Abstract

Iron deficiency and obesity are global epidemiological problems affecting billions of people worldwide. In the last 30 years, the prevalence of obesity in Europe has risen to 23% and continues to increase. The unequivocal molecular-level connection between obesity and iron deficiency has been demonstrated. Due to the lifestyle and diet of modern humans, obesity and iron deficiency are no longer limited to industrialized countries; developing and underdeveloped nations are also affected by these issues. The most common form of anemia is iron-deficiency anemia. Although all recommendations unanimously advocate for iron correction before and after bariatric surgery, current guidelines are at level C and need improvement. Similarly, there is a growing emphasis in the literature on administering intravenous iron to patients during the first two weeks of hospitalization after bariatric surgery, followed by oral supplements upon discharge, although the specific type of oral supplements remains unclear. According to current protocols, patients are expected to be monitored for the next twelve months for anemia correction. Yet, after bariatric surgery the majority of patients do not receive additional information and advice on nutrition and iron supplementation, leaving them more or less to their own. Considering the numerous side effects associated with non-hem iron, a significant number of patients abandon iron therapy, which can undoubtedly impact the ultimate treatment outcome. Given the much better tolerance and high efficacy, the introduction of hem iron preparations may open a completely new chapter for research in this field.

Keywords:

anemia, bariatric surgery, heme iron

References:

1) Obesity and Overweight. Available online: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight (accessed on 22 August 2023

2) Janssen, I., Katzmarzyk, P.T., and Ross, R. 2002. Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch. Intern. Med. 162:2074–2079.

3) Bodary, P.F., Westrick, R.J., Wickenheiser, K.J., Shen, Y., and Eitzman, D.T. 2002. Effect of leptin on arterial thrombosis following vascular injury in mice. JAMA. 287:1706–1709

4) Arita, Y., et al. 1999. Paradoxical decrease of an adipose-specific protein, adiponectin, in obesity. Biochem. Biophys. Res. Commun. 257:79–83.

5) Hotamisligil, G.S., Shargill, N.S., and Spiegelman, B.M. 1993. Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science. 259:87–91.

6) Fried, S.K., Bunkin, D.A., and Greenberg, A.S. 1998. Omental and sub-cutaneous adipose tissues of obese subjects release interleukin-6: depot difference and regulation by glucocorticoid. J. Clin. Endocrinol. Metab. 83:847–850

7) Datz, C.; Felder, T.K.; Niederseer, D.; Aigner, E. Iron homeostasis in the metabolic syndrome. Eur. J. Clin. Investig. 2013, 43, 215–224. Lear, S.A.; Teo, K.; Gasevic, D.; Zhang, X.; Poirier, P.P.; Rangarajan, S.; Seron, P.; Kelishadi, R.; Tamil, A.M.; Kruger, A.; et al. The association between ownership of common household devices and obesity and diabetes in high, middle and low income countries. Can. Med. Assoc. J. 2014, 186, 258–266.

8) Zimmermann MB, Hurrell RF. Nutritional iron deficiency. Lancet 2007;370:511–20.

9) Anderson GJ, Powell LW, Halliday JW. Transferrin receptor distribu- tion and regulation in the rat small intestine. Effect of iron stores and erythropoiesis. Gastroenterology 1990;98:576–85

10) Finch CA, Cook JD, Labbe RF, Culala M. Effect of blood donation on iron stores as evaluated by serum ferritin. Blood 1977;50:441-7

11) Blachier F, Vaugelade P, Robert V, Kibangou B, Canonne-Hergaux F, Delpal S, Bureau F, Blottiere H, Dominique D. Comparative capacities of the pig colon and duodenum for luminal iron absorption. Can J Physiol Pharmacol 2007;85:185–92.

12) Bougle ́ D, Vaghefi-Vaezzadeh N, Roland N, Bouvard G, Arhan P, Bureau F, Neuville D, Maubois JL. Influence of short-chain fatty acids on iron absorption by proximal colon. Scand J Gastroenterol 2002;37:1008–11

13) Gunshin H, Mackenzie B, Berger UV, Gunshin Y, Romero MF, Boron WF, Nussberger S, Gollan JL, Hediger MA. Cloning and character- ization of a mammalian proton-couple metal-ion transporter. Nature 1997;388:482–8

14) Abboud, S.; Haile, D.J. A novel mammalian iron-regulated protein involved in intracellular iron metabolism. J. Biol. Chem. 2000, 275, 19906–19912

15) West A.R. Oates P.S.Mechanisms of heme iron absorption: Curent questions and contraversis. World J Gastroenterology 2008; 14(26): 4101-4110.

16) Ganz T, Olbina G, Girelli D, Nemeth E, Westerman M. Immuno- assay for human serum hepcidin. Blood 2008;112:4292-7.

17) Pak M, Lopez MA, Gabayan V, Ganz T, Rivera S. Suppression of hepcidin during anemia requires erythropoietic activity. Blood 2006;108:3730-5.

18) Ganz T. Molecular pathogenesis of anemia of chronic disease. Pediatr Blood Cancer 2006;46:554-7

19) Weisberg S.T. McCann D. Desai M. Rosenbaum M. Leibel R.L. Ferrante Jr. A.W; Obesity is associated with macrophage accumulation in adipose tissue. J Clin. Invest. 2003; 112: 1796-1808

20) Weisberg, S.P.; McCann, D.; Desai, M.; Rosenbaum, M.; Leibel, R.L.; Ferrante, A.W. Obesity is associated with macrophage accumulation in adipose tissue. J. Clin. Investig. 2003, 112, 1796–1808

21) Wu, L.E.; Samocha-Bonet, D.; Whitworth, P.T.; Fazakerley, D.J.; Turner, N.; Biden, T.J.; James, D.E.; Cantley, J. Identification of fatty acid binding protein 4 as an adipokine that regulates insulin secretion during obesity. Mol. Metab. 2014, 3, 465–473.

22) DeMaria EJ. (2007) Bariatric surgery for morbid obesity. N Engl J Med 356, 2176–2183

23) Bjorklund G. Peana M. Pivina L. Dosa L et al. Iron deficiency in obesity and after Bariatric surgery Biomolecules 2021; 11, 613

24) Peacock JC, Schmidt CE & Barry K (2016) A qualitative analysis of post-operative nutritional barriers and useful dietary services reported by bariatric surgical patients. Obes Surg 26, 2331–2339.

25) Moretti D. Goede J.S. Zeder C et al Oral ironsupplements increase hepcidin and decrease iron absorption from daily or twice daily doses in iron deplated young women. Blood 2015; 126:17

26) WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Intermittent Iron Supplementation in Preschool and School-Age Children. Geneva: World Health Organization. Copyright (c) World Health Organization 2011.; 2011

27) WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Intermittent Iron and Folic Acid Supplementation in Menstruating Women. Geneva: World Health Organization Copyright (c) World Health Organization 2011.; 2011