CHANGING PATTERNS OF DIETARY IRON OVERLOAD IN BLACK SOUTH-AFRICANS

Over the last 17 yr there was a significant reduction in the prevalence and severity of dietary Fe overload in urban blacks of Johannesburg, South Africa. This is attributed to a decrease in the consumption of traditionally brewed beer of high Fe content over this period. A 40% reduction was found in hepatic Fe concentrations measured in necropsy specimens from 248 male patients who died in 1976 as compared with 220 who died in 1959 and 1960. While hepatic Fe concentrations rose with age in both groups there was no evidence of Fe accumulation during the period between the 2 studies. Hepatic Fe concentrations measured in 345 female subjects were many fold less than those of males and the 1976 group did not differ significantly from the 1959-1960 group. A paradoxical increase in the prevalence of portal fibrosis and cirrhosis was seen and may be due to the effects of increased ingestion of spirits and fortified wine in recent years. Fe overload was significantly greater in males with carcinoma of the esophagus and in those with idiopathic heart failure when compared to subjects who died of other causes. This suggests excessive exposure of these subjects to traditionally brewed beverages and the adulterants present in them.