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McKay AKA, Anderson B, Peeling P, Whitfield J, Tee N, Zeder C, Zimmermann MB, Burke LM, Moretti D. Iron Absorption in Highly Trained Male Runners: Does it Matter When and Where You Eat Your Iron? Med Sci Sports Exerc 2024; 56:118-127. [PMID: 38098150 DOI: 10.1249/mss.0000000000003272] [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: 12/18/2023]
Abstract
PURPOSE We examined iron absorption and its regulation during two common scenarios experienced by endurance athletes. Our aims were to: (i) compare the effects of preexercise versus postexercise iron intake on iron absorption; and (ii) compare the impact of training at altitude (1800 m) on iron absorption preexercise. METHODS Male runners (n = 18) completed three exercise trials over a 5-wk period, each preceded by 24 h of standardized low-iron diets. First, athletes completed two 60-min treadmill running trials at 65% V̇O2max at near sea-level (580 m). In a randomized order, preexercise and postexercise test meals labeled with 4 mg of 57Fe or 58Fe were consumed 30 min before or 30 min after exercise. Then, the same exercise trial was performed after living and training at altitude (~1800 m) for 7 d, with the labeled test meal consumed 30 min preexercise. We collected venous blood samples preexercise and postexercise for markers of iron status and regulation, and 14 d later to measure erythrocyte isotope incorporation. RESULTS No differences in fractional iron absorption were evident when test meals were consumed preexercise (7.3% [4.4, 12.1]) or postexercise (6.2% [3.1, 12.5]) (n = 18; P = 0.058). Iron absorption preexercise was greater at altitude (18.4% [10.6, 32.0]) than at near sea-level (n = 17; P < 0.001) and hepcidin concentrations at altitude were lower at rest and 3 h postexercise compared with near sea level (P < 0.001). CONCLUSIONS In an acute setting, preexercise and postexercise iron absorption is comparable if consumed within 30 min of exercise. Preexercise iron absorption increases 2.6-fold at altitude compared with near sea-level, likely due to the homeostatic response to provide iron for enhanced erythropoiesis and maintain iron stores.
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Affiliation(s)
- Alannah K A McKay
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Vic, AUSTRALIA
| | | | | | - Jamie Whitfield
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Vic, AUSTRALIA
| | - Nicolin Tee
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Vic, AUSTRALIA
| | - Christophe Zeder
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, SWITZERLAND
| | - Michael B Zimmermann
- Medical Research Council Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UNITED KINGDOM
| | - Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Vic, AUSTRALIA
| | - Diego Moretti
- Nutrition Group, Health Department, Swiss Distance University of Applied Sciences (FFHS), Zürich, SWITZERLAND
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Webb KL, Gorman EK, Morkeberg OH, Klassen SA, Regimbal RJ, Wiggins CC, Joyner MJ, Hammer SM, Senefeld JW. The relationship between hemoglobin and [Formula: see text]: A systematic review and meta-analysis. PLoS One 2023; 18:e0292835. [PMID: 37824583 PMCID: PMC10569622 DOI: 10.1371/journal.pone.0292835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE There is widespread agreement about the key role of hemoglobin for oxygen transport. Both observational and interventional studies have examined the relationship between hemoglobin levels and maximal oxygen uptake ([Formula: see text]) in humans. However, there exists considerable variability in the scientific literature regarding the potential relationship between hemoglobin and [Formula: see text]. Thus, we aimed to provide a comprehensive analysis of the diverse literature and examine the relationship between hemoglobin levels (hemoglobin concentration and mass) and [Formula: see text] (absolute and relative [Formula: see text]) among both observational and interventional studies. METHODS A systematic search was performed on December 6th, 2021. The study procedures and reporting of findings followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Article selection and data abstraction were performed in duplicate by two independent reviewers. Primary outcomes were hemoglobin levels and [Formula: see text] values (absolute and relative). For observational studies, meta-regression models were performed to examine the relationship between hemoglobin levels and [Formula: see text] values. For interventional studies, meta-analysis models were performed to determine the change in [Formula: see text] values (standard paired difference) associated with interventions designed to modify hemoglobin levels or [Formula: see text]. Meta-regression models were then performed to determine the relationship between a change in hemoglobin levels and the change in [Formula: see text] values. RESULTS Data from 384 studies (226 observational studies and 158 interventional studies) were examined. For observational data, there was a positive association between absolute [Formula: see text] and hemoglobin levels (hemoglobin concentration, hemoglobin mass, and hematocrit (P<0.001 for all)). Prespecified subgroup analyses demonstrated no apparent sex-related differences among these relationships. For interventional data, there was a positive association between the change of absolute [Formula: see text] (standard paired difference) and the change in hemoglobin levels (hemoglobin concentration (P<0.0001) and hemoglobin mass (P = 0.006)). CONCLUSION These findings suggest that [Formula: see text] values are closely associated with hemoglobin levels among both observational and interventional studies. Although our findings suggest a lack of sex differences in these relationships, there were limited studies incorporating females or stratifying results by biological sex.
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Affiliation(s)
- Kevin L. Webb
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ellen K. Gorman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Olaf H. Morkeberg
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Stephen A. Klassen
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
| | - Riley J. Regimbal
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Chad C. Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Michael J. Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Shane M. Hammer
- Department of Kinesiology, Applied Health, and Recreation, Oklahoma State University, Stillwater, Oklahoma, United States of America
| | - Jonathon W. Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
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3
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Hayashi N, Nagastuka H, Sato M, Goto K. Effect of long-term carnosine/anserine supplementation on iron regulation after a prolonged running session. Phys Act Nutr 2023; 27:70-77. [PMID: 37583074 PMCID: PMC10440176 DOI: 10.20463/pan.2023.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/08/2023] [Accepted: 06/26/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE Exercise-induced hemolysis, which is caused by metabolic and/or mechanical stress during exercise, is considered a potential factor for upregulating hepcidin. Intramuscular carnosine has multiple effects including antioxidant activity. Therefore, this study aimed to determine whether long-term carnosine/anserine supplementation modulates exercise-induced hemolysis and subsequent hepcidin elevation. METHODS Seventeen healthy male participants were allocated to two different groups: participants consuming 1,500 mg/day of carnosine/anserine supplements (n = 9, C+A group) and participants consuming placebo powder supplements (n = 8, PLA group). The participants consumed carnosine/anserine or placebo supplements daily for 30.7 ± 0.4 days. They performed an 80-running session at 70% VO2peak pre-and post-supplementation. Iron regulation and inflammation in response to exercise were evaluated. RESULTS Serum iron concentrations significantly increased after exercise (p < 0.01) and serum haptoglobin concentrations decreased after exercise in both groups (p < 0.01). No significant differences in these variables were observed between pre-and post-supplementation. Serum hepcidin concentration significantly increased 180 min after exercise in both groups (p < 0.01). The integrated area under the curve of hepcidin significantly decreased after supplementation (p = 0.011) but did not vary between the C+A and PLA groups. CONCLUSION Long-term carnosine/anserine supplementation does not affect iron metabolism after a single endurance exercise session.
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Affiliation(s)
- Nanako Hayashi
- Research Organization of Science and Technology, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Haruna Nagastuka
- Faculty of Sports and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Mikako Sato
- NH Foods Ltd. R&D Center, Midorigahara, Tsukuba, Ibaraki, Japan
| | - Kazushige Goto
- Faculty of Sports and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
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Robbins JM, Rao P, Deng S, Keyes MJ, Tahir UA, Katz DH, Beltran PMJ, Marchildon F, Barber JL, Peterson B, Gao Y, Correa A, Wilson JG, Smith JG, Cohen P, Ross R, Bouchard C, Sarzynski MA, Gerszten RE. Plasma proteomic changes in response to exercise training are associated with cardiorespiratory fitness adaptations. JCI Insight 2023; 8:e165867. [PMID: 37036009 PMCID: PMC10132160 DOI: 10.1172/jci.insight.165867] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/21/2023] [Indexed: 04/11/2023] Open
Abstract
Regular exercise leads to widespread salutary effects, and there is increasing recognition that exercise-stimulated circulating proteins can impart health benefits. Despite this, limited data exist regarding the plasma proteomic changes that occur in response to regular exercise. Here, we perform large-scale plasma proteomic profiling in 654 healthy human study participants before and after a supervised, 20-week endurance exercise training intervention. We identify hundreds of circulating proteins that are modulated, many of which are known to be secreted. We highlight proteins involved in angiogenesis, iron homeostasis, and the extracellular matrix, many of which are novel, including training-induced increases in fibroblast activation protein (FAP), a membrane-bound and circulating protein relevant in body-composition homeostasis. We relate protein changes to training-induced maximal oxygen uptake adaptations and validate our top findings in an external exercise cohort. Furthermore, we show that FAP is positively associated with survival in 3 separate, population-based cohorts.
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Affiliation(s)
- Jeremy M. Robbins
- Division of Cardiovascular Medicine
- CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Prashant Rao
- Division of Cardiovascular Medicine
- CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Shuliang Deng
- CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michelle J. Keyes
- CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA
| | - Usman A. Tahir
- Division of Cardiovascular Medicine
- CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Daniel H. Katz
- Division of Cardiovascular Medicine
- CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - François Marchildon
- Laboratory of Molecular Metabolism, The Rockefeller University, New York, New York, USA
| | - Jacob L. Barber
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Bennet Peterson
- CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Yan Gao
- Jackson Heart Study, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Adolfo Correa
- Jackson Heart Study, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - James G. Wilson
- CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Jackson Heart Study, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - J. Gustav Smith
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University and the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine and
- Lund University Diabetes Center, Lund, Sweden
- Department of Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden
| | - Paul Cohen
- Laboratory of Molecular Metabolism, The Rockefeller University, New York, New York, USA
| | - Robert Ross
- School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada
| | - Claude Bouchard
- Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Mark A. Sarzynski
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Robert E. Gerszten
- Division of Cardiovascular Medicine
- CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
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5
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Menstrual cycle affects iron homeostasis and hepcidin following interval running exercise in endurance-trained women. Eur J Appl Physiol 2022; 122:2683-2694. [PMID: 36129579 PMCID: PMC9613712 DOI: 10.1007/s00421-022-05048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 09/10/2022] [Indexed: 11/30/2022]
Abstract
Purpose Menstrual cycle phase affects resting hepcidin levels, but such effects on the hepcidin response to exercise are still unclear. Thus, we investigated the hepcidin response to running during three different menstrual cycle phases. Methods Twenty-one endurance-trained eumenorrheic women performed three identical interval running protocols during the early-follicular phase (EFP), late-follicular phase (LFP), and mid-luteal phase (MLP). The protocol consisted of 8 × 3 min bouts at 85% of the maximal aerobic speed, with 90-s recovery. Blood samples were collected pre-exercise and at 0 h, 3 h and 24 h post-exercise. Results Data presented as mean ± SD. Ferritin were lower in the EFP than the LFP (34.82 ± 16.44 vs 40.90 ± 23.91 ng/ml, p = 0.003), while iron and transferrin saturation were lower during the EFP (58.04 ± 19.70 µg/dl, 14.71 ± 5.47%) compared to the LFP (88.67 ± 36.38 µg/dl, 22.22 ± 9.54%; p < 0.001) and the MLP (80.20 ± 42.05 µg/dl, 19.87 ± 10.37%; p = 0.024 and p = 0.045, respectively). Hepcidin was not affected by menstrual cycle (p = 0.052) or menstrual cycle*time interaction (p = 0.075). However, when comparing hepcidin at 3 h post-exercise, a moderate and meaningful effect size showed that hepcidin was higher in the LFP compared to the EFP (3.01 ± 4.16 vs 1.26 ± 1.25 nMol/l; d = 0.57, CI = 0.07–1.08). No effect of time on hepcidin during the EFP was found either (p = 0.426). Conclusion The decrease in iron, ferritin and TSAT levels during the EFP may mislead the determination of iron status in eumenorrheic athletes. However, although the hepcidin response to exercise appears to be reduced in the EFP, it shows no clear differences between the phases of the menstrual cycle (clinicaltrials.gov: NCT04458662). Supplementary Information The online version contains supplementary material available at 10.1007/s00421-022-05048-5.
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Barney DE, Ippolito JR, Berryman CE, Hennigar SR. A Prolonged Bout of Running Increases Hepcidin and Decreases Dietary Iron Absorption in Trained Female and Male Runners. J Nutr 2022; 152:2039-2047. [PMID: 35661896 DOI: 10.1093/jn/nxac129] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/22/2022] [Accepted: 05/31/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Declines in iron status are frequently reported in those who regularly engage in strenuous physical activity. A possible reason is increases in the iron regulatory hormone hepcidin, which functions to inhibit dietary iron absorption and can be induced by the inflammatory cytokine interleukin-6 (IL-6). OBJECTIVES The current study aimed to determine the impact of a prolonged bout of running on hepcidin and dietary iron absorption in trained female and male runners. METHODS Trained female and male collegiate cross country runners (n = 28, age: 19.7 ± 1.2 y, maximal oxygen uptake: 66.1 ± 6.1 mL $\cdot$ kg -1$\cdot$ min-2, serum ferritin: 21.9 ± 13.3 ng/mL) performed a prolonged run (98.8 ± 14.7 min, 21.2 ± 3.8 km, 4.7 ± 0.3 min/km) during a team practice. Participants consumed a stable iron isotope with a standardized meal 2 h postrun and blood was collected 1 h later. The protocol was repeated 2 wk later except participants abstained from exercise (rest). RBCs were collected 15 d after exercise and rest to determine isotope enrichment. Differences between exercise and rest were assessed by paired t tests and Wilcoxon matched-pairs signed rank tests. Data are means ± SDs. RESULTS Plasma hepcidin increased 51% after exercise (45.8 ± 34.4 ng/mL) compared with rest (30.3 ± 27.2 ng/mL, P = 0.0010). Fractional iron absorption was reduced by 36% after exercise (11.8 ± 14.6 %) compared with rest (18.5 ± 14.4 %, P = 0.025). Plasma IL-6 was greater after exercise (0.660 ± 0.354 pg/mL) than after rest (0.457 ± 0.212 pg/mL, P < 0.0001). Exploratory analyses revealed that the increase in hepcidin with exercise may be driven by a response in males but not females. CONCLUSIONS A prolonged bout of running increases hepcidin and decreases dietary iron absorption compared with rest in trained runners with low iron stores. The current study supports that IL-6 contributes to the increase in hepcidin with prolonged physical activity, although future studies should explore potential sex differences in the hepcidin response.This trial was registered at Clinicaltrials.gov as NCT04079322.
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Affiliation(s)
- David E Barney
- Department of Nutrition & Integrative Physiology, Florida State University, Tallahassee, FL, USA
| | - James R Ippolito
- Department of Nutrition & Integrative Physiology, Florida State University, Tallahassee, FL, USA
| | - Claire E Berryman
- Department of Nutrition & Integrative Physiology, Florida State University, Tallahassee, FL, USA
| | - Stephen R Hennigar
- Department of Nutrition & Integrative Physiology, Florida State University, Tallahassee, FL, USA
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Hayashi N, Ishibashi A, Iwata A, Yatsutani H, Badenhorst C, Goto K. Influence of an energy deficient and low carbohydrate acute dietary manipulation on iron regulation in young females. Physiol Rep 2022; 10:e15351. [PMID: 35785528 PMCID: PMC9251860 DOI: 10.14814/phy2.15351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/10/2022] [Accepted: 05/21/2022] [Indexed: 11/24/2022] Open
Abstract
Hepcidin is a liver‐derived hormone that regulates iron metabolism. Recent studies suggest that an energy‐deficient diet or low carbohydrate (CHO) availability may increase hepcidin in the absence of inflammation. The purpose of the present study was to examine the impact of either an energy‐deficient diet or an ED diet with low CHO intake during three consecutive days on hepcidin responses, hematological variables, and energy metabolism in young Japanese women. Twenty‐two young females were divided into two different groups, either an energy‐deficient with low CHO intake group (ED + LCHO; 2.0 ± 0.3 g/kg/day CHO, 39%CHO, 1123 kcal/day) or an energy deficient with moderate CHO intake group (ED; 3.4 ± 0.3 g/kg/day CHO, 63%CHO, 1162 kcal/day). During the three consecutive days of the dietary intervention program, participants consumed only the prescribed diet and maintained their habitual physical activity levels. Body composition, substrate oxidation, iron metabolism, and inflammation were evaluated pre‐ and post‐intervention. Serum iron and ferritin levels were significantly elevated following the intervention (p < 0.001, p = 0.003, respectively). Plasma interleukin‐6 (IL‐6) levels did not change following the intervention. Serum hepcidin levels significantly increased after the intervention (p = 0.002). Relative change in hepcidin levels was significantly higher in the ED + LCHO (264.3 ± 87.2%) than in the ED group (68.9 ± 22.1%, p = 0.048). Three consecutive days of an energy‐deficient diet increased fasting hepcidin levels. Moreover, elevated hepcidin levels were further augmented when an energy‐deficient diet was combined with a lower CHO intake.
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Affiliation(s)
- Nanako Hayashi
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Aya Ishibashi
- Department of Life Science, The University of Tokyo, Meguro, Tokyo, Japan
| | - Ayame Iwata
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Haruka Yatsutani
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Claire Badenhorst
- School of Sports, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Kazushige Goto
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
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Kahraman C, Turgay F, Yigittürk O, Canüzmez AE, Durmaz B, Aşikovali S. Does the TMPRSS6 C > T Polymorphism Modify the Endurance Training Effects on Hematological Parameters? Biol Trace Elem Res 2022; 200:2588-2596. [PMID: 34398419 DOI: 10.1007/s12011-021-02876-y] [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: 06/17/2021] [Accepted: 08/07/2021] [Indexed: 11/27/2022]
Abstract
This study investigated the role of TMPRSS6 C > T polymorphism (TMPRP) on the effects of chronic aerobic training on main hematological parameters in male soccer referees, which is yet unknown. Two groups composed of total of 45 healthy male soccer referees and 42 sedentary were compared for hemogram, serum hepcidin, ferritin, and iron levels. TMPRP was determined from genomic DNA samples. Participants' physical and physiological (Yoyo endurance level-2 test) measurements were carried out. The athletic T carrier (Tc = TT + TC) group RBC count was significantly higher than the control (p < 0.01), whereas the athletic CC homozygous group serum iron and transferrin saturation (TS) were lower than the control depending on the TMPRP. The ferritin and iron values of the athletic Tc group were higher than of the athletic CC group (29.2% and 14.1%, respectively; p > 0.05) although the control Tc group RBC (p < 0.05) and iron (23.8%, p > 0.05) values were lower than the control CC due to genetic tendency. The training did not change hepcidin levels. These results suggest that the TMPRP can modify the endurance training effects on iron and TS levels and RBC count (in the CC and Tc groups) respectively. The CC group may be adversely affected for iron and TS from endurance trainings. It may be recommended that the training programs should be organized according to phenotype characteristics.
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Affiliation(s)
- Cansu Kahraman
- Department of Sport Health Sciences, Institute of Health Sciences, Ege University, Izmir, Turkey
| | - Faruk Turgay
- Coaching Education Department, Faculty of Sport Sciences, Ege University, Izmir, Turkey
| | - Oya Yigittürk
- Department of Sport Health Sciences, Institute of Health Sciences, Ege University, Izmir, Turkey.
| | - Aykut Eren Canüzmez
- Coaching Education Department, Faculty of Sport Sciences, Ege University, Izmir, Turkey
| | - Burak Durmaz
- Medical Genetics Department, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Semih Aşikovali
- Department of Medical Genetics, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
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9
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Methodological Considerations for Investigating Iron Status and Regulation in Exercise and Sport Science Studies. Int J Sport Nutr Exerc Metab 2022; 32:359-370. [PMID: 35365588 DOI: 10.1123/ijsnem.2021-0343] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/10/2022] [Accepted: 03/01/2022] [Indexed: 11/18/2022]
Abstract
Iron deficiency is a common health issue in active and athlete populations. Accordingly, research into iron status, regulation, absorption, and iron deficiency treatment strategies is increasing at a rapid rate. However, despite the increase in the quantity of research, various methodological issues need to be addressed as we progress our knowledge in this area. The purpose of this review is to highlight specific considerations for conducting iron-related research in active and athlete populations. First, we discuss the methodological importance of assessment and interpretation of iron status, with reference to blood collection protocols, participant screening procedures, and biomarker selection. Next, we consider numerous variables that should be accounted for in the design of iron-related research studies, such as the iron regulatory hormone hepcidin and its interaction with exercise, in addition to an examination of female physiology and its impact on iron metabolism. Subsequently, we explore dietary iron and nutrient interactions that impact iron regulation and absorption, with recommendations made for optimal methodological control. Consideration is then given to key features of long-term study designs, such as the monitoring of training load, oral iron supplementation, dietary analysis, and general lifestyle factors. Finally, we conclude our recommendations with an exploration of stable iron isotope tracers as a methodology to measure iron absorption. Ultimately, it is our intention that this review can be used as a guide to improve study design, biomarker analysis, and reporting of findings, to maximize the quality of future research outputs in iron-related research focused on active and athlete populations.
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10
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Delaney KM, Guillet R, Pressman EK, Ganz T, Nemeth E, O'Brien KO. Serum Erythroferrone During Pregnancy Is Related to Erythropoietin but Does Not Predict the Risk of Anemia. J Nutr 2021; 151:1824-1833. [PMID: 33982118 PMCID: PMC8245876 DOI: 10.1093/jn/nxab093] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/12/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Maintaining adequate iron status during pregnancy is important for the mother and her developing fetus. Iron homeostasis is influenced by 3 regulatory hormones: erythropoietin (EPO), hepcidin, and erythroferrone (ERFE). To date, normative data on ERFE across pregnancy and its relations to other hormones and iron status indicators are limited. OBJECTIVES The objective of this study was to characterize maternal ERFE across pregnancy and at delivery and evaluate the utility of hepcidin, ERFE, and EPO in identifying women with increased iron needs. METHODS ERFE was measured in extant serum samples collected from 2 longitudinal cohorts composed of women carrying multiple fetuses (n = 79) and pregnant adolescents (n = 218) at midgestation (∼26 wk) and delivery (∼39 wk). Receiver operating characteristic curves were generated to characterize the predictive ability of serum ERFE, hepcidin, and EPO and their ratios to identify women at increased risk of iron deficiency and anemia. RESULTS In these pregnant women, mean ERFE was 0.48 ng/mL at both ∼25 wk of gestation and at delivery. ERFE was positively associated with EPO at midgestation (β = 0.14, P = 0.002, n = 202) and delivery (β = 0.12, P < 0.001, n = 225) but was not significantly associated with maternal hepcidin at any time point surveyed. Of all hormones measured at midgestation and delivery, EPO was best able to identify women with anemia (AUC: 0.86 and 0.75, respectively) and depleted iron stores (AUC: 0.77 and 0.84), whereas the hepcidin-to-EPO ratio was best able to identify women with iron deficiency anemia (AUC: 0.85 and 0.84). CONCLUSIONS Maternal ERFE was significantly associated with EPO but was not able to identify women with gestational iron deficiency. At term, the hepcidin-to-EPO ratio, an index that accounts for both iron status and erythropoietic demand, and EPO were the strongest indicators of maternal iron deficiency and anemia. This trial was registered at clinicaltrials.gov as NCT04517734 (https://clinicaltrials.gov/ct2/show/NCT04517734).
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Affiliation(s)
| | - Ronnie Guillet
- Department of Pediatrics, Division of Neonatology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Eva K Pressman
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Tomas Ganz
- Center for Iron Disorders, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Elizabeta Nemeth
- Center for Iron Disorders, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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11
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Culliton K, Louati H, Laneuville O, Ramsay T, Trudel G. Six degrees head-down tilt bed rest caused low-grade hemolysis: a prospective randomized clinical trial. NPJ Microgravity 2021; 7:4. [PMID: 33589644 PMCID: PMC7884785 DOI: 10.1038/s41526-021-00132-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 01/13/2021] [Indexed: 01/31/2023] Open
Abstract
This study aimed to measure hemolysis before, during and after 60 days of the ground-based spaceflight analog bed rest and the effect of a nutritional intervention through a prospective randomized clinical trial. Twenty male participants were hospitalized for 88 days comprised of 14 days of ambulatory baseline, 60 days of 6° head-down tilt bed rest and 14 days of reambulation. Ten participants each received a control diet or daily polyphenol associated with omega-3, vitamin E, and selenium supplements. The primary outcome was endogenous carbon monoxide (CO) elimination measured by gas chromatography. Hemolysis was also measured with serial bilirubin, iron, transferrin saturation blood levels and serial 3-day stool collections were used to measure urobilinoid excretion using photometry. Total hemoglobin mass (tHb) was measured using CO-rebreathing. CO elimination increased after 5, 11, 30, and 57 days of bed rest: +289 ppb (95% CI 101-477 ppb; p = 0.004), +253 ppb (78-427 ppb; p = 0.007), +193 ppb (89-298 ppb; p = 0.001) and +858 ppb (670-1046 ppb; p < 0.000), respectively, compared to baseline. Bilirubin increased after 20 and 49 days of bed rest +0.8 mg/l (p = 0.013) and +1.1 mg/l (p = 0.012), respectively; and iron increased after 20 days of bed rest +10.5 µg/dl (p = 0.032). The nutritional intervention did not change CO elimination. THb was lower after 60 days of bed rest -0.9 g/kg (p = 0.001). Bed rest enhanced hemolysis as measured through all three by-products of heme oxygenase. Ongoing enhanced hemolysis over 60 days contributed to a 10% decrease in tHb mass. Modulation of red blood cell control towards increased hemolysis may be an important mechanism causing anemia in astronauts.
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Affiliation(s)
- Kathryn Culliton
- grid.412687.e0000 0000 9606 5108Department of Medicine, Division of Physical Medicine and Rehabilitation, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Hakim Louati
- grid.412687.e0000 0000 9606 5108Department of Medicine, Division of Physical Medicine and Rehabilitation, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Odette Laneuville
- grid.28046.380000 0001 2182 2255Department of Biology, Faculty of Science, University of Ottawa, Ottawa, ON Canada
| | - Tim Ramsay
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
| | - Guy Trudel
- grid.412687.e0000 0000 9606 5108Department of Medicine, Division of Physical Medicine and Rehabilitation, Ottawa Hospital Research Institute, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON Canada
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12
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Ryan BJ, Foug KL, Gioscia-Ryan RA, Varshney P, Ludzki AC, Ahn C, Schleh MW, Gillen JB, Chenevert TL, Horowitz JF. Exercise training decreases whole-body and tissue iron storage in adults with obesity. Exp Physiol 2021; 106:820-827. [PMID: 33559926 DOI: 10.1113/ep089272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/29/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Does exercise training modify tissue iron storage in adults with obesity? What is the main finding and its importance? Twelve weeks of moderate-intensity exercise or high-intensity interval training lowered whole-body iron stores, decreased the abundance of the key iron storage protein in skeletal muscle (ferritin) and tended to lower hepatic iron content. These findings show that exercise training can reduce tissue iron storage in adults with obesity and might have important implications for obese individuals with dysregulated iron homeostasis. ABSTRACT The regulation of iron storage is crucial to human health, because both excess and deficient iron storage have adverse consequences. Recent studies suggest altered iron storage in adults with obesity, with increased iron accumulation in their liver and skeletal muscle. Exercise training increases iron use for processes such as red blood cell production and can lower whole-body iron stores in humans. However, the effects of exercise training on liver and muscle iron stores in adults with obesity have not been assessed. The aim of this study was to determine the effects of 12 weeks of exercise training on whole-body iron stores, liver iron content and the abundance of ferritin (the key iron storage protein) in skeletal muscle in adults with obesity. Twenty-two inactive adults (11 women and 11 men; age, 31 ± 6 years; body mass index, 33 ± 3 kg/m2 ) completed 12 weeks (four sessions/week) of either moderate-intensity continuous training (MICT; 45 min at 70% of maximal heart rate; n = 11) or high-intensity interval training (HIIT; 10 × 1 min at 90% of maximal heart rate, interspersed with 1 min active recovery; n = 11). Whole-body iron stores were lower after training, as indicated by decreased plasma concentrations of ferritin (P = 3 × 10-5 ) and hepcidin (P = 0.02), without any change in C-reactive protein. Hepatic R2*, an index of liver iron content, was 6% lower after training (P = 0.06). Training reduced the skeletal muscle abundance of ferritin by 10% (P = 0.03), suggesting lower muscle iron storage. Interestingly, these adaptations were similar in MICT and HIIT groups. Our findings indicate that exercise training decreased iron storage in adults with obesity, which might have important implications for obese individuals with dysregulated iron homeostasis.
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Affiliation(s)
- Benjamin J Ryan
- Substrate Metabolism Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Katherine L Foug
- Substrate Metabolism Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rachel A Gioscia-Ryan
- Substrate Metabolism Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Pallavi Varshney
- Substrate Metabolism Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Alison C Ludzki
- Substrate Metabolism Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Cheehoon Ahn
- Substrate Metabolism Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael W Schleh
- Substrate Metabolism Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jenna B Gillen
- Substrate Metabolism Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Thomas L Chenevert
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeffrey F Horowitz
- Substrate Metabolism Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
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13
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Brittenham GM. Short-term periods of strenuous physical activity lower iron absorption. Am J Clin Nutr 2021; 113:261-262. [PMID: 33437998 PMCID: PMC7851816 DOI: 10.1093/ajcn/nqaa365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Gary M Brittenham
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplant, Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, NY, USA
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14
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Hennigar SR, McClung JP, Hatch-McChesney A, Allen JT, Wilson MA, Carrigan CT, Murphy NE, Teien HK, Martini S, Gwin JA, Karl JP, Margolis LM, Pasiakos SM. Energy deficit increases hepcidin and exacerbates declines in dietary iron absorption following strenuous physical activity: a randomized-controlled cross-over trial. Am J Clin Nutr 2021; 113:359-369. [PMID: 33184627 DOI: 10.1093/ajcn/nqaa289] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/22/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Strenuous physical activity promotes inflammation and depletes muscle glycogen, which may increase the iron regulatory hormone hepcidin. Hepcidin reduces dietary iron absorption and may contribute to declines in iron status frequently observed following strenuous physical activity. OBJECTIVES To determine the effects of strenuous physical activity on hepcidin and dietary iron absorption and whether energy deficit compared with energy balance modifies those effects. METHODS This was a randomized, cross-over, controlled-feeding trial in healthy male subjects (n = 10, mean ± SD age: 22.4 ± 5.4 y, weight: 87.3 ± 10.9 kg) with sufficient iron status (serum ferritin 77.0 ± 36.7 ng/mL). Rest measurements were collected before participants began a 72-h simulated sustained military operation (SUSOPS), designed to elicit high energy expenditure, glycogen depletion, and inflammation, followed by a 7-d recovery period. Two 72-h SUSOPS trials were performed where participants were randomly assigned to consume either energy matched (±10%) to their individual estimated total daily energy expenditure (BAL) or energy at 45% of total daily energy expenditure to induce energy deficit (DEF). On the rest day and at the completion of BAL and DEF, participants consumed a beverage containing 3.8 mg of a stable iron isotope, and plasma isotope appearance was measured over 6 h. RESULTS Muscle glycogen declined during DEF and was preserved during BAL (-188 ± 179 mmol/kg, P-adjusted < 0.01). Despite similar increases in interleukin-6, plasma hepcidin increased during DEF but not BAL, such that hepcidin was 108% greater during DEF compared with BAL (7.8 ± 12.2 ng/mL, P-adjusted < 0.0001). Peak plasma isotope appearance at 120 min was 74% lower with DEF (59 ± 38% change from 0 min) and 49% lower with BAL (117 ± 81%) compared with rest (230 ± 97%, P-adjusted < 0.01 for all comparisons). CONCLUSIONS Strenuous physical activity decreases dietary iron absorption compared with rest. Energy deficit exacerbates both the hepcidin response to physical activity and declines in dietary iron absorption compared with energy balance. This trial was registered at clinicaltrials.gov as NCT03524690.
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Affiliation(s)
- Stephen R Hennigar
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL, USA.,Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA.,Oak Ridge Institute of Science and Technology, Belcamp, MD, USA
| | - James P McClung
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Adrienne Hatch-McChesney
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Jillian T Allen
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA.,Oak Ridge Institute of Science and Technology, Belcamp, MD, USA
| | - Marques A Wilson
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Christopher T Carrigan
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Nancy E Murphy
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Hilde K Teien
- Norwegian Defense Research Establishment, Kjeller, Norway
| | - Svein Martini
- Norwegian Defense Research Establishment, Kjeller, Norway
| | - Jess A Gwin
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA.,Oak Ridge Institute of Science and Technology, Belcamp, MD, USA
| | - J Philip Karl
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Lee M Margolis
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Stefan M Pasiakos
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
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15
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Robach P, Gammella E, Recalcati S, Girelli D, Castagna A, Roustit M, Lundby C, Lundby AK, Bouzat P, Vergès S, Séchaud G, Banco P, Uhr M, Cornu C, Sallet P, Cairo G. Induction of erythroferrone in healthy humans by micro-dose recombinant erythropoietin or high-altitude exposure. Haematologica 2021; 106:384-390. [PMID: 31919080 PMCID: PMC7849588 DOI: 10.3324/haematol.2019.233874] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/02/2020] [Indexed: 01/22/2023] Open
Abstract
The erythropoietin (Epo)-erythroferrone (ERFE)-hepcidin axis coordinates erythropoiesis and iron homeostasis. While mouse studies have established that Epo-induced ERFE production represses hepcidin synthesis by inhibiting hepatic BMP/SMAD signaling, evidence for the role of ERFE in humans is limited. To investigate the role of ERFE as a physiological erythroid regulator in humans, we conducted two studies. First, 24 males were given six injections of saline (placebo), recombinant Epo (rhEpo) at a dose of 20 IU/kg (micro-dose) or rhEpo at 50 IU/kg (low dose). Second, we quantified ERFE in 22 subjects exposed to high altitude (3800 m) for 15 h. In the first study, total hemoglobin mass (Hbmass) increased after low- but not after micro-dose injections, when compared to the mass after placebo injections. Serum ERFE levels were enhanced by rhEpo, remaining higher than after placebo for 48 h (micro-dose) or 72 h (low-dose) after injections. Conversely, hepcidin levels decreased when Epo and ERFE rose, before any changes in serum iron parameters occurred. In the second study, serum Epo and ERFE increased at high altitude. The present results demonstrate that in healthy humans ERFE responds to slightly increased Epo levels not associated with Hbmass expansion and downregulates hepcidin in an apparently iron-independent way. Notably, ERFE flags micro-dose Epo, thus holding promise as a novel biomarker of doping.
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Affiliation(s)
- Paul Robach
- National School for Mountains Sports, Chamonix, France
| | - Elena Gammella
- Dept Biomedical Sciences for Health, University of Milan, Italy
| | | | | | | | | | - Carsten Lundby
- Center for Physical Activity Research, University Hospital, Copenhagen, Denmark
| | | | - Pierre Bouzat
- Grenoble Alpes University Hospital, Grenoble, France
| | - Samuel Vergès
- HP2 Laboratory, U1042, Grenoble Alpes University, INSERM, Grenoble, France
| | | | | | - Mario Uhr
- Dept. Hematology Synlab-Suisse, Lugano, Switzerland
| | - Catherine Cornu
- Hospices Civils de Lyon INSERM CIC1407/UMR5558, Hôpital Louis Pradel, Bron, France
| | | | - Gaetano Cairo
- Dept Biomedical Sciences for Health, University of Milan, Italy
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16
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Association of Serum Hepcidin Levels with Aerobic and Resistance Exercise: A Systematic Review. Nutrients 2021; 13:nu13020393. [PMID: 33513924 PMCID: PMC7911648 DOI: 10.3390/nu13020393] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Prevalence of iron deficiency is commonly reported among athletic population groups. It impairs physical performance due to insufficient oxygen delivery to target organs and low energy production. This is due to the high demand of exercise on oxygen delivery for systemic metabolism by the erythrocytes in the blood. Hepcidin, the key regulator of iron homeostasis, decreases to facilitate iron efflux into the circulation during enhanced erythropoiesis. However, acute anaemia of exercise is caused by increased hepcidin expression that is induced by stress and inflammatory signal. The study aimed to systematically review changes in serum hepcidin levels during resistance and aerobic exercise programmes. Methods: A systemic literature search from 2010 to April 2020 across seven databases comprised of Cochrane library, PubMed, Web of Science, Scopus, Embase, MEDLINE, and OpenGrey. The primary outcome was increased or decreased serum hepcidin from baseline after the exercise activity. Risks of bias were evaluated by using the National Institutes of Health (NIH) for quality assessment of before and after different exercise programmes. Results: Overall, twenty-three studies met the inclusion criteria. Out of the 23 studies, 16 studies reported significantly exercise-induced serum hepcidin elevation. Of the 17 studies that evaluated serum interleukin (IL)-6 levels, 14 studies showed significant exercise-induced serum IL-6 elevation. Changes in exercise-induced serum hepcidin and IL-6 levels were similar in both resistance and endurance exercise. Significant correlations were observed between post-exercise hepcidin and baseline ferritin levels (r = 0.69, p < 0.05) and between post-exercise hepcidin and post-exercise IL-6 (r = 0.625, p < 0.05). Conclusion: Resistance and endurance training showed significant increase in serum hepcidin and IL-6 levels in response to exercise. Baseline ferritin and post-exercise IL-6 elevation are key determining factors in the augmentation of hepcidin response to exercise.
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17
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Pasricha SR, Tye-Din J, Muckenthaler MU, Swinkels DW. Iron deficiency. Lancet 2021; 397:233-248. [PMID: 33285139 DOI: 10.1016/s0140-6736(20)32594-0] [Citation(s) in RCA: 333] [Impact Index Per Article: 111.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 02/06/2023]
Abstract
Iron deficiency is one of the leading contributors to the global burden of disease, and particularly affects children, premenopausal women, and people in low-income and middle-income countries. Anaemia is one of many consequences of iron deficiency, and clinical and functional impairments can occur in the absence of anaemia. Iron deprivation from erythroblasts and other tissues occurs when total body stores of iron are low or when inflammation causes withholding of iron from the plasma, particularly through the action of hepcidin, the main regulator of systemic iron homoeostasis. Oral iron therapy is the first line of treatment in most cases. Hepcidin upregulation by oral iron supplementation limits the absorption efficiency of high-dose oral iron supplementation, and of oral iron during inflammation. Modern parenteral iron formulations have substantially altered iron treatment and enable rapid, safe total-dose iron replacement. An underlying cause should be sought in all patients presenting with iron deficiency: screening for coeliac disease should be considered routinely, and endoscopic investigation to exclude bleeding gastrointestinal lesions is warranted in men and postmenopausal women presenting with iron deficiency anaemia. Iron supplementation programmes in low-income countries comprise part of the solution to meeting WHO Global Nutrition Targets.
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Affiliation(s)
- Sant-Rayn Pasricha
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Diagnostic Haematology, The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.
| | - Jason Tye-Din
- Immunology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Martina U Muckenthaler
- Department of Pediatric Oncology, Hematology, and Immunology and Molecular Medicine Partnership Unit, University of Heidelberg, Heidelberg, Germany; Molecular Medicine Partnership Unit, European Molecular Biology Laboratory, Heidelberg, Germany; Translational Lung Research Center, German Center for Lung Research, Heidelberg, Germany; German Centre for Cardiovascular Research, Partner Site Heidelberg, Mannheim, Germany
| | - Dorine W Swinkels
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
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18
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Alfaro-Magallanes VM, Benito PJ, Rael B, Barba-Moreno L, Romero-Parra N, Cupeiro R, Swinkels DW, Laarakkers CM, Peinado AB. Menopause Delays the Typical Recovery of Pre-Exercise Hepcidin Levels after High-Intensity Interval Running Exercise in Endurance-Trained Women. Nutrients 2020; 12:nu12123866. [PMID: 33348847 PMCID: PMC7766833 DOI: 10.3390/nu12123866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022] Open
Abstract
Menopause commonly presents the gradual accumulation of iron in the body over the years, which is a risk factor for diseases such as cancer, osteoporosis, or cardiovascular diseases. Running exercise is known to acutely increase hepcidin levels, which reduces iron absorption and recycling. As this fact has not been studied in postmenopausal women, this study investigated the hepcidin response to running exercise in this population. Thirteen endurance-trained postmenopausal women (age: 51.5 ± 3.89 years; height: 161.8 ± 4.9 cm; body mass: 55.9 ± 3.6 kg; body fat: 24.7 ± 4.2%; peak oxygen consumption: 42.4 ± 4.0 mL·min-1·kg-1) performed a high-intensity interval running protocol, which consisted of 8 × 3 min bouts at 85% of the maximal aerobic speed with 90-second recovery. Blood samples were collected pre-exercise, 0, 3, and 24 hours post-exercise. As expected, hepcidin exhibited higher values at 3 hours post-exercise (3.69 ± 3.38 nmol/L), but also at 24 hours post-exercise (3.25 ± 3.61 nmol/L), in comparison with pre-exercise (1.77 ± 1.74 nmol/L; p = 0.023 and p = 0.020, respectively) and 0 hour post-exercise (2.05 ± 2.00 nmol/L; p = 0.021 and p = 0.032, respectively) concentrations. These differences were preceded by a significant increment of interleukin-6 at 0 hour post-exercise (3.41 ± 1.60 pg/mL) compared to pre-exercise (1.65 ± 0.48 pg/m, p = 0.003), 3 hours (1.50 ± 0.00 pg/mL, p = 0.002) and 24 hours post-exercise (1.52 ± 0.07 pg/mL, p = 0.001). Hepcidin peaked at 3 hours post-exercise as the literature described for premenopausal women but does not seem to be fully recovered to pre-exercise levels within 24 hours post-exercise, as it would be expected. This suggests a slower recovery of basal hepcidin levels in postmenopausal women, suggesting interesting applications in order to modify iron homeostasis as appropriate, such as the prevention of iron accumulation or proper timing of iron supplementation.
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Affiliation(s)
- Víctor M. Alfaro-Magallanes
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain; (V.M.A.-M.); (B.R.); (L.B.-M.); (N.R.-P.); (R.C.); (A.B.P.)
| | - Pedro J. Benito
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain; (V.M.A.-M.); (B.R.); (L.B.-M.); (N.R.-P.); (R.C.); (A.B.P.)
- Correspondence: ; Tel.: +34-910-677-866
| | - Beatriz Rael
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain; (V.M.A.-M.); (B.R.); (L.B.-M.); (N.R.-P.); (R.C.); (A.B.P.)
| | - Laura Barba-Moreno
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain; (V.M.A.-M.); (B.R.); (L.B.-M.); (N.R.-P.); (R.C.); (A.B.P.)
| | - Nuria Romero-Parra
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain; (V.M.A.-M.); (B.R.); (L.B.-M.); (N.R.-P.); (R.C.); (A.B.P.)
| | - Rocío Cupeiro
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain; (V.M.A.-M.); (B.R.); (L.B.-M.); (N.R.-P.); (R.C.); (A.B.P.)
| | - Dorine W. Swinkels
- Translational Metabolic Laboratory (TML 830), Medical Center, Department of Laboratory Medicine, Radboud University, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; (D.W.S.); (C.M.L.)
- Hepcidinanalysis.com, Geert Grooteplein 10 (830), 6525 GA Nijmegen, The Netherlands
| | - Coby M. Laarakkers
- Translational Metabolic Laboratory (TML 830), Medical Center, Department of Laboratory Medicine, Radboud University, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; (D.W.S.); (C.M.L.)
- Hepcidinanalysis.com, Geert Grooteplein 10 (830), 6525 GA Nijmegen, The Netherlands
| | - Ana B. Peinado
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain; (V.M.A.-M.); (B.R.); (L.B.-M.); (N.R.-P.); (R.C.); (A.B.P.)
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19
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Zügel M, Treff G, Steinacker JM, Mayer B, Winkert K, Schumann U. Increased Hepcidin Levels During a Period of High Training Load Do Not Alter Iron Status in Male Elite Junior Rowers. Front Physiol 2020; 10:1577. [PMID: 32038278 PMCID: PMC6985289 DOI: 10.3389/fphys.2019.01577] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 12/16/2019] [Indexed: 12/21/2022] Open
Abstract
The liver-derived hormone hepcidin plays a key role in iron metabolism by mediating the degradation of the iron export protein ferroportin 1 (FPN1). Circulating levels of hepcidin and the iron storage protein ferritin are elevated during the recovery period after acute endurance exercise, which can be interpreted as an acute phase reaction to intense exercise with far-reaching consequences for iron metabolism and homeostasis. Since absolute and functional iron deficiency (ID) potentially lead to a loss of performance and well-being, it is surprising that the cumulative effects of training stress on hepcidin levels and its interplay with cellular iron availability are not well described. Therefore, the aim of this study was to determine serum levels of hepcidin at six time points during a 4-week training camp of junior world elite rowers preparing for the world championships and to relate the alterations in training load to overall iron status determined by serum ferritin, transferrin, iron, and soluble transferrin receptor (sTfR). Serum hepcidin levels increased significantly (p = 0.02) during the initial increase in training load (23.24 ± 2.43 ng/ml) at day 7 compared to the start of training camp (11.47 ± 3.92 ng/ml) and turned back on day 13 (09.51 ± 3.59 ng/ml) already, meeting well the entrance level of hepcidin at day 0. Serum ferritin was significantly higher at day 7 compared to all other timepoints with exception of the subsequent time point at day 13 reflecting well the time course pattern of hepcidin. Non-significant changes between training phases were found for serum iron, transferrin, and sTfR levels as well as for transferrin saturation, and ferritin-index (sTfR/log ferritin). Our findings indicate that hepcidin as well as ferritin, both representing acute phase proteins, are sensitive to initial increases in training load. Erythropoiesis was unaffected by iron compartmentalization through hepcidin. We conclude that hepcidin is sensitive to rigorous changes in training load in junior world elite rowers without causing short-term alterations in functional iron homeostasis.
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Affiliation(s)
- Martina Zügel
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, Ulm University, Ulm, Germany
| | - Gunnar Treff
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, Ulm University, Ulm, Germany
| | - Jürgen M Steinacker
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, Ulm University, Ulm, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kay Winkert
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, Ulm University, Ulm, Germany
| | - Uwe Schumann
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, Ulm University, Ulm, Germany
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The diagnostic potential of the iron-regulatory hormone hepcidin. Hemasphere 2019; 3:HemaSphere-2019-0026. [PMID: 35309797 PMCID: PMC8925696 DOI: 10.1097/hs9.0000000000000236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 01/12/2023] Open
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MCCORMICK RACHEL, MORETTI DIEGO, MCKAY ALANNAHKA, LAARAKKERS COBYM, VANSWELM RACHEL, TRINDER DEBBIE, COX GREGORYR, ZIMMERMAN MICHAELB, SIM MARC, GOODMAN CARMEL, DAWSON BRIAN, PEELING PETER. The Impact of Morning versus Afternoon Exercise on Iron Absorption in Athletes. Med Sci Sports Exerc 2019; 51:2147-2155. [DOI: 10.1249/mss.0000000000002026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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