The effect of withdrawal of food iron fortification in Sweden as studied with phlebotomy in subjects with genetic hemochromatosis

Olsson, K. Sigvard; Väisänen, Marja‐Leena; Konar, Jan; Bruce, Åke

doi:10.1038/sj.ejcn.1600488

Cited by 46 publications

(25 citation statements)

References 8 publications

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“…If heterozygosity for the C282Y allele has adverse health consequences, such practices should perhaps be reconsidered. Concern about the potential ill effects of mandatory iron-fortification of foods on the part of the Danish and Swedish governments led to its discontinuation in those countries in 1987 and 1995, respectively (43,44). Indirect evidence exists for increased resistance of breast cancer to chemotherapy when excess iron is present.…”

Section: Discussionmentioning

confidence: 99%

Increased Prevalence of theHFE C282YHemochromatosis Allele in Women with Breast Cancer

Kallianpur

Hall

Yadav

et al. 2004

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Individuals with the major hemochromatosis (HFE) allele C282Y and iron overload develop hepatocellular and some extrahepatic malignancies at increased rates. No association has been previously reported between the C282Y allele and breast cancer. We hypothesized that due to the pro-oxidant properties of iron, altered iron metabolism in C282Y carriers may promote breast carcinogenesis. Because 1 in 10 Caucasians of Northern European ancestry carries this allele, any impact it may have on breast cancer burden is potentially great. We determined C282Y genotypes in 168 patients who underwent high-dose chemotherapy and blood cell transplantation for cancer: 41 with breast cancer and 127 with predominantly hematological cancers (transplant cohort). Demographic, clinical, and tumor characteristics were reviewed in breast cancer patients. The frequency of C282Y genotypes in breast cancers was compared with the frequency in nonbreast cancers, an outpatient sample from Tennessee (n ‫؍‬ 169), and a published United States national sample. The frequency of at least one C282Y allele in breast cancers was higher (36.6%, 5 homozygotes/10 heterozygotes) than frequencies in Tennessee (12.7%, P < 0.001), the general population (12.4%, P < 0.001), and similarly selected nonbreast cancers (17.0%, P ‫؍‬ 0.008). The likelihood of breast cancer in the transplant cohort increased with C282Y allele dose (P trend ‫؍‬ 0.010). These results were supported by the finding in a nontransplant cohort of a higher frequency of C282Y mutations in Caucasian (18.4%, P ‫؍‬ 0.039) and African-American (8.5%, P ‫؍‬ 0.005) women with breast cancer than race-specific national frequency estimates. A high prevalence of C282Y alleles in women with breast cancer with and without poor risk features suggests that altered iron metabolism in C282Y carriers may promote the development of breast cancer and/or more aggressive forms of the disease.

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Section: Discussionmentioning

confidence: 99%

Increased Prevalence of theHFE C282YHemochromatosis Allele in Women with Breast Cancer

Kallianpur

Hall

Yadav

et al. 2004

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Suboptimal nutrition in a population with a health status above the average might be an argument for food fortification. In Sweden, food iron fortification was abolished in 1995 (Olsson et al, 1997), and folate fortification is now being considered, nota bene with respect to neural tube defects.…”

Section: Discussionmentioning

confidence: 99%

Reduction of plasma homocysteine and serum methylmalonate concentrations in apparently healthy elderly subjects after treatment with folic acid, vitamin B12 and vitamin B6: a randomised trial

et al. 2003

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Objectives: To investigate, in an elderly population: (1) the effects of oral B-vitamin therapy on P-tHcys, S-MMA and Hb/MCV, (2) the appropriate decision limit for 'high' metabolite concentrations and (3) the estimated prevalence of vitamin B 12 /folate deficiency on the basis of different decision limits. Design: Double-blind placebo-controlled intervention study. Setting: Outpatient clinic. Subjects: A total of 209 community-dwelling subjects, median age 76 y (range 70-93) y. Intervention: Four months of oral daily supplementation with 0.5 mg cyanocobalamin, 0.8 mg folic acid and 3 mg vitamin B 6 . Results: High P-tHcys was found in 64% of men and 45% of women, high S-MMA in 11% of both. Vitamin B 12 deficiency was observed in 7.2% and folate deficiency in 11% of all subjects. Health-related upper reference limits for the metabolites at the start were higher than the laboratory's upper reference limits. The latter were, however, similar to those of the vitamin replete group. There was a significant decrease in P-tHcys (Po0.001) and S-MMA (P ¼ 0.009) after 4 months of vitamin treatment. In a multivariate analysis, the P-Hcys change correlated positively with baseline P-tHcys and inversely with baseline P-folate and transferrin saturation (Fe/TIBC ratio). The S-MMA change correlated with baseline S-MMA and inversely with baseline vitamin B 12 and age. Conclusions: Suboptimal vitamin status is an important cause of elevated P-tHcys and S-MMA in apparently healthy elderly subjects. Oral B-vitamin therapy is an effective and convenient way to normalise P-tHcys and S-MMA. Sponsorship: SupportFRecip AB.

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“…In 2000, 5 years after this removal, the prevalence of iron deficiency in adolescent girls (15-16 years of old) had increased from 39.3 to 50.4% (Hallberg and Hulthen, 2002). Furthermore, based on the observed increased phlebotomy interval in Swedish haemochromatosis patients, it has been proposed that the mean absorbed quantity of iron decreased by 0.65 mg/day following the withdrawal of iron fortification (Olsson et al, 1997). Thus, in the Swedish high bioavailability diet, it seems that the iron fortification had a beneficial effect.…”

Section: Discussionmentioning

confidence: 99%

The importance of bioavailability of dietary iron in relation to the expected effect from iron fortification

2007

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Background:The most common method of combating iron deficiency is iron fortification, especially in developing countries. However, few studies have shown a significant effect on iron status following iron fortification of low bioavailability diets. Objective: To investigate how iron fortification and dietary modifications affect iron absorption and rates of changes in iron stores. Methods: Research has made it possible to predict both iron absorption and the effects of iron fortification and diet modifications on iron stores using recently developed algorithms. Iron absorption and rate of change in iron stores were calculated from nine diets representing a broad range of iron bioavailability and iron contents. The calculations were related to the main target group for iron fortification, that is, women of reproductive age having empty stores but normal haemoglobin concentrations. Results: As the only measure, iron fortification has practically no effect on iron status if the original diet has low bioavailability. However, after dietary modifications such a diet shows a positive effect on iron stores. The combined action of fortification (6 mg/day) and modest bioavailability changes in a low bioavailability diet results approximately in 40 and 70% greater increases in iron stores than through iron fortification or dietary modification alone. Conclusions: It is difficult to achieve good effects on iron status from iron fortification as the only measure if the diet has low bioavailability. Both dietary modifications as well as iron fortification are required to improve effectively the iron status of a population.

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The effect of withdrawal of food iron fortification in Sweden as studied with phlebotomy in subjects with genetic hemochromatosis

Cited by 46 publications

References 8 publications

Increased Prevalence of theHFE C282YHemochromatosis Allele in Women with Breast Cancer

Increased Prevalence of theHFE C282YHemochromatosis Allele in Women with Breast Cancer

Reduction of plasma homocysteine and serum methylmalonate concentrations in apparently healthy elderly subjects after treatment with folic acid, vitamin B12 and vitamin B6: a randomised trial

The importance of bioavailability of dietary iron in relation to the expected effect from iron fortification

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