Does Fat Distribution Play a Role in Obesity-Associated Iron Deficiency Anemia? An Anthropometry-based Analysis in Young Women

Document Type : Original Article


1 Department of Physiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Maharashtra, India

2 Department of Physiology, Government Institute of Medical Sciences, Greater Noida, India


Background and aim: High hepcidin levels in obesity reduce iron absorption, leading to iron deficiency anemia. Visceral fat is metabolically more active than subcutaneous fat. We wanted to assess if hemoglobin (Hb), serum iron, and serum ferritin levels correlated with surrogate markers of visceral fat and subcutaneous fat, i.e., waist circumference (WC) and the sum of three skinfold thicknesses (SFT3), respectively.
Material and methods: Thirty young women aged 17-20 years, BMI => 25.0 kg/m2, participated in the cross-sectional analytical study. Data collected: Anthropometry- weight and height for Body Mass Index (BMI) calculation, WC, and skinfold thickness at three sites – triceps, abdomen, and suprailiac regions for SFT3; Haematology parameters - Hb, serum ferritin, and serum iron levels. Data analysis: Pearson's Correlation coefficient (p< 0.05) was calculated for both WC and SFT3, with S. Iron, S. Ferritin, and Hemoglobin.
Results: Thirty percentage of the participants were anemic (Hb < 12.0 mg/dl). Their Iron stores and serum levels were poor (Serum Ferritin < 15.0 ng/ml and S. Iron < 60.0 µ/dl): 67.0% and 70.0%, respectively. WC and SFT3 correlated negatively with hemoglobin. SFT3 and BMI correlated positively with serum ferritin, but WC correlated negatively. Serum iron levels correlated negatively with WC and BMI but positively with SFT3. However, any positive or negative correlation was not found to be significant.
Conclusions: There was a positive association between obesity with iron deficiency anemia. However, whether visceral or subcutaneous fat is more associated with the same remained inconclusive.


Main Subjects

[1]  Chaparvo CM, Suchder PS. Anemia epidemiology, patho physiology and etiology in lowand middle-income countries. Ann: NY A cad. Sci. 2019;1450(1):15-31.
[2]  Allen LH. Anemia and iron deficiency: effects on pregnancy outcome. The American Journal of Clinical Nutrition. 2000;71(5):1280S-4S.
[3]  McLean E, Cogswell M, Egli I, Wojdyla D, De Benoist B. Worldwide prevalence of anaemia, WHO vitamin and mineral nutrition information system, 1993–2005. Public health nutrition. 2009;12(4):444-54.
[4]  DağZÖ DB. Impact of obesity on infertility in women. J Turk Ger Gynecol Assoc. 2015;16(2):111-7.
[5]  Aigner E, Feldman A, Datz C. Obesity as an emerging risk factor for iron deficiency. Nutrients, 2014;6: 3587-3600.
[6]  Gokhale MI, Agarwal PR, Patil AR. Correlation of Body Fat Distribution with Iron Profile and Haemoglobin Level in Young Overweight Females. International Journal of Pharmaceutical Research. 2019;11(1):1153-56.
[7]  Aeberli I, Gut-Knabenhans M, Kusche-Ammann RS, Molinari L, Zimmermann MB. A composite score combining waist circumference and body mass index more accurately predicts body fat percentage in 6-to 13-year-old children. European journal of nutrition. 2013;52(1):247-53.
[8]  Piers LS, Rowley KG, Soares MJ, O'dea K. Relation of adiposity and body fat distribution to body mass index in Australians of Aboriginal and European ancestry. European journal of clinical nutrition. 2003;57(8):956-63.
[9]  Rieken R, Calis EA, Tibboel D, Evenhuis HM, Penning C. Validation of skinfold measurements and bioelectrical impedance analysis in children with severe cerebral palsy: a review. Clinical nutrition. 2010;29(2):217-21.
[10] Borruel S, Molto JF, Alpanes M, Fernandez-Duran E, Alvarez-Blasco F, Luque-Ramirez M, Escobar-Morreale HF. Surrogate markers of visceral adiposity in young adults: waist circumference and body mass index are more accurate than waist hip ratio, model of adipose distribution and visceral adiposity index. PloS one. 2014;9(12):e114112.
[11] Mager DR, Yap J, Rodriguez‐Dimitrescu C, Mazurak V, Ball G, Gilmour S. Anthropometric measures of visceral and subcutaneous fat are important in the determination of metabolic dysregulation in boys and girls at risk for nonalcoholic fatty liver disease. Nutrition in Clinical Practice. 2013;28(1):101-11.
[12] Cornier MA, Després JP, Davis N, Grossniklaus DA, Klein S, Lamarche B, Lopez-Jimenez F, Rao G, St-Onge MP, Towfighi A, Poirier P. Assessing adiposity: a scientific statement from the American Heart Association. Circulation. 2011;124(18):1996-2019.
[13] Abbaspour N, Hurrell R, Kelishadi R. Review on iron and its importance for human health. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2014;19(2):164-74.
[14] Wallace DF. The regulation of iron absorption and homeostasis. The Clinical Biochemist Reviews. 2016;37(2):51-62.
 [15] del Giudice EM, Santoro N, Amato A, Brienza C, Calabro P, Wiegerinck ET, Cirillo G, Tartaglione N, Grandone A, Swinkels DW, Perrone L. Hepcidin in obese children as a potential mediator of the association between obesity and iron deficiency. The Journal of Clinical Endocrinology & Metabolism. 2009;94(12):5102-7.
[16] Reichert CO, Marafon F, Levy D, Maselli LM, Bagatini MD, Blatt SL, Bydlowski SP, Spada C. Influence of Hepcidin in the Development of Anemia. Current Topics in Anemia. 2018;7:217.
[17] Tussing-Humphreys L, Pustacioglu C, Nemeth E, Braunschweig C. Rethinking iron regulation and assessment in iron deficiency, anemia of chronic disease, and obesity: introducing hepcidin. Journal of the Academy of Nutrition and Dietetics. 2012;112(3):391-400.
[18] Warner MJ, Kamran MT. Iron deficiency anemia.[Updated 2021 Aug 11]. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2022.
[19] Lee P, Peng H, Gelbart T, Wang L, Beutler E. Regulation of hepcidin transcription by interleukin-1 and interleukin-6. Proceedings of the National Academy of Sciences. 2005;102(6):1906-10.
[20] Shuster A, Patlas M, Pinthus JH, Mourtzakis M. The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis. The British journal of radiology. 2012;85(1009):1-0.
[21] Stoffel NU, El-Mallah C, Herter-Aeberli I, Bissani N, Wehbe N, Obeid O, Zimmermann MB. The effect of central obesity on inflammation, hepcidin, and iron metabolism in young women. International Journal of Obesity. 2020;44(6):1291-300.
 [22] World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. World Health Organization; 2011.
 [23] World Health Organization. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. World Health Organization; 2011.
 [24] Devkota BP. Iron: Reference Range, Interpretation, Collection and Panels. Staro EB, editor. Medscape Drugs & Diseases. New York: Medscape; 2020.
 [25] Alam F, Memon AS, Fatima SS. Increased body mass index may lead to hyperferritinemia irrespective of body iron stores. Pakistan journal of medical sciences. 2015;31(6):1521-26.
 [26] Rad HA, Sefidgar SA, Tamadoni A, Sedaghat S, Bakouei F, Bijani A, Omidvar S. Obesity and iron-deficiency anemia in women of reproductive age in northern Iran. Journal of education and health promotion. 2019;8:117.
 [27] Lee BJ, Kim JY. Identification of hemoglobin levels based on anthropometric indices in elderly Koreans. PloS one. 2016;11(11):e0165622.