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Overweight impairs efficacy of iron supplementation in iron-deficient South African children: a randomized controlled intervention

International Journal of Obesity volume 37, pages 24–30 (2013)Cite this article

Subjects

Abstract

Background:

Many countries in the nutrition transition have high rates of iron deficiency (ID) and overweight (OW). ID is more common in OW children; this may be due to adiposity-related inflammation reducing iron absorption.

Objective:

We investigated whether weight status predicts response to oral iron supplementation in ID South African children.

Design:

A placebo-controlled trial of oral iron supplementation (50 mg, 4 × weeks for 8.5 months) was done in ID 6- to 11-year-old children (n=321); 28% were OW or obese. BMI-for-age z-scores (BAZ), hepcidin (in a sub-sample), hemoglobin, serum ferritin (SF), transferrin receptor (TfR), zinc protoporphyrin (ZnPP) and C-reactive protein (CRP) were measured; body iron was calculated from the SF to TfR ratio.

Results:

At baseline, BAZ correlated with CRP (r=0.201, P<0.001) and CRP correlated with hepcidin (r=0.384, P<0.001). Normal weight children supplemented with iron had significantly lower TfR concentrations at endpoint than the OW children supplemented with iron and the children receiving placebo. Higher BAZ predicted higher TfR (β=0.232, P<0.001) and lower body iron (β=−0.090, P=0.016) at endpoint, and increased the odds ratio (OR) for remaining ID at endpoint in both the iron and placebo groups (iron: OR 2.31, 95% CI: 1.13, 4.73; placebo: OR 1.78, 95% CI: 1.09, 2.91). In the children supplemented with iron, baseline hepcidin and BAZ were significant predictors of endpoint TfR, with a trend towards a hepcidin × BAZ interaction (P=0.058).

Conclusion:

South African children with high BAZ have a two-fold higher risk of remaining ID after iron supplementation. This may be due to their higher hepcidin concentrations reducing iron absorption. Thus, the current surge in OW in rapidly developing countries may undercut efforts to control anemia in vulnerable groups. The trial is registered at clinicaltrials.gov as NCT01092377.

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Acknowledgements

We thank all the fieldworkers, teachers and principals of the schools for their support of the study, the children and parents for their participation in the trial, MRC and NWU colleagues and students, especially J Greeff, for their assistance during field and laboratory work, Anja Fleisch for doing preliminary data analyses and interpretation within her Bachelor’s thesis, and PL Jooste, and JC Jerling for acting as the Safety Monitoring Board. We thank Paul Lohmann GmbH (Lomapharm, Emmertal, Germany) for supplying the iron tablets used in the trial, and ET Wiegerinck (Hepcidinanalysis.com, Nijmegen, The Netherlands) for technical assistance. Financial support for the study was provided by Unilever Research and Development (Vlaardingen, The Netherlands) and The Medicor Foundation (Vaduz, Principality of Liechtenstein).

Author contributions

MZ, CMS, JB and LM designed and conducted the study; JB and IA analyzed the data and performed the statistical analyses; HT conducted the hepcidin analyses; JB, IA and MZ wrote the first draft of the manuscript; and all authors read and edited the manuscript. All authors had full access to all the data and JB had the responsibility for the final content of the paper and the decision to submit for publication.

The trial is registered at clinicaltrials.gov as NCT01092377.

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Authors and Affiliations

  1. Centre of Exellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa

    J Baumgartner, C M Smuts & L Malan

  2. Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Switzerland

    J Baumgartner, I Aeberli & M B Zimmermann

  3. Department of Laboratory Medicine, Laboratory of Genetic, Endocrine and Metabolic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    H Tjalsma

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  1. J Baumgartner
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Correspondence to J Baumgartner.

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Baumgartner, J., Smuts, C., Aeberli, I. et al. Overweight impairs efficacy of iron supplementation in iron-deficient South African children: a randomized controlled intervention. Int J Obes 37, 24–30 (2013). https://doi.org/10.1038/ijo.2012.145

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