Evaluation of Hematological Parameters and Iron Level in Obese Children and Adolescents

Abstract

Objectives: The aim of the study was to investigate hematological parameters and iron level in obese children and adolescents in different age groups.
Materials and Methods: The study population consisted of hundred-fifty four obese children and adolescents aged between 3 and 18 years, who were being followed at the Cumhuriyet University Faculty of Medicine Hospital, Pediatric Endocrinology Clinic. As the control group, 158 healthy age and sex-matched children were also included. The children were divided into three groups according to age: Group 1 (3-7 years), Group 2 (7-12 years), and Group 3 (12-18 years). Hematological parameters, serum iron, total iron-binding capacity, and ferritin levels were compared, and their correlations with body mass index(BMI) were investigated.
Results: The mean ages of the control (10,66±3,40; %55,80 girls) and case (10± 4,16; %62 girls) groups were similar. When compared serum iron, total iron-binding capacity, transferrin saturation and ferritin levels, in obese children aged between 12-18 years, serum iron and transferrin saturation was lower whereas ferritin level and total iron-binding capacity were higher (p<0,001). On the other hand, the ferritin level and total iron-binding capacity were higher in obese children aged between 7-12 years, while the other parameters were similar. When the correlations between BMI-SDS and hematological parameters were evaluated; positive correlations with white blood cell count (r = 0.46, p< 0.001), absolute neutrophil count (r = 0.40, p< 0.001) and ferritin levels (r = 0.36, P <0.001), while a negative correlation with transferrin saturation percentage (r = -0.22, p = 0.02) were found.
Conclusion: Obese adolescents are prone to iron deficiency with low saturation index. Therefore ferritin level may be misled for investigating iron deficiency status in obese adolescents

Keywords

• Children,Obesity,Iron deficiency,ferritin

Obez Çocuk ve Adolesanlarda Hematolojik Parametreler ve Demir Düzeyinin Değerlendirilmesi

Öz

Amaç: Bu çalışmanın amacı farklı yaş gruplarındaki obez çocuk ve adolesanlarda hematolojik parametreler ve demir düzeylerini araştırmaktır.
Materyal ve Metot: Bu çalışmaya Cumhuriyet Üniversitesi Tıp Fakültesi, Çocuk Endokrinoloji Polikliniğinde takip edilen, 3-18 yaş arası yüz ellidört çocuk ve adolesan dahil edilmiştir. Kontrol grubu olarak ise, yaş ve cinsiyetleri benzer, sağlıklı 158 çocuk alınmıştır. Çocuklar yaş gruplarına göre, Grup 1 (3-7 yaş), Grup 2 (7-12 yaş) ve Grup 3 (12-18 yaş) olmak üzere 3’e ayrıldı. Hematolojik parametreler, serum demir, demir bağlama kapasitesi(FeBK) ve ferritin düzeyleri karşılaştırıldı, Vücut Kitle İndeksi(VKI) ile olan korelasyonları araştırıldı.
Bulgular: Kontrol (10,66±3,40; %55,8 kız) ve vaka (10± 4,16; %62 kız) gruplarında yaş ortalamalrı benzerdi. Serum demir, FeBK, transferrin saturasyonu ve ferritin düzeyleri karşılaştırıldığında ise 12-18 yaş grubunda, obez çocuklarda, serum demiri ve transferrin saturasyonu daha düşükken, ferritin düzeyi ve FeBK daha yüksekti (p<0,001). 7-12 yaş grubunda ise obez çocuklarda ferritin düzeyi ve FeBK daha yüksekken diğer parametreler benzerdi. Vücut kitle indeksi standart sapma (VKI-SDS) ile hematolojik parametrelerin korelasyonları karşılaştırıldığında, VKI-SDS Beyaz Küre Sayısı (r=0,46, p<0,001), Absolü Nötrofil Sayısı (r=0,40, p<0.001) ve Ferritin (r=0,36, p<0,001) ile pozitif korelasyon gösterirken, Transferrin Saturasyon Yüzdesi ile negatif bir korelasyon ( r=-0,22, p=0,02 ) gösteriyordu.
Sonuç: Obez adolesanlar düşük saturasyon indeksi nedeni ile demir eksikliğine yatkındırlar. Obezlerde demir durumu araştırılırken ferritin düzeyi tek başına yanıltıcı olabilir.

Anahtar Kelimeler

• Çocuklar,obezite,demir eksikliği,ferritin

Kaynakça

1. 1. Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011;377:557-67.
2. 2. Doak CM, Visscher TL, Renders CM, Seidell JC. The prevention of overweight and obesity in children and adolescents: a review of interventions and programmes. Obesity Reviews 2006;7:1:111-36 (doi:10.1111/j.1467-789X.2006.00234.x).
3. 3. Albuquerque D, Stice E, Rodriguez-Lopez R, Manco L, Nöbrega C. Current review of genetics of human obesity: from molecular mechanisms to an evolutionary perspective. Mol Genet Genomics 2015;290:1015-9.
4. 4. WHO.EURO. http://www.euro.who.int/__data/assets/pdf_file/0020/123176/FactSheet_5.pdf.2014 (Erişim Tarihi:23.05.2019).
5. 5. De OM, Blossner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr 2010;92:1257-64.
6. 6. Bereket A, Atay Z. Current status of childhood obesity and its associated morbidities in Turkey. J Clin Res Pediatr Endocrinol 2012;4:1-7.
7. 7. Petek GK, Tolga T, Sinan MK, Nihal M, Bahar T, Berkan G. The frequency of overweight, obesity and short stature among primary school students in three different regions of Turkey. SETB 2011;45(1):13-8.
8. 8. Sağlık Bakanlığı, Hacettepe Üniversitesi Sağlık Bilimleri Fakültesi Beslenme ve Diyetetik Bölümü, T.C. Milli Eğitim Bakanlığı. Türkiye'de Okul Çağı Çocuklarında (6-10 Yaş Grubu) Büyümenin İzlenmesi Projesi Araştırma Raporu (TOÇBİ). Kuban Matbaacılık: Ankara; 2011.

9. 9. Ağadayı E, Çelik N, Aydın S, Karaca SN, Sivas İli Kırsal Bir İlçede Okul Çağı Çocuklar ve Adolesanlarda Obezite Sıklığının ve etkıleyen Faktörlerin Belirlenmesi, 12. Aile Hekimliği Güz Okulu Kongresi Özet Kitabı, 26-30 Eylül 2018, Antalya.
10. 10. Wenzel BJ, Stults HB, Mayer J. Hypoferraemia in obese adolescents. Lancet 1962;2(7251):327-8.
11. 11. Nead KG, Halterman JS, Kaczorowski JM, Auinger P, Weitzman M. Overweight children and adolescents: a risk group for iron deficiency. Pediatrics 2004;114(1):104-08.
12. 12. Aeberli I, Hurrell RF, Zimmermann MB. Overweight children have higher circulating hepcidin concentrations and lower iron status but have dietary iron intakes and bioavailability comparable with normal weight children. Int J Obes (Lond) 2009;33(10):1111-7.
13. 13. Seltzer CC, Mayer J. Serum Iron and Iron-Binding Capacity in Adolescents. Ii. Comparison of Obese and Nonobese Subjects. Am J Clin Nutr 1963;13:354-61.
14. 14. Dallman P. Nutrition clinics. Aust Fam Physician 1993;22(10):1738-9.
15. 15. Robins EB, Blum S: Hematologic reference values for African American children and adolescents. Am J Hematol 2007;82:611–4.
16. 16. Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, Neyzi O. Body mass index references for Turkish children. Acta Paediatr. 2006 Feb;95(2):194-8.
17. 17. Hutchinson C. A review of iron studies in overweight and obese children and adolescents: a double burden in the young? Eur J Nutr, 55 (2016):2179-97.
18. 18. Pinhas-Hamiel O, Newfield RS, Koren I, Agmon A, Lilos P, Phillip M . Greater prevalence of iron deficiency in overweight and obese children and adolescents. Int J Obes Relat Metab Disord, 27 2003;27:416-8.
19. 19. Manios Y, Moschonis G, Chrousos GP, et al. The double burden of obesity and iron deficiency on children and adolescents in Greece: the Healthy Growth Study. J Hum Nutr Diet, 26 2013;26:470-8.
20. 20. Grandone A., Marzuillo P.,Perrone L., Del Giudice EM. Iron Metabolism Dysregulation and Cognitive Dysfunction in Pediatric Obesity: Is There a Connection? Nutrients 2015 Nov 6;7(11):9163-70.
21. 21. Ford ES, Cogswell ME. Diabetes and serum ferritin concentration among U.S. adults. Diabetes Care 1999;22(12):1978-3.
22. 22. Baynes RD. Refining the assessment of body iron status. Am J Clin Nutr 1996;64(5):793-4.
23. 23. Longfils P, Heang UK, Soeng H, Sinuon M. Weekly iron and folic acid supplementation as a tool to reduce anemia among primary school children in Cambodia. Nutr Rev 2005;63:139-45.
24. 24. Yanoff LB, Menzie CM, Denkinger B, et al. Inflammation and iron deficiency in the hypoferremia of obesity. Int J Obes (Lond) 2007;31(9):1412-9.
25. 25. Coban E, Ozdogan M, Yazicioglu G, Akcit F. The mean platelet volume in patients with obesity. Int J Clin Pract. 2005 Aug;59(8):981-2.
26. 26. Toplak H, Wascher TC. Influence of weight reduction on platelet volume: different effects of a hypocaloric diet and a very low calorie diet. Eur J Clin Invest 1994; 24:778–80.