Iron supplement use and iron status among US adults: results from the third National Health and Nutrition Examination Survey
Open accessAbstract
Background Patients with hemochromatosis are instructed to avoid taking supplemental iron. Whether supplemental iron intakes lead to higher iron status among healthy persons remains less clear.Objective The objective was to ascertain whether supplemental iron intakes are associated with increases in iron transport (transferrin saturation) and stores (serum ferritin) among US adults aged > or = 19 y.Design We analyzed data for 5948 adults from whom a fasting serum sample was collected during the third National Health and Nutrition Examination Survey. We used multivariable linear regression and analysis of variance to assess the association of supplemental iron intake with iron transport and stores among men (aged 19-30 y or > 30 y) and women (nonpregnant premenopausal or postmenopausal); multiple comparison tests were also performed.Results Healthy adults who took supplements containing average daily amounts of iron at < or = 3 times the recommended dietary allowance (RDA) did not have significantly higher iron transport or stores than did those who did not take supplements. In younger men, the intake of > 32 mg Fe/d (> 4x RDA) was associated with mean transport iron concentrations that were significantly higher than those in persons who took 0 to < or = 24 mg Fe/d. In older men, the intake of > 32 mg Fe/d (> 4x RDA) was associated with mean iron stores that were significantly higher than those in persons who took 0 to < or = 24 mg Fe/d; a similar result was observed in postmenopausal women, but it was of borderline statistical significance.Conclusion Supplement users should be made aware of the amount of iron necessary to satisfy dietary requirements and informed of the possible influence that excess iron intake can have on body iron stores and health.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
High iron intake from supplements or fortified products is known to be toxic, has been linked to negative health effects such as adverse neurodevelopmental outcomes, and may be particularly harmful for some genetically susceptible people.
“very high iron intake in supplemental or forti fi ed forms is known to be toxic and has been associated with negative health impacts, including adverse neurodevelopmental outcomes, and could be especially harmful for certain genetically susceptible individuals (42, 45).”
From Maternal Intake of Supplemental Iron and Risk of Autism Spectrum Disorder (2014) · cites this paper as [42]
In both groups, average iron intake from cereals and supplements across pregnancy exceeded the Tolerable Upper Intake Limit for iron, yet matched national supplement-intake estimates for pregnant women (48 mg/day) and women of childbearing age (18 mg/day).
“Average iron intake from cereals and supplements throughout pregnancy for both groups in this study was above the Tolerable Upper Intake Limit for iron (40) but was in line with national estimates of intake from supplements for pregnant women (48 mg/day) (41) and women of childbearing age (18 mg/day) (42).”
From Maternal Intake of Supplemental Iron and Risk of Autism Spectrum Disorder (2014) · cites this paper as [42]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Acute-Phase Proteins and Other Systemic Responses to Inflammation
Gabay, C., & Kushner, I. (1999) · New England Journal of Medicine · doi:10.1056/nejm199902113400607 · Cited by 6,734 · see citing works
Trumbo (2001) · doi:10.1016/s0002-8223(01)00078-5 · Cited by 4,852 · see citing works
An Approximate Distribution of Estimates of Variance Components
Satterthwaite, F. E. (1946) · Biometrics Bulletin · doi:10.2307/3002019 · Cited by 4,373 · see citing works
Surveillance for waterborne-disease outbreaks--United States, 1993-1994.
Kramer, M. H., Herwaldt, B. L., Craun, G. F., Calderon, R. L., & Juranek, D. D. (1996) · PubMed · Cited by 2,058 · see citing works
A Clinical Evaluation of Serum Ferritin as an Index of Iron Stores
Lipschitz, D. A., Cook, J. D., & Finch, C. A. (1974) · New England Journal of Medicine · doi:10.1056/nejm197405302902201 · Cited by 934 · see citing works
Recommendations to Prevent and Control Iron Deficiency in the United States
(1998) · PsycEXTRA Dataset · doi:10.1037/e547762006-001 · Cited by 816 · see citing works
The diagnosis of iron deficiency anemia
Bainton, D. F., & Finch, C. A. (1964) · The American Journal of Medicine · doi:10.1016/0002-9343(64)90212-8 · Cited by 430 · see citing works
Gunter, E. W., Lewis, B. G., & Koncikowski, S. M. (1996) · Cited by 399 · see citing works
Association Between Body Iron Stores and the Risk of Acute Myocardial Infarction in Men
Tuomainen, T.-P., Punnonen, K., Nyyssönen, K., & Salonen, J. T. (1998) · Circulation · doi:10.1161/01.cir.97.15.1461 · Cited by 286 · see citing works
Barton, J. C., McDonnell, S. M., Adams, P. C., Brissot, P., Powell, L. W., Edwards, C. Q., Cook, J., Kowdley, K. V., & and The Hemochromatosis Management Working Group* (1998) · Annals of Internal Medicine · doi:10.7326/0003-4819-129-11_part_2-199812011-00003 · Cited by 273 · see citing works
Prevalence of C282Y and H63D Mutations in the Hemochromatosis (HFE) Gene in the United States
STEINBERG, K. K., Cogswell, M. E., Chang, J. C.-W., Caudill, S. P., McQuillan, G. M., Bowman, B. A., Grummer‐Strawn, L. M., Sampson, E. J., Khoury, M. J., & Gallagher, M. L. (2001) · JAMA · doi:10.1001/jama.285.17.2216 · Cited by 229 · see citing works
Self-citation[Management of hemochromatosis].
Régent, L. (2007) · PubMed · Cited by 209 · see citing works
Powell, L. W., George, D. K., McDonnell, S. M., & Kowdley, K. V. (1998) · Annals of Internal Medicine · doi:10.7326/0003-4819-129-11_part_2-199812011-00002 · Cited by 185 · see citing works
Jiang, R., Ma, J., Ascherio, A., Stampfer, M. J., Willett, W. C., & Hu, F. B. (2004) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/79.1.70 · Cited by 172 · see citing works
Prenatal Iron Supplements Impair Zinc Absorption in Pregnant Peruvian Women
O'Brien, K. O., Zavaleta, N., Caulfield, L. E., Wen, J., & Abrams, S. A. (2000) · Journal of Nutrition · doi:10.1093/jn/130.9.2251 · Cited by 163 · see citing works
Fleming, D. J., Tucker, K. L., Jacques, P. F., Dallal, G. E., Wilson, P. W., & Wood, R. J. (2002) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/76.6.1375 · Cited by 153 · cited 4× · see citing works
“Fleming et al (4) found that subjects aged 68–93 y in the Framingham Heart Study cohort who took 30 mg supplemental iron/d had significantly higher iron stores than did subjects taking no supplemental iron.”
BackgroundResultInfluentialZinc absorption in women during pregnancy and lactation: a longitudinal study
Fung, E. B., Ritchie, L. D., Woodhouse, L. R., Roehl, R., & King, J. C. (1997) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/66.1.80 · Cited by 151 · see citing works
Serum ferritin and risk of myocardial infarction in the elderly: the Rotterdam Study
Klipstein‐Grobusch, K., Koster, J. F., Grobbee, D. E., Lindemans, J. W., Boeing, H., Albert Hofman, D., & Witteman, J. C. M. (1999) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/69.6.1231 · Cited by 135 · see citing works
Bell, H., Skinningsrud, A., Raknerud, N., & Try, K. (1994) · Journal of Internal Medicine · doi:10.1111/j.1365-2796.1994.tb00802.x · Cited by 117 · see citing works
Serum Ferritin and Death from all Causes and Cardiovascular Disease
Sempos, C. T., Looker, A. C., Gillum, R. F., McGee, D., Vuong, C. V., & Johnson, C. L. (2000) · Annals of Epidemiology · doi:10.1016/s1047-2797(00)00068-5 · Cited by 116 · see citing works
Body iron stores and their determinants in healthy postmenopausal US women
Liu, J.-M., Hankinson, S. E., Stampfer, M. J., Rifai, N., Willett, W. C., & Ma, J. (2003) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/78.6.1160 · Cited by 102 · see citing works
Hemochromatosis : genetics, pathophysiology, diagnosis, and treatment
Barton, J. C., & Edwards, C. Q. (2000) · Cambridge University Press eBooks · Cited by 86 · see citing works
Population norms for serum ferritin.
Custer, E. M., Finch, C. A., Sobel, R. E., & Zettner, A. (1995) · PubMed · Cited by 80 · see citing works
Hemochromatosis: Genetics, Pathophysiology, Diagnosis, and Treatment
Felitti, V. J. (2000) · JAMA · doi:10.1001/jama.284.12.1581 · Cited by 59 · see citing works
Edwards, C. Q., Griffen, L. M., Kaplan, J., & Kushner, J. P. (1989) · Journal of Internal Medicine · doi:10.1111/j.1365-2796.1989.tb01411.x · Cited by 54 · see citing works
McLaren, C. E., Li, K.-T., Gordeuk, V. R., Hasselblad, V., & McLaren, G. D. (2001) · Blood · doi:10.1182/blood.v98.8.2345 · Cited by 42 · see citing works
Garry, P. J., Hunt, W. C., & Baumgartner, R. (2000) · Journal of the American College of Nutrition · doi:10.1080/07315724.2000.10718925 · Cited by 41 · see citing works
Mei, Z., Parvanta, I., Cogswell, M. E., et al. (2003) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/77.5.1229 · Cited by 30 · see citing works
Self-citationHemochromatosis caused by excessive vitamin iron intake.
Hennigar, G. R., Wb, G., Walker, E. M., et al. (1979) · PubMed · Cited by 25 · see citing works
Iron stores in female blood donors evaluated by serum ferritin
Milman, N. T., S�ndergaard, M., & S�rensen, C. M. (1985) · Annals of Hematology · doi:10.1007/bf00320044 · Cited by 22 · see citing works
HFE genotype and transferrin saturation in the United States
Cogswell, M. E., Gallagher, M. L., STEINBERG, K. K., Caudill, S. P., Looker, A. C., Bowman, B. A., Gunter, E. W., Franks, A. L., Satten, G. A., Khoury, M. J., et al. (2003) · Genetics in Medicine · doi:10.1097/01.gim.0000076976.08421.ab · Cited by 19 · see citing works
Self-citationIron Overload Related to Excessive Vitamin C Intake
Mallory, M. A., Sthapanachai, C., & Kowdley, K. V. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-139-6-200309160-00032 · Cited by 17 · see citing works
Secondary hemochromatosis due to prolonged iron ingestion.
Green, P., Eviatar, J., Sirota, P., et al. (1989) · PubMed · Cited by 11 · see citing works
A brief history of hemochromatosis
Barton, J. C. (2000) · Cambridge University Press eBooks · doi:10.1017/cbo9780511666476.002 · Cited by 9 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Barton JC, McDonnell SM, Adams PC, et al. Management of hemo- chromatosis. Ann Intern Med 1998;129:932-9.
- National Center for Health Statistics. Plan and operation of the third National Health and Nutrition Examination Survey, 1988 -94. Vital Health Stat 1 1994;32:1-407.
Cited by
Sorted by citations
Maternal Intake of Supplemental Iron and Risk of Autism Spectrum Disorder
Schmidt, R. J., Tancredi, D. J., Krakowiak, P., Hansen, R. L., & Ozonoff, S. (2014) · American Journal of Epidemiology · doi:10.1093/aje/kwu208 · Cited by 184 · see citing works
- Authors
- Blanck, H. M., Cogswell, M. E., Gillespie, C., & Reyes, M.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Blanck, Heidi Michels
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2005-11
- Volume
- 82
- Issue
- 5
- Pages
- 1024-1031
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2132855548
- Cited by
- 24
- References
- 34
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 1 · 2019: 1 · 2018: 2 · 2017: 1 · 2015: 2 · 2014: 1 · 2013: 2 · 2012: 1
- FWCI
- 0.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Trace Elements in Health
- Keywords
- iron supplementation, iron status, serum ferritin, transferrin saturation, iron stores, iron intake, hemochromatosis, RDA, sex differences, age differences, healthy adults
- MeSH terms
- Adult, Analysis of Variance, Dose-Response Relationship, Drug, Female, Ferritins, Humans, Iron, Male, Menopause, Middle Aged, Nutrition Surveys, Nutritional Requirements, Sex Factors, Transferrin, United States, Linear Models, Nutrition Policy, Iron, Dietary, Dietary Supplements
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
