Iron status in Danish women, 1984–1994: a cohort comparison of changes in iron stores and the prevalence of iron deficiency and iron overload
Authors: Milman Nils , Byg Keld‐Erik , Ovesen Lars , Kirchhoff Marianne , Jürgensen Kirsten S‐L 
Published: June 2003

Abstract: Background and objectives: From 1954 to 1986, flour in Denmark was fortified with 30 mg carbonyl iron per kilogram. This mandatory enrichment of cereal products was abolished in 1987. The aim was to evaluate iron status in the Danish female population before and after abolishment of iron fortification.

Methods: Iron status, serum ferritin and haemoglobin, was assessed in population surveys in 1983–1984 comprising 1221 Caucasian women (1089 non‐blood‐donors, 130 donors) and in 1993–1994 comprising 1261 women (1155 non‐blood‐donors, 104 donors) equally distributed in age cohorts of 40, 50, 60 and 70 yr.

Results: In the 1984 survey, median ferritin values in the four age cohorts in non‐blood‐donors were 44, 57, 84 and 80 μg/L, and in the 1994 survey 40, 67, 97 and 95 μg/L, respectively. In 1984, premenopausal women had median ferritin of 43 μg/L and in 1994 of 39 μg/L (NS). In 1984, postmenopausal women had median ferritin of 75 μg/L and in 1994 of 93 μg/L (P < 0.0001). The prevalence of depleted iron stores (ferritin < 16 μg/L) was not significantly different in 1984 and 1994 either in premenopausal or in postmenopausal women. The prevalence of small + depleted iron stores (ferritin ≤32 μg/L) was not significantly different in 1984 compared with 1994 either in premenopausal women (35.8% vs. 41.0%) (P = 0.15) or in postmenopausal women (9.7% vs. 7.4%) (P = 0.15). There was no significant difference between the two surveys concerning the prevalence of iron deficiency anaemia (ferritin <13 μg/L and haemoglobin <5th percentile for iron replete women). From 1984 to 1994, the prevalence of iron overload (ferritin >300 μg/L) was unchanged in premenopausal women and had increased from 2.4% to 5.5% in postmenopausal women (P = 0.003). During the study period there was an increase in body mass index both in premenopausal and postmenopausal women (P = 0.06 and P = 0.008). Postmenopausal women displayed an increase in alcohol consumption (P < 0.0001) and a decrease in tobacco smoking (P < 0.001). In premenopausal women, there was a marked increase in the use of non‐steroid anti‐inflammatory drugs (P < 0.0001) in the study period, while this was unchanged in postmenopausal women. In premenopausal blood donors, median ferritin decreased from 1984 to 1994 (36 μg/L vs. 24 μg/L, P < 0.06). In postmenopausal blood donors, ferritin was not significantly different from 1984 to 1994 (50 μg/L vs. 41 μg/L, P = 0.15).

Conclusion: Abolition of iron fortification reduced the median dietary iron intake in Danish women from 12 to 9 mg/d. Despite the absence of food iron fortification, from 1984 to 1994, body iron stores were unchanged in premenopausal women, whereas iron stores and the prevalence of iron overload in postmenopausal women had increased significantly. The reason appears to be the changes in dietary habits with a lower consumption of dairy products and eggs, which inhibit iron absorption, and a higher consumption of alcohol, meat and poultry, containing heme iron and enhancing iron absorption.