Association between obesity and iron deficiency (Review)

Alshwaiyat,Naseem Mohammad; Ahmad,Aryati; Wan Hassan,Wan Mohd Razin; Al‑Jamal,Hamid Ali Nagi

doi:10.3892/etm.2021.10703

Association between obesity and iron deficiency (Review)

Authors:
- Naseem Mohammad Alshwaiyat
- Aryati Ahmad
- Wan Mohd Razin Wan Hassan
- Hamid Ali Nagi Al‑Jamal
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Affiliations: School of Nutrition and Dietetics, Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, Kuala Terengganu, Terengganu 21300, Malaysia, Faculty of Medicine, Universiti Sultan Zainal Abidin, Medical Campus, Kuala Terengganu, Terengganu 20400, Malaysia, School of Biomedicine, Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, Kuala Terengganu, Terengganu 21300, Malaysia
Published online on: September 7, 2021 https://doi.org/10.3892/etm.2021.10703
Article Number: 1268
Copyright: © Alshwaiyat et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Obesity is a risk factor for several comorbidities and complications, including iron deficiency anemia. Iron deficiency anemia is a serious global public health problem, with a worldwide prevalence. The high prevalence of obesity in combination with iron deficiency incidence observed in different age and sex categories suggests an association between obesity and iron status. Obesity may disrupt iron homeostasis, resulting in iron deficiency anemia. The association between obesity and iron deficiency may be due to increased hepcidin levels mediated by chronic inflammation. Hepcidin is a small peptide hormone that functions as a negative regulator of intestinal iron absorption. Significant body weight loss in overweight and obese individuals decreases chronic inflammation and serum hepcidin levels, resulting in improved iron status due to increased iron absorption. However, further randomized controlled trials are required to confirm this effect.

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1	Chooi YC, Ding C and Magkos F: The epidemiology of obesity. Metabolism. 92:6–10. 2019.PubMed/NCBI View Article : Google Scholar
2	Cappellini MD, Musallam KM and Taher AT: Iron deficiency anaemia revisited. J Intern Med. 287:153–170. 2020.PubMed/NCBI View Article : Google Scholar
3	Gregg EW and Shaw JE: Global health effects of overweight and obesity. N Engl J Med. 377:80–81. 2017.PubMed/NCBI View Article : Google Scholar
4	Camaschella C: New insights into iron deficiency and iron deficiency anemia. Blood Rev. 31:225–233. 2017.PubMed/NCBI View Article : Google Scholar
5	Percy L, Mansour D and Fraser I: Iron deficiency and iron deficiency anaemia in women. Best Pract Res Clin Obstet Gynaecol. 40:55–67. 2017.PubMed/NCBI View Article : Google Scholar
6	Halib H, Muda WM, Dam PC and Mohamed HJ: Prevalence of iron deficiency and its associated risk factors among primary school children in Kelantan. J Fundam Appl Sci. 9:397–412. 2017.
7	Bah F, Harith S and Farisni TN: Food knowledge and practices related to anemic conditions among pregnant women in Kuala Terengganu, Malaysia. Indonesian J Pub Health. 7:19–28. 2020.
8	Zani H, Shahril MR, Wan Abdul Rahman WN, Mukhali HB, Ismail R and Mohd Yusop Y: Anaemia-related knowledge amongst pregnant women in Kuala Terengganu, Malaysia. Asian J Med Biomed. 4:1–9. 2020.
9	Zhao L, Zhang X, Shen Y, Fang X, Wang Y and Wang F: Obesity and iron deficiency: A quantitative meta-analysis. Obes Rev. 16:1081–1093. 2015.PubMed/NCBI View Article : Google Scholar
10	Pinhas-Hamiel O, Newfield RS, Koren I, Agmon A, Lilos P and Phillip M: Greater prevalence of iron deficiency in overweight and obese children and adolescents. Int J Obes Relat Metab Disord. 27:416–418. 2003.PubMed/NCBI View Article : Google Scholar
11	Nead KG, Halterman JS, Kaczorowski JM, Auinger P and Weitzman M: Overweight children and adolescents: A risk group for iron deficiency. Pediatrics. 114:104–108. 2004.PubMed/NCBI View Article : Google Scholar
12	Yanoff LB, Menzie CM, Denkinger B, Sebring NG, McHugh T, Remaley AT and Yanovski JA: Inflammation and iron deficiency in the hypoferremia of obesity. Int J Obes (Lond). 31:1412–1419. 2007.PubMed/NCBI View Article : Google Scholar
13	Kaner G, Pekcan G, Pamuk G, Pamuk B and Amoutzopoulos B: Is iron deficiency related with increased body weight? A cross-sectional study. Prog Nutr. 18:102–110. 2016.
14	Huang YF, Tok TS, Lu CL, Ko HC, Chen MY and Chen SC: Relationship between being overweight and iron deficiency in adolescents. Pediatr Neonatol. 56:386–392. 2015.PubMed/NCBI View Article : Google Scholar
15	Egwurugwu JN, Ekweogu CN, Nwamkpa P, Ohamaeme MC, Ugwuezumba PC and Ogunnaya FU: Association between serum phosphate and iron concentrations with body mass index in a population of adults in Orlu, Imo State, Nigeria. Niger J Exp Clin Biosci. 6:1–7. 2018.
16	D'angelo G: Role of hepcidin in the pathophysiology and diagnosis of anemia. Blood Res. 48:10–15. 2013.PubMed/NCBI View Article : Google Scholar
17	Aigner E, Feldman A and Datz C: Obesity as an emerging risk factor for iron deficiency. Nutrients. 6:3587–3600. 2014.PubMed/NCBI View Article : Google Scholar
18	Al-Fartusie FS and Mohssan SN: Essential trace elements and their vital roles in human body. Indian J Adv Chem Sci. 5:127–136. 2017.
19	Anderson GJ and Frazer DM: Current understanding of iron homeostasis. Am J Clin Nutr. 106 (Suppl 6):1559S–1566S. 2017.PubMed/NCBI View Article : Google Scholar
20	Milto IV, Suhodolo IV, Prokopieva VD and Klimenteva TK: Molecular and cellular bases of iron metabolism in humans. Biochemistry (Mosc). 81:549–564. 2016.PubMed/NCBI View Article : Google Scholar
21	Abbaspour N, Hurrell R and Kelishadi R: Review on iron and its importance for human health. J Res Med Sci. 19:164–174. 2014.PubMed/NCBI
22	Dev S and Babitt JL: Overview of iron metabolism in health and disease. Hemodial Int. 21 (Suppl 1):S6–S20. 2017.PubMed/NCBI View Article : Google Scholar
23	Fuqua BK, Vulpe CD and Anderson GJ: Intestinal iron absorption. J Trace Elem Med Biol. 26:115–119. 2012.PubMed/NCBI View Article : Google Scholar
24	Morgan EH and Oates PS: Mechanisms and regulation of intestinal iron absorption. Blood Cells Mol Dis. 29:384–399. 2002.PubMed/NCBI View Article : Google Scholar
25	Handelman GJ and Levin NW: Iron and anemia in human biology: A review of mechanisms. Heart Fail Rev. 13:393–404. 2008.PubMed/NCBI View Article : Google Scholar
26	Ganz T and Nemeth E: Hepcidin and iron homeostasis. Biochim Biophys Acta. 1823:1434–1443. 2012.PubMed/NCBI View Article : Google Scholar
27	Reichert CO, da Cunha J, Levy D, Maselli LM, Bydlowski SP and Spada C: Hepcidin: Homeostasis and diseases related to iron metabolism. Acta Haematol. 137:220–236. 2017.PubMed/NCBI View Article : Google Scholar
28	Ganz T: Hepcidin-a regulator of intestinal iron absorption and iron recycling by macrophages. Best Pract Res Clin Haematol. 18:171–182. 2005.PubMed/NCBI View Article : Google Scholar
29	Sangkhae V and Nemeth E: Regulation of the iron homeostatic hormone hepcidin. Adv Nutr. 8:126–136. 2017.PubMed/NCBI View Article : Google Scholar
30	Chaston T, Chung B, Mascarenhas M, Marks J, Patel B, Srai SK and Sharp P: Evidence for differential effects of hepcidin in macrophages and intestinal epithelial cells. Gut. 57:374–382. 2008.PubMed/NCBI View Article : Google Scholar
31	Ellulu MS, Patimah I, Khaza'ai H, Rahmat A and Abed Y: Obesity and inflammation: The linking mechanism and the complications. Arch Med Sci. 13:851–863. 2017.PubMed/NCBI View Article : Google Scholar
32	Fontana L, Eagon JC, Trujillo ME, Scherer PE and Klein S: Visceral fat adipokine secretion is associated with systemic inflammation in obese humans. Diabetes. 56:1010–1013. 2007.PubMed/NCBI View Article : Google Scholar
33	Coimbra S, Catarino C and Santos-Silva A: The role of adipocytes in the modulation of iron metabolism in obesity. Obes Rev. 14:771–779. 2013.PubMed/NCBI View Article : Google Scholar
34	Nemeth E, Rivera S, Gabayan V, Keller C, Taudorf S, Pedersen BK and Ganz T: IL-6 mediates hypoferremia of inflammation by inducing the synthesis of the iron regulatory hormone hepcidin. J Clin Invest. 113:1271–1276. 2004.PubMed/NCBI View Article : Google Scholar
35	Wrighting DM and Andrews NC: Interleukin-6 induces hepcidin expression through STAT3. Blood. 108:3204–3209. 2006.PubMed/NCBI View Article : Google Scholar
36	Stoffel NU, El-Mallah C, Herter-Aeberli I, Bissani N, Wehbe N, Obeid O and Zimmermann MB: The effect of central obesity on inflammation, hepcidin, and iron metabolism in young women. Int J Obes (Lond). 44:1291–1300. 2020.PubMed/NCBI View Article : Google Scholar
37	Gozzelino R and Arosio P: Iron homeostasis in health and disease. Int J Mol Sci. 17(130)2016.PubMed/NCBI View Article : Google Scholar
38	Schmidt PJ: Regulation of iron metabolism by hepcidin under conditions of inflammation. J Biol Chem. 290:18975–18983. 2015.PubMed/NCBI View Article : Google Scholar
39	Weiss G: Iron metabolism in the anemia of chronic disease. Biochim Biophys Acta. 1790:682–693. 2009.PubMed/NCBI View Article : Google Scholar
40	David V, Martin A, Isakova T, Spaulding C, Qi L, Ramirez V, Zumbrennen-Bullough KB, Sun CC, Lin HY, Babitt JL and Wolf M: Inflammation and functional iron deficiency regulate fibroblast growth factor 23 production. Kidney Int. 89:135–146. 2016.PubMed/NCBI View Article : Google Scholar
41	Shimada T, Hasegawa H, Yamazaki Y, Muto T, Hino R, Takeuchi Y, Fujita T, Nakahara K, Fukumoto S and Yamashita T: FGF-23 is a potent regulator of vitamin D metabolism and phosphate homeostasis. J Bone Miner Res. 19:429–435. 2004.PubMed/NCBI View Article : Google Scholar
42	Agoro R, Park MY, Le Henaff C, Jankauskas S, Gaias A, Chen G, Mohammadi M and Sitara D: C-FGF23 peptide alleviates hypoferremia during acute inflammation. Haematologica. 106:391–403. 2021.PubMed/NCBI View Article : Google Scholar
43	Agoro R, Montagna A, Goetz R, Aligbe O, Singh G, Coe LM, Mohammadi M, Rivella S and Sitara D: Inhibition of fibroblast growth factor 23 (FGF23) signaling rescues renal anemia. FASEB J. 32:3752–3764. 2018.PubMed/NCBI View Article : Google Scholar
44	Wenzel B, Stults H and Mayer J: Hypoferraemia in obese adolescents. Lancet. 2:327–328. 1962.PubMed/NCBI View Article : Google Scholar
45	Lecube A, Carrera A, Losada E, Hernández C, Simó R and Mesa J: Iron deficiency in obese postmenopausal women. Obesity (Silver Spring). 14:1724–1730. 2006.PubMed/NCBI View Article : Google Scholar
46	Menzie CM, Yanoff LB, Denkinger BI, McHugh T, Sebring NG, Calis KA and Yanovski JA: Obesity-related hypoferremia is not explained by differences in reported intake of heme and nonheme iron or intake of dietary factors that can affect iron absorption. J Am Diet Assoc. 108:145–148. 2008.PubMed/NCBI View Article : Google Scholar
47	Aderibigbe OR, Pisa PT, Vorster HH and Kruger SH: The relationship between iron status and adiposity in women from developing countries: A review. Crit Rev Food Sci Nutr. 54:553–560. 2014.PubMed/NCBI View Article : Google Scholar
48	Paknahad Z, Mahboob S, Omidvar N, Ebrahimi M, Ostadrahimi A and Afiatmilani SH: Body Mass Index and its relationship with haematological indices in Iranian women. Pak J Nutr. 7:377–380. 2008.
49	Ettyang GA, van Marken Lichtenbelt WD, Oloo A and Saris WH: Serum retinol, iron status and body composition of lactating women in Nandi, Kenya. Ann Nutr Metab. 47:276–283. 2003.PubMed/NCBI View Article : Google Scholar
50	Famodu AA and Awodu OA: Anthropometric indices as determinants of haemorheological cardiovascular disease risk factors in Nigerian adults living in a semi-urban community. Clin Hemorheol Microcirc. 43:335–344. 2009.PubMed/NCBI View Article : Google Scholar
51	Aderibigbe OR, Pisa PT, Mamabolo RL, Kruger HS, Vorster HH and Kruger A: Iron status and cardiovascular disease risk in black South African women: The PURE study. South African J Clin Nutr. 24:179–185. 2011.
52	Eckhardt CL, Torheim LE, Monterrubio E, Barquera S and Ruel MT: The overlap of overweight and anaemia among women in three countries undergoing the nutrition transition. Eur J Clin Nutr. 62:238–246. 2008.PubMed/NCBI View Article : Google Scholar
53	Kordas K, Fonseca Centeno ZY, Pachón H and Jimenez Soto AZ: Being overweight or obese is associated with lower prevalence of anemia among Colombian women of reproductive age. J Nutr. 143:175–181. 2013.PubMed/NCBI View Article : Google Scholar
54	Cheng HL, Bryant C, Cook R, O'Connor H, Rooney K and Steinbeck K: The relationship between obesity and hypoferraemia in adults: A systematic review. Obes Rev. 13:150–161. 2012.PubMed/NCBI View Article : Google Scholar
55	Zimmermann MB, Zeder C, Muthayya S, Winichagoon P, Chaouki N, Aeberli I and Hurrell RF: Adiposity in women and children from transition countries predicts decreased iron absorption, iron deficiency and a reduced response to iron fortification. Int J Obes (Lond). 32:1098–1104. 2008.PubMed/NCBI View Article : Google Scholar
56	Alam F, Memon AS and Fatima SS: Increased body mass index may lead to hyperferritinemia irrespective of body iron stores. Pak J Med Sci. 31:1521–1526. 2015.PubMed/NCBI View Article : Google Scholar
57	Shekarriz R and Vaziri MM: Iron profile and inflammatory status of overweight and obese women in Sari, North of Iran. Int J Hematol Oncol Stem Cell Res. 11:108–113. 2017.PubMed/NCBI
58	Tussing-Humphreys LM, Nemeth E, Fantuzzi G, Freels S, Guzman G, Holterman AX and Braunschweig C: Elevated systemic hepcidin and iron depletion in obese premenopausal females. Obesity (Silver Spring). 18:1449–1456. 2010.PubMed/NCBI View Article : Google Scholar
59	Abdel Hamed ER, Sallam SF, Hamdy HA, El Shafie AI, El Kassas GM, Khairy SA and Abdelsalam HM: Serum hepcidin level and iron status in a sample of obese Egyptian children. Med Res J. 14:7–11. 2015.
60	Cheng HL, Bryant CE, Rooney KB, Steinbeck KS, Griffin HJ, Petocz P and O'Connor HT: Iron, hepcidin and inflammatory status of young healthy overweight and obese women in Australia. PLoS One. 8(e68675)2013.PubMed/NCBI View Article : Google Scholar
61	Baumgartner J, Smuts CM, Aeberli I, Malan L, Tjalsma H and Zimmermann MB: Overweight impairs efficacy of iron supplementation in iron-deficient South African children: A randomized controlled intervention. Int J Obes (Lond). 37:24–30. 2013.PubMed/NCBI View Article : Google Scholar
62	Teng IC, Tseng SH, Aulia B, Shih CK, Bai CH and Chang JS: Can diet-induced weight loss improve iron homoeostasis in patients with obesity: A systematic review and meta-analysis. Obes Rev. 21(e13080)2020.PubMed/NCBI View Article : Google Scholar
63	Chang JS, Li YL, Lu CH, Owaga E, Chen WY and Chiou HY: Interleukin-10 as a potential regulator of hepcidin homeostasis in overweight and obese children: A cross-sectional study in Taiwan. Nutrition. 30:1165–1170. 2014.PubMed/NCBI View Article : Google Scholar
64	Sanad M, Osman M and Gharib A: Obesity modulate serum hepcidin and treatment outcome of iron deficiency anemia in children: A case control study. Ital J Pediatr. 37(34)2011.PubMed/NCBI View Article : Google Scholar
65	Amato A, Santoro N, Calabrò P, Grandone A, Swinkels DW, Perrone L and del Giudice EM: Effect of body mass index reduction on serum hepcidin levels and iron status in obese children. Int J Obes (Lond). 34:1772–1774. 2010.PubMed/NCBI View Article : Google Scholar
66	Gong L, Yuan F, Teng J, Li X, Zheng S, Lin L, Deng H, Ma G, Sun C and Li Y: Weight loss, inflammatory markers, and improvements of iron status in overweight and obese children. J Pediatr. 164:795–800.e2. 2014.PubMed/NCBI View Article : Google Scholar
67	Coimbra S, Catarino C, Nascimento H, Inês Alves A, Filipa Medeiros A, Bronze-da-Rocha E, Costa E, Rocha-Pereira P, Aires L, Seabra A, et al: Physical exercise intervention at school improved hepcidin, inflammation, and iron metabolism in overweight and obese children and adolescents. Pediatr Res. 82:781–788. 2017.PubMed/NCBI View Article : Google Scholar
68	Cepeda-Lopez AC, Allende-Labastida J, Melse-Boonstra A, Osendarp SJ, Herter-Aeberli I, Moretti D, Rodriguez-Lastra R, Gonzalez-Salazar F, Villalpando S and Zimmermann MB: The effects of fat loss after bariatric surgery on inflammation, serum hepcidin, and iron absorption: A prospective 6-mo iron stable isotope study. Am J Clin Nutr. 104:1030–1038. 2016.PubMed/NCBI View Article : Google Scholar
69	Cheng HL, Griffin HJ, Bryant CE, Rooney KB, Steinbeck KS and O'Connor HT: Impact of diet and weight loss on iron and zinc status in overweight and obese young women. Asia Pac J Clin Nutr. 22:574–582. 2013.PubMed/NCBI View Article : Google Scholar
70	Kaner G, Pekcan AG and Şarer Yürekli BP: Effect of a weight loss intervention on iron parameters in overweight and obese Turkish women. Prog Nutr. 21:50–56. 2019.