الفهرس 
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Abstract
Obesity is a risk factor for numerous of comorbidities and complications, including iron deficiency anemia. The high prevalence of obesity combined with the high incidence of iron
deficiency suggests an association between obesity and iron status. This association could be attributed to high hepcidin levels mediated by chronic inflammation. Hepcidin disrupts iron
homeostasis by acting as a negative regulator of intestinal iron absorption, resulting in iron deficiency anemia.
The main objective of this research work was to study the interrelationships between obesity, iron status and the level of thyroid hormones in a sample of adult women with obesity in the governorate of Alexandria, Egypt.
In this study, we determined the prevalence and factors associated with obesity among some women with obesity aged between 18-60 years with or without iron deficiency anemia and hypothyroidism. The study was carried out in private nutritional clinic and at the integrated health clinic that affiliated to the high institute of public health in Alexandria
between June 2019 and October 2021.
100 women having BMI ≥30 kg\m
2 were enrolled in this study who fulfilled a structured questionnaire which designed to collect detailed information about sociodemographic characteristics, family disease history, general background knowledge of obesity
and iron through their daily routine of dietary practices, menstruation cycle, physical activity, 24hrs food recall to estimate food adequacy.
The nutritional status assessed through the anthropometric measurements including weight, height and total body fat %. Women provided us with their medical laboratory tests for iron status (serum iron, serum ferritin, transferrin saturation%), thyroid gland hormones
(FT3, FT4, TSH) and complete blood count (Hb, HCT, RBCs).
All statistics were performed using a statistical analysis software program for tabulation and statistical analysis to achieve the objective of the study, results were considered
statistically significant at p≤0.05.
The most important results could be summarized as the following:
1- The mean age of participated women was 41.76 years and ranged between 18-60 years, 72% of them had a university education, 46% with income ranges between 3000-4000 LE per month.
2- 76% of the studied participants assessed their weight lately (less than 6 months), the majority of them 40% had first family grade relative, 74% depended on visiting doctors
specialized in nutrition, while 66% followed nutritional diet.
3- Women with obesity formerly used herbs to combat obesity mainly the green tea followed by ginger.
4- The mean BMI for 100 women with obesity was 38.31 where 28% had BMI class1, 44% had BMI class2 and 28% for BMI class3.
5- 54% of women with obesity had excess body fat (31-40%) and 46% had high body fat risk (>40%).
6- According to anemia: only 26% of women with obesity confirmed that they suffer from iron deficiency, while their laboratory tests figured out that Hb mean level was 9.22 g/dl where all women had low hemoglobin level less than 12 g/dl. 10% of women with obesity had mild anemia, 75% had moderate anemia and 15% had severe anemia.
Summary 86
7- According to hypothyroidism: only 16% of obese women confirmed suffering from
thyroid disorder, while 72% reported that they don’t suffer from thyroid disorders, the laboratory tests figured out that 8% of the studied sample had normal hypothyroidism, 56% had primary hypothyroidism, 18% had secondary hypothyroidism and 18% had subclinical hypothyroidism.
8- All anemic women suffered from primary hypothyroidism where (70%, 56% and 46.7%) were classified for mild, moderate and severe anemia respectively.
9- Regarding eating habits: (1): 64% of the studied sample had breakfast daily, 72% ate breakfast at regular time, 24% slept directly after breakfast. (2): 88% of the studied sample had their lunch daily, 88% ate at specific time, 44% slept directly after lunch. (3):
52% of the studied sample had dinner daily, 50% ate dinner at specific time, 18% slept directly after dinner, the majority of women with obesity (44%) watched TV. while eating.
10- Regarding eating practices: half of the women with obesity ate outside their homes, 56% of them explained that tasty food is the main reason for eating out their homes, 32% did not have time to cook, while 24% of women ate away from their homes to interact socially with their friends.
11- 74% of obese women reported that they ate directly when they felt hungry, they explained the failure of weight loss efforts because of the joy of eating itself (52%), 46% ate plenty of food because of stress and sadness, 14% ate directly at hunger due to boring. Further, 38.46% drank water to avoid eating once they feel hunger, while 30.76% ate salad.
12- 38% of women with obesity had irregularity in the menstrual cycle.
13- Regarding physical activities: 88% of women with obesity did their exercise, 61.4% of them practiced 3-4 times per week, 51.1% spent around 30-60 min\day with a moderate level of intensity (52.3%). Only 12% of women with obesity reported that they could not do their exercise because they had children or had no time in an equal proportion (33.3%), 16.7% of women claimed that their obesity hindered them from practicing.
14- The majority of women aged 51-60 years suffered from severe and moderate anemia (40% and 30.7%) respectively. while the majority of women aged 41-50 years suffered from mild anemia (40%).
15- All women with obesity had moderate anemia (79.5%, 75% and 67.9%) for BMI class 2, 3 and 1 respectively. In contrast; women with BMI class3 and BMI class1 suffered from mild anemia (10.7% and 7.1%) respectively, while only 9.1% of women with BMI class2 had severe anemia.
16- All women with obesity had primary hypothyroidism (64.3%, 56.8% and 46.4%) for BMI class3, 2 and 1 respectively. In contrast; women with BMI class2 and 3 suffered from secondary hypothyroidism (11.4% and 10.7%) respectively, while only 7.1% of women with BMI class1 had normal hypothyroidism.
17- Women with obesity had normal FT3 level (89.3%, 78.6% and 75%) for BMI class1, 3 and 2 respectively. and low FT4 level (82.1%, 75% and 68.2%) respectively for BMI class1, 3 and 2. further, obese women had high TSH level (89.3%, 75% and 57.1%) for BMI class3, 2 and 1 respectively.
18- Ferritin is a remarkable parameter to identify iron deficiency anemia, 48% of women with moderate anemia had low serum ferritin, while 60% of women with mild and severe anemia had quite high normal ferritin level.