Background: Iron deficiency produces a reversible hypercholesterolemia in animal models and may do so in humans. Thus, iron deficiency may be an important modifiable risk factor in atherosclerosis prevention. Objective: To determine if an association exists between iron status as measured by iron intake and total cholesterol levels and to understand how change in iron status impacts serum cholesterol response to a lipid lowering diet. Methods: We conducted a retrospective chart review of 62 pediatric patients composed of 29 females and 33 males whose ages ranged from 2 to 16 years with a mean age of 8 years who were referred to a tertiary care center for management of hypercholesterolemia. Patients receiving pharmacotherapy were excluded. At each visit, a lipid profile was drawn and iron intake (mg/day) was determined by nutritional analysis of a prospective 3-day food record. Results: Average length of follow up was 2 years. Mean iron intake as a percent of the recommended dietary allowance (RDA) at the first visit was 112.5% ± 46.2%. Fourteen% of the patients, n=9, were iron deficient (intake <67% of the RDA), all patients had corrected by the follow up visit. Lipid profiles at entry were; total cholesterol 237.0 ± 58.0, triglyceride 134.2 ± 74.1, LDL-cholesterol 165.7 ± 60.6, and HDL-cholesterol 44.5 ± 11.4. By multiple regression analysis, iron deficiency was associated with worsening cholesterol status over the follow up period (p=0.03). Conclusions: Iron status as estimated by iron intake has a statistically significant association with hypercholesterolemia. Poor iron status appears to correlate with a poorer lipid response as compared to non-iron deficient patients. Confirmation of this association is warranted by utilizing a clinical iron index such as ferritin, and clinicians may need to consider iron status in the management of hypercholesterolemia.
