1. Iron Deficiency in Patients With Nonalcoholic Fatty Liver Disease Is Associated With Obesity, Female Gender, and Low Serum Hepcidin
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Kathryn J. Fowler, Nicholas Raviele, Linda D. Ferrell, Maximillian Lee, Debra King, Melissa Paiz, Puneet Puri, Michael Fuchs, Michael S. Middleton, Tarek Hassanein, Edward Doo, Danielle Brandman, Katie Gelinas, Kim M. Cecil, Ryan M. Gill, Katie Amsden, Sherry Boyett, Archana Bhatt, Melissa Young, Mangesh R. Pagadala, Carol Sargeant, Jean P. Molleston, Mark Fishbein, Averell H. Sherker, Deana Rich, Muhammad Y. Sheikh, Kumar Sandrasegaran, Jaividhya Dasarathy, Sarah E. Barlow, Cheryl Shaw, Laura R. Carucci, Randolph K. Otto, Kimberly Pfeifer, James Tonascia, Ann O. Scheimann, Kimberlee Bernstein, Karen F. Murray, Laura A. Wilson, Amy Jones, Carol Hawkins, Evelyn K. Hsu, Laura Miriel, Miriam B. Vos, Joan Siegner, Gerald Behr, Brandon Ang, Stavra A. Xanthakos, Adina Alazraki, Elizabeth M. Brunt, Michael Torbenson, Cynthia Behling, Alexander Ko, Daniel J. Podberesky, Milana Isaacson, Peter F. Whitington, Elizabeth Kirwan, Girish Subbarao, Emily R. Perito, Saeed Mohammad, Ryan Himes, Pat Osmack, Jolene Schlosser, Patrika Tsai, Kenneth A. Kraft, Patricia Ugalde-Nicalo, Ronen Arnon, Melissa J. Contos, Bimalijit Sandhu, Mariel Boyd, Cynthia D. Guy, ünalp-Arida Aynur ünalp-Arida, Elena Reynoso, Pradeep R. Atla, Ajay Jain, Oscar W. Cummings, Shetal N. Shah, Shannon Cooney, Rajesh Krisnamurthy, Srinivasan Dasarathy, Sonia Garcia, Matthew M. Yeh, Rohit Loomba, Rohit Kohli, Ruth Sargent, Patricia Belt, Patricia R. Robuck, Ivana A. Vaughn, Mandeep Singh, Marwan Ghabril, Mohhamad S. Siddiqui, Kimberly Noble, Kara Cooper, Kimberly P. Newton, Kevin P. May, Brent A. Neuschwander-Tetri, Joel E. Lavine, Rish K. Pai, Chia Wang, Stephanie H. Abrams, Velimir A. Luketic, Kris V. Kowdley, Christopher J. N. Kigongo, Arthur J. McCullough, David E. Kleiner, Jay H. Hoofnagle, Katherine P. Yates, Sandra Arroyo, Jeanne M. Clark, Erin Corless, Melanie B. White, Dawn Piercy, Yi Ping Pan, Iliana Doycheva, Camille Langlois, Philip J. Rosenthal, Ann Quinn, James E. Nelson, Ali A. Mencin, Cynthia K. Rigsby, Stephanie Buie, Nadia Ovchinsky, Tracey Pierce, Jose Derdoy, Kathleen Lake, Cynthia Fleming, Mark L. Van Natta, Asma Siddique, Arun J. Sanyal, Janis Durelle, Phirum Nguyen, Anna Mae Diehl, Crystal Slaughter, Mazen Noureddin, Leanel Maldonado, Rebekah Garcia, Nathan M. Bass, Linda Ragozzino, Jody Mooney, Smitha Marri, Claudia Ortiz Zein, Beverly Morris, Bilal Hameed, Claude B. Sirlin, Alice L. Sternberg, Jeffrey B. Schwimmer, Melissa Wagner, David L. Coy, Michele Donithan, Naga Chalasani, Heather Patton, Susan Stewart, Dana Romo, Stephanie DeVore, Manal F. Abdelmalek, Shannon Fleck, Gilman D. Grave, Saul J. Karpen, Aliya Qayyum, Ann Klipsch, Bradley E. Aouizerat, Simon Horslen, Mustafa R. Bashir, Norah A. Terrault, Lacey Siekas, Elizabeth Byam, Sarah Ackermann, Jennifer Collins, Patricia Brandt, Ben Wolford, Raj Vuppalanchi, Rebecca Cleeton, and Cathy Hurtado
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Adult ,Male ,Serum ,medicine.medical_specialty ,Interleukin-1beta ,Ferroportin ,Article ,Body Mass Index ,Young Adult ,Sex Factors ,Hepcidins ,Non-alcoholic Fatty Liver Disease ,Risk Factors ,Hepcidin ,Internal medicine ,Diabetes mellitus ,Nonalcoholic fatty liver disease ,medicine ,Humans ,Obesity ,Aged ,Aged, 80 and over ,Hepatology ,biology ,Interleukin-6 ,Transferrin saturation ,business.industry ,Racial Groups ,Gastroenterology ,Iron Deficiencies ,Iron deficiency ,Middle Aged ,medicine.disease ,Endocrinology ,biology.protein ,Female ,Metabolic syndrome ,business ,Body mass index ,Alaska - Abstract
Iron deficiency is often observed in obese individuals. The iron regulatory hormone hepcidin is regulated by iron and cytokines interleukin (IL) 6 and IL1β. We examine the relationship between obesity, circulating levels of hepcidin, and IL6 and IL1β, and other risk factors in patients with nonalcoholic fatty liver disease (NAFLD) with iron deficiency.We collected data on 675 adult subjects (18 years old) enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network. Subjects with transferrin saturation20% were categorized as iron deficient, whereas those with transferrin saturation ≥20% were classified as iron normal. We assessed clinical, demographic, anthropometric, laboratory, dietary, and histologic data from patients, and serum levels of hepcidin and cytokines IL6 and IL1β. Univariate and multivariate analysis were used to identify risk factors for iron deficiency.One-third of patients (231 of 675; 34%) were iron deficient. Obesity, diabetes, and metabolic syndrome were more common in subjects with iron deficiency (P.01), compared with those that were iron normal. Serum levels of hepcidin were significantly lower in subjects with iron deficiency (61 ± 45 vs 81 ± 51 ng/mL; P.0001). Iron deficiency was significantly associated with female gender, obesity, increased body mass index and waist circumference, presence of diabetes, lower alcohol consumption, black or American Indian/Alaska Native race (P ≤ .018), and increased levels of IL6 and IL1β (6.6 vs 4.8 for iron normal, P ≤ .0001; and 0.45 vs 0.32 for iron normal, P ≤ .005).Iron deficiency is prevalent in patients with NAFLD and associated with female gender, increased body mass index, and nonwhite race. Serum levels of hepcidin were lower in iron-deficient subjects, reflecting an appropriate physiologic response to decreased circulating levels of iron, rather than a primary cause of iron deficiency in the setting of obesity and NAFLD.
- Published
- 2014
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