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American Journal of Epidemiology Advance Access published online on November 23, 2005
American Journal of Epidemiology, doi:10.1093/aje/kwj018
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American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received May 20, 2005
Accepted August 24, 2005

ORIGINAL CONTRIBUTIONS

Iron Deficiency and Helicobacter pylori Infection in the United States

Victor M. Cardenas 1 *, Zuber D. Mulla 2, Melchor Ortiz 3, and David Y. Graham 4

1 Division of Epidemiology, University of Texas School of Public Health, El Paso, TX
2 Division of Epidemiology, University of Texas School of Public Health, El Paso, TX; Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, El Paso, TX
3 Division of Biostatistics, University of Texas School of Public Health, El Paso, TX
4 Gastroenterology Section, Baylor College of Medicine, Houston, TX

* To whom correspondence should be addressed.
Victor M. Cardenas, E-mail: victor.cardenas{at}uth.tmc.edu


  Abstract

Using data from the current National Health and Nutrition Examination Survey (1999-2000), the authors assessed whether Helicobacter pylori infection is associated with iron deficiency and iron-deficiency anemia (IDA) in the United States. Iron deficiency was defined as at least two abnormal results out of three biomarkers of iron stores. IDA was defined as a low hemoglobin level in the presence of iron deficiency. H. pylori infection was measured by serology. Complex survey estimators were used in the analysis. For 7,462 survey participants aged ≥3 years, H. pylori infection was associated with decreased serum ferritin levels (percent change = -13.9%, 95% confidence interval (CI): -19.5, -8.0) but not with levels of free erythrocyte protoporphyrin, transferrin saturation, or hemoglobin (percent change = 1.5%, -2.8%, and -1.1%, respectively). Multinomial logistic regression analyses indicated that H. pylori infection was associated with the prevalence of IDA (prevalence odds ratio (POR) = 2.6, 95% CI: 1.5, 4.6) and, to a lesser degree, other types of anemia (POR = 1.3, 95% CI: 1.0, 1.7). H. pylori infection was associated with a 40% increase in the prevalence of iron deficiency (POR = 1.4, 95% CI: 0.9, 2.0) after controlling for relevant covariates. In the United States, H. pylori infection was associated with iron deficiency/IDA regardless of the presence or absence of peptic ulcer disease.

Keywords: anemia; anemia, iron deficiency; Helicobacter pylori; iron; peptic ulcer.
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