Iron metabolism in patients with anorexia nervosa: elevated serum hepcidin concentrations in the absence of inflammation.
BACKGROUND
Only a few studies based on small cohorts have been carried out on iron status in anorexia nervosa (AN) patients.


OBJECTIVE
The aim of this study was to evaluate the role of hepcidin in hyperferritinemia in AN adolescents.


METHODS
Twenty-seven adolescents hospitalized for AN in the pediatric inpatient unit of Ambroise Paré Academic Hospital were enrolled in the study. The control group comprised 11 patients. Hematologic variables and markers of iron status, including serum hepcidin, were measured before and after nutritional rehabilitation.


RESULTS
The mean age of patients was 14.4 y. Except for 2 AN patients and 1 control patient, all patients presented normal hemoglobin, vitamin B-12, and folate concentrations. Markers of inflammation and cytokines were normal throughout the study. None of the muscular lysis markers were elevated. Most AN patients had normal serum iron concentrations on admission. Serum ferritin concentrations were significantly higher in patients than in control subjects (198 compared with 49 μg/L, respectively; P < 0.001). The median hepcidin concentration was significantly higher in AN patients than in the control group (186.5 compared with 39.5 μg/L, respectively; P = 0.002). There was a highly significant correlation between ferritinemia and serum hepcidin concentrations (P < 0.0001). After nutritional rehabilitation, a significant reduction was observed (P = 0.004) in serum ferritin. Serum hepcidin analyzed in a smaller number of patients also returned to within the normal range.


CONCLUSIONS
Hepcidin and ferritin concentrations were higher in the serum of AN patients, without any evidence of iron overload or inflammation. These concentrations returned to normal after nutritional rehabilitation. These results suggest that nutritional stress induced by malnourishment in the hepatocyte could be yet another mechanism that regulates hepcidin.
AP-HP, Service de Pédiatrie, Hôpital Bichat, Paris, France.
Solesne
S
Papillard-Marechal
Marc
M
Sznajder
Margarita
M
Hurtado-Nedelec
Yasmin
Y
Alibay
Caroline
C
Martin-Schmitt
Monique
M
Dehoux
Mark
M
Westerman
Carole
C
Beaumont
Bertrand
B
Chevallier
Herve
H
Puy
Chantal
C
Stheneur
D000293:Adolescent; D000856:Anorexia Nervosa / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D023181:Antimicrobial Cationic Peptides / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D016207:Cytokines / Q000097:blood; D005260:Female; D005293:Ferritins / Q000097:blood; D005500:Follow-Up Studies; D064451:Hepcidins; D006760:Hospitalization; D006801:Humans; D007249:Inflammation / Q000378:metabolism / Q000503:physiopathology; D019189:Iron Metabolism Disorders / Q000150:complications / Q000503:physiopathology; D019266:Iron, Dietary / Q000378:metabolism*; D008297:Male
D023181:Antimicrobial Cationic Peptides; D015415:Biomarkers; D016207:Cytokines; C578702:HAMP protein, human; D064451:Hepcidins; D019266:Iron, Dietary; D005293:Ferritins