Associations of iron overload in Africa with hepatocellular carcinoma and tuberculosis: Strachan's 1929 thesis revisited

Abstract

We analyzed data from the first study of iron overload in Africans, conducted between 1925 and 1928, to determine whether this common condition is associated with death from hepatocellular carcinoma and/or tuberculosis. In the original study, necropsies were performed on 714 adult blacks from southern Africa. Hepatic and splenic iron levels were measured semiquantitatively in 604 subjects and one of five iron grades was assigned. We examined death from hepatocellular carcinoma or from tuberculosis and the variables of age, sex, the presence of cirrhosis or other diagnoses that might be influenced by iron status, and tissue iron grades. Nineteen percent of men and 16% of women had the highest grade of hepatic iron. After adjustment for the presence of cirrhosis, hepatic iron grade was the variable most significantly associated with death from hepatocellular carcinoma (P = .021). The odds of death from hepatocellular carcinoma in subjects with the highest grade of hepatic iron was 23.5 (95% confidence interval, 2.1 to 225) times the odds in subjects with the three lowest grades. Splenic iron was the variable most significantly associated with death from tuberculosis (P >.0001). The odds of death from tuberculosis with the highest grade of splenic iron was 16.9 (4.8 to 59.9) times the odds with the two lowest grades. These findings suggest that iron overload in black Africans may be a risk factor for death from hepatocellular carcinoma and for death from tuberculosis.

Dietary iron overload as a risk factor for hepatocellular carcinoma in black africans

“…20 A recent proportional mortality analysis of the 1920s autopsy series, in which Strachan first described iron overload in Africans, showed an association between high hepatic iron levels and death from HCC. 21 Because of the limited information obtained in this study concerning the presence of coexisting cirrhosis, we are unable to state whether iron loading is an independent cause of the tumor or acts as an indirect carcinogen by inducing chronic necroinflammatory hepatic disease. The controls did not have liver biopsies performed, and it was not possible to reliably diagnose cirrhosis on the biopsies used to confirm the presence of HCC.…”

A systematic review of the epidemiology of unrecorded alcohol consumption and the chemical composition of unrecorded alcohol

“…There are two Supporting information Appendix Tables 1 and 2 with a short description of all references which contain additional references .…”

Iron and iron chelating agents modulateMycobacterium tuberculosisgrowth and monocyte-macrophage viability and effector functions

“…In the 19th century Trousseau, a Parisian professor in clinical medicine, warned his students that iron supplementation in patients with quiescent tuberculosis (TB) could trigger clinical disease. Several studies confirmed the link between TB and iron, showing that excess in iron markedly increases mycobacterial growth in vitro, in the extra- [9] and intracellular milieu [10], while in vivo it decreases resistance and worsens the outcome in mice [11] and humans [12,13]. The association between iron overload and TB is particularly prominent in Sub-Saharan Africa, illustrated by epidemiological studies [12,13] and reviewed in [14].…”