ironjustice

"Iron depletion by venesection favours the normalization of insulin
resistance and raised liver enzymes"

Venesection for non-alcoholic fatty liver disease unresponsive to
lifestyle counselling—a propensity score-adjusted observational study
Oxford Journals Medicine QJM: An International Journal of Medicine
Volume104, Issue2Pp. 141-149.L.
Valenti1, S. Moscatiello2, E. Vanni3, A.L. Fracanzani1, E. Bugianesi3,
S. Fargion1 and G. Marchesini2
+ Author Affiliations
From the 1Department of Internal Medicine, University of Milan,
Fondazione Ospedale Maggiore Policlinico IRCCS, Milan, 2Unit of
Metabolism and Clinical Dietetics, Alma Mater Studiorum University,
Bologna and 3Department of Gastroenterology and Hepatology, University
of Turin, Turin, Italy
Address correspondence to Prof. G. Marchesini, Unit of Clinical
Dietetics, ‘Alma Mater’ University of Bologna, Policlinico S. Orsola,
Via Massarenti, 9, I-40138 Bologna, Italy. email:
giulio.marchesini@unibo.it
Received April 2, 2010.
Revision received August 12, 2010.
Abstract
Background/Aim:
To test the short-term clinical usefulness of venesection associated
with lifestyle counselling as against counselling alone on insulin
resistance and liver enzymes in subjects with non-alcoholic fatty
liver disease (NAFLD), using a propensity score approach.
Methods:
We carried out a 6- to 8-month observational ****ysis of 198 NAFLD
patients in three Italian referral centres (79 venesection and 119
counselling alone). Insulin resistance was measured by the homeostasis
model assessment (HOMA) method. Logistic regression was used to
identify factors associated with normal HOMA and normal alanine
aminotransferase (ALT) at the end of observation. The results were
adjusted for the propensity score to be enrolled in the venesection
programme, based on clinical and laboratory data, including common HFE
polymorphisms and liver biopsy (available in 161 cases).
Results:
After adjustment for propensity and changes in BMI, venesection was
significantly associated with normal HOMA [all cases: odds ratio (OR)
3.00; 95% confidence interval (CI) 1.51–5.97; cases with histology: OR
2.29; 95% CI 1.08–4.87] and ALT within normal limits (all cases: OR
2.56; 95% CI 1.29–5.10; cases with histology: OR 2.81; 95% CI 1.20–
5.24). The results were confirmed in an ****ysis of 57 pairs matched
for propensity, where venesection similarly increased the probability
of normal HOMA (OR 3.27; 95% CI 1.16–7.84) and normal ALT (OR 5.60;
95% CI 2.09–15.00). Similar data were obtained in the subset of cases
with normal basal ferritin (<350 ng/ml).
Conclusion:
Iron depletion by venesection favours the normalization of insulin
resistance and raised liver enzymes in non-haemochromatosis patients
with NAFLD.
© The Author 2010. Published by Oxford University Press on behalf of
the Association of Physicians. All rights reserved. For Permissions,
please email: journals.permissions@oxfordjournals.org


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