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Iron status of the free-living, elderly Framingham Heart Study cohort: an iron-replete population with a high prevalence of elevated iron stores^1,2,3,4

¹ From the Mineral Bioavailability Laboratory and the Epidemiology Program, Jean Mayer–US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston; The Framingham Heart Study, Boston University School of Medicine, Framingham, MA; Boston University School of Public Health/Framingham Heart Study, Boston; and Boston University Mathematics and Statistics Department/Framingham Heart Study, Boston.

Background: Although iron deficiency occurs commonly in vulnerable groups of women of reproductive age, infants, and children, less is known about the iron nutriture of the elderly.

Objective: Our objective was to evaluate the iron status of a noninstitutionalized, elderly US population, with a particular focus on 2 concerns unique to the elderly: 1) potential confounding effects of chronic disease on iron measures and 2) increased occurrence of elevated iron stores.

Design: Multiple iron measures, including serum ferritin (SF), transferrin saturation, mean cell volume, and hemoglobin, were used to evaluate the prevalence of iron deficiency (ID), iron deficiency anemia (IDA), and other measures of iron nutriture in 1016 elderly white Americans aged 67–96 y from the Framingham Heart Study. "Diseased" subjects were defined as those with possible pathologically altered iron measures due to inflammation, infection, elevated liver enzymes, hereditary hemochromatosis, or cancer. The effect of altered iron status on various prevalence estimates was assessed.

Results: The elderly subjects had a low prevalence of ID (2.7%), IDA (1.2%), and depleted iron stores (3%; SF < 12 µg/L). In contrast, 12.9% had elevated iron stores (SF > 300 µg/L in men and SF > 200 µg/L in women), of which only 1% was attributable to chronic disease. The prevalence of ID, IDA, and depleted iron stores was unaffected by the presence of chronic disease.

Conclusions: The Framingham Heart Study cohort is an iron-replete elderly population with a high prevalence of elevated iron stores in contrast with a low prevalence of iron deficiency, with insignificant effects of chronic disease on these iron status estimates. The likely liability in iron nutriture in free-living, elderly white Americans eating a Western diet is high iron stores, not iron deficiency.

Key Words: Iron status • elderly population • Americans • anemia of chronic disease • anemia • iron overload • iron deficiency • serum ferritin • iron supplements • hemochromatosis

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