title: Adiposity in women and children from transition countries predicts decreased iron absorption, iron deficiency and a reduced response to iron fortification.
abstract: BACKGROUND
  Overweight is increasing in transition countries, while iron deficiency remains common. In industrialized countries, greater adiposity increases risk of iron deficiency. Higher hepcidin levels in obesity may reduce dietary iron absorption. Therefore, we investigated the association between body mass index (BMI) and iron absorption, iron status and the response to iron fortification in populations from three transition countries (Thailand, Morocco and India).
  
  
  METHODS
  In Thai women (n=92), we examined the relationship between BMI and iron absorption from a reference meal containing approximately 4 mg of isotopically labeled fortification iron. We analyzed data from baseline (n=1688) and intervention (n=727) studies in children in Morocco and India to look for associations between BMI Z-scores and baseline hemoglobin, serum ferritin and transferrin receptor, whole blood zinc protoporphyrin and body iron stores, and changes in these measures after provision of iron.
  
  
  RESULTS
  In the Thai women, 20% were iron deficient and 22% were overweight. Independent of iron status, a higher BMI Z-score was associated with decreased iron absorption (P=0.030). In the Indian and Moroccan children, 42% were iron deficient and 6.3% were overweight. A higher BMI Z-score predicted poorer iron status at baseline (P<0.001) and less improvement in iron status during the interventions (P<0.001).
  
  
  CONCLUSIONS
  Adiposity in young women predicts lower iron absorption, and pediatric adiposity predicts iron deficiency and a reduced response to iron fortification. These data suggest the current surge in overweight in transition countries may impair efforts to control iron deficiency in these target groups. Interactions of the 'double burden' of malnutrition during the nutrition transition may have adverse consequences.
authors.affiliation: Human Nutrition Laboratory, Swiss Federal Institute of Technology, Zürich, Switzerland. michael.zimmermann@ilw.agrl.ethz.ch
authors.forename: M B
authors.initials: MB
authors.lastname: Zimmermann
authors.forename: C
authors.initials: C
authors.lastname: Zeder
authors.forename: S
authors.initials: S
authors.lastname: Muthayya
authors.forename: P
authors.initials: P
authors.lastname: Winichagoon
authors.forename: N
authors.initials: N
authors.lastname: Chaouki
authors.forename: I
authors.initials: I
authors.lastname: Aeberli
authors.forename: R F
authors.initials: RF
authors.lastname: Hurrell
mesh_terms: D050154:Adiposity; D000293:Adolescent; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000378:metabolism*; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002648:Child; D003906:Developing Countries; D005260:Female; D005293:Ferritins / Q000097:blood; D005527:Food, Fortified; D006306:Health Surveys; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007194:India; D007408:Intestinal Absorption; D007501:Iron / Q000378:metabolism*; D019189:Iron Metabolism Disorders / Q000097:blood; D019266:Iron, Dietary / Q000008:administration & dosage; D007553:Isotope Labeling; D008297:Male; D008875:Middle Aged; D009018:Morocco; D015999:Multivariate Analysis; D011524:Protoporphyrins / Q000032:analysis; D011990:Receptors, Transferrin / Q000097:blood; D013785:Thailand
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D019266:Iron, Dietary; D011524:Protoporphyrins; D011990:Receptors, Transferrin; C017803:zinc protoporphyrin; D005293:Ferritins; D007501:Iron