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Clinical Research

The effect of central obesity on inflammation, hepcidin, and iron metabolism in young women

International Journal of Obesity volume 44, pages 1291–1300 (2020)Cite this article

Subjects

Abstract

Background/objectives

In overweight and obesity (OW/OB), greater total body fat predicts higher serum hepcidin (SHep) which can impair iron homeostasis and increase risk for iron deficiency (ID). However, the effect of body fat distribution on SHep and iron homeostasis is unclear. In central obesity, interleukin (IL)-6 released from visceral adipose tissue into portal blood could strongly stimulate hepatic hepcidin synthesis. Thus, our hypothesis was that higher amounts of android fat, rather than gynoid fat, would predict impaired iron metabolism in OW/OB.

Subjects/methods

In this cross-sectional study, we enrolled 117 otherwise-healthy women into two groups: normal weight; BMI < 25 (n = 36) and OW/OB; BMI ≥ 25 (n = 81); we then subdivided the OW/OB using DEXA into tertiles based on the ratio of android fat/total body fat (AF/TBF). We measured inflammation and iron status, and assessed iron absorption in two ways: by measuring erythrocyte isotope incorporation from a labeled test meal containing 6 mg 57Fe (representing dietary iron); and by measuring change in serum iron (ΔSeFe) after a 100 mg oral iron challenge (representing supplemental iron).

Results

Greater AF/TBF correlated with higher CRP, AGP, SHep, and TIBC, and lower transferrin saturation and SeFe/SHep ratio (for all, p < 0.05). Greater AF/TBF correlated with lower supplemental iron absorption (ΔSeFe) (p = 0.08) but not lower dietary iron absorption. In multiple regressions, AF/TBF positively predicted CRP (p < 0.001) and SHep (p < 0.05); a model including AF/TBF and serum ferritin as covariates explained 65% of the variance in SHep. AF/TBF negatively predicted TSAT (p < 0.05) and iron absorption (ΔSeFe) (p = 0.07). In contrast, the ratio of gynoid fat/total body fat was not significantly associated with these variables.

Conclusion

Body fat distribution affects iron metabolism: women with greater central adiposity have higher SHep, greater impairments in iron homeostasis, and reduced iron absorption from a supplemental iron dose.

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Fig. 1
Fig. 2: In otherwise-healthy normal-weight women (n = 36) and overweight/obese women (n = 81), correlations between android fat/total fat ratio, inflammation and serum hepcidin.
Fig. 3: In otherwise-healthy normal-weight women (n = 36) and overweight/obese women (n = 81), correlations between android fat/total fat ratio and iron status parameters.
Fig. 4: In otherwise-healthy normal-weight women (n = 36) and overweight/obese women (n = 81), correlation between Δserum iron and serum hepcidin.

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Author notes

  1. These authors contributed equally: Nicole U. Stoffel, Carla El Mallah

Authors and Affiliations

  1. Department of Health Science and Technology, Laboratory of Human Nutrition, Institute of Food Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092, Zurich, Switzerland

    Nicole U. Stoffel, Isabelle Herter-Aeberli & Michael B. Zimmermann

  2. Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon

    Carla El-Mallah, Nour Bissani, Nour Wehbe & Omar Obeid

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  1. Nicole U. Stoffel
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Stoffel, N.U., El-Mallah, C., Herter-Aeberli, I. et al. The effect of central obesity on inflammation, hepcidin, and iron metabolism in young women. Int J Obes 44, 1291–1300 (2020). https://doi.org/10.1038/s41366-020-0522-x

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