The double burden of obesity and iron deficiency on children and adolescents in Greece: the Healthy Growth Study

J Hum Nutr Diet. 2013 Oct;26(5):470-8. doi: 10.1111/jhn.12025. Epub 2012 Dec 30.


Background: Some small cohort studies have noted that obesity co-exists with lower serum iron levels. The present study aimed to examine the association between being overweight and iron deficiency (ID) in a large cohort of Greek children and adolescents.

Methods: A representative sample of 2492 primary schoolchildren aged 9-13 years old was examined. Anthropometric, biochemical, clinical, dietary intake and physical activity data were collected.

Results: The prevalence of ID and iron deficiency anaemia (IDA) was higher in obese boys and girls compared to their normal-weight peers (P < 0.05). Serum ferritin was higher in obese compared to normal-weight boys (P = 0.024) and higher in obese compared to normal-weight and overweight girls (P = 0.001). By contrast, a negative association was found between transferrin saturation and adiposity in both boys and girls (P = 0.001 and P = 0.005). Furthermore, obese girls had significantly higher fibre intake than normal-weight girls (P = 0.048) and also overweight and obese boys and girls recorded significantly fewer pedometer steps than their normal-weight peers (P < 0.001). Finally, obesity more than doubled the likelihood of ID in both boys (odds ratio = 2.83; 95% confidence inteval = 1.65-4.85) and girls (odds ratio = 2.03; 95% confidence interval = 1.08-3.81) after controlling for certain lifestyle and clinical indices as potential confounders.

Conclusions: The present study shows that obese children and adolescents were at greater risk for ID and IDA than their normal-weight peers. Low grade inflammation induced by excessive adiposity may be a reason for the observed low iron levels. This is also strengthened by the elevated serum ferritin levels, comprising an acute phase protein that is plausibly increased in inflammation.

Keywords: adolescents; children; diet; inflammation; iron deficiency; obesity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adiposity
  • Adolescent
  • Anemia, Iron-Deficiency / blood
  • Anemia, Iron-Deficiency / epidemiology*
  • Body Mass Index
  • Child
  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • Ferritins / blood
  • Greece / epidemiology
  • Humans
  • Life Style
  • Logistic Models
  • Male
  • Motor Activity
  • Multivariate Analysis
  • Nutrition Assessment
  • Overweight / epidemiology
  • Pediatric Obesity / blood
  • Pediatric Obesity / epidemiology*
  • Physical Examination
  • Prevalence
  • Socioeconomic Factors


  • Ferritins