Additional effect of low iron diet on iron reduction therapy by phlebotomy for chronic hepatitis C.
OBJECTIVE
Iron-induced oxidative stress plays an important role in the pathogenesis of chronic hepatitis C. Both phlebotomy for removing body iron stores and low iron diet for minimizing portal iron supply to the liver have been shown to improve serum transaminase levels in patients with the disease. However, the cooperative effects of phlebotomy and low iron diet have not yet been elucidated in detail.


METHODS
A pilot study was undertaken to investigate whether a low iron diet could improve the efficacy of phlebotomy in iron reduction therapy. Of 21 patients diagnosed with chronic hepatitis C, 10 patients were treated with phlebotomy alone (group A) while 11 patients were treated with a low iron plus phlebotomy (group B). Phlebotomy was repeated biweekly until serum ferritin levels reached 10 ng/mL in both A and B groups. In addition, a low iron diet (iron intake of 8 mg/day or less) was recommended for group B, followed by estimation of iron intake from daily diet records.


RESULTS
Serum alanine aminotransferase levels were significantly improved from 106+/-30 to 68+/-22 IU/L (p<0.005, paired t-test) in group A and from 100+/-33 to 46+/-10 IU/L (p<0.002, paired t-test) in group B. The enzyme levels after treatment were significantly higher in group A (p<0.02, non-paired t-test), which showed a higher upward distribution of the enzyme activity. The estimated dietary iron intake in group B was reduced from 17.6+/-6.1 to 8.2+/-3.7 mg/day.


CONCLUSIONS
These findings suggest that phlebotomy alone does not completely remove iron-induced oxidative stress and a low iron diet induces an additional effect in iron reduction therapy for chronic hepatitis C.
Kimura
Fumiaki
F
Department of Internal Medicine, Tamano-Municipal Hospital, Tamano City, Okayama, Japan. f-kimura@po1.oninet.ne.jp
Hayashi
Hisao
H
Yano
Motoyoshi
M
Yoshioka
Kentaro
K
Matsumura
Tadashi
T
Fukuda
Tomoko
T
Shigeto
Nobuyuki
N
Yamahara
Shigehiro
S
Koushi
Fukada
F
Mishima
Yasuo
Y
Yoshino
Tadashi
T
Tanimoto
Mitsune
M
Kimura
Ikuro
I
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D004032:Diet; D004305:Dose-Response Relationship, Drug; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood / Q000178:diet therapy / Q000378:metabolism* / Q000628:therapy*; D006801:Humans; D007501:Iron / Q000097:blood / Q000378:metabolism*; D019266:Iron, Dietary / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D018962:Phlebotomy; D010865:Pilot Projects; D016896:Treatment Outcome
D019266:Iron, Dietary; D007501:Iron; D000410:Alanine Transaminase