OBEZ BİREYLERDE SERUM FERRİTİN DÜZEYLERİ, İNSÜLİN DİRENCİ, METABOLİK SENDROM VE BESLENME DURUMLARI ARASINDAKİ İLİŞKİNİN RETROSPEKTİF ANALİZİ

Öz

Bu çalışmada, obez bireylerin beslenme durumlarının serum ferritin değerleri, insülin direnci ve metabolik sendrom ile ilişkisi bakımından retrospektif olarak incelenmesi amaçlanmıştır. Araştırmanın örneklemini Özel 19 Mayıs Hastanesi Beslenme ve Diyet polikliniğine 1 Ocak 2020’den itibaren başvurmuş 210 obez birey oluşturmaktadır. Bu bireylerin antropometrik ölçümleri, biyokimyasal bulguları, genel sağlık durumları ve beslenme durumları hasta dosyalarından kaydedilmiştir. Çalışmaya dahil edilen bireyler serum ferritin değerlerine göre; ferritin düzeyi ˂14,52 ng/mL ise kuartil 1 (Q1), 14,52-35,49 ng/mL ise Q2, 35,49-70,68 ng/mL ise Q3, ˃70,68 ng/mL ise Q4 olarak 4 gruba ayrılmıştır. Bireylerin beden kütle indeksi (kg/ m2) ferritin kuartillerine göre incelendiğinde Q2’de en yüksek beden kütle indeksi (32,5±6,4 kg/m2) gözlenmiştir (p˃0,05). Bel çevresi ölçümlerinde en yüksek bel çevresi ortalaması Q4’te olup (114,85±15,09 cm), kuartiller arasındaki fark anlamlı bulunmamıştır (p˃0.05). Bireylerin serum HOMA-IR ortalama değerleri en yüksek Q4’de (4,10±5,05) bulunmaktadır. HOMA-IR düzeyleri ferritin kuartiline göre istatistiksel açıdan önemli bulunmuştur (p˂0.05) Trigliserit değerleri Q4’te (169,43±93,40); HDL değerleri Q2’de (58,68±11,69); LDL değerleri ise Q4’te (127,21±35,15) en yüksek bulunmuştur. (˂0.05) Bireylerin ferritin quartillerine göre beslenme durumlarına bakıldığında protein tüketiminin en yüksek Q4’te olduğu (112,1±29,8 g/gün), karbonhidrat tüketiminin ise en yüksek Q1’de (395,2±83,6 g/gün) olduğu görülmüştür (p˂0.05). Obez bireylerin protein tüketimleri (g/gün) ile serum ferritin düzeyleri arasında pozitif yönlü orta kuvvetli bir ilişki tespit edilmiştir (r:0,506, p:0,000). Sonuç olarak yüksek serum ferritin konsantrasyonları yüksek trigliserit, yüksek LDL, yüksek HOMA, AST ve ALT değerleri ve daha düşük HDL değerleri ile ilişkilendirilmiştir. Obez bireylerde serum ferritinin yüksek olması insülin direnci ve metabolik sendrom için risk faktörü olabileceği belirlenmiştir. Bu risk faktörlerinden korunmak için obez bireylere yaşam tarzı değişikliği önerilmelidir.

Anahtar Kelimeler

• obezite
• insülin direnci
• serum ferritin
• metabolik sendrom

RETROSPECTIVE ANALYSIS OF THE RELATIONSHIP BETWEEN SERUM FERRITIN LEVELS, INSULIN RESISTANCE, METABOLIC SYNDROME, AND NUTRITIONAL STATUS IN OBESE INDIVIDUALS

Abstract

This retrospective study was conducted to evaluate the relationship between serum ferritin, insulin resistance, metabolic syndrome and nutrition status in obese people. Total of 210 individuals, who were diagnosed as obese in 19 Mayıs Hospital, were included in this retrospective analysis. Anthropometric measurements, health status, biochemical results and nutrition status were obtained from patient files and recorded in the patient information form. Individuals that applied to this study seperated four quartiels according to their serum ferritin level; serum ferritin level ˂14,52 ng/mL as quartile 1 (Q1), 14,52-35,49 ng/mL as quartile 2 (Q2), 35,49-70,68 ng/mL as quartile 3 (Q3) and ˃70,68 ng/mL as quartile 4 (Q4). In waist circumference measurements, waist circumference in Q4 (114.85±15.09 cm) was greater than other quartiles, and the difference was not significant (p˃0.05). According to quartiles, trigliserit (169,43±93,40) and LDL levels (127,21±35,15) of Q4 and HDL levels of Q2 (58,68±11,69) were higher than other quartiles (p˂0.05). Protein consumption was greater in Q4 (112,1±29,8 g/day), and carbonhydrates consumption was greater in Q1 (395,2±83,6 g/day) than other quartiles (p˂0.05). A positive, moderate correlation was found between the protein consumption (g/day) of obese individuals and serum ferritin levels (r:0,506, p:0,000). As a result, high serum ferritin concentrations were associated with high triglyceride, high LDL, high HOMA, AST and ALT values, and lower HDL values. High serum ferritin in obese individuals may be a risk factor for insulin resistance and metabolic syndrome. Lifestyle changes should be recommended to obese individuals to avoid these risk factors.Keywords: Obesity, insülin resistance, serum ferritin, metabolic syndrom

Keywords

• obesity
• insulin resistance
• serum ferritin
• metabolic syndrome

Kaynakça

1. Referans 1 : Leonard AJ, Chalmers KA, Collins CE, Patterson AJ. The effect of nutrition knowledge and dietary iron intake on iron status in young women. Appetite. 2014; 81:225-31.
2. Referans 2 : Kojta I, Chacińska M, Błachnio-Zabielska A. Obesity, Bioactive Lipids, and Adipose Tissue Inflammation in Insulin Resistance. Nutrients. 2020;12(5):1305.
3. Referans 3 :Pillon NJ, Loos RJF, Marshall SM, Zierath JR. Metabolic consequences of obesity and type 2 diabetes: Balancing genes and environment for personalized care. CellPress. 2021;184(6):1530-44.
4. Referans4: Giudice A, Crispo A, Massimiliano G, D’Arena G, Tecce MF, Grimaldi M, vd. Metabolic syndrome, insulin resistance, circadian disruption, antioxidants and pancreatic carcinoma: an overview. J Gastrointest Liver Dis JGLD. 2014; 23(1):73-7.
5. Referans5: Beck KL, Kruger R, Conlon CA, Heath A-LM, Matthys C, Coad J, vd. Suboptimal iron status and associated dietary patterns and practices in premenopausal women living in Auckland, New Zealand. Eur J Nutr. 2013; 52(2):467-76.
6. Referans6: Yu F-J, Huang M-C, Chang W-T, Chung H-F, Wu C-Y, Shin S-J, vd. Increased ferritin concentrations correlate with insulin resistance in female type 2 diabetic patients. Ann Nutr Metab. 2012; 61(1):32-40.
7. .referans7: Backe M, Moen IW, Ellervik C. Iron Regulation of Pancreatic Beta-Cell Functions and Oxidative Stress. Annual Review of Nutrition. 2016; Vol. 36:241-273
8. Referans8: Krisai P, Leib S, Aeschbacher S, Kofler T, Assadian M, Maseli A, vd. Relationships of iron metabolism with insulin resistance and glucose levels in young and healthy adults. Eur J Intern Med. 2016; 32:31-7.

9. Referans9: Mee Kyoung Kim 1, Ki Hyun Baek, Ki-Ho Song, Moo Il Kang. Increased serum ferritin predicts the development of hypertension among middle-aged men. Am J Hypertens. 2012 Apr;25(4):492-7
10. Referans10: Han L, Wang Y, Li J, Zhang X, Bian C, Wang H, vd. Gender differences in associations of serum ferritin and diabetes, metabolic syndrome, and obesity in the China Health and Nutrition Survey. Mol Nutr Food Res. 2014; 58(11):2189-95.
11. Referans11: Qin Tang, Zhenfang Liu, Yan Tang, et al. High serum ferritin level is an independent risk factor for metabolic syndrome in a Chinese male cohort population. Diabetology & Metabolic Syndrome. Diabetol Metab Syndr. 2015 Feb 24;7:11
12. Referans12: Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412-9.
13. Referans13: International Diabetes Federation (IDF). The IDF consensus worldwide definition of the Metabolic Syndrome. 2006. https://www.idf.org/component/attachments/attachments.html?id=705&task=download. Erişim Tarihi: 21.11.2021.
14. Referans14: Piperno A, Trombini P, Gelosa M, Mauri V, Pecci V, Vergani A, vd. Increased serum ferritin is common in men with essential hypertension. J Hypertens. 2002;20(8):1513-8.
15. Referans15: Williams MJA, Poulton R, Williams S. Relationship of serum ferritin with cardiovascular risk factors and inflammation in young men and women. Atherosclerosis. 2002;165(1):179-84.
16. Referans16: Aguirre L, Urrunaga-Pastor D, Moncada-Mapelli E, Mirella Guarnizo-Poma et al. High serum ferritin levels are associated with insulin resistance but not with impaired glucose tolerance in a healthy people population. Diabetes Metab Syndr 2017;11(2):983-S988
17. Referans17: Ledesma M, Hurtado-Roca Y, Leon M, Giraldo P, Pocovi M, Civeira F, vd. Association of ferritin elevation and metabolic syndrome in males. Results from the Aragon Workers’ Health Study (AWHS). J Clin Endocrinol Metab. 2015;100(5):2081-9.
18. Referans18: Li J, Wang R, Luo D, Li S, Xiao C. Association between serum ferritin levels and risk of the metabolic syndrome in Chinese adults: a population study. PloS One. 2013;8(9):e74168.
19. Referans19: Bhattacharyya S, Ghosh J, Sil PC. Iron induces hepatocytes death via MAPK activation and mitochondria-dependent apoptotic pathway: beneficial role of glycine. Free Radic Res. 2012;46(10):1296-307.
20. Referans20: Simcox JA, McClain DA. Iron and diabetes risk. Cell Metab. 2013;17(3):329-41.
21. Referans21: Syrovatka P, Kraml P, Potockova J, Fialova L, Vejrazka M, Crkovska J, et al. Relationship between increased body iron stores, oxidative stress and insulin resistance in healthy men. Ann Nutr Metab. 2009;54(4):268-74.
22. Referans22: Chen L, Li Y, Zhang F, Zhang S, Zhou X, Ji L. Association of serum ferritin levels with metabolic syndrome and insulin resistance in a Chinese population. J Diabetes Complications. 2017;31(2):364-8.
23. Referans23: Park SK, Choi WJ, Oh C-M, Kim M-G, Ham WT, Choi J-M, vd. Clinical significance of serum ferritin level as an independent predictor of insulin resistance in Korean men. Diabetes Res Clin Pract. 2015;107(1):187-93.
24. Referans24: Felipe A, Guadalupe E, Druso P, Carlos M, Pablo S, Oscar C, vd. Serum Ferritin Is Associated with Metabolic Syndrome and Red Meat Consumption. Oxid Med Cell Longev. 2015; 2015:769739.
25. Referans25: Akter S, Nanri A, Kuwahara K, Matsushita Y, Nakagawa T, Konishi M, vd. Circulating ferritin concentrations and risk of type 2 diabetes in Japanese individuals. J Diabetes Investig. 2017;8(4):462-70.
26. Referans26: Podmore C, Meidtner K, Schulze MB, Scott RA, Ramond A, Butterworth AS, vd. Association of Multiple Biomarkers of Iron Metabolism and Type 2 Diabetes: The EPIC-InterAct Study. Diabetes Care. 2016;39(4):572-81.
27. Referans27: Luan DC, Li H, Li SJ, Zhao Z, Li X, Liu ZM. Body iron stores and dietary iron intake in relation to diabetes in adults in North China. Diabetes Care. 2008;31(2):285-6.