The Effect of Treatment on Weight Gain in Iron Deficiency Anemia and Its Association with Ghrelin and Hepcidin Levels

Year 2023, , 236 - 241, 30.12.2023

Halil Cansun Kılınç , Birgül Öneç , Kursad Onec , Handan Ankaralı

https://doi.org/10.18678/dtfd.1323406

Abstract

Aim: Although loss of appetite in iron deficiency anemia (IDA) and weight gain during treatment are common complaints, there are very few studies in adults. This study aimed to determine the levels of ghrelin, one of the appetite-related hormones, and hepcidin, one of the main regulators of iron metabolism, in IDA, and to examine the effects of treatment on weight gain and the levels of these hormones.
Material and Methods: Eighty-seven adult patients with IDA and a control group of 50 healthy volunteers were included in the study. Anthropometric measurements and blood samples were obtained from the patient and control groups before treatment, and repeated after treatment in the IDA group.
Results: No significant difference was found in terms of weight, body mass index (BMI), and waist-to-hip ratio between groups but there was a significant increase in weight and BMI, in the patient group after treatment (both p<0.001). Pre-treatment hepcidin and ghrelin levels of the patient group were significantly lower than the control group (p<0.001, and p=0.026, respectively), and hepcidin levels increased significantly after treatment (p<0.001). The increase in ghrelin was not statistically significant but showed a positive weak correlation with both weight (r=0.254, p=0.018) and BMI (r=0.231, p=0.031) increase. Hepcidin levels were not correlated with weight and BMI changes.
Conclusion: These findings revealed low levels of ghrelin and hepcidin in adults with IDA and an increase in weight and BMI with treatment. Hepcidin increased with treatment but was not correlated with weight gain, ghrelin was weakly correlated.

Keywords

İron deficiency anemia, appetite, weight gain, ghrelin, hepcidin

Supporting Institution

Düzce Üniversitesi Bilimsel Araştırma Projeleri Koordinatörlüğü

Project Number

2015.04.03.396

Thanks

This study is supported by Duzce University Scientific Research Projects Coordinator ship with project number of 2015.04.03.396 .

Demir Eksikliği Anemisinde Tedavinin Kilo Alımına Etkisi ve Ghrelin ve Hepsidin Düzeyleri ile İlişkisi

Abstract

Amaç: Demir eksikliği anemisi (DEA)’nde iştahsızlık ve tedavi sırasında kilo alımı sık yakınmalar olsa da bu konuda erişkinlerde yapılmış çok az çalışma mevcuttur. Bu çalışmada, DEA’da iştah ile ilgili hormanlardan biri olan ghrelin ve demir metabolizmasının temel düzenleyicilerinden biri olan hepsidin seviyelerinin belirlenmesi ile tedavinin kilo alımına ve bu hormonların düzeylerine etkisinin incelenmesi amaçlandı.
Gereç ve Yöntemler: Çalışmaya DEA tanılı 87 erişkin hasta ve 50 sağlıklı gönüllüden oluşan kontrol grubu dahil edildi. Hasta ve kontrol grubunda tedavi öncesi antropometrik ölçümler yapılarak kan örnekleri alındı ve tedavi sonrasında DEA grubunda tekrarlandı.
Bulgular: Gruplar arasında kilo, vücut kitle indeksi (VKİ), bel-kalça oranı açısından anlamlı fark yoktu ancak hasta grubunda tedavi sonrasında kilo ve VKİ’de anlamlı artış saptandı (her iki p<0,001). Hasta grubunun tedavi öncesi hepsidin ve ghrelin seviyesi kontrol grubuna göre anlamlı olarak daha düşüktü (sırasıyla p<0,001 ve p=0,026) ve tedavi sonrası hepsidin seviyeleri anlamlı olarak arttı (p<0,001). Tedavi sonrası ghrelin artışı istatistiksel olarak anlamlı değildi ancak hem kilo (r=0,254; p=0,018) hem de VKİ (r=0,231; p=0,031) artışı ile pozitif yönde zayıf korelasyon gösteriyordu. Hepsidin düzeylerinin kilo ve VKİ değişimleri ile korelasyonu saptanmadı.
Sonuç: Bu bulgular erişkinlerde DEA’da ghrelin ve hepsidinin düşük olduğunu ve tedavi ile hastalarda objektif bir kilo ve VKİ artışı olduğunu ortaya koydu. Hepsidin tedavi ile artış göstermekle beraber kilo alımı ile korele değildi, ghrelin zayıf korelasyon göstermekteydi.

Keywords

Demir eksikliği anemisi, iştah, kilo alımı, ghrelin, hepsidin

Project Number

2015.04.03.396

References

• World Health Organization (WHO). de Benoist B, McLean E, Egli I, Cogswell M, editors. Worldwide prevalence of anaemia 1993-2005: WHO global database on anaemia. Spain: WHO; 2008.
• World Health Organization (WHO). Nutritional anaemias: report of a WHO scientific group. Geneva, Switzerland: WHO; 1968.
• Turkish Society of Hematology. Erythrocyte diseases and hemoglobin disorders: diagnosis and treatment guidelines, version 1.3 - May 2022, İstanbul, Türkiye: Galenos Publishing House; 2022. Turkish.
• Gereklioglu C, Asma S, Korur A, Erdogan F, Kut A. Medication adherence to oral iron therapy in patients with iron deficiency anemia. Pak J Med Sci. 2016;32(3):604-7.
• Grumbach MM, Styne DM. Puberty: Ontogeny, neuroendocrinology, physiology, and disorders. In: Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, Wilson JD, Foster DW, editors. Williams textbook of endocrinology. 10th edition. Philadelphia: Saunders; 2003. p.1156.
• Saltık Temizel İN. A child with low appetite. Çocuk Sağlığı ve Hastalıkları Dergisi. 2008;51(3):176-81. Turkish.
• Anderson GJ, Darshan D, Wilkins SJ, Frazer DM. Regulation of systemic iron homeostasis: How the body responds to changes in iron demand. Biometals. 2007;20(3-4):665-74.
• Ganz T. Hepcidin and its role in regulating systemic iron metabolism. Hematology Am Soc Hematol Educ Program. 2006;1:29-35.
• Isguven P, Arslanoglu I, Erol M, Yildiz M, Adal E, Erguven M. Serum levels of ghrelin, leptin, IGF-I, IGFBP-3, insulin, thyroid hormones and cortisol in prepubertal children with iron deficiency. Endocr J. 2007;54(6):985-90.
• Akarsu S, Ustundag B, Gurgoze MK, Sen Y, Aygun AD. Plasma ghrelin levels in various stages of development of iron deficiency anemia. J Pediatr Hematol Oncol. 2007;29(6):384-7.
• Kucuk N, Orbak Z, Karakelloglu C, Akcay F. The effect of therapy on plasma ghrelin and leptin levels, and appetite in children with iron deficiency anemia. J Pediatr Endocrinol Metab. 2019;32(3):275-80.
• Bhanusahali MM, Shirode AR, Joshi YM, Kadam VJ. An intervention on iron deficiency anemia and change in dietary behavior among adolescent girls. Int J Pharm Pharm Sci. 2011;3(1):40-2.
• Aukett MA, Parks YA, Scott PH, Wharton BA. Treatment with iron increases weight gain and psychomotor development. Arch Dis Child. 1986;61(9):849-57.
• Luo QQ, Zhou G, Huang SN, Mu MD, Chen YJ, Qian ZM. Ghrelin is negatively correlated with iron in the serum in human and mice. Ann Nutr Metab. 2018;72(1):37-42.
• Ghrayeb H, Elias M, Nashashibi J, Youssef A, Manal M, Mahagna L, et al. Appetite and ghrelin levels in iron deficiency anemia and the effect of parenteral iron therapy: A longitudinal study. PLoS One. 2020;15(6):e0234209.
• McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993-2005. Public Health Nutr.2009;12(4):444-54.
• Naiman JL, Oski FA, Diamond LK, Vawter GF, Shwachman H. The gastrointestinal effects of iron-deficiency anemia. Pediatrics. 1964;33:83-99.
• Inui A, Asakawa A, Bowers CY, Mantovani G, Laviano A, Meguid MM, et al. Ghrelin, appetite, and gastric motility: the emerging role of the stomach as an endocrine organ. FASEB J. 2004;18(3):439-56.
• Wren AM, Seal LJ, Cohen MA, Brynes AE, Frost GS, Murphy KG, et al. Ghrelin enhances appetite and increases food intake in humans. J Clin Endocrinol Metab. 2001;86(12):5992.
• Gibbons C, Hopkins M, Beaulieu K, Oustric P, Blundell JE. Issues in measuring and interpreting human appetite (satiety/satiation) and its contribution to obesity. Curr Obes Rep. 2019;8(2):77-87.
• Shiiya T, Nakazato M, Mizuata M, Date Y, Mondal MS, Tanaka M, et al. Plasma ghrelin levels in lean and obese humans and the effect of glucose on ghrelin secretion. J Clin Endocrinol Metab. 2002;87(1):240-4.
• Otto B, Cuntz U, Fruehauf E, Wawarta R, Folwaczny C, Riepl RL, et al. Weight gain decreases elevated plasma ghrelin concentrations of patients with anorexia nervosa. Eur J Endocrinol. 2001;145(5):669-73.
• Kulaksiz H, Gehrke SG, Janetzko A, Rost D, Bruckner T, Kallinowski B, et al., Pro-hepcidin: expression and cell specific localisation in the liver and its regulation in hereditary haemochromatosis, chronic renal insufficiency, and renal anaemia. Gut. 2004;53(5):735-43.
• Fleming RE, Bacon BR. Orchestration of iron homeostasis. N Engl J Med. 2005;352(17):1741-4.
• Ganz T. Hepcidin--a regulator of intestinal iron absorption and iron recycling by macrophages. Best Pract Res Clin Haematol. 2005;18(2):171-82.
• Dallalio G, Fleury T, Means RT. Serum hepcidin in clinical specimens. Br J Haematol. 2003;122(6):996-1000.
• Semercioğlu EA, Solgun HA, Kılınç Y. The relationship of iron metabolism and hepcidin in childhood. Cerrahpaşa Med J. 2020;44(3):145-52.Turkish.
• Galesloot TE, Vermeulen SH, Geurts-Moespot AJ, Klaver SM, Kroot JJ, van Tienoven D, et al. Serum hepcidin: reference ranges and biochemical correlates in the general population. Blood. 2011;117(25):e218-25.
• Traglia M, Girelli D, Biino G, Campostrini N, Corbella M, Sala C, et al. Association of HFE and TMPRSS6 genetic variants with iron and erythrocyte parameters is only in part dependent on serum hepcidin concentrations. J Med Genet. 2011;48(9):629-34.
• Oates PS, Ahmed U. Molecular regulation of hepatic expression of iron regulatory hormone hepcidin. J Gastroenterol Hepatol. 2007;22(9):1378-87.
• Dogan A, Alioglu B, Dindar N, Dallar Y. Increased serum hepcidin and ghrelin levels in children treated for iron deficiency anemia. J Clin Lab Anal. 2013;27(1):81-5.
• Mayasari NR, Bai CH, Hu TY, Chao JC, Chen YC, Huang YL, et al. Associations of food and nutrient intake with serum hepcidin and the risk of gestational iron-deficiency anemia among pregnant women: a population-based study. Nutrients. 2021;13(10):3501.
• Kimita W, Bharmal SH, Ko J, Cho J, Petrov MS. Relationship between energy balance and circulating levels of hepcidin and ferritin in the fasted and postprandial states. Nutrients. 2021;13(10):3557.