title: Additional effect of low iron diet on iron reduction therapy by phlebotomy for chronic hepatitis C.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Tamano-Municipal Hospital, Tamano City, Okayama, Japan. f-kimura@po1.oninet.ne.jp
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Kimura
authors.forename: Hisao
authors.initials: H
authors.lastname: Hayashi
authors.forename: Motoyoshi
authors.initials: M
authors.lastname: Yano
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yoshioka
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsumura
authors.forename: Tomoko
authors.initials: T
authors.lastname: Fukuda
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Shigeto
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Yamahara
authors.forename: Fukada
authors.initials: F
authors.lastname: Koushi
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Mishima
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yoshino
authors.forename: Mitsune
authors.initials: M
authors.lastname: Tanimoto
authors.forename: Ikuro
authors.initials: I
authors.lastname: Kimura
mesh_terms: 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
chemical_list: D019266:Iron, Dietary; D007501:Iron; D000410:Alanine Transaminase