ORIGINAL ARTICLE Serum hepcidin levels and iron metabolism in obese children with and without fatty liver: case–control study Fatih Demircioğlu & Gökhan Görünmez & Emine Dağıstan & Sevil Bilir Göksügür & Mervan Bekdaş & Mehmet Tosun & Betül Kızıldağ & Erol Kısmet Received: 11 October 2013 /Revised: 13 January 2014 /Accepted: 16 January 2014 # Springer-Verlag Berlin Heidelberg 2014 Abstract Hepcidin is a regulator of iron balance that is in- creased in obesity. It reduces the absorption of iron, reduces the transfer of iron from macrophages to the plasma and/or prevents mobilisation of stored iron. Obese patients with non- alcoholic fatty liver disease (NAFLD) demonstrate adipokine and cytokine release promoting inflammatory response. We aimed to analyse the hepcidin levels and iron metabolism in obese children with and without NAFLD and non-obese healthy controls. The study population consisted of 110 chil- dren aged 7–18 years in three groups: 50 obese patients without NAFLD, 30 obese patients with NAFLD, and 30 non-obese healthy controls. Serum hepcidin, ferritin, and iron levels, iron-binding capacity, lipid profile, and liver function tests were measured, and hepatic ultrasonography was per- formed in all participants. Obese patients’ white blood cell counts, total cholesterol, triglyceride levels, and homeostatic model assessment of insulin resistance (HOMA-IR) were significantly higher than those of the control group. Iron- binding capacity was significantly higher in obese patients without NAFLD compared with obese patients with NAFLD (p =0.002). Hepcidin levels were not significantly different between obese patients and the control group. However, hepcidin levels in obese patients with NAFLD were signifi- cantly higher than those in obese patients without NAFLD (p <0.001). Conclusions: Hepcidin levels were significantly higher in obese children with NAFLD than those without NAFLD. Obese children with NAFLD should receive atten- tion regarding iron metabolism disorders. Serum hepcidin could be a marker of iron metabolism status and NAFLD in these groups of patients. Keywords Fatty liver . Obesity . Children . Hepcidin . Iron metabolism Introduction Obesity and iron deficiency or iron metabolism disorders are independent, common health problems in children. The frequen- cy of both problems is increasing worldwide. Adipose tissue is an active endocrine organ that secretes many adipokines (cytokines). These cytokines have significant effects on the development of complications of obesity, such as insulin resis- tance and non-alcoholic fatty liver disease (NAFLD) [10, 11]. NAFLD is an important complication of obesity that emerges as macrovesicular hepatic steatosis without alcohol intake. Various clinical conditions, such as fatty liver, steatohepatosis, fibrosis and end-stage liver disease, can de- velop. Lipid metabolism changes, due to insulin-resistance and adipokines released from adipose tissue, play a role in the development of NAFLD. It has been shown that the incidences of insulin resistance, body mass index (BMI), risk of cytokine release and inflammation are higher in the obese with NAFLD compared to those obese without NAFLD [10, 14]. The prevalences of iron deficiency anaemia and iron me- tabolism disorders in obese individuals are higher than in Communicated by David Nadal F. Demircioğlu (*) : E. Kısmet Department of Pediatrics, Division of Pediatric Hematology-Oncology, Faculty of Medicine, Abant Izzet Baysal University, Gölköy, Bolu 14280, Turkey e-mail: fatih_demircioglu@yahoo.com G. Görünmez : S. B. Göksügür : M. Bekdaş Department of Pediatrics, Faculty of Medicine, Abant Izzet Baysal University, Gölköy, Bolu 14280, Turkey E. Dağıstan : B. Kızıldağ Department of Radiology, Faculty of Medicine, Abant Izzet Baysal University, Gölköy, Bolu 14280, Turkey M. Tosun Department of Biochemistry, Faculty of Medicine, Abant Izzet Baysal University, Gölköy, Bolu 14280, Turkey Eur J Pediatr DOI 10.1007/s00431-014-2268-8