Advertisement

The effect of alcohol consumption on the prevalence of iron overload, iron deficiency, and iron deficiency anemia

      Abstract

      Math Eq Our aim was to investigate the relationship between alcohol consumption and iron overload, iron deficiency, or iron deficiency anemia in the U.S. population. Math Eq Adult participants of the Third National Health and Nutrition Examination Survey who did not consume alcohol (n = 8839) were compared with participants who consumed ≤1 (n = 4976), >1 to ≤2 (n = 1153), or >2 (n = 915) alcoholic drinks/day during the preceding 12 months. We examined the following markers of iron overload: elevated serum transferrin-iron saturation (TS) level (>45%, >50%, and >60%), elevated serum ferritin level (>300, >400, >500, and >600 ng/mL), and combinations of both elevated serum TS and ferritin levels. Iron deficiency was defined as the presence of at least 2 of the following: serum ferritin level <12 ng/mL, serum TS level <15%, and erythrocyte protoporphyrin level >1.24 μmol/L. Iron deficiency anemia was defined as the presence of both iron deficiency and anemia. Math Eq Compared with nondrinkers, the prevalence of all markers of iron overload was significantly elevated among those who consumed >2 alcoholic drinks/day after adjusting for potential confounders. Consumption of any amount of alcohol was associated with a 40% reduction in the risk of iron deficiency anemia. Math Eq Consumption of up to 2 alcoholic drinks/day seems to be associated with reduced risk of iron deficiency and iron deficiency anemia without a concomitant increase in the risk of iron overload. Consumption of >2 alcoholic drinks/day is associated with a significant elevation in the risk of iron overload.

      Abbreviations:

      CI (confidence interval), NHANES III (Third National Health and Nutrition Examination Survey), OR (odds ratio), TS (transferrin-iron saturation)
      To read this article in full you will need to make a payment
      AGA Member Login
      Login with your AGA username and password.
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Chapman R.W.
        • Morgan M.Y.
        • Laulicht M.
        • Hoffbrand A.V.
        • Sherlock S.
        Hepatic iron stores and markers of iron overload in alcoholics and patients with idiopathic hemochromatosis.
        Dig Dis Sci. 1982; 27: 909-916
        • Ludwig J.
        • Hashimoto E.
        • Porayko M.K.
        • Moyer T.P.
        • Baldus W.P.
        Hemosiderosis in cirrhosis.
        Gastroenterology. 1997; 112: 882-888
        • Ford C.
        • Wells F.E.
        • Rogers J.N.
        Assessment of iron status in association with excess alcohol consumption.
        Ann Clin Biochem. 1995; 32: 527-531
        • Bell H.
        • Skinningsrud A.
        • Raknerud N.
        • Try K.
        Serum ferritin and transferrin saturation in patients with chronic alcoholic and non-alcoholic liver diseases.
        J Intern Med. 1994; 236: 315-322
        • Chick J.
        • Pikkarainen J.
        • Plant M.
        Serum ferritin as a marker of alcohol consumption in working men.
        Alcohol Alcohol. 1987; 22: 75-77
        • Irving M.G.
        • Halliday J.W.
        • Powell L.W.
        Association between alcoholism and increased hepatic iron stores.
        Alcohol Clin Exp Res. 1988; 12: 7-13
        • Kristenson H.
        • Fex G.
        • Trell E.
        Serum ferritin, gammaglutamyl-transferase and alcohol consumption in healthy middle-aged men.
        Drug Alcohol Depend. 1981; 8: 43-50
        • Moirand R.
        • Lescoat G.
        • Delamaire D.
        • Lauvin L.
        • Campion J.P.
        • Deugnier Y.
        • Brissot P.
        Increase in glycosylated and nonglycosylated serum ferritin in chronic alcoholism and their evolution during alcohol withdrawal.
        Alcohol Clin Exp Res. 1991; 15: 963-969
        • Whitfield J.B.
        • Zhu G.
        • Heath A.C.
        • Powell L.W.
        • Martin N.G.
        Effects of alcohol consumption on indices of iron stores and of iron stores on alcohol intake markers.
        Alcohol Clin Exp Res. 2001; 25: 1037-1045
        • Milman N.
        • Kirchhoff M.
        Relationship between serum ferritin, alcohol intake, and social status in 2235 Danish men and women.
        Ann Hematol. 1996; 72: 145-151
        • Fletcher L.M.
        • Dixon J.L.
        • Purdie D.M.
        • Powell L.W.
        • Crawford D.H.
        Excess alcohol greatly increases the prevalence of cirrhosis in hereditary hemochromatosis.
        Gastroenterology. 2002; 122: 281-289
        • Tsukamoto H.
        • Horne W.
        • Kamimura S.
        • Niemela O.
        • Parkkila S.
        • Yla-Herttuala S.
        • Brittenham G.M.
        Experimental liver cirrhosis induced by alcohol and iron.
        J Clin Invest. 1995; 96: 620-630
        • Bacon B.R.
        • Britton R.S.
        The pathology of hepatic iron overload.
        Hepatology. 1990; 11: 127-137
        • Britton R.S.
        Metal-induced hepatotoxicity.
        Semin Liver Dis. 1996; 16: 3-12
        • Pietrangelo A.
        Iron, oxidative stress and liver fibrogenesis.
        J Hepatol. 1998; 28: 8-13
        • Kaplowitz N.
        • Tsukamoto H.
        Oxidative stress and liver disease.
        Prog Liver Dis. 1996; 14: 131-159
        • Niemela O.
        • Parkkila S.
        • Britton R.S.
        • Brunt E.
        • Janney C.
        • Bacon B.
        Hepatic lipid peroxidation in hereditary hemochromatosis and alcoholic liver injury.
        J Lab Clin Med. 1999; 133: 451-460
        • Looker A.C.
        • Dallman P.R.
        • Carroll M.D.
        • Gunter E.W.
        • Johnson C.L.
        Prevalence of iron deficiency in the United States.
        JAMA. 1997; 277: 973-976
      1. National Center for Health Statistics. Plan and operation of the Third National Health and Nutrition Examination Survey, 1988–1994. National Center for Health Statistics, Hyattsville, MD1994
        • Gunter E.W.
        • Lewis B.G.
        • Koncikowski S.M.
        Laboratory procedures used for the Third National Health and Nutrition Examination Survey (NHANES III), 1988–1994. Centers for Disease Control and Prevention, Hyattsville, MD1996
        • Looker A.C.
        • Gunter E.W.
        • Johnson C.L.
        Methods to assess iron status in various NHANES surveys.
        Nutr Rev. 1995; 53: 246-254
        • Bassett M.L.
        • Halliday J.W.
        • Ferris R.A.
        • Powell L.W.
        Diagnosis of hemochromatosis in young subjects.
        Gastroenterology. 1984; 87: 628-633
        • Alter M.J.
        • Kruszon-Moran D.
        • Nainan O.V.
        • McQuillan G.M.
        • Gao F.
        • Moyer L.A.
        • Kaslow R.A.
        • Margolis H.S.
        The prevalence of hepatitis C virus infection in the United States, 1988 through 1994.
        N Engl J Med. 1999; 341: 556-562
        • Nainan O.V.
        • Cromeans T.L.
        • Margolis H.S.
        Sequence-specific, single-primer amplification and detection of PCR products for identification of hepatitis viruses.
        J Virol Methods. 1996; 61: 127-134
        • Expert Scientific Working Group
        Summary of a report on assessment of the iron nutritional status of the United States population.
        Am J Clin Nutr. 1985; 42: 1318-1330
        • Cook J.D.
        • Finch C.A.
        • Smith N.J.
        Evaluation of the iron status of a population.
        Blood. 1976; 48: 449-455
        • Pilch S.M.
        • Sentri F.R.
        Assessment of the iron nutritional status of the U.S. population based on data collected in the Second Health and Nutrition Examination Survey, 1976–1980. Federation of American Societies of Experimental Biology, Bethesda, MD1984
        • Guyatt G.H.
        • Oxman A.D.
        • Ali M.
        • Willan A.
        • McIlroy W.
        • Patterson C.
        Laboratory diagnosis of iron-deficiency anemia.
        J Gen Intern Med. 1992; 7: 145-153
        • Guyatt G.H.
        • Patterson C.
        • Ali M.
        • Singer J.
        • Levine M.
        • Turpie I.
        • Meyer R.
        Diagnosis of iron-deficiency anemia in the elderly.
        Am J Med. 1990; 88: 205-209
        • Lipschitz D.A.
        • Cook J.D.
        • Finch C.A.
        A clinical evaluation of serum ferritin as an index of iron stores.
        N Engl J Med. 1974; 290: 1213-1216
        • Olynyk J.K.
        • Cullen D.J.
        • Aquilia S.
        • Rossi E.
        • Summerville L.
        • Powell L.W.
        A population-based study of the clinical expression of the hemochromatosis gene.
        N Engl J Med. 1999; 341: 718-724
        • Edwards C.Q.
        • Griffen L.M.
        • Goldgar D.
        • Drummond C.
        • Skolnick M.H.
        • Kushner J.P.
        Prevalence of hemochromatosis among 11,065 presumably healthy blood donors.
        N Engl J Med. 1988; 318: 1355-1362
        • Skikne B.S.
        • Flowers C.H.
        • Cook J.D.
        Serum transferrin receptor.
        Blood. 1990; 75: 1870-1876
        • Celada A.
        • Rudolf H.
        • Donath A.
        Effect of experimental chronic alcohol ingestion and folic acid deficiency on iron absorption.
        Blood. 1979; 54: 906-915
        • MacDonald R.A.
        • Blaumsberg N.
        Iron in alcoholic beverages.
        Am J Med Sci. 1964; 247: 649
        • Perman G.
        Hemochromatosis and red wine.
        Acta Med Scand. 1967; 182: 281-284
        • Stibler H.
        • Borg S.
        Glycoprotein glycosyltransferase activities in serum in alcohol-abusing patients and healthy controls.
        Scand J Clin Lab Invest. 1991; 51: 43-51
        • Xin Y.
        • Lasker J.M.
        • Rosman A.S.
        • Lieber C.S.
        Isoelectric focusing/western blotting.
        Alcohol Clin Exp Res. 1991; 15: 814-821
        • Suzuki Y.
        • Saito H.
        • Suzuki M.
        • Hosoki Y.
        • Sakurai S.
        • Fujimoto Y.
        • Kohgo Y.
        Up-regulation of transferrin receptor expression in hepatocytes by habitual alcohol drinking is implicated in hepatic iron overload in alcoholic liver disease.
        Alcohol Clin Exp Res. 2002; 26: 265-315
        • Callender S.T.
        • Malpas J.S.
        Absorption of iron in cirrhosis of the liver.
        Br Med J. 1963; 2: 1516-1518
        • Friedman I.M.
        • Kraemer H.C.
        • Mendoza F.S.
        • Hammer L.D.
        Elevated serum iron concentration in adolescent alcohol users.
        Am J Dis Child. 1988; 142: 156-159
        • Greenberg M.S.
        • Strohmeyer G.
        • Hine G.J.
        • Keene W.R.
        • Curtis G.
        • Chalmers T.C.
        Studies in iron absorption III. Body radioactivity measurements of patients with liver disease.
        Gastroeneterology. 1964; 46: 651-661
        • Davis A.E.
        • Biggs J.C.
        Iron absorption in haemochromatosis and cirrhosis of the liver.
        Aust Ann Med. 1964; 13: 201-203
        • Deller D.J.
        Iron-59 absorption measurements by whole body counting.
        Am J Dig Dis. 1965; 10: 249-258
        • Friedman B.I.
        • Schaefer J.W.
        • Schiff L.
        Increased iron-59 absorption in patients with hepatic cirrhosis.
        J Nucl Med. 1966; 7: 594-602
        • Williams R.
        • Williams H.S.
        • Scheuer P.J.
        • Pitcher C.S.
        • Loizeau E.
        • Sherlock S.
        Iron absorption and siderosis in chronic liver disease.
        Q J Med. 1967; 36: 151-166
        • Duane P.
        • Raja K.B.
        • Simpson R.J.
        • Peters T.J.
        Intestinal iron absorption in chronic alcoholics.
        Alcohol Alcohol. 1992; 27: 539-544
        • Cushman M.
        • Legault C.
        • Barrett-Connor E.
        • Stefanick M.L.
        • Kessler C.
        • Judd H.L.
        • Sakkinen P.A.
        • Tracy R.P.
        Effect of postmenopausal hormones on inflammation-sensitive proteins.
        Circulation. 1999; 100: 717-722
        • Mulholland C.W.
        • Elwood P.C.
        • Davis A.
        • Thurnham D.I.
        • Kennedy O.
        • Coulter J.
        • Fehily A.
        • Strain J.J.
        Antioxidant enzymes, inflammatory indices and lifestyle factors in older men.
        Q J Med. 1999; 92: 579-585
        • Konijn A.M.
        Iron metabolism in inflammation.
        Baillieres Clin Haematol. 1994; 7: 829-849
        • Baer D.M.
        • Simons J.L.
        • Staples R.L.
        • Rumore G.J.
        • Morton C.J.
        Hemochromatosis screening in asymptomatic ambulatory men 30 years of age and older.
        Am J Med. 1995; 98: 464-468
      2. Iron overload disorders among Hispanics-San Diego, California, 1995.
        MMWR. 1996; 45: 991-993
      3. http://www.cdc.gov/nchs/about/major/nhanes/NHANESIII_Reference_Manuals.htm, Appendix B; 39–44. Accessed: September 2003.