Jurnal Gizi dan Dietetik Indonesia
(Indonesian Journal of Nutrition and Dietetics)
Vol. 9, No. 2, 2021: 85-93

Available online at: http://ejournal.almaata.ac.id/index.php/IJND
DOI : http://dx.doi.org/10.21927/ijnd.2020.9(2).85-93

Iron status and Hepcidin Level of normal and obese adolescents
Setyo Utami Wisnusanti1,2*, Lily Arsanti Lestari1,2, Siti Helmyati1,2
Department of Nutrition and Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada,
Farmako Street, Sekip Utara, Sleman, Yogyakarta, 55281, Indonesia
2
Center of Health and Human Nutrition, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada,
Farmako Street, Sekip Utara, Sleman, Yogyakarta, 55281, Indonesia
*Correspondence: setyo.utami.w@ugm.ac.id
1

ABSTRAK
Latar Belakang: Faktor risiko anemia pada remaja obesitas meningkat dengan adanya gangguan
homeostasis besi yang terjadi, ditandai dengan kadar feritin dan kadar hepcidin tinggi namun kadar
hemoglobin rendah yang disebabkan oleh adanya inflamasi kronik derajat ringan terkait obesitas.
Tujuan: Penelitian ini dilakukan untuk mengetahui hubungan antara obesitas, faktor perantara yang
memengaruhi, dan kejadian anemia pada remaja usia 12-15 tahun di SMP di Kota Yogyakarta.
Metode: Penelitian yang dilakukan adalah penelitian observasional dengan rancangan penelitian potong
lintang pada 68 siswa SMP di Kota Yogyakarta yang mempunyai status gizi normal dan obesitas. Pengukuran
tinggi badan, berat badan, indeks massa tubuh, kadar hepcidin, kadar feritin, kadar hemoglobin, dan
penilaian asupan zat gizi responden dilakukan dalam satu kurun waktu yang hampir bersamaan.
Hasil: Persentase anemia pada kelompok normal sebesar 15,15% sedangkan pada kelompok obesitas
sebesar 2,85%. Pada penelitian ini, tidak terdapat perbedaan secara signifikan pada prevalensi anemia
antara remaja status gizi normal dan obesitas (p=0,074). Median data kadar hemoglobin pada kelompok
normal 14,2 g/dl dan kelompok obesitas 14,5 g/dl. Kadar feritin pada kelompok obesitas lebih tinggi secara
signifikan dibandingkan dengan kelompok normal, masing-masing 9,7 ng/ml pada kelompok normal, 11,59
ng/ml pada kelompok obesitas sedang dan 15,81 ng/ml kelompok obesitas berat. Terdapat perbedaan
signifikan pada kadar leukosit pada kedua kelompok responden (p=0,0443), namun tidak terdapat
perbedaan signifikan pada kadar hepcidin (p=0,511). Tidak terdapat korelasi antara kadar hepcidin dan
feritin pada seluruh responden (p=0,396), serta terdapat korelasi positif tingkat rendah antara kadar feritin
dan hemoglobin pada seluruh responden (p=0,0008).
Kesimpulan: Terjadi proses inflamasi kronis derajat ringan pada kelompok obesitas, namun tidak terjadi
gangguan metabolisme besi akibat inflamasi. Penelitian lebih lanjut dibutuhkan untuk menggali hubungan
anemia dengan obesitas di masa dewasa.
KATA KUNCI: anemia; gizi remaja; Hemoglobin; obesitas

ABSTRACT
Background: The risk factor for anemia in obese adolescents is increased by the presence of iron
homeostatic disorder that occurs, characterized by high levels of ferritin and hepcidin levels but low
hemoglobin levels which is caused by mild chronic inflammation associated with obesity.
Objectives: This study was conducted to determine the relationship between obesity and intermediary
factors that affect the incidence of anemia in adolescents aged 12-15 years in Junior High School, Yogyakarta
Methods: This study was observational research with a cross-sectional study design on 68 junior high
school students in Yogyakarta City who had normal and obese nutritional status. Measurement of height,
weight, body mass index, hepcidin levels, ferritin levels, hemoglobin levels, and assessment of nutrient
intake of respondents performed in a period of time.
Results: The percentage of anemia in the Normal Group (NG) was 15.15% meanwhile in the Obese Group
(OG) was 2.85%. In this study, there was no significant difference in the prevalence of anemia between
NG and OG (p=0.074). Median data hemoglobin levels in the NG were 14.2 g/dl and in the OG was 14.5
g/dl. Surprisingly, there was a significantly higher level of ferritin found in the OG than NG, respectively

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9,7 ng/ml in NG, 11.59 ng/ml in the moderately obese group, and 15.81 ng/ml severe obese. There was a
significant difference in leukocyte levels between groups (p = 0.0443), however, there was no significant
difference in hepcidin levels (p=0.511). There was no correlation between hepcidin and ferritin levels in all
respondents (p=0.396), and there was a low positive correlation between ferritin and hemoglobin levels in
all respondents (p=0.0008).
Conclusions: Low-grade chronic systemic inflammation occurs in the OG, but no iron metabolism disorder
occurs due to inflammation. Further study is needed to explore the correlation between anemia and obesity
in adulthood.
KEYWORDS: adolescents; anaemia; Haemoglobin; obesity

Article info:
Article submitted on April 29, 2021
Articles revised on June 3, 2021
Articles received on July 9, 2021

INTRODUCTION
Iron deficiency and obesity are two nutritional
problems that are globally experienced by billion of
humans over the world. Iron deficiency and obesity
are known to be related and often occur together.
Based on Basic Health Survey 2013 data, the
prevalence of obesity in Indonesia in the adult age
group (above 18 years) was 13.3% while in the 1315 year age group was 2.5%. In the Special Region
of Yogyakarta, the prevalence of obesity in the adult
age group was 15.8% with the highest prevalence
in Yogyakarta City (22.8%), while in the 13-15 year
age group was 4.2% with prevalence in Yogyakarta
City was 2.0% (1).
Obesity is associated with a low-grade degree
of chronic inflammation. Obesity and inflammation
are often associated with the incidence of anemia in
obese individuals with hepcidin as a key mediator (25). Hepcidin can control the amount of iron in blood
circulation by increasing the amount of stored iron.
Expression of hepcidin is influenced by several
conditions, such as levels of iron in the circulation,
the process of erythropoietic, inflammation, and
hypoxia (6).
Hepcidin may affect elevated levels of
ferritin under conditions of chronic inflammation
as a defense mechanism to minimize iron serum
(functional iron) in the blood used by bacteria or other
infectious agents. The iron serum will be converted
into iron storage in the form of ferritin so that there

will be an increase in ferritin levels (6, 7).
Children and adolescents are at risk for iron
deficiency due to iron requirements increasing
during growth periods. Iron requirements decrease
from age 6 months to 3 years but gradually increase
until puberty age (8). Factors that may increase
the risk of anemia in adolescents are inadequate
iron intake, increased body mass, increased iron
requirement, and do unhealthy diet (9). Although,
some interventions are already conducted to
overcome anemia in adolescents, such as nutrition
education and school-based intervention (10, 11),
but the prevalence of anemia remains high.
Based on the age group, the prevalence of
anemia in the age group of 5-14 years was 26.4%
and as much as 18.4% in the 15-24 age group (1).
The occurrence of anemia and obesity is often
associated with inflammation in obese adolescents.
The risk factors for anemia in obese adolescents
increase with the presence of iron metabolism
disorder, characterized by low iron serum levels, low
saturation transferrin levels but high ferritin levels
(4,8,9,12).
This study was conducted to determine the
correlation between obesity and anemia, also
its intermediary factors in adolescents aged 1215 years in junior high school, Yogyakarta. This
study could describe the prevalence of anemia
in the obese adolescent population in Indonesia,
add the theoretical basis to overcome anemia of
inflammation in obese adolescents, and can describe

Iron status and Hepcidin Level of normal and obese adolescents

the urgency of overcoming anemia of inflammation
in obese adolescents in Indonesia.
MATERIALS AND METHODS
This study was an observational study with
a cross-sectional design. Body mass index, serum
ferritin, hepcidin, and hemoglobin levels were
measured over the same period. The study was
conducted for 5 months (December 2016 - April
2017).
Data collection on subjects was conducted in
4 junior high schools in Yogyakarta, namely State
Junior High School 1 Yogyakarta, State Junior High
School 2 Yogyakarta, Muhammadiyah 3 Junior High
School Yogyakarta, and Masjid Syuhada Islamic
Junior High School, Yogyakarta. Measurements
of body mass index and blood sampling were
done at school. Examination of serum ferritin and
hepcidin levels was performed at the Biochemistry
Laboratory, Faculty of Medicine, Universitas Gadjah
Mada (UGM). Complete blood count analysis was
analyzed at Clinical Pathology Laboratory, Faculty
of Medicine, UGM.
The population of this study was adolescents
in Yogyakarta City. The subjects of this study are
adolescents aged 12-15 years in Yogyakarta Junior
High School with the following inclusion criteria:
a. Obtaining parental consent by filling out and
signing informed consent and being willing to be
the subject of the study by filling out and signing
informed consent.
b. Having BMI/A (Body Mass Index per Age) which
was normal or obese.
Exclusion criteria of research subjects were:
a. Suffering from chronic illness (based on medical
history).
b. Suffer from infectious diseases (leukocyte level
> 10.8 × 109/L).
c. Consume iron supplements within the last 3
months.
d. Have severe bleeding within the last 3 months.
The sample size was calculated by the
sample formula for the cross-sectional study of the
proportion of 2 populations with a 95% confidence
level and 92% power. The estimated proportion of

87

anemia in the obese adolescent population was
8.7% and the estimated proportion of anemia in the
normal nutritional status adolescent population was
3.2% (10). From the calculation, the obtained sample
size minimum was 68 subjects.
The subject’s selection was done by cluster
sampling based on their school. The selection of
schools was done by simple random sampling to
determine which schools will be screened. Four
schools were taken as research locations of all
junior high schools in Yogyakarta. Subjects selection
was preceded by nutritional status screening in
all schools. The selection of subjects was using
randomization methods which were differentiated
by sex to obtain a proportionate amount between
the male and female subjects.
Characteristic of subjects was taken by using
characteristic from which self-filled by subjects.
Height measurement was done by using microtoise
with a precision level of 0.1 cm. Weight measurement
was performed using calibrated digital body scales
with a precision level of 0.1 kg. Assessment of
subjects’ nutrient intake was done using a validated
SQ-FFQ form. Measurement of height, weight, and
assessment of nutrient intake was carried out by
nutritionists.
Blood sampling was done by a health
analyst. Analysis of hepcidin and ferritin levels was
performed by ELISA using ELISA kit (DRG EIA-1872
for ferritin and Fine Test EH-3221 for hepcidin),
whereas hemoglobin level was analyzed using
Sysmex Hematology Analyzer. Hemoglobin levels
were categorized as normal if the value was ≥12 g/
dl and if the hemoglobin level of subjects was <12 g/
dl, subjects were categorized as anemic (13).
Calculation of z-score values from
anthropometric data was analyzed using WHO
Anthro Plus software. Data analysis was performed
using STATA 12. Data analysis was analyzed by
univariate analysis that was by displaying data
descriptively. Furthermore, the data were analyzed
by bivariate analysis to know the relationship
between two variables. Data analysis was done
by non-parametric test because of abnormal data
distribution. This research has obtained the ethical
license from the Ethical Commission, Faculty of

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Setyo Utami Wisnusanti, Lily Arsanti Lestari, Siti Helmyati, Vol 9 No. 2, 2021: 29-37

Medicine, Public Health and Nursing UGM with the
number: KE/FK/0154/EC/2017.
RESULTS AND DISCUSSIONS
Measurement of nutritional status was
performed on all grade 8 students at the four schools.
Nutritional status was categorized into 4 categories
based on WHO 2007 Growth References.
From the data of nutritional status measurement
in all grade 8 students in four junior high schools, 68
students were eligible as subjects according to the
inclusion and exclusion criteria. The characteristics
of the subjects of this study can be seen in Table 1.
Table 1. Characteristics of Subjects
Characteristics
Age (years)a
Genderb
Male
Female
Body weight (kg)c
Height (cm)c
Mother’s Occupationb
Housewife
Civil Servant
Private Sector
Enterpreuner
Farmer
Merchant
Labour
Honorary Staff
Father’s Occupationb
Civil Servant
Private Sector
Enterpreuner
Merchant
Labour
Unemployed
Total Family Incomeb
< Rp1.000.000

Mean or n(%)
13.81 ± 0.39
34 (50)
34 (50)
62.5 (50.05 ; 75.4)
159 (155.63 ; 164.25)
25 (36.76)
10 (14.71)
12 (17.65)
7 (10.29)
8 (11.76)
3 (4.41)
2 (2.94)
1 (1.47)
18 (26.47)
22 (32.35)
14 (20.59)
9 (13.24)
2 (2.94)
3 (4.41)
4 (5.88)

Rp1000.000-Rp3.000.000
19 (27.94)
Rp3.000.000-Rp5.000.000 18 (26.47)
Rp5.000.000-Rp7.000.000 5 (7.35)
Rp7.000.000- Rp10.000.000 15 (22.06)
Rp10.000.0003 (4.41)
Rp20.000.000
> Rp20.000.000,00
4 (5.88)
a
Data presented by mean ± SD, b Data were presented by
n (%), cData were presented by median (Q1;Q3)

Data of the total leukocyte count of subjects
can be seen in Table 2. Data of measurement of
nutritional status of subjects can be seen in Table 3.
Table 2. Mean of Total Leukocyte Count of Subjects
Nutrition
Status

Mean ± SD (x 109/L)

Normal

7.49 ± 1.72

Obese

8.34 ± 1.69

P-Value
0.0443*

*Independent t-test, p<0,05
Table 3. Nutritional Status of Subjects
Normal
Median (Q1;Q3)

Obese
Median (Q1;Q3)

BMI/A (kg/
m2)

19.8 (18.6 ; 20.7)

28.7 (28 ; 32.1)

z-score
BMI/A

0.17 (-0.255 ; 0.47)

2.19 (2.37 ; 2.87)

Indicator

To see the differences in hepcidin, ferritin, and
hemoglobin levels in the subjects with moderate
and severe obesity, data were then grouped into 3
groups. Subjects with BMI <100% 95th percentiles
were categorized as a normal group, subjects with
BMI 100%-119% 95th percentiles were categorized
as moderate obese and subjects with BMI ≥ 120%
95th percentile were categorized as a severe obese
group (12). Data of hepcidin, ferritin and hemoglobin
based on normal, moderate and severe obesity can
be seen in Table 4.

Iron status and Hepcidin Level of normal and obese adolescents

89

Table 4. Hepcidin, Ferritin, and Hemoglobin Levels of Subjects Based on Normal, Moderate and Severe Obese
Groups
Indicator

Normal
Median (Q1;Q3)

Nutritional Status
Moderate Obese
Median (Q1;Q3)

Hepcidin (ng/ml)

29.23a
(18.99 ; 38.05)

29.8a
(20.26 ; 41.31)

28.88a
(22.27 ; 40.93)

Feritin (ng/ml)

9.7a
(1.91 ; 19.47)

11.59ab
(2.91 ; 17.56)

15.81b
(11.44 ; 34.71)

Hemoglobin (g/dl)

14.2a
(13.25 ; 15)

14.35a
(13.45 ; 15.2)

14.5a
(13.4 ; 15.2)

Severe Obese
Median (Q1;Q3)

Data analysis were performed using the Mann-Whitney test
a,b
different font within rows showed significant different (p<0,05)

The result of analysis of the relationship
between obesity and the incidence of anemia was

analyzed by Fisher Exact test can be seen in Table 5.

Table 5. Prevalence of Anemia
Nutritional Status

Anemia Status

Total

Normal

Obese

Anemia

5 (15.15%)

1 (2.85%)

6 (8.82%)

Non Anemia

28 (84.84%)

34 (97.14%)

62 (91.17%)

Total

33 (100%)

35 (100%)

68 (100%)

The relationship between hepcidin and ferritin
levels was analyzed by the Spearman test. From
the outlier identification. found that there was outlier
data (outlier was found on hepcidin and ferritin level
data) so that data transformation was performed

P-Value
0.074

before data analysis. Data transformation was
performed by square root data transformation The
data transformation was chosen based on skewness
type of data which was positive.

Hepcidin and Ferritin Levels Scatter Diagram

Hepcidin (ng/ml)

120
100
80
60
40
20
0

0

20

40

60

80

Ferritin (ng/ml)

100

120
P = 0.396

Figure 1. Hepcidin and Ferritin Levels Scatter Diagram

Ferritin and Hemoglobin Levels Scatter Diagram

140

0

0

20

40

60

80

100

120

Ferritin (ng/ml)

90

140

P = 0.396

Setyo Utami Wisnusanti, Lily Arsanti Lestari, Siti Helmyati, Vol 9 No. 2, 2021: 29-37

The relationship between ferritin levels and
hemoglobin levels was analyzed by the Spearman
test. Data of hemoglobin levels were transformed by

inverse square root transformation in accordance
with the negative skewness type of data.

Ferritin and Hemoglobin Levels Scatter Diagram
140
120
Feritin (ng/ml)

100
80
60
40
20
0
-20

0

5

10
Hemoglobin (g/dl)

15

20

P = <0.001
spearman’s rho = 0.3978

Figure 2. Ferritin and Hemoglobin Levels Scatter Diagram

Total leukocytes count between subjects with
normal and obese nutritional status were significantly
different (p = 0.0443) with the average total leukocyte
on normal nutritional status was 7.49±1.72 × 109/L
and on obese subjects was 8.34±1.69 × 109/L.
The results of data analysis showed a significant
difference. Levels of inflammatory markers in obese
adolescents were higher than those with normal
nutritional status. although leukocyte count in both
groups remained within the normal range of <10.8
× 109/L.
Leukocytes are positively correlated with
CRP levels. which is one of the most sensitive
inflammatory markers (1). Leukocytes are elevated
during inflammation. The increase in total leukocytes
in the blood shows a low grade of systemic
inflammation that occurs in obese individuals (1-4).
Hepcidin levels are associated with
inflammation in the human body. Inflammation can
lead to an increase in hepcidin levels. In this study.
hepcidin levels in subjects with normal nutritional
status and obesity were not significantly different
(p = 0.511). The median of hepcidin levels in the
subjects with normal nutritional status was 29.23 mg/

mL meanwhile in the obese group was 29.32 ng/mL.
In this study. inflammatory markers of total leukocyte
count in the obese group were significantly higher
compared with those with normal nutritional status.
This illustrates the occurrence of inflammation in
obese adolescents. but the inflammation does not
affect hepcidin levels shown by the analysis of
hepcidin levels relationship between the subjects
with normal nutritional status and obese which was
not significantly different.
The results are consistent with the research
of Ridha & Daud who found no significant difference
in hepcidin levels among adolescents with normal
and obese nutritional status (5). In that study. found
significant differences in hepcidin levels in subjects
with normal nutritional status and superobese.
Compared with obese individuals. individuals with
superobese conditions experienced differences in
the degree of inflammation. greater exposure. and
long processes to stimulate the release of hepcidin.
Thus. it may be concluded that although the obese
subjects have been experienced by inflammation.
but not enough to stimulate the release of hepcidin
by hepatocytes.

Iron status and Hepcidin Level of normal and obese adolescents

The impact of increased leukocytes may
not affect hepcidin levels due to changes in body
composition and age group. The degree of chronic
inflammation experienced by obese adolescents is
related to the fat mass in the body. Fat mass in the
adolescent body is very easy to change because
they are still in their growth periods. The growth
and development of children will accelerate during
puberty and affect the body composition (6-8). At the
age of 13 years. an increase in the percentage of fat
mass is due to physiological changes associated
with puberty in adolescent girls. At the age of 13-17
years. adolescent males experience increased fatfree body mass due to puberty (9).
Inflammation that occurs in the body of obese
individuals is also affected by age. As humans get
older. CRP levels will increase. In a 15-year cohort
study. there was found an increase in CRP levels in
both male and female subjects. The impact of BMI
increase as age increases can increase oxidative
stress and inflammation characterized by elevated
levels of CRP. glutamyltransferase. and uric acid
(10).
In this research. the median data of ferritin
levels of subjects with normal nutritional status was
9.7 ng/mL while the obese was 14.35 ng/mL. The
results of statistical analysis showed no relationship
between hepcidin levels and ferritin levels in the
respondents (p = 0.39). This is in line with the
results of leukocyte level relationship analysis with
hepcidin levels that are not significantly related. This
illustrates the inflammatory outcomes that occur in
obese subjects not seen in hepcidin levels or ferritin
levels of subjects.
Based on Ridha & Daud. the absence of
significant difference of ferritin level in adolescents
with normal and obese nutritional status and
adolescents with normal nutritional status and
superobese because hepcidin released by
hepatocytes is not enough. the intensity is strong
enough and exposure has not been experienced
for a long time (5).
Hepcidin may affect elevated levels of ferritin
under conditions of chronic inflammation in the body
as a body’s defense mechanism to minimize serum
iron (functional iron) in the blood used by bacteria.

91

The iron serum will be converted into iron storage in
the form of ferritin so that there will be an increase
in ferritin levels. Hepcidin can cause a decrease
in ferritin levels in iron deficiency conditions and
there is no interruption of iron metabolism disorder
related to inflammation. Hepcidin will respond to
iron deficiency to convert iron reserves in the form
of ferritin into functional iron in the form of iron serum
(11-12).
The level of ferritin is indicated by iron storage
in the body. When the body has iron deficiency. serum
ferritin levels will decrease due to iron changes in the
form of ferritin into functional iron. Functional iron
will be used as a synthesis component of various
compounds in the body. one of them is hemoglobin.
In this study obtained median data hemoglobin
levels on the subjects with normal nutritional status
was 14.2 g/dL while on obese was 14.5 g/dL. The
result of data analysis showed a positive correlation
with the low strength level between ferritin level
and hemoglobin level on the subjects (p = 0.0008.
r = 0.3978). This indicates the absence of iron
metabolism disturbance on obese subjects.
In anemia caused by inflammation. ferritin
levels show a negative correlation with hemoglobin
levels. Anemia that is found in this study was iron
deficiency anemia characterized by a positive
correlation between ferritin and hemoglobin levels.
The prevalence of anemia in all subjects was
8.82%. Subjects who experienced anemia in the
group of normal nutritional status were 5 people
(15.15%) while in a group of obese there was only
1 person (2.85%). The median hemoglobin level
in the normal nutritional status group was slightly
lower than the median hemoglobin level in the obese
group. namely 14.2 and 14.5 g/dL respectively. The
prevalence difference of anemia in both groups was
not significant (p=0.074).
The result of this study is also in line with the
study conducted by Viana et al. in 707 adolescents
aged 11-19.9 years who found no association
between BMI on hemoglobin levels. although
hemoglobin levels in overweight women were
significantly lower when compared with adolescent
girls with normal nutritional status (13).
Similar results were also found by Ausk &

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Ioannou who examined the association of obesity
with anemia in adults with normal nutritional status.
overweight. mild. moderate. and severely obese
(14). The results showed lower serum levels of
iron and transferrin. higher CRP. and serum ferritin
levels in adult individuals with moderate and severe
obese nutrition status compared with normal adult
individuals. Hemoglobin levels and percentage of
anemia did not differ significantly in the five groups
of subjects. It shows that obesity is not a single factor
as a risk factor for obese individuals.
A study conducted by Ridha & Daud also
showed no difference in levels of ferritin and serum
transferrin in obese and superobese adolescents
compared with normal nutritional status (5). In the
study. there was a difference in mean hepcidin and
CRP levels in the superobese group compared
with the normal nutritional status group. This
suggests that superobese and obese conditions
differ in degree of inflammation. greater exposure
and inflammatory processes have lasted longer to
stimulate the release of hepcidin.
The result of this study was in contrast with
several studies. Based on Nazif et al.. there was
a significant decrease in hemoglobin. iron serum.
serum ferritin. and transferrin in obese teenagers
compared with non-obese teenagers (15). The
hepcidin level was positively correlated with BMI
and CRP levels but negatively correlated with iron
status in obese adolescents. A study conducted by
Newfield et al. showed a proportion of iron deficiency
(iron serum <8 μmol/L) greater in obese children and
adolescents than normal (16).
Similar results were also found by Keikhaei
et al. which suggests a greater risk of anemia in
adolescents with abnormal nutritional status (thin.
overweight. and obese) compared with adolescents
with normal nutritional status (17). A study conducted
by Peter et al. showed a negative correlation
between hemoglobin and BMI levels in overweight
and obese women aged 16-30 years old (18).
Iron deficiency in obese adolescents can
be caused by metabolic disorders due to hepcidin
mediation in decreased iron absorption and
increased iron storage formation. Obesity can
not be the single cause of anemia associated

with inflammation in obese adolescents. Intake
of iron. body fat mass. inflammation rate (obesity
comorbidity). age. and sex into other factors that
can cause anemia associated with inflammation in
obese individuals (5. 13-19).
In this study. there was no significant difference
in the prevalence of anemia between adolescents
of normal nutritional status and obesity. There were
significant differences in leukocyte levels (higher
in the obese group) in both groups of respondents.
but no significant difference in hepcidin levels.
Levels of leukocytes in all subjects were still within
normal levels. There was no correlation between
hepcidin and ferritin levels in all subjects. and there
was a positive correlation between ferritin and
hemoglobin levels in all subjects. This suggests a
low-grade degree of chronic inflammation in the
obese group. but no metabolic disorders of iron
due to inflammation in the obese group. A positive
correlation between ferritin and hemoglobin levels
showed that the anemia found in this study was iron
deficiency anemia and unrelated to inflammation.
CONCLUSIONS AND RECOMMENDATIONS
There was a low-grade degree of the chronic
inflammatory process in the obese group. but
there was no disturbance of iron metabolism due
to inflammation in the obese group. Further study
is needed to explore more about the correlation of
anemia. iron status. and obesity in another stage
of life.
In the next research. it is better to consider the
variable of comorbidity degree of obesity. fat mass.
and long exposure of inflammation due to obesity.
This study can be performed on obese adult women
and conducted with a balanced proportion of anemic
and non-anemic subjects. Anemia elimination
program in adolescents is appropriate which is to
overcome iron deficiency anemia due to inadequate
intake of iron.
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