Obez Ergenlerde Demir Eksikliği Anemisinin Değerlendirilmesi, Rol Oynayan Faktörlerin Belirlenmesi

Öz

Amaç: Ergen nüfusun özellikle risk altında olduğu, yaygınlığını koruyan halk sağlığı sorunlarından obezite ve demir eksikliğinin önemli klinik sonuçları olabilmektedir. Bu çalışmada obez ergenlerde demir parametrelerinin ve serum vitamin B12 düzeylerinin değerlendirilmesi ve anemi gelişiminde rol oynayan faktörlerin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Bu çalışmada T.C. Sağlık Bakanlığı Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi Çocuk Polikliniklerine Mart 2013-Mayıs 2015 tarihleri arasında başvuran 260 çocuk (130 obez, 130 kontrol) geriye dönük olarak değerlendirilmiştir. Akut veya kronik hastalığı olmayan ve vücut kitle indeksi (VKİ) yaş ve cinsiyete göre 95. persentilin üzerinde olan 12-18 yaş arası çocuklar çalışma grubuna dahil edilmiştir. Fiziksel muayene bulguları, sosyodemografik özellikler, günlük beslenme durumu ve fiziksel aktivite düzeyi hakkında bilgi toplamak için hasta dosyalarından elde edilen veriler kullanılmıştır. Tüm hastalarda CRP, demir parametreleri, B12 vitamini ve tam kan sayımı değerlendirmeleri yapılmıştır. Bulgular: Serum demir ve vitamin B12 düzeyleri, obez grupta kontrol gruba oranla düşük (sırasıyla p = 0.036, p = 0.047), serum ferritin düzeyi ise obez grupta kontrol gruba kıyasla istatistiksel olarak anlamlı derecede yüksek saptanmıştır (p=0.002). Obez grupta yüksek CRP düzeylerinin, artmış VKI ile ilişkili olduğu gösterilmiştir. Sonuç: Obezitenin kronik enflamasyon durumu, enflamatuar patofizyolojik yolakların aktive olmasına neden olarak demir eksikliği ve diğer beslenme yetersizliklerine yol açabilir. Obezite kronik bir hastalık olarak takip edilmeli ve özellikle büyümesini tamamlamamış ergenlerde beslenme yetersizlikleri açısından izlenmelidir.

Anahtar Kelimeler

• Demir eksikliği
• obezite
• ergenlik dönemi

Assessing Iron Deficiency Anemia in Obese Adolescents and Identifying Contributing Factors

Öz

Objective: Obesity and iron deficiency, which are public health problems that maintain their prevalence and for which the adolescent population is particularly at risk, may have important clinical consequences. This study aimed to assess the iron parameters and blood vitamin B12 levels in obese adolescents and identify the contributing variables to the development of anemia. Material and Methods: The present study involved a retrospective evaluation of 260 children (130 obese-130 control) who were admitted to the Ankara Children’s Haematology Oncology Training and Research Hospital, Pediatric Outpatient Clinics, between March 2013 and May 2015. Children aged 12 to 18 years without acute or chronic illnesses and body mass index (BMI) above the 95th percentile for age and gender were required for inclusion in the study group. Data from patient files were used to collect information on physical examination findings, sociodemographic characteristics, daily dietary status, and level of physical activity. All patients had evaluations for CRP, iron parameters, vitamin B12, and complete blood count. Results: The study revealed that the obese group had significantly higher serum ferritin levels (p=0.002) and lower serum iron and vitamin B12 levels (p=0.036 and 0.047, respectively) as compared to the control group. In the obese population, elevated BMI has been demonstrated to be correlated with elevated CRP and ferritin levels. Conclusion: Obesity’s chronic inflammation state may lead inflammatory pathophysiological pathways to activate resulting in iron deficiency and other nutritional deficiencies. Obesity should be followed up as a chronic disease and monitored in terms of nutritional deficiencies, especially in adolescents who have not completed their growth.

Anahtar Kelimeler

• Iron deficiency
• obesity
• adolescence

Kaynakça

1. Tsoi MF, Li HL, Feng Q, Cheung CL, Cheung TT, Cheung BM. Prevalence of childhood obesity in the United States in 1999–2018: A 20-year analysis. Obes Facts 2022;15: 560-9.
2. 2. Wang T, Gao Q, Yao Y, Luo G, Lv T, Xu G,et al. Causal relationship between obesity and iron deficiency anemia: a two-sample Mendelian randomization study. Front Public Health 2023; 11: 1188246.
3. 3. Ogden CL, Fryar CD, Hales CM, Carroll MD, Aoki Y, Freedman DS. Differences in obesity prevalence by demographics and urbanization in US children and adolescents, 2013-2016. Jama 2018; 319: 2410-8.
4. 4. Calcaterra V, Verduci E, Milanta C, Agostinelli M, Todisco CF, Bona F, et al. Micronutrient Deficiency in Children and Adolescents with Obesity—A Narrative Review. Children (Basel) 2023; 10: 695.
5. 5. Pasricha SR, Tye-Din J, Muckenthaler MU, Swinkels DW. Iron deficiency. Lancet 2021; 397: 233-48.
6. 6. Ibáñez-Alcalde MM, Vázquez-López MÁ, López-Ruzafa E, Lendínez-Molinos FJ, Bonillo-Perales A, Parrón-Carreño T. Prevalence of iron deficiency and related factors in Spanish adolescents. Eur J Pediatr 2020; 179: 1587-95.
7. 7. Alshwaiyat NM, Ahmad A, Wan Hassan WMR, Al‑Jamal HAN. Association between obesity and iron deficiency. Exp Ther Med 2021;22: 1-7.
8. 8. Stoffel NU, El-Mallah C, Herter-Aeberli I, Bissani N, Wehbe N, Obeid O, et al. The effect of central obesity on inflammation, hepcidin, and iron metabolism in young women. Int J Obes 2020; 44: 1291-300.

9. 9. Kozioł-Kozakowska A, Kozłowska M, Jagielski P. Assessment of diet quality, nutrient intake, and dietary behaviours in obese children compared to healthy children. Pediatr Endocrinol Rev 2020; 26: 27-38.
10. 10. Gunanti IR, Marks GC, Al-Mamun A, Long KZ. Low serum vitamin B-12 and folate concentrations and low thiamin and riboflavin intakes are inversely associated with greater adiposity in Mexican American children. J Nutr 2014; 144: 2027-33.
11. 11. Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, Neyzi O. Body mass index references for Turkish children. Acta Paediatr 2006; 95: 194-8.
12. 12. Jetté M, Sidney K, Blümchen G. Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity. Clin Cardiol 1990; 13: 555-65.
13. 13. Tapiero H, Gate L, Tew K. Iron: deficiencies and requirements. Biomed Pharmacother 2001; 55: 324-32.
14. 14. World Health Organization (WHO). Assessing The Iron Status Of Populations: Report of a Joint World Health Organization/ Centers of Disease Control and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva 2004. Accessed: January 7, 2024. Available from: https://www.who.int/publications/i/item/9789241596107.
15. 15. Ortiz Perez M, Vazquez Lopez MA, Ibanez Alcalde M, Galera Martinez R, Martin Gonzalez M, Lendinez Molinos F, et al. Relationship between obesity and iron deficiency in healthy adolescents. Child Obes 2020; 16: 440-7.
16. 16. Atrushi AM, Armishty FS, Saleh SA, Abdulrahman MS. The Association Between Iron Deficiency Anemia and Obesity in Children. J Contemp Med Sci 2022; 8: 220-3.
17. 17. Panichsillaphakit E, Suteerojntrakool O, Pancharoen C, Nuchprayoon I, Chomtho S. The Association between hepcidin and iron status in children and adolescents with obesity. J Nutr Metab 2021; 2021: 9944035.
18. 18. Larsen B, Baller EB, Boucher AA, Calkins ME, Laney N, Moore TM, et al. Development of Iron Status Measures during Youth: Associations with Sex, Neighborhood Socioeconomic Status, Cognitive Performance, and Brain Structure. Am J Clin Nutr 2023; 118: 121-31.
19. 19. Nead KG, Halterman JS, Kaczorowski JM, Auinger P, Weitzman M. Overweight children and adolescents: a risk group for iron deficiency. Pediatrics 2004; 114: 104-8.
20. 20. Castillo-Valenzuela O, Duarte L, Arredondo M, Iñiguez G, Villarroel L, Pérez-Bravo F. Childhood Obesity and Plasma Micronutrient Deficit of Chilean Children between 4 and 14 Years Old. Nutrients 2023; 15: 1707.
21. 21. Yardim M, Özcebe L, Araz Ö, Üner S, Li S, Ünlü H, et al. Prevalence of childhood obesity and related parental factors across socioeconomic strata in Ankara, Turkey. East Mediterr Health J 2019; 25: 374-84.
22. 22. Gökler ME, Buğrul N, Metintaş S, Kalyoncu C. Adolescent obesity and associated cardiovascular risk factors of rural and urban life (Eskisehir, Turkey). Cent Eur J Public Health 2015; 23: 20-5.