Impact of Food Rations and Supplements on Micronutrient Status by Trimester of Pregnancy: Cross-Sectional Studies in the Maela Refugee Camp in Thailand

Micronutrient fortified flour (MFF), supplementary food rations and micronutrient (MN) supplements may prevent deficiencies among pregnant women. Objectives of cross-sectional surveys in 2004 (n = 533) and 2006 (n = 515) were to assess the impact of new food rations (flour, oil) and supplements on MN status by trimester of pregnancy in the Maela refugee camp. Hemoglobin, iron status, zinc, retinol, β-carotene and tryptophan decreased, while α-/γ-tocopherol and 5-methyltetrahydrofolate (5-MTHF) increased from first to third trimester. In 2006, mean zinc and α-tocopherol for each trimester was significantly higher than in 2004. The weeks of supplemented thiamine and folic acid were positively correlated with thiamine diphosphate (TDP) and 5-MTHF, but not for ferrous sulfate as iron deficiency was observed in 38.5% of third-trimester women. Frequent consumption of fish paste and owning a garden or animal were associated with significantly higher iron status, retinol, β-carotene, and 5-MTHF. In conclusion, MFF and supplementary oil were most likely to explain improved zinc and α-tocopherol status, while thiamine and folate supplements ensured high TDP and 5-MTHF in late pregnancy. MN supplements, MN-rich staple food, small gardens, and programs to improve iron compliance are promising strategies to prevent MN deficiencies during pregnancy in vulnerable populations.     

Increased risk of iron deficiency and reduced iron absorption but no difference in zinc,vitamin A or B-vitamin status in obese women in India

Purpose

Two objectives were investigated: (1) to assess the risk of micronutrient deficiencies in relation to weight status in Indian women with a focus on iron but also including zinc, vitamin A and B vitamins and (2) to compare fractional iron absorption between obese (OB) and normal weight (NW) women.

Methods

Part 1 was a cross-sectional study including 146 healthy, middle-class women from Bangalore, India, with a BMI between 19 and 40 kg/m². Anthropometrics and blood pressure were measured, and a fasting blood sample was obtained for the analysis of vitamin and mineral status, hepcidin, blood lipids and glucose. In part 2, 16 OB and 13 NW women consumed a standardized test meal labeled with the stable iron isotope ⁵⁷Fe. Incorporation of the iron isotope into erythrocytes was measured 14 days later. In addition, iron status, hepcidin and inflammatory markers were determined.

Results

In part 1, compared to NW women, overweight/OB subjects had significantly higher C-reactive protein, serum ferritin, soluble transferrin receptor (sTfR) and hepcidin concentrations (p < 0.05). The odds ratio for having high sTfR concentrations (i.e., low iron status) with increasing BMI was 1.09 (95 % CI 1.02–1.17). None of the other micronutrients investigated showed any differences between weight status groups. In part 2, fractional iron absorption was significantly lower in the OB group compared to the NW group even after controlling for differences in iron status (10.0 ± 6.5 vs. 16.7 ± 4.6 %; p = 0.038).

Conclusions

OB women in Bangalore have an increased risk of low iron status and absorb less dietary iron; however, their risk of other micronutrient deficiencies was similar to NW women. Our results clearly demonstrate the importance of considering the double burden of malnutrition in the planning of prevention strategies especially in transition countries with emerging obesity epidemics.

     

Relationship between vitamin D deficiency, bone remodelling and iron status in iron-deficient young women consuming an iron-fortified food

Background

Iron and vitamin D deficiencies are two of the most widespread nutritional disorders in the world. Our aim was to know whether the consumption of an iron-fortified fruit juice modifies bone remodelling and the possible influence of baseline vitamin D status on the recovery of iron status in a group of iron-deficient women.

Methods

Iron biomarkers, 25-hydroxyvitamin D levels and dietary intake were measured in 123 iron-deficient menstruating women. A subgroup (n = 41) participated in a randomised double-blind placebo-controlled study of 16-weeks during winter. They consumed a placebo fruit juice (P) or iron-fortified fruit juice (F). Dietary intake, 25-hydroxyvitamin D, parathormone (PTH), bone alkaline phosphatase (ALP), aminoterminal telopeptide of collagen I (NTX) and iron biomarkers were determined.

Results

Ninety-two per cent of the iron-deficient women were vitamin D deficient or insufficient. Transferrin saturation and 25-hydroxyvitamin D were positively correlated. Iron status improved in F, 25-hydroxyvitamin D decreased in F and P, and PTH, ALP and NTX levels were within the normal range and did not vary. Women with 25-hydroxyvitamin D ≥ 50 nmol/L compared with 25-hydroxyvitamin D < 50 nmol/L showed a higher increase in transferrin saturation (a marker of iron supply to tissues) during iron recovery.

Conclusion

The prevalence of vitamin D deficiency or insufficiency is very high in iron-deficient women. The recovery of iron status by consuming an iron-fortified food does not affect 25-hydroxyvitamin D levels; however, the increase in iron supply to tissues is lower if the women also present vitamin D deficiency. Although bone health does not seem to be affected in this group of women, correction of iron and vitamin D deficiencies should be promoted in young women to improve present and future health.     

Iron status of one-year-olds and association with breast milk, cow’s milk or formula in late infancy

Purpose

Studies on iron status in infancy and early childhood have shown contradicting results concerning prolonged breast-feeding and cow’s milk intake. The aim of the present study was to investigate associations between iron status among one-year-olds and feeding, with focus on the type of milk.

Methods

Randomly selected healthy infants were prospectively investigated until 1 year of age in two cohorts born 1995–1996 (n = 114) and 2005 (n = 140). Information on birth data, feeding and growth until 12 months and iron status at 12 months was collected. Data from the two cohorts were pooled and the infants categorized into three groups according to their predominant milk consumption at 9 months of age, that is, breast milk, cow’s milk or follow-on formula.

Results

The prevalence of iron deficiency was highest in the cow’s milk group and lowest in the follow-on formula group. According to a linear model, adjusted for gender, birth weight and exclusive breast-feeding duration, cow’s milk consumption was negatively associated with serum ferritin (SF) and formula positively, but breast milk not. Predicted SF (μg/l) = 11.652(intercept) ? 5.362(boy) + 0.005 × birth weight (g) + 2.826(exclusively breastfed ≥ 4 months) + 0.027 × formula (ml) ? 0.022 × cow’s milk (ml) + 0.005 × breast milk (ml). Correction for other dietary factors did not change these results.

Conclusion

In this pooled analysis, cow’s milk intake in late infancy associated negatively, and follow-on formula positively, with iron status. Prolonged partial breast-feeding does not seem to be of importance for iron status. Fortified food seems to improve iron status in late infancy.     

Suboptimal iron status and associated dietary patterns and practices in premenopausal women living in Auckland, New Zealand

Purpose

To investigate associations between dietary patterns and suboptimal iron status in premenopausal women living in Auckland, New Zealand.

Methods

Premenopausal women (n = 375; 18–44 years) were included in this cross-sectional analysis. Suboptimal iron status was defined as serum ferritin <20 μg/L. Participants completed a 144-item iron food frequency questionnaire (FeFFQ) and a questionnaire on dietary practices to assess dietary intake over the past month. Factor analysis was used to determine dietary patterns from the FeFFQ. Logistic regression was used to determine associations between these dietary patterns and iron status.

Results

Seven dietary patterns were identified: refined carbohydrate and fat; Asian; healthy snacks; meat and vegetable; high tea and coffee; bread and crackers; and milk and yoghurt. Logistic regression suggested that following a “meat and vegetable” dietary pattern reduced the risk of suboptimal iron status by 41 % (95 % CI: 18, 58 %; P = 0.002) and following a “milk and yoghurt” pattern increased the risk of suboptimal iron status by 50 % (95 % CI: 15, 96 %; P = 0.003).

Conclusions

These results suggest that dietary patterns characterized by either a low intake of meat and vegetables or a high intake of milk and yoghurt are associated with an increased risk of suboptimal iron status. Dietary pattern analysis is a novel and potentially powerful tool for investigating the relationship between diet and iron status.     

Zinc deficiency in a semiurban Nigerian community: prevalence and relationship with socioeconomic status and indices of metabolic syndrome

Aim

The main objectives of this study were to evaluate the prevalence of zinc deficiency in a semiurban community in Nigeria and to determine its relationship with the socioeconomic status and indices of metabolic syndrome in that community.

Subjects and method

Serum zinc concentrations were measured in 212 subjects during a community health screening programme. We determined zinc deficiency in the subjects using a normal reference range for serum zinc of 8–20 μmol/l.

Results

Two hundred twelve participants were enrolled in the study. Of these, 112 (52.83 %) were females. The average age of the study subjects was 44.6?±?14.2 years. Prevalence of zinc deficiency in the community was estimated to be 50 %. The mean serum zinc level was significantly higher in participants older than 60 years compared with younger age groups (F (2,209)?=?5.88, p?p?r?=??0.104, p?>?0.05) and random blood sugar (r?=??0.026, p?>?0.05). No significant difference was observed between social class categories using the Registrar General’s scale of social classes (F (4,207)?=?1.97, p?>?0.05).     

The effect of iron and zinc supplementation and its discontinuation on liver antioxidant status in rats fed deficient diets

Purpose

The aim was to investigate the effect of iron or combined iron/zinc supplementation on rat liver antioxidant status.

Methods

The 6-week male Wistar rats were examined in 3 stages: (1) 4-week adaptation to the diets (C—control AIN-93M diet, D—iron deficient and R—with 50 % reduction in all vitamin and mineral amounts); (2) 4-week supplementation with the same regimen enriched with tenfold more iron or iron/zinc; (3) 2-week post-supplementation period (the same diets as in the stage I).

Results

Combined iron/zinc supplementation similarly to iron supplementation alone significantly (p values ≤ 0.05) increased the iron content in the liver in D and R rats after stages II and III. Moreover, iron/zinc supplementation compared to iron supplementation alone significantly decreased the liver concentration of 8-isoprostane (after stage II in D and after stage III in R rats), protein carbonyl groups (only after stage III in R rats) and 8-hydroxy-2-deoxyguanosine (after stage II in R and after stage III in D and R rats). In rats fed R-type of diets after stage II hepatic superoxide dismutase (SOD) and catalase (CAT) activity, but not glutathione peroxidation activity and total antioxidant capacity, was lower in iron and iron/zinc supplemented than in non-supplemented rats, whereas after stage III in iron/zinc supplemented SOD was lower and CAT activity was higher in comparison with non-supplemented and iron supplemented rats.

Conclusions

The simultaneous iron/zinc supplementation can protect liver against peroxidative damage induced by high doses of iron during and after the intervention in rats fed iron-deficient diet and diet with reduced amounts of vitamins and minerals. The post-intervention observation is relevant because the effect may be delayed and visible only after this period.     

Association between full breastfeeding,timing of complementary food introduction,and iron status in infancy in Germany: results of a secondary analysis of a randomized trial

Purpose

Considering the low content in breast milk breastfed infants might be at particular risk for depleted iron stores after the first months of life. This study evaluates the association of the mode of milk feeding and the timing of complementary food (CF) introduction with parameters of iron status in term healthy infants in Germany.

Methods

In this secondary analysis of a randomized controlled trial, parents recorded all foods consumed by their infants from the age of 8 weeks onwards. Mothers were advised on the German food-based dietary guidelines for infants. Accordingly, CF was introduced between the fifth and seventh month of age. Blood samples were taken at 4 and at 10 months of age for analyses of iron status parameters. Iron depletion was defined as serum ferritin <12 ng/mL.

Results

The iron intake was lower in breastfed infants (n = 50) than in formula fed (n = 23) with decreasing differences during the course of infancy. At 10 months of age, most iron parameters were not associated with the mode of milk feeding or the timing of CF introduction. At this age, the iron depletion prevalence was >34% without general differences according to the mode of milk feeding or the timing of CF introduction.

Conclusion

The high prevalence of depleted iron stores observed in both breastfed and formula-fed infants illustrates the need for further studies to improve our understanding of the optimal iron intake and sensitive parameters of iron status in infancy.

     

The effect of gold kiwifruit consumed with an iron fortified breakfast cereal meal on iron status in women with low iron stores: A 16 week randomised controlled intervention study

Background

Dietary treatment is often recommended as the first line of treatment for women with mild iron deficiency. Although it is well established that ascorbic acid enhances iron absorption, it is less clear whether the consumption of ascorbic acid rich foods (such as kiwifruit) with meals fortified with iron improves iron status. The aim of this study is to investigate whether the consumption of ZESPRI^® GOLD kiwifruit (a fruit high in ascorbic acid and carotenoids) with an iron fortified breakfast cereal meal increases iron status in women with low iron stores.

Methods/Design

Eighty nine healthy women aged 18-44 years with low iron stores (serum ferritin (SF) ≤ 25 μg/L, haemoglobin (Hb) ≥ 115 g/L) living in Auckland, New Zealand were randomised to receive an iron fortified breakfast cereal (16 mg iron per serve) and either two ZESPRI^® GOLD kiwifruit or a banana (low ascorbic acid and carotenoid content) to eat at breakfast time every day for 16 weeks. Iron status (SF, Hb, C-reactive protein (CRP) and soluble transferrin receptor (sTfR)), ascorbic acid and carotenoid status were measured at baseline and after 16 weeks. Anthropometric measures, dietary intake, physical activity and blood loss were measured before and after the 16 week intervention.

Discussion

This randomised controlled intervention study will be the first study to investigate the effect of a dietary based intervention of an iron fortified breakfast cereal meal combined with an ascorbic acid and carotenoid rich fruit on improving iron status in women with low iron stores.

Trial registration

ACTRN12608000360314

     

Diet-induced obese rats have higher iron requirements and are more vulnerable to iron deficiency

Purpose

Since obesity is associated with poorer iron status, the effects of diet-induced obesity on iron status and iron-regulatory pathways were examined.

Methods

Weanling male diet-induced obese sensitive (n = 12/diet group) and resistant (n = 12/diet group) rats were fed one of four high-fat, high-energy diets supplemented with 5 (5Fe, low), 15 (15Fe, marginal), 35 (35Fe, normal) or 70 (70Fe, high) mg iron/kg diet for 12 weeks. At the end of the study, rats in each diet group were categorised as obese (>19 %) or lean (<17 %) based on percentage body fat.

Results

Obese rats gained more weight, had larger total lean mass, consumed more food and showed greater feed efficiency compared with lean rats. Obese rats fed the 5Fe and 15Fe diets had poorer iron status than lean rats fed the same diet. Obese 5Fe rats had lower serum iron and more severe iron-deficiency anaemia. Obese 15Fe rats had lower mean corpuscular haemoglobin and liver iron concentrations. Hepcidin mRNA expression in liver and adipose tissue was similar for obese and lean rats. Iron concentration and content of the iron transporters divalent metal transporter 1 and ferroportin 1 in duodenal mucosa were also similar.

Conclusions

Obese rats that were larger, regardless of adiposity, had higher iron requirements compared with lean rats that appeared independent of hepcidin, inflammation and intestinal iron absorption. Higher iron requirements may have resulted from larger accretion of body mass and blood volume. Greater food consumption did not compensate for the higher iron needs, indicating increased susceptibility to iron deficiency.     

Calcium and zinc decrease intracellular iron by decreasing transport during iron repletion in an in vitro model

Purpose

Iron is an essential micronutrient that participates in a number of vital reactions and its absorption may be altered by various nutritional factors such as other micronutrients. Our hypothesis is that iron absorption is decreased because of the interactions with zinc and calcium. We evaluated the interaction between calcium and zinc on iron uptake and transport, intracellular Fe and Zn levels and mRNA expression of DMT1, ferroportin, Zip4 and ZnT1 in an in vitro model.

Methods

Caco-2 cells were cultivated with 1 mM Ca; 10 or 30 µM Zn and/or 10, 20 or 30 µM Fe for 24 h.

Results

Intracellular Fe decreased in cells incubated with 30 µM Zn or with the mix Ca/10 µM Zn/Fe. Zn mostly increased under Ca, Zn and Fe treatment. DMT1 mRNA expression decreased when intracellular Fe increased. Ferroportin expression displayed no change in cells cultured with different Fe concentrations. The mix of Ca, Zn and Fe increased DMT1 and ferroportin expression mainly under high Zn concentration. Zip4 expression was mostly augmented by Ca and Fe; however, ZnT1 showed no change in all conditions studied. Fe uptake was higher in all the conditions studied compared to control cells; however, Fe transport increased only in cells incubated with Fe alone. In all the other conditions, Fe transport was lower than that in control cells.

Conclusions

The present findings suggest that Ca and Zn interfere with iron metabolism. This interference is through an increase in ferroportin activity, which results in a diminished net iron absorption.

     

Effect of hereditary haemochromatosis genotypes and iron overload on other trace elements

Purpose

Hereditary haemochromatosis is a common genetic disorder involving dysregulation of iron absorption. There is some evidence to suggest that abnormal iron absorption and metabolism may influence the status of other important trace elements. In this study, the effect of abnormal HFE genotypes and associated iron overload on the status of other trace elements was examined.

Methods

Dietary data and blood samples were collected from 199 subjects (mean age = 55.4 years; range = 21–81 years). Dietary intakes, serum selenium, copper and zinc concentrations and related antioxidant enzymes (glutathione peroxidase and superoxide dismutase) in subjects with normal HFE genotype (n = 118) were compared to those with abnormal HFE genotype, with both normal iron status (n = 42) and iron overload (n = 39).

Results

For most dietary and biochemical variables measured, there were no significant differences between study groups. Red cell GPx was significantly higher in male subjects with normal genotypes and normal iron status compared to those with abnormal genotypes and normal iron status (P = 0.03) or iron overload (P = 0.001). Red cell GPx was also highest in normal women and significantly lower in the abnormal genotype and normal iron group (P = 0.016), but not in the iron overload group (P = 0.078).

Conclusion

Although it may not be possible to exclude a small effect between the genotype groups on RBC GPx, overall, haemochromatosis genotypes or iron overload did not appear to have a significant effect on selenium, copper or zinc status.     

Low iron status as a factor of increased bone resorption and effects of an iron and vitamin D-fortified skimmed milk on bone remodelling in young Spanish women

Purpose

This study aimed to determine whether there is a relationship between iron status and bone metabolism, and to compare the effects of the consumption, as part of the usual diet, of an iron or iron and vitamin D-fortified skimmed milk on bone remodelling in iron-deficient women.

Methods

Young healthy iron-deficient or iron-sufficient women (serum ferritin ≤30 ng/mL or >30 ng/mL, respectively) were recruited. Iron-deficient women were assigned to a nutritional intervention consisting of a randomised, controlled, double-blind, parallel design trial of 16 weeks during winter. They consumed, as part of their usual diet, an iron (Fe group, n = 54) or iron and vitamin D-fortified (Fe+D group, n = 55) flavoured skimmed milk (iron, 15 mg/day; vitamin D₃, 5 μg/day, 200 IU). The iron-sufficient women followed their usual diet without supplementation (R group, n = 56). Dietary intake, body weight, iron biomarkers, 25-hydroxyvitamin D (25OHD), parathyroid hormone (PTH), procollagen-type 1 N-terminal propeptide (P1NP), and aminoterminal telopeptide of collagen I (NTx) were determined.

Results

Negative correlations were found between baseline log-ferritin and log-NTx (p < 0.001), and between transferrin and P1NP (p = 0.002). Serum 25OHD increased (from 62 ± 21 to 71 ± 21 nmol/L, mean ± SD, p < 0.001) while P1NP and NTx decreased in Fe+D during the assay (p = 0.004 and p < 0.001, respectively). NTx was lower in Fe+D compared to Fe at week 8 (p < 0.05) and was higher in Fe and Fe+D compared to R throughout the assay (p < 0.01). PTH did not show changes.

Conclusions

Iron deficiency is related with higher bone resorption in young women. Consumption of a dairy product that supplies 5 μg/day of vitamin D₃ reduces bone turnover and increases circulating 25OHD to nearly reach an optimal vitamin D status, defined as 25OHD over 75 nmol/L.     

Reducing Iron Deficiency in 18–36-months-old US Children: Is the Solution Less Calcium?

Objectives National surveys consistently identify iron deficiency (ID) in US children between 1 and 3 years of age, when the brain is rapidly developing and vulnerable to the effects of ID. However, controversy remains as to how best to recognize and prevent ID in young children, in part because of the multiple potential etiologies. The objective of this project was to assess ID in children and identify potential individual dietary predictors of status. Methods We examined three biomarkers of ID [soluble transferrin receptor (sTfR) and serum ferritin (SF), and body iron (calculated from sTfR and SF)] against parent-provided dietary calcium and iron intake for eight-three 18–36 month old children from middle class families. Results Using literature-based cutoffs, fourteen children (16.9 %) had at least one indicator of ID: low SF(<10 μg/l, 7.2 %), negative body iron (<0 mg/kg, 7.2 %) or elevated sTfR (>8.4 μg/ml, 13.2 %). All children consumed more than the Dietary Reference Intake (DRI) Estimated Average Requirement of 3 mg/d iron. The mean iron intake of children identified with ID approximated the Recommended Dietary Allowance of 7 mg/d. Most children (81 %) consumed above the DRI Adequate Intake of 500 mg/d of calcium. Calcium intakes were generally high and predicted lower body iron (p = 0.0005), lower SF (p = 0.0086) and higher sTfR (p = 0.0176). Conclusions for Practice We found rates of ID similar to US national averages. Dietary calcium intake predicted lower iron status more than deficits in iron intake. Teaching parents to balance calcium and iron intake in toddlers could be a strategy to prevent ID.     

Changes in mineral status are associated with improvements in insulin sensitivity in obese patients following l-arginine supplementation

Purpose

The aim of this study is to evaluate the long-term influence of l-arginine intake on mineral concentration in patients with obesity and to assess the changes in lipid serum levels, fat content, and insulin resistance that result.

Methods

A randomized double-blind placebo-controlled study was conducted. 88 obese patients were randomly assigned to receive either 9 g of l-arginine or placebo daily, for 6 months. At baseline and after 6 months, selected anthropometrical measurements and blood biochemical analyses were performed and mineral levels were assessed. To assess insulin sensitivity, the gold-standard euglycemic clamp methodology was used.

Results

We found that 6 months of l-arginine supplementation resulted in significant increases in insulin sensitivity (Δ1.1 mg/kg/min, P < 0.01) and zinc levels (Δ1.5 μmol/L, P < 0.001). Moreover, a positive correlation between the change in zinc concentration in serum and the change in insulin sensitivity was observed (R = 0.80, P < 0.01). In the group of patients treated with l-arginine, a negative correlation between the change in zinc concentration in serum and the change in body fat content was noted (R = ?0.38, P < 0.05).

Conclusions

l-Arginine supplementation affects zinc status in obese patients. One beneficial influence is related to the improvements in insulin sensitivity.     

High-dose thiamine supplementation improves glucose tolerance in hyperglycemic individuals: a randomized, double-blind cross-over trial

Purpose

To assess the effect of high-dose oral thiamine supplements on glucose tolerance in patients with impaired glucose metabolism.

Methods

Twelve hyperglycemic subjects (10 cases of impaired glucose tolerance and 2 new cases of type 2 diabetes) completed this randomized, double-blind trial, where all participants received both placebo and thiamine capsules (3 × 100 mg/day) for 6 weeks in a cross-over manner. The main endpoint was changes in 2-h plasma glucose. Fasting plasma glucose and insulin, 2-h plasma insulin, the hemostatic model assessment of insulin resistance (HOMA-IR), renal function measurement and thiamin status were also evaluated at the commencement and completion of each treatment period.

Results

Thiamine supplementation resulted in significant decrease in 2-h plasma glucose relative to baseline (8.78 ± 2.20 vs. 9.89 ± 2.50 mmol/l, p = 0.004), with no significant change in the placebo arm. Fasting plasma glucose and insulin, and HOMA-IR increased significantly from baseline after 6 weeks in the placebo arm (p = 0.003, p = 0.04 and p = 0.02, respectively). These variables did not change with thiamine supplementation. There were no significant changes in 2-h plasma insulin or renal function marker, within or between arms.

Conclusion/interpretation

Supplementation with high-dose thiamine may prevent deterioration in fasting glucose and insulin, and improve glucose tolerance in patients with hyperglycemia. High-dose thiamine supplementation may prevent or slow the progression of hyperglycemia toward diabetes mellitus in individuals with impaired glucose regulation.     

Relative bioavailability of micronized,dispersible ferric pyrophosphate added to an apple juice drink

Background

Food iron fortification is a sustainable and relatively simple strategy to reduce/prevent iron deficiency but is a challenge for the food industry because of possible adverse organoleptic changes caused by the added iron. A micronized dispersible ferric pyrophosphate, trademarked as SunActive Fe^®, has recently been developed. SunActive Fe^® has a small particle size, is water soluble and may be suitable for fortifying liquid products.

Aim of the study

To determine the relative bioavailability of SunActive Fe^® and its suitability for addition to pure apple juice.

Methods

Iron absorption from SunActive Fe^® added to pure apple juice (Minute Maid^®) was compared with absorption from ferrous sulphate, a highly bioavailable form of iron, in 15 women with relatively low iron stores. Both forms of iron were enriched with an iron stable isotope and iron absorption from the apple juice drinks was calculated from the isotopic enrichment of red blood cells 14 days after the last test meal.

Results

Although mean absorption of iron from SunActive Fe^® was significantly lower than from ferrous sulphate (5.5% compared with 9.1%), the mean bioavailability of SunActive Fe^® iron relative to ferrous sulphate was 0.6, indicating that it is a good source of bioavailable iron. Iron Absorption from SunActive Fe^® was positively correlated (r = 0.97, P = 0.01) with absorption from ferrous sulphate, and negatively correlated with serum ferritin concentration (ferrous sulphate r = ?0.81, P < 0.001; SunActive Fe^® r = ?0.76, P = 0.01).

Conclusions

SunActive Fe^® was well absorbed from apple juice and is a potentially useful fortificant for liquid food products.

     

Ferrous ammonium phosphate (FeNH4PO4) as a new food fortificant: iron bioavailability compared to ferrous sulfate and ferric pyrophosphate from an instant milk drink

Purpose

The main purpose of this study was to establish bioavailability data in humans for the new (Fe) fortification compound ferrous ammonium phosphate (FAP), which was specially developed for fortification of difficult-to-fortify foods where soluble Fe compounds cannot be used due to their negative impact on product stability.

Methods

A double-blind, randomized clinical trial with cross-over design was conducted to obtain bioavailability data for FAP in humans. In this trial, Fe absorption from FAP-fortified full-cream milk powder was compared to that from ferric pyrophosphate (FPP) and ferrous sulfate. Fe absorption was determined in 38 young women using the erythrocyte incorporation dual stable isotope technique (⁵⁷Fe, ⁵⁸Fe).

Results

Geometric mean Fe absorption from ferrous sulfate, FAP and FPP was 10.4, 7.4 and 3.3 %, respectively. Fe from FAP was significantly better absorbed from milk than Fe from FPP (p < 0.0001). Fe absorption from FAP was significantly lower than Fe absorption from ferrous sulfate, which was used as water-soluble reference compound (p = 0.0002). Absorption ratios of FAP and FPP relative to ferrous sulfate as a measure of relative bioavailability were 0.71 and 0.32, respectively.

Conclusions

The results of the present studies show that replacing FPP with FAP in full-cream milk could significantly improve iron bioavailability.     

Regulation of iron metabolism in Hamp −/− mice in response to iron-deficient diet

Background

Hepcidin, the liver-secreted iron regulatory peptide, maintains systemic iron homeostasis in response to several stimuli including dietary iron levels and body iron status. In addition, iron metabolism is controlled by several local regulatory mechanisms including IRP and Hif-2α activities independently of hepcidin. However, the roles of these mechanisms and their interaction particularly in hepcidin-deficient individuals are not yet fully understood. We, therefore, aimed to explore whether Hamp disruption affects iron homeostatic responses to dietary iron deficiency.

Methods

Hepcidin1 knockout (Hamp ^?/?) mice and heterozygous littermates were fed with control or iron-deficient diet for 2 weeks. The expression of iron-related genes and proteins were determined by quantitative PCR and Western blot, respectively.

Results

Two-week iron-deficient diet feeding in Hamp ^?/? mice did not alter serum iron but significantly reduced liver non-heme iron levels. This was also associated with increased ferroportin protein expression in the duodenum and spleen, whereas decreased expression was found in the liver. In addition, significant inductive effects of iron-deficient diet on Dcytb and DMT1 mRNA expression in the duodenum were noted with more pronounced effects in Hamp ^?/? mice compared with controls.

Conclusions

Hamp ^?/? mice exhibited a more dramatic increase in the expression of iron transport machinery, which may be responsible for the unaltered serum iron levels upon iron-deficient diet feeding in these mice. Despite the lack of hepcidin, Hamp ^?/? mice can maintain a degree of iron homeostasis in response to altered dietary iron through several hepcidin-independent mechanisms.     

Health-related quality of life in outpatients with chronic heart failure associated with sideropenic anemia

Aims

The aim of this study was to assess the impact of anemia and iron deficiency on health-related quality of life (HRQoL) in outpatients with chronic congestive heart failure.

Methods

The data were collected from patients with chronic congestive heart failure admitted to a university hospital outpatient clinic who agreed to be involved in the cross-sectional study. According to the World Health Organization’s cutoffs to define anemia, the patients were further divided into two groups, with and without anemia. HrQoL was assessed using two questionnaires: a disease-specific instrument, the chronic heart failure questionnaire (CHFQ), and a generic instrument, the Sickness Impact Profile (SIP). The standardized questionnaire was used to collect data regarding patients’ gender, age, marital status, place of living, education, occupation, and duration of diseases and comorbidities. To assess the iron status, ferritin, serum iron, the total iron binding capacity/TIBC and transferrin were measured.

Results

In total, 200 outpatients with congestive heart failure were included in the study, 100 with and 100 without anemia. Patients with anemia were mainly female, had longer duration of disease (p?=?0.001) and more hospitalizations (p?=?0.001). Independent associations were found between the HrQoL and hemoglobin level (p?=?0.049), HrQoL and hematocrit value (p?=?0.006) and HrQoL and NYHA functional class (p?=?0.004). Iron deficiency was not associated with impaired HrQoL.

Conclusion

Anemia has a significant impact on self-perceived health. Anemic patients are more likely to have worse heart failure as indicated by a higher NYHA class, thus being at higher risk for a decline of HrQoL compared with non-anemic patients.