Phlebotomy and Lifestyle and Diet Advices vs Lifestyle and Diet Advices Only in Patients With Dysmetabolic Liversiderosis

Non applicable

Inclusion criteria

• Age over 18
• Signed written informed consent
• Ferritin ≥ 450 µg/L and ≤ 1500 µg/L
• Hepatic iron overload proved by MRI or histological biochemical measurement (Iron hepatic concentration ≥ 50 μmol/g)
• At least one of the following criteria :

• Body mass index > 25 kg/m²
• Systolic blood pressure ≥ 140mmHg or diastolic blood pressure ≥ 90 mmHg or antihypertensive treatment
• Abdominal obesity (waist measurement ≥ 94 cm for men and ≥ 80 cm for women)
• Fasting triglyceridemia ≥ 1.7 mmol/L or triglyceride-lowering treatment
• Fasting HDL cholesterol < 1.03 mmol/L for men and < 1.29 mmol/L for women or HDL cholesterol-elevating treatment
• Fasting blood glycemia ≥ 5.6 mmol/L

Exclusion criteria

• Subjects deprived of their liberty by judicial or administrative decision
• Pregnant women
• Other causes of increased serum ferritin levels:

• Inflammatory syndrome (CRP >10 mg/L) or inflammatory, immune or malignant diseases
• Hyper-hemolysis
• Alcohol consumption more than 210 g for men and 140 g for women per week within the year before inclusion
• Haemochromatosis established by the C282Y homozygous genotype
• Chronic hepatic cytolysis due to : viral infection (HBV, HCV), alcohol, hyperthyroid disease, celiac disease, drug or immune hepatitis
• Increased serum ferritin levels - cataract syndrome (familial cataract or personal history of cataract before 50 years of age)
• Low ceruloplasmin level
• Porphyria (cutaneous signs)
• Contraindication of phlebotomy

• Haemoglobin <13 g/dL for men and <12g/dL for women (threshold established by the French Blood Agency)
• Congestive heart failure or coronary heart disease
• Hepatic failure (TP<60%), renal failure (GFR <50mL/min) or respiratory insufficiency (chronic dyspnea)
• Poor venous system
• Fasting blood glycemia > 7 mmol/L or type 1 or type 2 diabetes, treated or not
• Use of drugs known to have anti-steatotic effects : metformin, thiazolidinedione