Serum Hepcidin Level in Obese Children and Adolescents: It’s Association with Iron Deficiency Anemia

Background: Childhood obesity is a worldwide chronic public health problem. It was found that obesity is associated with iron deficiency and iron profile abnormalities, which appear to be caused by several factors such as decreased intake, insufficient bioavailability, and deficient intestinal iron uptake as well as iron release from stores because of an over expression of hepcidin. Aim of the Work: Was to estimate serum hepcidin levels in obese children and adolescents and to evaluate its relation with iron deficiency anemia in these children. Subjects and Methods: The current study included 50 patients recruited from the Nutrition Clinic of Pediatric Department at Tanta University Hospital, 25 of them were obese with iron deficiency anemia and the other 25 were obese without iron deficiency anemia and 25 healthy children and adolescents of matched age and sex enrolled as controls. All studied children were subjected to complete history taking, thorough clinical examination including anthropometric measures (Weight, height, Body mass index), assessment of pubertal status using Tanner criteria and laboratory investigations including: CBC, BUN, creatinine, ALT, AST, stool analysis, occult blood in stool, CRP, iron profile, Serum Hepcidin, abdominal ultrasound. Results: There were significant differences between patients and control group as regard Weight, BMI and their z scores. Significantly lower levels of hemoglobin, serum ferritin, serum iron and transferrin saturation in obese children with IDA than obese children without IDA and controls and significantly higher levels of TIBC were found in obese children with IDA compared to obese children without IDA and controls. As regard CRP it was significantly higher in obese children than controls. Serum hepcidin was significantly higher in obese children than controls but there is no significant difference between obese children with IDA and obese children without IDA. Significant positive correlation between Serum hepcidin levels and BMI in obese children was found. Conclusion: Serum hepcidin level was significantly higher in obese children and adolescents in comparison with healthy lean control with no significant difference between obese children with IDA and obese children without IDA. So, estimation of serum hepcidin level is not diagnostic but it may be beneficial in screening of iron deficiency anemia in pediatric obese individuals. Further studies with larger sample size are needed to verify these findings.

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Comparative Study of the Effects of Lactoferrin versus Oral Iron Therapy in Obese Children and Adolescents with Iron Deficiency Anemia

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i2131138 ◽

2021 ◽

pp. 104-114

Author(s):

Manal Mahmoud Atia ◽

Rasha Mohamed Gama ◽

Mohamed Attia Saad ◽

Mohammed Amr Hamam

Keyword(s):

Iron Deficiency ◽

Children And Adolescents ◽

Iron Deficiency Anemia ◽

Interleukin 6 ◽

Oral Iron ◽

Iron Therapy ◽

Deficiency Anemia ◽

Obese Children ◽

Oral Iron Therapy ◽

Serum Hepcidin

Greater prevalence of iron deficiency (ID) has been observed in overweight and obese children and adolescents. Hepcidin acts as a key regulator of iron metabolism. Hepcidin synthesis increases in response inflammatory cytokines especially Interleukin-6 (IL-6). Considering that obesity represents a low grade chronic inflammatory state, a high concentration of hepcidin has been found in obese children. Elevated hepcidin level in obese children is associated with diminished response to oral iron therapy. Lactoferrin is an iron-binding multifunctional glycoprotein and has strong capacity to modulate the inflammatory response by its capacity to reduce pro-inflammatory cytokine expression in vivo, including IL-6 and hepcidin. Aim of the Work: To compare the efficacy of lactoferrin versus oral iron therapy in treatment of obese children and adolescents with iron deficiency anemia and the effect of therapy on serum hepcidin and interleukin 6 levels. Methodology: This prospective randomized clinical trial was conducted on 40 obese children and adolescents aged between 6 –18 years suffering from iron deficiency anemia (IDA). They were equally randomized into one of 2 groups. Group A received regular oral lactoferrin in a dose of 100 mg/day. Group B received regular oral iron supplementation (Ferric hydroxide polymaltose) in a dose of 6 mg elemental iron/kg /day.Baseline investigations included complete blood count (CBC), iron profile (Serum ferritin, serum iron, total iron binding capacity (TIBC), transferrin saturation), serum Interleukin 6, and serum hepcidin. Reevaluation of CBC was done monthly while iron status parameters, serum IL-6 and serum hepcidin were reevaluated after 3 months of receiving regular therapy. Results: Significant elevations in hemoglobin, MCV, MCH, Serum ferritin, serum iron and transferrin saturation with lactoferrin therapy compared to oral iron therapy. Significantly Lower TIBC after 3 months of lactoferrin therapy while the decrease in TIBC was insignificant in the iron therapy group.Lower serum hepcidin and IL6 after 3 months of lactoferrin therapy with no significant change in serum hepcidin and IL6 after iron therapy. Conclusion: This study clearly demonstrated the superiority of lactoferrin over iron use as oral in the treatment of iron deficiency anemia in obese children not only for the better response of hematological and iron status parameters and less gastrointestinal side effects but also for its effect on decreasing inflammatory biomarkers as hepcidin and IL6.

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Serum Concentration of Hepcidin as an Indicator of Iron Reserves in Children

Journal of Medical Biochemistry ◽

10.2478/jomb-2018-0003 ◽

2018 ◽

Vol 37 (4) ◽

pp. 456-464 ◽

Cited By ~ 2

Author(s):

Jelena Ćulafić ◽

Jovanka Kolarović ◽

Lato Pezo ◽

Velibor Čabarkapa ◽

Stanislava Nikolić ◽

...

Keyword(s):

Iron Deficiency ◽

Serum Concentration ◽

Iron Deficiency Anemia ◽

Iron Metabolism ◽

Transferrin Saturation ◽

The Body ◽

Deficiency Anemia ◽

Control Group ◽

Hepcidin Level ◽

Serum Hepcidin

SummaryBackground:Anemia represents a significant cause of maternal and perinatal mortality, as well as child mortality. The aim of the research was to determine the serum concentration of hepcidin in children aged 6 months to 2 years and adolescents aged 11 to 19 years which suffer from iron deficiency anemia and compare it with the serum concentration of hepcidin in the control groups, as well as to determine its connection with the parameters of the iron metabolism.Methods:The research included 173 examinees, 89 of them suffered from iron deficiency anemia and 84 did not suffer from iron deficiency anemia (the latter represented the control group). Blood samples were collected from all study participants. The samples were analyzed for complete blood count and parameters of iron metabolism. ELISA method was used for establishing serum hepcidin levels.Results:The research showed that the concentration of hepcidin is statistically lower in children (4.4 ng/mL) and adolescents (4.1 ng/mL) who suffer from iron deficiency anemia in comparison with the control group (14 ng/mL, 10 ng/mL, respectively). The positive correlation between serum hepcidin level and iron in the serum, ferritin, the mean corpuscular volume and transferrin saturation was confirmed, but the negative one occurred in serum hepcidin level, transferrin and reticulocytes.Conclusions:The age of the examinees does not influence the level of serum hepcidin which makes it a more sensitive indicator of the level of iron in the body. Besides this, serum hepcidin is a reliable biological marker for the assessment of iron deficiency anemia.

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Decreased Hepcidin Level in Iron Deficiency Anemia after Successful Helicobacter pylori Eradication Therapy: A Preliminary Data.

Blood ◽

10.1182/blood.v110.11.2678.2678 ◽

2007 ◽

Vol 110 (11) ◽

pp. 2678-2678

Author(s):

Yo-Han Cho ◽

Sun-Young Lee ◽

Eun Young Song ◽

Yeo Min Yun ◽

So Young Yoon ◽

...

Keyword(s):

Helicobacter Pylori ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Binding Capacity ◽

Eradication Therapy ◽

Deficiency Anemia ◽

Hepcidin Level ◽

Serum Hepcidin ◽

H Pylori ◽

Iron Binding Capacity

Abstract Background/Aim: Hepcidin, a hepatic antimicrobial protein, is usually over-expressed in iron deficiency anemia. However, whether gastric Helicobacter pylori (H. pylori) infection effects a change in hepcidin level in iron deficiency anemia is still uncertain. We evaluated whether H. pylori eradication decreased hepcidin level and increased hemoglobin and ferritin levels in iron deficiency anemia. Method: From October 2006 to April 2007, nine females (mean age of 32.2 year-old) who were diagnosed as iron deficiency anemia without definite blood loss, were included in the study. All the subjects underwent upper gastrointestinal endoscopy and colonoscopy to diagnose gastric H. pylori infection and to exclude any source of gastrointestinal bleeding. Blood samplings for hemoglobin, hematocrit, iron (Fe), total iron binding capacity (TIBC), ferritin and hepcidin tests were taken just before H. pylori eradication and four weeks after H. pylori eradication and oral iron supplement therapy, respectively. Serum prohepcidin level was measured by Hepcidin Prohormone ELISA (Solid Phase Enzyme-Linked Immunosorbent Assay) kits. Statistical analysis was done by Wilcoxon signed rank test. Result: H. pylori eradication was successful in all the subjects who revealed negative in urea breath test. Hemoglobin, hematocrit, Fe, TIBC and ferritin levels improved in all the subjects after H. pylori eradication (Table 1). Mean serum hepcidin level was 224.8 ± 23.2 ng/ml initially, but decreased to 179.7 ± 40.8 ng/ml after H. pylori eradication therapy (p = 0.015). Conclusion: Our result provides evidence that hepcidin level decreases after successful H. pylori eradication with the improvement of iron deficiency anemia. A fall in serum hepcidin level resulting from successful H. pylori eradication reflects that hepcidin is an important mediator of iron absorption in iron deficiency anemia associated with gastric H. pylori infection. Table 1. Results of blood tests before and after Helicobacter pylori eradication Before H. pylori eradication After H. pylori eradication p-value* *Wicoxon signed ranks test Fe, iron; TIBC, total iron binding capacity Hemoglobin (g/dl, mean ± SD) 7.67 ± 2.01 10.76 ± 2.43 0.008 Hematocrit (%, mean ± SD) 26.36 ± 5.76 34.26 ± 5.76 0.008 Fe (ug/dl, mean ± SD) 11.78 ± 4.21 45.00 ± 54.39 0.038 TIBC (ug/dl, mean ± SD) 480.78 ± 51.39 427.00 ± 66.30 0.008 Ferritin (ng/ml, mean ± SD) 2.67 ± 0.99 7.39 ± 6.38 0.021 Hepcidin (ng/ml, mean ± SD) 224.80 ± 23.23 179.70 ± 40.84 0.015

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Iron Deficiency Anemia and Serum Hepcidin Level in Children with Typhoid Fever: A Case–Control Study

Journal of Pediatric Infectious Diseases ◽

10.1055/s-0040-1715856 ◽

2020 ◽

Vol 15 (06) ◽

pp. 288-292

Author(s):

Ghada Mohamed ◽

Samir Aboelhassan ◽

Maysaa El Sayed Zaki ◽

Yahya Wahba

Keyword(s):

Iron Deficiency ◽

Typhoid Fever ◽

Iron Deficiency Anemia ◽

Serum Iron ◽

Case Control Study ◽

Case Control ◽

Deficiency Anemia ◽

Hepcidin Level ◽

Serum Hepcidin ◽

Control Study

Abstract Objective Typhoid fever is a common systemic bacterial infection in children with a complex interplay between serum hepcidin and iron. We investigated the relationship between iron deficiency anemia (IDA) and serum hepcidin level in children with acute typhoid fever. Methods We conducted a preliminary case–control study in Mansoura University Children's Hospital, Egypt from April 2017 to May 2019 including 30 children aged 5 to 15 years with confirmed acute typhoid fever. We recruited 15 healthy nonanemic children, of comparable ages and sex as controls from the same hospital while attending for nonfebrile complaints. Typhoid fever cases were subdivided according to IDA existence into 16 cases with IDA and 14 non-IDA cases. We excluded all children having diseases which may affect serum iron and hepcidin levels, for example, liver, blood, gastrointestinal, and kidney diseases, and patients receiving drugs interfering with iron metabolism. All participants were subjected to complete blood count, serum ferritin, iron, hepcidin levels, and total iron-binding capacity (TIBC). Results In non-IDA typhoid fever group, serum iron level was significantly low, while serum hepcidin level was significantly high when compared with controls (p < 0.001 and p = 0.02, respectively). In IDA typhoid fever group, no statistically significant difference existed as regards serum hepcidin level when compared with controls (p = 0.53). No significant correlations were detected between serum hepcidin levels and hemoglobin, serum iron, ferritin, and TIBC values in each group. Conclusion Preexisting iron status could affect serum hepcidin level in patients with acute typhoid fever. Coexistence of IDA might oppose the up-regulatory effect of acute typhoid fever on serum hepcidin level.

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IRON DEFICIENCY ANEMIA

The Professional Medical Journal ◽

10.29309/tpmj/2014.21.04.2423 ◽

2018 ◽

Vol 21 (04) ◽

pp. 734-738

Author(s):

Syed Qamar `Zaman ◽

Arshad Mahmood ◽

Shabbir Ahmed ◽

Shahid Mahmud

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Odds Ratio ◽

Deficiency Anemia ◽

Breath Holding ◽

Control Group ◽

P Value ◽

Healthy Children ◽

Significant Difference ◽

Qualitative Variables

Objective: To determine the association of breath holding spells with irondeficiency anemia in children. Study Design: Case control study. Place and Duration of Study:Military Hospital Rawalpindi from Jun 2012 to Dec 2012. Study Population: Sixty children ofeither gender meeting inclusion criteria aged 6 months to 5 years with 30 of breath holding spells incase group and 30 in control group as healthy children were included in the study after informedconsent from parents. Method: Complete blood picture and serum ferritin levels were performedof all children in both case and control groups. Tests were carried out at AFIP Rawalpindi. All datawas entered and analyzed using SPSS version 10. Frequencies and percentages were calculatedfor categorical (qualitative) variables like sex and children having iron deficiency anemia in casesand controls. Mean and Standard Deviation (SD) was calculated for numerical (quantitative)variable like Age. Odds ratio was calculated from the data of cases and controls. Regarding irondeficiency anemia p value <0.05 was considered as significant. Results: In this study, werecorded 43.33% (n=13) cases were between 0.6-3 years and 56.67% (n=17) were between 4-5years while 53.33% (n=16) controls were between 0.6-3 years and 46.67% (n=14) were between4-5 years. Mean±SD was calculated as 3.3+1.46 years in cases and 2.93+1.48 years in controlgroup. Male children were 60% (n=18) in patient group and 46.67% (n=14) in controls group.Female children were 40% (n=12) in patient and 53.33% (n=16) in control group respectively.Association of breath holding spells with iron deficiency anemia in children revealed as 56.67%(n=17) in cases and 3.33% (n=1) in control group while remaining 43.33% (n=13) in cases and96.67% (n=29) in control group had no findings of this association. P value was calculated as<0.0001 and Odds Ratio was 37.92 which shows a significant difference between the two groups.Conclusions: The association of breath holding spells with iron deficiency anemia in children issignificantly higher than healthy controls. So, it is recommended that every child who present withbreath holding spells should be evaluated for iron deficiency anemia

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Serum Hepcidin: Its Correlation with Serum Ferritin, Serum Iron and Hemoglobin in Patients of Iron Deficiency Anemia

Immunology Endocrine & Metabolic Agents - Medicinal Chemistry ◽

10.2174/187152221402150408110832 ◽

2015 ◽

Vol 14 (2) ◽

pp. 105-113

Author(s):

Sajjad H. Naqvi ◽

Syed Faizan-ul-Hassan Naqvi ◽

Iftikhar H. Naqvi ◽

Muhammad Farhan ◽

Tanveer Abbas ◽

...

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Serum Ferritin ◽

Serum Iron ◽

Deficiency Anemia ◽

Serum Hepcidin

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POS0567 HEPCIDIN IS POTENTIAL BIOMARKER TO DISTINGUISH BETWEEN IRON DEFICIENCY ANEMIA AND ANEMIA OF INFLAMMATION IN RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3303 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 518.2-518

Author(s):

E. Galushko ◽

A. Semashko ◽

A. Gordeev ◽

A. Lila

Keyword(s):

Rheumatoid Arthritis ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Complete Blood Count ◽

Deficiency Anemia ◽

Reactive Protein ◽

Potential Biomarker ◽

Serum Hepcidin ◽

Proper Diagnosis ◽

Anemia Of Inflammation

Background:Anemia of inflammation (AI) and iron deficiency anemia (IDA) are the two most prevalent forms of anemia in patients with rheumatoid arthritis (RA). Diagnosis becomes challenging if AI is associated with true ID (AI/ID), as there is still a lack of a gold standard for differentiation between AI and AI/ID. However, as therapies to overcome anemia differ, proper diagnosis and understanding of underlying pathophysiological regulations are necessary.Objectives:The aim of the study was to evaluate the clinical efficiency of hepcidin, a key regulator of iron metabolism, in the diagnosis of IDA, as well as the differential diagnosis of AI/ID and AI in patients with RA.Methods:The study was undertaken 96 patients with RA, 67 of them were diagnosed anemia according to WHO criteria (104,3±21,4 g/l). Anemic patients and anemia-free patients with RA (n=29) were comparable (p>0.05) in age (44.4±14.8 and 49.8±9.3 years), disease duration (73.5±65.4 and 59.8±48.3 months) and DAS28 (6.3±1.6 and 5.9±1.9). All cases were subjected to following tests: complete blood count with peripheral smear, serum C-reactive protein, serum interleukin-6, iron studies, serum soluble transferrin receptor (sTfR), and serum hepcidin. Patients with RA and anemia were divided two groups: 25 patients with IDA and 42 - with AI. The AI cases were subdivided into pure AI and AI with coexistent ID (n=15).Results:The mean serum hepcidin concentration was significantly increased in pure AI patients (123.85±25.8 ng/mL) as compared to those in IDA patients (63.9±22.8 ng/mL, P < 0.05) and anemia-free patients with RA (88.1±39.09 ng/mL). Also, compared to pure AI patients [normal sTfR levels (<3 µg/mL)], the serum hepcidin concentration was reduced significantly in AI patients with ID [high sTfR levels (≥3 µg/mL)] with a mean of 79.0±23.97 ng/mL.Conclusion:Hepcidin measurement can provide a useful tool for differentiating AI from IDA and also help to identify an iron deficiency in AI patients. This might aid in the appropriate selection of therapy for these patients.Disclosure of Interests:None declared

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The effect of nutrition education based on PRECEDE model on iron deficiency anemia among female students

BMC Women s Health ◽

10.1186/s12905-021-01394-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ali Khani Jeihooni ◽

Sanaz Hoshyar ◽

Pooyan Afzali Harsini ◽

Tayebeh Rakhshani

Keyword(s):

Iron Deficiency ◽

Nutrition Education ◽

Blood Level ◽

Iron Deficiency Anemia ◽

Female Students ◽

Deficiency Anemia ◽

Fars Province ◽

Significant Difference ◽

The Mean ◽

Experimental Group

Abstract Background Iron deficiency anemia disrupts the concentration of adolescent girls; reduces their academic achievement, productivity, and physical strength, and increases the risk of infection. This research aim was to evaluate the effectiveness of the PRECEDE model nutrition education on iron deficiency anemia among female students of Fasa City, Fars Province, Iran. Methods This quasi-experimental study was done on 160 students (80 experimental and 80 control groups) who were selected using a random sampling method in Fasa City, Fars Province, Iran, in 2018–2019. The educational intervention included six sessions based PRECEDE model for 45 or 50 min. A scale of this study consisted of two parts; demographic information, and PRECEDE constructs were used to determine the nutritional behaviors status concluding preventing iron deficiency anemia and hemoglobin, hematocrit, and ferritin blood level in two (before and 4 months after intervention) times. Results In the experimental group of the students the mean age was 13.85 + 1.72 years and in the controlled group was 13.60 + 1.81 years. Moreover, there was no significant difference in the PRECEDE constructs, and nutritional behaviors preventing iron deficiency anemia before the intervention in two groups of study. However, the experimental group showed a significant increase 4 months after the intervention. Also, there was no significant difference in the mean score of hemoglobin, hematocrit, and ferritin blood level between the two groups before the intervention. However, in ferritin level, a significant increase was shown in 4 months after the intervention in the experiential group. Conclusions Based on results, the nutrition intervention education base on PRECEDE model has a positive effect to improve iron deficiency anemia preventive behaviors in female students.

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Sandifer Syndrome

10.36502/2021/asjpch.6165 ◽

2021 ◽

Vol 3 (1) ◽

pp. 30-32

Author(s):

Juan Gomez

Keyword(s):

Iron Deficiency ◽

Gastroesophageal Reflux ◽

Children And Adolescents ◽

Hiatal Hernia ◽

Iron Deficiency Anemia ◽

Gastrointestinal Disorder ◽

Deficiency Anemia ◽

Neurological Manifestations ◽

Upper Gastrointestinal

Sandifer syndrome, named after neurologist Paul Sandifer, was first reported by Marcel Kinsbourne in 1962, who noted an upper gastrointestinal disorder that occurs in children and adolescents with neurological manifestations. Sandifer syndrome is a neurobehavioral disorder that causes a series of paroxysmal dystonic movements in association with gastroesophageal reflux and, in some cases, with hiatal hernia. It is characterized by esophagitis, iron deficiency anemia, and is often mistaken for a seizure of epileptic origin.

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Effects of Oral Vitamin C on Hepcidin Levels and Erythropoietin Requirements in Functional Iron Deficiency Anemia among Hemodialysis Patients

QJM ◽

10.1093/qjmed/hcab100.015 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mahmoud Mohamed Zaki Ali ◽

Maha Abd ElMoniem Behairy ◽

Reem Mohsen El Sharabasy ◽

Ahmed Hamed Ahmed Gharib

Keyword(s):

Iron Deficiency ◽

Vitamin C ◽

Iron Deficiency Anemia ◽

Hemodialysis Patients ◽

Deficiency Anemia ◽

Study Group ◽

Oral Vitamin ◽

Functional Iron Deficiency ◽

Serum Hepcidin ◽

Hs Crp

Abstract Background Hepcidin has long been postulated as a key regulatory peptide in iron homeostasis. Its reduced clearance and elevated levels in hemodialysis (HD) patients lead to functional iron deficiency (FID) and ESA resistance. Vitamin C may be used as adjuvant therapy in FID anemia, but there are limited studies investigating the direct relation between vitamin C and hepcidin levels in HD patients. We aimed to test the reducing effect of Oral vitamin C therapy on hepcidin levels among hemodialysis patients with functional iron deficiency anemia. Patients and Methods This study is an open label randomized controlled clinical trial. It was conducted in the hemodialysis units of Ain Shams University hospitals. 48 adult prevalent HD patients were included and were divided into two groups. Group 1 (study group) included 31 patients who received the conventional treatment of erythropoietin stimulating agents (ESAs) together with oral supplementation of vitamin C 500 mg every other day for 3 months in addition to IV iron therapy. Group 2 (control group) included 17 patients who received only the conventional therapy of ESAs according to their hemoglobin (Hb) levels in addition to IV iron therapy. Laboratory parameters including serum hepcidin levels, highly sensitive CRP (hs-CRP) titer, CBC, kidney function tests and iron indices were measured at the baseline of the study and after 3 months. Results Oral vitamin C therapy resulted in a statistically significant reduction in both hepcidin and hs-CRP levels in the study group after 3 months. The study group showed a significant reduction in serum iron and ferritin levels (P < 0.05). A Decrease in EPO requirements and elevation of hemoglobin level were observed in the study group but were not statistically significant as a short term effect of oral vitamin C, in comparison to the control group. A highly significant correlation was observed between serum hepcidin and hs-CRP (R=0.46, P<0.01). Conclusion Oral vitamin C may be a promising therapy in decreasing serum hepcidin and hs-CRP levels in prevalent hemodialysis patients with functional iron deficiency anemia.

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