Anemia and Iron Status Among Different Body Size Phenotypes in Chinese Adult Population: a Nation-Wide, Health and Nutrition Survey
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Previous studies have shown that there is a controversial relationship between iron homeostasis and obesity. This study aims to explore the relationship of anemia and iron status with different body size phenotypes in adult Chinese population. Using information on iron status-related parameters and lifestyle data from 8462 participants of the 2009 wave of China Health and Nutrition Survey (2009 CHNS), we performed multivariable logistic regression analyses to estimate the odds ratios (ORs) for the risk of anemia and iron parameters according to different body size phenotypes. Participants with higher body mass index (BMI) had a lower anemia prevalence with significant trends in both metabolic status groups (P < 0.001). Serum ferritin, transferrin, and soluble transferrin receptor (sTfR)/log ferritin index were significant in different metabolic status groups and in different body size phenotypes, respectively. The ORs for higher ferritin and transferrin increased across different body size phenotypes in both genders, and for sTfR/log ferritin index decreased (P < 0.01 for trend). This association was still statistically significant after adjustment for multiple confounders. We found an inverse association of BMI levels with the prevalence of anemia and strong association of serum ferritin and transferrin with higher risk of obesity or overweight in both metabolic status groups.
KeywordsAnemia Obesity Body mass index
We thank all the participants in China and the USA who have been involved in the China Health and Nutrition Survey, the blood sample test work, and the related pilot studies. This research uses data from the China Health and Nutrition Survey (CHNS). We thank the National Institute of Nutrition and Food Safety, the China Center for Disease Control and Prevention, the Carolina Population Center (5 R24 HD050924) at the University of North Carolina at Chapel Hill, the NIH (R01-HD30880, DK056350, R24 HD050924, and R01-HD38700), and the Fogarty International Center of the NIH for the financial support of the CHNS data collection and analysis files from 1989 to 2011 and future surveys, and the China-Japan Friendship Hospital, Ministry of Health, for the support of the 2009 CHNS. This study was also supported by the National Science Foundation of China (Nos. 81400356 and 81373773), the International Cooperation Project of the Ministry of Science and Technology (No. 2014DFA31490), and the China-Japan Friendship Hospital Youth Science and Technology Excellence Project (No. 2015-QNYC-B-11).
Study design: Jiang Li.
Data collection and analysis: Hui Yang, Yun Zhou.
Manuscript preparation: Jiang Li, Yongtong Cao, Rui Wang, Cheng Xiao.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
- 1.Jian-Hua P, Lai JQ, Yin SA, Jie XU, Qing-Mei XU, Yang XG (2005) Study on the anemia status of Chinese population. Acta Nutrimenta Sinica 27(4):268–267Google Scholar
- 2.Yichun H, Jing C, Min L, Weidong L, Yanhua Y, Lichen Y, Rui W, Jianhua P (2016) Study on the anemia status of Chinese urban residents in 2010–2012. Chin J Prev Med 50(3):213–216Google Scholar
- 3.Yang W, Xiao J, Yang Z, Ji L, Jia W, Weng J, Lu J, Shan Z, Liu J, Tian H, Ji Q, Zhu D, Ge J, Lin L, Chen L, Guo X, Zhao Z, Li Q, Zhou Z, Shan G, He J (2012) Serum lipids and lipoproteins in Chinese men and women. Circulation 125(18):2212–2221. https://doi.org/10.1161/CIRCULATIONAHA.111.065904 CrossRefPubMedGoogle Scholar
- 9.Becker C, Orozco M, Solomons NW, Schümann K (2015) Iron metabolism in obesity: how interaction between homoeostatic mechanisms can interfere with their original purpose Part I: underlying homoeostatic mechanisms of energy storage and iron metabolisms and their interaction. J Trace Elem Med Biol 30:195–201. https://doi.org/10.1016/j.jtemb.2014.10.011 CrossRefPubMedGoogle Scholar
- 10.Becker C, Orozco M, Solomons NW, Schümann K (2015) Iron metabolism in obesity: how interaction between homoeostatic mechanisms can interfere with their original purpose. Part II: epidemiological and historic aspects of the iron/obesity interaction. J Trace Elem Med Biol 30:202–206. https://doi.org/10.1016/j.jtemb.2014.10.012 CrossRefPubMedGoogle Scholar
- 11.Manios Y, Moschonis G, Chrousos GP, Lionis C, Mougios V, Kantilafti M, Tzotzola V, Skenderi KP, Petridou A, Tsalis G, Sakellaropoulou A, Skouli G, Katsarou C (2013) The double burden of obesity and iron deficiency on children and adolescents in Greece: the Healthy Growth Study. J Human Nutr Diet : Off J Br Diet Assoc 26(5):470–478. https://doi.org/10.1111/jhn.12025 CrossRefGoogle Scholar
- 12.del Giudice EM, Santoro N, Amato A, Brienza C, Calabro P, Wiegerinck ET, Cirillo G, Tartaglione N, Grandone A, Swinkels DW, Perrone L (2009) Hepcidin in obese children as a potential mediator of the association between obesity and iron deficiency. J Clin Endocrinol Metab 94(12):5102–5107. https://doi.org/10.1210/jc.2009-1361 CrossRefPubMedGoogle Scholar
- 16.Cepeda-Lopez AC, Osendarp SJ, Melse-Boonstra A, Aeberli I, Gonzalez-Salazar F, Feskens E, Villalpando S, Zimmermann MB (2011) Sharply higher rates of iron deficiency in obese Mexican women and children are predicted by obesity-related inflammation rather than by differences in dietary iron intake. Am J Clin Nutr 93(5):975–983. https://doi.org/10.3945/ajcn.110.005439 CrossRefPubMedGoogle Scholar
- 19.Ansari I, Sheikh A, Ahmed SS, Jabbar Q, Ali S (2014) Management of anemia and other hematologic derangements in patients with chronic kidney disease. Arab J Nephrol Trans 7(1):13–19Google Scholar
- 20.Jeon YJ, Jung IA, Kim SH, Cho WK, Jeong SH, Cho KS, Park SH, Jung MH, Suh BK (2013) Serum ferritin level is higher in male adolescents with obesity: results from the Korean National Health and Nutrition Examination Survey 2010. Ann Pediatr Endocrinol Metab 18(3):141–147. https://doi.org/10.6065/apem.2013.18.3.141 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Akter S, Nanri A, Kuwahara K, Matsushita Y, Nakagawa T, Konishi M, Honda T, Yamamoto S, Hayashi T, Noda M, Mizoue T (2017) Circulating ferritin concentrations and risk of type 2 diabetes in Japanese individuals. J Diabetes Invest 8(4):462–470. https://doi.org/10.1111/jdi.12617 CrossRefGoogle Scholar
- 26.Du T, Zhang J, Yuan G, Zhang M, Zhou X, Liu Z, Sun X, Yu X (2015) Nontraditional risk factors for cardiovascular disease and visceral adiposity index among different body size phenotypes. Nutr Metab Cardiovasc Dis : NMCD 25(1):100–107. https://doi.org/10.1016/j.numecd.2014.07.006 CrossRefPubMedGoogle Scholar
- 28.Alizadeh S, Mirzaei K, Mohammadi C, Keshavarz SA, Maghbooli Z (2017) Circulating omentin-1 might be associated with metabolic health status in different phenotypes of body size. Arch Endocrinol Metab. https://doi.org/10.1590/2359-3997000000269
- 29.Wildman RP, Kaplan R, Manson JE, Rajkovic A, Connelly SA, Mackey RH, Tinker LF, Curb JD, Eaton CB, Wassertheil-Smoller S (2011) Body size phenotypes and inflammation in the Women’s Health Initiative Observational Study. Obesity (Silver Spring) 19(7):1482–1491. https://doi.org/10.1038/oby.2010.332 CrossRefGoogle Scholar
- 30.De Benoist B, McLean E, Egli I, Cogswell M (2008) Worldwide prevalence of anaemia 1993–2005. World Health Organization, Geneva, pp 41Google Scholar
- 31.Control CfD, Prevention (1998) Recommendations to prevent and control iron deficiency in the United States. Mmwr Morbidity and Mortality Weekly Report. 47(RR-3):i–iii,1–29Google Scholar
- 39.Gartner A, Berger J, Bour A, El Ati J, Traissac P, Landais E, El Kabbaj S, Delpeuch F (2013) Assessment of iron deficiency in the context of the obesity epidemic: importance of correcting serum ferritin concentrations for inflammation. Am J Clin Nutr 98(3):821–826. https://doi.org/10.3945/ajcn.112.054551 CrossRefPubMedGoogle Scholar
- 40.Cepeda-Lopez AC, Aeberli I, Zimmermann MB (2010) Does obesity increase risk for iron deficiency? A review of the literature and the potential mechanisms. International journal for vitamin and nutrition research Internationale Zeitschrift fur vitamin- und Ernahrungsforschung journal international de vitaminologie et de. Nutrition 80(4–5):263–270. https://doi.org/10.1024/0300-9831/a000033 CrossRefGoogle Scholar