Causal relationship between obesity and iron deficiency anemia: a two-sample Mendelian randomization study

Impact of Side Effects on Anemia Therapy Compliance

BACKGROUND/OBJECTIVES

Iron deficiency anemia is a prevalent hematological condition globally, with treatment often complicated by adverse effects that compromise patient adherence and clinical outcomes. This study investigated the prevalence, severity, and management of side effects associated with anemia treatments among Romanian patients, aiming to identify key factors influencing treatment adherence and patient satisfaction.

METHODS

A prospective observational cross-sectional study was conducted using a questionnaire distributed to adult patients diagnosed with anemia. Data were collected from 382 participants, covering demographic variables, anemia causes, treatment types, and patient-reported side effects.

RESULTS

Of the participants, 45% reported side effects, with a higher prevalence in intravenous (52%) than oral administration (48%). Common side effects included gastrointestinal symptoms (nausea/vomiting, heartburn, abdominal pain) and systemic symptoms (fatigue, headaches). Our analysis revealed that as the patient age increased, the severity of treatment-related side effects also intensified (p < 0.01), particularly in gastrointestinal discomfort. Similarly, BMI was a significant predictor (p < 0.05), suggesting that metabolic factors play a role in symptom manifestation. Notably, severe side effects were significantly associated with treatment modifications and lower patient satisfaction. Supplements like magnesium and vitamin D3 showed positive effects in mitigating the side effects, whereas probiotics and vitamin C had mixed outcomes.

CONCLUSIONS

The study highlights the significant burden of side effects in anemia treatment, emphasizing the need for personalized management strategies to improve adherence and clinical outcomes.

Breast Cancer and Meningioma Risk: A Mendelian Randomization Study

BACKGROUND

The exact nature of the link between breast cancer and meningiomas is unknown, although observational studies have shown a correlation between the two. Using a two-sample Mendelian randomization (MR) strategy, we aimed to investigate the effect of breast cancer on meningiomas.

METHODS

Three sets of genetic instruments were utilized in this study based on publicly available genetic summary data. For breast cancer, we selected 62 strongly associated SNPs; separate datasets were curated for HER2-positive and HER2-negative subtypes. MR analyses included outlier testing, MR-Egger regression, MR-PRESSO, weighted median, and inverse variance weighted approaches.

RESULTS

The inverse variance weighted analysis demonstrated significant evidence for breast cancer's effect on meningioma risk (OR = 1.213, 95% CI = 1.054-1.396, p = 0.007), supported by MR-Egger (OR = 1.456, 95% CI = 1.066-1.988, p = 0.021) though not by the weighted median method (OR = 1.095, 95% CI = 0.914-1.311, p = 0.326). Inverse variance weighting specifically revealed a significant association between HER2-positive breast cancer and meningioma incidence (OR = 1.203, 95% CI = 1.048-1.381, p = 0.009). Furthermore, breast cancer risk was associated with an increased incidence of malignant meningiomas (OR = 1.64, 95% CI = 1.12-2.40, p = 0.011).

CONCLUSIONS

This represents the first MR study investigating the causal relationship between breast cancer and meningiomas. Our findings support the hypothesis that breast cancer may increase meningioma risk.

Physical Activity and Its Relationship With National-Based Examination Results Among Adolescents

INTRODUCTION

This study investigated the longitudinal relationship between self-reported physical activity and national examination results among adolescents in an upper-middle-income country.

METHODS

This study engaged in a secondary data analysis derived from a closed prospective cohort consisting of 579 students, who were recruited at the age of 13 in 2012 and followed up at ages 15 (2014) and 17 (2016) as part of the Malaysian Health and Adolescents Longitudinal Research Team (MyHeART) study, which was conducted across three states in Peninsula Malaysia. Physical activity levels were evaluated using the Physical Activity Questionnaire, and outcomes were assessed based on the National-Based Examinations at ages 15 (Form 3, Year 9) and 17 (Form 5, Year 11) in Malaysia. A multivariate ordinal regression employing complex sample analysis was applied to ascertain the relationship between physical activity and national examination results.

RESULTS

In Form 3 (Year 9), those physically active performed better in Malay Language, English Language, Mathematics and Science. Those physically active in Form 5 (Year 11), performed better in Modern Mathematics, Chemistry, and Principles of Accounting. Longitudinally, there was an increase in the overall percentage of those who were overweight and obese and an increase in those with suboptimal dietary and iron intake.

CONCLUSIONS

This study has shown that those physically active students fared better in several subjects in the national-based examinations. Suitable physical activity intervention should be tailored accordingly to support adolescents' optimum achievement in academia.

Association of life's essential 8 and inflammatory biomarkers with nutritional anemia in UK adults

Several modifiable health factors in Life's Essential 8 (LE8) are linked to nutritional anemia and can assess overall cardiovascular health (CVH). This study explored the associations of CVH measured by LE8 score with nutritional anemia and iron deficiency anemia (IDA), including the mediating role of inflammatory biomarkers. This prospective cohort study included 181,069 participants from UK Biobank. CVH was categorized into low (0-49), medium (50-79), and high (80-100) based on the LE8 score. Weibull regression models were used to quantify the association between CVH and nutritional anemia and IDA. During a median follow-up of 8.6 years, 6749 cases of nutritional anemia occurred, including 92% (6223/6749) IDA cases. After adjusting for covariates, participants with moderate CVH and high CVH had a 44% and 54% lower risk of nutritional anemia (Moderate: hazard ratio [HR] 0.56; 95% confidence interval [CI], 0.51-0.60; High: HR 0.46; 95% CI, 0.41-0.51), and a 46% and 54% lower risk of IDA (Moderate: HR 0.54; 95% CI, 0.50-0.59; High: HR 0.46; 95% CI, 0.41-0.51), respectively, compared to those with low CVH. An L-shaped association was observed between CVH score and both types of anemia. Inflammatory biomarkers explained 22.1% and 21.6% of the associations between CVH and nutritional anemia and IDA, respectively. Higher CVH scores were associated with lower risk of nutritional anemia and IDA, and these associations may be partially mediated by inflammatory biomarkers. These findings emphasize the importance of CVH and inflammation in preventing nutritional anemia.

The Prevalence and Characteristics of Anemia in Romanian Patients with Type 2 Diabetes: A Cross-Sectional Study

Background/Objectives: Anemia is a prevalent comorbidity of diabetes, and although various mechanisms have been shown to link these two conditions, their interaction has not been sufficiently explored. Our cross-sectional, non-interventional study aimed to evaluate the prevalence of anemia and its subtypes, as well as their interactions, in patients with type 2 diabetes (T2D). Methods: A total of 227 patients previously diagnosed with T2D were enrolled. These patients were assessed regarding their medical history and the evolution of their diabetes, and were screened for anemia. Results: Anemia was encountered in 32.6% of the 227 hospitalized patients previously diagnosed with T2D enrolled in this study. Its presence was associated with a higher prevalence of complications and comorbidities, such as chronic kidney disease (CKD), retinopathy, and atrial fibrillation. The most common types of anemia observed were those associated with CKD, other chronic conditions, and iron deficiency. A moderate, positive correlation (r = 0.307; p < 0.0001) has been observed between estimated glomerular filtration rate (eGFR) and hemoglobin, and a moderate, negative correlation has been observed between age and hemoglobin (r = -0.351; p < 0.0001), with the results also analyzed using multiple regression and ROC curve analysis. Additionally, a weak, positive, yet statistically significant correlation was observed between glycemic values and hemoglobin levels, which requires further research. Conclusions: Anemia is frequently encountered in patients with T2D, especially in those with increased age, decreased eGFR, and additional chronic degenerative complications or other comorbidities; thus, a systematic screening for an early diagnosis and interdisciplinary management is recommended for improved outcomes related to morbidity, mortality, and quality of life.

The application of sphingomyelin in mediating the causal role of the T-cell surface glycoprotein CD5 in Crohn's disease: A two-step Mendelian randomization study

To examine the possible causative association between Crohn disease (CD) and the T-cell surface glycoprotein CD5 and to ascertain whether sphingomyelin (SM) functions as a mediator. We conducted a two-step Mendelian randomization (MR) study to further explore the pathogenesis of Crohn and its related targets. MR study was performed on CD5 and CD using summary-level data from a genome-wide association study. Additionally, by employing a two-step MR study method, we determined that SM might mediate the causal effect of CD5 on CD. There was a favorable correlation between the surface glycoprotein CD5 on T cells and vulnerability to CD, and SM mediated the causal effect of CD5 on CD (the mediating effect accounts for 9.2%). Our study revealed that CD5 and CD are causally related, with SM mediating a small fraction of the impact (approximately 9.2%). The mediating function of SM in the link between CD5 and CD is anticipated to be realized through the regulation of immune cell transportation, apoptosis of intestinal barrier cells, and maintenance of the intestinal microenvironment.

Preoperative Laboratory Values Predicting Periprosthetic Joint Infection in Morbidly Obese Patients Undergoing Total Hip or Knee Arthroplasty

BACKGROUND

Morbidly obese patients are an ever-growing high-risk population undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) for end-stage osteoarthritis. This study sought to identify preoperative laboratory values that may serve as predictors of periprosthetic joint infection (PJI) in morbidly obese patients undergoing THA or TKA.

METHODS

All morbidly obese patients with preoperative laboratory data before undergoing primary elective TKA or THA were identified using the Premier Healthcare Database. Patients who developed PJI within 90 days after surgery were compared with patients without PJI. Laboratory value thresholds were defined by clinical guidelines or primary literature. Univariate and multivariable regression analyses were utilized to assess the association between PJI and preoperative laboratory values, including total lymphocyte count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), albumin level, platelet count, albumin-globulin ratio, hemoglobin level, and hemoglobin A1c.

RESULTS

Of the 6,780 patients identified (TKA: 76.67%; THA: 23.33%), 47 (0.69%) developed PJI within 90 days after surgery. The rate of PJI was 1.69% for patients with a hemoglobin level of <12 g/dL (for females) or <13 g/dL (for males), 2.14% for those with a platelet count of <142,000/µL or >417,000/µL, 1.11% for those with an NLR of >3.31, 1.69% for those with a PLR of >182.3, and 1.05% for those with an SII of >776.2. After accounting for potential confounding factors, we observed an association between PJI and an abnormal preoperative NLR (adjusted odds ratio [aOR]: 2.38, 95% confidence interval [CI]: 1.04 to 5.44, p = 0.039), PLR (aOR: 4.86, 95% CI: 2.15 to 10.95, p < 0.001), SII (aOR: 2.44, 95% CI: 1.09 to 5.44, p = 0.029), platelet count (aOR: 3.50, 95% CI: 1.11 to 10.99, p = 0.032), and hemoglobin level (aOR: 2.62, 95% CI: 1.06 to 6.50, p = 0.038).

CONCLUSIONS

This study identified preoperative anemia, abnormal platelet count, and elevated NLR, PLR, and SII to be associated with an increased risk of PJI among patients with a body mass index of ≥40 kg/m 2 . These findings may help surgeons risk-stratify this high-risk patient population.

LEVEL OF EVIDENCE

Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Assessing causal associations of bile acids with obesity indicators: A Mendelian randomization study

Maintaining a balanced bile acids (BAs) metabolism is essential for lipid and cholesterol metabolism, as well as fat intake and absorption. The development of obesity may be intricately linked to BAs and their conjugated compounds. Our study aims to assess how BAs influence the obesity indicators by Mendelian randomization (MR) analysis. Instrumental variables of 5 BAs were obtained from public genome-wide association study databases, and 8 genome-wide association studies related to obesity indicators were used as outcomes. Causal inference analysis utilized inverse-variance weighted (IVW), weighted median, and MR-Egger methods. Sensitivity analysis involved MR-PRESSO and leave-one-out techniques to detect pleiotropy and outliers. Horizontal pleiotropy and heterogeneity were assessed using the MR-Egger intercept and Cochran Q statistic, respectively. The IVW analysis revealed an odds ratio of 0.94 (95% confidence interval: 0.88, 1.00; P = .05) for the association between glycolithocholate (GLCA) and obesity, indicating a marginal negative causal association. Consistent direction of the estimates obtained from the weighted median and MR-Egger methods was observed in the analysis of the association between GLCA and obesity. Furthermore, the IVW analysis demonstrated a suggestive association between GLCA and trunk fat percentage, with a beta value of -0.014 (95% confidence interval: -0.027, -0.0004; P = .04). Our findings suggest a potential negative causal relationship between GLCA and both obesity and trunk fat percentage, although no association survived corrections for multiple comparisons. These results indicate a trend towards a possible association between BAs and obesity, emphasizing the need for future studies.

Prevalence of Overweight/Obesity Associated With Anemia Among Female Medical Students at Umm Al-Qura University in Makkah, Saudi Arabia: A Cross-Sectional Study

Introduction The obesity epidemic has been linked to a wide range of health and nutritional problems, including anemia, which is often caused by impaired iron metabolism. The World Health Organization considers anemia and obesity to be global health issues among adolescent girls and women experiencing menstruation. This study aims to examine the association between iron deficiency anemia and obesity/overweight among female medical students. Methodology This cross-sectional descriptive study conducted as an online self-administered questionnaire. Furthermore, blood samples were collected from 206 students to evaluate the complete blood count, iron and lipid profile. Results The convenience sampling technique was used and a total of 206 students were enrolled in the study. The average body mass index (BMI) was 22.51 ± 3.25, with 83.5% (n = 172) falling within the normal weight range, 12.6% (n = 26) as overweight, and 3.9% (n = 8) as obese. Anemia was present in 16.0% (n = 33) of the participants overall. Higher prevalence of anemia was observed among overweight participants with 10 out of 26 (38.5%) subjects compared to obese with two out of eight (25.0%) and normal weight 21 out of 172 (12.2%); this difference was highly significant (P = 0.005). Individuals with anemia exhibited a significant association with those experiencing a diet full of unhealthy fats and carbohydrates (P = 0.05) and a diet containing all essential nutrients (P = 0.01). There is no statistically significant correlation between anemia prevalence and participants' response to the presence of signs of anemia, physical activity or other dietary habits. Obese participants had a significantly higher mean value of triglycerides (129.5 ± 20.5) compared to normal weight and overweight participants (74.5 ± 12.02 and 51.2 ± 15.04), respectively (P = 0.001). Conclusion A dependable assembly exists between obesity and overweight in cases of iron deficient anemia. The prevalence of iron deficiency anemia was substantially higher among overweight/obese females, highlighting that overweight/obesity signifies both quantitative and qualitative malnutrition. A high BMI was associated with elevated triglycerides, typically considered indicators of obesity. This association may suggest compromised iron homeostasis.