Overweight Children and Adolescents: A Risk Group for Iron Deficiency
,
,
* Section of General Pediatrics, Department of Pediatrics, Yale University, New Haven, Connecticut
Strong Children’s Research Center, University of Rochester, Rochester, New York
American Academy of Pediatrics Center for Child Health Research, Rochester, New York
Background. The prevalence of obesity has increased at an epidemic rate, and obesity has become one of the most common health concerns in the United States. A few small studies have noted a possible association between iron deficiency and obesity.
Objective. To investigate the association between weight status, as measured by body mass index (BMI), and iron deficiency in a nationally representative sample of children and adolescents.
Design. National Health and Nutrition Examination Survey III (1988–1994) provides cross-sectional data on children 2 to 16 years of age. Recorded measures of iron status included transferrin saturation, free erythrocyte protoporphyrin levels, and serum ferritin levels. Children were considered iron-deficient if any 2 of these values were abnormal for age and gender. With the use of age- and gender-specific BMI percentiles, at risk for overweight was defined as a BMI of 
85th percentile and <95th percentile, and overweight was defined as a BMI of 95th percentile. The prevalence of iron deficiency was compared across weight groups. Logistic regression was used to estimate the association between iron status and overweight, controlling for age, gender, ethnicity, poverty status, and parental education level.
Results. In this sample of 9698 children, 13.7% were at risk for overweight and 10.2% were overweight. Iron deficiency was most prevalent among 12- to 16-year-old subjects (4.7%), followed by 2- to 5-year-old subjects (2.3%) and then 6- to 11-year-old subjects (1.8%). Overweight 2- to 5-year-old subjects (6.2%) and overweight 12- to 16-year-old subjects (9.1%) demonstrated the highest prevalences of iron deficiency. Overall, the prevalence of iron deficiency increased as BMI increased from normal weight to at risk for overweight to overweight (2.1%, 5.3%, and 5.5%, respectively), and iron deficiency was particularly common among adolescents (3.5%, 7.2%, and 9.1%, respectively). In a multivariate regression analysis, children who were at risk for overweight and children who were overweight were approximately twice as likely to be iron-deficient (odds ratio: 2.0; 95% confidence interval: 1.2–3.5; and odds ratio: 2.3; 95% confidence interval: 1.4–3.9; respectively) as were those who were not overweight.
Conclusions. In this national sample, overweight children demonstrated an increased prevalence of iron deficiency. Given the increasing numbers of overweight children and the known morbidities of iron deficiency, these findings suggest that guidelines for screening for iron deficiency may need to be modified to include children with elevated BMI.
Key Words: overweight • iron deficiency • nutritional deficiency
Abbreviations: NHANES, National Health and Nutrition Examination Survey • BMI, body mass index
Received for publication Jun 26, 2003; Accepted Jan 26, 2004.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  J. P. Karl, H. R. Lieberman, S. J. Cable, K. W. Williams, E. L. Glickman, A. J. Young, and J. P. McClung Poor Iron Status Is Not Associated with Overweight or Overfat in Non-Obese Pre-Menopausal Women J. Am. Coll. Nutr., February 1, 2009; 28(1): 37 - 42. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E Cusick, Z. Mei, D. S Freedman, A. C Looker, C. L Ogden, E. Gunter, and M. E Cogswell Unexplained decline in the prevalence of anemia among US children and women between 1988-1994 and 1999-2002 Am. J. Clinical Nutrition, December 1, 2008; 88(6): 1611 - 1617. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Y. Daniels Examining Attendance, Academic Performance, and Behavior in Obese Adolescents The Journal of School Nursing, December 1, 2008; 24(6): 379 - 387. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Karp, M. Kersey, and D. B. Cutts Iron Deficiency, Obesity, and Food Insecurity Arch Pediatr Adolesc Med, December 1, 2008; 162(12): 1194 - 1195. [Full Text] [PDF]
|
|
|
|
 |
|
 J. P. McClung, N. E. Andersen, T. N. Tarr, C. H. Stahl, and A. J. Young Physical Activity Prevents Augmented Body Fat Accretion in Moderately Iron-Deficient Rats J. Nutr., July 1, 2008; 138(7): 1293 - 1297. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Chung, P. Matak, A. T. McKie, and P. Sharp Leptin Increases the Expression of the Iron Regulatory Hormone Hepcidin in HuH7 Human Hepatoma Cells J. Nutr., November 1, 2007; 137(11): 2366 - 2370. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Brotanek, J. Gosz, M. Weitzman, and G. Flores Iron Deficiency in Early Childhood in the United States: Risk Factors and Racial/Ethnic Disparities Pediatrics, September 1, 2007; 120(3): 568 - 575. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. N. Ames Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage PNAS, November 21, 2006; 103(47): 17589 - 17594. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Pinhas-Hamiel, N. Doron-Panush, B. Reichman, D. Nitzan-Kaluski, S. Shalitin, and L. Geva-Lerner Obese Children and Adolescents: A Risk Group for Low Vitamin B12 Concentration. Arch Pediatr Adolesc Med, September 1, 2006; 160(9): 933 - 936. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Kasvosve, Z. A. Gomo, K. J Nathoo, P. Matibe, B. Mudenge, M. Loyevsky, and V. R Gordeuk Effect of ferroportin Q248H polymorphism on iron status in African children Am. J. Clinical Nutrition, November 1, 2005; 82(5): 1102 - 1106. [Abstract] [Full Text] [PDF]
|
|
