Comparison of hepcidin and iron metabolism between obesity with fatty liver-obesity without fatty liver and healthy control

Objectives: Measurement of levels of hepcidin, hematological parameters and iron metabolism were analyzed between the obese patients with fatty liver and the ones without fatty liver and healthy control group. Patients and methods: A total of 110 children (50 obese patients without fatty liver , 30 obese patients with fatty liver , 30 healthy children) with age interval 7-18 years, at the department of pediatric polyclinic of Abant İzzet Baysal University were included in the study. Children with body mass index higher than 95% by considering age and gender were defined as obese. Children received. Iron treatment in the last six months, active infection, a condition associated with inflammation, the ones with significant risk for iron deficiency, and the children with the red blood cell dysfunctions were not included in the study . The study was approved by the Ethics Committee of Abant İzzet Baysal University. After overnight fast for 12 hours complete blood count, ferritin, iron, iron binding capasity, lipid profile, liver function tests, serum hepcidin levels with fasting blood glucose and insulin levels were examined from all patients. HOMA-index was calculated to predict levels insulin sensitivity. Liver examinations were performed by an experienced sonographer and findings were determined by the US scoring system according to the degree of increased echogenicity, the right half of the diaphragm and intrahepatic vessels view. Results: Thirty healthy control and 80 obese children completed the study. Thirty children in the obese group were with fatty liver. The average age and sex distrubition of 80 obese children and control grup were similar (p=0.345 and p=0.876 respectively). The average of size were similar in two groups (p=0.589). There was significant difference between the two groups in weight for height ratio and body mass index ( p<0.001 and p<0.001 respectively). There was a grader difference between the obese patients with fatty liver compared to the obese ones without fatty liver.The obese boys were more likely than the obese girls to have fatty liver (p=0.01). The percentages of weight for height was significantly higher in obese patients with fatty liver ( p=0.001). Obese patients' white blood cell count was significantly higher than the control group but platelet values were not significantly different (p=0.030 and p=0.058 respectively). Also there was no significant difference between the two groups in mean platelet volume (p=0.828). Total cholesterol and triglyceride levels in patients with obesity were significantly higher ( p=0.042 and p=0.005 respectively). High density lipoprotein (HDL) levels were not significantly different (p=0,808). Alanine aminotransferase (ALT) levels and insulin resistance (HOMA index) in patients with obesity were significantly higher (p=0.002 and p<0.001 respectively). Aspartate aminotransferase levels were not different between the two groups (p=0.419). There was no significant difference in Hb (hemoglobin), hematocrit (Htc), mean corpuscular volume (MCV), MCH (mean corpuscular hemoglobin), mean corpuscular hemoglobin concentration (MCHC) and RDW (red cell distribution width) levels between obese patients and the healthy control group(p=0.543, p=0.995, p=0.17, p=0.62, p=0.11 and p=0.30 respectively). The average iron level in obese patients was lower but the levels of iron and iron binding capacity, there was no statistically significiant difference (p=0.287 and p=0.806 respectively). Also ferritin levels were higher in obese patients compared to the control group but there was no significant difference in ferritin levels (p=0.07). Likewise transferrin saturation was no significant difference between the control group and obese patients (p=0.475). Hepcidin levels of obese patients were higher than the control group but this difference was not significant (p=0.117). There was no significant difference in white blood cell count and platelet counts, mean platelet volume, AST, total cholesterol, HDL and LDL cholesterol, HOMA index between obese patients with fatty liver and obese patients without fatty liver (p=0.065, p=0.274, p=0.705, p=0.770, p=0.415, p=0.385, p=0.381 and p=0.301 respectively ). ALT levels were significantly higher in obese patients with fatty liver (p<0.001). There was no significant difference in Hb (hemoglobin), hematocrit (Htc), mean corpuscular volume(MCV), MCH (mean corpuscular hemoglobin), mean corpuscular hemoglobin concentration (MCHC) and RDW (red cell distribution width) levels between obese patients with fatty liver and obese patients without fatty liver (p=0.423, p=0.6, p=0.339, p=0.428, p=0.143 and p=0.384 respectively). There was no significant difference between the mean of the two groups of iron (p=0.787). Iron binding capacity was significantly higher in obese patients without fatty liver (p=0.002). Transferrin saturation levels were higher in obese patients with fatty liver compared to the obese ones without fatty liver but there was no significant difference (p=0.227). Ferritin levels of obese patients with fatty liver were higher than the values of obese patients without fatty liver but there was no statistically significant difference (p=0.171). Hepcidin levels of obese patients with fatty liver were significantly higher than the levels in obese patients without fatty liver (p<0.001). Conclusion: Hepcidin is a peptide hormone that is increased in obesity and other chronic inflammatory conditions and show a negative effect on the iron absorption and utilization. Earlier studies in adults, hepcidin increased in obese patients also patients with non-alcoholic fatty liver disease has increased and been shown to affect the use of iron. In our study, these results support these findings. This clinical trial is important because it is the first clinical study examining the relationship between fatty liver disease with hepcidin and iron parameters. Negative affect of hepcidin on iron metabolism was associated with increase in the obesity grade and presence of fatty liver. These findings show that, in obese children and obese patients with fatty liver needs attention for iron metabolism disorders like iron absorption and use of iron.