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Berton PF, Gambero A. Hepcidin and inflammation associated with iron deficiency in childhood obesity - A systematic review. J Pediatr (Rio J) 2024; 100:124-131. [PMID: 37541648 PMCID: PMC10943301 DOI: 10.1016/j.jped.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES This paper aims to review data on the association of obesity and iron deficiency in children and adolescents, exposing the possible involvement of hepcidin and interleukin-6 (IL-6), obesity's inflammation biomarkers. DATA SOURCE Articles from PUBMED and WEB OF SCIENCE database with no chronological limit were reviewed to write this systematic review. Keywords such as children, obesity, iron deficiency, and hepcidin were used. After deleting duplicated and review articles, 91 were screened, and 39 were selected as eligible. Sixteen articles were included because they involved serum hepcidin levels in obese children and adolescents as outcomes. SUMMARY OF FINDINGS Finally, those 16 articles were organized in two tables: one includes therapeutic interventions, and the other does not. As hepcidin was discovered in 2000, the first articles that presented serum hepcidin's quantification in obese children and adolescents, homeostasis iron markers, and their possible association with obesity's inflammatory environment began to be published in 2008. CONCLUSIONS Obesity's chronic inflammation state leads to the production of IL-6, which acts as a signaling molecule for hepcidin synthesis, resulting in iron deficiency, which is common in obese children and adolescents who respond inadequately to iron supplementation. On the other hand, that population responds adequately to therapeutic intervention programs that lead to weight loss, guaranteeing iron homeostasis improvement. Therefore, perhaps it is time to discuss serum hepcidin level quantification as part of evaluating children and adolescents with iron deficiency, which could guide clinical choices that might lead to better therapeutic outcomes.
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Affiliation(s)
- Pedro Ferro Berton
- Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brazil
| | - Alessandra Gambero
- Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brazil.
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Zhang Y, Ding R, Zhang Y, Qi J, Cao W, Deng L, Zhou L, Ye Y, Xue Y, Liu E. Dysfunction of DMT1 and miR-135b in the gut-testis axis in high-fat diet male mice. GENES & NUTRITION 2024; 19:1. [PMID: 38243197 PMCID: PMC10797958 DOI: 10.1186/s12263-024-00737-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 01/04/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Obese patients have been found to be susceptible to iron deficiency, and malabsorption of dietary iron is the cause of obesity-related iron deficiency (ORID). Divalent metal transporter 1 (DMT1) and ferroportin (FPN), are two transmembrane transporter proteins expressed in the duodenum that are closely associated with iron absorption. However, there have been few studies on the association between these two proteins and the increased susceptibility to iron deficiency in obese patients. Chronic inflammation is also thought to be a cause of obesity-related iron deficiency, and both conditions can have an impact on spermatogenesis and impair male reproductive function. Based on previous studies, transgenerational epigenetic inheritance through gametes was observed in obesity. RESULTS Our results showed that obese mice had decreased blood iron levels (p < 0.01), lower protein and mRNA expression for duodenal DMT1 (p < 0.05), but no statistically significant variation in mRNA expression for duodenal FPN (p > 0.05); there was an increase in sperm miR-135b expression (p < 0.05). Bioinformatics revealed ninety overlapping genes and further analysis showed that they were primarily responsible for epithelial cilium movement, fatty acid beta-oxidation, protein dephosphorylation, fertilization, and glutamine transport, which are closely related to spermatogenesis, sperm development, and sperm viability in mice. CONCLUSIONS In obese mice, we observed downregulation of DMT1 in the duodenum and upregulation of miR-135b in the spermatozoa.
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Affiliation(s)
- Yanru Zhang
- Laboratory Animal Center, Xi'an Jiaotong University Health Science Centre, Xi'an, 710061, China
| | - Ruike Ding
- Laboratory Animal Center, Xi'an Jiaotong University Health Science Centre, Xi'an, 710061, China
| | - Yulin Zhang
- Laboratory Animal Center, Xi'an Jiaotong University Health Science Centre, Xi'an, 710061, China
| | - Jia Qi
- Laboratory Animal Center, Xi'an Jiaotong University Health Science Centre, Xi'an, 710061, China
| | - Wenbin Cao
- Laboratory Animal Center, Xi'an Jiaotong University Health Science Centre, Xi'an, 710061, China
| | - Lijun Deng
- Spring Biological Technology Development Co., Ltd, Fangchenggang, Guangxi, 538000, China
| | - Lin Zhou
- Laboratory Animal Center, Xi'an Jiaotong University Health Science Centre, Xi'an, 710061, China
| | - Yun Ye
- Central Laboratory, The First Affiliated Hospital of Xi'an Medical University, Xi'an, 710000, China
| | - Ying Xue
- Laboratory Animal Center, Xi'an Jiaotong University Health Science Centre, Xi'an, 710061, China.
| | - Enqi Liu
- Laboratory Animal Center, Xi'an Jiaotong University Health Science Centre, Xi'an, 710061, China.
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education of China, Xi'an, 710049, China.
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Wang T, Gao Q, Yao Y, Luo G, Lv T, Xu G, Liu M, Xu J, Li X, Sun D, Cheng Z, Wang Y, Wu C, Wang R, Zou J, Yan M. Causal relationship between obesity and iron deficiency anemia: a two-sample Mendelian randomization study. Front Public Health 2023; 11:1188246. [PMID: 37397759 PMCID: PMC10313085 DOI: 10.3389/fpubh.2023.1188246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
Background Observational studies have suggested an association between obesity and iron deficiency anemia, but such studies are susceptible to reverse causation and residual confounding. Here we used Mendelian randomization to assess whether the association might be causal. Methods Data on single-nucleotide polymorphisms that might be associated with various anthropometric indicators of obesity were extracted as instrumental variables from genome-wide association studies in the UK Biobank. Data on genetic variants in iron deficiency anemia were extracted from a genome-wide association study dataset within the Biobank. Heterogeneity in the data was assessed using inverse variance-weighted regression, Mendelian randomization Egger regression, and Cochran's Q statistic. Potential causality was assessed using inverse variance-weighted, Mendelian randomization Egger, weighted median, maximum likelihood and penalized weighted median methods. Outlier SNPs were identified using Mendelian randomization PRESSO analysis and "leave-one-out" analysis. Results Inverse variance-weighted regression associated iron deficiency anemia with body mass index, waist circumference, trunk fat mass, body fat mass, trunk fat percentage, and body fat percentage (all odds ratios 1.003-1.004, P ≤ 0.001). Heterogeneity was minimal and no evidence of horizontal pleiotropy was found. Conclusion Our Mendelian randomization analysis suggests that obesity can cause iron deficiency anemia.
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Affiliation(s)
- Tingting Wang
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qi Gao
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuanyuan Yao
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ge Luo
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Lv
- Department of Anesthesiology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, China
| | - Guangxin Xu
- Department of Anesthesiology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, China
| | - Mingxia Liu
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingpin Xu
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuejie Li
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dawei Sun
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenzhen Cheng
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Wang
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chaomin Wu
- Department of Anesthesiology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, China
| | - Ruiyu Wang
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingcheng Zou
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Min Yan
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Abstract
Metabolic syndrome (MS), a conglomeration of several conditions including obesity, type 2 diabetes mellitus (T2DM), insulin resistance, elevated blood pressure, and dyslipidemia is reaching epidemic proportions. Anemia is caused by iron deficiency or dysregulation of iron homeostasis, leading to tissue hypoxia. Coexistence of anemia and MS or its components has been reported in the literature. The term "rubrometabolic syndrome" acts as a unifying entity linking the importance of blood in health and anemia in MS; it justifies two principles - redness of blood and low-grade inflammation. Chronic low-grade inflammation in MS affects iron metabolism leading to anemia. Tissue hypoxia that results from the anemic condition seems to be a major causative factor for the exacerbation of several microvascular and macrovascular components of T2DM, which include diabetic neuropathy, nephropathy, retinopathy, and cardiovascular complications. In obesity, anemia leads to malabsorption of micronutrients and can complicate the management of the condition by bariatric surgery. Anemia interferes with the diagnosis and management of T2DM, obesity, dyslipidemia, or hypertension due to its effect on pathological tests as well as medications. Since anemia in MS is multifaceted, the management of anemia is challenging as overcorrection of anemia with erythropoietin-stimulating agents can cause detrimental effects. These limitations necessitate availability of an effective and safe therapy that can maintain and elevate the hemoglobin levels along with maintaining the physiological balance of other systems. This review discusses the physiological links between anemia and MS along with diagnosis and management strategies in patients with coexistence of anemia and MS.
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Affiliation(s)
| | - Ankia Coetzee
- Division of Endocrinology, Stellenbosch University & Tygerberg Hospital, Cape Town, South Africa
| | - Philip A Kalra
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Joel R Saldaña
- Resultados Medicos, Desarrollo e Investigación, SC, Boulevard Valle de San Javier, Pachuca Hidalgo, Mexico City, Mexico
| | - Gary Kilov
- University of Melbourne, Launceston, Australia
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The Association between Index of Nutritional Quality (INQ) and Obesity: Baseline Data of Kharameh Cohort. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8321596. [PMID: 36817069 PMCID: PMC9929214 DOI: 10.1155/2022/8321596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/16/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022]
Abstract
Obesity is an increasing problem that can lead to noncommunicable diseases. The role of dietary factors on one's obesity is confirmed in many studies. One nutritional approach that can be used for assessment of the foods and diets is the Index of Nutritional Quality (INQ). Our study is aimed at exploring the association between INQ and obesity. Our hypothesis is that enriched and high-quality diets reduce the risk of overweight or obesity. This study was carried out on 6248 overweight and obese participants, from whom 4356 (69.7%) and 1892 (30.3%) were overweight and obese, respectively. To assess the dietary intake for the participants, a valid food frequency questionnaire (FFQ) with 130 food items was utilized. The analysis revealed an inverse association between the overweight and the INQ of iron, thiamin, riboflavin, B6, folate, zinc, magnesium, calcium, and vitamin C and E. For the obese group, this inverse association was found for iron, B6, folate, zinc, magnesium, calcium, and vitamin C and E. These results approved our hypothesis that a rich nutrition diet may lead to a lower risk of obesity.
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Changes in obesity and iron deficiency between 4 and 9 years of age. Longitudinal study of childhood obesity (ELOIN). Int J Obes (Lond) 2022; 46:1992-1999. [PMID: 35931811 DOI: 10.1038/s41366-022-01196-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Recent studies revealed that children who are overweight have a higher risk of iron deficiency, although the etiology of this relationship remains unclear. The aim of the study was to evaluate the association between changes in obesity status between 4 and 9 years of age and iron deficiency. SUBJECTS This population-based cohort study included 1347 children from the ELOIN study, conducted in Madrid, Spain. Follow-up with physical examinations and a computer-assisted telephone interview were carried out at 4, 6 and 9 years of age, and a blood test was performed at 9 years. METHODS Changes in obesity were estimated based on body mass index and waist circumference, according to the persistence or variation in obesity rates at 4, 6 and 9 years and were classified as follows: (1) Stable without obesity; (2) Remitting obesity at 9 years; (3) Incident obesity or relapse at 9 years; and (4) Stable with obesity. Iron deficiency was defined as transferrin saturation value below 16%. Odds ratios (ORs) for iron deficiency were estimated according to obesity status using logistic regression and adjusted for confounding variables, including C-reactive protein (CRP). RESULTS The prevalence of iron deficiency in the stable general obesity (GO) and abdominal obesity (AO) groups was 38.2% and 41.2%, versus 23.6% and 23.4% in the stable without obesity groups, respectively. The ORs for iron deficiency were 1.85 (95% CI: 1.03-3.32) in the stable GO group and 2.34 (95% CI: 1.29-4.24) in the stable AO group. This association disappeared when CRP was included in the analysis. CONCLUSIONS An extended state of obesity during the first stages of life is associated with iron deficiency, and this association may be mediated by CRP. Prevention and early detection of obesity in children should be a priority to avoid a double burden of malnutrition.
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Hernández-Aguilera A, Casacuberta N, Castañé H, Fibla M, Fernández-Arroyo S, Fort-Gallifa I, París M, Sabench F, Del Castillo D, Baiges-Gaya G, Rodríguez-Tomàs E, Sans T, Camps J, Joven J. Nonalcoholic Steatohepatitis Modifies Serum Iron-Related Variables in Patients with Morbid Obesity. Biol Trace Elem Res 2021; 199:4555-4563. [PMID: 33559024 DOI: 10.1007/s12011-021-02610-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/24/2021] [Indexed: 12/17/2022]
Abstract
Nonalcoholic steatohepatitis (NASH) is frequently associated with severe obesity. The liver is the principal storage repository for iron, and the excessive accumulation of this metal may promote hepatic inflammation. Laparoscopic sleeve gastrectomy (LSG) results in weight loss and improvement in comorbidities such as NASH. The aim of this study was to assess the specific NASH-related changes in iron metabolism and to investigate whether these changes are reversed by LSG. We included 150 patients with morbid obesity who provided 12-h fasting blood samples immediately before LSG together with an intraoperative wedge-liver biopsy. Thirty-eight patients with NASH underwent a second blood extraction 12 months postsurgery. Serum samples were collected from a control group comprising 50 healthy volunteers. We found significantly higher serum iron and transferrin concentrations in patients with NASH along with the highest degrees of steatosis, fibrosis, hepatocellular ballooning, and lobular inflammation. However, we did not find any significant accumulation of iron in the hepatic biopsies. Presurgery serum iron concentrations were lower in the patient group than in the control group and increased 1 year postsurgery. Serum ferritin levels showed changes in the opposite direction. We did not observe any significant change in serum transferrin concentrations. These changes were reversed by LSG. We conclude that alterations in serum iron-related variables are related to the severity of NASH in patients with morbid obesity, and these alterations are reversed by LSG. We also found that severe forms of NASH can be found in the absence of increased iron stores.
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Affiliation(s)
- Anna Hernández-Aguilera
- Universitat Rovira i Virgili, Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, C. Sant Joan s/n, 43201, Reus, Spain
| | - Núria Casacuberta
- Laboratoris ICS Camp de Tarragona-Terres de l'Ebre, Universitat Rovira i Virgili, C. Esplanetes 14, 43500, Tortosa, Spain
| | - Helena Castañé
- Universitat Rovira i Virgili, Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, C. Sant Joan s/n, 43201, Reus, Spain
| | - Montserrat Fibla
- Universitat Rovira i Virgili, Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, C. Sant Joan s/n, 43201, Reus, Spain
| | - Salvador Fernández-Arroyo
- Universitat Rovira i Virgili, Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, C. Sant Joan s/n, 43201, Reus, Spain
| | - Isabel Fort-Gallifa
- Laboratoris ICS Camp de Tarragona-Terres de l'Ebre, Universitat Rovira i Virgili, C. Esplanetes 14, 43500, Tortosa, Spain
| | - Marta París
- Universitat Rovira i Virgili, Department of Surgery, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitaria Pere Virgili, Av. Doctor Josep Laporte 2, 43204, Reus, Spain
| | - Fàtima Sabench
- Universitat Rovira i Virgili, Department of Surgery, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitaria Pere Virgili, Av. Doctor Josep Laporte 2, 43204, Reus, Spain
| | - Daniel Del Castillo
- Universitat Rovira i Virgili, Department of Surgery, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitaria Pere Virgili, Av. Doctor Josep Laporte 2, 43204, Reus, Spain
| | - Gerard Baiges-Gaya
- Universitat Rovira i Virgili, Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, C. Sant Joan s/n, 43201, Reus, Spain
| | - Elisabet Rodríguez-Tomàs
- Universitat Rovira i Virgili, Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, C. Sant Joan s/n, 43201, Reus, Spain
| | - Teresa Sans
- Laboratoris ICS Camp de Tarragona-Terres de l'Ebre, Universitat Rovira i Virgili, C. Esplanetes 14, 43500, Tortosa, Spain
| | - Jordi Camps
- Universitat Rovira i Virgili, Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, C. Sant Joan s/n, 43201, Reus, Spain.
| | - Jorge Joven
- Universitat Rovira i Virgili, Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, C. Sant Joan s/n, 43201, Reus, Spain
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Wang X, Fang X, Zheng W, Zhou J, Song Z, Xu M, Min J, Wang F. Genetic Support of A Causal Relationship Between Iron Status and Type 2 Diabetes: A Mendelian Randomization Study. J Clin Endocrinol Metab 2021; 106:e4641-e4651. [PMID: 34147035 PMCID: PMC8530720 DOI: 10.1210/clinem/dgab454] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Indexed: 12/15/2022]
Abstract
CONTEXT Iron overload is a known risk factor for type 2 diabetes (T2D); however, iron overload and iron deficiency have both been associated with metabolic disorders in observational studies. OBJECTIVE Using mendelian randomization (MR), we assessed how genetically predicted systemic iron status affected T2D risk. METHODS A 2-sample MR analysis was used to obtain a causal estimate. We selected genetic variants strongly associated (P < 5 × 10-8) with 4 biomarkers of systemic iron status from a study involving 48 972 individuals performed by the Genetics of Iron Status consortium and applied these biomarkers to the T2D case-control study (74 124 cases and 824 006 controls) performed by the Diabetes Genetics Replication and Meta-analysis consortium. The simple median, weighted median, MR-Egger, MR analysis using mixture-model, weighted allele scores, and MR based on a Bayesian model averaging approaches were used for the sensitivity analysis. RESULTS Genetically instrumented serum iron (odds ratio [OR]: 1.07; 95% CI, 1.02-1.12), ferritin (OR: 1.19; 95% CI, 1.08-1.32), and transferrin saturation (OR: 1.06; 95% CI, 1.02-1.09) were positively associated with T2D. In contrast, genetically instrumented transferrin, a marker of reduced iron status, was inversely associated with T2D (OR: 0.91; 95% CI, 0.87-0.96). CONCLUSION Genetic evidence supports a causal link between increased systemic iron status and increased T2D risk. Further studies involving various ethnic backgrounds based on individual-level data and studies regarding the underlying mechanism are warranted for reducing the risk of T2D.
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Affiliation(s)
- Xinhui Wang
- The Fourth Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Xuexian Fang
- The Fourth Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Wanru Zheng
- The Fourth Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Jiahui Zhou
- The Fourth Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Zijun Song
- The Fourth Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Mingqing Xu
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai 200030, China
| | - Junxia Min
- The Fourth Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Fudi Wang
- The Fourth Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
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Dorsey AF, Penny ME, Thompson AL. Adiposity and pathogen exposure: An investigation of response to iron supplementation and hypothesized predictors in anemic pre-school-aged children living in a dual burden environment. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021; 176:54-65. [PMID: 33852740 PMCID: PMC8376780 DOI: 10.1002/ajpa.24287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 03/13/2021] [Accepted: 03/24/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Peruvians are experiencing rapid dietary and lifestyle changes, resulting in a phenomenon known as the "dual burden of disease." A common manifestation of the dual burden in individuals is the co-occurrence of overweight and anemia. Despite recent initiatives introduced to address these concerns, rates continue to be public health concerns. This study investigates the relationship between immune activation and lack of response to iron supplementation after 1 month of treatment and explores variation in body fat stores as a potential moderator between immune function and response to treatment. METHODS Data come from children, aged 2-5 years (n = 50) from a peri-urban community in Lima, Peru. Multivariate logistic regression models were used to explore the associations between response to treatment (Hb > =11.0 g/dl) after 1 month of treatment), markers of immune activation (C-reactive protein [CRP] and reported morbidity symptoms), and measures of body fat (waist-to-height ratio, triceps skinfold thickness, and body mass index [BMI]). RESULTS We found that high CRP is associated with a lack of response to iron supplementation after 1 month of treatment and that BMI z-score may moderate this association. Generally, larger body size is associated with response to iron supplementation whether or not the children in this sample have high immune activation. However, the probability of anemic children responding to iron supplementation treatment differed across adiposity measures. CONCLUSIONS Our finding suggesting that adiposity and CRP influence response to iron supplementation, furthers our understanding of the relationship between inflammation and anemia treatment in children and has both theoretical and public health implications.
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Affiliation(s)
- Achsah F Dorsey
- Department of Anthropology, University of Massachusetts, Amherst, Massachusetts, USA
| | - Mary E Penny
- Instituto de Investigación Nutricional, La Molina, Lima, Peru
| | - Amanda L Thompson
- Department of Anthropology, University of North Carolina, Chapel Hill, North Carolina, USA
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Quilliot D, Coupaye M, Ciangura C, Czernichow S, Sallé A, Gaborit B, Alligier M, Nguyen-Thi PL, Dargent J, Msika S, Brunaud L. Recommendations for nutritional care after bariatric surgery: Recommendations for best practice and SOFFCO-MM/AFERO/SFNCM/expert consensus. J Visc Surg 2021; 158:51-61. [PMID: 33436155 DOI: 10.1016/j.jviscsurg.2020.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nutritional care after bariatric surgery is an issue of major importance, especially insofar as risk of deficiency has been extensively described in the literature. Subsequent to the deliberations carried out by a multidisciplinary working group, we are proposing a series of recommendations elaborated using the Delphi-HAS (official French health authority) method, which facilitates the drawing up of best practice and consensus recommendations based on the data of the literature and on expert opinion. The recommendations in this paper pertain to dietary management and physical activity, multivitamin and trace element supplementation and the prevention and treatment of specific deficiencies in vitamins B1, B9, B12, D and calcium, iron, zinc, vitamins A, E and K, dumping syndrome and reactive hypoglycemia.
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Affiliation(s)
- D Quilliot
- French Speaking Society of Clinical Nutrition and Metabolism (SFNCM), France.
| | - M Coupaye
- French Association for the Study and Research on Obesity (AFERO), France
| | - C Ciangura
- French Association for the Study and Research on Obesity (AFERO), France
| | - S Czernichow
- French Speaking Society of Clinical Nutrition and Metabolism (SFNCM), France
| | - A Sallé
- French Association for the Study and Research on Obesity (AFERO), France
| | - B Gaborit
- French Association for the Study and Research on Obesity (AFERO), France
| | - M Alligier
- French Obesity Research Center of Excellence (FORCE), France
| | - P-L Nguyen-Thi
- Medical Evaluation Department, Department of Clinical Research Support PARC, University of Lorraine, CHRU Nancy, Nancy, France
| | - J Dargent
- French and Francophone Society of Obesity Surgery and Metabolic Disorders (SO.FF.CO.MM), France
| | - S Msika
- French and Francophone Society of Obesity Surgery and Metabolic Disorders (SO.FF.CO.MM), France
| | - L Brunaud
- French and Francophone Society of Obesity Surgery and Metabolic Disorders (SO.FF.CO.MM), France
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11
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Anaemia, iron deficiency, iron-deficiency anaemia and their associations with obesity among schoolchildren in Guangzhou, China. Public Health Nutr 2020; 23:1693-1702. [PMID: 31910936 DOI: 10.1017/s1368980019003604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The association of Fe metabolism with obesity in children remains unclear. The present study aimed to assess the status of Fe metabolism parameters, the prevalence of anaemia, Fe deficiency (ID) and Fe-deficiency anaemia (IDA), and the associations of these variables with obesity in Chinese schoolchildren. DESIGN A cross-sectional study conducted in 5295 schoolchildren aged 7-11 years in Guangzhou, China, 2014-2015. Full data of anthropometric and Fe metabolic parameters were collected to assess obesity, anaemia, ID and IDA. Logistic regression models were established to determine the possible associations of anaemia, ID and IDA with obesity. Two-tailed P values of <0·05 was considered statistically significant. SETTING Guangzhou City, China. PARTICIPANTS Schoolchildren aged 7-11 years (n 5295). RESULTS In this sample, mean Hb concentration was 128·1 g/l and the prevalence of anaemia, ID and IDA was 6·6, 6·2 and 0·6 %, respectively. Of the participants, 14·0 % were overweight and 8·8 % were obese. Importantly, obesity was associated with lower anaemia risk (adjusted OR = 0·553; 95 % CI 0·316, 0·968) but higher ID risk (adjusted OR = 1·808; 95 % CI 1·146, 2·853) after adjustment for confounders. No significant relationship was found between obesity and IDA. CONCLUSIONS Our results confirmed that anaemia and ID remain public health concerns among schoolchildren in Guangzhou, while IDA is remarkably less prevalent. Furthermore, obesity was associated with lower anaemia risk, but higher ID risk. More efforts should be made to prevent the onset of ID and obesity in the same individual, thus improving the health and fitness of children.
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Antony Rathinasamy JIR, Uddandrao VVS, Raveendran N, Sasikumar V. Antiobesity Effect of Biochanin-A: Effect on Trace Element Metabolism in High Fat Diet-Induced Obesity in Rats. Cardiovasc Hematol Agents Med Chem 2020; 18:21-30. [PMID: 32031077 DOI: 10.2174/1871524920666200207101920] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Imbalanced diets have contributed to the increased prevalence of obesity and other metabolic disorders in the modern world including trace element metabolism. However, the underlying mechanisms are not fully understood. AIM AND OBJECTIVES The present study investigated the effects of Biochanin A (BCA) on the changes in element metabolism induced by HFD-induced obese rats. METHODS BCA was administered orally for 30 days to experimental obese rats. Changes in body weight, glucose, insulin resistance and lipid profiles of plasma, as well as the level of trace elements (Fe, Zn, Mg and Cu) in various tissues (liver, kidney, heart and pancreas) and hepsidine and heme oxygenase, were observed in experimental rats. RESULTS The administration of BCA elicited a significant (p<0.05) reduction in, glucose, insulin, ferritin, total cholesterol, phospholipids, free fatty acids, VLDL-C, LDL-C, triglycerides and hepsidin. Significant alterations were observed in trace elements level, HDL-C, transferrin, bilirubin and HO - 1 level. CONCLUSION These findings suggested that HFD results in derangement of trace elements in the tissues of rats fed with HFD. BCA may alleviate the derangement of HFD induced trace elements metabolism by modulating hyperglycemic and insulin resistance status and altering hepcidin and HO-1.
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Affiliation(s)
| | - Veera Venkata Sathibabu Uddandrao
- Centre for Biological Sciences, Department of Biochemistry, K.S. Rangasamy College of Arts and Science (Autonomous), Tiruchengode, Namakkal District, Tamilnadu-637215, India
| | - Nivedha Raveendran
- Centre for Biological Sciences, Department of Biochemistry, K.S. Rangasamy College of Arts and Science (Autonomous), Tiruchengode, Namakkal District, Tamilnadu-637215, India
| | - Vadivukkarasi Sasikumar
- Centre for Biological Sciences, Department of Biochemistry, K.S. Rangasamy College of Arts and Science (Autonomous), Tiruchengode, Namakkal District, Tamilnadu-637215, India
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Mörwald K, Aigner E, Bergsten P, Brunner SM, Forslund A, Kullberg J, Ahlström H, Manell H, Roomp K, Schütz S, Zsoldos F, Renner W, Furthner D, Maruszczak K, Zandanell S, Weghuber D, Mangge H. Serum Ferritin Correlates With Liver Fat in Male Adolescents With Obesity. Front Endocrinol (Lausanne) 2020; 11:340. [PMID: 32625166 PMCID: PMC7314945 DOI: 10.3389/fendo.2020.00340] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/30/2020] [Indexed: 12/11/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) contributes essentially to the burden of obesity and can start in childhood. NAFLD can progress to cirrhosis and hepatocellular carcinoma. The early phase of NAFLD is crucial because during this time the disease is fully reversible. Pediatric NAFLD shows unique features of histology and pathophysiology compared to adults. Changes in serum iron parameters are common in adult NAFLD and have been termed dysmetabolic iron overload syndrome characterized by increased serum ferritin levels and normal transferrin saturation; however, the associations of serum ferritin, inflammation, and liver fat content have been incompletely investigated in children. As magnetic resonance imaging (MRI) is an excellent measure for the degree of liver steatosis, we applied this method herein to clarify the interaction between ferritin and fatty liver in male adolescents. For this study, one hundred fifty male pediatric patients with obesity and who are overweight were included. We studied a subgroup of male patients with (n = 44) and without (n = 18) NAFLD in whom we determined liver fat content, visceral adipose tissue, and subcutaneous adipose tissue extent with a 1.5T MRI (Philips NL). All patients underwent a standardized oral glucose tolerance test. We measured uric acid, triglycerides, HDL-, LDL-, total cholesterol, liver transaminases, high sensitive CRP (hsCRP), interleukin-6, HbA1c, and insulin. In univariate analysis, ferritin was associated with MRI liver fat, visceral adipose tissue content, hsCRP, AST, ALT, and GGT, while transferrin and soluble transferrin receptor were not associated with ferritin. Multivariate analysis identified hsCRP and liver fat content as independent predictors of serum ferritin in the pediatric male patients. Our data indicate that serum ferritin in male adolescents with obesity is mainly determined by liver fat content and inflammation but not by body iron status.
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Affiliation(s)
- Katharina Mörwald
- Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Elmar Aigner
- Obesity Research Unit, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- First Department of Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Peter Bergsten
- Department of Medical Cell Biology, University Uppsala, Uppsala, Sweden
| | - Susanne M Brunner
- Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- Obesity Research Unit, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- Research Program for Receptor Biochemistry and Tumor Metabolism, Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Anders Forslund
- Department of Women's and Children's Health, University Uppsala, Uppsala, Sweden
| | - Joel Kullberg
- Department of Surgical Sciences, Radiology, University Uppsala, Uppsala, Sweden
| | - Hakan Ahlström
- Department of Surgical Sciences, Radiology, University Uppsala, Uppsala, Sweden
| | - Hannes Manell
- Department of Medical Cell Biology, University Uppsala, Uppsala, Sweden
| | - Kirsten Roomp
- Luxembourg Center for Systems Biomedicine, University Luxembourg, Luxembourg, Luxembourg
| | - Sebastian Schütz
- Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- Obesity Research Unit, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Fanni Zsoldos
- Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Wilfried Renner
- Luxembourg Center for Systems Biomedicine, University Luxembourg, Luxembourg, Luxembourg
| | - Dieter Furthner
- Obesity Research Unit, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics and Adolescent Medicine, Salzkammergut-Klinikum, Vöcklabruck, Austria
| | - Katharina Maruszczak
- Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- Obesity Research Unit, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Stephan Zandanell
- Obesity Research Unit, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- First Department of Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Daniel Weghuber
- Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- Obesity Research Unit, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Harald Mangge
- Clinical Institute for Medical and Chemical Laboratory Diagnosis, Medical University Graz, Graz, Austria
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Çağlar Şimşek CE, Çelik N, Aygüneş U, Yavuz Dönmez A, Avcı E, Ekici M. Evaluation of Hematological Parameters and Iron Level in Obese Children and Adolescents. ANKARA MEDICAL JOURNAL 2019. [DOI: 10.17098/amj.624400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Li J, Xiao C, Yang H, Zhou Y, Wang R, Cao Y. Anemia and Iron Status Among Different Body Size Phenotypes in Chinese Adult Population: a Nation-Wide, Health and Nutrition Survey. Biol Trace Elem Res 2018; 185:1-10. [PMID: 29224080 DOI: 10.1007/s12011-017-1213-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/28/2017] [Indexed: 12/18/2022]
Abstract
Previous studies have shown that there is a controversial relationship between iron homeostasis and obesity. This study aims to explore the relationship of anemia and iron status with different body size phenotypes in adult Chinese population. Using information on iron status-related parameters and lifestyle data from 8462 participants of the 2009 wave of China Health and Nutrition Survey (2009 CHNS), we performed multivariable logistic regression analyses to estimate the odds ratios (ORs) for the risk of anemia and iron parameters according to different body size phenotypes. Participants with higher body mass index (BMI) had a lower anemia prevalence with significant trends in both metabolic status groups (P < 0.001). Serum ferritin, transferrin, and soluble transferrin receptor (sTfR)/log ferritin index were significant in different metabolic status groups and in different body size phenotypes, respectively. The ORs for higher ferritin and transferrin increased across different body size phenotypes in both genders, and for sTfR/log ferritin index decreased (P < 0.01 for trend). This association was still statistically significant after adjustment for multiple confounders. We found an inverse association of BMI levels with the prevalence of anemia and strong association of serum ferritin and transferrin with higher risk of obesity or overweight in both metabolic status groups.
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Affiliation(s)
- Jiang Li
- Department of Laboratory Medicine, China-Japan Friendship Hospital, No. 2 Yinghua East Rd, Beijing, 100029, China.
| | - Cheng Xiao
- China-Japan Friendship Hospital, Institute of Clinical Medicine, Beijing, 100029, China
| | - Hui Yang
- Department of Laboratory Medicine, China-Japan Friendship Hospital, No. 2 Yinghua East Rd, Beijing, 100029, China
| | - Yun Zhou
- Department of Laboratory Medicine, China-Japan Friendship Hospital, No. 2 Yinghua East Rd, Beijing, 100029, China
| | - Rui Wang
- Blood Screening Laboratory, Beijing Red Cross Blood Center, Beijing, 100088, China
| | - Yongtong Cao
- Department of Laboratory Medicine, China-Japan Friendship Hospital, No. 2 Yinghua East Rd, Beijing, 100029, China.
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Cepeda-Lopez AC, Zimmermann MB, Wussler S, Melse-Boonstra A, Naef N, Mueller SM, Toigo M, Herter-Aeberli I. Greater blood volume and Hb mass in obese women quantified by the carbon monoxide-rebreathing method affects interpretation of iron biomarkers and iron requirements. Int J Obes (Lond) 2018; 43:999-1008. [PMID: 29907846 PMCID: PMC6760578 DOI: 10.1038/s41366-018-0127-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/04/2018] [Accepted: 04/22/2018] [Indexed: 12/21/2022]
Abstract
Background/objective Iron deficiency (ID) is common in overweight and obese individuals (OW/OB) but the mechanism is uncertain. Greater blood volume (BV) in OW/OB may increase hemoglobin (Hb) mass and iron requirements, and confound iron biomarkers by hemodilution. Quantification of BV/PV changes in OW/OB is challenging and a formula to estimate BV/PV based on anthropometric indices would be valuable. In normal weight (NW) and OW/OB women, we aimed at: (1) measure BV and assess whether differences in BV affect concentrations and total circulating mass of Hb and iron biomarkers; (2) develop an algorithm describing BV in OW/OB. Subjects/methods In a cross-sectional study, we measured BV in NW, OW, and OB non-anemic women (n = 62) by using the carbon monoxide-rebreathing method, body composition by dual energy X-ray absorptiometry, and iron and inflammatory status. Results OW and OB women had 11 and 16% higher mean BV and PV compared to NW (P < 0.05), respectively. In OW/OB compared to NW, total circulating masses of IL-6, hepcidin, Hb, and sTfR were higher, while total mass of serum iron was lower (for all, P < 0.05). An equation including height, body mass and lean mass to estimate BV in all BMI groups (R2 = 0.76). Conclusion An equation based on anthropometric indices provides a good estimate of increased BV in OW/OB women. In OW/OB women, there is an increase in Hb mass that likely increases iron requirements for erythropoiesis and circulating TfR mass. At the same time, higher hepcidin concentrations may lower serum iron mass. Both these mechanisms may increase risk for ID in OW/OB women.
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Affiliation(s)
- Ana C Cepeda-Lopez
- Division of Human Nutrition, Wageningen University (WU), Wageningen, The Netherlands. .,Health Sciences Division, University of Monterrey (UDEM), Monterrey, Mexico.
| | | | - Sophia Wussler
- Laboratory of Human Nutrition, ETH Zürich, Zürich, Switzerland
| | - Alida Melse-Boonstra
- Division of Human Nutrition, Wageningen University (WU), Wageningen, The Netherlands
| | - Nicole Naef
- University Hospital Balgrist, Balgrist Move>Med, Zurich, Switzerland
| | - Sandro Manuel Mueller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.,Institute of Human Movement Sciences, ETH Zurich, Zurich, Switzerland
| | - Marco Toigo
- Institute of Human Movement Sciences, ETH Zurich, Zurich, Switzerland.,University Hospital Balgrist, Laboratory for Muscle Plasticity, Zurich, Switzerland
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Are overweight and obesity in children risk factors for anemia in early childhood? Results from a national nutrition survey in Tajikistan. Int J Public Health 2018; 63:491-499. [DOI: 10.1007/s00038-018-1088-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 12/20/2017] [Accepted: 03/05/2018] [Indexed: 10/17/2022] Open
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Mchiza ZJ, Parker WA, Sewpaul R, Job N, Chola L, Mutyambizi C, Sithole M, Stokes A, Labadarios D. Understanding the determinants of hemoglobin and iron status: adolescent-adult women comparisons in SANHANES-1. Ann N Y Acad Sci 2018; 1416:31-47. [PMID: 29359477 DOI: 10.1111/nyas.13528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/21/2017] [Accepted: 09/21/2017] [Indexed: 12/18/2022]
Abstract
The study compared hemoglobin (Hb) and serum ferritin levels between adolescent and adult women with different body mass indices, dietary intake, and sociodemography. A secondary analysis of data for 3177 South African women ⩾15 years of age who participated in the SANHANES-1 study was undertaken. Abnormal Hb (≤12 g/dL) and serum ferritin (<15 μg/mL) were based on the World Health Organization's criteria for nonpregnant women aged ⩾15 years. Data were analyzed using STATA version 11. Overall, anemia was detected in 740 (23.3%) participants. Of the individuals in the subsample (n = 1123, 15-35 years) who had serum ferritin measured, 6.0% presented with iron depletion (ID) and 10.8% presented with iron-deficiency anemia (IDA). The highest prevalences of anemia, ID, and IDA were in 15- to 18-year-olds (11.2%, 8.8%, and 20.2%, respectively). Black young adults (19-24 years) were up to 40 times more likely to present with ID compared with their non-black counterparts. While overweight adolescents were three times more likely to be anemic, overweight and obese young adults, as well as obese older adults (25-35 years), were less likely to be anemic compared with normal-weight women of all age groups. Overconsumption of dietary fat increased ID by up to 54- and 11-fold (adolescents and 25- to 35-year-olds, respectively). In South Africa, anemia is most prevalent in adolescents and black women. Anemia is also an indicator of overconsumption of dietary fat and a marker of socioeconomic disadvantage.
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Affiliation(s)
- Zandile J Mchiza
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Whadi-Ah Parker
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Ronel Sewpaul
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Nophiwe Job
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Lumbwe Chola
- PRICELESS SA, University of Witwatersr and School of Public Health, Parktown, South Africa
| | - Chipo Mutyambizi
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Moses Sithole
- Centre for Science, Technology and Innovation Indicators, Cape Town, South Africa
| | - Andrew Stokes
- Boston University School of Public Health, Boston, Massachusetts
| | - Demetre Labadarios
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
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Sal E, Yenicesu I, Celik N, Pasaoglu H, Celik B, Pasaoglu OT, Kaya Z, Kocak U, Camurdan O, Bideci A, Cinaz P. Relationship between obesity and iron deficiency anemia: is there a role of hepcidin? ACTA ACUST UNITED AC 2018; 23:542-548. [PMID: 29318945 DOI: 10.1080/10245332.2018.1423671] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Iron deficiency is common in obese children although the underlying mechanism is unclear. The aim of this study was to investigate the associations between iron parameters, leptin, hepcidin and adiponectin levels in obese children. METHODS A total of 237 children, ranging in age from 5 to 18 years, 180 with primary obesity and 57 healthy children and adolescents, were enrolled. Complete blood count, serum iron levels, iron-binding capacity, ferritin levels, leptin, hepcidin and adiponectin levels were studied. RESULTS White blood cell and platelet count, iron-binding capacity, high-sensitive C-reactive protein, leptin and hepcidin values in the obese group were higher than those of the control group (p < 0.001, p = 0.002, p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). However, mean corpuscular volume, adiponectin and transferrin saturation values in the obese group were lower than in the control group (p = 0.026, p = 0.003, and p < 0.001, respectively). No significant differences were found in terms of hemoglobin, serum ferritin, iron and IL-6 levels. CONCLUSIONS Our study suggests that hepcidin levels do not contribute to the development of iron deficiency anemia in pediatric obese individuals.
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Affiliation(s)
- Ertan Sal
- a Department of Pediatric Hematology , Batman State Hospital , Batman , Turkey
| | - Idil Yenicesu
- b Pediatric Hematology , Gazi University , Ankara , Turkey
| | - Nurullah Celik
- c Pediatric Endocinology , Gazi University , Ankara , Turkey
| | | | - Bulent Celik
- e Chemistry Faculty Statistics , Gazi University , Ankara , Turkey
| | | | - Zühre Kaya
- b Pediatric Hematology , Gazi University , Ankara , Turkey
| | - Ulker Kocak
- b Pediatric Hematology , Gazi University , Ankara , Turkey
| | - Orhun Camurdan
- c Pediatric Endocinology , Gazi University , Ankara , Turkey
| | - Aysun Bideci
- c Pediatric Endocinology , Gazi University , Ankara , Turkey
| | - Peyami Cinaz
- c Pediatric Endocinology , Gazi University , Ankara , Turkey
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Han J, Plummer J, Liu L, Byrd A, Aschner M, Erikson KM. The impact of obesity on brain iron levels and α-synuclein expression is regionally dependent. Nutr Neurosci 2017; 22:335-343. [PMID: 29034829 DOI: 10.1080/1028415x.2017.1387720] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The importance of iron homeostasis is particularly apparent in the brain, where iron deficiency results in impaired cognition and iron accumulation is associated with neurodegenerative diseases. Obesity is linked to iron deficiency systemically, but the effects of obesity on brain iron and its associated consequences, including neurodegenerative processes remain unexplored. This preliminary study examined the effect of dietary-induced obesity on brain regional iron, α-synuclein expression, and F2-isoprostane (oxidative stress marker) concentrations in selected brain regions. OBJECTIVE The objective of the study was to elucidate the vulnerability of selected brain regions (e.g. midbrain, hippocampus) to the possible process of neurodegeneration due to the altered iron content associated with obesity. METHODS Twenty-one-day-old male C57BL/6J mice were fed with a high-fat diet (60% kcal from fat) or a control-fat diet (10% kcal from fat) for 20 weeks. Brain samples were collected and dissected into hippocampus, midbrain, striatum, and thalamus regions. Iron content, ferritin H (FtH) and α-synuclein protein and mRNA expressions, and F2-isoprostane were measured in selected regions. RESULTS The results indicated that obesity caused significant differences in iron levels in the midbrain and thalamus, but not in the hippocampus or striatum, compared to control mice. Furthermore, markers of neurodegeneration (α-synuclein mRNA expression and F2-isoprostanes) were increased in the midbrain. DISCUSSION These results support previous findings that brain iron metabolism responds to environmental stress in a regionally distinct manner and suggests that alterations in brain iron metabolism due to obesity may be relevant in neurodegeneration.
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Affiliation(s)
- Jian Han
- a Department of Biology , North Carolina Agricultural and Technical State University , Greensboro , NC 27411 , USA
| | - Justin Plummer
- b Department of Nutrition , The University of North Carolina at Greensboro , Greensboro , NC 27412 , USA
| | - Lumei Liu
- a Department of Biology , North Carolina Agricultural and Technical State University , Greensboro , NC 27411 , USA
| | - Aria Byrd
- c Department of Toxicology and Cancer Biology , University of Kentucky , Lexington , KY 40536 , USA
| | - Michael Aschner
- d Department of Molecular Pharmacology , Albert Einstein School of Medicine , Bronx , NY 10461 , USA
| | - Keith M Erikson
- b Department of Nutrition , The University of North Carolina at Greensboro , Greensboro , NC 27412 , USA
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Cepeda-Lopez AC, Allende-Labastida J, Melse-Boonstra A, Osendarp SJ, Herter-Aeberli I, Moretti D, Rodriguez-Lastra R, Gonzalez-Salazar F, Villalpando S, Zimmermann MB. The effects of fat loss after bariatric surgery on inflammation, serum hepcidin, and iron absorption: a prospective 6-mo iron stable isotope study. Am J Clin Nutr 2016; 104:1030-1038. [PMID: 27557657 DOI: 10.3945/ajcn.115.115592] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/22/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Iron deficiency is common in obese subjects. This may be due to an increase in serum hepcidin and a decrease in iron absorption from adiposity-related inflammation. OBJECTIVE We evaluated whether weight and fat loss in obese subjects would decrease inflammation and serum hepcidin and thereby improve iron absorption. DESIGN We performed a 6-mo prospective study in obese [body mass index (in kg/m2) ≥35 and <45] adults who had recently undergone laparoscopic sleeve gastrectomy. At 2 and 8 mo postsurgery, subjects consumed a test drink with 6 mg 57Fe as ferrous sulfate and were intravenously infused with 100 μg 58Fe as iron citrate. We then compared erythrocyte incorporation of iron isotopic labels, changes in body composition, iron status, hepcidin, and inflammation at each time point. RESULTS Forty-three subjects were studied at baseline, and 38 completed the protocol (32 women and 6 men). After 6 mo, total body fat, interleukin IL-6, and hepcidin were significantly lower (all P < 0.005). In iron-deficient subjects (n = 17), geometric mean (95% CI) iron absorption increased by 28% [from 9.7% (6.5%, 14.6%) to 12.4% (7.7%, 20.1%); P = 0.03], whereas in iron-sufficient subjects (n = 21), absorption did not change [5.9% (4.0%, 8.6%) and 5.6% (3.9%, 8.2%); P = 0.81]. CONCLUSION Adiposity-related inflammation is associated with a reduction in the normal upregulation of iron absorption in iron-deficient obese subjects, and this adverse effect may be ameliorated by fat loss. This protocol was approved by the ethics committees of Wageningen University, ETH Zurich, the University of Monterrey, and the Federal Commission for the Protection against Sanitary Risks, and registered at clinicaltrials.gov as NCT01347905.
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Affiliation(s)
- Ana C Cepeda-Lopez
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands; Health Sciences Division, University of Monterrey, Monterrey, Mexico;
| | | | | | - Saskia Jm Osendarp
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands; Micronutrient Initiative, Ottawa, Canada
| | | | | | | | | | - Salvador Villalpando
- Division of Nutrition and Health, National Institute of Public Health of Mexico, Cuernavaca, Mexico
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Affiliation(s)
- G L S Pawan
- Institute of Clinical Research and Medical Unit, Middlesex Hospital, London
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Gotardo ÉMF, Caria CREP, de Oliveira CC, Rocha T, Ribeiro ML, Gambero A. Effects of iron supplementation in mice with hypoferremia induced by obesity. Exp Biol Med (Maywood) 2016; 241:2049-2055. [PMID: 27439539 DOI: 10.1177/1535370216660398] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Iron is an important micronutrient, but it can also act as a dangerous element by interfering with glucose homeostasis and inflammation, two features that are already disturbed in obese subjects. In this work, we study the effects of systemic iron supplementation on metabolic and inflammatory responses in mice with hypoferremia induced by obesity to better characterize whether iron worsens the parameters that are already altered after 24 weeks of a high-fat diet (HFD). Mice were maintained on a control diet or a HFD for 24 weeks and received iron-III polymaltose (50 mg/kg/every 2 days) during the last two weeks. Glucose homeostasis (basal glucose and insulin test tolerance) and systemic and visceral adipose tissue (VAT) inflammation were assessed. Iron levels were measured in serum. The Prussian blue reaction was used in isolated macrophages to detect iron deposition. Iron supplementation resulted in an increased number of VAT macrophages that were positive for Prussian blue staining as well as increased serum iron levels. Systemic hepcidin, leptin, resistin, and monocyte chemoattractant protein-1 (MCP-1) levels were not altered by iron supplementation. Local adipose tissue inflammation was also not made worse by iron supplementation because the levels of hepcidin, MCP-1, leptin, and interleukin (IL)-6 were not altered. In contrast, iron supplementation resulted in an increased production of IL-10 by adipose tissue and VAT macrophages. Leukocytosis and VAT plasminogen activator inhibitor-1 (PAI-1) level were reduced, but insulin resistance was not altered after iron supplementation. In conclusion, systemic iron supplementation in mice with hypoferremia induced by obesity did not worsen inflammatory marker or adipose tissue inflammation or the metabolic status established by obesity. Iron deposition was observed in adipose tissue, mainly in macrophages, suggesting that these cells have mechanisms that promote iron incorporation without increasing the production of inflammatory mediators.
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Affiliation(s)
- Érica Martins Ferreira Gotardo
- Clinical Pharmacology and Gastroenterology Unit, São Francisco University Medical School, Bragança Paulista 12916-900, SP, Brazil
| | - Cintia Rabelo E Paiva Caria
- Clinical Pharmacology and Gastroenterology Unit, São Francisco University Medical School, Bragança Paulista 12916-900, SP, Brazil
| | - Caroline Candida de Oliveira
- Clinical Pharmacology and Gastroenterology Unit, São Francisco University Medical School, Bragança Paulista 12916-900, SP, Brazil
| | - Thalita Rocha
- Clinical Pharmacology and Gastroenterology Unit, São Francisco University Medical School, Bragança Paulista 12916-900, SP, Brazil
| | - Marcelo Lima Ribeiro
- Clinical Pharmacology and Gastroenterology Unit, São Francisco University Medical School, Bragança Paulista 12916-900, SP, Brazil
| | - Alessandra Gambero
- Clinical Pharmacology and Gastroenterology Unit, São Francisco University Medical School, Bragança Paulista 12916-900, SP, Brazil
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Liu L, Byrd A, Plummer J, Erikson KM, Harrison SH, Han J. The Effects of Dietary Fat and Iron Interaction on Brain Regional Iron Contents and Stereotypical Behaviors in Male C57BL/6J Mice. Front Nutr 2016; 3:20. [PMID: 27493939 PMCID: PMC4954826 DOI: 10.3389/fnut.2016.00020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/27/2016] [Indexed: 12/18/2022] Open
Abstract
Adequate brain iron levels are essential for enzyme activities, myelination, and neurotransmitter synthesis in the brain. Although systemic iron deficiency has been found in genetically or dietary-induced obese subjects, the effects of obesity-associated iron dysregulation in brain regions have not been examined. The objective of this study was to examine the effect of dietary fat and iron interaction on brain regional iron contents and regional-associated behavior patterns in a mouse model. Thirty C57BL/6J male weanling mice were randomly assigned to six dietary treatment groups (n = 5) with varying fat (control/high) and iron (control/high/low) contents. The stereotypical behaviors were measured during the 24th week. Blood, liver, and brain tissues were collected at the end of the 24th week. Brains were dissected into the hippocampus, midbrain, striatum, and thalamus regions. Iron contents and ferritin heavy chain (FtH) protein and mRNA expressions in these regions were measured. Correlations between stereotypical behaviors and brain regional iron contents were analyzed at the 5% significance level. Results showed that high-fat diet altered the stereotypical behaviors such as inactivity and total distance traveled (P < 0.05). The high-fat diet altered brain iron contents and FtH protein and mRNA expressions in a regional-specific manner: (1) high-fat diet significantly decreased the brain iron content in the striatum (P < 0.05), but not other regions, and (2) thalamus has a more distinct change in FtH mRNA expression compared with other regions. Furthermore, high-fat diet resulted in a significant decreased total distance traveled and a significant correlation between iron content and sleeping in midbrain (P < 0.05). Dietary iron also decreased brain iron content and FtH protein expression in a regionally specific manner. The effect of interaction between dietary fat and iron was observed in brain iron content and behaviors. All these findings will lay foundations to further explore the links among obesity, behaviors, and brain iron alteration.
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Affiliation(s)
- Lumei Liu
- Department of Biology, North Carolina Agricultural and Technical State University , Greensboro, NC , USA
| | - Aria Byrd
- Department of Biology, North Carolina Agricultural and Technical State University , Greensboro, NC , USA
| | - Justin Plummer
- Department of Nutrition, The University of North Carolina at Greensboro , Greensboro, NC , USA
| | - Keith M Erikson
- Department of Nutrition, The University of North Carolina at Greensboro , Greensboro, NC , USA
| | - Scott H Harrison
- Department of Biology, North Carolina Agricultural and Technical State University , Greensboro, NC , USA
| | - Jian Han
- Department of Biology, North Carolina Agricultural and Technical State University , Greensboro, NC , USA
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Hennigar SR, McClung JP. Nutritional Immunity: Starving Pathogens of Trace Minerals. Am J Lifestyle Med 2016; 10:170-173. [PMID: 30202269 PMCID: PMC6124953 DOI: 10.1177/1559827616629117] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Nutritional immunity is a process by which a host organism sequesters trace minerals in an effort to limit pathogenicity during infection. Circulating concentrations of minerals, such as iron and zinc, decline rapidly and dramatically with the inflammation associated with infection. The decline in iron and zinc is thought to starve invading pathogens of these essential elements, limiting disease progression and severity. The mechanisms contributing to the hypoferremia and hypozincemia of inflammation and potential interventions that exploit this process for the management of infection will be discussed.
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Affiliation(s)
| | - James P. McClung
- US Army Research Institute of Environmental Medicine, Military Nutrition Division, Natick, Massachusetts
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A review of iron studies in overweight and obese children and adolescents: a double burden in the young? Eur J Nutr 2016; 55:2179-97. [PMID: 26883916 DOI: 10.1007/s00394-016-1155-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 01/06/2016] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The connection between iron and excessive adiposity has received much research interest. Although children and adolescents have unique developmental phases and nutritional demands, to date, reviews of iron in the overweight (OW) and obese (OB) have combined studies of children and adults or have focussed on adults. PURPOSE The aim of this review was to critically evaluate studies of the relationship between iron and OW and obesity in children and adolescents, with emphasis on iron status, oral iron response, dietary intake and systemic inflammatory markers. METHODS A PubMed search was conducted to identify relevant articles published up to December 2015. Combinations of the following keywords were used: iron, OW, OB, children, adolescents, diet, hepcidin, inflammation, fortification, supplementation, weight loss, trace elements, obesity, iron deficiency (ID), minerals. RESULTS AND CONCLUSION A higher prevalence of ID, or risk of ID, among OW and OB children and adolescents has been consistently observed. Chronic inflammation caused by excessive adiposity offers a plausible explanation for this finding, rather than dietary factors. However, future studies must employ screening for the presence of both acute and chronic infections and inflammatory conditions and report other factors such as pubertal status. Intervention studies, although few, indicate that OW and OB children and adolescents have reduced response to oral iron. Further trials are needed to explore the connection between body fat mass, inflammatory proteins and iron absorption, together with the effect of weight loss on iron status in iron-deficient OW and OB children and adolescents.
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Cepeda-Lopez AC, Melse-Boonstra A, Zimmermann MB, Herter-Aeberli I. In overweight and obese women, dietary iron absorption is reduced and the enhancement of iron absorption by ascorbic acid is one-half that in normal-weight women. Am J Clin Nutr 2015; 102:1389-97. [PMID: 26561622 DOI: 10.3945/ajcn.114.099218] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 09/25/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Iron deficiency is common in overweight and obese individuals. This deficiency may be due to adiposity-related inflammation that increases serum hepcidin and decreases dietary iron absorption. Because hepcidin reduces iron efflux from the basolateral enterocyte, it is uncertain whether luminal enhancers of dietary iron absorption such as ascorbic acid can be effective in overweight and obese individuals. OBJECTIVE In this study, we compared iron absorption from a meal with ascorbic acid (+AA) and a meal without ascorbic acid (-AA) in women in a normal-weight group (NW) with those in overweight and obese groups combined (OW/OB). DESIGN Healthy, nonanemic women [n = 62; BMI (in kg/m(2)): 18.5-39.9] consumed a stable-isotope-labeled wheat-based test meal -AA and a wheat-based test meal +AA (31.4 mg ascorbic acid). We measured iron absorption and body composition with the use of dual-energy X-ray absorptiometry, blood volume with the use of a carbon monoxide (CO)-rebreathing method, iron status, inflammation, and serum hepcidin. RESULTS Inflammatory biomarkers (all P < 0.05) and hepcidin (P = 0.08) were lower in the NW than in the OW/OB. Geometric mean (95% CI) iron absorptions in the NW and OW/OB were 19.0% (15.2%, 23.5%) and 12.9% (9.7%, 16.9%) (P = 0.049), respectively, from -AA meals and 29.5% (23.3%, 38.2%) and 16.6% (12.8%, 21.7%) (P = 0.004), respectively, from +AA meals. Median percentage increases in iron absorption for -AA to +AA meals were 56% in the NW (P < 0.001) and 28% in OW/OB (P = 0.006). Serum ferritin [R(2) = 0.22; β = -0.17 (95% CI: -0.25, -0.09)], transferrin receptor [R(2) = 0.23; β = 2.79 (95% CI: 1.47, 4.11)], and hepcidin [R(2) = 0.13; β = -0.85 (95% CI: -1.41, -0.28)] were significant predictors of iron absorption. CONCLUSIONS In overweight and obese women, iron absorption is two-thirds that in normal-weight women, and the enhancing effect of ascorbic acid on iron absorption is one-half of that in normal-weight women. Recommending higher intakes of ascorbic acid (or other luminal enhancers of iron absorption) in obese individuals to improve iron status may have a limited effect. This trial was registered at clinicaltrials.gov as NCT01884506.
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Affiliation(s)
- Ana C Cepeda-Lopez
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands; División de Ciencias de la Salud, Universidad de Monterrey (UDEM), Monterrey, Mexico; and
| | | | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Isabelle Herter-Aeberli
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
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Zhao L, Zhang X, Shen Y, Fang X, Wang Y, Wang F. Obesity and iron deficiency: a quantitative meta-analysis. Obes Rev 2015; 16:1081-93. [PMID: 26395622 DOI: 10.1111/obr.12323] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/21/2015] [Accepted: 08/21/2015] [Indexed: 12/12/2022]
Abstract
Hypoferraemia (i.e. iron deficiency) was initially reported among obese individuals several decades ago; however, whether obesity and iron deficiency are correlated remains unclear. Here, we evaluated the putative association between obesity and iron deficiency by assessing the concentration of haematological iron markers and the risks associated with iron deficiency in both obese (including overweight) subjects and non-overweight participants. We performed a systematic search in the databases PubMed and Embase for relevant research articles published through December 2014. A total of 26 cross-sectional and case-control studies were analysed, comprising 13,393 overweight/obese individuals and 26,621 non-overweight participants. Weighted or standardized mean differences of blood iron markers and odds ratio (OR) of iron deficiency were compared between the overweight/obese participants and the non-overweight participants using a random-effects model. Compared with the non-overweight participants, the overweight/obese participants had lower serum iron concentrations (weighted mean difference [WMD]: -8.37 μg dL(-1) ; 95% confidence interval [CI]: -11.38 to -5.36 μg dL(-1) ) and lower transferrin saturation percentages (WMD: 2.34%, 95% CI: -3.29% to -1.40%). Consistent with this finding, the overweight/obese participants had a significantly increased risk of iron deficiency (OR: 1.31; 95% CI: 1.01-1.68). Moreover, subgroup analyses revealed that the method used to diagnose iron deficiency can have a critical effect on the results of the association test; specifically, we found a significant correlation between iron deficiency and obesity in studies without a ferritin-based diagnosis, but not in studies that used a ferritin-based diagnosis. Based upon these findings, we concluded that obesity is significantly associated with iron deficiency, and we recommend early monitoring and treatment of iron deficiency in overweight and obese individuals. Future longitudinal studies will help to test whether causal relationship exists between obesity and iron deficiency.
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Affiliation(s)
- L Zhao
- Department of Nutrition, Nutrition Discovery Innovation Center, Institute of Nutrition and Food Safety, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, Zhejiang, China
| | - X Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - Y Shen
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - X Fang
- Department of Nutrition, Nutrition Discovery Innovation Center, Institute of Nutrition and Food Safety, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Y Wang
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - F Wang
- Department of Nutrition, Nutrition Discovery Innovation Center, Institute of Nutrition and Food Safety, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, Zhejiang, China.,Department of Nutrition, Nutrition Discovery Innovation Institute, College of Public Health, Zhengzhou University, Zhengzhou, China
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Hennigar SR, McClung JP. Homeostatic regulation of trace mineral transport by ubiquitination of membrane transporters. Nutr Rev 2015; 74:59-67. [PMID: 26611242 DOI: 10.1093/nutrit/nuv060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 07/12/2015] [Indexed: 02/03/2023] Open
Abstract
Post-translational modification is a critical mechanism by which trace mineral transporters rapidly adapt to their environment to homeostatically regulate ion transport. Recently, a novel pathway was described whereby iron stimulates the ubiquitination and proteasomal degradation of the trace mineral transporter ZIP14. Discovery of this pathway suggests the proteasome as a potential therapeutic target for regulation of iron storage. Moreover, these findings contribute to a theoretical framework that can be applied to other ubiquitinated trace mineral transporters. This review will detail the current state of knowledge regarding the ubiquitination of trace mineral transporters, focusing on iron and zinc transporters, and the potential utility of post-translational modification of trace mineral transporters in the treatment of disease.
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Affiliation(s)
- Stephen R Hennigar
- S.R. Hennigar and J.P. McClung are with the Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - James P McClung
- S.R. Hennigar and J.P. McClung are with the Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA.
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31
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Increased risk of iron deficiency and reduced iron absorption but no difference in zinc, vitamin A or B-vitamin status in obese women in India. Eur J Nutr 2015; 55:2411-2421. [DOI: 10.1007/s00394-015-1048-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 09/16/2015] [Indexed: 12/16/2022]
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Choma SSR, Alberts M, Modjadji SEP. Conflicting effects of BMI and waist circumference on iron status. J Trace Elem Med Biol 2015; 32:73-8. [PMID: 26302915 DOI: 10.1016/j.jtemb.2015.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/24/2015] [Accepted: 06/17/2015] [Indexed: 02/07/2023]
Abstract
The association between obesity and iron status has a long history and is still receiving attention. However comparative analysis of the association between general obesity (BMI) and visceral obesity (waist circumference) with iron status has not been extensively researched. The aim of the present study is thus to determine if body mass index and waist circumference have the same correlation with iron status. One thousand one hundred and thirty people (225 men and 905 women) aged 30 years and above participated in this study. Anthropometric parameters, haemoglobin, iron and total iron binding capacity concentrations were measured using standard methods. Percentage transferrin saturation was calculated and ferritin concentrations were measured using an enzyme linked immunosorbent assay. Obese or overweight women had significantly lower iron and transferrin saturation concentration when compared to non-obese women. In contrast, women with high waist circumference had comparable plasma iron and transferrin saturation to women with normal waist circumference. Partial correlation analysis and linear regression analysis showed that BMI is negatively and significantly associated with plasma iron, transferrin saturation, Hb and ferritin concentration, whilst waist circumference is positively but insignificantly associated with plasma iron, transferrin saturation, Hb and ferritin concentration. Binary regression analysis showed that obese or overweight people are more likely to have iron deficiency, whilst those with raised waist circumference are more likely to have iron overload. Multivariate analysis showed that body mass index is negatively and significantly associated with low iron status, while waist circumference is positively and insignificantly associated with iron status. This is supported by a comparison of plasma iron, transferrin saturation and ferritin concentrations in participants with high body mass index and normal waist circumference and participants with normal body mass index and high waist circumference to those participants having normal body mass index and normal waist circumference. The present study suggests that in women body mass index is associated with low plasma iron, transferrin saturation and ferritin concentrations, while waist circumference is associated with high plasma iron, transferrin saturation and ferritin concentrations.
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Affiliation(s)
- Solomon Simon Ramphai Choma
- Department of Medical Sciences, Public Health and Health Promotion, Faculty of Health Sciences, University of Limpopo, Private Bag X1106, Sovenga, Polokwane, South Africa.
| | - Marianne Alberts
- Department of Medical Sciences, Public Health and Health Promotion, Faculty of Health Sciences, University of Limpopo, Private Bag X1106, Sovenga, Polokwane, South Africa.
| | - Sewela Elizabeth Perpetua Modjadji
- Department of Medical Sciences, Public Health and Health Promotion, Faculty of Health Sciences, University of Limpopo, Private Bag X1106, Sovenga, Polokwane, South Africa.
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Gao Y, Li Z, Gabrielsen JS, Simcox JA, Lee SH, Jones D, Cooksey B, Stoddard G, Cefalu WT, McClain DA. Adipocyte iron regulates leptin and food intake. J Clin Invest 2015; 125:3681-91. [PMID: 26301810 DOI: 10.1172/jci81860] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/17/2015] [Indexed: 12/17/2022] Open
Abstract
Dietary iron supplementation is associated with increased appetite. Here, we investigated the effect of iron on the hormone leptin, which regulates food intake and energy homeostasis. Serum ferritin was negatively associated with serum leptin in a cohort of patients with metabolic syndrome. Moreover, the same inverse correlation was observed in mice fed a high-iron diet. Adipocyte-specific loss of the iron exporter ferroportin resulted in iron loading and decreased leptin, while decreased levels of hepcidin in a murine hereditary hemochromatosis (HH) model increased adipocyte ferroportin expression, decreased adipocyte iron, and increased leptin. Treatment of 3T3-L1 adipocytes with iron decreased leptin mRNA in a dose-dependent manner. We found that iron negatively regulates leptin transcription via cAMP-responsive element binding protein activation (CREB activation) and identified 2 potential CREB-binding sites in the mouse leptin promoter region. Mutation of both sites completely blocked the effect of iron on promoter activity. ChIP analysis revealed that binding of phosphorylated CREB is enriched at these two sites in iron-treated 3T3-L1 adipocytes compared with untreated cells. Consistent with the changes in leptin, dietary iron content was also directly related to food intake, independently of weight. These findings indicate that levels of dietary iron play an important role in regulation of appetite and metabolism through CREB-dependent modulation of leptin expression.
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Becker C, Orozco M, Solomons NW, Schümann K. Iron metabolism in obesity: how interaction between homoeostatic mechanisms can interfere with their original purpose. Part I: underlying homoeostatic mechanisms of energy storage and iron metabolisms and their interaction. J Trace Elem Med Biol 2015; 30:195-201. [PMID: 25467855 DOI: 10.1016/j.jtemb.2014.10.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/29/2014] [Accepted: 10/29/2014] [Indexed: 02/07/2023]
Abstract
Adipose tissue plasticity mediated by inflammation is an important evolutionary achievement to survive seasonal climate changes. It permits to store excessive calories and to release them if required, using inflammatory cells to remove the debris. This process is regulated by a complex interaction of cytokines (TNF-α, IL-6), adipokines (adiponectin, apelin, liptin), adhesion molecules (ICAM-1, VCAM-1, E-selectin) and transcription factors (NF-κB, HIF-1α). Iron mediates electron transfer as an essential component of e.g. myeloperoxidase, hemoglobin, cytochrome C and ribonucleotide reductase. Conversely, unbound iron can catalyze oxidation of lipids, proteins, and DNA. To balance the essential with the potentially toxic function requires an efficient iron homoeostasis. This is mediated by hepcidin's interaction with the iron-exporter ferroportin, to adapt intestinal iron absorption and body iron-sequestration to changes in demand. In addition, the interaction of iron-responsive elements (IRE) and iron-responsive proteins (IRP), the IRE/IRP-mechanism, regulates cellular iron homoeostasis. Obesity-induced inflammation interacts with both these mechanisms and disturbs iron availability by impairing its absorption, and by sequestering it in the reticuloendothelial system. Both mechanisms lead to anemia and reduce physical fitness which, in a vicious cycle, can support the development of pathological obesity. Thus, interaction between these two sets of beneficial regulatory mechanisms can become detrimental in situations of ample calorie supply.
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Affiliation(s)
- Christiane Becker
- Institut für Tierernährung der TUM, Freising-Weihenstephan, Germany.
| | - Mónica Orozco
- Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala, Guatemala; Universidad de Valles, Solola, Guatemala
| | - Noel W Solomons
- Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala, Guatemala
| | - Klaus Schümann
- Research Center for Nutrition and Food Science (ZIEL) der TUM, Freising-Weihenstephan, Germany
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Mujica-Coopman MF, Brito A, López de Romaña D, Pizarro F, Olivares M. Body mass index, iron absorption and iron status in childbearing age women. J Trace Elem Med Biol 2015; 30:215-9. [PMID: 24813452 DOI: 10.1016/j.jtemb.2014.03.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/25/2014] [Accepted: 03/26/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND The prevalence of obesity has increased at an alarming rate worldwide. Some studies have observed an association between iron (Fe) deficiency (ID) and obesity, however more research is needed. OBJECTIVE To assess whether body mass index (BMI) is associated with both Fe absorption and Fe status. METHODS A cross sectional sample of 318 Chilean childbearing age women was studied. The women received either a single dose of 0.5mg of Fe (n=137, group 1) or 3mg of Fe plus ascorbic acid (1:2 molar ratio) (n=181, group 2), both as FeSO4 with labeled radioisotopes. Fe absorption was assessed through radio Fe erythrocyte incorporation. Fe status was determined by hemoglobin (Hb), mean corpuscular volume, serum Fe, total iron binding capacity, transferrin saturation, erythrocyte Zn protoporphyrin and serum ferritin (SF). RESULTS 29%, 47% and 24% of the women were classified as normal, overweight or obese, respectively. Fe absorption was significantly lower in obese women (p<0.05). In group 1, the geometric mean and range ±1 SD of the percentage of Fe absorption for normal-weight women was 32.9% vs. 19.7% in obese. For group 2, this percentage was 36% vs. 30%, respectively (2-way ANOVA: BMI classification and Fe dose p<0.05; interaction p=0.34). Although Fe absorption was lower in obese women, they had higher SF (p<0.01) and Hb (p<0.05) concentrations. CONCLUSION Although we did not observe a relationship between BMI and Fe status, obese women displayed lower Fe absorption compared with overweight and normal weight women, possibly due to subclinical inflammation associated with obesity.
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Affiliation(s)
| | - Alex Brito
- Micronutrients Laboratory, Institute of Nutrition and Food Technology, University of Chile, Chile; United States Department of Agriculture, Western Human Nutrition Research Center, University of California, Davis, USA
| | - Daniel López de Romaña
- Micronutrients Laboratory, Institute of Nutrition and Food Technology, University of Chile, Chile; The Micronutrient Initiative, Ottawa, ON, Canada
| | - Fernando Pizarro
- Micronutrients Laboratory, Institute of Nutrition and Food Technology, University of Chile, Chile
| | - Manuel Olivares
- Micronutrients Laboratory, Institute of Nutrition and Food Technology, University of Chile, Chile.
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Abstract
As an essential element, iron plays a central role in many physiological processes, including redox balance, inflammation, energy metabolism, and environment sensing. Perturbations in iron homeostasis are associated with several conditions, including hyperglycemia and diabetes, both of which have been studied in patients and animal models. To clarify the pleiotropic role of iron homeostasis in diabetes development, the early studies on diseases with iron-overload, studies on clinical iron depletion therapies, associations between iron-related genetic polymorphisms and diabetes, and etiological mechanisms underlying iron perturbations-impaired insulin secretion and insulin sensitivity were carefully reviewed and discussed. Hereditary hemochromatosis, transfusion-dependent thalassemia, and excess heme iron intake can increase the risk of developing diabetes. Genetically modified mice and mice fed a high-iron diet present with discrepant phenotypes due to differences in tissue iron distribution. Moreover, several genetic polymorphisms related to iron homeostasis have been associated with the risk of developing diabetes. Tightly controlled iron metabolism is essential for insulin secretion and insulin sensitivity, and iron overload in pancreatic islets alters reactive oxygen species (ROS) generation, as well as hypoxia-inducible factor-1α (HIF-1α) stability and adenosine triphosphate (ATP) synthesis, thereby impairing the function and viability of β-cells. Decreased levels of adiponectin, macrophage-mediated inflammation, and ROS-mediated liver kinase B1 (LKB1)/adenosine monophosphate-activated protein kinase (AMPK) activation can contribute to iron overload-induced insulin resistance, whereas iron deficiency could also participate in obesity-related inflammation, hypoxia, and insulin resistance. Because iron homeostasis is closely correlated with many metabolic processes, future studies are needed in order to elucidate the finely tuned network among iron homeostasis, carbohydrate and lipid metabolism, inflammation, and hypoxia.
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Affiliation(s)
- Xinhui Wang
- Department of Nutrition, Research Center for Nutrition and Health, Institute of Nutrition and Food Safety, School of Public Health, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, China
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Cortese S, Angriman M. Attention-deficit/hyperactivity disorder, iron deficiency, and obesity: is there a link? Postgrad Med 2014; 126:155-70. [PMID: 25141253 DOI: 10.3810/pgm.2014.07.2793] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The exact etiopathophysiology of attention-deficit/hyperactivity disorder (ADHD) remains elusive, likely because of its phenotypic heterogeneity. Given the involvement of iron in neurocognitive and behavioral functions, iron deficiency (ID) has been suggested as a possible etiopathophysiological factor in a subsample of individuals with ADHD. Most studies assessing ID in ADHD have focused on serum ferritin, a marker of peripheral iron status. Results from these studies are mixed, and the largest studies failed to find a significant association between ADHD and low serum ferritin levels. However, serum ferritin may be influenced by several conditions, including inflammatory status. Increasing evidence, especially from epidemiological studies, points to a significant association between ADHD and obesity. Interestingly, obesity is associated with a chronic inflammatory status, characterized by ID with normal-to-high serum ferritin levels. This article reviews the literature on iron status in ADHD and on the relationship between ADHD and obesity; discusses a possible link among ADHD, ID, and obesity; and proposes that comorbid obesity contributes to ID, via chronic inflammation, in a subsample of individuals with ADHD. Thus, the comorbidity between ADHD and obesity suggests moving beyond serum ferritin levels and assessing the molecular pathways of chronic inflammation that lead to ID in individuals with ADHD and obesity. In turns, this may pave the way for novel treatment strategies for cognitive and behavioral dysfunctions related to ID in ADHD.
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Affiliation(s)
- Samuele Cortese
- Child Neuropsychiatry Unit, G.B. Rossi Hospital, Department of Life Science and Reproduction, Verona University, Verona, Italy; Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center, New York University Langone Medical Center, New York, NY.
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Gotardo ÉMF, dos Santos AN, Miyashiro RA, Gambero S, Rocha T, Ribeiro ML, Gambero A. Mice that are fed a high-fat diet display increased hepcidin expression in adipose tissue. J Nutr Sci Vitaminol (Tokyo) 2014; 59:454-61. [PMID: 24418880 DOI: 10.3177/jnsv.59.454] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Since the discovery that hepcidin is expressed in the adipose tissue of obese subjects, attention has been increasingly focused on alterations in iron homeostasis that are associated with adiposity. We examined the production of hepcidin, the expression of hepcidin-related genes and the iron content of the adipose tissue in obesity using Swiss mice fed a high-fat diet (HFD). The mice were maintained on a control diet or HFD for 12 or 24 wk, and body weight, adiposity and glucose homeostasis were evaluated. The expression of several genes (hepcidin, TfR1, TfR2, DMT1, FT-heavy, ferroportin, IRP-1, IRP-2 and HIF-1) and the protein expression of hepcidin and IL-6 were quantified. The iron level was assessed using a Prussian blue reaction in paraffin-embedded tissue. After 24 wk on the HFD, we observed increases in the levels of hepcidin in the serum and the visceral adipose tissue. The IL-6 levels also increased in the visceral adipose tissue. Adipocytes isolated from the visceral adipose tissues of lean and obese mice expressed hepcidin at comparable levels; however, isolated macrophages from the stromal vascular fraction expressed higher hepcidin levels. Adipose tissues from obese mice displayed increased tfR2 expression and the presence of iron. Our results indicate that IL-6 and iron may affect the signaling pathways governing hepcidin expression. Thus, the mice fed HFD for 24 wk represent a suitable model for the study of obesity-linked hepcidin alterations. In addition, hepcidin may play local roles in controlling iron availability and interfering with inflammation in adipose tissue.
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Aigner E, Feldman A, Datz C. Obesity as an emerging risk factor for iron deficiency. Nutrients 2014; 6:3587-600. [PMID: 25215659 PMCID: PMC4179177 DOI: 10.3390/nu6093587] [Citation(s) in RCA: 183] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 08/29/2014] [Accepted: 09/03/2014] [Indexed: 12/14/2022] Open
Abstract
Iron homeostasis is affected by obesity and obesity-related insulin resistance in a many-facetted fashion. On one hand, iron deficiency and anemia are frequent findings in subjects with progressed stages of obesity. This phenomenon has been well studied in obese adolescents, women and subjects undergoing bariatric surgery. On the other hand, hyperferritinemia with normal or mildly elevated transferrin saturation is observed in approximately one-third of patients with metabolic syndrome (MetS) or nonalcoholic fatty liver disease (NAFLD). This constellation has been named the “dysmetabolic iron overload syndrome (DIOS)”. Both elevated body iron stores and iron deficiency are detrimental to health and to the course of obesity-related conditions. Iron deficiency and anemia may impair mitochondrial and cellular energy homeostasis and further increase inactivity and fatigue of obese subjects. Obesity-associated inflammation is tightly linked to iron deficiency and involves impaired duodenal iron absorption associated with low expression of duodenal ferroportin (FPN) along with elevated hepcidin concentrations. This review summarizes the current understanding of the dysregulation of iron homeostasis in obesity.
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Affiliation(s)
- Elmar Aigner
- First Department of Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria.
| | - Alexandra Feldman
- First Department of Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria.
| | - Christian Datz
- Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria.
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Demircioğlu F, Görünmez G, Dağıstan E, Göksügür SB, Bekdaş M, Tosun M, Kızıldağ B, Kısmet E. Serum hepcidin levels and iron metabolism in obese children with and without fatty liver: case-control study. Eur J Pediatr 2014; 173:947-51. [PMID: 24500395 DOI: 10.1007/s00431-014-2268-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 01/13/2014] [Accepted: 01/16/2014] [Indexed: 12/27/2022]
Abstract
UNLABELLED Hepcidin is a regulator of iron balance that is increased in obesity. It reduces the absorption of iron, reduces the transfer of iron from macrophages to the plasma and/or prevents mobilisation of stored iron. Obese patients with non-alcoholic fatty liver disease (NAFLD) demonstrate adipokine and cytokine release promoting inflammatory response. We aimed to analyse the hepcidin levels and iron metabolism in obese children with and without NAFLD and non-obese healthy controls. The study population consisted of 110 children aged 7-18 years in three groups: 50 obese patients without NAFLD, 30 obese patients with NAFLD, and 30 non-obese healthy controls. Serum hepcidin, ferritin, and iron levels, iron-binding capacity, lipid profile, and liver function tests were measured, and hepatic ultrasonography was performed in all participants. Obese patients' white blood cell counts, total cholesterol, triglyceride levels, and homeostatic model assessment of insulin resistance (HOMA-IR) were significantly higher than those of the control group. Iron-binding capacity was significantly higher in obese patients without NAFLD compared with obese patients with NAFLD (p = 0.002). Hepcidin levels were not significantly different between obese patients and the control group. However, hepcidin levels in obese patients with NAFLD were significantly higher than those in obese patients without NAFLD (p < 0.001). CONCLUSIONS Hepcidin levels were significantly higher in obese children with NAFLD than those without NAFLD. Obese children with NAFLD should receive attention regarding iron metabolism disorders. Serum hepcidin could be a marker of iron metabolism status and NAFLD in these groups of patients.
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Affiliation(s)
- Fatih Demircioğlu
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Faculty of Medicine, Abant Izzet Baysal University, Gölköy, Bolu, 14280, Turkey,
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Altunoğlu E, Müderrisoğlu C, Erdenen F, Ulgen E, Ar MC. The impact of obesity and insulin resistance on iron and red blood cell parameters: a single center, cross-sectional study. Turk J Haematol 2014; 31:61-7. [PMID: 24764731 PMCID: PMC3996629 DOI: 10.4274/tjh.2012.0187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 05/08/2013] [Indexed: 12/26/2022] Open
Abstract
Objective: Obesity and iron deficiency (ID) are the 2 most common nutritional disorders worldwide causing significant public health implications. Obesity is characterized by the presence of low-grade inflammation, which may lead to a number of diseases including insulin resistance (IR) and type 2 diabetes. Increased levels of acute-phase proteins such as C-reactive protein (CRP) have been reported in obesity-related inflammation. The aim of this study was to investigate the impact of obesity/IR on iron and red blood cell related parameters. Materials and Methods: A total of 206 patients and 45 control subjects of normal weight were included in this cross-sectional study. Venous blood samples were taken from each patient to measure hemoglobin (Hb), serum iron (Fe), iron-binding capacity (IBC), ferritin, CRP, fasting blood glucose, and fasting insulin. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated for each patient. IR was determined using the HOMA-IR formula. Results: Subjects were divided into 3 groups according to BMI. There were 152 severely obese (BMI: 42.6±10.1), 54 mildly obese (BMI: 32.4±2.1), and 45 normal-weight (BMI: 24.3±1.3) patients. Hb levels in severely obese patients and normal controls were 12.8±1.3 g/dL and 13.6±1.8 g/dL, respectively. We found decreasing Fe levels with increasing weight (14.9±6.9 µmol/L, 13.6±6.3 µmol/L, and 10.9±4.6 µmol/L for normal controls and mildly and severely obese patients, respectively). Hb levels were slightly lower in patients with higher HOMA-IR values (13.1±1.5 g/dL vs. 13.2±1.2 g/dL; p=0.36). Serum iron levels were significantly higher in the group with low HOMA-IR values (13.6±5.9 µmol/L vs. 11.6±4.9 µmol/L; p=0.008). IBC was found to be similar in both groups (60.2±11.4 µmol/L vs. 61.9±10.7 µmol/L; p=0.23). Ferritin was slightly higher in patients with higher HOMA-IR values (156.1±209.5 pmol/L vs. 145.3±131.5 pmol/L; p=0.62). Conclusion: Elevated BMI and IR are associated with lower Fe and hemoglobin levels. These findings may be explained by the chronic inflammation of obesity and may contribute to obesity-related co-morbidities. People with IR may present with ID without anemia.
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Affiliation(s)
- Esma Altunoğlu
- İstanbul Training and Research Hospital, Department of Internal Medicine, İstanbul, Turkey
| | - Cüneyt Müderrisoğlu
- İstanbul Training and Research Hospital, Department of Internal Medicine, İstanbul, Turkey
| | - Füsun Erdenen
- İstanbul Training and Research Hospital, Department of Internal Medicine, İstanbul, Turkey
| | - Ender Ulgen
- İstanbul Training and Research Hospital, Department of Internal Medicine, İstanbul, Turkey
| | - M Cem Ar
- Istanbul University, Cerrahpaşa Medical Faculty, Department of Internal Medicine, Division of Haematology, Istanbul, Turkey
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Aderibigbe OR, Pisa PT, Vorster HH, Kruger SH. The Relationship Between Iron Status and Adiposity in Women from Developing Countries: A Review. Crit Rev Food Sci Nutr 2013; 54:553-60. [DOI: 10.1080/10408398.2011.594914] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dao MC, Meydani SN. Iron biology, immunology, aging, and obesity: four fields connected by the small peptide hormone hepcidin. Adv Nutr 2013; 4:602-17. [PMID: 24228190 PMCID: PMC3823507 DOI: 10.3945/an.113.004424] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Iron status and immune response become impaired in situations that involve chronic inflammation, such as obesity or aging. Little is known, however, about the additional burden that obesity may place on the iron status and immune response in the elderly. This question is relevant given the rising numbers of elderly obese (BMI >30 kg/m(2)) individuals and the high prevalence of iron deficiency worldwide. Iron is necessary for proper function of both the innate and adaptive immune system. Hepcidin, a peptide hormone that regulates cellular iron export, is essential for the maintenance of iron homeostasis. Therefore, since immune cells require iron for proper function hepcidin may also play an important role in immune response. In this review, we summarize the evidence for hepcidin as a link between the fields of gerontology, obesity, iron biology, and immunology. We also identify several gaps in knowledge and unanswered questions pertaining to iron homeostasis and immunity in obese populations. Finally, we review studies that have shown the impact of weight loss, focusing on calorie restriction, iron homeostasis, and immunity. These studies are important both in elucidating mechanistic links between obesity and health impairments and identifying possible approaches to target immune impairment and iron deficiency as comorbidities of obesity.
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Affiliation(s)
- Maria Carlota Dao
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Nutrition Immunology Laboratory, Boston, MA
| | - Simin Nikbin Meydani
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Nutrition Immunology Laboratory, Boston, MA
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Budzyń M, Iskra M, Krasiński Z, Dzieciuchowicz Ł, Kasprzak M, Gryszczyńska B. Serum iron concentration and plasma oxidant-antioxidant balance in patients with chronic venous insufficency. Med Sci Monit 2012; 17:CR719-27. [PMID: 22129904 PMCID: PMC3628123 DOI: 10.12659/msm.882132] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The aim of this study was to evaluate serum iron concentration and influence of this element on biomarkers of oxidative stress in patients affected by chronic venous insufficiency (CVI). Material/Methods Serum iron (SI) concentration and plasma parameters of oxidant–antioxidant balance (i.e., malonyldialdehyde [MDA], uric acid [UA] concentration, and total antioxidant capacity [TAC]) were compared between 35 patients divided into appropriate groups and 23 healthy individuals. Results The subgroups analysis showed that SI concentration was significantly higher only in patients with shorter duration of CVI in comparison with the control group (P=0.013). Significant, negative correlation was found between SI concentration and duration of the disease (r=−0.422, P=0.014), age of the patients (r=−0.542, P=0.001) and BMI (r=−0.408, P=0.018). Mean value of MDA concentration and TAC capacity were higher in patients with CVI in comparison with healthy individuals (P<0.05). UA concentration was decreased, especially in CVI patients with mild clinical stage of disease and shorter CVI duration (P=0.047; P=0.034). There was no significant correlation found between SI concentration and the parameters of oxidant–antioxidant balance. Conclusions High concentration of MDA and low UA level in blood of CVI patients suggests that oxidative stress plays an important role in the pathogenesis of the disease. The increase in SI concentration observed in the early stage of CVI can enhance free radicals formation; however, direct evidence has not been provided by the present study.
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Affiliation(s)
- Magdalena Budzyń
- Department of General Chemistry, Chair of Chemistry and Clinical Biochemistry, Poznan University of Medical Sciences, Poznan, Poland
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Tussing-Humphreys L, Pusatcioglu C, Pustacioglu C, Nemeth E, Braunschweig C. Rethinking iron regulation and assessment in iron deficiency, anemia of chronic disease, and obesity: introducing hepcidin. J Acad Nutr Diet 2012; 112:391-400. [PMID: 22717199 PMCID: PMC3381289 DOI: 10.1016/j.jada.2011.08.038] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 06/17/2011] [Indexed: 12/26/2022]
Abstract
Adequate iron availability is essential to human development and overall health. Iron is a key component of oxygen-carrying proteins, has a pivotal role in cellular metabolism, and is essential to cell growth and differentiation. Inadequate dietary iron intake, chronic and acute inflammatory conditions, and obesity are each associated with alterations in iron homeostasis. Tight regulation of iron is necessary because iron is highly toxic and human beings can only excrete small amounts through sweat, skin and enterocyte sloughing, and fecal and menstrual blood loss. Hepcidin, a small peptide hormone produced mainly by the liver, acts as the key regulator of systemic iron homeostasis. Hepcidin controls movement of iron into plasma by regulating the activity of the sole known iron exporter ferroportin-1. Downregulation of the ferroportin-1 exporter results in sequestration of iron within intestinal enterocytes, hepatocytes, and iron-storing macrophages reducing iron bioavailability. Hepcidin expression is increased by higher body iron levels and inflammation and decreased by anemia and hypoxia. Importantly, existing data illustrate that hepcidin may play a significant role in the development of several iron-related disorders, including the anemia of chronic disease and the iron dysregulation observed in obesity. Therefore, the purpose of this article is to discuss iron regulation, with specific emphasis on systemic regulation by hepcidin, and examine the role of hepcidin within several disease states, including iron deficiency, anemia of chronic disease, and obesity. The relationship between obesity and iron depletion and the clinical assessment of iron status will also be reviewed.
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Affiliation(s)
- Lisa Tussing-Humphreys
- US Department of Agriculture/Agricultural Research Service (USDA/ARS), Baton Rouge, LA 70803, USA.
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Cheng HL, Bryant C, Cook R, O'Connor H, Rooney K, Steinbeck K. The relationship between obesity and hypoferraemia in adults: a systematic review. Obes Rev 2012; 13:150-61. [PMID: 21981048 DOI: 10.1111/j.1467-789x.2011.00938.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A growing number of studies suggest a potential link between obesity and altered iron metabolism. The purpose of this systematic review was to examine existing literature on iron status in obese populations. A comprehensive literature search was conducted. Included studies recruited participants ≥ 18 years with a body mass index ≥ 30 kg m(-2) and provided descriptive statistics for haemoglobin or ferritin at a minimum. There were 25 studies meeting all eligibility criteria, of these 10 examined iron status in free-living obese individuals and 15 reported baseline iron biomarkers from bariatric surgery candidates. Non-obese comparison groups were used by 10 (40%) articles. In these, seven obese groups reported higher mean haemoglobin concentration; six reported significantly higher ferritin concentration; and four significantly lower transferrin saturation. Due to insufficient data, it was not possible to make conclusions regarding mean differences for soluble transferrin receptor (sTfR), hepcidin or C-reactive protein. Existing evidence suggests a tendency for higher haemoglobin and ferritin concentration and lower transferrin saturation in obesity. Alternation of iron biomarkers in obese populations may be a result of obesity-related inflammation and/or related comorbidities. Further research incorporating measurement of inflammatory cytokines, sTfR and hepcidin is required to confirm the impact of obesity on iron status.
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Affiliation(s)
- H L Cheng
- Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.
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Sarafidis PA, Rumjon A, MacLaughlin HL, Macdougall IC. Obesity and iron deficiency in chronic kidney disease: the putative role of hepcidin. Nephrol Dial Transplant 2011; 27:50-7. [PMID: 22180541 DOI: 10.1093/ndt/gfr686] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Tussing-Humphreys L, Frayn KN, Smith SR, Westerman M, Dennis AL, Nemeth E, Thomson J, Pusatcioglu C. Subcutaneous adipose tissue from obese and lean adults does not release hepcidin in vivo. ScientificWorldJournal 2011; 11:2197-206. [PMID: 22125467 PMCID: PMC3217603 DOI: 10.1100/2011/634861] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 09/23/2011] [Indexed: 01/04/2023] Open
Abstract
Hepcidin is the main regulator of systemic iron homeostasis and is primarily produced by the liver but is also expressed, at the mRNA-level, in periphery tissues including the subcutaneous and visceral adipose tissue. Obesity is associated with elevated hepcidin concentrations and iron depletion suggesting that the exaggerated fat mass in obesity could contribute significantly to circulating hepcidin levels consequently altering iron homeostasis. The objective of this study was to determine if abdominal subcutaneous adipose tissue (AbScAT) releases hepcidin in vivo and if release is modified by obesity. Arterio-venous differences in concentrations of hepcidin were measured across AbScAT in 9 obese and 9 lean adults. Overall (n = 18), mean plasma hepcidin concentrations were significantly higher in arterialized compared to AbScAT venous samples [mean difference (arterialized-AbScAT venous plasma hepcidin) = 4.9 ± 9.6 ng/mL, P = 0.04]. Net regional release was not calculated because mean venous plasma hepcidin concentrations were lower than mean arterialized concentrations indicating no net release. Significant correlations between AbScAT venous and arterialized plasma hepcidin concentrations with anthropometric variables were not observed. Findings from this vein drainage study suggest there is no net release of hepcidin from the AbScAT depot and thereby no ability to signal systemically, even in obesity.
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Affiliation(s)
- Lisa Tussing-Humphreys
- USDA Agricultural Research Service, Louisiana State University AgCenter, Knapp Hall, Baton Rouge, LA 70803, USA.
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Hintze KJ, Snow D, Nabor D, Timbimboo H. Adipocyte hypoxia increases hepatocyte hepcidin expression. Biol Trace Elem Res 2011; 143:764-71. [PMID: 21181293 DOI: 10.1007/s12011-010-8932-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 12/08/2010] [Indexed: 01/07/2023]
Abstract
Hepcidin plays a key role in regulating iron metabolism by blocking iron efflux from macrophages and enterocytes. Hepcidin is synthesized primarily in the liver, and its expression is increased by iron overload and inflammation. Obesity is associated with chronic inflammation as well as poor iron status. Central obesity causes adipocyte hypoxia resulting in chronic inflammation. Therefore, the objective of the present study was to determine if adipocyte hypoxia and associated inflammation signal hepatocyte hepcidin expression. The effect of adipocyte hypoxia on hepcidin expression was modeled using a 3T3-L1 adipocyte/Huh7 hepatocyte co-culture model. Adipocytes were cultured at either standard conditions (19% O2) or hypoxic conditions (1% O2). Compared to standard conditions, hypoxic 3T3-L1 cells had significantly higher IL-6 and leptin expression. Treatment of Huh7 cells with media from hypoxic or LPS-treated 3T3-L1 adipocytes significantly increased hepcidin promoter activity and mRNA compared to cells treated with normoxic 3T3-L1 media or control media. When the hepcidin STAT3 binding site was mutated, promoter activation by hypoxic media was abrogated. These data suggest that adipocyte hypoxia (a feature of central obesity) may increase hepcidin expression and plays a role in the association between obesity and poor iron status.
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Affiliation(s)
- Korry Joseph Hintze
- Department of Nutrition, Dietetics, & Food Sciences, Utah State University, 8700 Old Main Hill, 750 North 1200 East, Logan, UT 89322-8700, USA.
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Hepcidin: A Critical Regulator of Iron Metabolism during Hypoxia. Adv Hematol 2011; 2011:510304. [PMID: 21912548 PMCID: PMC3170780 DOI: 10.1155/2011/510304] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 07/08/2011] [Indexed: 12/21/2022] Open
Abstract
Iron status affects cognitive and physical performance in humans. Recent evidence indicates that iron balance is a tightly regulated process affected by a series of factors other than diet, to include hypoxia. Hypoxia has profound effects on iron absorption and results in increased iron acquisition and erythropoiesis when humans move from sea level to altitude. The effects of hypoxia on iron balance have been attributed to hepcidin, a central regulator of iron homeostasis. This paper will focus on the molecular mechanisms by which hypoxia affects hepcidin expression, to include a review of the hypoxia inducible factor (HIF)/hypoxia response element (HRE) system, as well as recent evidence indicating that localized adipose hypoxia due to obesity may affect hepcidin signaling and organismal iron metabolism.
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