Relationship between transferrin-iron saturation, alcohol consumption, and the incidence of cirrhosis and liver cancer

Clin Gastroenterol Hepatol. 2007 May;5(5):624-9. doi: 10.1016/j.cgh.2007.01.008.


Background & aims: Excessive alcohol consumption and iron overload might act in synergy to promote hepatic fibrogenesis and carcinogenesis. We examined the relation between baseline serum transferrin-iron saturation (TS) and the incidence of hospitalizations or deaths related to cirrhosis and liver cancer as well as the influence of alcohol consumption on this relationship.

Methods: Participants included 8767 persons aged 25-74 years without evidence of cirrhosis at entry into the study or during the first 5 years of follow-up who were subsequently followed for a mean of 13.3 years as part of the first National Health and Nutrition Examination Survey.

Results: During 116,656 person-years of follow-up, 115 participants were hospitalized for or died of cirrhosis and 4 more of liver cancer. Compared with persons with low TS (<40%) and low alcohol consumption (</=1 drink/day) who had an incidence of cirrhosis/liver cancer of 70/100,000 person-years, the incidence was increased in persons with elevated TS (>/=40%) and low alcohol consumption (154/100,000; adjusted hazard ratio, 2.2; 95% confidence interval, 1.3-3.8) and in persons with low TS and elevated (>1 drink/day) alcohol consumption (198/100,000; adjusted hazard ratio, 2.9; 95% confidence interval, 1.7-5.0). The incidence of cirrhosis/liver cancer was particularly high among persons with both elevated TS and elevated alcohol consumption (480/100,000; adjusted hazard ratio, 6.8; 95% confidence interval, 3.6-12.9), exceeding the rate predicted by the addition of the separate attributable risks associated with drinking and elevated serum TS.

Conclusions: Elevated serum TS is associated with an increased incidence of cirrhosis or liver cancer particularly in the presence of elevated alcohol consumption.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Alcohol Drinking / blood*
  • Alcohol Drinking / epidemiology
  • Case-Control Studies
  • Cohort Studies
  • Female
  • Humans
  • Incidence
  • Iron / blood*
  • Liver Diseases / blood*
  • Liver Diseases / epidemiology*
  • Liver Diseases / psychology
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Transferrin / metabolism*
  • United States / epidemiology


  • Transferrin
  • Iron