International Journal of Applied Engineering Research ISSN 0973-4562 Volume 12, Number 24 (2017) pp. 15830-15837 © Research India Publications. http://www.ripublication.com Comparison of Serum Iron, Total Iron Binding Capacity and hemoglobin A1c level according to Obesity in South Korean Adult
Hea Shoon Lee Department of Nursing, Hannam University, Daejeon, South Korea.
Orcid: 0000-0002-2256-3352
Abstract order to prevent and effectively manage obesity, it is essential The purpose of this study was to investigate the difference in to accurately assess obesity[4]. serum Iron, total iron binding capacity(TIBC) and hemoglobin Obesity and related complications as well as iron A1c(HbA1c) according to the body mass index(BMI) of deficiency(ID) are major issues that affect significant South Korean adults. This study analyzed The Fifth Korea proportions of the global population[5]. The association National Health and Nutrition Examination Survey, and between iron status and obesity is one that should be explored classified in normal weight G(43.3%), Overweigh G (24.8%) further[6]. Type 2 diabetes mellitus is expected to affect and obesity G (31.9%), then analyzed survey and blood test of nearly 10% of the world’s population by 2030[7]. More than total of 4485 subject. Data were analyzed using descriptive 25% of the U.S. population aged 65 years has DM[8]. The statistics, χ2-test, ANOVA, Scheffe's test Pearson correlation epidemic of type 2 diabetes is linked to increasing rates of coefficient and multiple regression analysis(SPSS 24.0). overweight and obesity in the population[9]. The major findings of this study were as follows. First, The The obesity may be associated with changes in the iron age was the highest in the overweight G(52.66y), followed by parameters, including TIBC, Obesity-related inflammation is the obesity G(50.89y) and the lowest in the normal weight expected to result in reduced serum iron levels in obese adults. G(46.67y). Obesity and Overweight G showed more female Low iron levels were present in 38.8%, 12.1%, and 4.4% of than male. Second, There was no significant difference in obese, overweight and normal-weight subject[10]. Iron plays a serum iron(μg/ dL) between normal weight G(111.80), major role not only for hemoglobin synthesis alone, but also overweight G(115.13) and obesity G(115.93), TIBC(μg/ dL) for oxidative metabolism and energy production[11]. was the highest in the obesity G(319.93), followed by the The low iron levels in overweight and obese subjects are most overweight G(312.30) and the lowest in the normal weight probably caused by the inflammatory mechanisms, which G(312.13). arrest iron in the reticuloendothelial system by releasing HbA1c(%) was the highest in the obesity G(5.97), followed different inflammatory mediators like cytokines and so by the overweight G(5.83) and the lowest in the normal forth[12]. Association of ID with obesity doubles the ill health weight G(5.64). Third, BMI was not correlated with serum effects of the obesity itself. Though chronic inflammation iron, and positive correlated with TIBC and HbA1c. In caused by excess adipose tissue, rather than dietary factors, addition, TIBC and HbA1c appeared to be a factor affecting offers a plausible explanation for ID in obese people[13]. Iron the BMI. We want to provide a basis data for the prevention deficiency is associated with concurrent decreased serum iron and management of obesity intervention program for Korean and increased TIBC levels, so that iron divided by TIBC, also adult. known as iron saturation ratio, is usually quite low[14]. There Keywords: Adult, Body mass index, Serum iron, Total iron is a relative scarcity of more specific test for the diagnosis of binding capacity, HbA1c ID or IDA like TIBC and so forth[15]. Obesity is associated with chronic, low grade, systemic inflammation, the inflammatory state plays a causal role in the INTRODUCTION development of insulin resistance[16] and obesity is one of the The global incidence of obesity has increased dramatically modifiable risk factors of type 2 diabetes[17]. The HbA1c over the past 50 years. Currently more than 1 billion people helps in detecting undiagnosed diabetes, especially in high are thought to have a BMI of more than 30kg/m²[1]. Obesity risk individuals[18]. The earliest diagnostic marker for is a condition in which fat tissue accumulates excessively in diabetes is elevated plasma glucose levels, HbA1c gives the body and causes health problems[2]. Obesity is is information on the long term control of diabetes[19], HbA1c recognized as a major risk factor for chronic diseases[3]. In may serve as a better indicator for glucose control in diabetic patients than fasting blood sugar levels[20]. In 2011, the
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World Health Organization and the American Diabetic Serum iron, TIBC and HbA1c measurement Association accepted HbA1c≥6.5% as a diagnostic criterion The blood sampling was performed in the morning after for DM and HbA1c 5.7%~6.4% as a high-risk DM[21]. WHO fasting for 8 hours or more, and cubital vein was punctured classifies BMI over 25kg/m² as overweight and over 30kg/m² using a vacutainer needle and blood was drawn into a vacuum as obesity[22]. However, it is not appropriate to apply it to tube. Measurement of the serum iron Bathophenanthroline Asians because it was developed based on the results of direct method, reagent was L-Type Fe(Wako/Japan) and it is research on westerner[23]. World Health Organization analyzed by equipment; Hitachi Automatic Analyzer Western Pacific Region[24] defines obesity as over 25kg/m² 7600(Hitachi/Japan). Measurement of the TIBC was and this criterion is applied in this study as well. Calculation, reagent was IRON+UIBC and it is analyzed by In order to rule out the effects of DM and iron deficiency equipment; Hitachi Automatic Analyzer 7600(Hitachi/Japan). anemia(IDA), subjects who were diagnosed with DM and High Performance Liquid Chromatography; HLC-723G7 IDA were excluded. we tried to suggest a fundamental data of HbA1c (Tosoh/Japan) was used for measuring HbA1c and it adult obesity prevention and management program by is analyzed by the equipment; HLC-723G7 (Tosoh/Japan). checking a correlation of BMI, serum Iron, TIBC and HbA1c, targeting a adult. Data analysis
The collected data was analyzed by SPSS WIN 24.0 METHODS program(SPSS Inc. Chicago, IL, USA). The general Research Design characteristic of subjects was analyzed by descriptive statistics. The serum iron, TIBC and HbA1c differences according to This study is a descriptive survey study which attends a BMI levels were analyzed by χ2-test, ANOVA and Scheffe's secondary analysis of The Fifth Korea National Health and test. The relationship between BMI, serum iron, TIBC and Nutrition Examination Survey's raw data to check the HbA1c was analyzed by Pearson correlation coefficient. differences of serum Iron, TIBC and HbA1c depends on Factors influencing BMI were multiple regression analysis. Korean adults' obesity degree. When the value of p is under 0.05, it is statistically meaningful. Samples and setting . The subject of this study is adult and data is based on ‘The Ethical consideration Fifth Korea National Health and Nutrition Examination The Korea National Health and Nutrition Examination Survey Survey (KNHANES V-3), 2015’ which Ministry of Health which is used in this study was reviewed from Korea Centers and Welfare and Korea Centers for Disease control and for Disease Control and Prevention and Institutional Review prevention conducted. Board(2012-01EXP-01-2C), and subject's anonymity and The total number of subjects in the Fifth Korea National confidentiality were guaranteed by collecting their private Health and Nutrition Examination Survey was 8058, subjects information in serial number which is unable to distinguish who were diagnosed with DM, IDA, under19 years old and and we pactionally conducted a 2012 annual survey(48weeks non-responders were excluded. The 4485 adults analyzed as a year). final data of this study.
RESULTS Measuring methods General characteristics of subject BMI The mean age of the subjects was 49.50, 43.3% for male and The Height and weight were measured after overnight fasting 56.7% for female. Subjective figure recognition were skinny with participants shoeless and wearing a lightweight gown. 16.3%, normal 41.2%, and obese 42.3%. Weight change over BMI was calculated as weight(kg) divided by the square of the past year showed no change(within 0-3Kg) 66.7%, weight the height(m). Based on this, the BMI weight status loss 13.4% and weight gain 19.6%. The mean variables of the cartegories are Normal weight(BMI<23kg/m²), subjects were BMI 23.75kg/m², serum iron 119.25μg/dL, Overweight(23≤BMI<25kg/m²), and Obese TIBC 314.66μg/dL and HbA1c 5.79%(Table 1). (BMI≥25kg/m²)[25]. The representative method to measure obesity is BMI, and the way to change BMI into clinical obesity category has slight difference following weight distribution of west and east[26]. This study classified subject’s in normal weight G 1941 (43.3%), Overweigh G, 1112(24.8%) and obesity G 1423(31.9%), then analyzed survey and blood test of total of 4485 subject.
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Table 1: General characteristics of subject (N=4,485)
Variables Category Mean±SD Acquired score range n(%) Age(yrs) 49.50±16.18 19~88 19~29 569(12.7) 30~39 835(18.6) 40~49 807(18.0) 50~59 915(20.4) 60~69 758(16.9) Over 70 601(13.4) Gender Male 1940(43.3) Female 2545(56.7) Subjective figure Skinny 729(16.3) recognition Normal 1847(41.2) Obese 1896(42.3) Weight change over the No change(within 0-3Kg) 2991(66.7) past year Weight loss 601(13.4) Weight gain 874(19.5) Body mass index (kg/m²) 23.75±3.35 14~43 Normal weight(BMI<23.0) 1941(43.3) Overweigh (23≤BMI<25) 1112(24.8) Obesity(BMI≥25) 1432(31.9) Serum iron(µg/dL) 119.25±46.59 6~395 TIBC(µg/dL) 314.66±41.83 157~637 HbA1c(%) 5.64±0.55 4~15
Differences in Serum iron, TIBC and HbA1c according to overweight G(mean=5.83%) and the lowest in the normal subject's BMI weight G(mean=5.64%)(F=102.602, p<0.001)(Table 2). The Serum iron(μg/dL) was not significantly different Correlation between subject's BMI, Serum iron, TIBC between the normal G (mean=111.80), overweight and HbA1c G(mean=115.13) and obesity G(mean=115.93)(F=1.732, There was a significant positive correlation between the p=0.177). subject's BMI and TIBC(r=0.085, p<0.001), HbA1c(r=0.224, The TIBC(mg/dL) was higher in the obesity G(mean=319.93) p<0.001)(Table 3). than overweight G(mean=312.30) and normal weight G(mean=312.13)(F=16.787, p<0.001). The HbA1c(%) was the highest in the obesity G(mean=5.97%) followed by the
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Table 2: Differences in Serum iron, TIBC and HbA1c according to subject's BMI (N=4,485)
Normal weigh G¹ Overweigh G² Obesity G³ n=1941(43.3%) n=1112(24.8%) n=1432(31.9%) F/χ2 Variables Category Mean±SD Mean±SD Mean±SD (p value) n(%) n(%) n(%) 57.624 Age(mean,yrs) 46.67±17.04 52.66±15.11 50.89±15.14 (<0.001)
1<3<2 19~29 359(18.5) 88(7.9) 122(8.5)
30~39 416(21.4) 165(14.8) 254(17.7)
40~49 344(17.7) 181(16.3) 282(19.7) 178.884
50~59 333(17.2) 267(24.0) 315(22.0) (<0.001)
60~69 241(12.4) 248(22.3) 269(18.8)
Over 70 248(12.8) 163(14.7) 190(13.3)
Male 714(36.8) 526(47.3) 700(48.9) 58.999 Gender Female 1227(63.2) 586(52.7) 732(51.1) (<0.001) skinny 655(33.7) 51(4.6) 23(1.6) Subjective figure 1929.252 normal 1044(53.8) 574(51.6) 229(16.0) recognition (<0.001) obese 238(12.3) 481(43.3) 1177(82.2)
No change 1384(71.3) 770(69.2) 837(58.4) Weight change (within 0-3Kg) 149.610 over the past year Weight loss 301(15.5) 129(11.6) 171(11.9) (<0.001) Weight gain 249(12.8) 206(18.5) 419(29.3) 6171.819 BMI(kg/m²) 20.80±1.62 23.98±0.56 27.58±2.51 (<0.001) 1<2<3 1.732 Serum iron(µg/dL) 111.80±49.32 115.13±46.89 115.93±46.40 (0.177) 16.787 TIBC(µg/dL) 312.13±42.12 312.30±42.15 319.93±40.71 (<0.001) 1,2<3 102.602 HbA1c(%) 5.64±0.75 5.83±0.78 5.97±0.89 (<0.001) 1<2<3
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Table 3: Correlation between subject's BMI, Iron, TIBC and HbA1c (N=4,485) Variables BMI Serum iron TIBC HbA1c r (p value) BMI 1 Serum iron 0.020(0.184) 1 TIBC 0.085(<0.001) 0.048(0.001) 1 HbA1c 0.224(<0.001) -0.075(<0.001) 0.067(<0.001) 1
Table 4:. Factors affecting BMI in the adult subjects (N=4,485)
Model I Model II β t (p value) β t (p value) Age 0.167 15.509(<0.001) 0.137 12.197(<0.001) Gender -0.194 -18.184(<0.001) -0.200 -18.098(<0.001) Subjective figure recognition 0.697 61.962(<0.001) 0.680 60.691(<0.001) Weight change over the past year 0.175 16.285(<0.001) 0.170 16.078(<0.001) Serum iron -0.011 -1.019(0.308)
TIBC 0.052 4.813(<0.001)
HbA1c 0.107 9.590(<0.001)
Constant 80.823(<0.001) 25.716(<0.001)
R2 0.704 0.754 Adj R2 0.495 0.568 F (p) 1099.082(<0.001) 890.776(<0.001)
Factors affecting BMI in the adult subjects added as a variable that affected the subject's BMI. The explanatory power was improved by 7.3% over the model I. In order to confirm the relative influence of factors influencing BMI, we conducted a hierarchical regression analysis(Table 4) after controlling the age, gender, Subjective DISCUSSION figure recognition, Weight change over the past year that could affect the subject's BMI. In the model I, the control The study was to investigate the relationship between serum variable was used. In model II, the model I was used as the iron, TIBC and HbA1c according to BMI in Korean adults. independent variable Serum iron, TIBC and HbA1c. In this study, the age was found to be higher in the overweight Model I indicates the degree of influence of the control and obese G than in the normal G and overweight, obesity G variables on the subject's BMI. The regression model fit was showed more female than male. Obesity reports issued in statistically significant at 1099.082(<0.001). Age(β=0.167, 2014, from among 109 billion overweight adults over the age p<0.001), Gender(β=-0.194, p<0.001), Subjective figure 18,600 million were obese[27]. The studies, overweight and recognition(β=0.697, p<0.001) and Weight change over the obese G were older than normal[28], the results of this study past year(β=0.175, p<0.001) were found to affect the BMI of are the same. As get older, your basic metabolism decreases the subjects. and your weight gradually increases, with an average increase of 250g per year[29]. This is more common in women and is The regression model fit of model II was 890.776(<0.001), being considered as the most serious threat to human health TIBC(β=0.052, p<0.001) and HbA1c(β=0.107, p<0.001) was by different authorities[30]. The body weight is increased
15834 International Journal of Applied Engineering Research ISSN 0973-4562 Volume 12, Number 24 (2017) pp. 15830-15837 © Research India Publications. http://www.ripublication.com before and after menopause. Basal metabolic rate, which is the factor affecting the BMI of the subjects. Obesity is main factor of energy expenditure, gradually decreases from characterized by the presence of low-grade inflammation and 50 years old, but decreases by 2~3% in 10 years[31]. the risk of developing a number of chronic diseases such as impaired glucose tolerance, and type 2 diabetes[16]. Increased Overweight individuals are at higher risk of iron deficiency BMI among adults with DM reflected better HbA1c[41]. than normal-weight individuals[32]. The study found that both HbA1c is a form of hemoglobin that is measured in order to normal and obese female subjects had lower iron and identify the average concentration of plasma glucose over the hemoglobin levels than male[33]. Elevated BMI is associated relatively long term period of two to three months prior to the with lower iron, These findings may be explained by the date of measurement[42]. HbA1C levels in non-diabetic chronic inflammation of obesity and may contribute to normal between 4% to 6%[43]. A positive correlation between obesity-related co-morbidities[34], The supported the results BMI and HbA1c was report also BMI was an influential of this study. factor for HbA1c[44], The results of this study are the same. In this study, BMI was not correlated with serum iron, serum Any decrease in HbA1C of 1% will reduce the risk of death iron had no significant difference in obesity G, overweight G, from diabetes by 21%, 14% of heart attack, microvascular and normal weight G. Serum iron had no significant complications by 37% and 43% peripheral vascular difference in obesity G, overweight G, and normal weight disease[45]. Those obese both in childhood and in adulthood G[28], It shows similar results with this paper. However, the increased the risk of diabetes diagnosed by HbA1c in adults study, overweight and obesity were defined as 25≤BMI<30 was 5.93times[46]. One mechanism to explain the relationship and BMI≥30[28], which is different from the obesity to an increase in blood glucose levels in obese people which classification criteria of this study. There is a need to study the resulted in HbA1c levels also increased is through an increase standardized obesity assessment method in relation to obesity in body weight[47]. Supporting the results of this study. and serum iron. In this study, it is meaningful to confirm the difference On the other hand, Obesity and ID are the most common between serum iron, TIBC and HbA1c according to BMI of nutritional disorders worldwide[35]. Iron plays a vital role in Korean adult. The results of this study are intended to provide hemoglobin production and erythrocyte maturation[34]. Iron basic data for prevention and management of obesity in homeostasis in the body is controlled by a very complex Korean adults. mechanism, the main components of which are erythropoietic activity, hypoxia, iron stores, and inflammation[36]. In adult study, found significantly lower levels of serum iron in obese CONCLUSION people when compared to non-obese adults[37]. They In this study, BMI of Korean adults was significantly positive reported that the obese and the non-obese subjects did not correlated with TIBC and HbA1c. The TIBC and HbA1c are differ in daily iron consumption but that fat mass was a influencing factor of BMI, and TIBC and HbA1c were the significant negative predictor of serum iron[38]. The low- highest in the obese G. grade inflammation induced by the aforementioned cytokines In conclusion, adult obesity prevention and management may contribute to the development of obesity-associated programs should include serum iron, TIBC and HbA1c. anemia[39], This study, which showed no difference in serum iron according to BMI, was different from the general study results. After that, repeated studies that control racial ACKNOWLEDGEMENTS background, regional differences, socioeconomic level, This work was supported by 2017 Hannam University lifestyle, and age are necessary. Research Fund. In this study, BMI and TIBC were positive correlations, TIBC showed higher obesity G than overweight and normal weight G. In addition, TIBC appeared to be a factor affecting the REFERENCES BMI of the subjects. TIBC is a test required for ID or IDA [1] Chung, B., Matak, P., McKie, A.T., and Sharp, P., diagnosis[15]. 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