Interactive Effects of Dietary Fat/Carbohydrate Ratio and Body Mass Index on Iron Deficiency Anemia among Taiwanese Women
Abstract
:1. Introduction
2. Experimental Section
2.1. Study Design
2.2. Data Collection
2.3. Definitions of Iron Deficiency Anemia (IDA)
2.4. Definitions of Overweight and Obesity
2.5. Statistical Analyses
3. Results
3.1. Association between BMI and Iron Status
Variables | Underweight a | Normal Weight a | Overweight a | Obese a | p-trend |
---|---|---|---|---|---|
Number (n, %) | 103.0 (8.1) | 543.0 (42.6) | 306.0 (24.0) | 322.0 (25.2) | |
Age (years) | 39.3 (1.9) | 49.9 (0.8) | 57.2 (0.9) | 56.4 (0.9) | <0.0001 |
Waist (cm) | 64.7 (0.5) | 74.5 (0.3) | 83.5 (0.4) | 93.0 (0.5) | <0.0001 |
BMI (kg/m2) | 17.8 (0.1) | 21.6 (0.06) | 25.4 (0.04) | 30.1 (0.1) | <0.0001 |
Serum iron (μg/dL) | 99.9 (4.5) | 96.4 (1.8) | 97.2 (2.2) | 94.6 (1.9) | 0.2654 |
Serum ferritin (ng/mL) | 55.4 (5.1) | 89.2 (3.6) | 120.6 (5.7) | 120.4 (5.6) | <0.0001 |
Hemoglobin (g/dL) | 12.5 (0.1) | 12.6 (0.1) | 12.9 (0.1) | 13.0 (0.1) | <0.0001 |
Anemia (n, %) | 23.0 (22.3) | 124.0 (22.8) | 54.0 (17.6) | 50.0 (15.5) | 0.0280 |
Iron depletion (n, %) b | 54.0 (52.4) | 285.0 (52.4) | 158.0 (51.6) | 171.0 (53.1) | 0.9669 |
Iron deficiency (n, %) c | 15.0 (14.5) | 55.0 (10.1) | 20.0 (6.5) | 20.0 (6.2) | 0.0414 |
Iron deficiency anemia (n, %) d | 11.0 (10.6) | 45.0 (8.2) | 10.0 (3.2) | 14.0 (4.3) | 0.0024 |
3.2. Association between Dietary Components, BMI and Iron Deficiency Anemia
Variables | Iron Deficiency Anemia | ||||||
---|---|---|---|---|---|---|---|
Normal Weight Women a | Overweight/Obese Women b | ||||||
IDA (−) | IDA (+) | ORs (95% CI) c | IDA (−) | IDA (+) | p–value d | ORs (95% CI) c | |
Number (n) | 446.0 | 45.0 | 557.0 | 24.0 | |||
Age (years) | 50.0 (0.8) | 42.6 (2.03) | 0.974 (0.955–0.993) | 57.1 (0.7) | 44.5 (1.8) | <0.0001 | 0.951 (0.926–0.976) |
BMI (kg/m2) | 21.7 (0.06) | 21.3 (0.21) | 0.830 (0.660–1.043) | 27.8 (0.2) | 27.9 (0.6) | <0.0001 | 1.011 (0.896–1.140) |
Nutritional Intake e | |||||||
Protein (g/day) | |||||||
all | 69.0 (1.0) | 70.4 (3.1) | 1.004 (0.988–1.019) | 66.6 (1.0) | 64.3 (4.6) | 0.3805 | 0.996 (0.980–1.012) |
plant | 33.5 (0.8) | 32.5 (2.6) | 0.995 (0.975–1.015) | 31.9 (0.7) | 28.3 (3.3) | 0.4036 | 0.987 (0.962–1.013) |
animal | 32.2 (1.1) | 34.9 (3.4) | 1.006 (0.992–1.020) | 32.3 (1.0) | 34.3 (4.8) | 0.9861 | 1.003 (0.988–1.017) |
Fat (g/day) | 54.8 (1.0) | 51.0 (3.1) | 0.990 (0.974–1.007) | 54.4 (1.0) | 60.0 (4.7) | 0.0591 | 1.010 (0.993–1.027) |
Carbohydrate (g/day) | 222.0 (2) | 230.0 (8) | 1.003 (0.996–1.009) | 212.0 (2) | 198.0 (11) | 0.0457 | 0.996 (0.990–1.003) |
Fat/CHO ratio | 0.256 (0.007) | 0.234 (0.018) | 0.375 (0.036–4.022) | 0.260 (0.007) | 0.335 (0.046) | 0.0171 | 10.119 (1.267–80.797) |
Iron (mg/day) | |||||||
all | 14.8 (0.6) | 14.7 (2.0) | 0.998 (0.971–1.027) | 13.3 (0.4) | 12.6 (1.7) | 0.4919 | 0.991 (0.943–1.041) |
plant | 11.1 (0.6) | 10.8 (1.9) | 0.997 (0.967–1.027) | 10.0 (0.3) | 8.5 (1.6) | 0.4104 | 0.972 (0.911–1.037) |
animal | 3.4 (0.2) | 3.6 (0.6) | 1.013 (0.940–1.091) | 3.1 (0.1) | 3.9 (0.7) | 0.7126 | 1.041 (0.960–1.129) |
Plant/animal | 12.9 (01.7) | 4.6 (5.5) | 0.955 (0.904–1.008) | 12.7 (1.8) | 8.1 (8.6) | 0.7644 | 0.993 (0.966–1.020) |
Fiber (mg/day) | 17.9 (0.6) | 17.8 (1.9) | 0.998 (0.971–1.026) | 16.8 (0.5) | 12.7 (2.2) | 0.0991 | 0.959 (0.913–1.008) |
Vit B 6 (mg/day) | 1.67 (0.04) | 1.63 (0.13) | 0.948 (0.647–1.390) | 1.67 (0.04) | 1.31 (0.18) | 0.1988 | 0.586 (0.315–1.089) |
Vit B 12 (μg/day) | 6.1 (0.9) | 5.3 (2.7) | 0.996 (0.970–1.022) | 5.2 (0.4) | 3.7 (2.2) | 0.6834 | 0.988 (0.936–1.044) |
Vit C (mg/day) | 177 (7) | 197 (22) | 1.001 (0.999–1.003) | 166 (6) | 173 (30) | 0.5646 | 1.000 (0.998–1.003) |
Vit D (μg/day) | 6.9 (0.6) | 7.4 (1.9) | 1.002 (0.979–1.026) | 8.2 (0.5) | 4.0 (2.5) | 0.3068 | 0.951 (0.892–1.014) |
3.3. Interactive Effects of Dietary Fat/Carbohydrate Ratio and BMI on Iron Deficiency Anemia
Fat/CHO Ratio b | BMI a | |||||
---|---|---|---|---|---|---|
T1 | p-value | T2 | p-value | T3 | p-value | |
Crude | ||||||
T1 | Reference | - | 0.915 (0.354–2.363) | 0.853 | 0.381 (0.144–1.008) | 0.051 |
T2 | 1.402 (0.582–3.380) | 0.451 | 1.008 (0.390–2.610) | 0.986 | 0.370 (0.133–1.026) | 0.056 |
T3 | 1.519 (0.615–3.753) | 0.364 | 1.123 (0.433–2.915) | 0.811 | 0.748 (0.314–1.783) | 0.513 |
Age Adjusted | ||||||
T1 | Reference | - | 1.202 (0.454–3.181) | 0.711 | 0.547 (0.201–1.487) | 0.236 |
T2 | 1.093 (0.446–2.679) | 0.841 | 1.038 (0.396–2.725) | 0.939 | 0.488 (0.172–1.382) | 0.176 |
T3 | 1.016 (0.403–2.565) | 0.972 | 1.114 (0.423–2.936) | 0.827 | 0.798 (0.330–1.927) | 0.615 |
4. Discussion
Variables | IDA (−) | IDA (+) | ||||||
---|---|---|---|---|---|---|---|---|
BMI a | BMI b | |||||||
Energy Adjusted c | T1 | T2 | T3 | p-trend | T1 | T2 | T3 | p-trend |
Fat (g/day) | 54.3 (1.2) | 53.2 (1.2) | 56.0 (1.1) | 0.281 | 50.7 (4.4) | 55.8 (4.5) | 63.8 (4.3) | 0.035 |
Carbohydrate (g/day) | 218 (3) | 220 (3) | 212 (3) | 0.126 | 237 (11) | 222 (11) | 206 (11) | 0.045 |
Protein (g/day) | 69.0 (1.2) | 67.4 (1.2) | 67.0 (1.1) | 0.196 | 68.9 (4.3) | 76.0 (4.4) | 67.9 (4.2) | 0.871 |
Animal/Plant | 1.29 (0.07) | 1.33 (0.07) | 1.31 (0.07) | 0.805 | 1.11 (0.24) | 1.56 (0.25) | 1.34 (0.23) | 0.486 |
Fat/Carbohydrate | 0.27 (0.01) | 0.25 (0.01) | 0.28 (0.01) | 0.505 | 0.24 (0.03) | 0.25 (0.03) | 0.33 (0.03) | 0.041 |
Fat/Protein | 0.81 (0.02) | 0.80 (0.02) | 0.84 (0.02) | 0.337 | 0.78 (0.08) | 0.74 (0.08) | 0.98 (0.08) | 0.091 |
Iron (mg/day) | 15.9 (0.6) | 13.2 (0.6) | 13.2 (0.6) | 0.001 | 13.3 (1.5) | 16.8 (1.5) | 13.2 (1.4) | 0.954 |
Animal Fe/Plant Fe | 0.51 (0.03) | 0.45 (0.03) | 0.46 (0.03) | 0.245 | 0.43 (0.12) | 0.56 (0.12) | 0.53 (0.11) | 0.544 |
Plant Fe/Vit C | 0.13 (0.02) | 0.10 (0.02) | 0.13 (0.02) | 0.968 | 0.09 (0.10) | 0.12 (0.10) | 0.24 (0.10) | 0.275 |
Vit B6 + B12 | 8.75 (0.78) | 6.47 (0.78) | 6.90 (0.77) | 0.094 | 5.79 (1.53) | 8.12 (1.57) | 5.63 (1.49) | 0.941 |
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
- Pinhas-Hamiel, O.; Newfield, R.S.; Koren, I.; Agmon, A.; Lilos, P.; Phillip, M. Greater prevalence of iron deficiency in overweight and obese children and adolescents. Int. J. Obes. Relat. Metab. Disord. 2003, 27, 416–418. [Google Scholar]
- Nead, K.G.; Halterman, J.S.; Kaczorowski, J.M.; Auinger, P.; Weitzman, M. Overweight children and adolescents: A risk group for iron deficiency. Pediatrics 2004, 114, 104–108. [Google Scholar]
- Del Giudice, E.M.; Santoro, N.; Amato, A.; Brienza, C.; Calabro, P.; Wiegerinck, E.T.; Cirillo, G.; Tartaglione, N.; Grandone, A.; Swinkels, D.W.; et al. Hepcidin in obese children as a potential mediator of the association between obesity and iron deficiency. J. Clin. Endocrinol. Metab. 2009, 94, 5102–5107. [Google Scholar]
- Cepeda-Lopez, A.C.; Osendarp, S.J.; Melse-Boonstra, A.; Aeberli, I.; Gonzalez-Salazar, F.; Feskens, E.; Villalpando, S.; Zimmermann, M.B. Sharply higher rates of iron deficiency in obese Mexican women and children are predicted by obesity-related inflammation rather than by differences in dietary iron intake. Am. J. Clin. Nutr. 2011, 93, 975–983. [Google Scholar]
- Yanoff, L.B.; Menzie, C.M.; Denkinger, B.; Sebring, N.G.; McHugh, T.; Remaley, A.T.; Yanovski, J.A. Inflammation and iron deficiency in the hypoferremia of obesity. Int. J. Obes. (Lond.) 2007, 31, 1412–1419. [Google Scholar]
- Menzie, C.M.; Yanoff, L.B.; Denkinger, B.I.; McHugh, T.; Sebring, N.G.; Calis, K.A.; Yanovski, J.A. Obesity-related hypoferremia is not explained by differences in reported intake of heme and nonheme iron or intake of dietary factors that can affect iron absorption. J. Am. Diet. Assoc. 2008, 108, 145–148. [Google Scholar]
- Gartner, A.; el Ati, J.; Traissac, P.; Bour, A.; Berger, J.; Landais, E.; el Hsaini, H.; Ben Rayana, C.; Delpeuch, F. A double burden of overall or central adiposity and anemia or iron deficiency is prevalent but with little socioeconomic patterning among Moroccan and Tunisian urban women. J. Nutr. 2014, 144, 87–97. [Google Scholar]
- Ausk, K.J.; Ioannou, G.N. Is obesity associated with anemia of chronic disease? A population-based study. Obesity (Silver Spring) 2008, 16, 2356–2361. [Google Scholar]
- Neymotin, F.; Sen, U. Iron and obesity in females in the United States. Obesity (Silver Spring) 2011, 19, 191–199. [Google Scholar]
- Kozai, D.; Kabasawa, Y.; Ebert, M.; Kiyonaka, S.; Firman; Otani, Y.; Numata, T.; Takahashi, N.; Mori, Y.; Ohwada, T. Transnitrosylation directs TRPA1 selectivity in N-nitrosamine activators. Mol. Pharmacol. 2014, 85, 175–185. [Google Scholar]
- Karl, J.P.; Lieberman, H.R.; Cable, S.J.; Williams, K.W.; Glickman, E.L.; Young, A.J.; McClung, J.P. Poor iron status is not associated with overweight or overfat in non-obese pre-menopausal women. J. Am. Coll. Nutr. 2009, 28, 37–42. [Google Scholar]
- Eckhardt, C.L.; Torheim, L.E.; Monterrubio, E.; Barquera, S.; Ruel, M.T. The overlap of overweight and anaemia among women in three countries undergoing the nutrition transition. Eur. J. Clin. Nutr. 2008, 62, 238–246. [Google Scholar]
- Fanou-Fogny, N.; J Saronga, N.; Koreissi, Y.; A M Dossa, R.; Melse-Boonstra, A.; D Brouwer, I. Weight status and iron deficiency among urban Malian women of reproductive age. Br. J. Nutr. 2011, 105, 574–579. [Google Scholar]
- Kordas, K.; Fonseca Centeno, Z.Y.; Pachon, H.; Jimenez Soto, A.Z. Being overweight or obese is associated with lower prevalence of anemia among Colombian women of reproductive age. J. Nutr. 2013, 143, 175–181. [Google Scholar]
- Cheng, H.L.; Bryant, C.; Cook, R.; O’Connor, H.; Rooney, K.; Steinbeck, K. The relationship between obesity and hypoferraemia in adults: A systematic review. Obes. Rev. 2012, 13, 150–161. [Google Scholar]
- Andrews, N.C. Anemia of inflammation: The cytokine-hepcidin link. J. Clin. Investig. 2004, 113, 1251–1253. [Google Scholar]
- Nemeth, E.; Rivera, S.; Gabayan, V.; Keller, C.; Taudorf, S.; Pedersen, B.K.; Ganz, T. IL-6 mediates hypoferremia of inflammation by inducing the synthesis of the iron regulatory hormone hepcidin. J. Clin. Investig. 2004, 113, 1271–1276. [Google Scholar]
- DeGonzague, B.; Receveur, O.; Wedll, D.; Kuhnlein, H.V. Dietary intake and body mass index of adults in 2 Ojibwe communities. J. Am. Diet. Assoc. 1999, 99, 710–716. [Google Scholar]
- Markovic, T.P.; Natoli, S.J. Paradoxical nutritional deficiency in overweight and obesity: The importance of nutrient density. Med. J. Aust. 2009, 190, 149–151. [Google Scholar]
- Chang, J.S.; Lin, S.M.; Huang, T.C.; Chao, J.C.; Chen, Y.C.; Pan, W.H.; Bai, C.H. Serum ferritin and risk of the metabolic syndrome: A population-based study. Asia Pac. J. Clin. Nutr. 2013, 22, 400–407. [Google Scholar]
- Chang, J.S.; Lin, S.M.; Chao, J.C.; Chen, Y.C.; Wang, C.M.; Chou, N.H.; Pan, W.H.; Bai, C.H. Serum ferritin contributes to racial or geographic disparities in metabolic syndrome in Taiwan. Public Health Nutr. 2014, 17, 1498–1506. [Google Scholar]
- Pan, W.H.; Lee, M.S.; Chuang, S.Y.; Lin, Y.C.; Fu, M.L. Obesity pandemic, correlated factors and guidelines to define, screen and manage obesity in Taiwan. Obes. Rev. 2008, 9 (Suppl. 1), 22–31. [Google Scholar]
- Wu, S.J.; Pan, W.H.; Yeh, N.H.; Chang, H.Y. Trends in nutrient and dietary intake among adults and the elderly: From NAHSIT 1993–1996 to 2005–2008. Asia Pac. J. Clin. Nutr. 2011, 20, 251–265. [Google Scholar]
- Pan, W.H.; Wu, H.J.; Yeh, C.J.; Chuang, S.Y.; Chang, H.Y.; Yeh, N.H.; Hsieh, Y.T. Diet and health trends in Taiwan: Comparison of two nutrition and health surveys from 1993–1996 and 2005–2008. Asia Pac. J. Clin. Nutr. 2011, 20, 238–250. [Google Scholar]
- Willett, W.; Stampfer, M.J. Total energy intake: Implications for epidemiologic analyses. Am. J. Epidemiol. 1986, 124, 17–27. [Google Scholar]
- Looker, A.C.; Dallman, P.R.; Carroll, M.D.; Gunter, E.W.; Johnson, C.L. Prevalence of iron deficiency in the United States. JAMA 1997, 277, 973–976. [Google Scholar]
- Exceutive Summary of the Third Report of the National Cholesterol Education Program (NCEP). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001, 285, 2486–2497. [Google Scholar]
- Tan, C.E.; Ma, S.; Wai, D.; Chew, S.K.; Tai, E.S. Can we apply the National Cholesterol Education Program Adult Treatment Panel definition of the metabolic syndrome to Asians? Diabetes Care 2004, 27, 1182–1186. [Google Scholar]
- World Hhealth Organization. Thw Asia-Pacific Persepective: Redefining Obesity and Its Treatment; WHO: Geneva, Switzerland, 2000. [Google Scholar]
- Sonnweber, T.; Ress, C.; Nairz, M.; Theurl, I.; Schroll, A.; Murphy, A.T.; Wroblewski, V.; Witcher, D.R.; Moser, P.; Ebenbichler, C.F.; et al. High-fat diet causes iron deficiency via hepcidin-independent reduction of duodenal iron absorption. J. Nutr. Biochem. 2012, 23, 1600–1608. [Google Scholar]
- Chung, J.; Kim, M.S.; Han, S.N. Diet-induced obesity leads to decreased hepatic iron storage in mice. Nutr. Res. 2011, 31, 915–921. [Google Scholar]
- Tsuchiya, H.; Ebata, Y.; Sakabe, T.; Hama, S.; Kogure, K.; Shiota, G. High-fat, high-fructose diet induces hepatic iron overload via a hepcidin-independent mechanism prior to the onset of liver steatosis and insulin resistance in mice. Metabolism 2013, 62, 62–69. [Google Scholar]
- Jackson, K.A.; Byrne, N.M.; Magarey, A.M.; Hills, A.P. Minimizing random error in dietary intakes assessed by 24-h recall, in overweight and obese adults. Eur. J. Clin. Nutr. 2008, 62, 537–543. [Google Scholar]
- Goris, A.H.; Westerterp-Plantenga, M.S.; Westerterp, K.R. Undereating and underrecording of habitual food intake in obese men: Selective underreporting of fat intake. Am. J. Clin. Nutr. 2000, 71, 130–134. [Google Scholar]
© 2014 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).
Share and Cite
Chang, J.-S.; Chen, Y.-C.; Owaga, E.; Palupi, K.C.; Pan, W.-H.; Bai, C.-H. Interactive Effects of Dietary Fat/Carbohydrate Ratio and Body Mass Index on Iron Deficiency Anemia among Taiwanese Women. Nutrients 2014, 6, 3929-3941. https://doi.org/10.3390/nu6093929
Chang J-S, Chen Y-C, Owaga E, Palupi KC, Pan W-H, Bai C-H. Interactive Effects of Dietary Fat/Carbohydrate Ratio and Body Mass Index on Iron Deficiency Anemia among Taiwanese Women. Nutrients. 2014; 6(9):3929-3941. https://doi.org/10.3390/nu6093929
Chicago/Turabian StyleChang, Jung-Su, Yi-Chun Chen, Eddy Owaga, Khairizka Citra Palupi, Wen-Harn Pan, and Chyi-Huey Bai. 2014. "Interactive Effects of Dietary Fat/Carbohydrate Ratio and Body Mass Index on Iron Deficiency Anemia among Taiwanese Women" Nutrients 6, no. 9: 3929-3941. https://doi.org/10.3390/nu6093929