title: The effects of fat loss after bariatric surgery on inflammation, serum hepcidin, and iron absorption: a prospective 6-mo iron stable isotope study.
abstract: Iron deficiency is common in obese subjects. This may be due to an increase in serum hepcidin and a decrease in iron absorption from adiposity-related inflammation.
  
  
  
  We evaluated whether weight and fat loss in obese subjects would decrease inflammation and serum hepcidin and thereby improve iron absorption.
  
  
  
  We performed a 6-mo prospective study in obese [body mass index (in kg/m2) ≥35 and <45] adults who had recently undergone laparoscopic sleeve gastrectomy. At 2 and 8 mo postsurgery, subjects consumed a test drink with 6 mg57Fe as ferrous sulfate and were intravenously infused with 100 μg58Fe as iron citrate. We then compared erythrocyte incorporation of iron isotopic labels, changes in body composition, iron status, hepcidin, and inflammation at each time point.
  
  
  
  Forty-three subjects were studied at baseline, and 38 completed the protocol (32 women and 6 men). After 6 mo, total body fat, interleukin IL-6, and hepcidin were significantly lower (all P < 0.005). In iron-deficient subjects (n = 17), geometric mean (95% CI) iron absorption increased by 28% [from 9.7% (6.5%, 14.6%) to 12.4% (7.7%, 20.1%); P = 0.03], whereas in iron-sufficient subjects (n = 21), absorption did not change [5.9% (4.0%, 8.6%) and 5.6% (3.9%, 8.2%); P = 0.81].
  
  
  
  Adiposity-related inflammation is associated with a reduction in the normal upregulation of iron absorption in iron-deficient obese subjects, and this adverse effect may be ameliorated by fat loss. This protocol was approved by the ethics committees of Wageningen University, ETH Zurich, the University of Monterrey, and the Federal Commission for the Protection against Sanitary Risks, and registered at clinicaltrials.gov as NCT01347905.
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, Netherlands; Health Sciences Division, University of Monterrey, Monterrey, Mexico; ana.cepeda@udem.edu.
authors.forename: Ana C
authors.identifier: 0000-0002-3935-3917
authors.initials: AC
authors.lastname: Cepeda-Lopez
authors.affiliation: Health Sciences Division, University of Monterrey, Monterrey, Mexico.
authors.forename: Javier
authors.initials: J
authors.lastname: Allende-Labastida
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, Netherlands.
authors.forename: Alida
authors.identifier: 0000-0001-8406-7592
authors.initials: A
authors.lastname: Melse-Boonstra
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, Netherlands; Micronutrient Initiative, Ottawa, Canada.
authors.forename: Saskia Jm
authors.initials: SJ
authors.lastname: Osendarp
authors.affiliation: ETH Zurich, Zurich, Switzerland; and.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Herter-Aeberli
authors.affiliation: ETH Zurich, Zurich, Switzerland; and.
authors.forename: Diego
authors.initials: D
authors.lastname: Moretti
authors.affiliation: Health Sciences Division, University of Monterrey, Monterrey, Mexico.
authors.forename: Ramiro
authors.initials: R
authors.lastname: Rodriguez-Lastra
authors.affiliation: Health Sciences Division, University of Monterrey, Monterrey, Mexico.
authors.forename: Francisco
authors.identifier: 0000-0003-2832-4771
authors.initials: F
authors.lastname: Gonzalez-Salazar
authors.affiliation: Division of Nutrition and Health, National Institute of Public Health of Mexico, Cuernavaca, Mexico.
authors.forename: Salvador
authors.initials: S
authors.lastname: Villalpando
authors.affiliation: ETH Zurich, Zurich, Switzerland; and.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Zimmermann
mesh_terms: D000273:Adipose Tissue / Q000378:metabolism*; D050154:Adiposity; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D050110:Bariatric Surgery; D001823:Body Composition; D015992:Body Mass Index; D004912:Erythrocytes / Q000378:metabolism; D005260:Female; D005296:Ferrous Compounds / Q000378:metabolism; D064451:Hepcidins / Q000097:blood*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D015850:Interleukin-6 / Q000097:blood; D007408:Intestinal Absorption; D007501:Iron / Q000097:blood; D000090463:Iron Deficiencies; D007503:Iron Isotopes / Q000097:blood; D008297:Male; D009752:Nutritional Status; D009765:Obesity / Q000097:blood / Q000150:complications / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D012016:Reference Values; D015431:Weight Loss / Q000502:physiology*
chemical_list: D005296:Ferrous Compounds; D064451:Hepcidins; D015850:Interleukin-6; D007503:Iron Isotopes; C020748:ferrous sulfate; D007501:Iron
keywords: hepcidin; inflammation; iron absorption; iron deficiency; obesity; stable isotopes