Top

European Journal of Medical Research

Published in:

Open Access 01-12-2023 | Obesity | Research

The association of body mass index and weight waist adjustment index with serum ferritin in a national study of US adults

Authors: Hao Han, Ping Ni, Siqi Zhang, Xiaojuan Ji, Mingli Zhu, Wanyu Ma, Hongfeng Ge, Hailiang Chu

Published in: European Journal of Medical Research | Issue 1/2023

Abstract

Background

Abnormal serum ferritin levels are associated with a variety of diseases. Meanwhile, abnormal serum ferritin is influenced by a variety of risk factors, but its correlation with obesity remains poorly described.

Objective

This study aimed to investigate the association of body mass index (BMI) and weight waist adjustment index (WWI) with serum ferritin in US adults.

Methods

Participants in this study took part in the National Health and Nutrition Examination Survey (NHANES) prior to the pandemic from 2017 to March 2020. Serum ferritin was used as the sole response variable and BMI and WWI were used as independent variables. Multiple linear regression was used to assess the relationship between serum ferritin and the independent variables, and smoothed curve fitting and threshold effects analysis were performed to assess the presence of non-linear relationships. To validate the sensitive individuals for the correlation between the independent and the dependent variables, a subgroup analysis was performed.

Results

A final total of 7552 participants were included in this study. Both independent variables had a positive relationship with serum ferritin, with effect values of (β = 0.68, 95% CI: 0.17–1.19) when BMI was the independent variable and (β = 8.62, 95% CI: 3.53–13.72) when WWI was the independent variable in the fully adjusted model. This positive association between the two obesity-related indexes and serum ferritin became more significant as BMI and WWI increased (P for trend < 0.001). In subgroup analyses, the positive association between the independent variables and serum ferritin was more pronounced in participants who were male, 40–59 years old, white, and had diabetes and hypertension. In addition, smoothed curve fitting and threshold effects analysis demonstrated a linear positive association of BMI and WWI with serum ferritin.

Conclusions

In the US adult population, while there was a linear positive association of WWI and BMI with serum ferritin, the effect values between WWI and serum ferritin were more significant. Male, 40–59 years old, white, participants with diabetes and hypertension should be cautious that higher WWI might entail a risk of higher serum ferritin levels.

Available only for authorised users

Knovich MA, Storey JA, Coffman LG, Torti SV, Torti FM. Ferritin for the clinician. Blood Rev. 2009;23:95–104. https://doi.org/10.1016/j.blre.2008.08.001.CrossRefPubMed

Piperno A, Pelucchi S, Mariani R. Inherited iron overload disorders. Transl Gastroenterol Hepatol. 2020;5:25. https://doi.org/10.21037/tgh.2019.11.15.CrossRefPubMedPubMedCentral

Kushner JP, Porter JP, Olivieri NF. Secondary iron overload. Hematology Am Soc Hematol Educ Program. 2001. https://doi.org/10.1182/asheducation-2001.1.47.CrossRefPubMed

You SA, Wang Q. Ferritin in atherosclerosis. Clin Chim Acta. 2005;357:1–16. https://doi.org/10.1016/j.cccn.2005.02.001.CrossRefPubMed

Dhiman P, Kollipaka R. Association of hypothyroidism with low serum ferritin levels and iron-deficiency anemia during the first trimester of pregnancy. Cureus. 2022;14:e28307. https://doi.org/10.7759/cureus.28307.CrossRefPubMedPubMedCentral

Kalantar-Zadeh K, Kalantar-Zadeh K, Lee GH. The fascinating but deceptive ferritin: to measure it or not to measure it in chronic kidney disease. Clin J Am Soc Nephrol. 2006;1(Suppl 1):S9-18. https://doi.org/10.2215/CJN.01390406.CrossRefPubMed

Cullis JO, Fitzsimons EJ, Griffiths WJ, Tsochatzis E, Thomas DW. Investigation and management of a raised serum ferritin. Br J Haematol. 2018;181:331–40. https://doi.org/10.1111/bjh.15166.CrossRefPubMed

Purdy JC, Shatzel JJ. The hematologic consequences of obesity. Eur J Haematol. 2021;106:306–19. https://doi.org/10.1111/ejh.13560.CrossRefPubMed

Ward ZJ, Bleich SN, Cradock AL, Barrett JL, Giles CM, Flax C, et al. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med. 2019;381:2440–50. https://doi.org/10.1056/NEJMsa1909301.CrossRefPubMed

10.

Fantuzzi G. Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol. 2005;115:911–9. https://doi.org/10.1016/j.jaci.2005.02.023.CrossRefPubMed

11.

Gregor MF, Hotamisligil GS. Inflammatory mechanisms in obesity. Annu Rev Immunol. 2011;29:415–45. https://doi.org/10.1146/annurev-immunol-031210-101322.CrossRefPubMed

12.

Ali NB, Dibley MJ, Islam S, Rahman MM, Raihana S, Bhuiyan S, et al. Overweight and obesity among urban women with iron deficiency anaemia in Bangladesh. Matern Child Nutr. 2021;17:e13102. https://doi.org/10.1111/mcn.13102.CrossRefPubMed

13.

Bettini S, Bucca G, Sensi C, Dal Prà C, Fabris R, Vettor R, et al. Higher Levels of C-Reactive Protein and Ferritin in Patients with Overweight and Obesity and SARS-CoV-2-Related Pneumonia. Obes Facts. 2021;14:543–9. https://doi.org/10.1159/000517851.CrossRefPubMedPubMedCentral

14.

Johansen KL. Obesity and body composition for transplant wait-list candidacy–challenging or maintaining the BMI limits. J Ren Nutr. 2013;23:207–9. https://doi.org/10.1053/j.jrn.2013.02.005.CrossRefPubMedPubMedCentral

15.

Dixon AE, Peters U. The effect of obesity on lung function. Expert Rev Respir Med. 2018;12:755–67. https://doi.org/10.1080/17476348.2018.1506331.CrossRefPubMedPubMedCentral

16.

Rothman KJ. BMI-related errors in the measurement of obesity. Int J Obes (Lond). 2008;32(Suppl 3):S56–9. https://doi.org/10.1038/ijo.2008.87.CrossRefPubMed

17.

Qin Z, Chang K, Yang Q, Yu Q, Liao R, Su B. The association between weight-adjusted-waist index and increased urinary albumin excretion in adults: a population-based study. Front Nutr. 2022;9:941926. https://doi.org/10.3389/fnut.2022.941926.CrossRefPubMedPubMedCentral

18.

Oliveros E, Somers VK, Sochor O, Goel K, Lopez-Jimenez F. The concept of normal weight obesity. Prog Cardiovasc Dis. 2014;56:426–33. https://doi.org/10.1016/j.pcad.2013.10.003.CrossRefPubMed

19.

Ross R, Neeland IJ, Yamashita S, Shai I, Seidell J, Magni P, et al. Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nat Rev Endocrinol. 2020;16:177–89. https://doi.org/10.1038/s41574-019-0310-7.CrossRefPubMedPubMedCentral

20.

Kolb H. Obese visceral fat tissue inflammation: from protective to detrimental. BMC Med. 2022;20:494. https://doi.org/10.1186/s12916-022-02672-y.CrossRefPubMedPubMedCentral

21.

Matsuzawa Y, Shimomura I, Nakamura T, Keno Y, Kotani K, Tokunaga K. Pathophysiology and pathogenesis of visceral fat obesity. Obes Res. 1995;3(Suppl 2):187S-194S. https://doi.org/10.1002/j.1550-8528.1995.tb00462.x.CrossRefPubMed

22.

Banerji MA, Faridi N, Atluri R, Chaiken RL, Lebovitz HE. Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men. J Clin Endocrinol Metab. 1999;84:137–44. https://doi.org/10.1210/jcem.84.1.5371.CrossRefPubMed

23.

Park Y, Kim NH, Kwon TY, Kim SG. A novel adiposity index as an integrated predictor of cardiometabolic disease morbidity and mortality. Sci Rep. 2018;8:16753. https://doi.org/10.1038/s41598-018-35073-4.CrossRefPubMedPubMedCentral

24.

Kim NH, Park Y, Kim NH, Kim SG. Weight-adjusted waist index reflects fat and muscle mass in the opposite direction in older adults. Age Ageing. 2021;50:780–6. https://doi.org/10.1093/ageing/afaa208.CrossRefPubMed

25.

Kim JY, Choi J, Vella CA, Criqui MH, Allison MA, Kim NH. Associations between weight-adjusted waist index and abdominal fat and muscle mass: multi-ethnic study of atherosclerosis. Diabetes Metab J. 2022;46:747–55. https://doi.org/10.4093/dmj.2021.0294.CrossRefPubMedPubMedCentral

26.

Han X, He X, Hao G, Cao L, Qi Y, Han K. The association of asthma duration with body mass index and Weight-Adjusted-Waist index in a nationwide study of the US adults. Eur J Med Res. 2023;28:122. https://doi.org/10.1186/s40001-023-01089-4.CrossRefPubMedPubMedCentral

27.

Chung SJ, Lim HS, Lee MY, Lee YT, Yoon KJ, Park CH. Sex-specific associations between serum ferritin and osteosarcopenic obesity in adults aged over 50 years. Nutrients. 2022. https://doi.org/10.3390/nu14194023.CrossRefPubMedPubMedCentral

28.

Park SK, Choi WJ, Oh CM, Kim J, Shin H, Ryoo JH. Association between serum ferritin levels and the incidence of obesity in Korean men: a prospective cohort study. Endocr J. 2014;61:215–24. https://doi.org/10.1507/endocrj.ej13-0173.CrossRefPubMed

29.

Andrews M, Soto N, Arredondo-Olguín M. Association between ferritin and hepcidin levels and inflammatory status in patients with type 2 diabetes mellitus and obesity. Nutrition. 2015;31:51–7. https://doi.org/10.1016/j.nut.2014.04.019.CrossRefPubMed

30.

Shim YS, Kang MJ, Oh YJ, Baek JW, Yang S, Hwang IT. Association of serum ferritin with insulin resistance, abdominal obesity, and metabolic syndrome in Korean adolescent and adults: The Korean National Health and Nutrition Examination Survey, 2008 to 2011. Medicine (Baltimore). 2017;96:e6179. https://doi.org/10.1097/MD.0000000000006179.CrossRefPubMed

31.

Bjerregaard LG, Pedersen DC, Mortensen EL, Sørensen T, Baker JL. Breastfeeding duration in infancy and adult risks of type 2 diabetes in a high-income country. Matern Child Nutr. 2019;15:e12869. https://doi.org/10.1111/mcn.12869.CrossRefPubMedPubMedCentral

32.

Jaddoe VW, de Jonge LL, Hofman A, Franco OH, Steegers EA, Gaillard R. First trimester fetal growth restriction and cardiovascular risk factors in school age children: population based cohort study. BMJ. 2014;348:g14. https://doi.org/10.1136/bmj.g14.CrossRefPubMedPubMedCentral

33.

Rogero MM, Calder PC. Obesity, inflammation, toll-like receptor 4 and fatty acids. Nutrients. 2018. https://doi.org/10.3390/nu10040432.CrossRefPubMedPubMedCentral

34.

Ferrucci L, Guralnik JM, Woodman RC, Bandinelli S, Lauretani F, Corsi AM, et al. Proinflammatory state and circulating erythropoietin in persons with and without anemia. Am J Med. 2005;118:1288. https://doi.org/10.1016/j.amjmed.2005.06.039.CrossRefPubMed

35.

Zandman-Goddard G, Shoenfeld Y. Ferritin in autoimmune diseases. Autoimmun Rev. 2007;6:457–63. https://doi.org/10.1016/j.autrev.2007.01.016.CrossRefPubMed

36.

Mahroum N, Alghory A, Kiyak Z, Alwani A, Seida R, Alrais M, et al. Ferritin—from iron, through inflammation and autoimmunity, to COVID-19. J Autoimmun. 2022;126:102778. https://doi.org/10.1016/j.jaut.2021.102778.CrossRefPubMed

37.

Alkhateeb AA, Connor JR. The significance of ferritin in cancer: anti-oxidation, inflammation and tumorigenesis. Biochim Biophys Acta. 2013;1836:245–54. https://doi.org/10.1016/j.bbcan.2013.07.002.CrossRefPubMed

38.

Festa A, Agostino R Jr, Williams K, Karter AJ, Mayer-Davis EJ, et al. The relation of body fat mass and distribution to markers of chronic inflammation. Int J Obes Relat Metab Disord. 2001;25:1407–15. https://doi.org/10.1038/sj.ijo.0801792.CrossRefPubMed

39.

Park HS, Park JY, Yu R. Relationship of obesity and visceral adiposity with serum concentrations of CRP, TNF-alpha and IL-6. Diabetes Res Clin Pract. 2005;69:29–35. https://doi.org/10.1016/j.diabres.2004.11.007.CrossRefPubMed

40.

Rushton DH, Barth JH. What is the evidence for gender differences in ferritin and haemoglobin. Crit Rev Oncol Hematol. 2010;73:1–9. https://doi.org/10.1016/j.critrevonc.2009.03.010.CrossRefPubMed

41.

Ellidag HY, Eren E, Akdag M, Giray O, Kiraz K, Yilmaz N. The relationship between serum ferritin levels and serum lipids and HDL function with respect to age and gender. Ukr Biochem J. 2016;88:76–86. https://doi.org/10.15407/ubj88.06.076.CrossRefPubMed

42.

Gellner R, Domschke W. Epidemiology of obesity, Chirurg. (2008) 79:807–10, 812–6, 818. doi: https://doi.org/10.1007/s00104-008-1534-6

43.

Lemamsha H, Randhawa G, Papadopoulos C. Prevalence of overweight and obesity among libyan men and women. Biomed Res Int. 2019;2019:8531360. https://doi.org/10.1155/2019/8531360.CrossRefPubMedPubMedCentral

44.

Kwon H, Kim D, Kim JS. Body fat distribution and the risk of incident metabolic syndrome: a longitudinal cohort study. Sci Rep. 2017;7:10955. https://doi.org/10.1038/s41598-017-09723-y.CrossRefPubMedPubMedCentral

45.

Iwasaki T, Nakajima A, Yoneda M, Yamada Y, Mukasa K, Fujita K, et al. Serum ferritin is associated with visceral fat area and subcutaneous fat area. Diabetes Care. 2005;28:2486–91. https://doi.org/10.2337/diacare.28.10.2486.CrossRefPubMed

46.

Pasquali R. Obesity and androgens: facts and perspectives. Fertil Steril. 2006;85:1319–40. https://doi.org/10.1016/j.fertnstert.2005.10.054.CrossRefPubMed

47.

Yamashita N, Oba K, Nakano H, Metori S. Age-related changes in concentrations of ferritin, glyeosylated ferritin, and non-glycosylated ferritin. Nihon Ronen Igakkai Zasshi. 1996;33:754–60. https://doi.org/10.3143/geriatrics.33.754.CrossRefPubMed

48.

Ueno Y, Fujita K, Takashina N, Chiba S, Uzuka Y, Kinouchi T, et al. Studies on the change in the levels of serum ferritin, serum iron and total iron binding capacity caused by aging and sex difference. Rinsho Byori. 1991;39:523–30.PubMed

49.

Milman N. Serum ferritin in Danes: studies of iron status from infancy to old age, during blood donation and pregnancy. Int J Hematol. 1996;63:103–35. https://doi.org/10.1016/0925-5710(95)00426-2.CrossRefPubMed

50.

Hao H, Chen Y, Xiaojuan J, Siqi Z, Hailiang C, Xiaoxing S, et al. The association between METS-IR and serum ferritin level in United States female: a cross-sectional study based on NHANES. Front Med (Lausanne). 2022;9:925344. https://doi.org/10.3389/fmed.2022.925344.CrossRefPubMedPubMedCentral

51.

Peng P, Xiao F, Gao S, Fang W, Lin T, He W, et al. Association between serum ferritin and bone mineral density in US adults. J Orthop Surg Res. 2022;17:494. https://doi.org/10.1186/s13018-022-03357-1.CrossRefPubMedPubMedCentral

52.

Ogden CL, Fakhouri TH, Carroll MD, Hales CM, Fryar CD, Li X, et al. Prevalence of obesity among adults, by household income and education—United States, 2011–2014. MMWR Morb Mortal Wkly Rep. 2017;66:1369–73. https://doi.org/10.15585/mmwr.mm6650a1.CrossRefPubMedPubMedCentral

Title: The association of body mass index and weight waist adjustment index with serum ferritin in a national study of US adults
Authors: Hao Han
Ping Ni
Siqi Zhang
Xiaojuan Ji
Mingli Zhu
Wanyu Ma
Hongfeng Ge
Hailiang Chu
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Obesity
Obesity
Published in: European Journal of Medical Research / Issue 1/2023
Electronic ISSN: 2047-783X
DOI: https://doi.org/10.1186/s40001-023-01343-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The association of body mass index and weight waist adjustment index with serum ferritin in a national study of US adults

Abstract

Background

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2023

A review of neurological side effects of COVID-19 vaccination

Facial nerve in skullbase tumors: imaging and clinical relevance

Analysis of the differential expression and prognostic relationship of DEGs in AML based on TCGA database

Predicting mammographic density with linear ultrasound transducers

A landscape on disorders following different COVID-19 vaccination: a systematic review of Iranian case reports

Role of crescents for lupus nephritis in clinical, pathological and prognosis: a single-center retrospective cohort study