Effects of venesections and restricted diet in patients with the insulin-resistance hepatic iron overload syndrome

Goal: We evaluated the effect of venesections and restricted diet on iron and metabolic indices and liver function tests in patients with insulin-resistance hepatic iron overload (IR-HIO). Materials and methods: Patients were divided in three groups: (a) patients without any therapy who were followed-up for 36+28 months; (b) patients venesected; and (c) patients on dietary treatment. In each group baseline and end-point levels of serum iron and metabolic indices, and liver function tests were compared by Student's paired t-test and the relationship between serum ferritin and the other variables during treatment was evaluated by linear regression analysis. Findings and conclusions: In the follow-up group, iron and metabolic indices did not change over time. Serum alanine aminotransferase, gamma-glutamyl transferase, cholesterol and triglycerides significantly decreased after iron depletion. Serum glucose, cholesterol, triglyceride, ferritin and liver function tests significantly decreased after dietary treatment. Transferrin saturation decreased below 20% during phlebotomy treatment in 52% of the patients. In conclusion, our results show that IR-HIO patients had relatively low amount of iron overload that seems not to increase even after a long follow-up period. Both venesections and diet improved iron, metabolic and hepatic indices. Data suggest a relationship between hepatic iron overload and insulin resistance, and a role for both iron overload and insulin resistance in hepatocellular damage. The behaviour of iron indices during venesections suggests an impaired iron release from hepatic cells.