Dietary iron intake and serum iron status is not associated with

myocardial infarction among adults in the U.S.

M. Beck, N. Harrah, M. Meyer, M. Whitaker, J. Hansen, PhD, RD, LD
Graduate Programs in Human Nutrition
Results
Figure 4: Mean Serum Iron in Men and Women

Table 1: Subject Characteristics

Background
Over 1 million people have a myocardial infarction (MI) or heart
attack each year; approximately 50% of these individuals die.
In 1981, the Iron Hypothesis explained the sex difference in heart
disease and iron emerged as a possible risk factor for CVD.

Characteristics

Participants (n=1,847)

Age (y)

65 9.2*

BMI (kg/m2)

29.3 6.6*

Women (n)

774

100

Men, (n)

331

Non-Hispanic White (n)

788

Hypotheses:

* Mean Standard Deviation

Non-Hispanic Black (n)

510

Other/multiracial (n)

213

Men

Women

12

mg iron/
1000 kcal

8.2

We found no greater risk for history of MI among individuals with a

higher iron density or serum iron concentration, nor did we find a
correlation between iron density and serum iron. The latter suggests
that serum iron is not a good marker of dietary iron intake. A limitation
of our study was that we did not include iron supplementation, which
may have limited the range of iron density and serum iron in this
population. The average serum iron in the bottom and top tertiles were
53 and 120 mcg/dL, respectively; the normal range is 60-170 mcg/dL.
Including supplementation in our study may have yielded greater
variation in iron intake.

0.78

MI

no MI

Figure 6: Iron Density and Iron Biomarker

Odds Ratio with 95% CI

0.1

360

10

Y = -0.4076x + 87.817

Figure 3: Mean Iron Density in Men and Women

Figure 1: Exclusion Criteria

12

Serum
Iron
(ug/dL)

10

Further research should include iron supplementation data to yield

greater variation in iron intake and iron stores. While more research
should be done to investigate other markers of iron status used clinically
like ferritin or hemoglobin.

R2 = 0.0015
P = 0.09

240

NHANES Participants
n = 9,757

Future research:

r = -0.039

300

Acknowledgements

180

The team would like to acknowledge Diane Stadler PhD, RD, LD;
Jackie Shannon PhD; and Laura Zeigan MA, MLIS MPH, AHIP; Esther
Moe PhD, MPH for their contributions to this research project.

120

mg iron/
1000 kcal

60

7.7

7.9
0
0

16

24

32

Iron Density (iron mg/1000 kcal/day)

Men

Women

Our study did not include iron supplementation

Our study was a retrospective study thus cannot be used to assess
causality
Only serum iron was used as a biochemical indicator of dietary iron
intake

Conclusion

7.8

Higher serum iron

NHANES is a large, representative sample of the United States

population
Our study included both dietary and serum iron measures
Dietary iron was expressed as iron density in order to account for
caloric variation in participants diets

Limitations

10

Study Design: Cross sectional, retrospective study of 1,847 adults

Missing Biometric Data

n = 1,847

Strengths

Figure 5: Mean Iron Density and History of MI

1.38

Missing Serum Iron

n = 1,878

Figure 2: Association with History of MI

Methods

Missing Dietary Data

n = 2,026

78.7

25

Higher dietary iron

>51 years of age

n = 2,595

90.9

826

Other Hispanic (n)

aged 51 years or older who participated in NHANES 2011-2012.

Data Collection: Variables that were collected include MI history
from the Medical Conditions Questionnaire; iron and caloric intake
from two 24-hour dietary recalls; and serum iron from the
biochemistry profile.
Statistical Analysis: An odds ratio was calculated to assess the
association between dietary iron density 5 mg/1000 kcals/day
compared to iron density <5 mg/1000 kcals/day and history of MI. A
second odds ratio was calculated to assess highest versus lowest
tertiles of serum iron and history of MI. A one-sided, unpaired t-test
was used to calculate mean serum iron and dietary iron intake
between individuals with and without a history of MI. The correlation
between serum iron concentration and dietary iron density was
assessed with a Pearsons correlation coefficient.

75

Serum iron
(ug/dL)

50

Mechanism: the Oxidative Stress Theory states that free radicals

damage tissues, contributing to chronic disease. Excess iron may
help catalyze production of free radicals. Therefore, MI events may
be partially due to high dietary iron intakes and iron stores in adults,
which are hypothesized to increase oxidative stress.

1. MI prevalence will be higher among participants with an iron

density of 5 mg/1,000 kcal compared to <5 mg/1,000 kcal
2. MI prevalence will be higher among participants in the highest
tertile of serum iron compared to the lowest tertile
3. Iron intake and serum iron will be positively correlated

125

134 participants had a history of MI

Odds of MI among participants with an iron density 5 mg/1000 kcal
were 38% higher than among participants with an iron density <5
mg/1000 kcal, but this association was not statistically significant
(OR: 1.38, 95% CI: 0.71-2.69).
Odds of MI among participants in the highest tertile of serum iron
concentration were 22% lower than among participants in the lowest
tertile, but this relationship was also not statistically significant (OR:
0.78, 95% CI: 0.51-1.18).
Mean dietary iron intake among those with and without a history of
MI was not statistically significant, but trended in the direction of
higher intake among those with history of MI (P=0.089, No MI:
x=7.8,SD=3.06, MI: x=8.18 SD=3.08).
There was no significant correlation between iron density and serum
iron (r= -0.039, P=0.09).

40