Obesity modulate serum hepcidin and treatment outcome of iron deficiency anemia in children: A case control study

Italian Journal of Pediatrics, Jul 2011

Background Recently, hepcidin expression in adipose tissue has been described and shown to be increased in patients with severe obesity. We tried to assess the effect of obesity on hepcidin serum levels and treatment outcome of iron deficiency anemia in children. Methods This was a case control study included 70 children with iron deficiency anemia "IDA" (35 obese and 35 non-obese) and 30 healthy non-obese children with comparable age and sex(control group). Parameters of iron status (Serum iron, ferritin, transferrin, total iron binding capacity and transferrin saturation) and serum hepcidin levels were assessed initially and after 3 months of oral iron therapy for IDA. Results Compared to the control group, serum hepcidin was significantly lower in non-obese children with IDA(p < 0.01) and significantly higher in obese children with IDA (p < 0.01). Hepcidin increased significantly in non-obese children with IDA after 3 months of iron therapy (P < 0.01). On the other hand, obese children showed non-significant change in hepcidin level after iron therapy (p > 0.05). Although hepcidin showed significant positive correlations with Hb, serum iron and transferrin saturation in non-obese children with IDA, it showed significant negative correlations with Hb, serum iron and transferrin saturation in obese children with IDA (P < 0.05). Conclusions Obesity increased hepcidin levels and was associated with diminished response to oral iron therapy in childhood iron deficiency anemia.

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Obesity modulate serum hepcidin and treatment outcome of iron deficiency anemia in children: A case control study

Italian Journal of Pediatrics Obesity modulate serum hepcidin and treatment outcome of iron deficiency anemia in children: A case control study Mohammed Sanad 0 Mohammed Osman 0 Amal Gharib 1 0 Department of Pediatrics, Faculty of Medicine, Zagazig University , Egypt 1 Department of Biochemistry, Faculty of Medicine, Zagazig University , Egypt Background: Recently, hepcidin expression in adipose tissue has been described and shown to be increased in patients with severe obesity. We tried to assess the effect of obesity on hepcidin serum levels and treatment outcome of iron deficiency anemia in children. Methods: This was a case control study included 70 children with iron deficiency anemia IDA (35 obese and 35 non-obese) and 30 healthy non-obese children with comparable age and sex(control group). Parameters of iron status (Serum iron, ferritin, transferrin, total iron binding capacity and transferrin saturation) and serum hepcidin levels were assessed initially and after 3 months of oral iron therapy for IDA. Results: Compared to the control group, serum hepcidin was significantly lower in non-obese children with IDA(p < 0.01) and significantly higher in obese children with IDA (p < 0.01). Hepcidin increased significantly in non-obese children with IDA after 3 months of iron therapy (P < 0.01). On the other hand, obese children showed nonsignificant change in hepcidin level after iron therapy (p > 0.05). Although hepcidin showed significant positive correlations with Hb, serum iron and transferrin saturation in non-obese children with IDA, it showed significant negative correlations with Hb, serum iron and transferrin saturation in obese children with IDA (P < 0.05). Conclusions: Obesity increased hepcidin levels and was associated with diminished response to oral iron therapy in childhood iron deficiency anemia. Obesity; Hepcidin; Iron deficiency; Children - Background Obesity is associated with low-serum iron concentrations. The inverse relationship between iron status and adiposity was first reported in 1962, when Wenzel et al [1] unexpectedly found a significantly lower mean serum iron concentration in obese compared with nonobese adolescents. Most subsequent studies in pediatric and adult samples have shown similar results [2-5]. The etiology of the hypoferremia of obesity is uncertain. Among the proposed causes are deficient iron intake from an iron poor diet [2], and deficient iron stores owing to greater iron requirements in obese adults because of their larger blood volume [6]. Recently, fat mass was described as a significant negative predictor of serum iron and this hypoferremia seemed not to be explained by differences in iron intake [7]. Adipose tissue is a very active endocrine organ secreting numerous hormones and cytokines associated with important systemic effects on different metabolic processes [8]. Recently, hepcidin expression in adipose tissue has been described and shown to be increased in patients with severe obesity [9]. Hepcidin is a small, cysteine-rich cationic peptide produced by hepatocytes [10,11], secreted into plasma, and excreted in urine. Hepcidin expression is induced by iron stores and inflammation [11] and is suppressed by hypoxia and anemia [12]. Hepcidin is proposed to be a key regulator of iron metabolism and its discovery has changed our understanding of the pathophysiology of iron disorders [10]. Adipose tissue of obese patients produced increased amount of proinflammatory cytokines contributing to the development of a low-grade systemic inflammation in these patients [13]. At present, regulatory pathways that are generally thought to control liver hepcidin production include: (i) iron store-related regulation (ii) erythropoietic activity driven regulation, and (iii) inflammation related regulation. All are found to interact with liver cells to initiate the production of sufficient hepcidin for correct maintenance of iron homeostasis [14-17]. The aim of this study was to assess the effect of obesity on hepcidin serum levels and its relation to treatment outcome of iron deficiency anemia in children. Methods This was a prospective case control study performed in Zagazig University Children Hospital and Outpatient Clinics in the same Hospital from April 2009 to August 2010. Informed parental consent was obtained for enrollment into the study. The study was done according to the rules of the local ethics committee of Faculty of medicine, Zagazig University. The study included 70 children with iron deficiency anemia [35 obese with BMI 95thcentile for age and sex and 35 non-obese with BMI < 85thcentile for age and sex]. 30 healthy nonobese children of comparable age and sex served as a control group. Iron deficiency was defined as presence of one or more abnormal age-corrected iron parameters (iron, ferritin, transferrin and transferrin saturation). IDA was defined as concurrent iron deficiency and anemia [18]. We excluded from the study all patients with (...truncated)


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Mohammed Sanad, Mohammed Osman, Amal Gharib. Obesity modulate serum hepcidin and treatment outcome of iron deficiency anemia in children: A case control study, Italian Journal of Pediatrics, 2011, pp. 34, 37, DOI: 10.1186/1824-7288-37-34