Soluble transferrin receptor levels in obese and non obese adolescents

Zul Febrianti; Fadil Oenzil; Firman Arbi; Gustina Lubis

doi:10.14238/pi54.2.2014.77-81

Zul Febrianti Department of Child Health, Andalas University Medical School
Fadil Oenzil Department of Child Health, Andalas University Medical School
Firman Arbi Department of Child Health, Andalas University Medical School
Gustina Lubis Department of Child Health, Andalas University Medical School

DOI: https://doi.org/10.14238/pi54.2.2014.77-81

Keywords: soluble transferrin receptor, obese adolescents, body mass index, iron deficiency.

Abstract

Background Iron deficiency in children and adolescents maybe due
to an inadequate supply of iron as well as increased iron requirements
for growth and developmental processes. The incr easing prevalence of
obesity puts children at risk of iron deficiency. Studies on the effects
of obesity on iron deficiency have focused on low grade systemic
inflammation as well as examining soluble transferrin receptor levels
(sTfR) as an indicator ofiron deficiency.
Objective To compare sT fR levels in obese and non-obese
adolescents, assess for correlations between BMI, sTfR and obesity,
and determine the risk of iron deficiency in obese adolescents .
Method T his cross sectional study was conducted on 20 obese
and 20 non-obese adolescents aged 15-17 in East Aceh District,
from September to December 20 11. Subject were chosen through
cluster sampling. The obese subjects had BMI > 95th percentile
and the non-obese subjects had BMI s:851h percentile based on
the 2000 National Center for Health Statistics (NCHS). Exclusion
criteria were blood disorders, chronic diseases, and a history of
bleeding. Data were analyzed by Chi-square test and T test with
a significance level of P < 0.05, and Pearson's correlation.
Results The mean s TfR levels in obese adolescents was higher than
in non-obese adolescents, [2.59 (SD 0.76) vs 2.14 (SD 0.45) Î¼g/mL
(P = 0.030)]. Iron deficiency (sTfR> 2.5 Î¼gimL) was more common
in obese than in non-obese adolescents [ (55% vs . 15%, respectively,
(P = 0.019) ]. Analysis of the relationship between obesity according
to BMI andsTfRrevealedan OR of 6.93; 95% CI 1.53 to3 1.38. The
r elationship between the BMI and sTfR levels indicated a positive,
moderate strength of association (r = 0.392) .
Conclusion The mean sT fR levels in obese adolescents is significantly
higher than in non-obese individuals. Obese adolescents
have a 6.93 times higher risk of iron deficiency than non-obese
adolescents. Body mass index has a positive and moderate association
with sTfR.

References

Stoltzfus RJ. Defining iron-deficiency anemia in public health terms: A time for reflection. J Nutr 2001;131(Suppl):565S-7.

Raspati H, Reniarti L, Susanah S. Anemia defisiensi besi. In : Pennono B, Sutaryo, editors. Buku Ajar Hematologi - Onkologi Anak. Jakarta: IDAI; 2005. p.30-42.

Soegijanto S, Ugrasena. Anemia defisiensi besi pada bayi dan anak. Cetakan pertama. Jakarta: Ikatan Dokter Indonesia; 2004. p.1-34.

Digestive Health Founda tion. Clinical update : iron deficiency. [cited 2008 August]; Available from http://www.gesa.org.au.

McClung JP, Karl JP. Iron deficiency and obesity: the contribution of inflammation and diminished iron absorption. Nutr Rev 2009;67:100-4.

Alemzadeh R, Lifshitz F. Childhood obesity. In: Lifshitz F, editor. Pediatric Endocrinology. New York: Mercer Dekker, Inc.;1996. p.7 53-70.

Seltzer C, Mayer J. Serum iron and iron binding capacity in adolescents II, Comparison of obese and non obese subjects. Am J Clin Nutr. 1963;13;354-61.

Soetjiningsih. Obesitas pada anak. In: Soetjiningsih, Ranuh G, editors. Tumbuh Kembang Anak. Jakarta: EGC; 2002. p.183-90.

Visser M, Beuter LM, McQuillan GM, Wener MH, Harris TB. Low-grade systemic inflammation in overweight children. Pediatrics 2001;107:el3.

Ganz T. Hepcidin-a regulator of intestinal iron absorption and iron recycling by macrophages. Best Pract Res Clin Haematol 2005;18:171-82.

Yanoff LB, Menzie CM, Denkinger B, Sebring NG, McHugh T, Remaley AT, et al. Inflanunation and iron deficiency in the hypoferremia of obesity. Int J Obesity 2007;31:1412-9.

Dwiprahasto I. Terapi anemia defisiensi besi berbasis bukti. In: Triasih R, editor. Anemia defisiensi besi. Yogyakarta: Bagian Ilmu Kesehatan Anak FK UGM;2004. p.68-82.

Jain S, Narayan S, Chandra J, Sharma S, Jain S, Malhan P. Evaluation of serum transferrin receptor and sTfR ferritin indices in diagnosing and differentiating iron deficiency anemia from anemia of chronic disease. Indian J Pediatr. 2010;77:179-83.

Ahluwalia N. Diagnostic utility of serum trans ferrin receptors measurement in assessing iron status. Nutt Rev 1998;56:133-41.

Bambang S. Soluble transferrin receptor. In: Syamsul A, IDG Ugrasena, Alpha F, editors. Comprehensive management in children with hematology oncology problem. Surabaya: IDAI cabangJawa Timur; 2006. p.95-104.

Brandao M, Oliveira JC, Bravo F, Reis J, Garrido I, Porto G. The soluble transferrin receptor as a marker of iron homeostasis in normal subjects and in HFE-related hemochromatosis. Haematologica 2005;90:3l-7.

l7. Pinhas-Hamiel 0, Newfield RS, Koren I, Agmon A, Lilos P, Phillip M. Greater prevalence of iron deficiency in overweight and obese children and adolescents. Int J of Obes Relat Metab Disord. 2003:27;416-8.

Moayeri H, Bidad K, Zadboush S, Gholami N, Anari S. Increasing prevalence of iron deficiency in overweight and obese children and adolescents (Tehran Adolescent Obesity Study). Eur J Pediatr, 2006;165:813-4.

Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, et al. Obesity and the metabolic syndrome in children and adolescents. N Eng J Med. 2004;350:2362-74.

Nead KG, Halterman JS, Kaczorowski JM, Auinger P, Weitzman M. Overweight children and adolescents: a risk group for iron deficiency. Pediatrics 2004;114:104-8.

Aeberli I, Hurrel RF, Zimmerman MB. Overweight children have higher circulating hepcidin concentrations and lower iron status but have dietary iron intakes and bioavailability comparable to normal weight children. Int J Obesity 2009;33:1111-17.

Brittenhem GM. Disorder of iron metabolism-iron deficiency and overload. In: Hoffman R, Shattil SJ, Fune B, Cohen HJ, editors. Hematology: basic principles and practice. 7nd ed. New York: Churchill Livingstone; 1995. p.492-517.

Fleming RE, Bacon BR.Orchestration of iron homeostasis. N Engl J Med. 2005;352:1741-4.

Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States 1999-2004. JAMA 2006;295:1549-55.