Gastroenterology

Gastroenterology

Volume 126, Issue 5, May 2004, Pages 1293-1301
Gastroenterology

Clinical-liver, pancreas, and biliary tract
The effect of alcohol consumption on the prevalence of iron overload, iron deficiency, and iron deficiency anemia

https://doi.org/10.1053/j.gastro.2004.01.020Get rights and content

Abstract

Background & Aims: Our aim was to investigate the relationship between alcohol consumption and iron overload, iron deficiency, or iron deficiency anemia in the U.S. population. Methods: 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. Results: 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. Conclusions: 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.

Section snippets

Survey design and collection of data

NHANES III was conducted by the National Center for Health Statistics between 1988 and 1994 to assess the health and nutritional status of the civilian, noninstitutionalized population of the United States.19 It was a cross-sectional study of 33,994 persons at least 2 months of age from 89 randomly selected locations throughout the United States and involved household interviews, standardized physical examinations, and laboratory investigations.

Study sample

Of 20,511 NHANES III participants aged 16 years or

Results

Of the 15,883 participants, 8839 (56%) reported drinking no alcohol or fewer than 12 drinks over the past 12 months and 4976 (31%) reported mild, 1153 (7%) moderate, and 915 (6%) heavy alcohol consumption (Table 2). Increasing alcohol consumption was associated with hepatitis C infection, male sex, age 30–59 years, and abnormal values of serum aspartate and alanine aminotransferase. The proportion of participants whose income was below poverty level or who had education less than or equal to a

Discussion

In this population-based study, we observed that increasing alcohol consumption was associated with steadily increasing levels of serum ferritin, iron, and TS and decreased levels of erythrocyte protoporphyrin. The risks of iron deficiency and iron deficiency anemia were approximately 40% lower among persons who consumed any amount of alcohol compared with nondrinkers. However, among those who consumed more than 2 alcoholic drinks/day, there was also a significantly increased risk of iron

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    Supported by grant K24DK02957 (to K.V.K.) and a Junior Faculty Development Award from the American College of Gastroenterology (to G.N.I.).

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