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Abstract
Background/objectiveIron deficiency (ID) is common in overweight and obese individuals (OW/OB) but the mechanism is uncertain. Greater blood volume (BV) in OW/OB may increase hemoglobin (Hb) mass and iron requirements, and confound iron biomarkers by hemodilution. Quantification of BV/PV changes in OW/OB is challenging and a formula to estimate BV/PV based on anthropometric indices would be valuable. In normal weight (NW) and OW/OB women, we aimed at: (1) measure BV and assess whether differences in BV affect concentrations and total circulating mass of Hb and iron biomarkers; (2) develop an algorithm describing BV in OW/OB.Subjects/methodsIn a cross-sectional study, we measured BV in NW, OW, and OB non-anemic women (n = 62) by using the carbon monoxide-rebreathing method, body composition by dual energy X-ray absorptiometry, and iron and inflammatory status.ResultsOW and OB women had 11 and 16% higher mean BV and PV compared to NW (P < 0.05), respectively. In OW/OB compared to NW, total circulating masses of IL-6, hepcidin, Hb, and sTfR were higher, while total mass of serum iron was lower (for all, P < 0.05). An equation including height, body mass and lean mass to estimate BV in all BMI groups (R2 = 0.76).ConclusionAn equation based on anthropometric indices provides a good estimate of increased BV in OW/OB women. In OW/OB women, there is an increase in Hb mass that likely increases iron requirements for erythropoiesis and circulating TfR mass. At the same time, higher hepcidin concentrations may lower serum iron mass. Both these mechanisms may increase risk for ID in OW/OB women.
Highlights
Body mass index (BMI) is negatively correlated with serum iron and positively correlated with serum transferrin receptor in children and adults [1]
Total masses of serum transferrin receptor (sTfR) and serum ferritin (SF) were greater in overweight and obese individuals (OW/OB) compared to normal weight individuals (NW) (P = 0.07 and P = 0.03, respectively)
Hb concentration was not significantly different among the 3 groups, total Hb mass was 11–16% greater in OW/OB compared to NW
Summary
Body mass index (BMI) is negatively correlated with serum iron and positively correlated with serum transferrin receptor (sTfR) in children and adults [1]. The carbon monoxide (CO)rebreathing method is a valid and reliable method for assessing BV that is minimally invasive and involves no radioactivity [23] This method would be ideal to estimate the increase in BV in OB; the resulting BV measures could be used to estimate total circulating mass of the iron status biomarkers to clarify the etiology of ID in OB. We collected subject information using a questionnaire, measured body mass and height to determine BMI, and performed a pregnancy test. We verified the reproducibility of the method by a test–retest correlation analysis and quantified the typical error of measurement by calculation For this assessment, we applied the same optimized CO rebreathing method to the same subjects (n = 8) on two separate occasions. R2 was used to determine the accuracy of this approximation
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