الفهرس 
Iron status and IDAOnly 14 pages are availabe for public view
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Abstract
Anemia is a global public health problem affecting both developing and developed countries with major consequences for human health as well as social and economic development. It occurs at all stages of the life cycle, but is more prevalent in pregnant women and young children.(1) Iron deficiency anemia (IDA) is the world’s most prevalent nutritional deficiency making up about half of all the different types of anemias. In 2002 (IDA) was considered to be among the most important contributing factors to the global burden of disease. According to the Egypt Demographic Health Survey (2014)(EDHS), reporting on anemia prevalence indicated that anemia among women of child bearing age was found to be 25%.
Obesity and overweight have become a global problem affecting not only high income countries but also developing countries. According to the World Health Organization (WHO) (2015) more than 1 billion adults are overweight and at least 300 million of them are obese. Experimental and clinical studies indicate that there is
a relationship between iron metabolism and weight status.
Iron deficiency is significantly more prevalent among obese individuals compared to non-obese ones. Adipose tissue produces many pro-inflammatory cytokines (interleukin-1, interleukin- 6, tumor necrosis factor-α) and adipokines (leptin, adiponectin, resistin) that influence iron homeostasis. According to recent studies, hepcidin, the main regulator of iron metabolism, can also be synthesized by the adipocytes.
Iron plays an important role, not only in oxygen delivery to the tissues, but also as a cofactor with several enzymes involved in energy metabolism and thermoregulation. As a result, much research has been dedicated to understanding the ramifications of iron depletion and iron deficiency anemia on the physiological functions of these enzymes. There is evidence to suggest that iron depletion and iron deficiency anemia cause physiological changes in the body not only during exercise, but also under resting conditions.
Several minerals and trace elements like iron are essential for normal thyroid hormone metabolism. Iron deficiency impairs thyroid hormone synthesis by reducing activities of heme-dependent thyroid peroxidase. Iron deficiency anemia blunts and iron supplementation improves the efficacy of iodine supplementation. Iron plays an important role in thyroid hormone metabolism, thus iron deficiency anemia may lead to alterations in resting metabolic rate (RMR).
The general aim of the study is to assess the effect of iron supplementation on thyroid hormone levels and resting metabolic rate in obese adult females with iron-deficiency anemia. The specific objectives are to assess nutritional status and dietary history of anemic obese females, to determine the effect of iron supplementation on change in the following laboratory and clinical parameters: Thyroid hormone levels: T3, T4,TSH,and T3:T4 ratio. Hemoglobin concentration and Serum ferritin (SF) level. RMR and body composition and to explore the possible effect of change in RMR on the pattern of change in the body weight.
A interventional one group pre-post Experimental design study was conducted in a private medical center for obesity management in Alexandria Governorate. All overweight and obese adult females aged 20-40 years, with Body mass index BMI ≥30 kg/m2, hemoglobin <12 g/dl and Serum ferritin (SF) concentration <12 µg/l. were included in the study. The sample was collected till sample size 50 cases was completed.
The study group was interviewed to answer a pre-designed questionnaire which included sociodemographic, family, life style pattern, meal pattern, food habits, and dietary intake using 24 hour food recall. The dietary intake was analyzed using the Egyptian Food Composition tables into energy and macronutrients (protein, carbohydrates and fats). Nutrient density of the diet was calculated. Physical examination was carried out including blood pressure measurement. Anthropometric measurements were recorded including weight, height, BMI calculation; waist circumference, hip circumference, body composition and RMR were done. Also biochemical analysis was done all females were referred to the same private laboratory for measuring Hemoglobin, serum ferritin, T3and T4.
The results of the present study can be summarized as follows:
• About half of the sample (48.0%) fell in age group 30- 40 years. The mean age among cases was 31.9 ± 6.6 years.
• Sedentary ordinary daily activities was the most prevalent among cases 66%,, while a minority of cases were indulged in moderate ordinary daily activities. More than half of cases 58% were performing light leisure activity.
• Regarding taking meals outside home, the highest percentage of cases (74%).
• As regards tea drinking directly after meals, approximately half of cases drink tea after meals representing 56%. Majority of cases (78%) did not eat vitamin c rich food.
• The mean daily energy intake was 1511.8 ± 490.7 kcal and the median energy intake was 1536.0kcal.
• The nutrient density of consumed carbohydrates was 55.3% and for consumed fats was 28.5% and finally nutrient density of consumed proteins was 16.2%.
• The mean iron intake was 13.3 ± 8.1mg/day, also the mean vitamin C intake was 43.6 ± 48.3 mg/day.
• The mean body weight among cases s was 89.1 ± 13.7 kg and the mean height was 163.0 ± 7.4cm.
• The mean of waist circumference was 101.9 ± 12.9cm and the mean of hip circumference was 119.5 ± 13.6cm that makes the waist to hip ratio W/H =0.85.
• The mean BMI of cases was 33.4 ± 4.3 kg/m2.
• The mean body fat mass was 39.5 ± 10.2 kg, the mean body lean mass was 27.1 ± 5.0kg and the mean resting metabolic rate was 1422.6 ± 254.6Kcal.
• Concerning results of intervention study, the body weight decreased in the following 4 months of the study by 14.7%, As regards mean body fat mass it decreased by 11.2% and the mean FFM decreased by 10.6%.
• Regarding resting metabolic rate, it was found that RMR slightly increased by 0.36%.
• Concerning serum ferritin it is clear that the SF increased significantly by 12 %and Hb increased significantly by 6.2%.
• The mean T3 insignificantly increased by 0.044% and the mean T4 significantly increased by 2.4 %.
• There is a weak positive non-significant correlation between SF and T3, there is weak positive non-significant association between SF and body weight, Also there is weak positive non-significant correlation between SF and RMR.
from our study the most important conclusions:
• Correction of anemia before doing any weight reduction program.
• Improvement of iron status improves thyroid hormones T3,T4 levels.
• Significant improvements occurred in all body composition parameters.
• Iron deficiency is significantly more prevalent among obese individuals compared to non-obese ones.
• Iron deficiency with or without anemia impairs thyroid hormone metabolism.
• Resting metabolic rate improved significantly after iron supplementation.
• Alterations in RMR and thyroid hormone levels could have been a result of iron deficiency anemia.
The most important recommendations:
• To correct the anemia before doing any weight reduction program.
• A structured program that emphasizes life style changes should include nutrition education to physicians.
• All obese and overweight women should be test for SF level.
• Community based programs for prevention of IDA should be considered
• Life style modification is corner stone in prevention and management of obesity and should include both dietary and physical activity pattern changes.
• Individualized meal plan and dietary counseling by nutritionist is mandatory obese and IDA patients.