Iron Fortification and Supplementation: Fighting Anemia of Chronic Diseases or Fueling Obesity?

El-Mallah, Carla; Beyh, Yara S.; Obeid, Omar

doi:10.1093/cdn/nzab032

Cited by 7 publications

(5 citation statements)

References 110 publications

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“…Our data suggest that increased adiposity in PD patients may adversely affect mortality by increasing ferritin levels. Supporting our findings, high adiposity is characterized by chronic low-grade inflammation, increased hepcidin, and decreased iron absorption, eventually leading to anemia and high ferritin levels [38]. Hyperferritinemia has been documented in obesity-related chronic inflammatory conditions, such as type 2 diabetes mellitus, metabolic syndrome, and nonalcoholic fatty liver disease [24].…”

Section: Discussionsupporting

confidence: 83%

Elevated Ferritin Levels Associated with High Body Fat Mass Affect Mortality in Peritoneal Dialysis Patients

Lee

Noh

et al. 2023

Nutrients

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Obesity is a common health problem in peritoneal dialysis (PD) patients and causes high serum ferritin levels. However, mixed results have been reported on whether serum ferritin levels affect the prognosis of PD patients. We investigated the effect of increased adiposity on ferritin levels and its association with mortality in 350 well-nourished PD patients. Body composition was measured using a portable whole-body bioimpedance spectroscope, and clinical determinants of high ferritin levels were evaluated. High ferritin levels (≥600 ng/mL) were observed in 63 (18.0%) patients. Patients with high ferritin levels had a significantly higher body fat percentage and a lower lean tissue index than patients with low or normal ferritin levels. During a median follow-up of 30 months, there were 65 deaths. Ferritin ≥ 600 ng/mL was associated with significantly higher all-cause mortality compared with 200–600 ng/mL of ferritin. Multivariate analysis showed that high ferritin levels were significantly associated with a higher percentage of body fat after adjustment for lean tissue index and volume status. High ferritin increased all-cause mortality in PD patients, and increased fat mass was an important determinant of the high ferritin. Our results support that adiposity may lead to an adverse clinical outcome in PD patients.

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Section: Discussionsupporting

confidence: 83%

Elevated Ferritin Levels Associated with High Body Fat Mass Affect Mortality in Peritoneal Dialysis Patients

Lee

Noh

et al. 2023

Nutrients

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“…These different influences of BMI on anemia in pregnancy could be explained by different sociodemographic characteristics, differences in the prevalence of anemia and obesity, and different inclusion and exclusion criteria used in the studies. Obesity could increase anemia via inflammation, as adiposity has been extensively linked to inflammation [36]. Conversely, when increased BMI is related to increases in muscular bulk, obesity could decrease anemia because of good nutrition [36].…”

Section: Discussionmentioning

confidence: 99%

“…Obesity could increase anemia via inflammation, as adiposity has been extensively linked to inflammation [36]. Conversely, when increased BMI is related to increases in muscular bulk, obesity could decrease anemia because of good nutrition [36].…”

Section: Discussionmentioning

confidence: 99%

History of Pica, Obesity, and Their Associations with Anemia in Pregnancy: A Community-Based Cross-Sectional Study

Ali,

Hassan,

Adam

2023

Life

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Anemia in pregnancy represents a major global health problem, and progress is insufficient to meet the World Health Assembly’s global nutrition target of halving anemia prevalence by 2030. We assessed the prevalence and factors associated with anemia among pregnant women in northern Sudan. This community-based cross-sectional study was conducted at Almatamah, River Nile State, Sudan. Sociodemographic and obstetric data were collected using a questionnaire. Hemoglobin (Hb) was measured using an automated hematology analyzer. Multivariate and simple linear regression analyses were performed. A total of 586 pregnant women were enrolled. Their median (interquartile range, IQR) age was 25 (21–30) years. The median (IQR) of body mass index (BMI) was 26.67 (24.34–30.04) kg/m2. The median (IQR) for Hb was 11.0 (10.0–11.9) g/dL. Of the 586 women, 271 (46.2%) had anemia (Hb: <11 gm/dL). In multivariate analysis, increasing BMI and obesity were significantly associated with decreased odds ratios (ORs) of anemia, while pica was associated with increased ORs of anemia. In conclusion, anemia in pregnant women is a major public health problem, as approximately half of pregnant women in northern Sudan have anemia. Increasing BMI and obesity were associated with a lower risk for anemia. More efforts are needed to improve the maternal nutritional status for good pregnancy outcomes.

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“…Further research is needed for individual patient care in clinical settings, as cases of iron deficiency may be missed among WRA with OWOB if inflammation is not measured or accounted for in interpretations of ferritin concentrations. Additional consideration of the impacts of inflammation on iron status assessments and potential iron deficiency may be necessary in individuals with anemia of chronic disease ( 37 , 47 ).…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Ferritin and BMI is Mediated by Inflammation Among Women in Higher-Income Countries, But Not in Most Lower-Income Countries Nor Among Young Children: A Multi-Country Analysis

Davis

Williams

Rohner³

et al. 2022

Current Developments in Nutrition

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Background In the presence of inflammation, serum or plasma ferritin concentration (‘ferritin’) transiently increases, confounding its interpretation as an iron status marker. The extent to which adiposity-related inflammation may influence ferritin interpretation is uncertain. Objective To describe relationships between weight status, inflammation, and ferritin among non-pregnant women of reproductive age (15-49 years, WRA) and preschool-age children (6-59 months, PSC) with normal weight to overweight or obesity (OWOB) in differing geographic settings. Methods Cross-sectional data were separately analyzed from n = 18 surveys (WRA) and n = 25 surveys (PSC) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project, excluding observations with underweight, wasting, pregnancy, or malaria. Relationships were assessed between BMI (WRA) or BMI-for-age z-score (BAZ, PSC), inflammatory biomarkers C-reactive protein (CRP) and/or α-1-acid glycoprotein (AGP), and ferritin by linear regression, and potential mediation by CRP and/or AGP in relationships between BMI or BAZ and ferritin with structural equation modeling. Regression and mediation models accounted for complex survey designs. Results were grouped by World Bank income classifications. Included Kenya trial data registered at http://clinicaltrials.gov, identifier NCT01088958. Results In 5 of 6 surveys among WRA from upper-middle and high-income countries, ferritin was significantly positively associated with BMI, and this relationship was partially (or fully in the United States) mediated by CRP and/or AGP. Mediation was present in 4 of 12 surveys for WRA in low- and lower-middle income countries. Among PSC, ferritin was positively associated with CRP and/or AGP in all surveys, but there were no significant CRP- or AGP-mediated relationships between ferritin and BAZ, except a negative relationship in the Philippines. Conclusions Where OWOB are common among WRA, measurement of inflammatory biomarkers and their use in interpreting ferritin may improve iron status assessment. While these relationships were inconsistent among PSC, inflammation was common and should be measured to interpret iron status.

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Iron Fortification and Supplementation: Fighting Anemia of Chronic Diseases or Fueling Obesity?

Cited by 7 publications

References 110 publications

Elevated Ferritin Levels Associated with High Body Fat Mass Affect Mortality in Peritoneal Dialysis Patients

Elevated Ferritin Levels Associated with High Body Fat Mass Affect Mortality in Peritoneal Dialysis Patients

History of Pica, Obesity, and Their Associations with Anemia in Pregnancy: A Community-Based Cross-Sectional Study

The Relationship Between Ferritin and BMI is Mediated by Inflammation Among Women in Higher-Income Countries, But Not in Most Lower-Income Countries Nor Among Young Children: A Multi-Country Analysis

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