{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T15:53:13Z","timestamp":1787932393100,"version":"build-2784847793"},"reference-count":34,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Endocrino Diabet &amp;amp; Metabol"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obesity and anaemia are global epidemics with complex, overlapping pathophysiology. While excess adiposity is known to induce chronic inflammation that disrupts iron homeostasis, multiple population studies paradoxically report higher haemoglobin levels and lower anaemia prevalence among obese individuals. The nonlinear and potentially suppressive role of inflammation in this relationship remains understudied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed adults aged 18\u201364 from the 2015\u20132023 National Health and Nutrition Examination Survey (NHANES). Haemoglobin was modelled as a function of body\u2010mass index (BMI) using survey\u2010weighted linear regression with restricted cubic splines. Interactions with log\u2010transformed CRP were assessed, and ferritin was corrected for inflammation using BRINDA regression\u2010residual methods. Causal mediation analysis decomposed the total effect of BMI on haemoglobin into indirect (mediated by CRP) and direct effects. Secondary models examined anaemia (Hb &lt;\u200913.0\u2009g\/dL in men, &lt;\u200912.0\u2009g\/dL in women) using logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Haemoglobin increased steeply across lower BMI ranges but plateaued above 30\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      (p\u2010nonlinearity &lt;\u20090.001). The haemoglobin\u2013BMI curve flattened significantly at higher CRP levels, with strong evidence of interaction (p\u2010interaction &lt;\u20090.001). Mediation analysis showed that CRP significantly suppressed the BMI\u2013haemoglobin relationship (ACME\u2009=\u2009\u22120.044\u2009g\/dL,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; ADE\u2009=\u20090.216\u2009g\/dL,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In contrast, BRINDA\u2010adjusted ferritin mediated &lt;\u20092% of the association. Logistic models showed that anaemia risk declined sharply with increasing BMI but rose consistently with CRP. Anaemia mediation analysis revealed suppression as well (ACME &gt;\u20090; ADE &lt;\u20090), precluding interpretation of proportion mediated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>BMI is positively associated with haemoglobin in a non\u2010linear, CRP\u2010dependent fashion. Inflammation significantly suppresses the haematologic benefit of excess adiposity, while inflammation\u2010adjusted ferritin plays a minimal mediating role. These findings underscore the importance of modelling non\u2010linearity and correcting iron biomarkers for inflammation when studying obesity\u2010related anaemia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/edm2.70110","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T06:00:13Z","timestamp":1758261613000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Revisiting the Obesity\u2013Anaemia Paradox: Inflammation and Iron Homeostasis in the BMI\u2013Haemoglobin Relationship"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0172-0538","authenticated-orcid":false,"given":"Ali","family":"Hemade","sequence":"first","affiliation":[{"name":"Division of Hematology and Oncology, Department of Internal Medicine American University of Beirut Medical Center, Naef K. Bassile Cancer Institute  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4780-0772","authenticated-orcid":false,"given":"Pascale","family":"Salameh","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy Lebanese University  Hadat Lebanon"},{"name":"Gilbert and Rose\u2010Marie Chagoury School of Medicine Lebanese American University  Beirut Lebanon"},{"name":"Department of Primary Care and Population Health University of Nicosia Medical School  Nicosia Cyprus"},{"name":"Institut National de Sant\u00e9 Publique d'\u00c9pid\u00e9miologie Clinique et de Toxicologie\u2010Liban (INSPECT\u2010LB)  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(23)00160-6"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)02750-2"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(25)00355-1"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980024001794"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-83684-x"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2024.1304127"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-84498-7"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2021.e06429"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jped.2023.06.002"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.3892\/etm.2021.10703"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41366-018-0127-9"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.117.155903"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.0000000000000245"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfn543"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.116.141762"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tjnut.2023.02.016"},{"key":"e_1_2_10_18_1","first-page":"1","article-title":"Obesity: Preventing and Managing the Global Epidemic. 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