and environmental conditions, we describe how coastal, high-altitude, and Amazonian populations may be differentially affected by these interactions. This context-informed framework provides a structured basis for investigating whether chronic inflammatory and contextual factors add interpretative value beyond established approaches. Prospective and external validation across diverse populations will be required before clinical or public health implementation.<\/jats:p>","DOI":"10.3390\/nu18193152","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:29:53Z","timestamp":1790267393000},"page":"3152","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Context-Informed Framework for Interpreting Iron Status in Heterogeneous Settings: Insights from Peru"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7221-4052","authenticated-orcid":false,"given":"Jeannett","family":"Rivera-Manhualaya","sequence":"first","affiliation":[{"name":"Facultad de Ciencias e Ingenier\u00eda, Universidad Peruana Cayetano Heredia, Lima 15102, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0350-3469","authenticated-orcid":false,"given":"Parminder S.","family":"Suchdev","sequence":"additional","affiliation":[{"name":"Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA"},{"name":"Department of Pediatrics, Emory University, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6449-0377","authenticated-orcid":false,"given":"Chris A.","family":"Rees","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA"},{"name":"Department of Emergency Medicine, Children\u2019s Healthcare of Atlanta, Atlanta, GA 30342, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenia","family":"Lobo","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-An","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2768-1673","authenticated-orcid":false,"given":"Melissa F.","family":"Young","sequence":"additional","affiliation":[{"name":"Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1611-2894","authenticated-orcid":false,"given":"Gustavo F.","family":"Gonzales","sequence":"additional","affiliation":[{"name":"Academia Nacional de Medicina, Lima 15074, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3326-0437","authenticated-orcid":false,"given":"Cinthya","family":"V\u00e1squez-Velasquez","sequence":"additional","affiliation":[{"name":"Carrera de Ingenier\u00eda Biom\u00e9dica, Facultad de Ingenier\u00eda e Inteligencia Artificial, Universidad San Ignacio de Loyola, Lima 15024, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2024). 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