scholarly journals Hepcidin and Iron Deficiency in Women One Year after Sleeve Gastrectomy: A Prospective Cohort Study

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2516
Author(s):  
Thibaud Lefebvre ◽  
Muriel Coupaye ◽  
Marina Esposito-Farèse ◽  
Nathalie Gault ◽  
Neila Talbi ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Iron Deficiency ◽  
Iron Supplementation ◽  
Iron Homeostasis ◽  
Iron Absorption ◽  
Iron Status ◽  
Obese Women ◽  
Serum Hepcidin ◽  
One Year ◽  
The Impact

Iron deficiency with or without anemia, needing continuous iron supplementation, is very common in obese patients, particularly those requiring bariatric surgery. The aim of this study was to address the impact of weight loss on the rescue of iron balance in patients who underwent sleeve gastrectomy (SG), a procedure that preserves the duodenum, the main site of iron absorption. The cohort included 88 obese women; sampling of blood and duodenal biopsies of 35 patients were performed before and one year after SG. An analysis of the 35 patients consisted in evaluating iron homeostasis including hepcidin, markers of erythroid iron deficiency (soluble transferrin receptor (sTfR) and erythrocyte protoporphyrin (PPIX)), expression of duodenal iron transporters (DMT1 and ferroportin) and inflammatory markers. After surgery, sTfR and PPIX were decreased. Serum hepcidin levels were increased despite the significant reduction in inflammation. DMT1 abundance was negatively correlated with higher level of serum hepcidin. Ferroportin abundance was not modified. This study shed a new light in effective iron recovery pathways after SG involving suppression of inflammation, improvement of iron absorption, iron supply and efficiency of erythropoiesis, and finally beneficial control of iron homeostasis by hepcidin. Thus, recommendations for iron supplementation of patients after SG should take into account these new parameters of iron status assessment.

scholarly journals Heme- and nonheme-iron absorption and iron status 12 mo after sleeve gastrectomy and Roux-en-Y gastric bypass in morbidly obese women

2012 ◽  
Vol 96 (4) ◽  
pp. 810-817 ◽  
Author(s):  
Manuel Ruz ◽  
Fernando Carrasco ◽  
Pamela Rojas ◽  
Juana Codoceo ◽  
Jorge Inostroza ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Iron Absorption ◽  
Iron Status ◽  
Nonheme Iron ◽  
Morbidly Obese ◽  
Obese Women

scholarly journals Ferroportin in Erythrocytes: Importance for Iron Homeostasis and its Role in Infection

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. SCI-27-SCI-27
Author(s):  
Tracey Rouault
Keyword(s):  
Oxidative Stress ◽  
Iron Deficiency ◽  
Iron Overload ◽  
Serum Iron ◽  
Iron Supplementation ◽  
Iron Homeostasis ◽  
Erythroid Cells ◽  
Intracellular Iron ◽  
The Impact ◽  
In Erythroid Cells

Ferroportin (FPN), the only known vertebrate iron exporter, transports iron from intestinal, splenic, and hepatic cells into the blood to provide iron to other tissues and cells in vivo. Most of the circulating iron is consumed by erythroid cells to synthesize hemoglobin. Recently, we found that erythroid cells not only consume large amounts of iron, but also return significant amounts of iron to the blood. Erythroblast-specific Fpn knockout (Fpn KO) mice developed lower serum iron levels in conjunction with tissue iron overload and increased FPN expression in spleen and liver without changing hepcidin levels. Our results also showed that Fpn KO mice, which suffer from mild hemolytic anemia, were sensitive to phenylhydrazine-induced oxidative stress but were able to tolerate iron deficiency upon exposure to a low-iron diet and phlebotomy, supporting that the anemia of Fpn KO mice resulted from erythrocytic iron overload and resulting oxidative injury rather than a red blood cell (RBC) production defect. Moreover, we found that the mean corpuscular volume (MCV) values of gain-of-function FPN mutation patients were positively associated with serum transferrin saturations, whereas MCVs of loss-of-function FPN mutation patients were not, supporting that erythroblasts donate iron to blood through FPN in response to serum iron levels. Our results indicate that FPN of erythroid cells has an unexpectedly essential role in maintaining systemic iron homeostasis and protecting RBCs from oxidative stress, providing insight into the pathophysiology of FPN diseases. When malaria parasites invade red blood cells (RBCs), they consume copious amounts of hemoglobin, and severely disrupt iron regulation in humans. Anemia often accompanies malaria disease; however, iron supplementation therapy inexplicably exacerbates malarial infections. We recently found that the iron exporter ferroportin (FPN) was highly abundant in RBCs, and iron supplementation suppressed its activity. Conditional deletion of the Fpn gene in erythroid cells resulted in accumulation of excess intracellular iron, cellular damage, hemolysis, and increased fatality in malaria-infected mice. In humans, a prevalent FPN mutation,Q248H (glutamine to histidine at position 248), prevented hepcidin-induced degradation of FPN and protected against severe malaria disease. FPNQ248H appears to have been positively selected in African populations in response to the impact of malaria disease. Thus, FPN protects RBCs against oxidative stress and malaria infection. Zhang DL, Wu J, Shah BN et al. Erythrocytic ferroportin reduces intracellular iron accumulation, hemolysis, and malaria risk. Science. 2018;359 (6383):1520-1523. Zhang DL, Ghosh MC, Ollivierre H, Li Y, Rouault TA. Ferroportin deficiency in erythroid cells causes serum iron deficiency and promotes hemolysis due to oxidative stress. Blood. 2018;132 (19):2078-2087. Zhang DL, Rouault TA. How does hepcidin hinder ferroportin activity. Blood. 2018;131 (8):840-842. Disclosures No relevant conflicts of interest to declare.

scholarly journals The Association between Hepcidin and Iron Status in Children and Adolescents with Obesity

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Ekkarit Panichsillaphakit ◽  
Orapa Suteerojntrakool ◽  
Chitsanu Pancharoen ◽  
Issarang Nuchprayoon ◽  
Sirinuch Chomtho
Keyword(s):  
Iron Deficiency ◽  
Iron Homeostasis ◽  
Complete Blood Count ◽  
Iron Status ◽  
Standard Deviation Score ◽  
Transferrin Saturation ◽  
Obese Group ◽  
Control Group ◽  
Low Grade ◽  
Serum Hepcidin

Introduction. Iron deficiency (ID) is the most common nutritional deficiency found in pediatric practice. A higher prevalence of ID may be found in children with obesity. Obesity is a chronic low-grade inflammatory condition. It is postulated that inflammation increases hepcidin, a regulator of iron homeostasis. The aim of this study was to investigate the associations between iron status, hepcidin, and BMI-standard deviation score (BMI-SDS) in children with and without obesity. Methods. A cross-sectional study of Thai children with obesity (5 to 15 years old) versus age- and sex-matched, nonobese controls was conducted. A total of 63 children with obesity and 27 controls were enrolled. Complete blood count, serum iron, ferritin, transferrin saturation, and total iron binding capacity were analyzed. Serum hepcidin-25 was assayed using a hepcidin ELISA Kit (Human Hepc25). Results. There were 63 children with obesity, the median age (IQR) being 10 (9–13) years, and 27 controls. The median (IQR) BMI-SDS of the obese group was 2.3 (2.0–2.6) vs. −0.5 ((−1.3)−0.4) of the control group. ID was diagnosed in 27 children in the obese group (42.9%); 4 of the children with obesity and ID had anemia. Serum hepcidin-25 levels of the children with ID vs. without ID in the obese group were not significantly different (median (IQR) 25 (12.9–49.2) and 26.4 (12.6–43.6), respectively) but both of them were significantly higher than controls (19.7 (8.3–25.5) ng/ml, p  = 0.04). BMI-SDS was positively correlated with hepcidin-25 (r = 0.28, p  = 0.001). Conclusion. Prevalence of iron deficiency in Thai children with obesity and serum hepcidin-25 was higher than controls. Further study in a larger population, preferably with interventions such as weight loss program, is warranted to clarify this association.

The effect of iron supplementation on cognition, subjective mood, well-being and fatigue in women of reproductive age: a systematic review

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Hannah Avery ◽  
Philippa Jackson ◽  
Crystal Haskell-Ramsay
Keyword(s):  
Iron Deficiency ◽  
Iron Supplementation ◽  
Intervention Studies ◽  
Iron Status ◽  
Well Being ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Beneficial Effects ◽  
Subjective Fatigue ◽  
The Impact

AbstractIron deficiency remains the most prevalent nutritional deficiency worldwide and is considered the most significant contributor to anaemia onset in children and women of reproductive age in both developing and developed countries. Iron plays a role in neurodevelopment and early deficits in iron have been found to impact hippocampal function affecting cognition and subjective mood. However, it is now recognised that neural structures can adapt throughout the lifespan and it is possible that changes in iron levels beyond infancy could stimulate neural changes and subsequent cognitive deficits at any time of life. Evidence for a causal link through the conduct of intervention studies is still sparse and varied in regards to the impact of iron deficiency in women of reproductive age. Our aim was to systematically review current evidence from intervention studies to determine the impact of iron supplementation upon cognition, subjective mood, well-being and fatigue in women of reproductive age. Searches included PubMed, Web of Science, Cochrane and bibliographies. Study selection and risk of bias assessment were duplicated and all intervention studies assessing cognition, subjective fatigue, mood and/or well-being that met the inclusion criteria were included in the review. Fifteen RCTs of women aged 12–49 were included. Nine studies investigated cognitive function following iron supplementation; eight found significant beneficial effects. All studies suggested that a reduced iron status at baseline was detrimental to one or more cognitive parameters, including attention and memory domains. Seven studies investigated subjective fatigue following iron supplementation; five found significant beneficial effects from baseline. Nine studies investigated mood and well-being; seven found significant effects, however they were somewhat conflicting. There is evidence to suggest that iron supplementation can improve attention, memory, subjective fatigue, mood and well-being, but additional studies using consistent measures, intervention methods and definitions of iron deficiency are warranted. Further studies should consider controlling for extraneous variables of diet, lifestyle choices and menstrual cycle to ensure an accurate measure of iron status.

scholarly journals Clinical Immunoassay for Human Hepcidin Predicts Iron Deficiency in First-Time Blood Donors

2020 ◽  
Vol 5 (5) ◽  
pp. 943-953
Author(s):  
Patrick Gutschow ◽  
Huiling Han ◽  
Gordana Olbina ◽  
Keith Westerman ◽  
Elizabeta Nemeth ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Iron Homeostasis ◽  
Blood Donors ◽  
Iron Status ◽  
Characteristic Curve ◽  
Serum Markers ◽  
Ferritin Concentration ◽  
Limit Of Quantitation ◽  
Serum Hepcidin ◽  
First Time

Abstract Background Serum markers currently used as indicators of iron status have clinical limitations. Hepcidin, a key regulator of iron homeostasis, is reduced in iron deficiency (ID) and increased in iron overload. We describe the first CLIA-validated immunoassay with excellent accuracy and precision to quantify human serum hepcidin. Its diagnostic utility for detecting ID in first-time blood donors was demonstrated. Methods A monoclonal competitive ELISA (C-ELISA) was developed for the quantitation of human hepcidin and validated according to CLIA guidelines. Sera from nonanemic first-time blood donors (n = 292) were analyzed for hepcidin, ferritin, transferrin, and serum iron. Logistic regression served to determine the utility of hepcidin as a predictor of ID. Results The C-ELISA was specific for human hepcidin and had a low limit of quantitation (4.0 ng/mL). The hepcidin concentration measured with the monoclonal C-ELISA was strongly correlated with a previously established, extensively tested polyclonal C-ELISA (Blood 2008;112:4292–7) (r = 0.95, P < 0.001). The area under the receiver operating characteristic curve for hepcidin as a predictor of ID, defined by 3 ferritin concentration thresholds, was >0.9. For predicting ID defined by ferritin <15 ng/mL, hepcidin <10 ng/mL yielded sensitivity of 93.1% and specificity of 85.5%, whereas the same hepcidin cutoff for ferritin <30 ng/mL yielded sensitivity of 67.6% and specificity of 91.7%. Conclusion The clinical measurement of serum hepcidin concentrations was shown to be a potentially useful tool for diagnosing ID.

scholarly journals Effect of Daily Iron Supplementation on Infantile Iron Homeostasis in Preterm Infants

2021 ◽  
Vol 9 ◽  
Author(s):  
Mingyan Li ◽  
Ying Lv ◽  
Jionghuan Ying ◽  
Lin Xu ◽  
Weijun Chen ◽  
...  
Keyword(s):  
Side Effects ◽  
Iron Deficiency ◽  
Blood Transfusion ◽  
Preterm Infants ◽  
Early Treatment ◽  
Iron Supplementation ◽  
Iron Homeostasis ◽  
Iron Status ◽  
Deficiency Anemia ◽  
Factors Affecting

Objective: The aim of this study was to investigate the effects of unified iron supplementation and identify the factors related to the iron homeostasis among preterm infants.Method: A total of 250 preterm infants were divided into neonatal anemic (NA, n = 154) and non-neonatal anemic group (NNA, n = 96). Iron supplements at a dose of 2 mg/kg per day were given from 40 weeks' gestational age to 6 months. Iron status parameters were measured at 3 and 6 months, respectively. Prevalence of iron deficiency (ID) and iron deficiency anemia (IDA), and the correlated factors were analyzed. Growth and side-effects were monitored.Results: There were no significant differences for the prevalence of ID or IDA between the two groups. Multivariate regression analyses showed that higher Hb at birth and early treatment of blood transfusion reduced the risk of ID/IDA at 3 months (all p < 0.05); while higher level of Hb at 3 months (p = 0.004) and formula feeding reduced the occurrence of ID/IDA at 6 months (p < 0.05); males had a 3.35 times higher risk to develop ID/IDA than girls (p = 0.021). No differences in growth and side effects were found.Conclusion: A daily dose of 2 mg/kg iron supplement is beneficial to maintain iron homeostasis in majority preterm infants within 6 months regardless of their neonatal anemia history. Under the routine iron supplementation, Hb level at birth and at 3 months, early treatment of blood transfusion, gender and feeding patterns are the major factors affecting the prevalence of ID/IDA among preterm infants in infancy.

scholarly journals Iron Deficiency in Obesity and after Bariatric Surgery

Biomolecules ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 613
Author(s):  
Geir Bjørklund ◽  
Massimiliano Peana ◽  
Lyudmila Pivina ◽  
Alexandru Dosa ◽  
Jan Aaseth ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Iron Deficiency ◽  
Iron Absorption ◽  
Iron Status ◽  
Gastric Bypass Surgery ◽  
Acute Phase Reactant ◽  
Obese Patients ◽  
Obese Subjects

Iron deficiency (ID) is particularly frequent in obese patients due to increased circulating levels of acute-phase reactant hepcidin and adiposity-associated inflammation. Inflammation in obese subjects is closely related to ID. It induces reduced iron absorption correlated to the inhibition of duodenal ferroportin expression, parallel to the increased concentrations of hepcidin. Obese subjects often get decreased inflammatory response after bariatric surgery, accompanied by decreased serum hepcidin and therefore improved iron absorption. Bariatric surgery can induce the mitigation or resolution of obesity-associated complications, such as hypertension, insulin resistance, diabetes mellitus, and hyperlipidemia, adjusting many parameters in the metabolism. However, gastric bypass surgery and sleeve gastrectomy can induce malabsorption and may accentuate ID. The present review explores the burden and characteristics of ID and anemia in obese patients after bariatric surgery, accounting for gastric bypass technique (Roux-en-Y gastric bypass—RYGB) and sleeve gastrectomy (SG). After bariatric surgery, obese subjects’ iron status should be monitored, and they should be motivated to use adequate and recommended iron supplementation.

scholarly journals The Role of Iron in Brain Development: A Systematic Review

Nutrients ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 2001
Author(s):  
Samantha McCann ◽  
Marta Perapoch Amadó ◽  
Sophie E. Moore
Keyword(s):  
Iron Deficiency ◽  
Brain Development ◽  
Iron Supplementation ◽  
Iron Status ◽  
Developmental Outcomes ◽  
Early Infancy ◽  
Significant Heterogeneity ◽  
The Impact ◽  
In Pregnancy

One-third of children falter in cognitive development by pre-school age. Iron plays an important role in many neurodevelopmental processes, and animal studies suggest that iron sufficiency in pregnancy and infancy is particularly important for neurodevelopment. However, it is not clear whether iron deficiency directly impacts developmental outcomes, and, if so, whether impact differs by timing of exposure or developmental domain. We searched four databases for studies on iron deficiency or iron supplementation in pregnancy, or at 0–6 months, 6–24 months, or 2–4 years of age. All studies included neurodevelopmental assessments in infants or children up to 4 years old. We then qualitatively synthesized the literature. There was no clear relationship between iron status and developmental outcomes across any of the time windows or domains included. We identified a large quantity of low-quality studies, significant heterogeneity in study design and a lack of research focused on pregnancy and early infancy. In summary, despite good mechanistic evidence for the role of iron in brain development, evidence for the impact of iron deficiency or iron supplementation on early development is inconsistent. Further high-quality research is needed, particularly within pregnancy and early infancy, which has previously been neglected.

Compared to Normal-Weight Pregnant Women, Overweight Pregnant Women Fail to Upregulate Iron Absorption in the Third Trimester Despite Iron Deficiency and Their Infants Are Born with Lower Body Iron Stores

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 51-52
Author(s):  
Nicole Ursula Stoffel ◽  
Michael Bruce Zimmermann ◽  
Ana Carla Cepeda Lopez ◽  
Karla I Cervantes Gracia ◽  
Elida E Lee Bazaldua ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Iron Supplementation ◽  
Iron Absorption ◽  
Iron Status ◽  
Normal Weight ◽  
Lower Body ◽  
Iron Transfer ◽  
Significant Group ◽  
Iron Stores ◽  
The Impact

Introduction: Overweight/obesity (OWOB) causes low-grade systemic inflammation which induces hepcidin and a reduces fractional iron absorption (FIA) even when iron stores are low. Pregnancy increases iron needs because of the expansion of maternal blood volume and fetal needs. It is unclear whether and/or to what extent OWOB during pregnancy influences FIA, iron supply of the fetus and risk of iron deficiency in mother and newborn. In this study, we (1) determined the impact of maternal OWOB on FIA in pregnancy and on the transfer of iron to the fetus and newborn iron status; (2) confirmed the relationship between BMI, hepcidin, serum ferritin (SF) and inflammatory markers. Methods: In this prospective experimental multi-center case-control study (normal-weight (NW) n=40; OWOB n=37) we administered labeled [57Fe]- or [58Fe]-FeSO4 to women during the 2nd and 3rd trimester of pregnancy. We measured FIA by determining erythrocyte incorporation of iron stable isotopes 14 days after administration. From pregnancy week (PW) 12 until PW 36, iron-, inflammation and hepcidin were monitored. Iron transfer to the fetus was determined isotopically as the concentration of circulating iron in the infant aged three days. We assessed iron status in infants born to NW (n=29) and OWOB (n=31) at age three days, three months and six months. Results: Subject characteristics in PW 12 for the NW/OWOB were: mean (±SD) age: 29±6/ 30±6 years, median (IQR) pre-pregnancy BMI: 21.6 (20.3-23.7)/ 31.6 (28.4-35.9) kg/m2 (p<0.001), mean (±SD) hemoglobin: 12.3±1.1/ 12.4±0.9 g/dL, median (IQR) SF: 27.7 (17.3-48.2)/ 30.6 (16.6-64.4) µg/L and median (IQR) interleukin-6: 1.41 (1.03-1.95)/ 2.37 (1.91-3.85) pg/ml (p<0.001). Independent sample t-test showed no difference in FIA between NW and OWOB in the 2nd trimester with median FIA (IQR) 12.3 (7.2-20.6) and 10.1 (6.9-17.2) % (p=0.788). Despite the OWOB had ≈30% lower body iron stores (BIS) and comparable hepcidin concentrations to the NW in the 3rd trimester, FIA was significantly higher in the NW compared to the OWOB with median FIA (IQR) 22.3 (10.6-33.8) and 12.7 (10.4-18.1) % (p=0.042). In the NW, FIA was upregulated by 80% in the 3rd trimester compared to the 2nd trimester, whereas in the OWOB FIA, it was only upregulated by 25%. Linear mixed effect model analysis (LMM) showed a significant group-effects on weight, IL-6 and CRP throughout pregnancy (all p<0.05), but surprisingly no group-effect on hepcidin. In multiple regression analysis, the main predictor of hepcidin throughout pregnancy was BIS, not inflammation. Iron transfer to the newborn was non-significantly higher in the NW compared to the OWOB with mean (±SD) circulating iron in the newborn at age three days 136.6 ± 42.7 and 126.3 ± 32.4 mg. LMM on infant BIS and on infant serum transferrin receptor (sTfR) over the first six months showed significant group (p=0.024, p=0.046) and time-effects (both p<0.001) with lower BIS and higher sTfR in infants born to OWOB. Median (IQR) BIS at age six months were 7.7 (6.3-8.8) and 6.6 (4.6-9.2) mg/kg bodyweight in infants born to NW and OWOB. Conclusion: In normal pregnancy, FIA increases over time to support increased iron needs of mother and fetus. Our data show a dramatically reduced increase in FIA in OWOB pregnant women in the 3rd trimester, despite low BIS and low hepcidin, and this results in less iron transfer to the fetus. Future molecular studies are needed to clarify the mechanism of reduced FIA and fetal iron transfer in OWOB. To our knowledge, this is the first study assessing the impact of maternal OWOB on infant iron status at multiple time points over the first six months. Our findings strongly argue for careful monitoring of iron status in OWOB pregnancy and for defining a more effective iron supplementation regimen for this population group. Prevalence of anemia in pregnancy and infancy is high, especially in low and middle income countries and is often associated with severe health consequences. If iron status of OWOB pregnant women and their infants could be improved by optimizing iron supplementation guidelines for OWOB, this could have major benefits. Disclosures No relevant conflicts of interest to declare.

Effect of Eradication of Helicobacter pylori and Iron Supplementation on the Iron Status of Children with Iron Deficiency

2010 ◽  
Vol 41 (1) ◽  
pp. 38-45 ◽  
Author(s):  
Ximena Duque ◽  
Segundo Moran ◽  
Robertino Mera ◽  
Mayela Medina ◽  
Homero Martinez ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Iron Deficiency ◽  
Iron Supplementation ◽  
Iron Status
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