The Impact of Obesity and Insulin Resistance on Iron and Red Blood Cell Parameters: A Single Center, Cross-Sectional Study

OBJECTIVE: Obesity and iron deficiency (ID) are the 2 most common nutritional disorders worldwide causing significant public health implications. Obesity is characterized by the presence of low-grade inflammation, which may lead to a number of diseases including insulin resistance (IR) and type 2 diabetes. Increased levels of acute-phase proteins such as C-reactive protein (CRP) have been reported in obesity-related inflammation. The aim of this study was to investigate the impact of obesity/IR on iron and red blood cell related parameters. METHODS: A total of 206 patients and 45 control subjects of normal weight were included in this crosssectional study. Venous blood samples were taken from each patient to measure hemoglobin (Hb), serum iron (Fe), ironbinding capacity (IBC), ferritin, CRP, fasting blood glucose, and fasting insulin. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated for each patient. IR was determined using the HOMA-IR formula. RESULTS: Subjects were divided into 3 groups according to BMI. There were 152 severely obese (BMI: 42.6±10.1), 54 mildly obese (BMI: 32.4±2.1), and 45 normal-weight (BMI: 24.3±1.3) patients. Hb levels in severely obese patients and normal controls were 12.8±1.3 g/dL and 13.6±1.8 g/dL, respectively. We found decreasing Fe levels with increasing weight (14.9±6.9 μmol/L, 13.6±6.3 μmol/L, and 10.9±4.6 μmol/L for normal controls and mildly and severely obese patients, respectively). Hb levels were slightly lower in patients with higher HOMA-IR values (13.1±1.5 g/dL vs. 13.2±1.2 g/dL; p=0.36). Serum iron levels were significantly higher in the group with low HOMA-IR values (13.6±5.9 μmol/L vs. 11.6±4.9 μmol/L; p=0.008). IBC was found to be similar in both groups (60.2±11.4 μmol/L vs. 61.9±10.7 μmol/L; p=0.23). Ferritin was slightly higher in patients with higher HOMA-IR values (156.1±209.5 pmol/L vs. 145.3±131.5 pmol/L; p=0.62). CONCLUSION: Elevated BMI and IR are associated with lower Fe and hemoglobin levels. These findings may be explained by the chronic inflammation of obesity and may contribute to obesity-related co-morbidities. People with IR may present with ID without anemia

The Impact of Obesity and Insulin Resistance on Iron and Red Blood Cell Parameters: A Single Center, Cross-Sectional Study

OBJECTIVE: Obesity and iron deficiency (ID) are the 2 most common nutritional disorders worldwide causing significant public health implications. Obesity is characterized by the presence of low-grade inflammation, which may lead to a number of diseases including insulin resistance (IR) and type 2 diabetes. Increased levels of acute-phase proteins such as C-reactive protein (CRP) have been reported in obesity-related inflammation. The aim of this study was to investigate the impact of obesity/IR on iron and red blood cell related parameters. METHODS: A total of 206 patients and 45 control subjects of normal weight were included in this crosssectional study. Venous blood samples were taken from each patient to measure hemoglobin (Hb), serum iron (Fe), ironbinding capacity (IBC), ferritin, CRP, fasting blood glucose, and fasting insulin. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated for each patient. IR was determined using the HOMA-IR formula. RESULTS: Subjects were divided into 3 groups according to BMI. There were 152 severely obese (BMI: 42.6+-10.1), 54 mildly obese (BMI: 32.4+-2.1), and 45 normal-weight (BMI: 24.3+-1.3) patients. Hb levels in severely obese patients and normal controls were 12.8+-1.3 g/dL and 13.6+-1.8 g/dL, respectively. We found decreasing Fe levels with increasing weight (14.9+-6.9 μmol/L, 13.6+-6.3 μmol/L, and 10.9+-4.6 μmol/L for normal controls and mildly and severely obese patients, respectively). Hb levels were slightly lower in patients with higher HOMA-IR values (13.1+-1.5 g/dL vs. 13.2+-1.2 g/dL; p=0.36). Serum iron levels were significantly higher in the group with low HOMA-IR values (13.6+-5.9 μmol/L vs. 11.6+-4.9 μmol/L; p=0.008). IBC was found to be similar in both groups (60.2+-11.4 μmol/L vs. 61.9+-10.7 μmol/L; p=0.23). Ferritin was slightly higher in patients with higher HOMA-IR values (156.1+-209.5 pmol/L vs. 145.3+-131.5 pmol/L; p=0.62). CONCLUSION: Elevated BMI and IR are associated with lower Fe and hemoglobin levels. These findings may be explained by the chronic inflammation of obesity and may contribute to obesity-related co-morbidities. People with IR may present with ID without anemia

Akut Koroner Sendromlu Hastalarda Serum Gama Glutamiltransferaz, Kalsiyum, Fosfor Değerlerinin Erken Mortalite ile İlişkisi

Amaç: GGT, LDL-kolesterolün oksidasyon basamaklarındaki rolünden dolayı proaterojenik bir moleküldür; ayrıca glutatyon metabolizması ile ilişkili olup oksidatif stres için bir biomarkır olarak düşünülebilir. Serum inorganik fosfor düzeyleri de kardiyovasküler olay ve mortalite için bağımsız bir risk faktörü olşarak kabul edilmektedir. Biz de çalışmamızda akut koroner sendromlu hastalarda erken mortalite ile serum GGT, Ca, P değerlerinin ilişkisini araştırdık. Yöntemler: Çalışmamıza akut koroner sendrom tanısıyla Koroner Yoğun Bakım Ünitesine yatırılan kadın, erkek toplam 200 hasta alındı. Hepatobiliyer sistemle ilgili, kronik metabolik kemik hastalığı, paratiroid ve ciddi sistemik hastalığı olmayan, GFR 'si >60 mL/dk olan olgular çalışmaya alındı. Hastaların biyokimyasal verileri ile taburcu olduktan sonraki bir aylık dönemdeki kardiyak kaynaklı mortalitelerinin ilişkisi değerlendirildi. Serum GGT düzeyinin normal referans aralığı erkekler için 12-64 U/L, kadınlarda ise 9-36 U/L, kalsiyum düzeylerinin normal aralığı 8,4-10,2 mg/dL idi ve inorganik fosfor için üst sınır <=4,5 mg/dL olarak belirlendi. Tanımlayıcı istatistiksel metotların yanı sıra student's t test, Mann Whitney u test ve ki-kare testi kullanıldı. Bulgular: Bir aylık sürecin sonunda mortalite izlenen hastalarda (n=23) serum GGT, fosfor ve CaxP değerlerini (32,96 U/L, 3,66 mg/dL, 35,93 mg2 / dL2 ) mortalite izlenmeyen hastalarla karşılaştırdığımızda (n=177; 24,16 U/L, 3,27 mg/dL, 31,57 mg2 /dL2 ; p<0,001, p<0,001, p<0,001, sırasıyla) anlamlı olarak daha yüksek bulduk. Sonuç: Referans aralığındaki serum GGT aktivitesinin, fosfor ve CaxP dü- zeylerinin geleneksel kardiyovasküler hastalık risk faktörlerinden (Diabetes mellitus, hipertansiyon, iskemik kalp hastalığı öyküsü gibi) bağımsız olarak, kısa dönemde de prognostik değer taşıdığını gösterdik. Çalışmamız yüksek riskli populasyonlarda, hastaların risk açısından sınıflandırılmasına yardımcı olmak, agresiv tedavi yaklaşımları geliştirerek gelecekteki istenmeyen kardiyak ölümleri önlemek amacıyla GGT ve fosfor düzeyleri için yeni referans değerleri belirlenmesi gerekliliğini desteklemektedir.Objective: Gamma-glutamyltransferase (GGT) may be considered as a biomarker of &quot;oxidative stress&quot; associated with glutathione metabolism and a possible &quot;proatherogenic&quot; marker because of its indirect relationship with the biochemical steps in the oxidation of low density lipoprotein cholesterol. Serum inorganic phosphorus (P) level is also suggested as an independent risk factor for cardiac events and mortality in the long term. We aimed to observe the relationship of serum GGT, calcium (Ca), and P levels with 1 months' mortality after myocardial infarction. Methods: Our retrospective study included 200 patients (124 men and 76 women) with acute coronary syndrome (ACS) who were admitted to our hospital. We excluded subjects with severe systemic illness, hepatobiliary disease, alcohol consumption, chronic metabolic bone disease, malignancy, parathyroid disease, and patients who had a glomerular filtration rate (GFR) <60 mL/min. Fasting blood samples were taken in the first 24 h of admission to the coronary care unit (CCU). Reference values for GGT (9-36 U/L, for women; 12-64 U/L, for men), Ca (8.4-10.2 mg/dL), and inorganic P (<=4.5 mg/dL) were used. When the serum albumin level was <4.0 g/dL, corrected Ca levels were calculated using the equation [corrected Ca=measured Ca+(0.8&times;(4-serum albumin)]. Statistical analysis was performed using SPSS for Windows 10.0. Descriptive statistical analysis, Student's t-test, Mann-Whitney U-test, and chi-square test were used. Results: At the end of 1 month, we found significantly higher levels of blood GGT, P, and Ca&times;P products in patients who did not survive (n=23; 32.9 U/L, 3.66 mg/dL, 35.93 mg2 /dL2 ) than in survivors (n=177; 24.16 U/L, 3.27 mg/dL, 31.57 mg2 /dL2 ; p<0.001, p<0.001, p<0.001, respectively). Conclusion: Serum GGT, P, and Ca&times;P levels, even in the reference intervals, had a prognostic value in the short-term mortality apart from traditional risk factors such as diabetes mellitus, hypertension, and ischemic heart disease. This study also suggests constituting new reference values for this high risk population in stratifying patient risk and in assessing the intensity of appropriate treatment, with hopes of preventing cardiac deaths