Hemochromatosis and dietary iron supplementation: implications from US mortality, morbidity, and health survey data.
Trends in the mortality rates, morbidity rates, and hematologic screening parameters for hemochromatosis in the United States over the past 20 years were examined to assess whether dietary iron supplementation is a precipitating factor for hemochromatosis. From 1968 through 1987, there was an increase in the overall hemochromatosis mortality rates attributable to white women. From 1979 through 1987, the hospitalization rates for hemochromatosis ranged from 4 to 13 per 100,000 persons in Medicaid data (1984) and the National Hospital Discharge Survey (1979-1987) and are similar to estimates in the literature from 1955. Although the iron nutritional status of persons under 55 years of age increased from the first to the second National Health and Nutrition Examination Survey, there was no corresponding increase at the 95th percentile in the hemochromatosis screening parameters--serum iron concentration and transferrin saturation. A hypothetical scenario was used to examine the progression from homozygous gene frequency to phenotypic expression. It is concluded that clinical hemochromatosis is rarer than prevalence estimates of 100 to 500 per 100,000 persons predicted by gene frequency. In addition, there is no strong evidence of an increase in hemochromatosis from mortality, morbidity, or health survey data, which implies that dietary iron supplementation begun in 1940 has not accelerated manifestations of hemochromatosis. Any increase in hemochromatosis since iron fortification can probably be attributed to accuracy in diagnosis and enhanced awareness of the disease by physicians rather than to environmental factors.
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SysteMetrics/McGraw-Hill, Washington, DC 20008.
D000293:Adolescent; D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D005838:Genotype; D006432:Hemochromatosis / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics / Q000401:mortality; D006801:Humans; D007501:Iron / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010641:Phenotype; D015995:Prevalence; D014168:Transferrin / Q000032:analysis; D014481:United States / Q000453:epidemiology
D014168:Transferrin; D007501:Iron