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Inflammation and iron deficiency in the hypoferremia of obesity

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 μg/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.

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Acknowledgements

This work is supported by ZO1 HD-00641 (to JAY) from the National Institute of Child Health and Human Development and by Y2-OD-2067 (to JAY) from the Office of Dietary Supplements, National Institutes of Health, DHHS.

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Correspondence to J A Yanovski.

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Yanoff, L., Menzie, C., Denkinger, B. et al. Inflammation and iron deficiency in the hypoferremia of obesity. Int J Obes 31, 1412–1419 (2007). https://doi.org/10.1038/sj.ijo.0803625

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