Is There Any Relation Between Iron Deficiency Anemia and Lipid Profile in Women Aged 18-45 Years Old?: a Unicenter Retrospective Study

Acta Medica Mediterranea, 2018, 34: 1949

IS THERE ANY RELATION BETWEEN IRON DEFICIENCY ANEMIA AND LIPID PROFILE IN WOMEN AGED 18-45 YEARS OLD?: A UNICENTER RETROSPECTIVE STUDY

FATMA AVCI MERDİN1, ALPARSLAN MERDİN2 1Internal Medicine Clinic, University of Health Sciences Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey - 2Hematology Clinic and Bone Marrow Transplantation Unit, University of Health Sciences Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey

ABSTRACT

Introduction: Iron deficiency anemia (IDA) is commonly seen among premenopausal women with anemia. Iron is a vital nutrient that plays a role in some metabolic pathways. This study aims to determine whether there is a relationship between iron deficiency anemia and lipid profile by comparing serum triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol levels in patients with IDA and healthy controls. Materials and methods: The study included 56 female patients admitted to the Internal Medicine Outpatient Unit of University of Health Sciences Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital between 15 October 2016 and 30 June 2017. All 56 patients were diagnosed with iron deficiency anemia. Patients with certain diseases that may affect lipid profile such as hypertension, diabetes mellitus, and thyroid diseases, as well as those using medications that could affect serum cholesterol levels were not included in the study. Besides, patients with known infectious or inflammatory diseases were excluded from the study. The study also included 37 healthy women as control group. All of 37 healthy women were admitted to outpatient unit for routine tests and they had no known illnesses, either anemia or any known clinical condition that could affect their lipid levels. All of 37 healthy women and all of 56 female patients were 18-45 years old. Serum triglyceride, total cholesterol, HDL cholesterol, LDL cholesterol, iron, and ferritin levels, and hemogram parameters were evaluated retrospectively on the electronic patient file system. Results: The triglyceride, total cholesterol, HDL cholesterol and LDL cholesterol levels were compared between the two groups, and there were no statistically significant differences between the two groups in terms of triglyceride and HDL cholesterol levels (p>0.05). However, there was a statistically significant difference between the two groups with regard to total cholesterol levels (Z= -2.245; p=0.025). There was a statistically significant difference between the two groups with respect to LDL cholesterol levels (Z= -1.998; p=0.046). LDL cholesterol levels of patients with iron-deficiency anemia were found to be significantly higher than those of the control group. The mean age of the patients with iron deficiency anemia was also found to be significantly higher than that of the control group (Z= -2.925, p=0.003). Conclusion: It should be kept in mind that LDL cholesterol levels might be affected in patients with iron deficiency anemia.

Keywords: Iron deficiency, anemia, lipid profile, relation.

DOI: 10.19193/0393-6384_2018_6_303

Received July 12, 2018; Accepted August 30, 2018

Introduction Iron-deficiency anemia (IDA) is a common type of anemia in premenopausal women. A WHO (World Health Organization) scientif- Inadequate dietary iron intake, acute/chronic bleed- ic group reported that anemia existed in non-preg- ings, and conditions that lead to impaired iron nant females who had hemoglobine levels below 12 absorption from the digestive tract may be responsi- mg/dL(1). It was also reported that anemia existed in ble for iron deficiency. Iron is a vital nutrient that adult males who had hemoglobine levels below 13 plays roles in the pathways of oxygen transport and mg/dL(1). energy metabolism. 1950 Fatma Avci Merdin, Alparslan Merdin

Davis MR et al. reported metabolic alterations All of 37 healthy women and all of 56 female in glucose and lipid metabolisms in their study con- patients were 18-45 years old. Serum triglyceride, ducted on iron-deficient rats(2). Bristow-Craig H.E. total cholesterol, HDL cholesterol, LDL cholesterol, et al., in a study conducted on rats, investigated the iron, and ferritin levels, and hemogram parameters effect of dietary iron levels on blood lipids and were evaluated retrospectively on the electronic endogenous antioxidants and found an association patient file system. Prior to this study, a written per- between dietary iron levels and cholesterol levels(3). mission was obtained from the University of Health Cunnane et al. also demonstrated in their study that Sciences Ankara Dr. Abdurrahman Yurtaslan mild impairment in essential fatty acid metabolism Oncology Training and Research Hospital. might occur in rats with moderate iron deficiency(4). Exclusion Criteria: People under 18 years of In addition, Choi J.W. et al. showed that serum total age and over 45 years of age , males, people with cholesterol and triglyceride concentrations were accompanying hypothyroidism, people with known lower in girls with severe iron deficiency anemia cardiovascular diseases, people with diabetes melli- and returned to normal levels after iron replacement tus, patients with malignancy, patients with known therapy(5). Furthermore, Ohira Y. et al. reported that rheumatic diseases were not included in this study. serum total cholesterol levels increased after the Those with known clinical illnesses that might administration of erythrocyte suspension and iron affect the levels of ferritin were also excluded. supplements(6). Using medications that may affect serum choles- In their study including 64 premenopausal terol levels (such as statin group medications ) was women with iron-deficiency anemia and 21 healthy also an exclusion criteria for this study. In addition, female controls, Ozdemir et al. found that total cho- anemia patients with low levels of vitamin B12 lesterol and LDL cholesterol levels were lower in and/or folic acid were not included in the study. the patients with iron deficiency(7). Hereby, we Women known to be pregnant at the time of the aimed to determine whether there is a relationship study were also not included in the study. between iron deficiency anemia and lipid profile by comparing serum triglyceride (TG), total choles- Statistical Analysis terol (TC), high-density lipoprotein (HDL) choles- Statistical analyses were performed using a terol and low-density lipoprotein (LDL) cholesterol software package called SPSS (IBM SPSS levels in patients with IDA and healthy controls. Statistics 20). Parametric methods were used for the measurement values with normal distribution. Materials and methods “Kolmogorov-Smirnov” test was used for testing normality because the sample sizes were over 30. A total of 56 female patients admitted to the “Independent Sample-t” test (t-value) statistics Internal Medicine Outpatient Unit of University of were used to compare two independent groups, in Health Sciences Ankara Dr. Abdurrahman Yurtaslan accordance with the parametric methods. On the Oncology Training and Research Hospital between other hand, non-parametric methods were used for 15 October 2016 and 30 June 2017 and diagnosed the measurement values that were not normally dis- with iron deficiency anemia were included in this tributed. The “Mann-Whitney U” test (Z-score) was study. Patients with known diseases that may affect used to compare the measurement values of two lipid profile such as hypertension, diabetes mellitus, independent groups, in accordance with the non- and thyroid diseases, as well as those using medica- parametric methods. A p value of lower than 0.05 tions that could affect serum cholesterol levels were (p<0.05) was considered statistically significant. not included in the study. Besides, patients with known infectious or inflammatory diseases were Results excluded from the study. All of 56 female patients had hemoglobin levels below 12 g/dL and ferritin 56 female patients with iron deficiency anemia levels below 15 ng/mL. and 37 healthy women were included in this study. The study also included 37 healthy women as All female patients and healthy women were 18-45 control group. All 37 healthy women were admitted years old. The triglyceride, total cholesterol, HDL to outpatient unit for routine tests and they had no cholesterol and LDL cholesterol levels were com- known illnesses, either anemia or any clinical con- pared between the two groups, and there were no dition that could affect their lipid levels. statistically significant differences between the two Is there any relation between Iron deficiency anemia and lipid profile in women aged 18-45 yeras old... 1951 groups in terms of triglyceride levels (Z= -1.872; However, they also reported a significant p=0.061) and HDL cholesterol levels (t-value = decrease in triglyceride levels when they gave iron 0.997 ; p=0.321) (Table 1). However, there was a supplement to the group with severe iron deficien- statistically significant difference between the two cy(9). Sherman et al., in an experimental study con- groups with regard to total cholesterol levels (Z= - ducted on 3 groups of pregnant rats, gave each 2.245; p=0.025) (Table 1). Total cholesterol levels group a different amount of iron supplement and of patients with iron-deficiency anemia were found found that triglyceride and cholesterol levels were to be significantly higher than the healthy controls’ high in the rat pups of the group given the lowest (Table 1). level of iron supplement(10). There was a statistically significant difference Shirvani et al., in their study conducted on between the two groups with respect to LDL cho- elderly patients, demonstrated that serum triglyc- lesterol levels (Z= -1.998; p=0.046) (Table 1). LDL eride, cholesterol and LDL levels were lower in the cholesterol levels of patients with iron-deficiency iron deficiency group than in the control group(11). anemia were found to be significantly higher than On the other hand, Yang et al. reported that women those of the control group (Table 1). with iron deficiency anemia had higher serum There was also a significant difference triglyceride levels than healthy controls, while they between the groups in terms of mean age (Z=- had lower HDL cholesterol levels than healthy con- 2.925; p=0.003) (Table 1). The mean age of the trols(12). In our study, although there was a statisti- patients with iron deficiency anemia was signifi- cally significant difference in total cholesterol lev- cantly higher than that of the healthy controls els between healthy controls and patients with iron (Table 1). deficiency anemia, no statistically significant difference was found between triglyceride and HDL cho- Groups Statistical Analysis lesterol levels. Iron deficiency Control group Variable (N=93) Probability Verma et al., in a study involving Indian popu- anemia (n=56) (n=37) lation, found higher levels of triglyceride and Age (years) 38.0 [19.0-45.0] 28.0 [18.0-45.0] p=0.003 VLDL cholesterol and lower levels of LDL cholesterol in the group with iron-deficiency anemia(13). In Triglyceride 89.0 [42.0-216.0] 76.0 [37.0-398.0] p=0.061 addition, Balder J.W. et al. showed that there were Total Cholesterol 176.0 [110.0-274.0] 153.0 [114.0-288.0] p=0.025 age-related differences in plasma LDL cholesterol levels(14). Besides, Balder J.W. et al. also reported LDL Cholesterol 107.5 [31.0-197.0] 90.0 [60.0-215.0] p=0.046 that LDL cholesterol did not change from 18 till 35 (14) HDL Cholesterol 50.59±11.75 48.27±9.68 p=0.321 years of age in women . On the other hand, we found that LDL cholesterol levels were higher in Table I: Comparison of certain parameters according to the status of iron deficiency anemia. women with iron-deficiency anemia than those of the control group. In addition, the median age of the Discussion and conclusion IDA group in our study was higher than the control group. Dyslipidemia is a term that refers to elevated In conclusion, it should always be kept in or reduced levels and/or functional impairment of mind that patients with iron deficiency anemia lipoproteins. While primary dyslipidemias occur might have altered LDL cholesterol levels. In cases due to hereditary defects in lipoprotein metabolism, with dyslipidemia accompanying iron deficiency secondary dyslipidemias comprise lipid profile dis- anemia, it might be beneficial to reconsider the orders caused by other underlying factors. Known treatment plan and the follow-up period of dyslipi- causes of secondary dyslipidemias include obesity, demia after the re-analysis of clinical and laborato- hypothyroidism, sedentary lifestyle, type 2 diabetes ry findings following the iron deficiency treatment. mellitus, chronic kidney disease, excessive alcohol consumption, primary biliary cirrhosis, cholestatic liver diseases, rheumatic diseases, nephrotic syn- drome, HIV infection and some medications(8). Iron is utilised in some metabolic pathways. Amine et al. reported an increase in triglyceride levels in rats with severe iron deficiency anemia(9). 1952 Fatma Avci Merdin, Alparslan Merdin

References

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