title: Liver diseases in the hemochromatosis and iron overload screening study.
abstract: OBJECTIVE
  The Hemochromatosis and Iron Overload Screening (HEIRS) Study screened 101,168 primary care participants for iron overload with serum transferrin saturation (TS), ferritin, and C282Y and H63D mutations of the HFE gene.
  
  
  METHODS
  All C282Y homozygotes and participants with an increased TS (>45% women, >50% men) and serum ferritin level (> 200 microg/L women, >300 microg/L men) were recalled for a clinical history and physical examination, and blood tests including alanine transaminase (ALT) and aspartate transaminase levels. Hepatitis B surface antigen and anti-hepatitis C virus were measured if the ALT level was increased (>31 IU/L in women, >40 IU/L in men).
  
  
  RESULTS
  In the group of participants selected to return for clinical examination because of increased TS and ferritin levels, ALT increases and anti-hepatitis C virus were found in 95 of 284 (33%) African Americans, 50 of 466 (11%) Asian and Pacific Islanders, 21 of 120 (18%) Hispanics, and 40 of 477 (8.4%) Caucasians. ALT increases and hepatitis B surface antigen were detected in 24 of 466 (5%) Asian and Pacific Islanders, 10 of 284 (3.5%) African Americans, 3 of 120 (2.5%) Hispanics, and 2 of 477 (.42%) Caucasians. Of 86 liver biopsy specimens obtained for clinical purposes, 53 were reviewed by a single study pathologist. Liver fibrosis (stage 3 or 4) was present in 2 of 11 (18.2%) C282Y homozygotes that underwent central review and 2 of 302 (.66%) C282Y homozygotes attending the clinical examination.
  
  
  CONCLUSIONS
  Screening for iron overload with ferritin and TS detects persons with viral hepatitis and other types of liver disease. A minimum of .66% C282Y homozygotes have liver fibrosis.
authors.affiliation: Department of Medicine, University Hospital, 339 Windermere Road, London, Ontario, Canada N6A 5A5. padams@uwo.ca
authors.forename: Paul C
authors.initials: PC
authors.lastname: Adams
authors.forename: Leah
authors.initials: L
authors.lastname: Passmore
authors.forename: Subrata
authors.initials: S
authors.lastname: Chakrabarti
authors.forename: David M
authors.initials: DM
authors.lastname: Reboussin
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Acton
authors.forename: James C
authors.initials: JC
authors.lastname: Barton
authors.forename: Gordon D
authors.initials: GD
authors.lastname: McLaren
authors.forename: John H
authors.initials: JH
authors.lastname: Eckfeldt
authors.forename: Fitzroy W
authors.initials: FW
authors.lastname: Dawkins
authors.forename: Victor R
authors.initials: VR
authors.lastname: Gordeuk
authors.forename: Emily L
authors.initials: EL
authors.lastname: Harris
authors.forename: Catherine
authors.initials: C
authors.lastname: Leiendecker-Foster
authors.forename: Elaine
authors.initials: E
authors.lastname: Gossman
authors.forename: Phyliss
authors.initials: P
authors.lastname: Sholinsky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005293:Ferritins / Q000097:blood; D006432:Hemochromatosis / Q000097:blood / Q000150:complications* / Q000235:genetics; D000071020:Hemochromatosis Protein; D015395:Histocompatibility Antigens Class I / Q000235:genetics; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics; D008111:Liver Function Tests; D008297:Male; D008565:Membrane Proteins / Q000235:genetics; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data; D014168:Transferrin / Q000378:metabolism; D014481:United States
chemical_list: C103673:HFE protein, human; D000071020:Hemochromatosis Protein; D015395:Histocompatibility Antigens Class I; D008565:Membrane Proteins; D014168:Transferrin; D005293:Ferritins