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Nong J, Li H, Yang Y, Lu Q, Sun Y, Yin Q, He H. Low serum hepcidin levels in women with polycystic ovary syndrome: evidence from meta-analysis. Gynecol Endocrinol 2024; 40:2375568. [PMID: 38976752 DOI: 10.1080/09513590.2024.2375568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/28/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Iron metabolism plays a significant role in the development of metabolic disorders in women with polycystic ovary syndrome (PCOS). Despite the importance of hepcidin, a key iron regulator, current research on serum hepcidin levels in PCOS patients shows conflicting results. METHODS PubMed, Embase, Web of Science, Cochrane Library and the China National Knowledge Infrastructure (CNKI) database were systematically searched from their inception to 9 September 2023. The search aimed to identify studies in English and Chinese that examined hepcidin levels in women with PCOS compared to healthy control subjects. Standardized mean differences (SMDs) with corresponding 95% confidence intervals (95% CIs) were calculated to evaluate the difference in serum hepcidin levels between women with and without PCOS. RESULTS The meta-analysis included a total of 10 eligible studies, which encompassed 499 PCOS patients and 391 control subjects. The pooled analysis revealed a significant reduction in serum hepcidin levels among the PCOS patients compared to the healthy controls (SMD = -3.49, 95% CI: -4.68 to -2.30, p < .05). There was no statistically significant difference in serum hepcidin levels between PCOS patients with a body mass index (BMI) < 25 and those with a BMI ≥ 25 (p > .05). CONCLUSION The serum hepcidin levels of women with PCOS were significantly lower than those of healthy controls, which suggests that serum hepcidin could be a potential biomarker for PCOS.
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Affiliation(s)
- Jieou Nong
- Department of Clinical Laboratory, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Hua Li
- Department of Clinical Laboratory, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Yunfei Yang
- Department of Clinical Laboratory, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Qiujie Lu
- Department of Clinical Laboratory, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Yifan Sun
- Department of Clinical Laboratory, The Eighth Affiliated Hospital of Guangxi Medical University, Guigang City People's Hospital, Guigang, Guangxi, China
| | - Qi Yin
- Department of Clinical Laboratory, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China
| | - Hongying He
- Department of Gynecology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China
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Demirdjian SP, Kerr MA, Mulhern MS, Thompson PD, Ledwidge M, McCann MT. Association between Adiposity and Iron Status in Women of Reproductive Age: Data from the UK National Diet and Nutrition Survey (NDNS) 2008-2019. J Nutr 2024:S0022-3166(24)00510-8. [PMID: 39236809 DOI: 10.1016/j.tjnut.2024.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 08/07/2024] [Accepted: 08/29/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Overweight/obesity and iron deficiency (ID) are highly prevalent in women of reproductive age (WRA), impacting on women's health. Obesity is a risk factor for nutritional deficiencies but its association with ID is unclear. OBJECTIVES To determine the association between adiposity and markers of iron status and ID prevalence in WRA. METHODS This cross-sectional study analyzed the National Diet and Nutrition Survey (2008-2019) data, focusing on women aged 18-49 y with body mass index (BMI) ≥18.5 kg/m2. Prevalence of anemia, iron deficiency anemia (IDA), and ID were analyzed. Ferritin was adjusted for C-reactive protein. Iron status was assessed across high and low BMI, waist circumference (WC), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR). χ2, linear and logistic regressions were performed adjusting for covariates. RESULTS Among 1098 WRA, 496 normal weight and 602 overweight/obesity, prevalence rates were: anemia 9.2% and IDA 6.8%. Anemia was more prevalent in those with higher WHtR and WHR (11.9% compared with 5.9% and 16.7% compared with 6.5%, both P < 0.001). WRA with increased WC, WHtR, and WHR had higher IDA prevalence than those with lower adiposity (8.5% compared with 4.3%, P = 0.005; 9.4% compared with 3.3%, P < 0.001; 12.1% compared with 4.9%, P < 0.001). ID prevalence was 49.7% (ferritin cutoff 30 μg/L) and 19.6% (ferritin cutoff 15 μg/L), showing similar rates across adiposity groups. ID prevalence defined by soluble transferrin receptor (sTfR) was higher in women with increased WHR (P = 0.001). Higher WHR predicted ID categorized by sTfR (adjusted odds ratio [aOR]: 2.104, P = 0.004), and WHtR and WHR predicted anemia and IDA (anemia: WHtR aOR: 2.006, P = 0.036; WHR aOR: 4.489, P < 0.001 and IDA: WHtR aOR: 2.942, P = 0.012; WHR aOR: 4.142, P < 0.001). CONCLUSIONS At least 1 in 5 WRA in the UK are iron deficient, highlighting the need to revise current policies. Greater central adiposity was strongly associated with impaired iron status and the development of anemia, IDA, and ID.
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Affiliation(s)
- Sabrina P Demirdjian
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland
| | - Maeve A Kerr
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland
| | - Maria S Mulhern
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland
| | - Paul D Thompson
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland
| | - Mark Ledwidge
- School of Medicine, University College Dublin, Ireland
| | - Mary T McCann
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland.
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3
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Clark P. Iron Deficiency Related to Obesity. JOURNAL OF INFUSION NURSING 2024; 47:163-174. [PMID: 38744241 DOI: 10.1097/nan.0000000000000546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
There is a direct correlation between being overweight and iron deficiency. Physiological changes occur in obese adipose cells that contribute to the development of iron deficiency (ID) and iron deficiency anemia (IDA). These changes disrupt the normal iron metabolic checks and balances. Furthermore, bariatric surgery can lead to long-term ID and IDA. Oral iron supplementation may not be effective for many of these patients. Intravenous iron infusions can significantly increase the quality of life for individuals experiencing this condition but are also associated with potentially serious complications. Adequate knowledge about intravenous (IV) iron administration can greatly increase the safety of this beneficial therapy. This review article explains the relationship between obesity, ID/IDA, bariatric surgery and the safe administration of IV iron.
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Affiliation(s)
- Pamela Clark
- Author Affiliations: Houston Methodist Sugar Land Hospital, Outpatient IV Therapy Clinic, Sugar Land, Texas (Clark)
- Pamela Clark, RN, BSN, CRNI, has been a registered nurse for 47 years, practicing exclusively in infusion nursing for 40 of those years. She has worked in multiple practice settings, including home health, skilled nursing facilities, free-standing infusion centers, physician office-based infusion centers, and hospital-based infusion centers. Pamela has presented at Infusion Nurses Society conferences on various topics related to infusion nursing and is president of the Greater Houston Area Chapter of the Infusion Nurses Society
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Hoad VC, Castrén J, Norda R, Pink J. A donor safety evidence literature review of the short- and long-term effects of plasmapheresis. Vox Sang 2024; 119:94-101. [PMID: 37641582 DOI: 10.1111/vox.13512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023]
Abstract
Many blood establishments are expanding plasmapheresis collection capacity to achieve increasing plasma for fractionation volume targets, driven by immunoglobulin product demand. Some adverse events occur in both apheresis and whole blood collection, such as venepuncture-related trauma and vasovagal reactions. Others are specifically related to the apheresis procedure, such as citrate reactions, haemolysis, infiltration and air embolism. Whilst plasmapheresis procedures are generally well tolerated, theoretical longer term donor health considerations, such as the effects on donor plasma protein levels, bone mineral density, iron deficiency and malignancy also require consideration. An evidence-based framework that supports a safe and sustainable increase in the collection of plasma is essential. Our review demonstrates a lack of high-quality evidence on risks and outcomes specifically in plasmapheresis. Whilst conservative procedural controls and donor harm minimization policies will mitigate risk, high-quality evidence is needed to facilitate practice change that is safe and sustainable and maximizes the potential of individual donor differences.
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Affiliation(s)
- Veronica C Hoad
- Donor and Product Safety (DAPS) Policy Unit, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | | | - Rut Norda
- Clinical Immunology and Transfusion Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Joanne Pink
- Donor and Product Safety (DAPS) Policy Unit, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
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5
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Hissen SL, Takeda R, Badrov MB, Arias-Franklin S, Patel S, Nelson DB, Babb TG, Fu Q. Impact of maternal obesity on resting muscle sympathetic nerve activity during uncomplicated pregnancy: a longitudinal assessment. Am J Physiol Regul Integr Comp Physiol 2024; 326:R10-R18. [PMID: 37955129 PMCID: PMC11283889 DOI: 10.1152/ajpregu.00098.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/12/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023]
Abstract
Maternal obesity increases the risk of adverse pregnancy outcomes. The mechanisms that contribute to this elevated risk are unclear but may be related to greater activity of the sympathetic nervous system, which is associated with hypertensive disorders of pregnancy. We hypothesized that resting muscle sympathetic nerve activity (MSNA) would be greater in women with obesity during pregnancy when compared with normal-weight women. Blood pressure, heart rate, and MSNA were recorded during 5 min of supine rest in 14 normal-weight women [body mass index (BMI) 22.1 ± 2.1 (SD) kg/m2] and 14 women with obesity (BMI 33.9 ± 3.5 kg/m2) during (early and late) pregnancy and postpartum. All women had uncomplicated pregnancies. Resting MSNA burst frequency was not different between groups during early (normal weight 17 ± 10 vs. obesity 22 ± 15 bursts/min, P = 0.35) but was significantly greater in the obesity group during late pregnancy (23 ± 13 vs. 35 ± 15 bursts/min, P = 0.031) and not different postpartum (10 ± 6 vs. 9 ± 7 bursts/min, P = 0.74). These findings were also apparent when comparing burst incidence and total activity. Although still within the normotensive range, systolic blood pressure was greater in the obesity group across all time points (P = 0.002). Diastolic blood pressure was lower during pregnancy compared with postpartum (P < 0.001) and not different between groups (P = 0.488). Heart rate increased throughout pregnancy in both groups (P < 0.001). Our findings suggest that maternal obesity is associated with greater increases in sympathetic activity even during uncomplicated pregnancy. Future research is needed to determine if this is linked with an increased risk of adverse outcomes or is required to maintain homeostasis in pregnancy.NEW & NOTEWORTHY The impact of maternal obesity on resting muscle sympathetic nerve activity was examined during (early and late) and after uncomplicated pregnancy. Resting muscle sympathetic nerve activity is not different during early pregnancy or postpartum but is significantly elevated in women with obesity during late pregnancy when compared with normal-weight women. Future research is needed to determine if this is linked with an increased risk of adverse outcomes or is required to maintain homeostasis in pregnancy.
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Affiliation(s)
- Sarah L Hissen
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Ryosuke Takeda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Mark B Badrov
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- University Health Network, Toronto, Ontario, Canada
| | - Sonia Arias-Franklin
- The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Shivani Patel
- The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - David B Nelson
- The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- The University of Texas Southwestern Medical Center, Dallas, Texas, United States
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Oberholzer L, Montero D, Robach P, Siebenmann C, Ryrsøe CK, Bonne TC, Breenfeldt Andersen A, Bejder J, Karlsen T, Edvardsen E, Rønnestad BR, Hamarsland H, Cepeda-Lopez AC, Rittweger J, Treff G, Ahlgrim C, Almquist NW, Hallén J, Lundby C. Determinants and reference values for blood volume and total hemoglobin mass in women and men. Am J Hematol 2024; 99:88-98. [PMID: 38032792 DOI: 10.1002/ajh.27162] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/04/2023] [Accepted: 10/12/2023] [Indexed: 12/02/2023]
Abstract
Blood volume (BV) is an important clinical parameter and is usually reported per kg of body mass (BM). When fat mass is elevated, this underestimates BV/BM. One aim was to study if differences in BV/BM related to sex, age, and fitness would decrease if normalized to lean body mass (LBM). The analysis included 263 women and 319 men (age: 10-93 years, body mass index: 14-41 kg/m2 ) and 107 athletes who underwent assessment of BV and hemoglobin mass (Hbmass ), body composition, and cardiorespiratory fitness. BV/BM was 25% lower (70.3 ± 11.3 and 80.3 ± 10.8 mL/kgBM ) in women than men, respectively, whereas BV/LBM was 6% higher in women (110.9 ± 12.5 and 105.3 ± 11.2 mL/kgLBM ). Hbmass /BM was 34% lower (8.9 ± 1.4 and 11.5 ± 11.2 g/kgBM ) in women than in men, respectively, but only 6% lower (14.0 ± 1.5 and 14.9 ± 1.5 g/kgLBM )/LBM. Age did not affect BV. Athlete's BV/BM was 17.2% higher than non-athletes, but decreased to only 2.5% when normalized to LBM. Of the variables analyzed, LBM was the strongest predictor for BV (R2 = .72, p < .001) and Hbmass (R2 = .81, p < .001). These data may only be valid for BV/Hbmass when assessed by CO re-breathing. Hbmass /LBM could be considered a valuable clinical matrix in medical care aiming to normalize blood homeostasis.
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Affiliation(s)
- Laura Oberholzer
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - David Montero
- Department of Medicine, School of Clinical Medicine/Public Health, The University of Hongkong, Hongkong, China
| | - Paul Robach
- Ecole Nationale des Sports de Montagne, site de l'Ecole Nationale de Ski et d'Alpinisme, Chamonix, France
| | | | - Camilla Koch Ryrsøe
- Department of Infectious Diseases and Pulmonary Medicine, Nordsjaellands University Hospital, Hillerød, Denmark
| | - Thomas C Bonne
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
| | | | - Jacob Bejder
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
| | - Trine Karlsen
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Cardiac Exercise Research Group, Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science of Technology, Trondheim, Norway
| | - Elisabeth Edvardsen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Bent R Rønnestad
- Section for Health and Exercise Physiology, Inland Norway University of Applied Sciences, Lillehammer, Norway
| | - Håvard Hamarsland
- Section for Health and Exercise Physiology, Inland Norway University of Applied Sciences, Lillehammer, Norway
| | - Ana C Cepeda-Lopez
- Health Sciences Division, University of Monterrey (UDEM), Monterrey, Mexico
| | - Jörn Rittweger
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
- Department of Pediatrics and Adolescent Medicine, University Hospital Cologne, Cologne, Germany
| | - Gunnar Treff
- Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
| | - Christoph Ahlgrim
- University Heart Center Freiburg, Medical Center-University of Freiburg, Bad Krozingen, Germany
| | - Nicki Winfield Almquist
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
| | - Jostein Hallén
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Carsten Lundby
- Section for Health and Exercise Physiology, Inland Norway University of Applied Sciences, Lillehammer, Norway
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7
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Lundby C, Mazza O, Nielsen J, Haubro M, Kvorning T, Ørtenblad N, Gejl KD. Eight weeks of heavy strength training increases hemoglobin mass and V̇o 2peak in well-trained to elite female and male rowers. J Appl Physiol (1985) 2024; 136:1-12. [PMID: 37942530 DOI: 10.1152/japplphysiol.00587.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/19/2023] [Accepted: 11/06/2023] [Indexed: 11/10/2023] Open
Abstract
O2-transport and endurance exercise performance are greatly influenced by hemoglobin mass (Hbmass), which largely depends on lean body mass (LBM). This study investigated the effects of 8 wk with three weekly sessions of conventional (3-SET: 3 × 10 reps) or high-volume strength training (10-SET: 5-10 × 10 reps) on LBM, Hbmass, muscle strength, and exercise performance in female and male rowers. Hematological parameters were obtained through CO rebreathing and body composition by dual-energy X-ray absorptiometry (DEXA) scans before and after the training period. Concomitantly, V̇o2peak was determined during 2-km ergometer rowing and muscle strength by isometric midthigh pull. There were no differences in training responses between groups for any of the parameters. Pooled data revealed overall increments for Hbmass (10-SET: 882 ± 199 g to 897 ± 213 g; 3-SET: 936 ± 245 g to 962 ± 247 g, P = 0.02) and V̇o2peak (10-SET: 4.3 ± 1.0 to 4.4 ± 0.9 L·min-1; 3-SET: 4.5 ± 0.9 to 4.6 ± 0.9 L·min-1, P = 0.03), whereas LBM remained unchanged (10-SET: 58.7 ± 10.5 to 58.7 ± 10.1 kg; 3-SET: 64.1 ± 10.8 to 64.5 ± 10.6 kg, P = 0.42). Maximal isometric midthigh pull strength increased (10-SET: 224 ± 47 kg to 237 ± 55 kg; 3-SET: 256 ± 77 kg to 281 ± 83 kg, P = 0.001). Strong associations were observed between LBM and Hbmass and V̇o2peak (r2 = 0.88-0.90), entailing sex differences in Hbmass and V̇o2peak. Normalizing V̇o2peak to LBM reduced the sex difference to ∼10%, aligning with the sex difference in Hbmass·LBM-1. Strength training successfully increased Hbmass and V̇o2peak in elite female and male rowers, without an additional effect from increased training volume. Moreover, sex differences in V̇o2peak were mainly explained by differences in LBM, but likely also by differences in Hbmass·LBM-1.NEW & NOTEWORTHY This study in female and male rowers demonstrates that hemoglobin mass (Hbmass), V̇o2peak, and muscle strength increases with 8 wk of heavy strength training and that this response is not different between conventional (3 × 10 repetitions) and high-volume strength training (10 × 10 repetitions). Moreover, female rowers exhibited less hemoglobin per kilogram of lean body mass compared with their male counterparts, which likely contributes to sex differences in V̇o2peak and rowing performance.
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Affiliation(s)
- Carsten Lundby
- Section for Health and Exercise Physiology, Inland Norway University of Applied Sciences, Lillehammer, Norway
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Oscar Mazza
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Joachim Nielsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mads Haubro
- The Danish Rowing Federation, Bagsvaerd, Denmark
| | - Thue Kvorning
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Niels Ørtenblad
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kasper Degn Gejl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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van Kouswijk HW, Tolk JJ, van Bommel CPE, Reijman M, Kempink DRJ, de Witte PB. Effect of tranexamic acid on intraoperative blood loss in pediatric osteotomies around the hip: Study protocol for a double-blind randomized placebo-controlled trial. J Child Orthop 2023; 17:404-410. [PMID: 37799317 PMCID: PMC10549700 DOI: 10.1177/18632521231199518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/19/2023] [Indexed: 10/07/2023] Open
Abstract
Background Proximal femoral and/or pelvic osteotomies (PFPOs) can be indicated for a multitude of hip pathologies in (often asymptomatic) children, to prevent future hip problems. These procedures can result in significant blood loss. Tranexamic acid (TXA) is an antifibrinolytic agent routinely administered in adult trauma and joint reconstruction surgery to reduce blood loss. TXA is also registered for use in children and reported safe and beneficial for pediatric trauma, cardiac, and spinal surgery. However, for pediatric orthopedics, particularly for PFPOs, the available evidence is limited. Therefore, the current trial will investigate the potential reducing effect of preoperative TXA on intraoperative blood loss in pediatric PFPOs. Methods In this single-center, double-blind, randomized placebo-controlled trial, we aim to include 180 participants aged from 1 to 18 years undergoing PFPOs for any indication at our institution. Participants will be randomized to receive either TXA or placebo (saline) during anesthetic induction. The primary outcome is intraoperative estimated blood loss (mL/kg), which is determined gravimetrically. Secondary outcomes include the percentage of patients with excessive blood loss (>20 mL/kg), procedure time and hospital stay, and postoperative hemoglobin level changes. Discussion This will be the first prospective study investigating the effect of preoperative TXA on intraoperative blood loss in pediatric PFPOs. Its results will help to determine whether it would be advisable to adopt preoperative TXA as a standard medication to minimize blood loss and prevent complications in this vulnerable population. Trial registration EudraCT: 2022-002384-30. Prospectively registered on September 26, 2022.
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Affiliation(s)
- Hilde W van Kouswijk
- Department of Orthopaedics and Sports Medicine, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Orthopaedic Surgery, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jaap J Tolk
- Department of Orthopaedics and Sports Medicine, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Christian PE van Bommel
- Department of Hospital Pharmacy, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Max Reijman
- Department of Orthopaedics and Sports Medicine, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Dagmar RJ Kempink
- Department of Orthopaedics and Sports Medicine, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Pieter B de Witte
- Department of Orthopaedics and Sports Medicine, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
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9
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Whitley J, Dazelle W, Kripalani S, Ahmadzia H. The association between body mass index and postpartum hemorrhage after cesarean delivery. Sci Rep 2023; 13:11998. [PMID: 37491437 PMCID: PMC10368616 DOI: 10.1038/s41598-023-38526-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023] Open
Abstract
We aimed to evaluate the association between obesity and postpartum hemorrhage (PPH) after cesarean delivery (CD). This was a retrospective cohort study using a multicenter database of 20 hospitals in the United States. We analyzed 27,708 patients undergoing CD from 2015 to 2019. The exposure of interest was BMI, and the primary outcome was PPH (estimated blood loss [EBL] ≥ 1000 mL). Simple logistic regression was used to evaluate the relationship between obesity and intrapartum complications. Multivariable logistic regression was used to adjust for any confounding demographic variables. Hosmer and Lemeshow's purposeful selection algorithm was adapted to develop a multivariable logistic regression model of PPH. Analyses were conducted using STATA 16.1 (College Station, Texas) with p ≤ 0.05 considered significant. BMI exerted a significant effect on the frequency of PPH (p = 0.004). Compared to patients with BMI 18.5-24.9 kg/m2, patients with BMI between 25 and 59.9 kg/m2 had an increased odds of PPH. The odds of PPH in patients with BMI > 60 kg/m2 was not increased compared to patients with BMI 18.5-24.9 kg/m2. Obesity was associated with a decreased odds of blood transfusion (aOR 0.73, 95% CI 0.55-0.97). In conclusion, higher BMI was associated with PPH yet a lower odds of transfusion after CD.
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Affiliation(s)
- Julia Whitley
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA.
| | - Wayde Dazelle
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA
| | - Shawn Kripalani
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA
| | - Homa Ahmadzia
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA
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10
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Calcaterra V, Verduci E, Milanta C, Agostinelli M, Todisco CF, Bona F, Dolor J, La Mendola A, Tosi M, Zuccotti G. Micronutrient Deficiency in Children and Adolescents with Obesity-A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040695. [PMID: 37189944 DOI: 10.3390/children10040695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023]
Abstract
Childhood obesity represents a serious public health burden. Despite excessive dietary consumption, children with obesity present high rates of micronutrient deficiencies, such as deficiencies in minerals and specific vitamins; micronutrient deficiencies may have a pathogenic role in obesity-related metabolic comorbidities. In this narrative review, we analyzed the main deficiencies associated with obesity, their clinical consequences, and the evidence about a possible supplementation. Iron; vitamins A, B, C, D, and E; folic acid; zinc; and copper deficiencies represent the most common deficient microelements. The relationship between obesity and multiple micronutrient deficiencies remains unclear, and different mechanisms have been proposed. The medical care plan for pediatric obesity should include food choices with high nutritional content as part of a crucial approach to obesity-related complications. Unfortunately, only a few studies are available regarding the efficacy of oral supplementation or weight loss for treating them; thus, continuous nutritional monitoring is necessary.
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Affiliation(s)
- Valeria Calcaterra
- Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Elvira Verduci
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
- Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Chiara Milanta
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | | | | | - Federica Bona
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Jonabel Dolor
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Alice La Mendola
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Martina Tosi
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
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11
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Schmiedecker M, Krenn S, Waller M, Paschen C, Mussnig S, Niknam J, Wabel P, Mayer CC, Hecking M, Schneditz D. Ultrafiltration-induced decrease in relative blood volume is larger in hemodialysis patients with low specific blood volume: Results from a dialysate bolus administration study. Hemodial Int 2023; 27:174-183. [PMID: 36703281 DOI: 10.1111/hdi.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/04/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Prescribing the ultrafiltration in hemodialysis patients remains challenging and might benefit from the information on absolute blood volume, estimated by intradialytic dialysate bolus administration. Here, we aimed at determining the relationship between absolute blood volume, normalized for body mass (specific blood volume, Vs), and ultrafiltration-induced decrease in relative blood volume (∆RBV) as well as clinical parameters including body mass index (BMI). METHODS This retrospective analysis comprised 77 patients who had their dialysate bolus-based absolute blood volume extracted routinely with an automated method. Patient-specific characteristics and ∆RBV were analyzed as a function of Vs, dichotomizing the data above or below a previously proposed threshold of 65 ml/kg for Vs. Statistical methodology comprised descriptive analyses, two-group comparisons, and correlation analyses. FINDINGS Median Vs was 68.6 ml/kg (54.9 ml/kg [Quartile 1], 83.4 ml/kg [Quartile 3]). Relative blood volume decreased by 6.3% (2.6%, 12.2%) over the entire hemodialysis session. Vs correlated inversely with BMI (rs = -0.688, p < 0.001). ∆RBV was 9.8% in the group of patients with Vs <65 ml/kg versus 6.0% in the group of patients with Vs ≥65 ml/kg (p = 0.024). The two groups did not differ significantly regarding their specific ultrafiltration volume, normalized for body mass, which amounted to 34.1 ml/kg and 36.0 ml/kg in both groups, respectively (p = 0.630). ∆RBV correlated inversely with Vs (rs = -0.299, p = 0.008). DISCUSSION The present study suggests that patients with higher BMI and lower Vs experience larger blood volume changes, despite similar ultrafiltration requirements. These results underline the clinical plausibility and importance of dialysate bolus-based absolute blood volume determination in the assessment of target weight, especially in view of a previous study where intradialytic morbid events could be decreased when the target weight was adjusted, based on Vs.
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Affiliation(s)
- Michael Schmiedecker
- Department of Medicine III, Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria
| | - Simon Krenn
- Department of Medicine III, Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria.,Center for Public Health, Department of Epidemiology, Medical University of Vienna, Vienna, Austria.,AIT Austrian Institute of Technology, Center for Health & Bioresources, Medical Signal Analysis, Vienna, Austria
| | - Maximilian Waller
- Department of Medicine III, Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria.,Department of Nephrology, Klinik Favoriten Vienna, Vienna, Austria
| | - Christopher Paschen
- Department of Medicine III, Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria
| | - Sebastian Mussnig
- Department of Medicine III, Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria
| | - Janosch Niknam
- Department of Medicine III, Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria
| | | | - Christopher C Mayer
- AIT Austrian Institute of Technology, Center for Health & Bioresources, Medical Signal Analysis, Vienna, Austria
| | - Manfred Hecking
- Department of Medicine III, Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria
| | - Daniel Schneditz
- Otto Loewi Research Center, Division of Physiology, Medical University of Graz, Graz, Austria
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12
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Li N, Liao Y, Huang H, Fu S. Co-regulation of hepatic steatosis by ferritinophagy and unsaturated fatty acid supply. Hepatol Commun 2022; 6:2640-2653. [PMID: 35861547 PMCID: PMC9512465 DOI: 10.1002/hep4.2040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/06/2022] Open
Abstract
Both iron overload and iron deficiency have been reported in obesity and metabolic syndromes. Due to the presence of multiple intracellular iron pools and the dynamic nature of iron mobilization and use, the actual status and contribution of free and metabolically active iron toward metabolic syndrome remain to be established. The discovery of nuclear receptor coactivator 4 (NCOA4) as a ferritinophagy receptor provides an opening to address the connection between iron and metabolic diseases. This study aims to specifically dissect the role of hepatic ferritinophagy in lipid metabolism and hepatic steatosis. We conducted a series of Ncoa4 gain- and loss-of-function experiments to examine how ferritinophagy affects lipid metabolism through phenotypic and lipidomic analyses both in vitro and in vivo. We show that ferritinophagy is required to release iron from ferritin cages for biological use, and is induced by lipid loading in vitro and during the development of obesity in vivo. Ncoa4 knockdown impairs mitochondrial morphology and reduces palmitate-induced lipid droplet formation in cultured cells and the development of hepatic steatosis in obese mice models. Importantly, the effect of Ncoa4 deficiency on mitochondrial morphology and lipid accumulation is specifically linked to lipidomic reductions in unsaturated fatty acid content in triglycerides and cardiolipins, and an external supply of unsaturated fatty acids reverses these phenotypes. Conclusion: This study shows that ferritinophagy-derived iron supports fatty acid desaturation and the synthesis of unsaturated fatty acid-rich lipids to reduce lipotoxicity. However, the continuous activation of ferritinophagy contributes to the development of hepatic steatosis and liver damage in obesity.
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Affiliation(s)
- Ning Li
- School of Life Sciences, Tsinghua University, Beijing, China
| | - Yilie Liao
- School of Life Sciences, Tsinghua University, Beijing, China
| | - Haipeng Huang
- School of Life Sciences, Tsinghua University, Beijing, China
| | - Suneng Fu
- Department of Basic Research, Guangzhou Laboratory, Guangdong, China
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13
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Berton M, Bettonte S, Stader F, Battegay M, Marzolini C. Repository Describing the Anatomical, Physiological, and Biological Changes in an Obese Population to Inform Physiologically Based Pharmacokinetic Models. Clin Pharmacokinet 2022; 61:1251-1270. [PMID: 35699913 PMCID: PMC9439993 DOI: 10.1007/s40262-022-01132-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/24/2022]
Abstract
Background Obesity is associated with physiological changes that can affect drug pharmacokinetics. Obese individuals are underrepresented in clinical trials, leading to a lack of evidence-based dosing recommendations for many drugs. Physiologically based pharmacokinetic (PBPK) modelling can overcome this limitation but necessitates a detailed description of the population characteristics under investigation. Objective The purpose of this study was to develop and verify a repository of the current anatomical, physiological, and biological data of obese individuals, including population variability, to inform a PBPK framework. Methods A systematic literature search was performed to collate anatomical, physiological, and biological parameters for obese individuals. Multiple regression analyses were used to derive mathematical equations describing the continuous effect of body mass index (BMI) within the range 18.5–60 kg/m2 on system parameters. Results In total, 209 studies were included in the database. The literature reported mostly BMI-related changes in organ weight, whereas data on blood flow and biological parameters (i.e. enzyme abundance) were sparse, and hence physiologically plausible assumptions were made when needed. The developed obese population was implemented in Matlab® and the predicted system parameters obtained from 1000 virtual individuals were in agreement with observed data from an independent validation obese population. Our analysis indicates that a threefold increase in BMI, from 20 to 60 kg/m2, leads to an increase in cardiac output (50%), liver weight (100%), kidney weight (60%), both the kidney and liver absolute blood flows (50%), and in total adipose blood flow (160%). Conclusion The developed repository provides an updated description of a population with a BMI from 18.5 to 60 kg/m2 using continuous physiological changes and their variability for each system parameter. It is a tool that can be implemented in PBPK models to simulate drug pharmacokinetics in obese individuals.
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Affiliation(s)
- Mattia Berton
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Sara Bettonte
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
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14
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Leal LB, Nogueira MS, Mageski JGA, Martini TP, Barauna VG, Dos Santos L, de Carvalho LFDCES. Diagnosis of Systemic Diseases Using Infrared Spectroscopy: Detection of Iron Overload in Plasma-Preliminary Study. Biol Trace Elem Res 2021; 199:3737-3751. [PMID: 33415581 DOI: 10.1007/s12011-020-02510-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023]
Abstract
Despite the important role of iron in cellular homeostasis, iron overload (IO) is associated with systemic and tissue deposits which damage several organs. In order to reduce the impact caused by IO, invasive diagnosis exams (e.g., biopsies) and minimally invasive methods were developed including computed tomography and magnetic resonance imaging. However, current diagnostic methods are still time-consuming and expensive. A cost-effective solution is using Fourier-transform infrared spectroscopy (FTIR) for real-time and molecular-sensitive biofluid analysis during conventional laboratory exams. In this study, we performed the first evaluation of the accuracy of FTIR for IO diagnosis. The study was performed by collecting FTIR spectra of plasma samples of five rats intravenously injected with iron-dextran and five control rats. We developed a classification model based on principal component analysis and supervised methods including J48, random forest, multilayer perceptron, and radial basis function network. We achieved 100% accuracy for the classification of the IO status and provided a list of possible biomolecules related to the vibrational modes detected. In this preliminary study, we give a first step towards real-time diagnosis for acute IO or intoxication. Furthermore, we have expanded the literature knowledge regarding the pathophysiological changes induced by iron overload.
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Affiliation(s)
- Leonardo Barbosa Leal
- Department of Physiological Sciences, Federal University of Espírito Santo (UFES), Marechal Campos Ave, 1468, Maruípe, Vitória, Espírito Santo, 29040-090, Brazil.
| | - Marcelo Saito Nogueira
- Tyndall National Institute/University College Cork - Lee Maltings Complex, Dyke Parade, Cork, T12R5CP, Ireland
| | - Jandinay Gonzaga Alexandre Mageski
- Department of Physiological Sciences, Federal University of Espírito Santo (UFES), Marechal Campos Ave, 1468, Maruípe, Vitória, Espírito Santo, 29040-090, Brazil
| | - Thiago Pereira Martini
- Institute of Science and Technology, Federal University of Sao Paulo, São José dos Campos, Brazil
| | - Valério Garrone Barauna
- Department of Physiological Sciences, Federal University of Espírito Santo (UFES), Marechal Campos Ave, 1468, Maruípe, Vitória, Espírito Santo, 29040-090, Brazil
| | - Leonardo Dos Santos
- Department of Physiological Sciences, Federal University of Espírito Santo (UFES), Marechal Campos Ave, 1468, Maruípe, Vitória, Espírito Santo, 29040-090, Brazil
| | - Luis Felipe das Chagas E Silva de Carvalho
- Universidade de Taubaté. R. dos Operários, 09 - Centro, Taubaté, São Paulo, 12020-340, Brazil
- Centro Universitário Braz Cubas, Av. Francisco Rodrigues Filho, 1233 - Vila Mogilar, Mogi das Cruzes, São Paulo, Brazil
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15
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The effects of reducing chronic inflammation in overweight women on serum hepcidin and iron absorption with and without supplemental ascorbic acid. Br J Nutr 2021; 126:877-884. [PMID: 33243304 DOI: 10.1017/s0007114520004730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although hepcidin synthesis is stimulated by inflammation and inhibited by Fe deficiency, the strength of their opposing effects on serum hepcidin (SHep) in humans remains unclear. It was recently shown that an inflammatory stimulus in anaemic women did not increase SHep or decrease Fe absorption. The enhancing effect of ascorbic acid on Fe absorption may not be effective during inflammation because of increased SHep. Our study aim was to test whether reducing inflammation in Fe-depleted overweight (OW) women with low-grade inflammation would lower SHep and improve Fe absorption with and without ascorbic acid, compared with normal-weight (NW) women without inflammation. Before and after 14 d of anti-inflammatory treatment (3 × 600 mg ibuprofen daily) in OW and NW women (n 36; 19-46 years of age), we measured SHep and fractional Fe absorption (FIA) (erythrocyte Fe incorporation) from 57Fe- and 58Fe-labelled test meals with and without ascorbic acid. There were significant group effects on IL-6, C-reactive protein, serum ferritin and SHep (for all, P < 0·05). There was a significant treatment effect on SHep (P < 0·05): in OW women, treatment decreased IL-6 by approximately 30 % and SHep by approximately 45 %. However, there were no significant treatment or group effects on FIA. Body Fe stores (BIS) were a significant positive predictor of SHep before and after treatment (P < 0·001), but IL-6 was not. Reducing chronic inflammation in OW women halved SHep but did not affect Fe absorption with or without ascorbic acid, and the main predictor of Fe absorption was BIS.
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16
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Davarpasand T, Hosseinsabet A, Omidi F, Mohseni-Badalabadi R. Interaction effect of myocardial infarction and obesity on left atrial functions. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:431-441. [PMID: 33190233 DOI: 10.1002/jcu.22948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/12/2020] [Accepted: 10/23/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To determine whether myocardial infarction (MI) would lead to a greater decrease in left atrial (LA) functions in subjects with than without obesity. METHODS A total of 310 consecutive patients were divided into four groups according to the presence or absence of obesity and MI. The functions of the LA were evaluated in terms of longitudinal deformation of the LA myocardium via 2D speckle-tracking echocardiography. RESULTS The adjusted analysis showed a reduction in the strain and strain rate during the reservoir and contraction phases and in the strain rate during the conduit phase in patients with MI and in subjects with obesity (P < .05). In addition, there was a significant interaction effect of obesity and MI on the strain rate during the contraction phase (P = .048). CONCLUSIONS There is an independent and additional interaction effect of obesity and MI on the reservoir and conduit functions of the LA. MI was more deleterious to the contraction function in subjects without than with obesity, so that the contraction function was similar in MI patients without obesity and MI patients with obesity.
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Affiliation(s)
- Tahereh Davarpasand
- Assistant Professor of Cardiology, Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hosseinsabet
- Assistant Professor of Cardiology, Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Omidi
- Assistant Professor of Cardiology, Cardiology Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Mohseni-Badalabadi
- Assistant Professor of Cardiology, Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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17
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Malden S, Gillespie J, Hughes A, Gibson AM, Farooq A, Martin A, Summerbell C, Reilly JJ. Obesity in young children and its relationship with diagnosis of asthma, vitamin D deficiency, iron deficiency, specific allergies and flat-footedness: A systematic review and meta-analysis. Obes Rev 2021; 22:e13129. [PMID: 32808447 PMCID: PMC7611974 DOI: 10.1111/obr.13129] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 02/06/2023]
Abstract
There is evidence that a number of medical conditions and co-morbidities are associated with obesity in young children. This review explored whether there is evidence of associations with other conditions or co-morbidities. Observational studies of young children (mean age < 10 years) were identified using electronic searches of five databases (MEDLINE, Embase, CINAHL, AMED and SPORTDiscus). Of 27 028 studies screened, 41 (comprising 44 comparisons) met the inclusion criteria. These studies provided data on five distinct diseases/conditions: asthma (n = 16), vitamin D deficiency (n = 10), iron deficiency (n = 10), allergies (n = 4) and flat-footedness (n = 4). Thirty-two studies were appropriate for meta-analysis using random-effects models, and revealed obesity was significantly associated with having asthma (OR 1.5, 95% CI 1.3-1.7), vitamin D deficiency (OR 1.9, 95% CI 1.4-2.5) and iron deficiency (OR 2.1, 95% CI 1.4-3.2). Heterogeneity (I2 ) ranged from 57% to 61%. Narrative synthesis was conducted for all studies. There was no evidence of a consistent association between obesity in young children and eczema, dermatitis or rhinitis due to the low number of studies. However, there was an association with flat-footedness. These results have implications for health policy and practice and families. Further research leading to a greater understanding of the associations identified in this review is suggested.
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Affiliation(s)
- Stephen Malden
- Physical activity for Health group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
- Centre for Medical Informatics, the Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jenny Gillespie
- Physical activity for Health group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Adrienne Hughes
- Physical activity for Health group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Ann-Marie Gibson
- Physical activity for Health group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Abdulaziz Farooq
- Aspetar Orthopaedic and Sports Medicine Hospital, Athlete Health and Performance Research, Doha, Qatar
| | - Anne Martin
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - John J. Reilly
- Physical activity for Health group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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18
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Arana Echarri A, Beresford M, Campbell JP, Jones RH, Butler R, Gollob KJ, Brum PC, Thompson D, Turner JE. A Phenomic Perspective on Factors Influencing Breast Cancer Treatment: Integrating Aging and Lifestyle in Blood and Tissue Biomarker Profiling. Front Immunol 2021; 11:616188. [PMID: 33597950 PMCID: PMC7882710 DOI: 10.3389/fimmu.2020.616188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/11/2020] [Indexed: 01/10/2023] Open
Abstract
Breast cancer is the most common malignancy among women worldwide. Over the last four decades, diagnostic and therapeutic procedures have improved substantially, giving patients with localized disease a better chance of cure, and those with more advanced cancer, longer periods of disease control and survival. However, understanding and managing heterogeneity in the clinical response exhibited by patients remains a challenge. For some treatments, biomarkers are available to inform therapeutic options, assess pathological response and predict clinical outcomes. Nevertheless, some measurements are not employed universally and lack sensitivity and specificity, which might be influenced by tissue-specific alterations associated with aging and lifestyle. The first part of this article summarizes available and emerging biomarkers for clinical use, such as measurements that can be made in tumor biopsies or blood samples, including so-called liquid biopsies. The second part of this article outlines underappreciated factors that could influence the interpretation of these clinical measurements and affect treatment outcomes. For example, it has been shown that both adiposity and physical activity can modify the characteristics of tumors and surrounding tissues. In addition, evidence shows that inflammaging and immunosenescence interact with treatment and clinical outcomes and could be considered prognostic and predictive factors independently. In summary, changes to blood and tissues that reflect aging and patient characteristics, including lifestyle, are not commonly considered clinically or in research, either for practical reasons or because the supporting evidence base is developing. Thus, an aim of this article is to encourage an integrative phenomic approach in oncology research and clinical management.
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Affiliation(s)
| | - Mark Beresford
- Department of Oncology and Haematology, Royal United Hospitals Bath NHS Trust, Bath, United Kingdom
| | | | - Robert H. Jones
- Department of Medical Oncology, Velindre Cancer Centre, Cardiff, United Kingdom
- Department of Cancer and Genetics, Cardiff University, Cardiff, United Kingdom
| | - Rachel Butler
- South West Genomics Laboratory Hub, North Bristol NHS Trust, Bristol, United Kingdom
| | - Kenneth J. Gollob
- International Center for Research, A.C.Camargo Cancer Center, São Paulo, Brazil
| | - Patricia C. Brum
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Dylan Thompson
- Department for Health, University of Bath, Bath, United Kingdom
| | - James E. Turner
- Department for Health, University of Bath, Bath, United Kingdom
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Inflammatory Markers and Hepcidin are Elevated but Serum Iron is Lower in Obese Women of Reproductive Age. Nutrients 2021; 13:nu13010217. [PMID: 33466578 PMCID: PMC7828682 DOI: 10.3390/nu13010217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/17/2022] Open
Abstract
Limited evidence suggests that serum iron and hepcidin concentrations are dysregulated in obesity and inflammation. The objective of the present study was to compare C-reactive protein, interleukin-6, circulating levels of hepcidin, serum lipids, and iron status in obese vs. normal-weight women of childbearing age. Healthy women aged 18–30 years were recruited for the study (n = 47: 25 obese and 22 normal weight). Fasting blood samples were obtained to measure serum lipids (total cholesterol, HDL, LDL cholesterol, triglycerides, non-HDL cholesterol), complete blood count, serum iron, total iron-binding capacity, transferrin saturation, serum ferritin, hepcidin, C-reactive protein, and interleukin-6. Obese women had significantly higher mean serum C-reactive protein (p < 0.001), interleukin-6 (p < 0.001), hepcidin (p = 0.024), triglycerides (p < 0.001) and total cholesterol/HDL ratio (p < 0.001) but lower HDL (p = 0.001) and serum iron/hepcidin ratio (p = 0.011) compared with normal-weight women. BMI correlated positively with inflammatory markers, triglycerides, LDL and total cholesterol/HDL ratio, and negatively with HDL and serum iron/hepcidin ratio. Serum iron correlated negatively with ferritin in the obese group (p = 0.030) but positively in normal weight women (p = 0.002). BMI and ferritin were the only predictors of serum iron/hepcidin ratio accounting for 23% of the variation among subjects. Studies are needed to examine anti-inflammatory dietary approaches that can improve iron biomarkers in obese women.
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Purdy JC, Shatzel JJ. The hematologic consequences of obesity. Eur J Haematol 2020; 106:306-319. [PMID: 33270290 DOI: 10.1111/ejh.13560] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022]
Abstract
The prevalence of obesity is increasing and progressively influencing physician-patient interactions. While there is a sizable amount of data demonstrating that obesity is a state of low-grade inflammation, to our knowledge, there is no single review summarizing its effects on hematologic parameters and thrombotic risk. We performed a literature search which largely surfaced observational studies, with a few systematic reviews and meta-analyses of these studies. We took care to review the mechanisms driving an inflammatory state and obesity's effect on white blood cells, red blood cells, platelets, and thrombotic risk. There is an observed relative, and sometimes absolute leukocytosis driven by this inflammatory state. Obesity is also associated with increased platelet counts and an increased risk for venous thromboembolism (VTE). Lastly, the association between obesity, iron deficiency (ID), and red blood cell counts may be present but remains uncertain. Recognizing the above associations may provide clinicians with reassurance regarding otherwise unexplained hematologic abnormalities in obese individuals. We hope this review will prompt future studies to further understand the underlying mechanisms driving these abnormalities and identify modifiable risk factors and potential therapeutic targets to prevent the development of probable obesity-associated conditions with significant morbidity and mortality, such as ID and VTE.
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Affiliation(s)
- Johanna C Purdy
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Joseph J Shatzel
- Division of Hematology and Oncology, Oregon Health & Science University, Portland, OR, USA.,Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
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21
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Tao CY, Chen S, Li XY, Tang CS, Du JB, Jin HF. Body mass index is a promising predictor of response to oral rehydration saline in children with vasovagal syncope. Chin Med J (Engl) 2020; 134:463-468. [PMID: 33617185 PMCID: PMC7909309 DOI: 10.1097/cm9.0000000000001168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Vasovagal syncope (VVS) greatly impairs quality of life. The therapeutic efficacy of oral rehydration saline (ORS) for unselected VVS patients is not satisfactory due to the diverse mechanisms of the disease. Body mass index (BMI) was demonstrated to reflect blood volume to a certain extent. Therefore, the present study explored the capability of BMI to predict the therapeutic response of children with VVS to ORS treatment. METHODS Seventy-four children with VVS who visited the Syncope Unit of Pediatrics at Peking University First Hospital from November 2010 to June 2019 receiving ORS treatment were enrolled for this retrospective case-control study. A comparison of demographic, clinical, and hemodynamic characteristics was performed between responders and non-responders. The correlation between baseline BMI and response time was analyzed. To determine the value of baseline BMI in predicting the therapeutic efficacy of ORS in children with VVS, a receiver operating characteristic curve analysis was performed. RESULTS Fifty-two children were identified as responders, and the remaining 22 children were identified as non-responders. The baseline BMI of the responders was much lower than that of the non-responders (16.4 [15.5, 17.8] kg/m2vs. 20.7 ±e6 kg/m2, P < 0.001), and baseline BMI was positively correlated with response time in the head-up tilt test after adjusting for sex (r = 0.256, 95% confidence interval [CI]: 0.067-0.439, P = 0.029). The area under the receiver operating characteristic curve of baseline BMI was 0.818 (95% CI: 0.704-0.932, P < 0.001), and an optimal cut-off value of 18.9 kg/m2 yielded a sensitivity of 83% and a specificity of 73% to predict the efficacy of ORS in VVS. CONCLUSION Prior to treatment, baseline BMI is a promising predictor of response to ORS in children with VVS.
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Affiliation(s)
- Chun-Yan Tao
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
- Research Unit of Clinical Diagnosis and Treatment of Pediatric Syncope and Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Selena Chen
- Division of Biological Sciences, University of California, San Diego, CA 92093, USA
| | - Xue-Ying Li
- Department of Medical Statistics, Peking University First Hospital, Beijing 100034, China
| | - Chao-Shu Tang
- Department of Physiology and Pathophysiology, Peking University Health Science Center, Beijing 100191, China
| | - Jun-Bao Du
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
- Research Unit of Clinical Diagnosis and Treatment of Pediatric Syncope and Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Hong-Fang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
- Research Unit of Clinical Diagnosis and Treatment of Pediatric Syncope and Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
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Steenackers N, Mutwiri L, Schueren B, Matthys C. Do we need dietary reference values for people with obesity? NUTR BULL 2020. [DOI: 10.1111/nbu.12465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N. Steenackers
- Clinical and Experimental Endocrinology Department of Chronic Diseases and Metabolism KU Leuven Leuven Belgium
| | - L. Mutwiri
- Clinical and Experimental Endocrinology Department of Chronic Diseases and Metabolism KU Leuven Leuven Belgium
- School of Food and Nutrition Sciences Jomo Kenyatta University of Agriculture and Technology Nairobi Kenya
| | - B. Schueren
- Clinical and Experimental Endocrinology Department of Chronic Diseases and Metabolism KU Leuven Leuven Belgium
- Department of Endocrinology University Hospitals Leuven Leuven Belgium
| | - C. Matthys
- Clinical and Experimental Endocrinology Department of Chronic Diseases and Metabolism KU Leuven Leuven Belgium
- Department of Endocrinology University Hospitals Leuven Leuven Belgium
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Adenan DM, Jaafar Z, Jayapalan JJ, Abdul Aziz A. Plasma antioxidants and oxidative stress status in obese women: correlation with cardiopulmonary response. PeerJ 2020; 8:e9230. [PMID: 32477840 PMCID: PMC7243812 DOI: 10.7717/peerj.9230] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/30/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION A high body fat coupled with low cardiopulmonary fitness and an increase in oxidative stress has been connoted as contributing factors in developing cardiovascular comorbidities. This study aimed to investigate the correlation between antioxidants and oxidative stress status with cardiopulmonary responses in women of different body mass index (BMI). SUBJECTS AND METHODS Eighty female adults were recruited and divided into three groups; normal weight (n = 23), overweight (n = 28) and obese (n = 29), according to their BMI. Blood samples were obtained prior to cardiopulmonary exercise testing. Plasma samples were separated by centrifugation and analysed for enzymatic antioxidant activity including catalase, glutathione peroxidase and superoxide dismutase. Non-enzymatic antioxidant activities were assessed using 2, 2'-azino-bis (3-ethylbenzothiazoline-6-sulphonic acid) (ABTS) radical scavenging and ferric reducing ability of plasma (FRAP) assays. To evaluate the oxidative stress status of subjects, levels of reactive oxygen species and malondialdehyde, the by-product of lipid peroxidation, were measured. Cardiopulmonary responses were analysed using cardiopulmonary exercise testing (CPET) which involved 15 various parameters such as peak oxygen consumption, metabolic equivalents and respiratory exchange ratio. RESULTS The obese group had significantly lower ABTS radical scavenging and FRAP activities than the normal weight group. A higher catalase activity was observed in the obese group than the normal weight group. Spearman's correlation showed an inverse relationship between catalase and peak oxygen consumption, while partial correlation analysis showed inverse correlations between superoxide dismutase and respiratory frequency, ABTS activity and oxygen pulse, and between ABTS activity and cardiac output. CONCLUSION Our results demonstrate a lower cardiovascular fitness and antioxidant capacity in obese women; the higher catalase activity may be a compensatory mechanism. The negative correlations found between these two parameters may indicate the potential effect of antioxidants on the cardiopulmonary system and deserve further analysis in a larger population. Nevertheless, this study provides the basis for future studies to further explore the relationships between redox status and cardiopulmonary responses. This can potentially be used to predict future risk of developing diseases associated with oxidative stress, especially pulmonary and cardiovascular diseases.
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Affiliation(s)
- Dyg Mastura Adenan
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zulkarnain Jaafar
- Department of Sports Medicine, University Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia
| | | | - Azlina Abdul Aziz
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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25
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Increased adiposity by feeding growing rats a high-fat diet results in iron decompartmentalisation. Br J Nutr 2019; 123:1094-1108. [PMID: 32172712 DOI: 10.1017/s0007114519002320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The present study reports the effects of a high-fat (HF) diet of over 8 weeks on the Fe status of growing rats. Tissue Fe levels were analysed by atomic absorption spectrophotometry, and whole-body adiposity was measured by dual-energy X-ray absorptiometry. Histopathology and morphometry of adipose tissue were performed. Liver homogenates were used for measuring ferroportin-1 protein levels by immunoblotting, and transcript levels were used for Fe genes measured by real-time PCR. Tissue Fe pools were fit to a compartmental biokinetic model in which Fe was assessed using fourteen compartments and twenty-seven transfer constants (kj,i from tissue 'i' to tissue 'j') adapted from the International Commission on Radiological Protection (ICRP) 69. Ten kj,i were calculated from the experimental data using non-linear regression, and seventeen were estimated by allometry according to the formula ${k_{i,j}} = a \times {M^b}$. Validation of the model was carried out by comparing predicted and analysed Fe pool sizes in erythrocytes, the liver and the spleen. Body adiposity was negatively associated with serum Fe levels and positively associated with liver Fe stores. An inferred increase in Fe transfer from bone marrow to the liver paralleled higher hepatic Fe concentrations and ferritin heavy-chain mRNA levels in the HF diet-fed animals, suggesting that liver Fe accumulation occurred at least in part due to a favoured liver erythrocyte uptake. If this feeding condition was to be prolonged, impaired Fe decompartmentalisation may occur, ultimately resulting in dysmetabolic Fe overload.
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Yen Jean MC, Hsu CC, Hung WC, Lu YC, Wang CP, Tsai IT, Lu IC, Hung YH, Chung FM, Lee YJ, Yu TH. Association between lifestyle and hematological parameters: A study of Chinese male steelworkers. J Clin Lab Anal 2019; 33:e22946. [PMID: 31241225 PMCID: PMC6757129 DOI: 10.1002/jcla.22946] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 05/18/2019] [Indexed: 12/20/2022] Open
Abstract
Background Increasing evidence suggests an association between lifestyle and white blood cell (WBC) count; however, no study has examined the effects of lifestyle associations on hematological parameters. The aim of this study was to examine the association between lifestyle factors and hematological parameters in a large population‐based sample of Chinese male steelworkers. Methods This study included 3189 male workers at a steel plant who responded to a cross‐sectional questionnaire on basic attributes, lifestyle, and sleep. All workers in the plant underwent periodic health checkups. Hematological parameters were also examined at the checkup. Results Stepwise linear regression analyses showed that smoking, poor sleep, shift work, and obesity were all significant factors associated with WBC count. Obesity was independently associated with RBC count. Furthermore, smoking and obesity were associated with hemoglobin, and smoking, poor sleep, and obesity were independently associated with hematocrit. Moreover, smoking was the main factor associated with MCV and MCH. When the subjects were divided into quartiles according to WBC count, RBC count, hemoglobin, hematocrit, MCV, MCH, and increased WBC count were associated with smoking, poor sleep, shift work, and obesity. Increased hemoglobin was associated with smoking and obesity. Furthermore, an increased RBC count was associated with obesity, and increased hematocrit was associated with smoking, poor sleep, and obesity. Similarly, increased MCV and MCH were also associated with smoking. Conclusion This study indicates that lifestyle factors may exert an important effect on hematological parameters (eg, WBC count, RBC count, hemoglobin, hematocrit, MCV, and MCH).
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Affiliation(s)
- Mei-Chu Yen Jean
- Department of Occupational Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chia-Chang Hsu
- Division of Gastroenterology and Hepatology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Wei-Chin Hung
- Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yung-Chuan Lu
- Division of Endocrinologic, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
| | - Chao-Ping Wang
- Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
| | - I-Ting Tsai
- Department of Emergency, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - I-Cheng Lu
- Department of Occupational Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yi-Hsin Hung
- Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Fu-Mei Chung
- Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | | | - Teng-Hung Yu
- Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
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