# Estimation of New Regulators of Iron Metabolism in Short-Term Follow-Up After Bariatric Surgery

## TL;DR

This study found that bariatric surgery improves iron levels and reduces hepcidin, possibly due to reduced body fat and inflammation.

## Contribution

The study identifies new regulators of iron metabolism and their associations with body fat changes after bariatric surgery.

## Key findings

- Five months after surgery, hepcidin levels decreased significantly, while iron levels increased.
- Body fat reduction correlated positively with changes in hepcidin and soluble hemojuvelin levels.
- No patients showed signs of iron deficiency, suggesting improved iron status post-surgery.

## Abstract

Obesity and bariatric surgery are both associated with disrupted iron homeostasis. These alterations may be mediated by newly identified iron metabolism regulators. The aim of this study was to conduct a short-term, detailed analysis of hepcidin, soluble hemojuvelin, ferroportin, and erythroferrone—as well as whole-body composition—before and five months after sleeve gastrectomy. This approach may help elucidate the potential impact of bariatric surgery on iron metabolism and the timing of these changes. The study included 40 obese patients aged 26–64 eligible for laparoscopic sleeve gastrectomy. Iron parameters were assessed with immunoenzymatic methods. We found significantly increased iron levels (79 µg/dL vs. 95 µg/dL, p = 0.0016) as well as reduced hepcidin concentrations five months after bariatric surgery (54.46 ng/mL vs. 33.88 ng/mL, p = 0.0177). The change in the reduction in mean body fat (delta MBF) and body fat percentage (delta BPF) was positively associated with delta hepcidin levels with correlation coefficients of R = 0.36 (p = 0.0228) for MBF and R = 0.42 (p = 0.0070) for BPF. Moreover, significant correlations were observed between the reduction in body fat and soluble hemojuvelin (R = 0.31 p = 0.0489 for MBF) (R = 0.45 p = 0.0032 for PBF). No patient showed laboratory signs of iron deficiency. Decreased serum hepcidin levels observed five months after sleeve gastrectomy are associated with improved iron status, as indicated by increased serum iron and red blood cell indices. Positive correlations between body fat reduction and both hepcidin and soluble hemojuvelin levels suggest that the resolution of adipose tissue-related inflammation may contribute to improved iron bioavailability.