Dietary iron overload in southern African rural blacks
A survey conducted in rural southern African black subjects indicated that dietary iron overload remains a major health problem. A full blood count, erythrocyte sedimentation rate, serum concentrations of iron, total iron-binding capacity, ferritin, C-reactive protein (CRP), 1'-glutamyltransferase (GGn and serological screening for hepatitis B and human immunodeficiency virus (HIV) infections were carried out in 370 subjects (214 inpatients and 156 ambulatory Mozambican refugees). The fact that the geometric mean (SD range) serum ferritin concentration was much higher in the male hospital patients than in subjects living in the commpnity [1 581 ug/l (421 - 5944 ug/l) and 448 ug/l (103 - 1945 ug/l) respectively] suggested that dietary iron overload was not the only factor raising the serum ferritin concentration. The major additional factor appeared to be inflammation, since the geometric mean (SO range) serum CRP was significantly higher in male hospital patients [21 mg/l (8 - 53 mg/l)] than in subjects in the community [3 mg/l (1 - 5 mg)]. Alcohol ingestion, as judged by history and by serum GGT concentrations, was also associated with significantly raised serum ferritin concentrations. This finding was ascribed to the fact that traditional brews are not only associated with alcoholinduced hepatic damage but are also a very rich source of highly bio-available iron. The role of iron overload in the genesis of the raised serum ferritin concentrations are confirmed in the diagnostic liver biopsy study. The majority of biopsies showed heavy siderosis, with varying degrees of hepatic damage. No subject tested positive for HIV antibodies, while the hepatitis B infection rate was high (± 70%) in both hospital and community subjects, with a surface antigen carrier rate of roughly 10%.
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