Abstract
The relationship between obesity and iron deficiency has not been adequately defined. The study seeks to establish the relationship between the two conditions by analyzing the serum hepcidin concentration amongst individuals aged between 19 to 29 years of good health. The cross-sectional study will evaluate inflammatory markers, serum lipids, and iron status indicators amongst 100 male and female College Students. Though this design might not sufficiently confirm the causality between iron deficiency and obesity, the method is cost-effective. Information on the link between obesity and iron deficiency is essential in establishing strategies to improve the health status of College Students.
Introduction
The prevalence of obesity has become a common health complication within the United States and the world in general (Fruh, 2017). Iron deficiency and obesity remain public health problems drawing significant clinical impacts on the College Students population (Jamnok et al., 2020). Obesity develops due to the excessive deposition of fats within the body. This condition primarily arises as a result of poor eating habits (Rush & Yan, 2017). Adopting high-calorie intake, a sedentary lifestyle, and hereditary factors are the main factors causing iron deficiency among college students (Bhadoria et al., 2015). There has been a development of debates regarding the link between iron deficiency and obesity among healthcare practitioners (Alshwaiyat et al., 2021). Some preliminary studies explain the link between Iron deficiency and obesity amongst College Students. However, most of these studies are non-population based and tend to consider other variables that link iron deficiency and obesity. This study seeks to evaluate the levels of hepcidin and the degree of obesity to establish the relationship between obesity and iron deficiency among College Students.
Literature Review
Iron Assessment of the participants provides crucial information on the link between iron deficiency and obesity among College Students. Different indexes can be used when conducting an iron assessment; however, complications arise when the subject experiences inflammatory conditions such as obesity. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommend the measurement of serum ferritin and soluble transferrin receptor as the most appropriate method for evaluating iron status in a population (Ellulu et al., 2017). Recent studies by Pasricha et al. (2014) and Prentice et al. (2019) reveal a growing interest in using hepcidin as an indicator of iron status within a given population. Obese individuals tend to depict high concentrations of hepcidin in the event of iron deficiency.
Hepcidin tends to bind Ferroportin leading to its internalization and degradation. According to a study by Cepeda-Lopez et al. (2016), when levels of hepcidin increase, it leads to reduced intestinal iron absorption and reduced release of iron from the body. This situation leads to low serum iron amongst the victims. Different studies by D’Angelo (2013) and Camaschella (2017) reveal that among healthy individuals with iron deficiency, ferritin, serum hepcidin, and transferrin concentrations tend to be low. However, amongst obese individuals, hepcidin and ferritin concentrations tend to be elevated in cases of iron deficiency.
The increasing prevalence of levels of obesity has brought significant public health complications on iron status due to heightened adiposity. According to Welsh et al. (2010) and Gregor and Hotamisligil (2011), increased adiposity leads to increased levels of pro-inflammatory cytokines within the systematic circulation. Increased concentration levels of cytokine trigger the gene expression of hepcidin, thereby increasing hepcidin concentration. Therefore, obesity-linked low-grade inflammation can induce low circulating serum iron. This situation heightens the likelihood of iron deficiency anemia through hepcidin-mediated lowered iron absorption and release from storage (Cepeda-Lopez et al., 2010). A cross-sectional study by Aguree and Reddy (2021) on teenage women revealed a link between increased adiposity in obese women with heightened levels of inflammation, hepcidin, and reduced serum iron concentrations. In addition, increased total body fats indicate high levels of hepcidin, which tends to impair iron synthesis, leading to iron deficiency.
Different studies continue to depict hepcidin levels as a crucial factor explaining the relationship between iron deficiency and obesity. A survey by Vuppalanchi et al. (2013) links serum Hepcidin levels with obesity, not the liver disease. The study was conducted on liver tissue, serum from patients undergoing bariatric surgery, and blood serum from healthy individuals and linked obesity to increased hepcidin levels. A cross-sectional study done on young women by Stoffel et al. (2020) indicates that women with higher central adiposity tend to have raised serum hepcidin, heightened iron homeostasis impairments, and lowered levels of iron absorption. Iron deficiency continues to be a common condition among College Students populations. The available literature tends to examine the relationship between obesity and iron deficiency among older individuals of ages above 25 years. This study seeks to investigate the link between iron deficiency and obesity specifically on college students.
Methods
The research will adopt a cross-sectional study design and seek to evaluate inflammatory markers, serum lipids, and iron status indicators amongst 30 male and female College Students. This population will include obese females whose BMI is≥30 kg/m2 and a control group whose BMI falls from 18.5 to 24.9 kg/m2. The recruitment of research participants will be from a learning institution through email and flyers posted around the institutions. The inclusion criteria from the study include males and females aged between 18 years to 25 years of generally good health. Additionally, other inclusion criteria involve participants who are non-smokers and not pregnant. The exclusion criteria for the study will include cases of high blood pressure with the systolic blood pressure being < 90 or ≥130 mmHg, while those with a diastolic blood pressure of < 60 or ≥80 mmHg will be excluded from the study. Additionally, individuals with a previous hypertensive disorder, gastrointestinal complications, and chronic hypertension even if earlier controlled will be excluded from the study.
All the eligible applicants will be required to complete an online questionnaire through mediums such as Qualtrics. The eligible participants will later conduct a visit where their vital signs, such as height and weight, will be measured and their BMI calculated. collection of the participants’ blood samples for biochemical measurements where samples will be centrifuged at 300× g for 15 min (4 °C) will also be conducted the same day. This process will enable serum collection before the pieces are frozen at negative 80 °C until the study is complete. Variables for the study include factors that predict hepcidin like level of Ferritin, creatine and IL-6 on subjects. The markers of inflammation like C-reactive protein (CRP, plasma viscosity (PV) and erythrocyte sedimentation rate (ESR) will be tested for positive or negative association with hepcidin through a univariate analysis.
Challenges
The study faces different challenges that might affect the efficacy of the research. For instance, a cross-sectional study will involve a sample from other schools. As the basis of the study population will not be on a well-designed population-based sampling, the representativeness of the iron deficiency prevalence might be negatively affected. Additionally, using a cross-sectional design might not be sufficient to confirm the causality between iron deficiency and obesity, thereby calling for a need for longitudinal study in the future. Another limitation to the study is that the research will dwell on routine health check-ups of College Students; the study will not undertake any sophisticated laboratory tests to define iron deficiency. Nonetheless, this study will offer a cost-effective solution for physicians to recognize reduced iron stores when sophisticated laboratory testing is expensive.
Conclusion
The relationship between obesity and iron deficiency depends on which indicator defines iron deficiency. Increasing literature provides evidence that increased low-grade chronic inflammation raises serum hepcidin concentrations, leading to poor iron homeostasis and lack. As obesity and iron deficiency cases continue to affect most College Students populations globally, it is crucial to develop knowledge of the link between them. This information can be critical in developing strategies to curb the menace, improve health status and reduce the pressure it bears on the health system.
References
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