Jornal de Ensaios Clínicos
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Association between Dietary Iron Levels and All-Cause and Cancer-Cause Mortality: A Prospective Cohort Study

Jiahong Yi, Hui Guo, Lin Yang, Chang Jiang, Junyi Duan, Ju Xue, Yue Zhao, Wenzhuo He, Liangping Xia*

Objective: Although many studies paid attention to the connection between dietary iron and incidence of malignant tumor. Few studies elucidated the roles dietary iron played in all-caused or cancer-caused mortality. It is paradoxical about how total dietary iron influences all-cause/cancer-cause mortality.

Methods: Our study collected dietary iron and survival data from National Health and Nutrition Examination Survey (NHANES) 1999-2020. Multivariate cox proportional risk models and subgroup analysis were used to assess the relationship between dietary iron and all/cancer-caused death. Restricted Cubic Samples (RCS) were used to access the non-linear relationship between them.

Results: Dietary iron was a protective factor against all-cause mortality (p for trend=0.004), as well as cancer-caused mortality (p for trend=0.028). They had an "L" shaped nonlinear curve between dietary iron and all-cause mortality (p for overall<0.001; p for non-linearity<0.001), so as to the cancer-related death (p for overall=0.002，p for non- linearity=0.046). With increased dietary iron, all-cause death risk decreased in those were no more than 65 years (p for trend=0.001), males (p for trend=0.02), Non-Hispanic White (p for trend=0.02), Non-Hispanic Black (p for trend<0.001), former smokers (p for trend<0.001), moderate drinkers (p for trend<0.001), heavy drinkers (p for trend<0.001), as well as without hypertension (p for trend<0.001) or DM (p for trend<0.001). Iron intake decreased cancer-caused death in individuals who were<=65 years (p for trend=0.005), males (p for trend=0.04), non-Hispanic White (p for trend=0.03) or non-Hispanic Black (p for trend=0.001), as well as never smokers (p for trend=0.002).

Conclusion: Dietary iron was a positive factor for all/cancer-caused death in population and they had an "L" shaped nonlinear relationship. All-caused or cancer-caused mortality was attenuated by dietary iron in people who were no more than 65 years, males, Non-Hispanic White and Non-Hispanic Black, as well as people without hypertension or DM.