Although the iron-loading disease, hereditary hemochromatosis, has a strong causal association with hepatocellular carcinoma (HCC), the carcinogenic potential of dietary iron overload in Black Africans is not known. We investigated this potential by evaluating iron status, alcohol consumption, markers for hepatitis B (HBV) and C virus (HCV) infections, and exposure to dietary aflatoxin B 1 in 24 rural patients with this tumor, 48 race-, sex-, and age-matched hospital-based controls, and 75 related or unrelated close family members of the cancer patients. Iron overload was defined as a raised serum ferritin concentration in combination with a transferrin saturation H60%, and was confirmed histologically when possible. Among 24 patients and 48 hospital controls, the risk of developing HCC in the iron-loaded subjects was 10.6 (95% confidence limits of 1.

Non-transferrin-bound iron was found to be commonly present in African patients with dietary iron overload and to correlate with transferrin saturation and serum ferritin concentration. The independent relationship between NTBI and elevated liver function tests suggests that it may be part of a pathway leading to hepatic injury.

Objective: To determine if a traditional item in the diet might be useful in preventing iron de®ciency in African women of child-bearing age. Design: In a prospective study, the iron status of women who did and did not drink traditional beer high in iron and folic acid, was compared. Iron status was determined by a combination of haemoglobin, serum ferritin and transferrin saturation. Setting: The study was conducted amongst rural villagers in the Murehwa and Zaka districts of Zimbabwe and in Mpumalanga Province, South Africa. Subjects: 112 women aged between 12 and 50 y from a population of 425 rural people participating in on-going family genetic studies. Results: Women who consumed traditional beer had signi®cantly higher serum ferritin concentrations and transferrin saturations compared to non-drinkers (P 0.0001 and 0.03 respectively). Iron de®ciency anaemia was not present in drinkers but the prevalence in non-drinkers was 13%. Forty seven percent of the non-drinkers and only 14% of the drinkers had evidence of iron de®ciency (P 0.002). Six (21%) of the drinkers and none of the non-drinkers had evidence of iron overload (transferrin saturation b 55% and serum ferritin b 400 ugal). Conclusion: We conclude that the consumption of traditional beer, rich in iron, protects women against iron de®ciency. While the use of an alcoholic beverage is not ideal, our ®ndings suggest that indigenous cultural practices might be successfully employed or adapted for promoting iron nutrition.

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