Is iron treatment related to weight gain in female patients with iron deficiency anemia? :Osman Yokus, Habip Gedik, The Egyptian Journal of Haematology

ORIGINAL ARTICLE
Year : 2016 | Volume : 41 | Issue : 2 | Page : 42--44

Is iron treatment related to weight gain in female patients with iron deficiency anemia?

Osman Yokus¹, Habip Gedik²,
¹ Department of Hematology, Ministry of Health İstanbul Training and Research Hospital, İstanbul, Turkey
² Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Bakırköy Sadi Konuk Training and Research Hospital, İstanbul, Turkey

Correspondence Address:
Habip Gedik
Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Bakırköy Sadi Konuk Training and Research Hospital, 34700 İstanbul
Turkey

Abstract

Objectives To assess the relationship between iron treatments and to gain weight in the female patients. Materials and methods This study was conducted prospectively between 2013 and 2014 to assess the relationship between iron treatments and to gain weight in the female patients who were admitted to hematology clinic, Ministry of Health İstanbul Research Hospital with a diagnosis of iron deficiency anemia and iron therapy between the ages of 18 and 50 and signed informed consent. Results After 3 months of iron therapy, significant hemoglobin (Hgb) increase was observed in 30 of 33 patients. Weight gain and Hgb increase have not been found in three patients. Hgb increases in patients who gained weight more than 3 kg were found to be statistically significant than patients who gained weight 3 kg or less (P = 0.008). Conclusion Obesity and metabolic syndrome are current health problems in terms of mortality and morbidity. Weight gain related to iron therapy is a common problem in female patients with iron deficiency anemia. Patients under iron therapy should be counseled in terms of weight gain complication and benefits of diet and followed up serum ferritin and Hgb levels to prevent prolonged iron therapy. Physicians should pay attention to patients who do not gain weight without dieting.

How to cite this article:
Yokus O, Gedik H. Is iron treatment related to weight gain in female patients with iron deficiency anemia?.Egypt J Haematol 2016;41:42-44

How to cite this URL:
Yokus O, Gedik H. Is iron treatment related to weight gain in female patients with iron deficiency anemia?. Egypt J Haematol [serial online] 2016 [cited 2023 Mar 30 ];41:42-44
Available from: http://www.ehj.eg.net/text.asp?2016/41/2/42/186395

Full Text

Introduction

Iron deficiency anemia (IDA) is the most common cause of anemia, especially in children, and is observed more frequently in women undergoing menstruation and pregnancy. Inadequate dietary iron intake, bleeding hemorrhoids, and gynecological problems are commonly encountered causes of IDA. Although the age and geographical differences are observed, the frequency of IDA can be up to 60% in some regions of the world [1].

IDA is commonly observed in females; on the other hand, obesity and hyperglycemia have become a global problem increasing during pregnancy. Although obesity prevalence varies by age, it has been reported to be between 40 and 60% in some communities. Insulin resistance is associated with obesity and metabolic syndrome (MS). As is known, BMI greater than 25 is defined as overweight, and greater than 30 is defined as obesity [2].

Iron given for treatment of IDA and its excess were also reported to have an effect on lipid peroxidation and DNA damage by oxidative effect in vitro in animal studies [3]. In practice, the body iron stores are best measured by serum ferritin. Iron store excess causes insulin resistance, diabetes, nonalcoholic hepatic steatosis, and MS. Excess iron leads to insidious inflammation, especially on endothelial structures like oxygen radicals that have toxic effects [4]. Hepcidin, the production of which increases in fat tissue of obese people, was reported to reduce the response to iron therapy [5].

We have noticed that female patients with anemia cannot comply, and refrain from using these preparations as they claim to gain weight due to iron treatment. We conducted this study to assess the relationship between iron treatments and to gain weight in the female patients.

Materials and methods

This study was conducted prospectively between 2013 and 2014 to assess the relationship between iron treatments and to gain weight in the female patients who were admitted to hematology clinic, Ministry of Health İstanbul Research Hospital with a diagnosis of IDA and iron therapy between the ages of 18 and 50 and signed informed consent. The local ethic committee has approved this study. Diagnosis of iron deficiency has been done with complete blood count, serum ferritin, iron, iron binding capacity, sedimentation and biochemical parameters, and some other tests (such as the fecal occult blood) by hematology physician. Patients, who had other causes of anemia, those diseases that contribute to anemia different etiological factors [such as myelodysplastic syndrome (MDS)], combined vitamin deficiency and anemia associated with chronic illnesses, malignancy, history of using iron preparations at previous 6 months, metabolic and endocrine disorders, the use of oral contraceptives, comorbid disease, using drugs that interfere with iron drug, pregnancy and breastfeeding could not be followed up during study period, were excluded. Iron treatment was administered as oral 100-200 mg of elemental iron for 3 months or 5-10 days of intravenous/intramuscular followed by oral iron treatment. Patients' weights were measured at baseline and after 3 months of treatment at the clinic by calibrated scales.

Statistic

Statistical analysis was done using SPSS, version 21.0 (SPSS Inc., Chicago, Illinois, USA). Continuous variables were described as mean ± SD and range. Dichotomous variables were compared by Fisher's exact test for two by two comparisons or Pearson's χ2 for greater than two responses. Logistic regression analysis was conducted to obtain unadjusted odds ratios and revealed as (odds ratio; 95% confidence interval; P value). Statistical significance was defined as P value less than 0.05.

Results

A total of 34 female patients were enrolled in the study. Four patients who were diagnosed with celiac disease, gastric adenocarcinoma, hyperthyroidism, and one case who has undergone gastric surgery during the study period were excluded from the study. The mean age was 36.1 years (range: 19-50 years, [Table 1]). Three kilograms and overweight gain has occurred in 20 patients (60%) in the range of 3-11 kg. Seven patients (23%) who had 3 kg or less have revealed to pay attention to their diet ([Table 2]). After 3 months of iron therapy, significant hemoglobin (Hgb) increase was observed in 30 of 33 patients. Weight gain and Hgb increase have not been found in three patients. Hgb increases in patients who gained weight more than 3 kg were found to be statistically significant than patients who gained weight 3 kg or less (P = 0.008). In addition, serum ferritin levels of patients who gained weight 3 kg or more were found to be higher than those who gained weight by 3 kg or less, but it was not statistically significant (P = 0.79; [Table 3]).{Table 1}{Table 2}{Table 3}

Discussion

Patients who receive iron treatment gain weight, if they do not make diet or have a metabolic disease. So, iron therapy increases serum ferritin levels accompanying with body weight. Our study results are consistent with this hypothesis, which was supported by other published studies as well. A study was conducted in Finland with 691 patients (289 men and 402 women) to investigate the relationship between serum ferritin level and MS development within 6.5 years [4]. During this period, MS developed in 18% of all cases developed; the development of MS in both women and men who have had high ferritin values reported to be more statistically significant. It was also reported that there is a correlation between the increase around the waist as an indicator of obesity and serum ferritin value [5]. Patients who are inclined to obesity, hyperglycemia, or insulin resistance should be counseled in terms of diet, weight gain, the monitoring of the response to treatment of anemia, and not to extension of treatment after recovery of anemia. Further studies are needed to evaluate how much and how long iron administration lead to insulin resistance, and whether serum iron levels increase weight. However, this study is significant in terms of a preliminary study to shed light on this. A study, which was conducted to investigate the relationship between blood ferritin and glucose intolerance in 104 pregnant women without anemia who received 75 g oral glucose for glucose tolerance test reported that serum glucose levels at 2 h were found to be higher in women with ferritin level more than 38.8 µg/l than in women with lower than this value [6]. Therefore, pregnant women should be more carefully evaluated in terms of iron stores, and iron treatment could hazard in pregnant women without anemia. Perinatal iron deficiency combined with a high-fat diet were reported to cause obesity and cardiovascular dysregulation [7].Supplied iron is likely to be related to weight gain due to insulin resistance or the amount of excess iron, as shown in our study. The relationship between ferritin levels and development of insulin resistance after treatment should be investigated to clarify the situation.

One study was conducted to investigate serum ferritin and high sensitive C-reactive protein (hsCRP) in 132 cases who were either obese-non-diabetic or obese-diabetic and normal control group including 146 cases. High serum ferritin levels of obesity cases were reported to be related to high serum hsCRP levels as being independent from diabetes mellitus [2]. Serum ferritin and hsCRP levels were also reported to be high in patients with type 2 diabetes mellitus and obesity as well [8]. High serum ferritin levels are likely to induce inflammation and development of MS. Weight gain related to iron administration and unresponsiveness to iron treatment related to hepcidin in obese patients were reported as well [5]. In this respect, diet prevents weight gain and its related MS complications in patients receiving iron treatment. However, patients who do not gain weight under iron administration, without diet should be examined in terms of malignancy, inflammatory bowel disease, hyperthyroidism, etc.

Only female patients were included in the study as they commonly apply to the ambulatory patient clinic with a diagnosis of IDA and complaint weight gain related to iron administration.

Conclusion

Obesity and MS are current health problems in terms of mortality and morbidity. Weight gain related to iron therapy is a common problem in female patients with IDA. Patients under iron therapy should be counseled in terms of weight gain complication and benefits of diet and followed up serum ferritin and Hgb levels to prevent prolonged iron therapy. Physicians should pay attention to patients who do not gain weight without diet.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1	Hercberg S, Preziosi P, Galan P. Iron deficiency in Europe. Public Health Nutr 2001; 4 :537-545.
2	Chambers EC, Heshka S, Gallagher D, Wang J, Pi-Sunyer FX, Pierson RN Jr. Serum iron and body fat distribution in a multiethnic cohort of adults living in New York City. J Am Diet Assoc 2006; 106 :680-684.
3	Zhuang T, Han H, Yang Z. Iron, oxidative stress and gestational diabetes. Nutrients. 2014; 6 :3968-3980.
4	Hämäläinen P, Saltevo J, Kautiainen H, Mäntyselkä P, Vanhala M. Serum ferritin levels and the development of metabolic syndrome and its components: a 6.5-year follow-up study. Diabetol Metab Syndr 2014; 6 :114.
5	Aigner E, Feldman A, Datz C. Obesity as an emerging risk factor for iron deficiency. Nutrients 2014; 6 :3587-3600.
6	Zein S, Rachidi S, Awada S, Osman M, Al-Hajje A, Shami N, et al. High iron level in early pregnancy increased glucose intolerance. J Trace Elem Med Biol 2015; 30 :220-225.
7	Bourque SL, Komolova M, McCabe K, Adams MA, Nakatsu K. Perinatal iron deficiency combined with a high-fat diet causes obesity and cardiovascular dysregulation. Endocrinology 2012; 153 :1174-1182.
8	Andrews M, Soto N, Arredondo-Olguín M. Association between ferritin and hepcidin levels and inflammatory status in patients with type 2 diabetes mellitus and obesity. Nutrition 2015; 31:51-57.