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Associations Between Iron Intake and Serum Iron with Inflammatory Bowel Disease and Chronic Diarrheal Symptoms in Adults: the National Health and Nutrition Examination Survey, 2007–2010

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Abstract

Iron may be involved in the etiology of inflammatory bowel disease (IBD) and chronic diarrhea by modulating gut microbiota and immune responses, but data from epidemiological studies in adults examining this relationship are limited. Thus, the aim of this study was to evaluate the association between iron intake and serum iron levels with IBD and chronic diarrhea in adults. Data from the National Health and Nutritional Examination Surveys (NHANES) between 2007 and 2010 for adults ≥ 20 years were obtained. Chronic diarrheal symptoms were determined by using the 2007–2010 NHANES questionnaire which included questions pertaining to bowel health. The presence of IBD was analyzed from the NHANES data, directly querying the presence or absence of ulcerative colitis (UC) and Crohn’s disease (CD). A total of 9605 participants were initially included in this study. Multivariable logistic regression analysis was used and stratified by gender. Compared with quartile 1 (the lowest quartile), the multivariate-adjusted ORs (95% CI) for risk of having chronic diarrheal symptoms were 1.01 (0.86–1.18), 1.29 (1.07–1.56) and 1.25 (1.02–1.54) across quartiles 2 to 4 of iron intake. This significant association remained among men, but not among women in subgroup analyses. No significant association between either iron intake or serum iron level and the risk of IBD was observed. Generally, there was a positive association between iron intake and chronic diarrheal symptoms in adults that was modified by sex.

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The data of this study will be made available on reasonable request.

References

  1. Kappelman MD, Rifas-Shiman SL, Kleinman K, Ollendorf D, Bousvaros A, Grand RJ, Finkelstein JA (2007) The prevalence and geographic distribution of Crohn’s disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol 5(12):1424–1429. https://doi.org/10.1016/j.cgh.2007.07.012

    Article  PubMed  Google Scholar 

  2. Ganz ML, Sugarman R, Wang R, Hansen BB, Håkan-Bloch J (2016) The economic and health-related impact of Crohn’s disease in the United States: evidence from a nationally representative survey. Inflamm Bowel Dis 22(5):1032–1041. https://doi.org/10.1097/MIB.0000000000000742

    Article  PubMed  Google Scholar 

  3. Barros LL, Farias AQ, Rezaie A (2019) Gastrointestinal motility and absorptive disorders in patients with inflammatory bowel diseases: prevalence, diagnosis and treatment. World J Gastroenterol 25(31):4414–4426. https://doi.org/10.3748/wjg.v25.i31.4414

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Baumgart DC, Carding SR (2007) Inflammatory bowel disease: cause and immunobiology. Lancet 369(9573):1627–1640. https://doi.org/10.1016/S0140-6736(07)60750-8

    Article  CAS  PubMed  Google Scholar 

  5. Kaplan GG, Ng SC (2017) Understanding and preventing the global increase of inflammatory bowel disease. Gastroenterology 152(2):313–321. https://doi.org/10.1053/j.gastro.2016.10.020

    Article  PubMed  Google Scholar 

  6. Owczarek D, Rodacki T, Domagała-Rodacka R, Cibor D, Mach T (2016) Diet and nutritional factors in inflammatory bowel diseases. World J Gastroenterol 22(3):895–905. https://doi.org/10.3748/wjg.v22.i3.895

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Mohammadi E, Qujeq D, Taheri H, Hajian-Tilaki K (2017) Evaluation of serum trace element levels and superoxide dismutase activity in patients with inflammatory bowel disease: translating basic research into clinical application. Biol Trace Elem Res 177(2):235–240. https://doi.org/10.1007/s12011-016-0891-0

    Article  CAS  PubMed  Google Scholar 

  8. Opstelten JL, Leenders M, Dik VK, Chan SS, van Schaik FD, Khaw KT, Luben R, Hallmans G, Karling P, Lindgren S, Grip O, Key TJ, Crowe FL, Boeing H, Bergmann MM, Overvad K, Palli D, Masala G, Racine A, Carbonnel F, Boutron-Ruault MC, Tjønneland A, Olsen A, Andersen V, Kaaks R, Katzke VA, Tumino R, Trichopoulou A, Siersema PD, Bueno-de-Mesquita HB, Hart AR, Oldenburg B (2016) Dairy products, dietary calcium, and risk of inflammatory bowel disease: results from a european prospective cohort investigation. Inflamm Bowel Dis 22(6): 1403-1411. https://doi.org/10.1097/MIB.0000000000000798

  9. Zhang L, Shao F, Li L (2020) Association of copper and zinc intake with inflammatory bowel disease and fecal incontinence symptoms: evidence from the national health and nutrition examination survey. Biol Trace Elem Res. https://doi.org/10.1007/s12011-020-02390-7

  10. Cairo G, Bernuzzi F, Recalcati S (2006) A precious metal: Iron, an essential nutrient for all cells. Genes Nutr 1(1):25–39. https://doi.org/10.1007/BF02829934

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Simcox JA, McClain DA (2013) Iron and diabetes risk. Cell Metab 17(3):329–341. https://doi.org/10.1016/j.cmet.2013.02.007

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Gujja P, Rosing DR, Tripodi DJ, Shizukuda Y (2010) Iron overload cardiomyopathy: better understanding of an increasing disorder. J Am Coll Cardiol 56(13):1001–1012. https://doi.org/10.1016/j.jacc.2010.03.083

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Paganini D, Zimmermann MB (2017) The effects of iron fortification and supplementation on the gut microbiome and diarrhea in infants and children: a review. Am J Clin Nutr 106(Suppl 6):1688S–1693S. https://doi.org/10.3945/ajcn.117.156067

    Article  PubMed  PubMed Central  Google Scholar 

  14. Paganini D, Uyoga MA, Zimmermann MB (2016) Iron fortification of foods for infants and children in low-income countries: effects on the gut microbiome, gut inflammation, and diarrhea. Nutrients 8(8). https://doi.org/10.3390/nu8080494

  15. Stochel-Gaudyn A, Fyderek K, Kościelniak P (2019) Serum trace elements profile in the pediatric inflammatory bowel disease progress evaluation. J Trace Elem Med Biol 55:121–126. https://doi.org/10.1016/j.jtemb.2019.06.016

    Article  CAS  PubMed  Google Scholar 

  16. de Silva PS, Yang X, Korzenik JR, Goldman RH, Arheart KL, Caban-Martinez AJ (2017) Association of urinary phenolic compounds, inflammatory bowel disease and chronic diarrheal symptoms: evidence from the National Health and Nutrition Examination Survey. Environ Pollut 229:621–626. https://doi.org/10.1016/j.envpol.2017.06.023

    Article  CAS  PubMed  Google Scholar 

  17. Whelton PK, Carey RM, Aronow WS, Casey DJ, Collins KJ, Dennison HC, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SJ, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KS, Williamson JD, Wright JJ (2018) 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 138(17):e426–e483. https://doi.org/10.1161/CIR.0000000000000597

    Article  PubMed  Google Scholar 

  18. Ballou S, Singh P, Rangan V, Iturrino J, Nee J, Lembo A (2019) Obesity is associated with significantly increased risk for diarrhoea after controlling for demographic, dietary and medical factors: a cross-sectional analysis of the 2009-2010 National Health and Nutrition Examination Survey. Aliment Pharmacol Ther 50(9):1019–1024. https://doi.org/10.1111/apt.15500

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gera T, Sachdev HP (2002) Effect of iron supplementation on incidence of infectious illness in children: systematic review. BMJ 325(7373):1142. https://doi.org/10.1136/bmj.325.7373.1142

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Soofi S, Cousens S, Iqbal SP, Akhund T, Khan J, Ahmed I, Zaidi AK, Bhutta ZA (2013) Effect of provision of daily zinc and iron with several micronutrients on growth and morbidity among young children in Pakistan: a cluster-randomized trial. Lancet 382(9886):29–40. https://doi.org/10.1016/S0140-6736(13)60437-7

    Article  CAS  PubMed  Google Scholar 

  21. Richard SA, Zavaleta N, Caulfield LE, Black RE, Witzig RS, Shankar AH (2006) Zinc and iron supplementation and malaria, diarrhea, and respiratory infections in children in the Peruvian Amazon. Am J Trop Med Hyg 75(1):126–132. https://doi.org/10.4269/ajtmh.2006.75.1.0750126

    Article  CAS  PubMed  Google Scholar 

  22. Dewey KG, Domellöf M, Cohen RJ, Landa RL, Hernell O, Lönnerdal B (2002) Iron supplementation affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and Honduras. J Nutr 132(11):3249–3255. https://doi.org/10.1093/jn/132.11.3249

    Article  CAS  PubMed  Google Scholar 

  23. Kortman GA, Boleij A, Swinkels DW, Tjalsma H (2012) Iron availability increases the pathogenic potential of Salmonella typhimurium and other enteric pathogens at the intestinal epithelial interface. Plos One 7(1):e29968. https://doi.org/10.1371/journal.pone.0029968

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Emerit J, Beaumont C, Trivin F (2001) Iron metabolism, free radicals, and oxidative injury. Biomed Pharmacother 55(6):333–339. https://doi.org/10.1016/s0753-3322(01)00068-3

    Article  CAS  PubMed  Google Scholar 

  25. Lovell RM, Ford AC (2012) Effect of gender on prevalence of irritable bowel syndrome in the community: systematic review and meta-analysis. Am J Gastroenterol 107(7):991–1000. https://doi.org/10.1038/ajg.2012.131

    Article  PubMed  Google Scholar 

  26. Singh P, Mitsuhashi S, Ballou S, Rangan V, Sommers T, Cheng V, Iturrino-Moreda J, Friedlander D, Nee J, Lembo A (2018) Demographic and dietary associations of chronic diarrhea in a representative sample of adults in the United States. Am J Gastroenterol 113(4):593–600. https://doi.org/10.1038/ajg.2018.24

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank the National Center for Health Statistics of the Centers for Disease Control and Prevention for sharing the data.

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Author notes

  1. Fen Chen and Dongliang Yang contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai, 200011, China

    Fen Chen, Dongliang Yang & Zhenlong Wang

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  1. Fen Chen
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Correspondence to Zhenlong Wang.

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NHANES was approved by the National Center for Health Statistics Research Ethics Review Board.

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The code of this study will be made available on reasonable request.

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Chen, F., Yang, D. & Wang, Z. Associations Between Iron Intake and Serum Iron with Inflammatory Bowel Disease and Chronic Diarrheal Symptoms in Adults: the National Health and Nutrition Examination Survey, 2007–2010. Biol Trace Elem Res 199, 4084–4091 (2021). https://doi.org/10.1007/s12011-020-02550-9

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  • DOI: https://doi.org/10.1007/s12011-020-02550-9

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