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

Strengths

Figure 5: Mean iron density and history of MI

Table 1. Subject Characteristics

12

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.
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.

Participants (n=1,847)

Age (y)

65 9.2*

BMI (kg/m2)

29.3 6.6*

Women (n)

774

Men, (n)

826

Other Hispanic (n)

331

Non-Hispanic White (n)

788

Non-Hispanic Black (n)

510

Other/multiracial (n)

213

10

mg iron/1000 kcal

Background

Characteristics

Limitations

Figure 2: Association with History of MI

Conclusion
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.

360

300

Serum Iron (ug/dL)

1.38

Methods
Higher dietary iron

0.78

240

Y = -0.4076x + 87.817
180

r = -0.039
R2 = 0.0015

120

Future research:

P = 0.09

Higher serum iron

60

Further research should include iron supplementation

data to yield greater variation in iron intake and iron
stores
More research needs to be done to investigate other
markers of iron status used clinically like ferritin or
hemoglobin

0
0.1

10

Odds Ratio with 95% CI

Figure 1: Exclusion Criteria

NHANES Participants
n = 9,757

12

>51 years of age

n = 2,595

Figure 4:
Mean serum
iron in men
and women

Figure 3:
Mean iron
density in
men and
women

125

Serum iron (ug/dL)

mg iron/1000 kcal

75

50

91

79

25
2

Men

Women

Men

32

Results

100

24

40

Acknowledgements

16

Iron Density (iron mg/1000 kcal/day)

10

Missing Biometric Data

n = 1,847

no MI

Figure 6: Iron Density and Iron Biomarker

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

Missing Serum Iron

n = 1,878

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

* Mean Standard Deviation

Hypotheses:

Missing Dietary Data

n = 2,026

MI

Study Design: Cross sectional, retrospective study of 1,847 adults 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 24hour 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.

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

Women

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: 0.712.69).
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: 0.511.18).
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).

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