Prediction of dietary iron absorption: an algorithm for calculating absorption and bioavailability of dietary iron

BACKGROUND: Dietary iron absorption from a meal is determined by iron status, heme- and nonheme-iron contents, and amounts of various dietary factors that influence iron absorption. Limited information is available about the net effect of these factors. OBJECTIVE: The objective was to develop an algorithm for predicting the effects of factors known to influence heme- and nonheme-iron absorption from meals and diets. DESIGN: The basis for the algorithm was the absorption of iron from a wheat roll (22.1 +/- 0.18%) containing no known inhibitors or enhancers of iron absorption and adjusted to a reference dose absorption of 40%. This basal absorption was multiplied by the expected effect of different amounts of dietary factors known to influence iron absorption: phytate, polyphenols, ascorbic acid, meat, fish and seafood, calcium, egg, soy protein, and alcohol. For each factor, an equation describing the dose-effect relation was developed. Special considerations were made for interactions between individual factors. RESULTS: Good agreement was seen when measurements of iron absorption from 24 complete meals were compared with results from use of the algorithm (r(2) = 0.987) and when mean iron absorption in 31 subjects served a varied whole diet labeled with heme- and nonheme-iron tracers over a period of 5 d was compared with the mean total iron absorption calculated by using the algorithm (P = 0.958). CONCLUSIONS: This algorithm has several applications. It can be used to predict iron absorption from various diets, to estimate the effects expected by dietary modification, and to translate physiologic into dietary iron requirements from different types of diets.     

Effect of ascorbic acid intake on nonheme-iron absorption from a complete diet

BACKGROUND: Ascorbic acid has a pronounced enhancing effect on the absorption of dietary nonheme iron when assessed by feeding single meals to fasting subjects. This contrasts with the negligible effect on iron balance of long-term supplementation with vitamin C. OBJECTIVE: Our goal was to examine the effect of vitamin C on nonheme-iron absorption from a complete diet rather than from single meals. DESIGN: Iron absorption from a complete diet was measured during 3 separate dietary periods in 12 subjects by having the subjects ingest a labeled wheat roll with every meal for 5 d. The diet was freely chosen for the first dietary period and was then altered to maximally decrease or increase the dietary intake of vitamin C during the second and third periods. RESULTS: There was no significant difference in mean iron absorption among the 3 dietary periods despite a range of mean daily intakes of dietary vitamin C of 51-247 mg/d. When absorption values were adjusted for differences in iron status and the 3 absorption periods were pooled, multiple regression analysis indicated that iron absorption correlated negatively with dietary phosphate (P = 0.0005) and positively with ascorbic acid (P = 0.0069) and animal tissue (P = 0.0285). CONCLUSIONS: The facilitating effect of vitamin C on iron absorption from a complete diet is far less pronounced than that from single meals. These findings may explain why several prior studies did not show a significant effect on iron status of prolonged supplementation with vitamin C.     

Soy protein, phytate, and iron absorption in humans.

The effect of reducing the phytate in soy-protein isolates on nonheme-iron absorption was examined in 32 human subjects. Iron absorption was measured by using an extrinsic radioiron label in liquid-formula meals containing hydrolyzed corn starch, corn oil, and either egg white or one of a series of soy-protein isolates with different phytate contents. Iron absorption increased four- to fivefold when phytic acid was reduced from its native amount of 4.9-8.4 to less than 0.01 mg/g of isolate. Even relatively small quantities of residual phytate were strongly inhibitory and phytic acid had to be reduced to less than 0.3 mg/g of isolate (corresponding to less than 10 mg phytic acid/meal) before a meaningful increase in iron absorption was observed. However, even after removal of virtually all the phytic acid, iron absorption from the soy-protein meal was still only half that of the egg white control. It is concluded that phytic acid is a major inhibitory factor of iron absorption in soy-protein isolates but that other factors contribute to the poor bioavailability of iron from these products.     

Apparent absorption of eight micronutrients and phytic acid from vegetarian meals in ileostomized human volunteers

OBJECTIVES: Apparent absorption of eight micronutrients and degradation of phytic acid were studied in human subjects who underwent ileostomy. The prominent factors affecting micronutrient absorption from vegetarian Indian meals (n = 11) were identified. METHODS: Levels of beta-carotene, ascorbic acid, riboflavin, and thiamine in food and ileostomy contents were estimated by spectrophotometry and spectrofluorometry. Contents of zinc, iron, copper, and manganese were estimated by atomic absorption spectrometry and that of phytic acid by gradient elution ion exchange chromatography. Statistical analyses were done with SPSS 10.0. RESULTS: Absorption of beta-carotene, ascorbic acid, riboflavin, and thiamine was 63% to 75.6%. There was a negative non-significant trend in values of beta-carotene absorption with increased intake of beta-carotene (r = - 0.51, P > 0.1) and iron (r = -0.67, P = 0.1) but a positive significant trend with riboflavin intakes (r = 0.84, P = 0.018). Percentage of absorption of ascorbic acid showed weak positive associations with intakes of riboflavin (r = 0.71) and ascorbic acid (r = 0.5). Percentage of absorption of ascorbic acid was positively correlated with percentage of absorption of beta-carotene (r = 0.80, P < 0.05), iron, and riboflavin (r = 0.64, P = 0.086), indicating some common influencing factors. Percentages of absorption for zinc (20.2), iron (9.9), and copper (17.6) was comparable with those reported for soy protein-based, high phytate diets. Pattern of phytic acid in the meals and output indicated partial degradation and absorption (34%). CONCLUSIONS: For vegetarian Indian meals, apparent absorptions of beta-carotene and ascorbic acid were 76% and 73.5% and of riboflavin and thiamine was 63%. Zinc, copper, and iron showed a lower absorption (10% to 20%).     

Nonheme-iron absorption from a phytate-rich meal is increased by the addition of small amounts of pork meat

BACKGROUND: Muscle tissue from various sources is known to promote nonheme-iron absorption. However, systematic studies of the dose dependency of this effect of meat on iron absorption from an inhibitory meal with low amounts of meat are lacking. OBJECTIVE: We investigated the dose-response effect of small amounts of meat on nonheme-iron absorption from a meal presumed to have low iron bioavailability. DESIGN: Forty-five healthy women with a mean (+/-SD) age of 24 +/- 3 y were randomly assigned to 1 of 3 groups, each of which was served (A) a basic meal (rice, tomato sauce, pea purée, and a wheat roll) and (B) the basic meal with either 25, 50, or 75 g pork (longissimus muscle). Meal A contained 2.3 mg nonheme iron, 7.4 mg vitamin C, and 220 mg (358 micro mol) phytate. Each meal was served twice, and the order of the meals was ABBA or BAAB. The meals were extrinsically labeled with (55)Fe or (59)Fe. Iron absorption was determined from measurements of (59)Fe whole-body retention and the activity of (55)Fe and (59)Fe in blood samples. RESULTS: Twenty-five grams meat did not increase nonheme-iron absorption significantly (P = 0.13), whereas absorption increased 44% (P < 0.001) and 57% (P < 0.001), respectively, when 50 and 75 g meat were added to the basic meal. In absolute values, this corresponds to an absorption that was 2.6% and 3.4% higher, respectively, than that with the basic meal after adjustment of the data to a level of 40% absorption from a reference dose. CONCLUSION: Small amounts of meat (>or=50 g) significantly increase nonheme-iron absorption from a phytate-rich meal low in vitamin C.     

Erythorbic acid is a potent enhancer of nonheme-iron absorption

BACKGROUND: Erythorbic acid, a stereoisomer of ascorbic acid with similar physicochemical properties, is widely used as an antioxidant in processed foods. OBJECTIVES: The aims of the present study were to evaluate the effect of erythorbic acid on iron absorption from ferrous sulfate at molar ratios of 2:1 and 4:1 (relative to iron) and to compare the effect of erythorbic acid directly with that of ascorbic acid at a molar ratio of 4:1. DESIGN: Iron absorption from iron-fortified cereal was measured in 10 women on the basis of erythrocyte incorporation of stable iron isotopes ((57)Fe or (58)Fe) 14 d after administration. Each woman consumed 4 ferrous-sulfate-fortified test meals (containing 5 mg Fe/meal) with or without added erythorbic or ascorbic acid. The data were evaluated by use of paired t tests, and the results are presented as geometric means. RESULTS: Iron absorption from the test meal without any added enhancer was 4.1%. The addition of erythorbic acid (at molar ratios of 2:1 and 4:1 relative to iron) increased iron absorption 2.6-fold (10.8%; P < 0.0001) and 4.6-fold (18.8%; P < 0.0001), respectively. The addition of ascorbic acid (molar ratio of 4:1) increased iron absorption 2.9-fold (11.7%; P = 0.0004). At a molar ratio of 4:1, erythorbic acid was 1.6-fold (P = 0.0002) as potent an enhancer of iron absorption as was ascorbic acid. CONCLUSION: Although erythorbic acid is a potent enhancer of iron absorption, its lack of antiscorbutic activity limits its usefulness in iron-fortification programs. However, it may play a major role in enhancing iron bioavailability from mixed diets that include foods preserved with erythorbic acid.     

Inhibitory effects of dietary calcium on the initial uptake and subsequent retention of heme and nonheme iron in humans: comparisons using an intestinal lavage method

BACKGROUND: Calcium is the only reported dietary inhibitor of both heme- and nonheme-iron absorption. It has been proposed that the 2 forms of iron enter a common pool in the enterocyte and that calcium inhibits the serosal transfer of iron into blood. OBJECTIVES: We aimed to ascertain whether the inhibitory effect of calcium occurs during initial mucosal uptake or during serosal transfer and to compare the serosal transfer of heme and nonheme iron, which should not differ if the 2 forms have entered a common mucosal iron pool. DESIGN: Whole-gut lavage and whole-body counting were used to measure the initial uptake (8 h) and retention (2 wk) of heme and nonheme iron with and without a calcium supplement (450 mg). Two experiments tested basal meals with low iron bioavailability and 360 mg Ca (n = 15) or with high iron bioavailability and 60 mg Ca (n = 12). RESULTS: Added calcium reduced the initial uptake of heme iron by 20%, from 49% to approximately 40% from both meals (P = 0.02), and reduced the total iron absorbed from the low- and high-bioavailability meals by approximately 25% [from 0.033 to 0.025 mg (P = 0.06) and from 0.55 to 0.40 mg (P < 0.01), respectively]. Calcium did not affect the serosal transfer of either form of iron. CONCLUSIONS: Calcium supplementation reduced heme and total iron without significantly affecting nonheme-iron absorption, regardless of meal bioavailability. Calcium inhibited the initial mucosal uptake rather than the serosal transfer of heme iron. Differences in serosal transfer indicate that heme and nonheme iron did not enter a common absorptive pool within 8 h after a meal.     

Green tea or rosemary extract added to foods reduces nonheme-iron absorption

BACKGROUND: Phenolic compounds act as food antioxidants. One of the postulated mechanisms of action is chelation of prooxidant metals, such as iron. Although the antioxidative effect is desirable, this mechanism may impair the utilization of dietary iron. OBJECTIVE: We sought to determine the effect of phenolic-rich extracts obtained from green tea or rosemary on nonheme-iron absorption. DESIGN: Young women aged 19-39 y consumed test meals on 4 separate occasions. The meals were identical except for the absence (meal A) or presence (meal B) of a phenolic-rich extract from green tea (study 1; n = 10) or rosemary (study 2; n = 14). The extracts (0.1 mmol) were added to the meat component of the test meals. The meals were extrinsically labeled with either 55Fe or 59Fe and were consumed on 4 consecutive days in the order ABBA or BAAB. Iron absorption was determined by measuring whole-body retention of 59Fe and the ratio of 55Fe to 59Fe activity in blood samples. RESULTS: The presence of the phenolic-rich extracts resulted in decreased nonheme-iron absorption. Mean (+/-SD) iron absorption decreased from 12.1 +/- 4.5% to 8.9 +/- 5.2% (P < 0.01) in the presence of green tea extract and from 7.5 +/- 4.0% to 6.4 +/- 4.7% (P < 0.05) in the presence of rosemary extract. CONCLUSION: Phenolic-rich extracts used as antioxidants in foods reduce the utilization of dietary iron.     

No enhancing effect of vitamin A on iron absorption in humans

BACKGROUND: Vitamin A and beta-carotene were recently reported to enhance iron absorption by counteracting the inhibitory effect of phytic acid in cereal-based meals and of polyphenol-containing beverages on nonheme-iron absorption in humans. OBJECTIVE: Our objective was to further evaluate the influence of vitamin A on iron absorption. DESIGN: Iron absorption from corn bread with or without added vitamin A (retinyl palmitate) was determined in 5 studies in young adult human subjects by using either a stable-isotope method (2 studies) or a radioisotope technique (3 studies). Iron absorption was measured by erythrocyte incorporation of the isotopic labels and by whole-body retention of (59)Fe. Corn bread was served with water (studies 1 and 3) or coffee (studies 2, 4, and 5). The studies differed in the amounts and chemical forms of added tracer and fortification iron. The possibility of methodologic artifacts in earlier investigations was evaluated. RESULTS: No effect of vitamin A on iron absorption from the test meals was identified in the individual studies by using paired Student's t test. A slightly negative effect of vitamin A on iron absorption was found with the use of analysis of variance. CONCLUSIONS: The previously reported findings of a positive effect of vitamin A on nonheme-iron absorption in humans was not confirmed. Incomplete isotopic equilibration of the tracer with native iron in the meal or with fortification iron cannot explain the previous findings. However, the present study does not exclude the possibility that suboptimal vitamin A status influences the effect of dietary vitamin A on iron absorption.     

Predicting bioavailable zinc from lower phytate forms, folic Acid and their interactions with zinc in vegetarian meals

OBJECTIVE: To develop a statistical model for predicting zinc bioavailability from cereal-based vegetarian meals using relative proportion of nutrients, non-nutrients and their interactive effects. METHODS: A database on in vitro zinc dialysability (by isotopic tracer, 65Zn) of vegetarian meals (266 out of 326) from Asia, Africa, Europe /US and Latin America was used to develop a model for estimating zinc bioavailability. A multiple regression analysis adjusted for energy content was carried out for net bioavailable zinc from a meal with the predictor variables as meal contents of iron, zinc, copper, ascorbic acid, beta-carotene, riboflavin, thiamine, folic acid, tannic acid, fiber, phytate degradation products (IP6 to IP1), along with their interaction terms. Reproducibility of the model was tested with remaining 60 meals. Validation of the model was done with zinc absorption data of i) 12 young adults on 24 meals and ii) 5 adults with ileostomy on 7 meals. RESULTS: Folic acid, IP3 and IP5 were significant influencing factors for bioavailable zinc. Weighted multiple regression equation was: ln (bioavailable zinc in mg) = -1.701 + 1.285 x ln [(IP5 in mg] x (Zn in mg)] -1.222 x ln(IP5 in mg) -0.0078 x folic acid in microg -0.137 x ln [(IP3 in mg) x (Zn in mg)] with adjusted R--[2] = 0.64, p = 0.0001. The correlation between predicted and observed dialysability of meals was found to be 0.96 (p < 0.01). A significant correlation between observed and predicted amount of absorbed zinc (r = 0.85, p < 0.01) was obtained for the human data of zinc absorption in 12 healthy and 5 subjects with ileostomy. CONCLUSIONS: Bioavailable amount of zinc from vegetarian meals was influenced by IP3, IP5 and folic acid content and their interactive effect with zinc content.     

Effect of ascorbic acid and particle size on iron absorption from ferric pyrophosphate in adult women

The effects of added ascorbic acid and particle size on iron absorption from ferric pyrophosphate were evaluated in adult women (9-10 women/study) based on erythrocyte incorporation of iron stable isotopes (57Fe or 58Fe) 14 days after administration. Three separate studies were made with test meals of iron-fortified infant cereal (5 mg iron/meal) and the results are presented as geometric means and relative bioavailability values (RBV, FeSO4 = 100%). The results of study 1 showed that iron absorption was significantly lower from ferric pyrophosphate (mean particle size 8.5 microm) than from FeSO4 in meals without ascorbic acid (0.9 vs. 2.6%, p < 0.0001, RBV 36%) and in the same meals with ascorbic acid added at a 4:1 molar ratio relative to fortification iron (2.3 vs. 9.7%, p < 0.0001, RBV 23%). Ascorbic acid increased iron absorption from ferric pyrophosphate slightly less (2.6-fold) than from FeSO4 (3.7-fold) (p < 0.05). In studies 2 and 3, RBV of ferric pyrophosphate with an average particle size of 6.7 microm and 12.5 pm was not significantly different at 52 and 42% (p > 0.05), respectively. In conclusion, the addition of ascorbic acid increased fractional iron absorption from ferric pyrophosphate significantly, but to a lesser extent than from FeSO4. Decreasing the mean particle size to 6.7 microm did not significantly increase iron absorption from ferric pyrophosphate.     

Iron bioavailability from maize and beans: a comparison of human measurements with Caco-2 cell and algorithm predictions

BACKGROUND: An in vitro digestion and Caco-2 cell model may predict iron bioavailability to humans; however, direct comparisons are lacking. OBJECTIVE: The objective was to test the differences in iron bioavailability between 2 maize varieties and 2 bean varieties (white beans and colored beans) by comparing human, Caco-2, and algorithm results. DESIGN: Two randomized, 2 x 2 factorial experiments compared women's iron absorption from 2 maize varieties (ACR and TZB; n = 26) and 2 bean varieties (great northern and pinto; n = 13), each fed with and without ascorbic acid (AA) from orange juice. Nonheme iron bioavailability was determined from 2-wk retention of extrinsic radioiron tracers and was compared with Caco-2 cell and algorithm results from identical meals. RESULTS: Without AA supplementation, women absorbed only about 2% of the iron from the maize or bean meals. The results were unaffected by the variety of either maize or beans. Adding AA (15-20 molar ratios of AA:iron) roughly tripled the iron absorption (P < 0.0001) from all test meals. Although the Caco-2 model predicted a slightly improved bioavailability of iron from ACR maize than from TZB maize (P < 0.05), it accurately predicted relative iron absorption from the maize meals. However, the Caco-2 model inaccurately predicted both a considerable difference between bean varieties (P < 0.0001) and a strong interaction between bean varieties and enhancement by AA (P < 0.0001). The algorithm method was more qualitatively than quantitatively useful and requires further development to accurately predict the influence of polyphenols on iron absorption. CONCLUSIONS: Caco-2 predictions confirmed human iron absorption results for maize meals but not for bean meals, and algorithm predictions were only qualitatively predictive.     

Degradation of phytic acid in cereal porridges improves iron absorption by human subjects

BACKGROUND: Phytic acid in cereal-based and legume-based complementary foods inhibits iron absorption. Low iron absorption from cereal porridges contributes to the high prevalence of iron deficiency in infants from developing countries. OBJECTIVE: The objective was to measure the influence of phytic acid degradation on iron absorption from cereal porridges. DESIGN: An exogenous phytase was used to fully degrade phytic acid during the manufacture of 9 roller-dried complementary foods based on rice, wheat, maize, oat, sorghum, and a wheat-soy blend. Iron absorption from the phytate-free and native phytate porridges prepared with water or milk (wheat only) was measured in adult humans with an extrinsic-label radioiron technique. Ascorbic acid was added to some porridges. RESULTS: When the foods were reconstituted with water, dephytinization increased iron absorption from rice porridge from 1.73% to 5.34% (P < 0.001), from oat from 0.33% to 2.79% (P < 0.0001), from maize from 1.80% to 8.92% (P < 0.0001), from wheat from 0.99% to 11.54% (P < 0.0001), from the wheat-soy blend without ascorbic acid from 1.15% to 3.75% (P < 0.005), and from the wheat-soy blend with ascorbic acid from 2.40% to 8.46% (P < 0.005). Reconstituting wheat porridge with milk instead of water markedly decreased or completely removed the enhancing effect of dephytinization on iron absorption in the presence and absence of ascorbic acid. Dephytinization did not increase iron absorption from high-tannin sorghum porridge reconstituted with water but increased iron absorption from low-tannin sorghum porridge by approximately 2-fold (P < 0.01). CONCLUSIONS: Phytate degradation improves iron absorption from cereal porridges prepared with water but not with milk, except from high-tannin sorghum.     

Phytic acid added to white-wheat bread inhibits fractional apparent magnesium absorption in humans

BACKGROUND: Phytic acid has been reported to impair the absorption of minerals and trace elements such as calcium, zinc, and iron in humans. However, limited information is available on the effect of phytic acid on magnesium absorption. OBJECTIVE: The objective was to evaluate the effect of phytic acid on fractional apparent magnesium absorption in humans. DESIGN: Two stable-isotope studies were performed with 8-9 healthy adults per study. Test meals were based on 200 g phytic acid-free wheat bread; test meals with and without added phytic acid were served on days 1 and 3 according to a crossover design. Phytic acid was added in amounts similar to those naturally present in whole-meal (1.49 mmol) and in brown bread (0.75 mmol). Each test meal was labeled with 0.7 mmol (25)Mg or 1.1 mmol (26)Mg. The total magnesium content was standardized to 3.6 mmol in all test meals. Apparent magnesium absorption was based on fecal monitoring. RESULTS: The addition of phytic acid lowered fractional apparent magnesium absorption from 32.5 +/- 6.9% (no added phytic acid) to 13.0 +/- 6.9% (1.49 mmol added phytic acid; P < 0.0005) and from 32.2 +/- 12.0% (no added phytic acid) to 24.0 +/- 12.9% (0.75 mmol added phytic acid; P < 0.01). The inhibiting effect of phytic acid was dose dependent (P < 0.005). CONCLUSION: The results show that fractional magnesium absorption from white-wheat bread is significantly impaired by the addition of phytic acid, in a dose-dependent manner, at amounts similar to those naturally present in whole-meal and brown bread.     

High iron content and bioavailability in humans from four species of marine algae

Searching for economical, nonconventional sources of iron is important in underdeveloped countries to combat iron deficiency and anemia. Our objective was to study iron, vitamin C, and phytic acid composition and also iron bioavailability from 4 species of marine algae included in a rice-based meal. Marine algae (Ulva sp, Sargassum sp, Porphyra sp, and Gracilariopsis sp) were analyzed for monthly variations in iron and for ascorbic acid and phytic acid concentrations. A total of 96 subjects received rice-based meals containing the 4 species of marine algae in different proportions, raw or cooked. All meals contained radioactive iron. Absorption was evaluated by calculating the radioactive iron incorporation in subjects' blood. Iron concentrations in algae were high and varied widely, depending on the species and time of year. The highest iron concentrations were found in Sargassum (157 mg/100 g) and Gracilariopsis (196 mg/100 g). Phytates were not detected in the algae and ascorbic acid concentration fluctuated between 38 microg/g dry weight (Ulva) and 362 microg/g dry weight (Sargassum). Algae significantly increased iron absorption in rice-based meals. Cooking did not affect iron absorption compared with raw algae. Results indicate that Ulva sp, Sargassum sp, Porphyra sp, and Gracilariopsis sp are good sources of ascorbic acid and bioavailable iron. The percentage of iron absorption was similar among all algae tested, although Sargassum sp resulted in the highest iron intake. Based on these results, and on the high reproduction rates of algae during certain seasons, promoting algae consumption in some countries could help to improve iron nutrition.     

Statistical model for predicting non-heme iron bioavailability from vegetarian meals

Availability of non-heme iron has been extensively discussed when meals comprise heme as well as non-heme iron, but seldom so for exclusively vegetarian meals. The present study aimed to develop a statistical model for predicting non-heme iron availability from a composite vegetarian meal. Radioisotopic measurements of in vitro iron dialyzability of 208 out of 274 meals representing vegetarian diets from Asia, Africa, Europe and Latin America and the meal contents of iron, zinc, copper, ascorbic acid, beta-carotene, riboflavin, thiamin, folic acid, tannic acid, fiber and degraded phytate forms (IP6-IP1) were used for development of the model. A multiple regression model weighted for calorie contents was developed for the percentage iron dialyzability with the possible predictors as meal contents along with plausible interaction terms. The model was validated with in vitro iron dialyzability of 66 meals and in vivo iron absorption in five ileostomized adults. Application of the model was demonstrated using data on the daily dietary intake of 215 young adults whose hemoglobin levels were estimated twice in 3 weeks. Weighted multiple regression model was: ln(% Fe dialyzability)=1.340-0.259xln(IP2 [mg])+0.188xln(IP3 [mg])-0.278xln(IP5 [mg])+0.0912xln(ascorbic acid [mg])+0.06693xln(tannins [mg])+0.09552xln(beta-carotene [microg])+0.137xln(hemicellulose [g]) (P<0.01, R2=0.51). Good agreement was seen between observed and predicted dialyzability (r=0.90) and human absorption (r=0.89). The model would be useful to estimate bioavailable iron intakes of vegetarian populations and to identify at-risk individuals.     

The efficacy of a local ascorbic acid-rich food in improving iron absorption from Mexican diets: a field study using stable isotopes

BACKGROUND: One potentially sustainable approach to improving iron status at the community level is to encourage the consumption of local ascorbic acid-rich foods, in conjunction with meals high in nonheme iron. OBJECTIVE: The study, conducted in rural Mexico, measured stable isotopes of iron to evaluate the effect on iron absorption of the addition of 25 mg ascorbic acid as agua de limón (limeade) to 2 typical meals per day for 2 wk. DESIGN: Fifteen nonpregnant, nonlactating, iron-deficient (ferritin < 12 microg/L) women (x +/- SD age: 28.3 +/- 7.7 y) fasted overnight and were brought to a community clinic. After an initial blood sample, subjects consumed 0.25 mg (57)Fe with both breakfast and lunch for 14 d. On day 29, another blood sample was taken, and a reference dose of 2.7 mg (58)Fe with 25 mg ascorbic acid was given. For the following 15 d, participants consumed 0.25 mg (57)Fe added to both breakfast and lunch with 25 mg ascorbic acid added to each meal as limeade. A final blood sample was taken on day 59. RESULTS: Iron absorption was calculated from recovery of isotopes in blood obtained 14 d after administration of each isotope. When 25 mg ascorbic acid as limeade was added to test meals twice a day for 2 wk, iron absorption increased significantly (P < 0.001) in every subject: the mean absorption rose from 6.6 +/- 3.0% to 22.9 +/- 12.6%. CONCLUSIONS: The consumption of 25 mg ascorbic acid as limeade twice daily with meals substantially improved iron absorption and may improve the iron status of nonpregnant, nonlactating, iron-deficient women.     

Iron status and food matrix strongly affect the relative bioavailability of ferric pyrophosphate in humans

BACKGROUND: Although ferric pyrophosphate is a promising compound for iron fortification of foods, few data are available on the effect of food matrices, processing, and ascorbic acid on its bioavailability. OBJECTIVE: We compared the relative bioavailability (RBV) of ferrous sulfate in an experimental form of micronized dispersible ferric pyrophosphate (MDFP) in a wheat-milk infant cereal given with and without ascorbic acid with the RBV of MDFP from a processed and unprocessed rice meal. DESIGN: A crossover design was used to measure iron absorption in young women (n = 26) from test meals fortified with isotopically labeled [57Fe]-MDFP and [58Fe]-ferrous sulfate, based on erythrocyte incorporation of stable isotope labels 14 d later. RESULTS: Geometric mean iron absorption from the wheat-based meal fortified with MDFP was 2.0% and that from the meal fortified with ferrous sulfate was 3.2% (RBV = 62). The addition of ascorbic acid at a molar ratio of 4:1 to iron increased iron absorption from MDFP to 5.8% and that from ferrous sulfate to 14.8% (RBV = 39). In the rice meals, mean iron absorption from MDFP added to the rice at the time of feeding was 1.7%, and that from ferrous sulfate was 11.6% (RBV = 15). The mean iron absorption from MDFP extruded into artificial rice grains was 3.0% and that from ferrous sulfate in unprocessed rice was 12.6% (RBV = 24). Sixteen of 26 subjects were iron deficient. Iron status was a highly significant predictor of the RBV of MDFP (P < 0.001). CONCLUSION: RBV of the experimental MDFP varied markedly with food matrix and iron status. Assigning a single RBV value to poorly soluble compounds may be of limited value in evaluating their suitability for food fortification.     

Human milk as a source of ascorbic acid: no enhancing effect on iron bioavailability from a traditional complementary food consumed by Bangladeshi infants and young children

BACKGROUND: Iron bioavailability from traditional complementary foods based on cereals and legumes can be expected to be low unless ascorbic acid-rich foods are incorporated into the diet. OBJECTIVE: We evaluated human milk as a source of ascorbic acid for enhancing iron bioavailability from khichuri, a complementary food based on rice and lentils. DESIGN: Erythrocyte incorporation of stable iron isotopes 14 d after administration was used as a proxy for iron bioavailability. Children aged 8-18 mo (n = 31) were breastfed (32-90 mg ascorbic acid/kg human milk) immediately after intake of 4 servings of khichuri labeled with (57)Fe (test meal B) and were offered water after intake of 4 servings of khichuri labeled with (58)Fe (test meal A). Test meals were fed twice daily during 4 d in the order of AABBAABB or BBAABBAA. RESULTS: The mean intakes of human milk and ascorbic acid were 274 g (range: 60-444 g) and 14 mg (range: 4-28 mg, respectively). The mean molar ratio of ascorbic acid to iron was 2.3 (range: 0.7-4.6). The geometric mean iron bioavailability from khichuri fed with or without human milk was 6.2% and 6.5%, respectively (P = 0.76, paired Student's t test). CONCLUSIONS: Although human milk contributed significant quantities of ascorbic acid, no significant difference in iron bioavailability was found between khichuri consumed with water and that consumed with human milk. These results indicate either that the molar ratio of ascorbic acid to iron was not sufficiently high to overcome the inhibitory effect of phytic acid in khichuri (30 mg/serving) or that components of human milk modified the influence of ascorbic acid on iron bioavailability.     

Improving iron absorption from a Peruvian school breakfast meal by adding ascorbic acid or Na2EDTA

BACKGROUND: Iron-fortified school breakfasts have been introduced in Peru to combat childhood iron deficiency. OBJECTIVE: We evaluated whether iron absorption from a school breakfast meal was improved by increasing the ascorbic acid content or by adding an alternative enhancer of iron absorption, Na2EDTA. DESIGN: In a crossover design, iron absorption from test meals was evaluated by erythrocyte incorporation of 58Fe and 57Fe. The test meals (wheat bread and a drink containing cereal, milk, and soy) contained 14 mg added Fe (as ferrous sulfate) including 2.0-2.6 mg 58Fe or 4.0-7.0 mg 57Fe. RESULTS: Geometric mean iron absorption increased significantly from 5.1% to 8.2% after the molar ratio of ascorbic acid to fortification iron was increased from 0.6:1 to 1.6:1 (P < 0.01; n = 9). Geometric mean iron absorption increased significantly from 2.9% to 3.8%, from 2.2% to 3.5%, and from 2.4% to 3.7% after addition of Na2EDTA at molar ratios relative to fortification iron of 0.3:1, 0.7:1, and 1:1, respectively, compared with test meals containing no added enhancers (P < 0.01; n = 10 for all). Iron absorption after addition of ascorbic acid (molar ratio 0.6:1) was not significantly different from that after addition of Na2EDTA (molar ratio 0.7:1). CONCLUSIONS: Ascorbic acid and Na2EDTA did not differ significantly in their enhancing effects on iron absorption at molar ratios of 0.6:1 to 0.7:1 relative to fortification iron. Additional ascorbic acid (molar ratio 1.6:1) increased iron absorption significantly. Increasing the molar ratio of Na2EDTA to fortification iron from 0.3:1 to 1:1 had no effect on iron absorption.