Inflammation and iron deficiency in the hypoferremia of obesity

L B Yanoff, C M Menzie, B Denkinger, N G Sebring, T McHugh, A T Remaley, J A Yanovski, L B Yanoff, C M Menzie, B Denkinger, N G Sebring, T McHugh, A T Remaley, J A Yanovski

Abstract

Context: Obesity is associated with hypoferremia, but it is unclear if this condition is caused by insufficient iron stores or diminished iron availability related to inflammation-induced iron sequestration.

Objective: To examine the relationships between obesity, serum iron, measures of iron intake, iron stores and inflammation. We hypothesized that both inflammation-induced sequestration of iron and true iron deficiency were involved in the hypoferremia of obesity.

Design: Cross-sectional analysis of factors anticipated to affect serum iron.

Setting: Outpatient clinic visits.

Patients: Convenience sample of 234 obese and 172 non-obese adults.

Main outcome measures: Relationships between serum iron, adiposity, and serum transferrin receptor, C-reactive protein, ferritin, and iron intake analyzed by analysis of covariance and multiple linear regression.

Results: Serum iron was lower (75.8+/-35.2 vs 86.5+/-34.2 g/dl, P=0.002), whereas transferrin receptor (22.6+/-7.1 vs 21.0+/-7.2 nmol/l, P=0.026), C-reactive protein (0.75+/-0.67 vs 0.34+/-0.67 mg/dl, P<0.0001) and ferritin (81.1+/-88.8 vs 57.6+/-88.7 microg/l, P=0.009) were higher in obese than non-obese subjects. Obese subjects had a higher prevalence of iron deficiency defined by serum iron (24.3%, confidence intervals (CI) 19.3-30.2 vs 15.7%, CI 11.0-21.9%, P=0.03) and transferrin receptor (26.9%, CI 21.6-33.0 vs 15.7%, CI 11.0-21.9%, P=0.0078) but not by ferritin (9.8%, CI 6.6-14.4 vs 9.3%, CI 5.7-14.7%, P=0.99). Transferrin receptor, ferritin and C-reactive protein contributed independently as predictors of serum iron.

Conclusions: The hypoferremia of obesity appears to be explained both by true iron deficiency and by inflammatory-mediated functional iron deficiency.

Figures

Figure 1
Figure 1
Univariate associations between BMI and (a) serum iron (r2 = 0.06, P<0.0001), (b) serum transferrin receptor (r2=0.05, P<0.0001), (c) ferritin (r2=0.002, P=0.11) and (d) C-reactive protein (r2=0.20, P<0.0001).
Figure 2
Figure 2
Univariate associations between fat mass and (a) serum iron (r2=0.075, P<0.0001), (b) serum transferrin receptor (r2=0.03, P=0.002), (c) ferritin (r2=0.001, P=0.59) and (d) C-reactive protein (r2=0.22, P<0.0001).

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