Obesity As an Emerging Risk Factor for Iron Deficiency

Overview

Journal Nutrients

Date 2014 Sep 13

PMID 25215659

Citations 126

Authors

Elmar Aigner

Alexandra Feldman

Christian Datz

Affiliations

Soon will be listed here.

Abstract

Iron homeostasis is affected by obesity and obesity-related insulin resistance in a many-facetted fashion. On one hand, iron deficiency and anemia are frequent findings in subjects with progressed stages of obesity. This phenomenon has been well studied in obese adolescents, women and subjects undergoing bariatric surgery. On the other hand, hyperferritinemia with normal or mildly elevated transferrin saturation is observed in approximately one-third of patients with metabolic syndrome (MetS) or nonalcoholic fatty liver disease (NAFLD). This constellation has been named the "dysmetabolic iron overload syndrome (DIOS)". Both elevated body iron stores and iron deficiency are detrimental to health and to the course of obesity-related conditions. Iron deficiency and anemia may impair mitochondrial and cellular energy homeostasis and further increase inactivity and fatigue of obese subjects. Obesity-associated inflammation is tightly linked to iron deficiency and involves impaired duodenal iron absorption associated with low expression of duodenal ferroportin (FPN) along with elevated hepcidin concentrations. This review summarizes the current understanding of the dysregulation of iron homeostasis in obesity.

Citing Articles

Effect of a high-fat diet and iron overload on erythropoiesis in mice.

Varghese J, Varghese J, Jacob M Biochem Biophys Rep. 2025; 41:101919.

PMID: 39980584 PMC: 11841077. DOI: 10.1016/j.bbrep.2025.101919.

Association Between Dietary Inflammatory Index and Triglyceride Glucose-Body Mass Index with Iron Deficiency in Reproductive Age Women: Evidence from NHANES 2005-2018.

Ding J, Xu Z, Liang R, Xie S Int J Womens Health. 2025; 17:355-367.

PMID: 39959754 PMC: 11827504. DOI: 10.2147/IJWH.S507765.

Burden and trends of dietary iron deficiency in the Middle East and North Africa region, 1990-2021.

Safiri S, Amiri F, Karamzad N, Sullman M, Kolahi A, Abdollahi M Front Nutr. 2025; 11:1517478.

PMID: 39906895 PMC: 11790450. DOI: 10.3389/fnut.2024.1517478.

Effects of bone metabolism on hematopoiesis: A Mendelian randomization study.

Ho S, Hoi-Yee Li G, Leung A, Choon-Beng Tan K, Cheung C Osteoporos Sarcopenia. 2025; 10(4):151-156.

PMID: 39835327 PMC: 11742307. DOI: 10.1016/j.afos.2024.10.001.

Diabesity is associated with a worse joint specific functional outcome following primary total knee replacement.

Lovie J, Clement N, MacDonald D, Ahmed I Arch Orthop Trauma Surg. 2025; 145(1):124.

PMID: 39797927 DOI: 10.1007/s00402-024-05704-9.

References

Flancbaum L, Belsley S, Drake V, Colarusso T, Tayler E . Preoperative nutritional status of patients undergoing Roux-en-Y gastric bypass for morbid obesity. J Gastrointest Surg. 2006; 10(7):1033-7. DOI: 10.1016/j.gassur.2006.03.004. View

SELTZER C, Mayer J . SERUM IRON AND IRON-BINDING CAPACITY IN ADOLESCENTS. II. COMPARISON OF OBESE AND NONOBESE SUBJECTS. Am J Clin Nutr. 1963; 13:354-61. DOI: 10.1093/ajcn/13.6.354. View

Ganz T . Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation. Blood. 2003; 102(3):783-8. DOI: 10.1182/blood-2003-03-0672. View

Nairz M, Haschka D, Demetz E, Weiss G . Iron at the interface of immunity and infection. Front Pharmacol. 2014; 5:152. PMC: 4100575. DOI: 10.3389/fphar.2014.00152. View

Pinhas-Hamiel O, Newfield R, Koren I, Agmon A, Lilos P, Phillip M . Greater prevalence of iron deficiency in overweight and obese children and adolescents. Int J Obes Relat Metab Disord. 2003; 27(3):416-8. DOI: 10.1038/sj.ijo.0802224. View

Anty R, Dahman M, Iannelli A, Gual P, Staccini-Myx A, Amor I . Bariatric surgery can correct iron depletion in morbidly obese women: a link with chronic inflammation. Obes Surg. 2008; 18(6):709-14. DOI: 10.1007/s11695-007-9276-y. View

Patel S, Hakim D, Mason J, Hakim N . The duodenal-jejunal bypass sleeve (EndoBarrier Gastrointestinal Liner) for weight loss and treatment of type 2 diabetes. Surg Obes Relat Dis. 2013; 9(3):482-4. DOI: 10.1016/j.soard.2013.01.015. View

Beard J, Borel M, Peterson F . Changes in iron status during weight loss with very-low-energy diets. Am J Clin Nutr. 1997; 66(1):104-10. DOI: 10.1093/ajcn/66.1.104. View

Shander A, Van Aken H, Colomina M, Gombotz H, Hofmann A, Krauspe R . Patient blood management in Europe. Br J Anaesth. 2012; 109(1):55-68. PMC: 3374574. DOI: 10.1093/bja/aes139. View

10.

Manios Y, Moschonis G, Chrousos G, Lionis C, Mougios V, Kantilafti M . The double burden of obesity and iron deficiency on children and adolescents in Greece: the Healthy Growth Study. J Hum Nutr Diet. 2013; 26(5):470-8. DOI: 10.1111/jhn.12025. View

11.

Shi Z, Lien N, Kumar B, Dalen I, Holmboe-Ottesen G . The sociodemographic correlates of nutritional status of school adolescents in Jiangsu Province, China. J Adolesc Health. 2005; 37(4):313-22. DOI: 10.1016/j.jadohealth.2004.10.013. View

12.

Bekri S, Gual P, Anty R, Luciani N, Dahman M, Ramesh B . Increased adipose tissue expression of hepcidin in severe obesity is independent from diabetes and NASH. Gastroenterology. 2006; 131(3):788-96. DOI: 10.1053/j.gastro.2006.07.007. View

13.

Mujica-Coopman M, Brito A, de Romana D, Pizarro F, Olivares M . Body mass index, iron absorption and iron status in childbearing age women. J Trace Elem Med Biol. 2014; 30:215-9. DOI: 10.1016/j.jtemb.2014.03.008. View

14.

Matak P, Zumerle S, Mastrogiannaki M, El Balkhi S, Delga S, Mathieu J . Copper deficiency leads to anemia, duodenal hypoxia, upregulation of HIF-2α and altered expression of iron absorption genes in mice. PLoS One. 2013; 8(3):e59538. PMC: 3610650. DOI: 10.1371/journal.pone.0059538. View

15.

Marambio A, Watkins G, Castro F, Riffo A, Zuniga R, Jans J . Changes in iron transporter divalent metal transporter 1 in proximal jejunum after gastric bypass. World J Gastroenterol. 2014; 20(21):6534-40. PMC: 4047338. DOI: 10.3748/wjg.v20.i21.6534. View

16.

Myint P, Kwok C, Luben R, Wareham N, Khaw K . Body fat percentage, body mass index and waist-to-hip ratio as predictors of mortality and cardiovascular disease. Heart. 2014; 100(20):1613-9. DOI: 10.1136/heartjnl-2014-305816. View

17.

Wenzel B, STULTS H, Mayer J . Hypoferraemia in obese adolescents. Lancet. 1962; 2(7251):327-8. DOI: 10.1016/s0140-6736(62)90110-1. View

18.

Korolnek T, Hamza I . Like iron in the blood of the people: the requirement for heme trafficking in iron metabolism. Front Pharmacol. 2014; 5:126. PMC: 4045156. DOI: 10.3389/fphar.2014.00126. View

19.

Skroubis G, Kouri N, Mead N, Kalfarentzos F . Long-term results of a prospective comparison of Roux-en-Y gastric bypass versus a variant of biliopancreatic diversion in a non-superobese population (BMI 35-50 kg/m(2)). Obes Surg. 2013; 24(2):197-204. DOI: 10.1007/s11695-013-1081-1. View

20.

Vulpe C, Kuo Y, MURPHY T, Cowley L, Askwith C, Libina N . Hephaestin, a ceruloplasmin homologue implicated in intestinal iron transport, is defective in the sla mouse. Nat Genet. 1999; 21(2):195-9. DOI: 10.1038/5979. View