Overweight is increasing in transition countries, while iron deficiency remains common. In industrialized countries, greater adiposity increases risk of iron deficiency. Higher hepcidin levels in obesity may reduce dietary iron absorption. Therefore, we investigated the association between body mass index (BMI) and iron absorption, iron status and the response to iron fortification in populations from three transition countries (Thailand, Morocco and India).
In Thai women (n=92), we examined the relationship between BMI and iron absorption from a reference meal containing ∼4 mg of isotopically labeled fortification iron. We analyzed data from baseline (n=1688) and intervention (n=727) studies in children in Morocco and India to look for associations between BMI Z-scores and baseline hemoglobin, serum ferritin and transferrin receptor, whole blood zinc protoporphyrin and body iron stores, and changes in these measures after provision of iron.
In the Thai women, 20% were iron deficient and 22% were overweight. Independent of iron status, a higher BMI Z-score was associated with decreased iron absorption (P=0.030). In the Indian and Moroccan children, 42% were iron deficient and 6.3% were overweight. A higher BMI Z-score predicted poorer iron status at baseline (P<0.001) and less improvement in iron status during the interventions (P<0.001).
Adiposity in young women predicts lower iron absorption, and pediatric adiposity predicts iron deficiency and a reduced response to iron fortification. These data suggest the current surge in overweight in transition countries may impair efforts to control iron deficiency in these target groups. Interactions of the ‘double burden’ of malnutrition during the nutrition transition may have adverse consequences.
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We thank the participating women and children, as well as the local health care staff in Thailand, Morocco and India for their assistance on the project. We thank M Andersson (Zürich, Switzerland), D Moretti (Vlaardingen, The Netherlands), T Walcyzk (Singapore), P Thankachan and A Kurpad (Bangalore, India), S Tuntipopipat (Bangkok, Thailand), and A Saad (Rabat, Morocco). MZ, CZ, SM, PW, NC did the field work, MZ wrote the first draft of the manuscript, all authors contributed to the writing and editing of the manuscript. None of the authors has a conflict of interest relating to this paper. This study was supported by the Thrasher Foundation (Salt Lake City, USA) the Micronutrient Initiative (Ottawa, Canada); the Nestlé Foundation (Lausanne, Switzerland); the Foundation for Micronutrients in Medicine (Rapperswil, Switzerland) and the Swiss Federal Institute of Technology (Zürich, Switzerland).
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Zimmermann, M., Zeder, C., Muthayya, S. et al. Adiposity in women and children from transition countries predicts decreased iron absorption, iron deficiency and a reduced response to iron fortification. Int J Obes 32, 1098–1104 (2008). https://doi.org/10.1038/ijo.2008.43
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