Dietary intake of heme iron is associated with ferritin and hemoglobin levels in Dutch blood donors: results from Donor InSight

Abstract

Whole blood donors, especially frequently donating donors, have a risk of iron deficiency and low hemoglobin levels, which may affect their health and eligibility to donate. Lifestyle behaviors, such as dietary iron intake and physical activity, may influence iron stores and thereby hemoglobin levels. We aimed to investigate whether dietary iron intake and questionnaire-based moderate-to-vigorous physical activity were associated with hemoglobin levels, and whether ferritin levels mediated these associations. In Donor InSight-III, a Dutch cohort study of blood and plasma donors, data on heme and non-heme iron intake (mg/day), moderate-to-vigorous physical activity (10 minutes/day), hemoglobin levels (mmol/L) and ferritin levels (μg/L) were available in 2,323 donors (1,074 male). Donors with higher heme iron intakes (regression coefficients (β) in men and women: 0.160 and 0.065 mmol/L higher hemoglobin per 1 mg of heme iron, respectively) and lower non-heme iron intakes (β: -0.014 and -0.017, respectively) had higher hemoglobin levels, adjusted for relevant confounders. Ferritin levels mediated these associations (indirect effect (95% confidence interval) in men and women respectively: 0.074 (0.045; 0.111) and 0.061 (0.030; 0.096) for heme and -0.003 (-0.008;0.001) and -0.008 (-0.013;-0.003) for non-heme). Moderate-to-vigorous physical activity was negatively associated with hemoglobin levels in men only (β: -0.005), but not mediated by ferritin levels. In conclusion, higher heme and lower non-heme iron intake were associated with higher hemoglobin levels in donors, via higher ferritin levels. This indicates that donors with high heme iron intake may be more capable of maintaining iron stores to recover hemoglobin levels after blood donation.

Diagnostic Relevance of Ferrokinetic Laboratory Markers in Anemic Pregnant Women

“…The increase in serum ferritin concentration was established to be consistent with the increase of Hb levels. Similar observations were also reported by other researchers [27].…”

“…Threshold values are not specified as well [26]. The iron balance is also affected by the hormonal background, as not only progesterone increases during pregnancy but also estrogen, which affects iron metabolism [27].…”

Dietary iron intake and the risk of type 2 diabetes mellitus in middle-aged and older adults in urban China: a prospective cohort study

“…Consequently, heme iron can contribute to over 40% of the total absorbed iron in diet (33,34) . Heme iron intake has been previously shown a positive association with body iron store, while nonheme iron intake has been previously shown no association (35)(36)(37) .…”

“…In healthy individuals, the amount of iron in the body is controlled by its absorption, mobilization, storage, and recycling, but iron excretion is not actively regulated (45) . Dietary iron intake might increase iron absorbed by the intestine and body iron stores (46) , studies have previously reported a positive association between dietary iron intake and body iron status (35,38) . Iron could trigger inflammatory responses and promote ROS generation (47,48) .…”

Individual and environmental determinants of serum ferritin levels: A structural equation model

“…Higher body mass index (BMI) is associated with higher ferritin levels 8 . In recent decades, many other factors that affect iron status have been identified: diet, 9,10 genetics, 11,12 ethnicity, 13 and iron supplementation, which is mostly studied among blood donors 14,15 …”