Helicobacter pylori infection and serum ferritin: A population-based studyamong 1806 adults in Germany

OBJECTIVE: Helicobacter pylori may possibly affect the iron metabolism by o ccult bleeding, impaired absorption of non-hem iron, and by scavenging hem iron or ferritin, as some studies have suggested. The aim of this study was to analyze the: association between H. pylori infection and serum ferritin , a marker of the body iron stores. In this analysis, we paid particular at tention to the role of dietary iron intake and CagA, an established virulen ce factor of the agent. METHODS: The analysis is based on a cross-sectional national health and nut rition survey among healthy people in Germany conducted in 1987/1988. The e xamination included a detailed questionnaire on medical history and lifesty le factors, a 7-day food record, and blood samples. Infection with H. pylor i was measured serologically by ELISA and Westernblot. RESULTS: In total, 39.2% of 1806 persons aged 18 to 89 yr included in the s tudy were H. pylori positive, of whom 57.6% had an infection with a CagA-po sitive H. pylori strain. Age- and sex-adjusted geometric mean of ferritin w as 54.5 mug/dl among H. pylori-infected compared with 63.8 mug/dl among uni nfected persons. A multiple linear regression model with log-transformed se rum ferritin concentration as dependent variable and H. pylori infection an d several potential confounding factors as independent variable was fitted. In this model, H. pylori infection was associated with a 17.0% decrease of the serum ferritin concentration (95% CI = 9.8-23.6). The association betw een H. pylori infection and serum ferritin levels did not vary by gender, a ge, and iron intake, and it was similar for CagA-positive and CagA-negative H. pylori infections. CONCLUSIONS: The decreased serum ferritin concentration among subjects infe cted with H. pylori might be induced by the uptake of ferritin in the stoma ch by H. pylori. Possible health implications of H. pylori-induced low ferr itin levels warrant further investigation, (Am J Gastroenterol 2001;96: 101 4-1018. (C) 2001 by Am. Coll. of Gastroenterology).