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Navidifar T, Meftah E, Baghsheikhi H, Kazemzadeh K, Karimi H, Rezaei N. Dual role of hepcidin in response to pathogens. Microb Pathog 2025; 203:107496. [PMID: 40118299 DOI: 10.1016/j.micpath.2025.107496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 03/15/2025] [Accepted: 03/19/2025] [Indexed: 03/23/2025]
Abstract
Hepcidin is the primary regulator of vertebrate iron homeostasis. Its production is stimulated by systemic iron levels and inflammatory signals. Although the role of hepcidin in iron homeostasis is well characterized, its response to pathogenic agents is complex and diverse. In this review, we examine studies that investigate the role of hepcidin in response to infectious agents. Interleukin-6 (IL-6) is a key factor responsible for the induction of hepcidin expression. During infection, hepcidin-mediated depletion of extracellular iron serves as a protective mechanism against a variety of pathogens. However, accumulation of iron in macrophages through hepcidin-mediated pathways may increase susceptibility to intracellular pathogens such as Mycobacterium tuberculosis. Prolonged elevation of hepcidin production can lead to anemia due to reduced iron availability for erythropoiesis, a condition referred to as anemia of inflammation. In addition, we highlight the role of hepcidin upregulation in several infectious contexts, including HIV-associated anemia, iron deficiency anemia in Helicobacter pylori infection, and post-malarial anemia in pediatric patients. In addition, we show that certain infectious agents, such as hepatitis C virus (HCV), can suppress hepcidin production during both the acute and chronic phases of infection, while hepatitis B virus (HBV) exhibits similar suppression during the chronic phase.
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Affiliation(s)
- Tahereh Navidifar
- Department of Basic Sciences, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran; Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Elahe Meftah
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hediyeh Baghsheikhi
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran; USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kimia Kazemzadeh
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanie Karimi
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Science, Tehran, Iran.
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Lupu A, Mihai CM, Dragan F, Tarnita I, Alecsa M, Chisnoiu T, Morariu ID, Cuciureanu M, Nedelcu AH, Salaru DL, Anton E, Danielescu C, Fotea S, Stoleriu G, Beser OF, Lupu VV. Antioxidant Supplementation in Childhood Obesity: A Path to Improved Metabolic Health? Antioxidants (Basel) 2025; 14:466. [PMID: 40298814 PMCID: PMC12024302 DOI: 10.3390/antiox14040466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2025] [Revised: 04/09/2025] [Accepted: 04/10/2025] [Indexed: 04/30/2025] Open
Abstract
Childhood obesity is linked to heightened oxidative stress, a key driver of endothelial dysfunction, inflammation, and metabolic complications. Antioxidants, including Vitamins C and E, are vital in neutralizing free radicals and mitigating oxidative damage. This non-systematic review examines the potential advantages of antioxidant supplementation in pediatric obesity, focusing on its effects on vascular health, insulin sensitivity, and inflammatory processes. Emerging data suggest that antioxidants may improve endothelial function, reduce blood pressure, and enhance metabolic homeostasis in obese children. However, the long-term efficacy and safety of antioxidant supplementation remain uncertain, necessitating further rigorous randomized controlled trials. A deeper understanding of antioxidants' role in pediatric obesity could unlock novel therapeutic approaches for managing obesity-related complications and improving children's overall health outcomes.
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Affiliation(s)
- Ancuta Lupu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.L.); (M.A.); (V.V.L.)
| | - Cristina Maria Mihai
- Pediatrics, Faculty of Medicine, “Ovidius” University, 900470 Constanta, Romania; (C.M.M.); (T.C.)
| | - Felicia Dragan
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Irina Tarnita
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.L.); (M.A.); (V.V.L.)
| | - Mirabela Alecsa
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.L.); (M.A.); (V.V.L.)
| | - Tatiana Chisnoiu
- Pediatrics, Faculty of Medicine, “Ovidius” University, 900470 Constanta, Romania; (C.M.M.); (T.C.)
| | - Ionela Daniela Morariu
- Faculty of Pharmacy, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Magdalena Cuciureanu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.); (A.H.N.); (D.L.S.); (E.A.); (C.D.)
| | - Alin Horatiu Nedelcu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.); (A.H.N.); (D.L.S.); (E.A.); (C.D.)
| | - Delia Lidia Salaru
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.); (A.H.N.); (D.L.S.); (E.A.); (C.D.)
| | - Emil Anton
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.); (A.H.N.); (D.L.S.); (E.A.); (C.D.)
| | - Ciprian Danielescu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.); (A.H.N.); (D.L.S.); (E.A.); (C.D.)
| | - Silvia Fotea
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania; (S.F.); (G.S.)
| | - Gabriela Stoleriu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania; (S.F.); (G.S.)
| | - Omer Faruk Beser
- Department of Pediatric Gastroenterology, Hepatology & Nutrition, Cerrahpasa Medical Faculty, Istanbul University Cerrahpasa, 34776 Istanbul, Turkey;
| | - Vasile Valeriu Lupu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.L.); (M.A.); (V.V.L.)
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Bonofiglio D. Effects of Mediterranean Diet on Chronic Degenerative Diseases and Human Healthy Lifestyle. Nutrients 2025; 17:1231. [PMID: 40218989 PMCID: PMC11990738 DOI: 10.3390/nu17071231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2025] [Accepted: 03/25/2025] [Indexed: 04/14/2025] Open
Abstract
Noncommunicable diseases (NCDs), known as chronic diseases, including diabetes mellitus, obesity, cardiovascular diseases, chronic kidney disease, neurodegenerative diseases, and cancers, represent an important public concern, leading to prolonged disability and death [...].
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Affiliation(s)
- Daniela Bonofiglio
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Cosenza, Italy; ; Tel.: +39-0984-496208
- Centro Sanitario, University of Calabria, 87036 Rende, Cosenza, Italy
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Parani MSN, Patalen CF, Sumangue CD, Duante CA, Angeles-Agdeppa I. Prevalence and Factors Associated With Intra-Individual Double Burden of Malnutrition Among Filipino Women of Reproductive Age. Asia Pac J Public Health 2025; 37:237-246. [PMID: 39718000 DOI: 10.1177/10105395241306481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2024]
Abstract
In the Philippines, the co-occurrence of two or more types of malnutrition in an individual, also known as intra-individual double burden of malnutrition (DBM), has rarely been investigated. This study aimed to determine the prevalence and the factors associated with DBM at the individual level among Filipino women of reproductive age (WRA) using the data collected from the 2018 Philippine Expanded National Nutrition Survey. For this study, intra-individual DBM was defined as the co-existence of overweight or obesity and anemia in an individual. Analysis showed that a significantly high prevalence of intra-individual DBM was found among WRA aged 40 to 49 years old, widowed, and those with a waist circumference of ≥80 cm. Furthermore, a waist circumference of ≥80 cm was highly associated with the likelihood of having intra-individual DBM among this age group. On the contrary, being single had a significantly lower risk of having this condition.
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Affiliation(s)
- Maria Stephanie N Parani
- Department of Science and Technology, Food and Nutrition Research Institute, DOST Compound, Taguig City, Metro Manila, Philippines
| | - Chona F Patalen
- Department of Science and Technology, Food and Nutrition Research Institute, DOST Compound, Taguig City, Metro Manila, Philippines
| | - Cheder D Sumangue
- Department of Science and Technology, Food and Nutrition Research Institute, DOST Compound, Taguig City, Metro Manila, Philippines
| | - Charmaine A Duante
- Department of Science and Technology, Food and Nutrition Research Institute, DOST Compound, Taguig City, Metro Manila, Philippines
| | - Imelda Angeles-Agdeppa
- Department of Science and Technology, Food and Nutrition Research Institute, DOST Compound, Taguig City, Metro Manila, Philippines
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Broekaert IJ, Assa A, Borrelli O, Saccomani MD, Homan M, Martin‐de‐Carpi J, Mas E, Miele E, Misak Z, Sila S, Thomson M, Tzivinikos C, Dolinsek J. Approach to anaemia in gastrointestinal disease: A position paper by the ESPGHAN Gastroenterology Committee. J Pediatr Gastroenterol Nutr 2025; 80:510-532. [PMID: 39783775 PMCID: PMC11874238 DOI: 10.1002/jpn3.12454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 10/31/2024] [Accepted: 12/10/2024] [Indexed: 01/12/2025]
Abstract
Anaemia is a frequent consequence of many gastrointestinal (GI) diseases in children and it can even be the initial presenting symptom of underlying chronic GI disease. The definition of anaemia is age and gender-dependent and it can be classified based on pathophysiology, red cell morphology, and clinical presentation. Although nutritional deficiencies, including GI malabsorption of nutrients and GI bleeding, play a major role, other pathophysiologic mechanisms seen in chronic GI diseases, whether inflammatory (e.g., inflammatory bowel disease) or not (e.g., coeliac disease and dysmotility), are causing anaemia. Drugs, such as proton pump inhibitors, mesalamine, methotrexate and sulfasalazine, are also a potential cause of anaemia. Not uncommonly, due to a combination of factors, such as iron deficiency and a chronic inflammatory state, the underlying pathophysiology may be difficult to decipher and a broad diagnostic work-up is required. The goal of treatment is correction of anaemia by supplementation of iron and vitamins. The first therapeutic step is to treat the underlying cause of anaemia including bleeding control, restoration of intestinal integrity and reduction of inflammatory burden. The route of iron and vitamin supplementation is guided by the severity of anaemia.
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Affiliation(s)
- Ilse Julia Broekaert
- Department of Paediatrics, Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
| | - Amit Assa
- The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical CentreThe Hebrew UniversityJerusalemIsrael
| | - Osvaldo Borrelli
- Division of Neurogastroenterology & Motility, Department of Paediatric GastroenterologyGreat Ormond Street HospitalLondonUK
| | | | - Matjaž Homan
- Department of Gastroenterology, Hepatology and Nutrition, University Children's HospitalFaculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Javier Martin‐de‐Carpi
- Department of Paediatric Gastroenterology, Hepatology and NutritionHospital Sant Joan de DéuBarcelonaSpain
| | - Emmanuel Mas
- Service de Gastroentérologie, Hépatologie, Nutrition et Maladies Héréditaires du Métabolisme, Hôpital des Enfants, and IRSDUniversité de Toulouse, INSERM, INRAE, ENVT, UPSToulouseFrance
| | - Erasmo Miele
- Department of Translational Medical Science, Section of PediatricsUniversity of Naples “Federico II”NaplesItaly
| | - Zrinjka Misak
- Referral Centre for Paediatric Gastroenterology and NutritionChildren's Hospital ZagrebZagrebCroatia
| | - Sara Sila
- Referral Centre for Paediatric Gastroenterology and NutritionChildren's Hospital ZagrebZagrebCroatia
| | - Mike Thomson
- Centre for Paediatric GastroenterologySheffield Children's Hospital NHS Foundation TrustSheffieldUK
| | - Christos Tzivinikos
- Paediatric Gastroenterology Department, Al Jalila Children's Specialty HospitalMohammed Bin Rashid University, Dubai Medical CollegeDubaiUnited Arab Emirates
| | - Jernej Dolinsek
- Department of PaediatricsUniversity Medical Centre MariborMariborSlovenia
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Gong L, Mai Y, Wu Z, Luo J, Wen G. Associations between iron status and diabetic kidney disease: A nationwide study. Nutr Metab Cardiovasc Dis 2025:103907. [PMID: 40087039 DOI: 10.1016/j.numecd.2025.103907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 01/01/2025] [Accepted: 02/05/2025] [Indexed: 03/16/2025]
Abstract
BACKGROUND AND AIM Iron status plays a crucial role in various physiological processes, and its dysregulation is associated with numerous health conditions. However, research on the relationship between iron status and diabetic kidney disease (DKD) is quite limited. Therefore, this study aims to investigate the connection between iron status and DKD. METHODS AND RESULTS This population-based cross-sectional survey included adult diabetes patients from five National Health and Nutrition Examination Survey (NHANES) cycles spanning 1999 to 2006 and 2017 to 2018. Regression models were used to assess the impact of iron status on the prevalence of diabetic nephropathy. Restricted cubic spline models further explored potential nonlinear dose-response relationships. Subgroup analyses clarified the effects of other covariates on these associations. Iron and TIBC were negatively correlated with DKD, albuminuria, and low estimated glomerular filtration rate (eGFR). TSAT was negatively correlated with DKD and showed an "L"-shaped nonlinear correlation with albuminuria and low-eGFR. Ferritin exhibited a "J"-shaped nonlinear correlation with DKD, albuminuria, and low-eGFR. Subgroup analysis revealed that the association between TIBC and reduced risk of low eGFR was more pronounced in individuals with hypertension. The associations between iron and TSAT with a reduced risk of DKD were more significant in smokers, while the association between ferritin and an increased risk of albuminuria was also more pronounced in smokers. CONCLUSIONS In diabetic patients, iron status is closely associated with DKD. Monitoring these iron status markers can help improve the prevention and management of kidney health in diabetic patients.
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Affiliation(s)
- Liya Gong
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yanpei Mai
- School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Ziqi Wu
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jingwen Luo
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Ge Wen
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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Song J, Wang H, Gao X, Yang F, Zhu X, Qiao G, Gan T, Tao J. The serum hepcidin and the hepcidin/ferritin ratio in NAFLD: a systematic review and meta-analysis. BMC Gastroenterol 2025; 25:62. [PMID: 39915727 PMCID: PMC11804044 DOI: 10.1186/s12876-025-03620-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 01/15/2025] [Indexed: 02/09/2025] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a spectrum of chronic liver diseases characterized by hepatic steatosis exceeding 5% in the absence of alcohol and other liver-damaging factors. Clinical studies have identified a potential link between abnormal iron metabolism and the high incidence of NAFLD; however, the results from clinical trials remain inconsistent. This meta-analysis aims to compare serum hepcidin levels and the hepcidin/ferritin ratio between adults with NAFLD and those without to explore their potential relationship with NAFLD. METHODS A systematic search was conducted across the Web of Science platform, Cochrane, Scopus, Embase, and PubMed databases from their inception until December 18, 2024. The analysis primarily focused on serum hepcidin levels and the hepcidin/ferritin ratio. Observational studies comparing serum hepcidin levels and the hepcidin/ferritin ratio between individuals with NAFLD and control groups were included. A random-effects model was employed to calculate effect estimates, and outcomes were reported as standardized mean differences (SMD) with 95% confidence intervals (95% CI). RESULTS Following the systematic review, a total of 19 studies, comprising 2216 patients and 2125 controls, were included. The findings revealed a statistically significant difference in both hepcidin levels (SMD = 1.03, 95% CI: 0.49 to 1.56, p < 0.001) and the hepcidin/ferritin ratio (SMD = -1.13, 95% CI: -1.79 to -0.46, p < 0.001) between NAFLD and controls. Significant heterogeneity was observed across studies for both hepcidin (I² = 98.2%) and the hepcidin/ferritin ratio (I² = 93.3%), and the limited number of studies on hepcidin/ferritin were acknowledged as key limitations. Subgroup analysis revealed that patients with obesity exhibited higher levels of hepcidin (SMD = 1.12, 95% CI: 0.40 to 1.97) than overweight (SMD = 0.88, 95% CI: 0.05 to 1.72). Meta-regression analysis identified the hepcidin measurement method (p < 0.01), male-to-female ratio (p < 0.01), and study quality (p < 0.01) as significant moderators of the observed heterogeneity. CONCLUSION This meta-analysis revealed a significant association between hepcidin levels, the hepcidin/ferritin ratio and NAFLD in adults. Further investigations are needed to fully elucidate the role of these variables in iron metabolism and their potential impact on the diagnosis, prevention, and management of NAFLD.
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Affiliation(s)
- Jingmin Song
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, 430065, China
| | - Heqing Wang
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, 430065, China
| | - Xiaolian Gao
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, 430065, China.
- Hubei Shizhen Laboratory, Wuhan, 430065, China.
| | - Fen Yang
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, 430065, China
- Hubei Shizhen Laboratory, Wuhan, 430065, China
| | - Xinhong Zhu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, 430065, China
- Hubei Shizhen Laboratory, Wuhan, 430065, China
| | - Guiyuan Qiao
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, 430065, China
- Hubei Shizhen Laboratory, Wuhan, 430065, China
| | - Ting Gan
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, 430065, China
- Hubei Shizhen Laboratory, Wuhan, 430065, China
| | - Junxiu Tao
- Hepatic Disease Institute, Hubei Key Laboratory of Theoretical and Applied Research of Liver and Kidney in Traditional Chinese Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, 430061, China.
- Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, 430074, China.
- Hubei Province Academy of Traditional Chinese Medicine, Wuhan, 430074, China.
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Rachmah Q, Mondal P, Phung H, Ahmed F. Association between overweight/obesity and iron deficiency anaemia among women of reproductive age: a systematic review. Public Health Nutr 2024; 27:e176. [PMID: 39324337 PMCID: PMC11504706 DOI: 10.1017/s1368980024001794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 05/08/2024] [Accepted: 06/04/2024] [Indexed: 09/27/2024]
Abstract
OBJECTIVE Numerous studies have examined the relationship between overweight/obesity and iron deficiency anaemia (IDA) across diverse population groups, but a definitive link has not been clearly determined. This systematic review examined the association between overweight/obesity and IDA in women of reproductive age (WRA). DESIGN The initial search was performed in the CINAHL, Embase, MEDLINE, SCOPUS and Web of Science databases. The studies included should report at least one Fe status with/without an inflammatory marker, using the BMI to define overweight/obesity. Only baseline data were extracted for longitudinal studies. SETTING Global. PARTICIPANT Pregnant or non-pregnant women aged 18-50 years. RESULTS In total, twenty-seven papers were included (twelve addressing pregnant women and fifteen addressing non-pregnant women). Overall, most of the studies reported no association between overweight/obesity and Hb concentration. However, a positive association was reported more frequently in pregnant women. The association between overweight/obesity and serum ferritin concentrations was mixed. Most of the studies on non-pregnant women reported a positive association. Only a few studies measured hepcidin and inflammatory markers, and the majority revealed an increased level among overweight/obese WRA. Among pregnant women, overweight/obesity was positively associated with anaemia and IDA but negatively associated with iron deficiency (ID). Meanwhile, overweight/obese non-pregnant women were positively associated with anaemia, ID and IDA. CONCLUSIONS Overweight/obesity was associated with a decreased prevalence of anaemia and IDA but an increased prevalence of ID, while its association with several Fe markers was inconclusive. Further studies integrating the assessment of various Fe markers, inflammatory markers and hepcidin are needed.
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Affiliation(s)
- Qonita Rachmah
- Public Health, School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Prasenjit Mondal
- Public Health, School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Hai Phung
- Public Health, School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Faruk Ahmed
- Public Health, School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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Mahar B, Shah T, Shaikh K, Shaikh SN, Uqaili AA, Memon KN, Warsi J, Mangi R, Aliyu S, Abbas Q, Shaikh F. Uncovering the hidden health burden: a systematic review and meta-analysis of iron deficiency anemia among adolescents, and pregnant women in Pakistan. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:149. [PMID: 39289759 PMCID: PMC11409484 DOI: 10.1186/s41043-024-00643-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/10/2024] [Indexed: 09/19/2024]
Abstract
INTRODUCTION Iron deficiency anemia (IDA) is the most prevalent diet-related disorder and mainly affects women and children. To determine the trend of anemia incidence in Pakistan, a current review was carried out. This review aimed to estimate the prevalence of anemia among pregnant women and adult/adolescent nonpregnant women in Pakistan and to provide a 15-year trend analysis. MATERIALS AND METHODS Studies were identified by searching PubMed, Google Scholar, Scopus, and Science Direct, complementing this digital exploration, and a manual review of reference lists from previously published prevalence studies was performed to enhance the scope of relevant articles. A total of twenty-seven population-based anemia studies on adolescent/adult females and pregnant women published in Pakistan from January 1st-2007 until December 2021 were included. Systematic data extraction was facilitated through the implementation of a standardized and rigorously pretested data extraction checklist. For the subsequent analysis, the sophisticated capabilities of R statistical software were harnessed. The I2 test was used to assess heterogeneity among studies, and the pooled prevalence of anemia was calculated. RESULTS The final analysis included 27 research articles as well as two extensive National Nutrition survey reports, NNS 2011 and NNS 2018. The forest plot of sixteen studies on pregnant women revealed that the overall pooled prevalence of anemia among pregnant females in Pakistan was 70.4% (95% CI: 0.619, 0.789), and the forest plot of eleven studies on non-pregnant adolescent and adult females reported the pooled prevalence was 54.6% (95% CI: 0.422, 0.669). Subgroup analysis among pregnant women based on region, trimester and socioeconomic status revealed that the highest anemia incidence was observed in Punjab (77.4%). Similarly, females in the second trimester reported a higher prevalence of anemia 78% (95% CI, 0.556 1.015), and the status-wise group with a mixed background reported a higher prevalence 72.8% (95% CI, 0.620 0.835). According to the subgroup analysis, eleven studies of adult nonpregnant groups of mixed socioeconomic status reported a higher prevalence of 56.9% (95% CI, 0.292 0.845). CONCLUSION In Pakistan, anemia, is widespread among pregnant women and nonpregnant adolescent/adult females. A deeper understanding of anemia in Pakistani women is necessary for targeted interventions and policy decisions to predict demographic shifts.
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Affiliation(s)
- Benazir Mahar
- Department of Community Health, University Putra Malaysia, Serdang, Selangor, Malaysia.
| | - Tazeen Shah
- Department of Physiology, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, Sindh, Pakistan
| | - Khalida Shaikh
- Department of Physiology, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, Sindh, Pakistan
| | - Saima Naz Shaikh
- Department of Physiology, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, Sindh, Pakistan
| | - Arsalan Ahmed Uqaili
- Department of Physiology, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, Sindh, Pakistan
| | - Khalida Naz Memon
- Department of Community Medicine, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, Sindh, Pakistan
| | - Jamshed Warsi
- Department of Physiology, University of Sindh, Jamshoro, Pakistan
| | - Rozina Mangi
- Department of Physiology, Bilawal Medical College, Jamshoro, Sindh, Pakistan
| | - Sani Aliyu
- Department of Microbiology, Faculty of Natural and Applied Science, Umaru Musa Yar'adua University, Katsina, Nigeria
| | - Qamar Abbas
- Department of Biology, College of Science University of Bahrain, Manama, Bahrain
| | - Farheen Shaikh
- Department of Biochemistry, Peoples University of Medical and Health Sciences for Women Nawab Shah-Shaheed Benazir Abad, Nawabshah, Sindh, Pakistan
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Ciulei MA, Gallagher K, Ba DM, Beck C, Pobee RA, Gernand AD, Walker RE. Iron status and anemia in a representative sample of US pregnant women is not associated with pre-pregnancy BMI: Results from the NHANES (1999-2010) study. PLoS One 2024; 19:e0300912. [PMID: 39255312 PMCID: PMC11386453 DOI: 10.1371/journal.pone.0300912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/23/2024] [Indexed: 09/12/2024] Open
Abstract
Iron deficiency in pregnancy is related to many poor health outcomes, including anemia and low birth weight. A small number of previous studies have identified maternal body mass index (BMI) as a potential risk factor for poor iron status. Our objective was to examine the association between pre-pregnancy BMI, iron status, and anemia in a nationally representative sample of US adult women. We used data from the National Health and Nutrition Examination Survey (NHANES; 1999-2010) for pregnant women ages 18-49 years (n = 1156). BMI (kg/m2) was calculated using pre-pregnancy weight (self-reported) and height (measured at examination). Iron deficiency (ID) was defined as total body iron (calculated from serum ferritin and transferrin receptor using Cook's equation) < 0 mg/kg and anemia as hemoglobin < 11 g/dL. Associations were examined using weighted linear and Poisson regression models, adjusted for confounders (age, race/ethnicity, education, and trimester). Approximately 14% of pregnant women had ID and 8% had anemia in this sample. Ferritin and total body iron trended slightly lower (p = 0.12, p = 0.14) in women with pre-pregnancy BMI in the normal and overweight categories compared to the underweight and obese categories; hemoglobin concentrations were similar across BMI groups (p = 0.76). There were no differences in the prevalence of ID or anemia in women with pre-pregnancy overweight and obesity (ID: overweight, adjusted prevalence ratio (PR) = 1.27, 95%CI: 0.89-1.82; obesity, PR = 0.75, 95%CI: 0.39-1.45; anemia: overweight, PR = 1.08, 95%CI: 0.53-2.19; obesity, PR = 0.99, 95%CI: 0.49-2.01) compared to women with a normal BMI. Findings from these US nationally representative data indicate that total body iron, serum hemoglobin, ID, and anemia in pregnancy do not differ by pre-pregnancy BMI. Since ID and anemia during pregnancy remain significant public health concerns, NHANES should consider measuring current iron status in upcoming cycles.
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Affiliation(s)
- Mihaela A Ciulei
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Kelly Gallagher
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Celeste Beck
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Ruth A Pobee
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Rachel E Walker
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
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11
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Yunita S, Adnani QES, Zuhairini Y, Dhamayanti M, Rahmatika NS, Anwar R, Ghozali M. Anthropometry Indices and Body Composition in Adolescent Girls with Anemia: A Scoping Review. J Multidiscip Healthc 2024; 17:4131-4141. [PMID: 39220327 PMCID: PMC11363963 DOI: 10.2147/jmdh.s481134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024] Open
Abstract
To reduce anemia rates, it is crucial to gain a deeper understanding of anemia and its associated factors. It is essential for teenagers who are going through a period of rapid growth to promptly address anemia since untreated anemia can negatively impact their reproductive health. This literature review investigated the relationship between nutritional and anthropometric status indicators, body composition, and prevalence of anemia in teenage girls. Studies were selected based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. A comprehensive search across multiple databases (PubMed= 409, ScienceDirect= 3153, Scopus= 4, Sage Journals= 358) and manual citation of five articles yielded 3929 articles, of which 630 were excluded for irrelevance, one was inaccessible, and nine articles were included in the study after assessing their eligibility. The review's findings suggest that indicators such as Body Mass Index (BMI) and Mid-Upper Arm Circumference (MUAC) are indicated as initial assessments to screen the nutritional status of adolescent females and estimate their risk of anemia. Only one article has specifically discussed the connection between fat mass and anemia in terms of body composition. The need for studies on anthropometry and body composition-related anemia underscores the need to broaden investigations to gain a more nuanced understanding of this subject.
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Affiliation(s)
- Sri Yunita
- Master of Midwifery Program, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | | | - Yenni Zuhairini
- Departement of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Meita Dhamayanti
- Department of Child Health, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Nur Syifa Rahmatika
- Master of Biomedical Sciences Program, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Faculty of Medicine, Universitas Halu Oleo, Kendari, Southeast Sulawesi, Indonesia
| | - Ruswana Anwar
- Department of Obstetrics and Gynecology, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Mohammad Ghozali
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Jatinangor, West Java, Indonesia
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12
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Campbell RK, Dewage BG, Cordero C, Maldonado LE, Sotres-Alvarez D, Daviglus ML, Argos M. Prevalence and Risk Factors of Iron Deficiency and Anemia in Women of Reproductive Age in the Hispanic Community Health Study/Study of Latinos. Curr Dev Nutr 2024; 8:104419. [PMID: 39224140 PMCID: PMC11367547 DOI: 10.1016/j.cdnut.2024.104419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/10/2024] [Accepted: 07/14/2024] [Indexed: 09/04/2024] Open
Abstract
Background Women of reproductive age are at elevated risk of iron deficiency (ID) and anemia; in the United States, those of Hispanic/Latino background are at especially high risk. Causes of ID and anemia and variations in risk within Hispanic/Latino women of reproductive age are not well described. Objectives To characterize ID and anemia and their risk factors/markers in Hispanic/Latina women. Methods Data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were used. HCHS/SOL enrolled participants in 2008-2011 at 4 sites: Bronx, Chicago, Miami, and San Diego; 5386 were non-pregnant women ages 18-49 y. Primary outcomes were ID (ferritin <30 μg/L) and anemia (hemoglobin <12 g/dL). Predictors were background/heritage, Short Acculturation Scale for Hispanics scores, years lived in the United States, and interview language, diet summarized in the Alternate Healthy Eating Index 2010, sociodemographic covariates, and study site. Main analyses used survey log binomial regressions adjusted for age, site, and smoking. Results Almost half (42%) of participants were of Mexican background, 15% of Cuban background, and <15% each were of Puerto Rican, Dominican, Central American, or South American background. ID prevalence was 34.4% overall but differed by site-background pairings. The lowest and highest prevalence were 26% and 42% among women of Cuban background in Miami and women of Mexican background in Chicago, respectively. Anemia prevalence was 16% and ranged from 8.9% (Central American background/Miami) to 22% (Dominican background/Bronx). Acculturation, sociodemographic, and diet variables examined did not explain observed prevalence differences by site/background. Conclusions Prevalence of ID and anemia were high among HCHS/SOL women and differed by field center and background. These differences highlight the importance of characterizing nutritional risk by background within Hispanic/Latino women.
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Affiliation(s)
- Rebecca K Campbell
- Division of Epidemiology and Biostatistics, University of Illinois Chicago School of Public Health, Chicago, IL, United States
| | - Bhagya Galkissa Dewage
- Division of Environmental and Occupational Health Sciences, University of Illinois Chicago School of Public Health, Chicago, IL, United States
| | - Christina Cordero
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Luis E Maldonado
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, United States
| | - Martha L Daviglus
- University of Illinois College of Medicine, Chicago, IL, United States
| | - Maria Argos
- Division of Epidemiology and Biostatistics, University of Illinois Chicago School of Public Health, Chicago, IL, United States
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13
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Farhan HA, Al-Ghannam FAA, Wani K, Khattak MNK, Alnaami AM, Alharbi MG, Alamro AA, Sabico S, Al-Daghri NM. Associations between Serum Iron Indices and Self-Assessed Multiple Intelligence Scores among Adolescents in Riyadh, Saudi Arabia. Biomedicines 2024; 12:1578. [PMID: 39062151 PMCID: PMC11274694 DOI: 10.3390/biomedicines12071578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/15/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Micronutrient deficiencies, including iron deficiency, are linked to different cognitive impairments and sensory functions. However, whether circulating iron levels affect self-assessed multiple intelligence (MI) scores in adolescents remains uninvestigated. This study aimed to investigate associations between serum iron levels and self-assessed MI scores in adolescents in Riyadh, Saudi Arabia. Recruiting 434 Saudi adolescents (174 boys and 260 girls, aged 12-17), we administered the McKenzie questionnaire to assess MI across nine categories. Anthropometrics and fasting blood samples were collected to measure circulating iron and transferrin levels. Total iron-binding capacity (TIBC) and transferrin saturation (TSAT) levels were calculated. Notably, girls exhibited significantly higher MI scores in the interactive domain than boys (age and BMI-adjusted OR = 1.36, 95% confidence interval = 1.07-1.73, p = 0.01). No significant correlations were observed between serum iron and MI. However, normal TSAT levels (TSAT > 20%) corresponded with higher age and BMI-adjusted odds of MI scores in the musical (OR = 1.59, 95%CI = 1.1-2.2, p = 0.006), linguistic (1.57, 1.1-2.3, p = 0.016), kinesthetic (1.48, 1.1-2.1, p = 0.024), spatial (1.45, 1.1-2.1, p = 0.03), and existential (1.56, 1.1-2.1, p = 0.01) categories compared to ones with lower TSAT levels (TSAT ≤ 20%), only in boys. In conclusion, serum iron levels may not directly influence MI domains in adolescents in Riyadh, Saudi Arabia; however, lower TSAT levels, indicative of iron-deficiency anemia, may influence MI, only in boys, indicating a possible relationship between iron metabolism and cognitive functions.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Nasser M. Al-Daghri
- Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
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14
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Frydrych A, Frankowski M, Jurowski K. The toxicological analysis and assessment of essential elements (Cu, Fe, Mn, Zn) in Food for Special Medical Purposes (FSMP) dedicated to oncological patients available in Polish pharmacies. Food Chem Toxicol 2024; 189:114768. [PMID: 38810942 DOI: 10.1016/j.fct.2024.114768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 05/31/2024]
Abstract
Foods for Special Medical Purposes (FSMP) for oncology patients, available in pharmacies, play a crucial role in providing nutrition and supplementation. However, the scientific literature lacks comprehensive research on the safety of essential trace elements in these products. This study aimed to assess Cu, Fe, Mn and Zn levels in commonly prescribed FSMPs (n = 23) from Polish pharmacies. Using ICP-MS after microwave-induced digestion (using concentrated nitric acid and hydrogen peroxide), we evaluated element levels. Our research used three approaches: the raw score for Cu, Fe, Mn, and Zn; single intake per serving; and the daily ration, compared with the reference values of the European Food Safety Authority. Discrepancies were found between the actual and declared product compositions, influenced by the route of administration and the recommended intake. Despite variations, all products were considered safe for oncological patients based on current evidence. However, it is recommended to have clear guidelines for FSMPs in cancer care. This pioneering study evaluates the safety and quality of prescription FSMPs for cancer patients from toxicological and nutritional perspectives, highlighting the need for standardised protocols in pharmacy-dispensed FSMPs.
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Affiliation(s)
- Adrian Frydrych
- Laboratory of Innovative Toxicological Research and Analyzes, Institute of Medical Sciences, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, 35-959, Rzeszów, Poland
| | - Marcin Frankowski
- Department of Analytical and Environmental Chemistry, Faculty of Chemistry, Adam Mickiewicz University in Poznań, Uniwersytetu Poznańskiego 8, 61-614, Poznań, Poland
| | - Kamil Jurowski
- Laboratory of Innovative Toxicological Research and Analyzes, Institute of Medical Sciences, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, 35-959, Rzeszów, Poland; Department of Regulatory and Forensic Toxicology, Institute of Medical Expertises in Łódź, ul. Aleksandrowska 67/93, 91-205, Łódź, Poland.
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15
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Calcaterra V, Verduci E, Milanta C, Agostinelli M, Bona F, Croce S, Valsecchi C, Avanzini MA, Zuccotti G. The Benefits of the Mediterranean Diet on Inflamm-Aging in Childhood Obesity. Nutrients 2024; 16:1286. [PMID: 38732533 PMCID: PMC11085692 DOI: 10.3390/nu16091286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: Numerous elements of the Mediterranean diet (MD) have antioxidant and anti-inflammatory qualities. (2) Methods: We present a narrative review of the potential benefits of the Mediterranean dietary pattern (MD) in mitigating aging-related inflammation (inflamm-aging) associated with childhood obesity. The mechanisms underlying chronic inflammation in obesity are also discussed. A total of 130 papers were included after screening abstracts and full texts. (3) Results: A complex interplay between obesity, chronic inflammation, and related comorbidities is documented. The MD emerges as a promising dietary pattern for mitigating inflammation. Studies suggest that the MD may contribute to weight control, improved lipid profiles, insulin sensitivity, and endothelial function, thereby reducing the risk of metabolic syndrome in children and adolescents with obesity. (4) Conclusions: While evidence supporting the anti-inflammatory effects of the MD in pediatric obesity is still evolving, the existing literature underscores its potential as a preventive and therapeutic strategy. However, MD adherence remains low among children and adolescents, necessitating targeted interventions to promote healthier dietary habits. Future high-quality intervention studies are necessary to elucidate the specific impact of the MD on inflammation in diverse pediatric populations with obesity and associated comorbidities.
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Affiliation(s)
- Valeria Calcaterra
- Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy;
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (C.M.); (M.A.); (F.B.); (G.Z.)
| | - Elvira Verduci
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (C.M.); (M.A.); (F.B.); (G.Z.)
- Department of Health Sciences, University of Milano, 20142 Milan, Italy
| | - Chiara Milanta
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (C.M.); (M.A.); (F.B.); (G.Z.)
| | - Marta Agostinelli
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (C.M.); (M.A.); (F.B.); (G.Z.)
| | - Federica Bona
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (C.M.); (M.A.); (F.B.); (G.Z.)
| | - Stefania Croce
- Immunology and Transplantation Laboratory, Cell Factory, Pediatric Hematology Oncology, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy; (S.C.); (C.V.); (M.A.A.)
| | - Chiara Valsecchi
- Immunology and Transplantation Laboratory, Cell Factory, Pediatric Hematology Oncology, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy; (S.C.); (C.V.); (M.A.A.)
| | - Maria Antonietta Avanzini
- Immunology and Transplantation Laboratory, Cell Factory, Pediatric Hematology Oncology, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy; (S.C.); (C.V.); (M.A.A.)
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (C.M.); (M.A.); (F.B.); (G.Z.)
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
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16
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Shen C, Yuan M, Zhao S, Chen Y, Xu M, Zhang Y, Gu W, Wang W, Liu R, Wang J, Hong J. Association of iron status with all-cause and cause-specific mortality in individuals with diabetes. Diabetes Res Clin Pract 2024; 207:111058. [PMID: 38104902 DOI: 10.1016/j.diabres.2023.111058] [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: 10/12/2023] [Revised: 11/19/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
AIMS Current evidence regarding iron status and mortality risk among patients with diabetes is limited. This study aimed to evaluate association of iron indices with all-cause and cause-specific mortality risk among patients with diabetes. METHODS The current study included 2080 (with ferritin data), 1974 (with transferrin saturation (Tsat) data), and 1106 (with soluble transferrin receptor (sTfR) data) adults with diabetes from NHANES 1999-2018. Death outcomes were obtained from National Death Index through December 31, 2019. Cox proportional hazards models were employed to calculate hazard ratios and 95% confidence intervals for mortality. RESULTS Association with all-cause mortality was demonstrated to be J-shaped for serum ferritin (Pnonlinearity < 0.01), U-shaped for Tsat (Pnonlinearity < 0.01) and linear for sTfR (Plinearity < 0.01). Ferritin 300-500 ng/mL possessed lower all-cause mortality risk than ferritin ≤ 100 ng/mL, 100-300 ng/mL, and > 500 ng/mL. Tsat 25-32 % showed a protective effect on all-cause mortality risk compared with Tsat ≤ 20 %, 20-25 %, and > 32 %. Individuals with sTfR < 4 mg/L were associated with a lower risk of all-cause mortality than those with higher sTfR. CONCLUSIONS Moderate levels of serum ferritin (300-500 ng/mL), Tsat (25 %-32 %) and a lower concentration of sTfR (< 4 mg/L) identified adults with diabetes with lower all-cause mortality risk, adding novel modifiers to diabetes management.
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Affiliation(s)
- Chongrong Shen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, PR China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai 200025, PR China
| | - Miaomiao Yuan
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, PR China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai 200025, PR China
| | - Shaoqian Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, PR China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai 200025, PR China
| | - Yufei Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, PR China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai 200025, PR China
| | - Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, PR China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai 200025, PR China
| | - Yifei Zhang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, PR China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai 200025, PR China
| | - Weiqiong Gu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, PR China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai 200025, PR China
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, PR China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai 200025, PR China
| | - Ruixin Liu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, PR China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai 200025, PR China
| | - Jiqiu Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, PR China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai 200025, PR China.
| | - Jie Hong
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, PR China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai 200025, PR China.
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17
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Rashnoo F, Seifinezhad A, Zefreh H, Sheikhbahaei E, Irajpour AH. The Effect of Laparoscopic Sleeve Gastrectomy on Serum Levels of Vitamin A, D and B12 and Iron Profile on Patients with Morbid Obesity. Adv Biomed Res 2023; 12:211. [PMID: 38073759 PMCID: PMC10699212 DOI: 10.4103/abr.abr_166_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/13/2022] [Accepted: 07/20/2022] [Indexed: 01/03/2025] Open
Abstract
BACKGROUND One of the concerns after bariatric surgery is the lack of nutrients and vitamins due to anatomical and physiological changes that occur after the surgery. The aim of the present study is to evaluate the effect of laparoscopic sleeve gastrectomy on these nutrients and vitamins. MATERIALS AND METHODS This prospective study was performed in Tehran and all the patients who met the inclusion criteria before the surgery were tested for serum levels of vitamins A, B12, D, ferritin, serum iron, and TIBC. The patients were tested once again for the same micronutrients, one year after surgery. RESULTS A total of 120 patients had the inclusion criteria and all of them completed the follow-up period. Of the patients, 64.2% (77 patients) were female and 35.8% (43 patients) were male. The mean weight of the patients was 122.1 ± 14.8 kg and the mean BMI of patients before surgery was 43.6 ± 4.4 kg/m2. Comparing these parameters before and after surgery showed that serum levels of vitamins A and B12, ferritin, and TIBC were not significantly different from before surgery. However, vitamin D levels after surgery were significantly higher than before (p < 0.001). CONCLUSION The result of the present study demonstrated that laparoscopic sleeve gastrectomy is one of the most effective surgical methods for obesity treatment and does not cause a lack of nutrients and vitamins in long term and does not require supplementation. In addition, it promotes serum levels of vitamin D, which is effective in preventing the effects of vitamin D deficiency in obese patients.
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Affiliation(s)
- Fariborz Rashnoo
- Department of Surgery, Loghman Hakim University Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arsham Seifinezhad
- Student Research Committee, School of Medicine, Isfahan, Iran, University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Zefreh
- Student Research Committee, School of Medicine, Isfahan, Iran, University of Medical Sciences, Isfahan, Iran
| | - Erfan Sheikhbahaei
- Student Research Committee, School of Medicine, Isfahan, Iran, University of Medical Sciences, Isfahan, Iran
- Isfahan Minimally Invasive and Obesity Surgery Research Center, Alzahra University Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Hossein Irajpour
- Department of Surgery, Loghman Hakim University Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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18
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Ssewanyana D, Borque SL, Lye SJ, Matthews SG. Hepcidin across pregnancy and its correlation with maternal markers of iron and inflammation, maternal body weight outcomes, and offspring neurodevelopmental outcomes: a systematic review and meta-analysis. AJOG GLOBAL REPORTS 2023; 3:100222. [PMID: 37645642 PMCID: PMC10461250 DOI: 10.1016/j.xagr.2023.100222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE This study evaluated the correlation between maternal hepcidin and other biomarkers of iron status, markers of inflammation, and maternal body weight during pregnancy, as well as neurodevelopment in the offspring. DATA SOURCES PubMed, Web of Science, Scopus, and Embase were searched from inception until March 2022. STUDY ELIGIBILITY CRITERIA Studies conducted among pregnant women without apparent pregnancy complications were included. Eligible studies reported correlation coefficients between maternal hepcidin and any outcomes of maternal biomarkers of iron status or inflammatory load during pregnancy, prenatal maternal body weight, and offspring neurodevelopment. Studies without correlation data were eligible if they quantitatively reported volumes of both maternal hepcidin and any marker of iron status and/or inflammatory load during gestation. METHODS Pooled correlation coefficients between maternal hepcidin and outcomes of interest were calculated using the Fisher r-to-Z transformation. Both fixed-effects and DerSimonian and Laird random-effects models were used to calculate pooled correlation coefficient. When meta-analysis was not feasible, results were descriptively synthesized. RESULTS Forty-six studies with 6624 participants were eligible. Hepcidin was significantly correlated with hemoglobin in the third trimester (r=0.21; 95% confidence interval, 0.1-0.32); ferritin in the first (r=0.31; 95% confidence interval, 0.01-0.61) and third trimester (r=0.35; 95% confidence interval, 0.23-0.48); soluble transferrin receptor in the second trimester (r=-0.27; 95% confidence interval, -0.4 to -0.14); total iron-binding capacity in the second trimester (r=0.37; 95% confidence interval, 0.24-0.50); and serum iron in the third trimester (r=0.11; 95% confidence interval, 0.02-0.19). Hepcidin was significantly correlated with the inflammatory marker interleukin-6 in the third trimester (r=0.26; 95% confidence interval, 0.17-0.34) and C-reactive protein in the second (r=0.16; 95% confidence interval, 0.03-0.30) and third trimester (r=0.28; 95% confidence interval, 0.04-0.52). Four out of 5 studies reported weak-to-moderate positive correlation between hepcidin and body mass index. Hepcidin levels varied across body mass index categories. No single study reported the relationship between maternal hepcidin and neurodevelopment in offspring. CONCLUSION Hepcidin weakly to moderately correlates with biomarkers of iron and inflammation in pregnancy.
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Affiliation(s)
- Derrick Ssewanyana
- Departments of Physiology (Drs Ssewanyana, Lye, and Matthews)
- Medicine (Drs Ssewanyana, Lye, and Matthews), University of Toronto, Toronto, Canada
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, Canada (Drs Ssewanyana, Lye, and Matthews)
| | - Stephane L. Borque
- Department of Anesthesiology and Pain Medicine and Pharmacology, University of Alberta, Edmonton, Canada (Dr Borque)
| | - Stephen J. Lye
- Departments of Physiology (Drs Ssewanyana, Lye, and Matthews)
- Medicine (Drs Ssewanyana, Lye, and Matthews), University of Toronto, Toronto, Canada
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, Canada (Drs Ssewanyana, Lye, and Matthews)
| | - Stephen G. Matthews
- Departments of Physiology (Drs Ssewanyana, Lye, and Matthews)
- Medicine (Drs Ssewanyana, Lye, and Matthews), University of Toronto, Toronto, Canada
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, Canada (Drs Ssewanyana, Lye, and Matthews)
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Naz N, Khan MR, Shabbir MA, Faisal MN. Effect of iron-fortified jamun leather on the Asunra-induced anemia in Sprague Dawley rats. Front Nutr 2023; 10:1195981. [PMID: 37384107 PMCID: PMC10293738 DOI: 10.3389/fnut.2023.1195981] [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: 04/12/2023] [Accepted: 05/25/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction Micronutrients such as minerals and vitamins are required in a minute quantity but play a pivotal role in the functioning of the body. Therefore, deficiency in one of them can lead to lethal health conditions. Iron deficiency anaemia is one of the most common micronutrient deficiencies across the world and is affecting women and children. Methods The present study aimed to investigate the anti-anaemic effect of fortified jamun leather on anaemia biomarkers and haematology in anaemic female Sprague Dawley rats. A total of 40 Sprague Dawley rats were used in 4 groups. Iron deficiency anaemia was induced by oral administration of the Asunra drug. The treatments were fed at two dosage levels i.e., 40 and 60% iron-fortified leather. All animals were treated for 60 days and the parameters including biochemical, and histopathology of the kidney and liver were examined. Results The experiment's findings showed that the group fed with iron-fortified leather (G3) succeeded significantly (P < 0.05) in restoring the serum iron (98.68 ± 2.88 μg/dL), haemoglobin (12.41 ± 0.32 g/dL), ferritin (24.54 ± 1.98 ng/mL) and haematocrit levels (39.30 ± 1.66%) at the end of the 60 days period. Additionally, the treated group's mean values for transferrin and total iron binding capacity were lower than those of the anaemic rats, indicating an improvement in iron levels. The microscopic analysis revealed that treatments had no toxic effects on the kidney and liver tissues, except in the diseased group, which had necrosis and irregular cell structure. Conclusion Conclusively, iron-fortified jamun leather helped improve iron deficiency biomarkers and imparted a non-toxic effect on tissues in rats.
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Affiliation(s)
- Nosheen Naz
- National Institute of Food Science and Technology, University of Agriculture, Faisalabad, Pakistan
| | - Moazzam Rafiq Khan
- National Institute of Food Science and Technology, University of Agriculture, Faisalabad, Pakistan
| | - Muhammad Asim Shabbir
- National Institute of Food Science and Technology, University of Agriculture, Faisalabad, Pakistan
| | - Muhammad Naeem Faisal
- Institute of Pharmacy, Physiology, and Pharmacology, University of Agriculture, Faisalabad, Pakistan
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Kosaruk W, Brown JL, Towiboon P, Punyapornwithaya V, Pringproa K, Thitaram C. Measures of Oxidative Status Markers in Relation to Age, Sex, and Season in Sick and Healthy Captive Asian Elephants in Thailand. Animals (Basel) 2023; 13:ani13091548. [PMID: 37174585 PMCID: PMC10177462 DOI: 10.3390/ani13091548] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Oxidative stress is a pathological condition that can have adverse effects on animal health, although little research has been conducted on wildlife species. In this study, blood was collected from captive Asian elephants for the assessment of five serum oxidative status markers (reactive oxygen species (ROS) concentrations; malondialdehyde, MDA; albumin; glutathione peroxidase, GPx; and catalase) in healthy (n = 137) and sick (n = 20) animals. Health problems consisted of weakness, puncture wounds, gastrointestinal distress, eye and musculoskeletal problems, and elephant endotheliotropic herpesvirus hemorrhagic disease (EEHV-HD). Fecal samples were also collected to assess glucocorticoid metabolites (fGCMs) as a measure of stress. All data were analyzed in relation to age, sex, sampling season, and their interactions using generalized linear models, and a correlation matrix was constructed. ROS and serum albumin concentrations exhibited the highest concentrations in aged elephants (>45 years). No sex differences were found for any biomarker. Interactions were observed for age groups and seasons for ROS and catalase, while GPx displayed a significant interaction between sex and season. In pairwise comparisons, significant increases in ROS and catalase were observed in summer, with higher ROS concentrations observed only in the adult female group. Lower catalase activity was exhibited in juvenile males, subadult males, adult females, and aged females compared to subadult and adult elephants (males and females) in winter and the rainy season. There was a positive association between catalase activity and fGCMs (r = 0.23, p < 0.05), and a number of red blood cell parameters were positively associated with several of these biomarkers, suggesting high oxidative and antioxidative activity covary in red cells (p < 0.05). According to health status, elephants with EEHV-HD showed the most significant changes in oxidative stress markers, with MDA, GPx, and catalase being higher and albumin being lower than in healthy elephants. This study provides an analysis of understudied health biomarkers in Asian elephants, which can be used as additional tools for assessing the health condition of this species and suggests age and season may be important factors in data interpretation.
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Affiliation(s)
- Worapong Kosaruk
- Doctoral Degree Program in Veterinary Science, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand
- Center of Elephant and Wildlife Health, Chiang Mai University Animal Hospital, Chiang Mai 50100, Thailand
- Elephant, Wildlife, and Companion Animals Research Group, Chiang Mai University, Chiang Mai 50100, Thailand
| | - Janine L Brown
- Center of Elephant and Wildlife Health, Chiang Mai University Animal Hospital, Chiang Mai 50100, Thailand
- Elephant, Wildlife, and Companion Animals Research Group, Chiang Mai University, Chiang Mai 50100, Thailand
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA 22630, USA
| | - Patcharapa Towiboon
- Center of Elephant and Wildlife Health, Chiang Mai University Animal Hospital, Chiang Mai 50100, Thailand
| | - Veerasak Punyapornwithaya
- Department of Food Animal Clinic, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand
| | - Kidsadagon Pringproa
- Elephant, Wildlife, and Companion Animals Research Group, Chiang Mai University, Chiang Mai 50100, Thailand
- Department of Veterinary Bioscience and Veterinary Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand
| | - Chatchote Thitaram
- Center of Elephant and Wildlife Health, Chiang Mai University Animal Hospital, Chiang Mai 50100, Thailand
- Elephant, Wildlife, and Companion Animals Research Group, Chiang Mai University, Chiang Mai 50100, Thailand
- Department of Companion Animal and Wildlife Clinic, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand
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Calcaterra V, Verduci E, Milanta C, Agostinelli M, Todisco CF, Bona F, Dolor J, La Mendola A, Tosi M, Zuccotti G. Micronutrient Deficiency in Children and Adolescents with Obesity-A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:695. [PMID: 37189944 PMCID: PMC10136772 DOI: 10.3390/children10040695] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023]
Abstract
Childhood obesity represents a serious public health burden. Despite excessive dietary consumption, children with obesity present high rates of micronutrient deficiencies, such as deficiencies in minerals and specific vitamins; micronutrient deficiencies may have a pathogenic role in obesity-related metabolic comorbidities. In this narrative review, we analyzed the main deficiencies associated with obesity, their clinical consequences, and the evidence about a possible supplementation. Iron; vitamins A, B, C, D, and E; folic acid; zinc; and copper deficiencies represent the most common deficient microelements. The relationship between obesity and multiple micronutrient deficiencies remains unclear, and different mechanisms have been proposed. The medical care plan for pediatric obesity should include food choices with high nutritional content as part of a crucial approach to obesity-related complications. Unfortunately, only a few studies are available regarding the efficacy of oral supplementation or weight loss for treating them; thus, continuous nutritional monitoring is necessary.
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Affiliation(s)
- Valeria Calcaterra
- Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Elvira Verduci
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy
- Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Chiara Milanta
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy
| | | | | | - Federica Bona
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Jonabel Dolor
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Alice La Mendola
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Martina Tosi
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
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Irache A, Anjorin SS, Caleyachetty R, Gill P. Trends in the Intraindividual Double Burden of Overweight/Obesity and Anemia among Adult Women Living in 33 Low- and Middle-Income Countries: A Secondary Analysis of Demographic and Health Surveys from 2000-2019. J Nutr 2023; 153:1111-1121. [PMID: 36796481 PMCID: PMC10196605 DOI: 10.1016/j.tjnut.2023.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/02/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Changes in overweight/obesity and anemia among women have been investigated in multiple studies, but the rate at which their coexistence at the individual level has evolved remains unknown. OBJECTIVES We aimed to 1) document trends in the magnitude and inequalities of the co-occurrence of overweight/obesity and anemia; and 2) compare these with overall trends in overweight/obesity, anemia, and the co-occurrence of anemia with normal weight or underweight. METHODS For this cross-sectional series study, we used 96 Demographic and Health Surveys from 33 countries with available anthropometric and anemia data among nonpregnant adult women (20-49 y old; n = 1,648,308). The primary outcome was defined as the coexistence of overweight or obesity (BMI ≥25kg/m2) and anemia (hemoglobin concentrations <12.0 g/dL) within the same individual. We computed overall and regional trends through multilevel linear regression models and by sociodemographic characteristics (i.e., wealth, education, and residence). Estimates at the country level were calculated through ordinary least square regression models. RESULTS From 2000 to 2019, the co-occurrence of overweight/obesity and anemia increased modestly at an annual rate of 0.18 percentage points (95% CI: 0.08, 0.28 percentage points; P < 0.001), ranging from 0.73 percentage points in Jordan to -0.56 percentage points in Peru. This trend occurred in parallel with overall increases in overweight/obesity and reductions in anemia. The co-occurrence of anemia with normal weight or underweight was reducing in all countries, except Burundi, Sierra Leone, Jordan, Bolivia, and Timor-Leste. Stratified analyses yielded an upward trend in the co-occurrence of overweight/obesity and anemia across all subgroups but particularly in women from the 3 middle wealth groups, no education, and capital city or rural residents. CONCLUSIONS The rising trend in the intraindividual double burden suggests that efforts to reduce anemia among women living with overweight/obesity may need to be revisited to accelerate progress toward the 2025 global nutrition target of halving anemia.
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Affiliation(s)
- Ana Irache
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Medical School Building, Coventry, United Kingdom.
| | - Seun Stephen Anjorin
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Medical School Building, Coventry, United Kingdom
| | - Rishi Caleyachetty
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Medical School Building, Coventry, United Kingdom
| | - Paramjit Gill
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Medical School Building, Coventry, United Kingdom
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Hepcidin: a New Serial Biomarker for Iron Deficiency Anemia in Bariatric Surgery. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03690-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
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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: 2] [Impact Index Per Article: 0.7] [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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Serum Ferritin Threshold for Iron Deficiency Screening in One-Year-Old Children. J Pediatr 2022; 245:217-221. [PMID: 35114287 DOI: 10.1016/j.jpeds.2022.01.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 11/23/2022]
Abstract
The American Academy of Pediatrics recommends universal hemoglobin screening for iron deficiency anemia using hemoglobin <110 g/L at the 1-year-old well child visit. Our retrospective study suggests the need for combined hemoglobin and serum ferritin iron deficiency screening and raising the diagnostic serum ferritin threshold to 24-25 μg/L.
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de Souza DW, Ceglarek VM, Siqueira BS, Volinski CZ, Nenevê JZ, Arruda JPDA, Vettorazzi JF, Grassiolli S. Phenylhydrazine-induced anemia reduces subcutaneous white and brown adipose tissues in hypothalamic obese rats. Exp Physiol 2022; 107:575-588. [PMID: 35396880 DOI: 10.1113/ep089883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 03/29/2022] [Indexed: 11/08/2022]
Abstract
NEW FUNDINGS What is the central question of this study? This study aims to assess whether an anemic state could modify adiposity and metabolic parameters in hypothalamic obese rats. What is the main finding and its importance? Our results indicate that hypothalamic obese rats do not display iron deficiency. However, the pharmacological induction of anemia in hypothalamic-obese rats resulted in reduced adiposity, characterized by a decrease in subcutaneous white and brown adipose tissue depots. These findings suggest that iron imbalance in obesity may elevate lipolysis. ABSTRACT Iron imbalance is frequent in obesity. Herein, we evaluated the impact of anemia induced by phenylhydrazine on adiposity and metabolic state of hypothalamic obese rats. Hypothalamic obesity was induced by high doses of glutamate monosodium (MSG; 4g/Kg) administered to neonatal male rats (n = 20). Controls (CTL; non-obese rats) received saline equimolar (n = 20). Rats were weaned at 21 days of life. At 70 days, half of the rats received three intraperitoneal doses of phenylhydrazine (PHZ; 40mg/Kg/dose) or saline solution. Body weight and food intake were accompanied for four weeks after PHZ administration. At 92 days, rats were euthanized, blood was collected for microcapillary hematocrit (Hct) analysis and plasma quantification of glucose, triglycerides, total cholesterol, and iron levels. The liver, the spleen, and the white (WAT) and brown (BAT) adipose tissues were excised, weighed, and used for histology. MSG-treated rats developed obesity, hypertriglyceridemia, and insulin resistance, compared to CTL rats, without changes in iron levels and Hct. PHZ administration reduced iron plasma levels and promoted similar tissue injuries in the spleen and liver from MSG and CTL rats. However, in MSG-treated rats, PHZ decreased fasting glucose levels and Hct, as well as diminished the subcutaneous WAT and BAT mass. Although MSG-obesity does not affect iron plasma levels and Hct by itself, PHZ-induced anemia associated with obesity induces a marked drop in subcutaneous WAT and BAT mass, suggesting that iron imbalance may lead to increased lipolytic responses in obese rats, compared to lean rats. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Domwesley Wendreo de Souza
- Programa de Pós-Graduação em Biociências e Saúde, CCBS, Universidade Estadual do Oeste do Paraná (Unioeste), Cascavel, PR, Brasil
| | - Vanessa Marieli Ceglarek
- Programa de Pós-Graduação em Ciências Biológicas: Fisiologia, Universidade Federal do Rio Grande do Sul (UFRG), Porto Alegre, RS, Brasil
| | - Bruna Schumaker Siqueira
- Programa de Pós-Graduação em Biociências e Saúde, CCBS, Universidade Estadual do Oeste do Paraná (Unioeste), Cascavel, PR, Brasil
| | - Caroline Zanella Volinski
- Graduação Enfermagem, CCBS - Universidade Estadual do Oeste do Paraná (Unioeste), Cascavel, PR, Brasil
| | - Juliane Zanon Nenevê
- Graduação Enfermagem, CCBS - Universidade Estadual do Oeste do Paraná (Unioeste), Cascavel, PR, Brasil
| | - João Paulo de Amorin Arruda
- Programa de Pós-Graduação em Odontologia, CCBS - Universidade Estadual do Oeste do Paraná (Unioeste), Cascavel, PR, Brasil
| | | | - Sabrina Grassiolli
- Programa de Pós-Graduação em Biociências e Saúde, CCBS, Universidade Estadual do Oeste do Paraná (Unioeste), Cascavel, PR, Brasil
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Giannini C, Polidori N, Saltarelli MA, Chiarelli F, Basilico R, Mohn A. Increased hepcidin levels and non-alcoholic fatty liver disease in obese prepubertal children: a further piece to the complex puzzle of metabolic derangements. J Pediatr Endocrinol Metab 2022; 35:39-47. [PMID: 34726357 DOI: 10.1515/jpem-2021-0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 10/11/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Several studies on obese youths and adults have reported increased hepcidin levels, which seems to be related to metabolic and iron metabolism alterations. The complete mechanisms involved in hepcidin increase remain to be elucidated, and particularly its role in the development of other known complications such as Nonalcoholic Fatty Liver Disease (NAFLD). NAFLD in prepubertal children might be of special interest in understanding the underlying mechanisms. METHODS Anthropometric measurements, liver ultrasonography, lipid profile, liver function, oxidative stress, inflammatory state, and iron metabolism were studied in 42 obese prepubertal children and 33 healthy controls. We, therefore, evaluated the presence of possible correlations between Hepcidin and the other metabolic variables, and the possible association between NAFLD and iron metabolism. RESULTS Hepcidin levels were significantly increased in the obese prepubertal children (p=0.001) with significant differences between obese children with and without NAFLD (p=0.01). Blood iron was lower in obese children (p=0.009). In the obese group, a negative correlation between hepcidin and both blood iron levels (p=0.01) and LagPHASE (p=0.02) was found. In addition, a positive association between hepcidin and NAFLD (p=0.03) was detected. CONCLUSIONS We suggest that an increase in hepcidin levels may represent an early step in iron metabolism derangements and metabolic alterations, including NAFLD, in prepubertal obese children.
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Affiliation(s)
- Cosimo Giannini
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Clinical Research Center, "G. d'Annunzio" Foundation, University of Chieti, Chieti, Italy
| | - Nella Polidori
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | | | - Francesco Chiarelli
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Clinical Research Center, "G. d'Annunzio" Foundation, University of Chieti, Chieti, Italy
| | - Raffaella Basilico
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Angelika Mohn
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Clinical Research Center, "G. d'Annunzio" Foundation, University of Chieti, Chieti, Italy
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Assessment of baseline rates of functional and absolute iron deficiency in bariatric surgery candidates: a retrospective study. Surg Obes Relat Dis 2021; 17:2009-2014. [PMID: 34620564 DOI: 10.1016/j.soard.2021.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/30/2021] [Accepted: 09/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Preoperative optimization of iron status is a priority in candidates for bariatric surgery. Inflammation is strongly associated with obesity, and as a consequence, functional iron deficiency (ID) is potentially an underreported issue in surgical candidates. OBJECTIVES In light of updated practice guidelines, to retrospectively review preoperative iron status in an Irish cohort of bariatric surgery candidates, taking account of the relative incidence rate of functional ID. SETTING A tertiary care obesity service with bariatric surgery referral in Ireland. METHODS Baseline nutritional biochemistry records were reviewed between February 2017 and February 2020 in a hospital, Dublin, Ireland. Absolute ID was defined as serum ferritin <30 μg/L; functional ID was defined as ferritin, 30 to 100 μg/L, in the presence of C-reactive protein >5 mg/L. Anemia was indexed with reference to hemoglobin and qualified by vitamin B12 and folate status to rule out anemia unrelated to primary ID. RESULTS The analysis included 120 patients, 68% female, 49.6 ± 9.3 years, and body mass index, 52.0 ± 9.6 kg/m2. The prevalence of absolute and functional ID was 11.7% and 30.8%, respectively (P = .0003). Anemia was associated with absolute ID and functional ID in 14.3% and 10.8% of patients (P = .29). Folate and vitamin B12 deficiency occurred in <5% of patients. CONCLUSION In patients seeking bariatric surgery for severe obesity, the prevalence of baseline functional ID is substantial and can be associated with anemia. These findings raise queries with regard to how best to optimize preoperative iron status in the context of ongoing inflammation.
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Jones AD, Shi Z, Lambrecht NJ, Jiang Y, Wang J, Burmeister M, Li M, Lozoff B. Maternal Overweight and Obesity during Pregnancy Are Associated with Neonatal, but Not Maternal, Hepcidin Concentrations. J Nutr 2021; 151:2296-2304. [PMID: 33979838 PMCID: PMC8349130 DOI: 10.1093/jn/nxab133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Overweight or obesity among pregnant women may compromise maternal and neonatal iron status by upregulating hepcidin. OBJECTIVES This study determined the association of 1) maternal and neonatal iron status with maternal and neonatal hepcidin concentrations, and 2) maternal prepregnancy weight status with maternal and neonatal hepcidin concentrations. METHODS We examined hematologic data from 405 pregnant women and their infants from the placebo treatment group of a pregnancy iron supplementation trial in rural China. We measured hepcidin, serum ferritin (SF), soluble transferrin receptor (sTfR), and high-sensitivity C-reactive protein in maternal blood samples at mid-pregnancy and in cord blood at delivery. We used regression analysis to examine the association of maternal prepregnancy overweight or obese status with maternal hepcidin concentration in mid-pregnancy and cord hepcidin concentrations. We also used path analysis to examine mediation of the association of maternal prepregnancy overweight or obese status with maternal iron status by maternal hepcidin, as well as with neonatal hepcidin by neonatal iron status. RESULTS Maternal iron status was positively correlated with maternal hepcidin at mid-pregnancy (SF: r = 0.63, P < 0.001; sTfR: r = -0.37, P < 0.001). Neonatal iron status was also positively correlated with cord hepcidin (SF: r = 0.61, P < 0.001; sTfR: r = -0.39, P < 0.001). In multiple linear regression models, maternal prepregnancy overweight or obese status was not associated with maternal hepcidin at mid-pregnancy but was associated with lower cord hepcidin (coefficient = -0.21, P = 0.004). Using path analysis, we observed a significant indirect effect of maternal prepregnancy overweight or obese status on cord hepcidin, mediated by neonatal iron status. CONCLUSIONS In both pregnant women and neonates, hepcidin was responsive to iron status. Maternal prepregnancy overweight status, with or without including obese women, was associated with lower cord blood hepcidin, likely driven by lower iron status among the neonates of these mothers.
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Affiliation(s)
- Andrew D Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Zhen Shi
- Peking University First Hospital, Beijing, China
- Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Nathalie J Lambrecht
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Yaping Jiang
- Peking University First Hospital, Beijing, China
| | - Jingmin Wang
- Peking University First Hospital, Beijing, China
| | - Margit Burmeister
- Department of Computational Medicine & Bioinformatics, Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Ming Li
- Peking University First Hospital, Beijing, China
| | - Betsy Lozoff
- Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, MI, USA
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Abstract
Background Iron absorption is disturbed after Roux-en-Y gastric bypass (RYGB) and iron deficiency with or without anaemia affects almost half of all patients. Intravenous iron is an option when per oral iron is insufficient or not tolerated. This study explores whether routinely offering intravenous iron treatment when iron stores are empty can prevent anaemia and iron deficiency after RYGB. Methods This is a study of prospectively registered data on clinical information, haematological tests and intravenous iron treatment from 644 RYGB patients who underwent surgery between 2004 and 2013, postoperatively followed more than 5 years. Intravenous iron treatment was offered to patients with ferritin ≤ 15 μg/L. Results Clinical information was available for all patients at baseline and for 553/644 patients at 5 years; laboratory results were available for 540/644 patients at baseline and 411/644 patients after 5 years. The mean age was 39.8 (± 9.7) years. Overall, 187/483 (38.7%) women and 9/161 (5.6%) men were given intravenous iron treatment in the observation period. From baseline to 5 years, mean haemoglobin decreased by 0.3 g/dL in both men and women. Anaemia occurred in 18/311 (5.8%) women and 9/100 (9%) men at 5 years. Depleted iron stores (ferritin ≤ 15 μg/L) were seen among 44/323(13.6%) women and 3/102 (2.9%) men, and low iron stores (ferritin 16–50 μg/L) occurred in 144/326 (44.6%) women and 38/102 (37.3%) men 5 years after RYGB. Conclusion By routinely offering intravenous iron treatment to patients with depleted iron stores after RYGB, haemoglobin levels were preserved. Half of the patients experienced low or depleted iron stores at 5 years.
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El-Mallah CA, Beyh YS, Obeid OA. Iron Fortification and Supplementation: Fighting Anemia of Chronic Diseases or Fueling Obesity? Curr Dev Nutr 2021; 5:nzab032. [PMID: 33959691 PMCID: PMC8085477 DOI: 10.1093/cdn/nzab032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/07/2021] [Accepted: 03/31/2021] [Indexed: 12/13/2022] Open
Abstract
The significant worldwide increase in obesity has become a major health problem. Excess adiposity has been extensively linked to inflammation. Recently, studies have shown that dietary intake and microbiota dysbiosis can affect the health of the gut and lead to low-grade systemic inflammation, worsening the state of obesity and further exacerbating inflammation. The latter is shown to decrease iron status and potentially increase the risk of anemia by inhibiting iron absorption. Hence, anemia of obesity is independent of iron intake and does not properly respond to increased iron ingestion. Therefore, countries with a high rate of obesity should assess the health impact of fortification and supplementation with iron due to their potential drawbacks. This review tries to elucidate the relation between inflammation and iron status to better understand the etiology of anemia of obesity and chronic diseases and wisely design any dietary or medical interventions for the management of anemia and/or obesity.
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Affiliation(s)
- Carla A El-Mallah
- Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Yara S Beyh
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Omar A Obeid
- Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
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Oxidative Stress, Plant Natural Antioxidants, and Obesity. Int J Mol Sci 2021; 22:ijms22041786. [PMID: 33670130 PMCID: PMC7916866 DOI: 10.3390/ijms22041786] [Citation(s) in RCA: 217] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023] Open
Abstract
Oxidative stress is important in the pathophysiology of obesity, altering regulatory factors of mitochondrial activity, modifying the concentration of inflammation mediators associated with a large number and size of adipocytes, promoting lipogenesis, stimulating differentiation of preadipocytes to mature adipocytes, and regulating the energy balance in hypothalamic neurons that control appetite. This review discusses the participation of oxidative stress in obesity and the important groups of compounds found in plants with antioxidant properties, which include (a) polyphenols such as phenolic acids, stilbenes, flavonoids (flavonols, flavanols, anthocyanins, flavanones, flavones, flavanonols, and isoflavones), and curcuminoids (b) carotenoids, (c) capsaicinoids and casinoids, (d) isothiocyanates, (e) catechins, and (f) vitamins. Examples are analyzed, such as resveratrol, quercetin, curcumin, ferulic acid, phloretin, green tea, Hibiscus Sabdariffa, and garlic. The antioxidant activities of these compounds depend on their activities as reactive oxygen species (ROS) scavengers and on their capacity to prevent the activation of NF-κB (nuclear factor κ-light-chain-enhancer of activated B cells), and reduce the expression of target genes, including those participating in inflammation. We conclude that natural compounds have therapeutic potential for diseases mediated by oxidative stress, particularly obesity. Controlled and well-designed clinical trials are still necessary to better know the effects of these compounds.
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Neumann G, Hottenrott K, Hottenrott L. Der Eisenstoffwechsel und seine Bedeutung für das Höhentraining. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2021. [DOI: 10.1007/s12662-021-00707-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungEin Eisenmangel und eine katabole Stoffwechsellage behindern die Zunahme des Gesamthämoglobins und damit einen Anstieg der Sauerstofftransportkapazität, sodass die Wirksamkeit des Höhentrainings herabgesetzt ist. Die Eisenhomöostase wird sehr fein durch das hepatische Hormon Hepcidin (HEPC) kontrolliert, welches die Eisenaufnahmefähigkeit der Darmzellen über ein spezielles Protein, dem Ferroportin, kontrolliert. Unter Hypoxie stimuliert das Protein HIF-1 α die Freisetzung des Erythropoitins (EPO). Unzureichende Eisenspeicher und/oder eine Vitamin-B12-Unterversorgung bei Athleten, besonders bei jungen Frauen, sind Wochen vor einem Höhentraining durch eine orale Eisen- und/oder Vitamin-B12-Substitution unter ärztlicher Kontrolle, aufzufüllen. Voraussetzung für eine leistungsfördernde Wirkung des Höhentrainings ist ein mehrmaliger Aufenthalt in mittleren Höhen von 1700 m bis 3000 m. Als Aufenthaltsdauer werden 350 h bis 500 h oder zwei bis drei Wochen empfohlen. Mangelnde Eisenverfügbarkeit und ein Energiedefizit können die Wirksamkeit des Höhentrainings negativ beeinflussen. Liegt aus medizinischer Sicht eine Eisenunterversorgung vor, dann wird zu einer oralen Supplementation vor und während des Höhentrainings geraten. Bei normaler Eisenverfügbarkeit führt die gesteigerte Hämatopoese durch EPO zur Zunahme des Gesamthämoglobins. Die Wirkung des hypoxieinduzierten Hämoglobinanstiegs ist nach dem Höhentraining auf drei bis vier Wochen begrenzt.
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Silva DLF, Höfelmann DA, Taconeli CA, Lang RMF, Dallazen C, Tietzmann DC, Moreira JD, Silva SAD, Nilson EAF, Gonçalves VSS, Crispim SP. Individual and contextual predictors of children's hemoglobin levels from Southern Brazilian municipalities in social vulnerability. CAD SAUDE PUBLICA 2021; 36:e00166619. [PMID: 33440420 DOI: 10.1590/0102-311x00166619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 05/06/2020] [Indexed: 11/21/2022] Open
Abstract
Few studies have investigated the simultaneous effect of individual and contextual factors on the occurrences of anemia. This study aims to evaluate the variability of children's hemoglobin levels from municipalities in social vulnerability and its association with factors of individual and municipal nature. This is a cross-sectional, multi-center study, with children data (12-59 months) collected from 48 municipalities of the Southern region of Brazil, that were included in the Brazil Without Poverty Plan. Individuals' data were collected using a structured questionnaire, and secondary and ecological data of children's municipalities were collected via national surveys and institutional websites. The outcome was defined as the hemoglobin level obtained by HemoCue. A multilevel analysis was performed using Generalized Linear Models for Location Scale and Shape using R, with a 5% significance level. A total of 1,501 children were evaluated. The mean hemoglobin level was 12.8g/dL (95%CI: 12.7-12.8), with significant variability between municipalities. Lower values of hemoglobin were observed in children who lived in municipalities with a higher urbanization rate and a lower number of Community Health Agents, in relation to the reference categories. At the individual level, lower hemoglobin values were identified for children under 24 months, not enrolled at daycares, who were beneficiaries of the conditional cash transfer program and diagnosed with underweight. The results shed light on important factors at the municipal and the individual levels that were associated to the hemoglobin levels of children living in municipalities in social vulnerability.
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Affiliation(s)
| | | | | | | | - Camila Dallazen
- Departamento de Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil
| | - Daniela Cardoso Tietzmann
- Departamento de Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil
| | - Julia Dubois Moreira
- Departamento de Nutrição, Universidade Federal de Santa Catarina, Florianópolis, Brasil
| | - Sara Araújo da Silva
- Coordenação Geral de Alimentação e Nutrição, Ministério da Saúde, Brasília, Brasil
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Yook JS, You M, Kim Y, Zhou M, Liu Z, Kim YC, Lee J, Chung S. The thermogenic characteristics of adipocytes are dependent on the regulation of iron homeostasis. J Biol Chem 2021; 296:100452. [PMID: 33631196 PMCID: PMC8010711 DOI: 10.1016/j.jbc.2021.100452] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 12/15/2022] Open
Abstract
The development of thermogenic adipocytes concurs with mitochondrial biogenesis, an iron-dependent pathway. Iron regulatory proteins (IRP) 1 and 2 are RNA-binding proteins that regulate intracellular iron homeostasis. IRPs bind to the iron-response element (IRE) of their target mRNAs, balancing iron uptake and deposition at the posttranscriptional levels. However, IRP/IRE-dependent iron regulation in adipocytes is largely unknown. We hypothesized that iron demands are higher in brown/beige adipocytes than white adipocytes to maintain the thermogenic mitochondrial capacity. To test this hypothesis, we investigated the IRP/IRE regulatory system in different depots of adipose tissue. Our results revealed that 1) IRP/IRE interaction was increased in proportional to the thermogenic function of the adipose depot, 2) adipose iron content was increased in adipose tissue browning upon β3-adrenoceptor stimulation, while decreased in thermoneutral conditions, and 3) modulation of iron content was linked with mitochondrial biogenesis. Moreover, the iron requirement was higher in HIB1B brown adipocytes than 3T3-L1 white adipocytes during differentiation. The reduction of the labile iron pool (LIP) suppressed the differentiation of brown/beige adipocytes and mitochondrial biogenesis. Using the 59Fe-Tf, we also demonstrated that thermogenic stimuli triggered cell-autonomous iron uptake and mitochondrial compartmentalization as well as enhanced mitochondrial respiration. Collectively, our work demonstrated that IRP/IRE signaling and subsequent adaptation in iron metabolism are a critical determinant for the thermogenic function of adipocytes.
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Affiliation(s)
- Jin-Seon Yook
- Department of Nutrition and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - Mikyoung You
- Department of Nutrition and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - Yongeun Kim
- Department of Nutrition and Health Sciences, University of Nebraska, Lincoln, Nebraska, USA
| | - Mi Zhou
- Department of Nutrition and Health Sciences, University of Nebraska, Lincoln, Nebraska, USA
| | - Zhenhua Liu
- Department of Nutrition and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - Young-Cheul Kim
- Department of Nutrition and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - Jaekwon Lee
- Department of Biochemistry, University of Nebraska, Lincoln, Nebraska, USA
| | - Soonkyu Chung
- Department of Nutrition and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA; Department of Nutrition and Health Sciences, University of Nebraska, Lincoln, Nebraska, USA.
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Ali NB, Dibley MJ, Islam S, Rahman MM, Raihana S, Bhuiyan SET, Rahman QS, Rahman H, Arifeen SE, Huda TM. Overweight and obesity among urban women with iron deficiency anaemia in Bangladesh. MATERNAL AND CHILD NUTRITION 2020; 17:e13102. [PMID: 33111455 PMCID: PMC7988850 DOI: 10.1111/mcn.13102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/29/2020] [Accepted: 09/29/2020] [Indexed: 01/17/2023]
Abstract
In this study, we aimed to determine the prevalence and factors associated with overweight and obesity among nonpregnant and nonlactating (NPNL) women of reproductive age with iron deficiency anaemia (IDA) in urban Bangladesh. We obtained data from the baseline assessment of a randomized control trial conducted among 525 women of reproductive age (18–49 years) with IDA (Hb < 12 gdl−1 and serum ferritin <30 μg L−1). The study was carried out in Mirpur, Dhaka, Bangladesh, between December 2017 and January 2019. We collected information on women's socio‐demographic characteristics and anthropometry. Body mass index (BMI) was calculated using the following formula: weight in kilograms per height in square metres. BMI ≥ 25–29.9 kg m−2 was considered as overweight, whereas BMI ≥ 30 kg m−2 as obese. A multivariable logistic regression model was used to ascertain the risk factors of overweight and obesity. The prevalence of overweight and obesity was 29.9% (95% CI: 26.0–34.0) and 13.1% (95% CI: 10.4–16.3), respectively. The combined prevalence of overweight and obesity was 43.0% (95% CI: 38.7–47.4). The multivariable analysis showed married women (aOR: 4.4; CI: 1.8–11.1), women aged 30–49 years (aOR: 7.6; CI: 2.4–24.1), unemployed women (aOR 1.5; CI: 1.0–2.4) and women from the wealthier households (aOR 3.9; CI: 2.3–6.8) had the highest risk of being overweight and obese compared with their counterparts. Both age and household wealth statuses showed dose–response relationships. Combination of overweight and obesity with IDA poses a particular challenge for public health interventions. The policymakers should consider what new interventions and policy initiatives are needed to address this combination of overweight and obesity with IDA.
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Affiliation(s)
- Nazia Binte Ali
- Maternal and Child Health Division (MCHD), icddr,b, Dhaka, Bangladesh
| | - Michael J Dibley
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Sajia Islam
- Maternal and Child Health Division (MCHD), icddr,b, Dhaka, Bangladesh
| | | | - Shahreen Raihana
- Maternal and Child Health Division (MCHD), icddr,b, Dhaka, Bangladesh.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Hafizur Rahman
- Maternal and Child Health Division (MCHD), icddr,b, Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division (MCHD), icddr,b, Dhaka, Bangladesh
| | - Tanvir M Huda
- Maternal and Child Health Division (MCHD), icddr,b, Dhaka, Bangladesh.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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Estimation of the risk of fibrosis in children with nonalcoholic fatty liver disease. Clin Exp Hepatol 2020; 6:220-227. [PMID: 33145428 PMCID: PMC7592087 DOI: 10.5114/ceh.2020.99515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/29/2020] [Indexed: 01/02/2023] Open
Abstract
Aim of the study Assessment of liver fibrosis as a predictive factor of liver-related mortality in children with nonalcoholic fatty liver disease (NAFLD) is crucial. This study aims to estimate the risk of fibrosis using noninvasive markers. Material and methods The study group of 49 children with NAFLD (age range 3-16, mean 10.51 ±3.18 years) was created. The diagnosis was based on clinical picture, abdominal ultrasound, and laboratory tests; four children underwent liver biopsy. Then homeostatic model assessment (HOMA-IR) and noninvasive hepatic fibrosis scores were calculated, and patients were divided into four groups depending on body mass index (BMI, obese vs. lean) and aminotransferases. Results 71.43% of patients were obese, and 14.29% were overweight. We found that overweight children had lower mean corpuscular volume (MCV) than lean patients. In a group of patients with a high risk of fibrosis or significant fibrosis due to pediatric NAFLD fibrosis score (PNFS), higher alanine aminotransferase (ALT) to platelet ratio (APRI) values were observed. The highest values of APRI were found in a group of lean patients with elevated aminotransferases and the highest value of PNFS – among obese patients with elevated aminotransferases. A strong significant correlation between APRI and PNFS was found (r = 0.88). Conclusions Apart from aminotransferase activity, complete blood count should be assessed looking for lower MCV caused by iron deficiency. In contrast to FIB-4 (fibrosis score), PNFS and APRI proved to be more accurate in our group. PNFS seems to be appropriate to evaluate fibrosis in a noninvasive diagnostic algorithm.
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38
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Jamil O, Gonzalez-Heredia R, Quadri P, Hassan C, Masrur M, Berger R, Bernstein K, Sanchez-Johnsen L. Micronutrient Deficiencies in Laparoscopic Sleeve Gastrectomy. Nutrients 2020; 12:nu12092896. [PMID: 32971950 PMCID: PMC7551377 DOI: 10.3390/nu12092896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 12/14/2022] Open
Abstract
The purpose of this study was to conduct a literature review to examine micronutrient deficiencies in laparoscopic sleeve gastrectomy. We conducted a literature review using PubMed and Cochrane databases to examine micronutrient deficiencies in SG patients in order to identify trends and find consistency in recommendations. Seventeen articles were identified that met the defined criteria. Iron, vitamin B12 and vitamin D were the primary micronutrients evaluated. Results demonstrate the need for consistent iron and B12 supplementation, in addition to a multivitamin, while vitamin D supplementation may not be necessary. Additional prospective studies to establish a clearer picture of micronutrient deficiencies post-SG are needed.
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Affiliation(s)
- Omar Jamil
- Department of Internal Medicine, University of Chicago, Chicago, IL 60637, USA;
| | - Raquel Gonzalez-Heredia
- Department of Surgery, University of Illinois at Mount Sinai Hospital, Chicago, IL 60609, USA;
| | - Pablo Quadri
- Department of Surgery, Saint Louis University, St. Louis, MO 63104, USA;
| | - Chandra Hassan
- Department of Surgery, Division of General, Minimally Invasive & Robotic Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA; (C.H.); (M.M.)
| | - Mario Masrur
- Department of Surgery, Division of General, Minimally Invasive & Robotic Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA; (C.H.); (M.M.)
| | - Reed Berger
- Departments of Surgery and Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Karen Bernstein
- Department of Pediatrics, Division of Adolescent Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Lisa Sanchez-Johnsen
- Department of Family Medicine, Rush University Medical Center, Chicago, IL 60612, USA
- Correspondence: ; Tel.: +1-312-563-1290
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Rockey DC, Altayar O, Falck-Ytter Y, Kalmaz D. AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia. Gastroenterology 2020; 159:1097-1119. [PMID: 32828801 PMCID: PMC10824166 DOI: 10.1053/j.gastro.2020.06.045] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Don C Rockey
- Digestive Disease Research Center, Medical University of South Carolina, Charleston, South Carolina
| | - Osama Altayar
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | - Yngve Falck-Ytter
- Department of Medicine and Gastroenterology, Case Western Reserve; University; Veterans Affairs Northeast Ohio Health System, Cleveland, Ohio
| | - Denise Kalmaz
- Division of Gastroenterology, University of California, San Diego, California
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Restrepo-Gallego M, Díaz LE, Rondó PHC. Classic and emergent indicators for the assessment of human iron status. Crit Rev Food Sci Nutr 2020; 61:2827-2840. [PMID: 32619106 DOI: 10.1080/10408398.2020.1787326] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Iron deficiency is the leading cause of anemia, a significant global public health problem. Different methods exist for assessing iron nutritional status, including laboratory tests that focus on storage, transportation, and iron functional compartment parameters. Classical markers such as bone marrow, serum iron, ferritin, hemoglobin, erythrocyte parameters, transferrin, transferrin receptors, and zinc protoporphyrin are discussed in this review. Additional parameters calculated from these indicators, including transferrin saturation, ferritin index and Thomas plot, and some emergent parameters such as hepcidin, erythroferrone, and low hemoglobin density are also discussed. There is no a single indicator for assessing iron nutritional status. Therefore, the use of more than one indicator may be the best practice to obtain the correct diagnosis, also considering the influence of inflammation/infection on many of these indicators. The constant validation of the current parameters, the improvement of assessment methods, and the identification of new indicators will be the key to refine the assessment of iron nutritional status and the right choice of treatment for its improvement.
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Affiliation(s)
| | - Luis E Díaz
- Doctorate Program in Bioscience, La Sabana University, Chía, Colombia
| | - Patrícia H C Rondó
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
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Lyons J, van der Linden EL, Meeks K, Beune E, Smeeth L, Bahendeka S, Spranger J, Klipstein-Grobusch K, Mockenhaupt FP, Danquah I, Agyemang C. Inverse Association between Iron Deficiency and Glycated Hemoglobin Levels in Ghanaian Adults-the RODAM Study. J Nutr 2020; 150:1899-1908. [PMID: 32433726 PMCID: PMC7330469 DOI: 10.1093/jn/nxaa109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/10/2020] [Accepted: 03/27/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Glycated hemoglobin (HbA1c) is often used to diagnose type 2 diabetes (T2D), but studies show that iron deficiency (ID) is associated with elevated HbA1c in the absence of hyperglycemia. It is unknown whether ID prevalence varies between sub-Saharan African populations living in different locations and whether ID influences HbA1c levels in these populations. OBJECTIVES We assessed the prevalence of ID among Ghanaian migrants in Europe and nonmigrant Ghanaians, and the influence of ID on HbA1c categories among Ghanaians without T2D. METHODS We used the database from the cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study. This contained data on 3377 Ghanaian men and women aged 25-70 y living in urban and rural Ghana and Ghanaian migrants living in Amsterdam, London, and Berlin. ID was defined as ferritin < 15 ng/mL or, if C-reactive protein was ≥5 mg/mL, as ferritin < 30 ng/mL according to the WHO. We used binary logistic regression to assess differences in ID between sites and its association with clinically defined HbA1c categories (<5.5%, ≥5.5% to <6.5%, ≥6.5%). Men and women were analyzed separately. RESULTS The prevalence of ID was higher in migrant [28.4%; adjusted OR (aOR): 3.08; 95% CI: 2.04, 4.65)] and urban (23.2%; aOR: 2.37; 95% CI: 1.56, 3.59) women than in rural women (11.9%). Among women, ID was associated with higher odds of HbA1c ≥ 5.5% to <6.5% in the absence of hyperglycemia (aOR: 1.43; 95% CI: 1.08, 1.87). This association was not found in men. CONCLUSIONS Further research is needed to identify factors underlying the high prevalence of ID among urban and migrant Ghanaian women, and the association of ID with HbA1c ≥ 5.5% to <6.5% in women. In addition, our study reinforces the need to consider iron concentrations if interpreting HbA1c among African populations.
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Affiliation(s)
- Julia Lyons
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Eva L van der Linden
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Karlijn Meeks
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, NIH, Bethesda, MD, USA
| | - Erik Beune
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Joachim Spranger
- Department of Endocrinology and Metabolism, Charité University Hospital Berlin, Berlin, Germany
- Center for Cardiovascular Research, Charité University Hospital Berlin, Berlin, Germany
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité University Hospital Berlin, Berlin, Germany
| | - Ina Danquah
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Hospital Berlin, corporate member of Free University Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Charles Agyemang
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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42
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Anemia of Chronic Diseases: Wider Diagnostics-Better Treatment? Nutrients 2020; 12:nu12061784. [PMID: 32560029 PMCID: PMC7353365 DOI: 10.3390/nu12061784] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/29/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022] Open
Abstract
Anemia of chronic diseases is a condition that accompanies a specific underlying disease, in which there is a decrease in hemoglobin, hematocrit and erythrocyte counts due to a complex process, usually initiated by cellular immunity mechanisms and pro-inflammatory cytokines and hepcidin. This is the second most common type of anemia after iron deficiency anemia in the world. Its severity generally correlates with the severity of the underlying disease. This disease most often coexists with chronic inflammation, autoimmune diseases, cancer, and kidney failure. Before starting treatment, one should undertake in-depth diagnostics, which includes not only assessment of complete blood count and biochemical parameters, but also severity of the underlying disease. The differential diagnosis of anemia of chronic diseases is primarily based on the exclusion of other types of anemia, in particular iron deficiency. The main features of anemia of chronic diseases include mild to moderate lowering of hemoglobin level, decreased percentage of reticulocyte count, low iron and transferrin concentration, but increased ferritin. Due to the increasingly better knowledge of the pathomechanism of chronic diseases and cancer biology, the diagnosis of this anemia is constantly expanding with new biochemical indicators. These include: the concentration of other hematopoietic factors (folic acid, vitamin B12), hepcidin, creatinine and erythropoietin. The basic form of treatment of anemia of chronic diseases remains supplementation with iron, folic acid and vitamin B12 as well as a diet rich in the above-mentioned hematopoietic factors. The route of administration (oral, intramuscular or intravenous) requires careful consideration of the benefits and possible side effects, and assessment of the patient’s clinical status. New methods of treating both the underlying disease and anemia are raising hopes. The novel methods are associated not only with supplementing deficiencies, but also with the administration of drugs molecularly targeted to specific proteins or receptors involved in the development of anemia of chronic diseases.
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Haidari F, Abiri B, Haghighizadeh MH, Kayedani GA, Birgani NK. Association of Hematological Parameters with Obesity- Induced Inflammation Among Young Females in Ahvaz, South-West of Iran. Int J Prev Med 2020; 11:55. [PMID: 32577185 PMCID: PMC7297432 DOI: 10.4103/ijpvm.ijpvm_35_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/31/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Iron deficiency is prevalent in overweight and obese individuals and may be induced by adiposity-related inflammation that affect iron metabolism. Objective: The objective of this study was to investigate the relationship between hematological parameters and obesity-induced inflammation among young females. Methods: A total of 170 young women (aged between 18-35 years) participated in this cross-sectional study. Obesity was assessed by BMI (body mass index), WHR (waist to hip ratio), and body fat percentage. Inflammatory and hematological parameters including hs-CRP (high-sensitivity C-reactive protein), serum Fe, hemoglobin, ferritin, transferrin, TIBC (total iron binding capacity) were measured. Dietary intakes of some nutrients (total iron, proteins, calcium, and vitamin C) were assessed according to BMI, WHR and fat mass categories. Results: Serum iron were negatively correlated with BMI (P = 0.045, r = −0.154) and hs-CRP (P = 0.032, r = −0.165). Hemoglobin were also negatively correlated with BMI (P = 0.043, r = −0.155). A significant correlation was also shown between WHR with transferrin (P = 0.034, r = 0.163) and TIBC levels (P = 0.035, r = 0.162), hs-CRP was positively correlated with BMI (P = 0.014, r = 0.183), WHR (P = 0.009, r = 0.202) and body fat percentage (P = 0.037, r = 0.353). Dietary intakes did not differ significantly among BMI, WHR and fat mass categories (P > 0.05). Conclusions: Obesity-induced inflammation, regardless of dietary intake of iron, can lead to iron deficiency. Therefore, weight control, especially in obese subjects is necessary to prevent iron deficiency and anemia.
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Affiliation(s)
- Fatemeh Haidari
- Department of Nutrition, Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Behnaz Abiri
- Department of Nutrition, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad-Hossein Haghighizadeh
- Department of Biostatistics and Epidemiology, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Gholam A Kayedani
- Department of Laboratory Sciences, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Negar K Birgani
- Department of Nutrition, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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44
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Han Z, Xu Z, Chen L, Ye D, Yu Y, Zhang Y, Cao Y, Djibril B, Guo X, Gao X, Zhang W, Yu M, Liu S, Yan G, Jin M, Huang Q, Wang X, Hua B, Feng C, Yang F, Ma W, Liu Y. Iron overload inhibits self-renewal of human pluripotent stem cells via DNA damage and generation of reactive oxygen species. FEBS Open Bio 2020; 10:726-733. [PMID: 32053740 PMCID: PMC7193162 DOI: 10.1002/2211-5463.12811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/19/2020] [Accepted: 02/12/2020] [Indexed: 12/17/2022] Open
Abstract
Iron overload affects the cell cycle of various cell types, but the effect of iron overload on human pluripotent stem cells has not yet been reported. Here, we show that the proliferation capacities of human embryonic stem cells (hESCs) and human induced pluripotent stem cells (hiPSCs) were significantly inhibited by ferric ammonium citrate (FAC) in a concentration‐dependent manner. In addition, deferoxamine protected hESCs/hiPSCs against FAC‐induced cell‐cycle arrest. However, iron overload did not affect pluripotency in hESCs/hiPSCs. Further, treatment of hiPSCs with FAC resulted in excess reactive oxygen species production and DNA damage. Collectively, our findings provide new insights into the role of iron homeostasis in the maintenance of self‐renewal in human pluripotent stem cells.
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Affiliation(s)
- Zhenbo Han
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Zihang Xu
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Lei Chen
- Beijing Ruihua Heart Rehabilitation Research Center, China
| | - Danyu Ye
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Yang Yu
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Ying Zhang
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Yang Cao
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Bamba Djibril
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Xiaofei Guo
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Xinlu Gao
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Wenwen Zhang
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Meixi Yu
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Shenzhen Liu
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Gege Yan
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Mengyu Jin
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Qi Huang
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Xiuxiu Wang
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Bingjie Hua
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Chao Feng
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Fan Yang
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Wenya Ma
- Department of Pharmacy, The Affiliated Second Hospital, Harbin Medical University, Harbin, China.,Department of Pharmacology (The Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Yu Liu
- Department of Clinical Laboratory, Fourth Affiliated Hospital of Harbin Medical University, China
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Vega-Sánchez R, Tolentino-Dolores MC, Cerezo-Rodríguez B, Chehaibar-Besil G, Flores-Quijano ME. Erythropoiesis and Red Cell Indices Undergo Adjustments during Pregnancy in Response to Maternal Body Size but not Inflammation. Nutrients 2020; 12:E975. [PMID: 32244712 PMCID: PMC7230988 DOI: 10.3390/nu12040975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 12/17/2022] Open
Abstract
During human pregnancy, iron requirements gradually increase, leading to higher amounts of erythropoietin (EPO) and reticulocytes, and changes in erythrocyte size and density. Women with pregestational obesity experience "obesity hypoferremia" during pregnancy, which alters iron homeostasis. In this study we aimed to describe the relationship between EPO and iron nutrition status during nonanemic pregnancy, and to explore whether obesity and inflammation influence erythropoiesis and red cell indices. We conducted a secondary analysis of a cohort followed throughout pregnancy. Participants were nonanemic women assigned to two study groups based on pregestational body mass index (pgBMI): adequate weight (AW, n = 53) or obesity (Ob, n = 40). All received a multivitamin supplement. At gestational ages (GA) 13, 21, 28 and 34, we measured hemoglobin and red cell indices with an ACT-5DIFF hematology counter, and reticulocyte percentage by manual cell counting. EPO, interleukin (IL-6) and markers of iron status, i.e., hepcidin, serum transferrin receptor (sTfr) and ferritin, were measured by ELISA. Bivariate correlations showed that EPO was positively associated with pgBMI, GA, sTfr and IL-6, but negatively associated with hepcidin, ferritin and hemoglobin, and unrelated to iron intake. Generalized linear models adjusted for confounding factors showed that EPO and erythrocyte concentrations were significantly higher in women in the Ob group, while mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and red cell distribution width (RDW) were lower; reticulocytes and mean corpuscular hemoglobin concentration (MCHC) were not different. Differences were not altered when controlling for inflammation (IL-6). These changes suggest that, in addition to altering iron metabolism, a larger maternal body size during pregnancy results in higher erythropoiesis without increasing hemoglobin, which is exhibited in the latter being distributed among more and smaller erythrocytes.
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Affiliation(s)
- Rodrigo Vega-Sánchez
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México CP. 11000, Mexico; (R.V.-S.); (M.C.T.-D.)
| | - Mari Cruz Tolentino-Dolores
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México CP. 11000, Mexico; (R.V.-S.); (M.C.T.-D.)
| | - Blanca Cerezo-Rodríguez
- Departamento de Ciencias de la Salud, Universidad del Valle de México, Coyoacán, Ciudad de México CP. 04910, Mexico;
| | - Georgette Chehaibar-Besil
- Departamento de Salud, Universidad Iberoamericana, Lomas de Santa Fe, Ciudad de México CP. 01219, Mexico;
| | - María Eugenia Flores-Quijano
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México CP. 11000, Mexico; (R.V.-S.); (M.C.T.-D.)
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46
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Means RT. Iron Deficiency and Iron Deficiency Anemia: Implications and Impact in Pregnancy, Fetal Development, and Early Childhood Parameters. Nutrients 2020; 12:E447. [PMID: 32053933 PMCID: PMC7071168 DOI: 10.3390/nu12020447] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 12/16/2022] Open
Abstract
A normal pregnancy consumes 500-800 mg of iron from the mother. Premenopausal women have a high incidence of marginal iron stores or iron deficiency (ID), with or without anemia, particularly in the less developed world. Although pregnancy is associated with a "physiologic" anemia largely related to maternal volume expansion; it is paradoxically associated with an increase in erythrocyte production and erythrocyte mass/kg. ID is a limiting factor for this erythrocyte mass expansion and can contribute to adverse pregnancy outcomes. This review summarizes erythrocyte and iron balance observed in pregnancy; its implications and impact on mother and child; and provides an overview of approaches to the recognition of ID in pregnancy and its management, including clinically relevant questions for further investigation.
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Affiliation(s)
- Robert T. Means
- Departments of Internal Medicine, Medical Education, and Pathology, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA; ; Tel.: +1-423-439-6499; Fax: +1-423-439-6470
- Internal Medicine, Building 2/Room 109, Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
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47
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Haider BA, Spiegelman D, Hertzmark E, Sando D, Duggan C, Makubi A, Sudfeld C, Aris E, Chalamilla GE, Fawzi WW. Anemia, Iron Deficiency, and Iron Supplementation in Relation to Mortality among HIV-Infected Patients Receiving Highly Active Antiretroviral Therapy in Tanzania. Am J Trop Med Hyg 2020; 100:1512-1520. [PMID: 31017077 DOI: 10.4269/ajtmh.18-0096] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Anemia in HIV-infected patients improves with highly active antiretroviral therapy (HAART); however, it may still be associated with mortality among patients receiving treatment. We examined the associations of anemia severity and iron deficiency anemia (IDA) at HAART initiation and during monthly prospective follow-up with mortality among 40,657 adult HIV-infected patients receiving HAART in Dar es Salaam, Tanzania. Proportional hazards models were used to examine the associations of anemia severity and IDA at HAART initiation and during follow-up with mortality. A total of 6,261 deaths were reported. Anemia severity at HAART initiation and during follow-up was associated with an increasing risk of mortality (trend tests P < 0.001). There was significantly higher mortality risk associated with IDA at HAART initiation and during follow-up versus no anemia or iron deficiency (both P < 0.001). These associations differed significantly by gender, body mass index, and iron supplement use (all interaction test P < 0.001). The magnitude of association was stronger among men. Mortality risk with severe anemia was 13 times greater versus no anemia among obese patients, whereas it was only two times greater among underweight patients. Higher mortality risk was observed among iron supplement users, irrespective of anemia severity. Anemia and IDA were significantly associated with a higher mortality risk in patients receiving HAART. Iron supplementation indicated an increased mortality risk, and its role in HIV infections should be examined in future studies. Given the low cost of assessing anemia, it can be used frequently to identify high-risk patients in resource-limited settings.
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Affiliation(s)
- Batool A Haider
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.,Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| | - Donna Spiegelman
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts.,Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts.,Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.,Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| | - Ellen Hertzmark
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - David Sando
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Christopher Duggan
- Center for Nutrition, Boston Children's Hospital, Boston, Massachusetts.,Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| | - Abel Makubi
- School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.,Management and Development for Health, Dar es Salaam, Tanzania
| | - Christopher Sudfeld
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts
| | - Eric Aris
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Guerino E Chalamilla
- Management and Development for Health, Dar es Salaam, Tanzania.,Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts.,Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts.,Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
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48
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Zhu Y, Liu X, Li N, Cui L, Zhang X, Liu X, Yu K, Chen Y, Wan Z, Yu Z. Association Between Iron Status and Risk of Chronic Kidney Disease in Chinese Adults. Front Med (Lausanne) 2020; 6:303. [PMID: 31998726 PMCID: PMC6961557 DOI: 10.3389/fmed.2019.00303] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/02/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Even though it is well-known that iron deficiency is the result of chronic kidney disease (CKD), whether iron will affect kidney function and disease in the general population is not clear. We thus conducted a nationwide cross-sectional study using data from the China Health and Nutrition Survey (CHNS) to assess the relationship of iron status with estimated glomerular filtration rate (eGFR) and CKD among general adults. Methods: A total of 8,339 adults from the China Health and Nutrition Survey in the wave of 2009 were included to assess the association between iron status and eGFR/CKD. Serum ferritin (SF), transferrin, soluble transferrin receptor (sTfR), and hemoglobin (Hb) were measured. The relationship of iron status and eGFR was evaluated by using multi-variable linear regression model. The effect of iron status on the odds of CKD was calculated by logistic regression model. Results: For the association between iron status and eGFR, every 100 μg/L increase in SF was correlated with 0.26 ml/min per 1.73 m2 (95% CI: 0.08-0.44) decrease in eGFR, and every 5 mg/L increase in sTfR was associated with a decrease of 6.00 ml/min per 1.73 m2 (95% CI: 3.79-8.21) in eGFR. There were no significant associations between Hb or transferrin with eGFR. For the association between iron status and CKD, every 5 g/L increase in sTfR was associated with an odds ratio of 3.72 (95% CI: 2.16-6.13) for CKD. The concentrations of Hb were associated with the odds of CKD in a U-shaped manner, with the lowest risk in the Hb range of 136-141 g/L. There was a positive correlation between SF concentration and CKD prevalence but not in a dose-response manner. The odds of CKD for participants in the highest tertile increased by 28% (98% CI: 1-63%) compared with those in the lowest tertile. Conclusion: The concentration of SF and sTfR was positively correlated with the odds of CKD, and Hb was associated with the odds of CKD in a U-shaped manner. Further large prospective researches are warranted to confirm these findings.
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Affiliation(s)
- Yongjian Zhu
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaozhuan Liu
- College of Food Science and Technology, Henan Agriculture University, Zhengzhou, China
| | - Ning Li
- College of Food Science and Technology, Henan Agriculture University, Zhengzhou, China
| | - Lingling Cui
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaofeng Zhang
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xinxin Liu
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Kailun Yu
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yao Chen
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zhongxiao Wan
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zengli Yu
- School of Public Health, Zhengzhou University, Zhengzhou, China
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49
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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: 0.4] [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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50
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Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Ann N Y Acad Sci 2019; 1450:15-31. [PMID: 31008520 PMCID: PMC6697587 DOI: 10.1111/nyas.14092] [Citation(s) in RCA: 379] [Impact Index Per Article: 63.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/04/2019] [Accepted: 03/18/2019] [Indexed: 12/14/2022]
Abstract
Anemia affects a third of the world's population and contributes to increased morbidity and mortality, decreased work productivity, and impaired neurological development. Understanding anemia's varied and complex etiology is crucial for developing effective interventions that address the context-specific causes of anemia and for monitoring anemia control programs. We outline definitions and classifications of anemia, describe the biological mechanisms through which anemia develops, and review the variety of conditions that contribute to anemia development. We emphasize the risk factors most prevalent in low- and middle-income countries, including nutritional deficiencies, infection/inflammation, and genetic hemoglobin disorders. Recent work has furthered our understanding of anemia's complex etiology, including the proportion of anemia caused by iron deficiency (ID) and the role of inflammation and infection. Accumulating evidence indicates that the proportion of anemia due to ID differs by population group, geographical setting, infectious disease burden, and the prevalence of other anemia causes. Further research is needed to explore the role of additional nutritional deficiencies, the contribution of infectious and chronic disease, as well as the importance of genetic hemoglobin disorders in certain populations.
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Affiliation(s)
| | - Parminder S. Suchdev
- Department of Pediatrics, Emory University, Atlanta, Georgia
- Emory Global Health Institute, Emory University, Atlanta, Georgia
- Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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