title: Proinflammatory state, hepcidin, and anemia in older persons.
abstract: In patients with overt inflammatory diseases, up-regulated hepcidin impairs iron absorption and macrophage release, causing anemia. Whether the mild proinflammatory state of aging is associated with increased hepcidin is unknown. We characterized the relationships between urinary hepcidin, iron status, anemia, and inflammation in 582 patients 65 years or older participating in the InCHIANTI (Invecchiare in Chianti, "Aging in the Chianti Area") study, a population-based study of aging in Tuscany, Italy. Compared with nonanemic persons, urinary hepcidin (nanograms/milligram of urinary creatinine) was significantly lower in iron deficiency and inflammation anemia compared with no anemia or other anemia types. Urinary hepcidin was positively correlated with log(ferritin) and negatively correlated with the soluble transferrin receptor/log(ferritin) ratio but not correlated with markers of inflammation: interleukin-6 (IL-6), IL-1beta, tumor necrosis factor-alpha, and C-reactive protein (CRP). Lower iron was significantly correlated with higher IL-6 and CRP. Adjusting for confounders, IL-6 and CRP remained significantly associated with serum iron, with no evidence that such a relationship was accounted for by variability in urinary hepcidin. In conclusion, elevated proinflammatory markers were associated with anemia and low iron status, but not with higher urinary hepcidin. Future studies should test whether hepcidin production becomes up-regulated only in situations of overt inflammation.
authors.affiliation: Intramural Research Program, National Institute on Aging, Baltimore, MD 21225, USA. ferruccilu@grc.nia.nih.gov
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
authors.forename: Richard D
authors.initials: RD
authors.lastname: Semba
authors.forename: Jack M
authors.initials: JM
authors.lastname: Guralnik
authors.forename: William B
authors.initials: WB
authors.lastname: Ershler
authors.forename: Stefania
authors.initials: S
authors.lastname: Bandinelli
authors.forename: Kushang V
authors.initials: KV
authors.lastname: Patel
authors.forename: Kai
authors.initials: K
authors.lastname: Sun
authors.forename: Richard C
authors.initials: RC
authors.lastname: Woodman
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Andrews
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Cotter
authors.forename: Tomas
authors.initials: T
authors.lastname: Ganz
authors.forename: Elizabeta
authors.initials: E
authors.lastname: Nemeth
authors.forename: Dan L
authors.initials: DL
authors.lastname: Longo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D018798:Anemia, Iron-Deficiency / Q000097:blood* / Q000652:urine; D023181:Antimicrobial Cationic Peptides / Q000652:urine*; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D064451:Hepcidins; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000276:immunology* / Q000652:urine; D018836:Inflammation Mediators / Q000097:blood*; D053583:Interleukin-1beta / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007558:Italy; D008297:Male; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D023181:Antimicrobial Cationic Peptides; D015415:Biomarkers; C578702:HAMP protein, human; D064451:Hepcidins; D018836:Inflammation Mediators; D053583:Interleukin-1beta; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein