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Iron overload in Sub-Saharan Africa: to what extent is it a public health problem?

Published online by Cambridge University Press:  09 March 2007

Alexander R. P. Walker  and
Isidor Segal
Alexander R. P. Walker*
Affiliation:
Human Biochemistry Research Unit, Department of Tropical Diseases, School of Pathology of the University of the Witwatersrand, and the South African Institute for Medical Research, Johannesburg, South Africa
Isidor Segal
Affiliation:
Gastroenterology Unit Department of Medicine, Baragwanath Hospital and the University of the Witwatersrand, Johannesburg 2000, South Africa
*
*Corresponding author: Dr A. R. P. Walker, fax +27 11 489 9001, email [email protected]
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Abstract

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Excessive deposition of Fe in the organs and tissues of Sub-Saharan Africans was first described in South Africa in 1929. Fe overload, or siderosis, was initially attributed to infections and to metallic poisoning (Cu, Sn, Zn), and then to malnutrition. In 1953 it was hypothesized that it was due primarily to excessive Fe intake derived from foods and drinks prepared in Fe vessels. Recently, in 1992 it was advanced that a gene distinct from any HLA-linked locus may also play a role. As to sequelae, in early research on series of hospital patients, the condition was linked to scurvy, osteoporosis, diabetes, cirrhosis, and latterly, to hepatocellular cancer and tuberculosis. Accordingly, many have concluded that Fe overload is responsible for considerable morbidity and mortality, that adventitious Fe intake should be reduced, and that phlebotomy be recommended for those severely affected. However, there are numerous limitations in the evidence. There are also problems in interpretation, since levels of Fe in the serum are affected additionally by a variety of factors: infection, inflammation, certain cancers and alcohol intake. These considerations complicate attempts to assess to what extent the associations described denote causation, and whether Fe overload has significant ramifications for ill in the general African population. While the adverse sequelae of overload may be less of significance than many believe, the precise pathogenicity of the phenomenon will remain uncertain until further investigations, including prospective studies, are undertaken.

Keywords

Iron overloadAfricaCirrhosisHepatocellular carcinoma
Type
Review article
Information
British Journal of Nutrition , Volume 81 , Issue 6 , June 1999 , pp. 427 - 434
Copyright
Copyright © The Nutrition Society 1999

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