Abstract
Iron deficiency with or without anemia, needing continuous iron supplementation, is very common in obese patients, particularly those requiring bariatric surgery. The aim of this study was to address the impact of weight loss on the rescue of iron balance in patients who underwent sleeve gastrectomy (SG), a procedure that preserves the duodenum, the main site of iron absorption. The cohort included 88 obese women; sampling of blood and duodenal biopsies of 35 patients were performed before and one year after SG. An analysis of the 35 patients consisted in evaluating iron homeostasis including hepcidin, markers of erythroid iron deficiency (soluble transferrin receptor (sTfR) and erythrocyte protoporphyrin (PPIX)), expression of duodenal iron transporters (DMT1 and ferroportin) and inflammatory markers. After surgery, sTfR and PPIX were decreased. Serum hepcidin levels were increased despite the significant reduction in inflammation. DMT1 abundance was negatively correlated with higher level of serum hepcidin. Ferroportin abundance was not modified. This study shed a new light in effective iron recovery pathways after SG involving suppression of inflammation, improvement of iron absorption, iron supply and efficiency of erythropoiesis, and finally beneficial control of iron homeostasis by hepcidin. Thus, recommendations for iron supplementation of patients after SG should take into account these new parameters of iron status assessment.
Highlights
The prevalence of obesity has increased substantially over the past three decades, reaching 23% in the WHO European Region [1]
Women aged 18–60 years whose body mass index was greater than 40 kg/m2, and eligible for sleeve gastrectomy (SG), were included between September 2012 and October 2014
For that we explored the expression levels of DMT1, FPN and DcytB (Duodenal Cytochrome B reductase) in the duodenum biopsies, and we combined the data with the assessment of iron status
Summary
The prevalence of obesity has increased substantially over the past three decades, reaching 23% in the WHO European Region [1]. Sleeve gastrectomy (SG) (reduction in the gastric capacity) and Roux-en-Y gastric bypass (exclusion from the gastrointestinal tract) are the most common performed worldwide [2]. Reports indicate that iron deficiency with or without anemia is frequent in people with obesity and recurrently occurred after each bariatric surgery procedure [3]. The adiposity-associated low-grade inflammation, the reduced iron absorption and menorrhagia are the main explanations of iron deficiency [4,5,6]. By reducing the excess of adipose tissue, bariatric surgery should correct the origin of inflammation and restore iron availability. The expected causes of this iron deficiency anemia may be the postoperative inflammatory stimulus itself or the reduction in nutrient absorption, and they have a direct impact on iron intake within duodenal enterocytes. The benefit of SG on iron absorption and erythropoiesis remains partially known
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