Serum iron concentration as a tool to measure relative iron absorption from elemental iron powders in man

OBJECTIVE

To present a new method for measuring the relative bioavailability (RBV) of commercial elemental iron powders by investigating induced changes of serum iron concentration (S-Fe) in relation to ferrous sulphate (FeSO4). Earlier studies have shown that in a group of subjects there is good agreement between the increase in S-Fe and the amount of iron absorbed from a simple iron salt as FeSO4.

METHODS

The study included two groups of male blood donors (n=2 x 16 subjects) who were served three meals with an interval of approximately nine weeks between each one. In one group the meal was fortified with reduced iron, ferrous sulphate or no iron at all. In the other group the meal was fortified with electrolytic iron, ferrous sulphate or no iron. The S-Fe increase was followed for 6 h. Studying the non-iron meals was necessary so that the basal diurnal variation in the S-Fe during the six hours could be measured and subtracted.

RESULTS

The mean S-Fe increase calculated as the area under the curve (AUC) from the reduced iron (RBV=0.43) and the electrolytic iron (RBV=0.73) differed significantly from the AUC following FeSO4 (p=0.002 and p=0.021, respectively). The difference between the reduced and the electrolytic iron was also statistically significant (p=0.036).

CONCLUSION

Measuring increases in S-Fe could be a reliable and simple method to determine the RBV in comparative studies of elemental iron powders in relation to FeSO4.

The importance of bioavailability of dietary iron in relation to the expected effect from iron fortification

BACKGROUND

The most common method of combating iron deficiency is iron fortification, especially in developing countries. However, few studies have shown a significant effect on iron status following iron fortification of low bioavailability diets.

OBJECTIVE

To investigate how iron fortification and dietary modifications affect iron absorption and rates of changes in iron stores.

METHODS

Research has made it possible to predict both iron absorption and the effects of iron fortification and diet modifications on iron stores using recently developed algorithms. Iron absorption and rate of change in iron stores were calculated from nine diets representing a broad range of iron bioavailability and iron contents. The calculations were related to the main target group for iron fortification, that is, women of reproductive age having empty stores but normal haemoglobin concentrations.

RESULTS

As the only measure, iron fortification has practically no effect on iron status if the original diet has low bioavailability. However, after dietary modifications such a diet shows a positive effect on iron stores. The combined action of fortification (6 mg/day) and modest bioavailability changes in a low bioavailability diet results approximately in 40 and 70% greater increases in iron stores than through iron fortification or dietary modification alone.

CONCLUSIONS

It is difficult to achieve good effects on iron status from iron fortification as the only measure if the diet has low bioavailability. Both dietary modifications as well as iron fortification are required to improve effectively the iron status of a population.

MR characteristics and neuropathology in adult-onset autosomal dominant leukodystrophy with autonomic symptoms

BACKGROUND AND PURPOSE

Three families with adult-onset autosomal dominant leukodystrophy (ADLD) presenting autonomic dysfunction as the first symptom are reported. We describe detailed MR appearances of the brain in 2 new families and neuropathology in 2 patients and compare the findings with those in other adult-onset leukodystrophies.

METHODS

Twenty subjects (12 women and 8 men; age range, 29-70 years) from 2 unrelated families with ADLD were examined with MR. Six subjects were asymptomatic. Fourteen had autonomic dysfunction. Eleven of them also had pyramidal signs and ataxia. The brains of 2 autopsied patients were examined histopathologically.

RESULTS

Two subjects manifested no neurologic symptoms, signs, or MR pathology. Eighteen subjects displayed radiologic abnormalities ranging from subtle T2 high-signal-intensity changes in the upper corticospinal tract to extensive confluent white matter changes, predominantly in a frontoparietal distribution, along the corticospinal tracts down to the medulla oblongata and in the upper and middle cerebellar peduncles. Periventricular white matter was spared or less affected than the adjacent white matter. Histopathology revealed marked loss of cerebral and cerebellar myelin without signs of inflammation. Oligodendrocytes were relatively spared, the number of axons not markedly decreased, and reactive gliosis was modest. The number of Purkinje cells in the cerebellum was reduced.

CONCLUSIONS

Two families with adult-onset ADLD with the disease entity originally reported by Eldridge et al. (N Engl J Med 1984;311:948-53) were described. We propose naming the disease "adult-onset ADLD with autonomic symptoms." The characteristic radiologic findings, combined with the clinical symptoms and mode of inheritance, enable the diagnosis.

Meal pattern, food choice, nutrient intake and lifestyle factors in The Göteborg Adolescence Study

OBJECTIVE

To relate meal pattern of Swedish adolescents to food choice, nutrient intake and other lifestyle factors.

DESIGN

Cross-sectional study including diet history and interview about smoking, ethnicity, social factors and retrospectively collected data of menarche and growth.

SETTING

School setting, Göteborg, Sweden.

SUBJECTS

A total of 611 boys and 634 girls in grade 9 (15-16 y).

RESULTS

The majority of the students, 65% of the boys and 52% of the girls, consumed three main meals daily. The in-between meals, however, contributed the major part of the energy intake. The energy intake was 12.9+/-3.5 MJ (mean+/-s.d.) for boys and 9.0+/-2.5 MJ for girls. Irregular breakfast eating, 12% of the boys and 24% of the girls, was related to negative lifestyle factors where smoking was the strongest, odds ratio 3.8 (95% CI: 2.6-5.4) and to irregular intake of lunch and dinner. These boys and girls had a food choice including a higher percentage of energy from snack food (26% vs 20% and 19% in boys and girls respectively, all P<0.001), mostly consumed between the main meals. These groups had significantly lower intakes of micronutrients, but higher intakes of sucrose and alcohol compared to the groups with regular breakfast intake. Girls omitting breakfasts and lunches (8%) also had a less healthy food choice and the poorest nutrient intake. These girls had matured earlier, with menarche age of 12.2+/-1.1 y vs 12.9+/-1.0 y (P<0.001) in girls with regular main meal intake.

CONCLUSIONS

Meal pattern with omission of breakfast or breakfast and lunch was related to a clustering of less healthy lifestyle factors and food choice leading to a poorer nutrient intake.

SPONSORSHIP

The Swedish Medical Research Council (project B94-19X-04721-19A), the Swedish Mill Industry and the Wilhelm and Martina Lundgren Foundation.

Energy intake in Swedish adolescents: validation of diet history with doubly labelled water

OBJECTIVE

To compare habitual energy intake (EI) estimated from diet history (DH) with total energy expenditure (TEE) measured with doubly labelled water (DLW) in adolescents.

DESIGN

DH included a detailed questionnaire and an interview. TEE was measured during a 14-day period. Adequate (AR), under- (UR) and over-reporters (OR) were defined from the ratio EI/TEE: AR 0.84-1.16, UR <0.84 and OR >1.16.

SETTING

Participants were recruited from grade 9 in a compulsory school in Göteborg, Sweden. All data were collected at school and DLW dosages were distributed at Sahlgrenska University Hospital.

SUBJECTS

A total of 35 adolescents (18 boys, 17 girls), 15.7 (0.4) y.

RESULTS

EI was 11.0 (3.6) MJ and TEE was 11.4 (2.1) MJ (P=0.42). DH was able to rank EI compared to TEE (Spearman's r=0.59, P< or =0.001). For girls, EI was 18% lower (P=0.0067) and for boys, EI was 7% higher (P=0.26) compared to TEE. The 95% limits of agreement for difference between TEE and EI were -5.6 to 6.5 MJ. In total, 20 subjects were defined as AR (57%), nine as UR (26%) and six as OR (17%). Energy from in-between meals was 33% lower (P=0.0043) in UR girls and 57% higher (P=0.026) in OR boys, compared to adequate reporting girls and boys, respectively. In UR girls, energy-adjusted intake (10 MJ) of specific foods did not differ significantly, fat was lower and carbohydrate and vitamin C were higher compared to AR girls (all P<0.05). OR boys had no significant differences in food and nutrient intake in 10 MJ compared to AR boys.

CONCLUSION

The diet history was able to capture EI for the group and to rank subjects. There was a wide individual range in reporting-accuracy related to gender.

SPONSORSHIP

The Ingabritt and Arne Lundberg Foundation, The Wilhelm and Martina Lundgren Foundation.

Advantages and disadvantages of an iron-rich diet

BACKGROUND AND OBJECTIVE

A review by invitation about advantages and disadvantages of an iron-rich diet by analyzing physiological iron requirements, dietary factors influencing iron absorption and the regulatory systems available to control iron absorption according to needs.

RESULTS

The control to prevent iron deficiency is good but not perfect, as observed in previously described studies on relationships between individual iron requirements and the probability of iron deficiency developing in relation to diet. The control to prevent iron overload seems to be perfect except in the few subjects being homozygotes for hereditary hemochromatosis.

CONCLUSIONS

A diet rich in easily available iron is important for covering basal iron losses, menstrual iron losses and the high iron requirements for growth from infancy to adolescence and for pregnancy.

Perspectives on nutritional iron deficiency

Nutritional iron deficiency (ID) is caused by an intake of dietary iron insufficient to cover physiological iron requirements. Studies on iron absorption from whole diets have examined relationships between dietary iron bioavailability/absorption, iron losses, and amounts of stored iron. New insights have been obtained into regulation of iron absorption and expected rates of changes of iron stores or hemoglobin iron deficits when bioavailability or iron content of the diet has been modified and when losses of iron occur. Negative effects of ID are probably related to age, up to about 20 years, explaining some of earlier controversies. Difficulties in establishing the prevalence of mild ID are outlined. The degree of underestimation of the prevalence of mild ID when using multiple diagnostic criteria is discussed. It is suggested that current low-energy lifestyles are a common denominator for the current high prevalence not only of ID but also of obesity, diabetes, and osteoporosis.

GH is needed for the maturation of muscle mass and strength in adolescents

The postpubertal period and the early years of adulthood may be of importance for continuing tissue maturation of importance in adulthood and aging. An example of this is the peak bone mass. This study has evaluated the importance of GH for lean mass and muscle strength in adolescents and young adults. GH treatment was discontinued in 40 adolescents aged 16-21 yr with GH deficiency of childhood onset. Measurements of isometric and isokinetic knee-extensor and flexor strength, handgrip strength, lean body mass, fat-free mass, and total body nitrogen were performed annually for 2 yr. Two hundred fifty healthy adolescents were randomly selected for prospective measurements of lean mass and handgrip strength between the ages of 17 and 21 yr. In the adolescents with continuing GH deficiency, lean body mass decreased, compared with the patients defined as having sufficient endogenous GH. The isometric strength in knee flexors increased in the sufficient endogenous GH group and was unchanged in the GH deficiency group during the 2 yr off GH treatment (between group, P < 0.05). The mean and peak handgrip strength increased on average by 9-15% in the group with sufficient endogenous GH and was unchanged in those with GH deficiency (P < 0.05). Lean body mass and handgrip strength (both, P < 0.001) increased in both the healthy boys and girls who were followed for 4 yr with a more marked increase in the boys. The mean increase in handgrip between the age of 17 and 21 yr was 7-9%. The increased lean mass and improved muscle performance seen in healthy adolescents did not occur in adolescents with GH deficiency. These findings suggest that GH is of importance for the maturation of lean mass and muscle strength in adolescents and young adults.

Cancer risk in Swedish women: the relation to size at birth

The relationship between fetal growth as indicated by weight and length at birth, and cancer risk in 1080 adult Swedish women was examined. Birth factors were retrieved from original midwife records for the years 1914, 1918, 1922 and 1930, and primary cancer cases were identified by matching with national and regional cancer registries through the year 1998. A positive and statistically significant increased risk for cancer was found with increasing birth weight or birth length for all site cancer and non-hormone related cancer, defined as all cancer sites excluding breast, uterus and ovary. Addition of factors suspected to influence cancer risk, maternal proteinuria, birth order, own parity and age at menarche, did not attenuate this relation. Previously only breast cancer has been reported to be related to size at birth in adult women and this is the first study to report that cancer sites other than the major hormone-related sites may be influenced by size at birth, as measured by either weight or length at birth; these findings warrant further investigation.

Blood pressure and hypertension in middle-aged women in relation to weight and length at birth: a follow-up study

OBJECTIVES

To examine the relationship between indicators at birth and adult blood pressure and risk for developing hypertension at two age levels.

DESIGN

Original midwife records of 438 women born at term participating in a prospective population study in Göteborg, Sweden with blood pressure and hypertension assessment at both 50 and 60 years of age.

RESULTS

Systolic blood pressure at both age levels showed a U-shaped relationship to weight and length at birth. Hypertension prevalence at 60 years was significantly and inversely related to both weight and length at birth, but not at 50 years. Significantly higher risk for hypertension was found in the lowest birth weight quintile [odds ratio (OR) = 2.0, 95% confidence interval (CI) 1.1-3.8] and lowest birth length tertile (OR = 1.8, 95% CI 1.1-3.0), in relation to the middle quintile/tertile, with or without adjustment for adult body size (as body mass index), at 60 years but not at 50 years. At 50 years, hypertension risk decreased by 3% (95% CI 0.92-1.01) for every 100 g increase in birth weight and 6% (95% CI 0.83-1.05) per cm birth length. At age 60 years, hypertension risk decreased by 4% (95% CI 0.92-0.99) per 100 g birth weight and 10% (95% CI 0.81-0.99) per cm length.

CONCLUSIONS

Size at birth was a predictor of hypertension risk in women at 60 years but not 50 years. This study supports the hypothesis that poor fetal growth, as measured by low weight or length at birth, may contribute to the development of hypertension in later life and that this relationship became stronger with age.

Poor agreement between self-reported birth weight and birth weight from original records in adult women

Data from an ongoing prospective population study of women in Göteborg, Sweden, were used to assess agreement between self-reported birth weight and birth weight obtained from original delivery records of women aged 44-60 years. Of the eligible population with traced delivery records (n = 693), only 28% (n = 192) could report their own birth weight. Spearman correlation between self-reported birth weight and birth weight from original records was r = 0.76. However, a difference plot, with limits of agreement at -1,028 to 1,038 g (95% confidence limits: lower limit, -1,157 to -901 g, upper limit, 910 to 1,166 g) revealed poor agreement between methods. Of the self-reported birth weights, 53% were in error by 250 g or more, and 31% were positively or negatively discordant by 500 g or more. Application in an analysis of cardiovascular risk factors in adulthood found conflicting results between self-reported and recorded birth weights. Low reporting rate, poor reporting accuracy, and misleading findings in application led to the conclusion that self-reported birth weights from middle-aged women would not be a satisfactory replacement for birth weights from original records.

Iron stores and haemoglobin iron deficits in menstruating women. Calculations based on variations in iron requirements and bioavailability of dietary iron

BACKGROUND

Iron stores and haemoglobin iron deficits in menstruating women can be calculated from body iron losses and absorption of dietary iron using recently developed methods.

OBJECTIVE

To examine iron balance (iron status) expressed as body iron stores or haemoglobin iron deficits in menstruating women from amounts of iron lost (iron requirements) and amounts of dietary iron absorbed. Calculations are made both of stationary states and of the rate of changes in iron stores (iron status) when any of the two main factors determining iron balance are changed.

DESIGN

The study is based on (1) previous and new equations describing relationships between iron absorption, iron requirements (losses), iron stores and/or haemoglobin deficits and (2) published data on iron requirements and their variation in menstruating adult women.

RESULTS

Both iron stores and haemoglobin iron deficits are strongly related to iron requirements and absorption of dietary iron and follow the same equations during states of iron repletion and iron deficiency. When, for example, increasing or decreasing the bioavailability of the dietary iron, about 90% of the change in iron stores will occur within 1 y.

CONCLUSIONS

There are strong relationships between iron requirements, bioavailability of dietary iron and amounts of stored iron. The observations that a reduction in iron stores and a calculated decrease of haemoglobin iron had the same increasing effect on iron absorption suggest that the control of iron absorption is mediated from a common cell, that may register both size of iron stores and hemoglobin iron deficit, eg the hepatocyte. European Journal of Clinical Nutrition (2000) 54, 650-657.

Optimal outcome measures, research priorities, and international cooperation

The participants in the Eriksholm Workshop on "Measuring Outcomes in Audiological Rehabilitation Using Hearing Aids" debated three issues that are reported in this article. First, it was agreed that the characteristics of an optimal outcome measure vary as a function of the purpose of the measurement. Potential characteristics of outcome self-report tools for four common goals of outcome measurement are briefly presented to illustrate this point. Second, 10 important research priorities in outcome measurement were identified and ranked. They are presented with brief discussion of the top five. Third, the concept of generating a brief universally applicable outcome measure was endorsed. This brief data set is intended to supplement existing outcome measures and to promote data combination and comparison across different social, cultural, and health-care delivery systems. A set of seven core items is proposed for further study.

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.

Sociodemographic characteristics influencing birth outcome in Sweden, 1908-1930. Birth variables in the Population Study of Women in Gothenburg

STUDY OBJECTIVE

To identify variables available in early Swedish delivery records and their relation to birth outcomes for home and hospital deliveries in Gothenburg at the early part of this century.

DESIGN

A retrospective recovery of original delivery records and social variables in a cross sectional population.

SETTING

Gothenburg, Sweden.

PARTICIPANTS

851 fullterm singleton female births with known gestational age born into five birth cohorts on selected dates (1908, 1914, 1918, 1922 and 1930).

MAIN RESULTS

Delivery site, maternal parity, gestational age, and social group were significant factors influencing birth outcome as birth weight and length. The mean birth weight and length of hospital born infants was consistently lower than for home deliveries across all cohorts. Site of delivery changed significantly during the period of births under study, 1908-1930.

CONCLUSIONS

In this study, which was based on original delivery records from the early part of this century, it was found that delivery site was an important factor influencing birth outcome across five birth cohorts. Utilisation of delivery services changed during the period of study. Thus, to avoid selection bias, the application of delivery records should reflect the birthing practice of the time period in question.

Inositol phosphates with different numbers of phosphate groups influence iron absorption in humans

BACKGROUND

Inositol hexaphosphate (IP(6)) is a well-known inhibitor of iron absorption, whereas the effects of the less-phosphorylated derivatives of IP(6) are less known.

OBJECTIVES

The objective was to investigate the effects of inositol tri-, tetra-, and pentaphosphates (IP(3), IP(4), and IP(5), respectively) on iron absorption in humans.

DESIGN

Iron absorption was measured in 5 experiments from single meals by extrinsic labeling with (55)Fe and (59)Fe and determination of whole-body retention and the erythrocyte uptake of isotopes. In experiments 1-3 the meals contained white-wheat rolls to which 10 mg P as IP(5), IP(4), or IP(3), respectively, was added. Inositol 1,2,6-triphosphate [Ins(1,2, 6)P(3)] and a mixture of isomers of IP(4) and IP(5) were studied. White-wheat rolls contained 10 mg P as IP(3) + IP(4) and 2 mg P as IP(5) + IP(6) in experiment 4 and 20 mg P as IP(3) + IP(4) and 3 mg P as IP(5) + IP(6) in experiment 5; inositol phosphates were obtained via fermentation of sodium phytate. Each experiment had 8-11 subjects.

RESULTS

In experiment 1, iron absorption was reduced by 39%, whereas there was no significant effect on iron absorption in experiments 2 and 3. In experiments 4 and 5, iron absorption was reduced by 54% and 64%, respectively, suggesting that IP(3) and IP(4) contributed to the inhibitory effect.

CONCLUSIONS

IP(5) has an inhibitory effect on iron absorption, whereas IP(3) and IP(4) in isolated form have no such effect. IP(3) and IP(4) in processed food contribute to the negative effect on iron absorption, presumably by binding iron between different inositol phosphates. To improve iron absorption from cereals and legumes, degradation of inositol phosphates needs to be to less-phosphorylated inositol phosphates than IP(3).

Carboxypeptidase E (CPE) deficiency in mice with the fat mutation have reduced stomach function

An obese mouse model (Cpefat/Cpefat) that has hyperproinsulinemia and late onset obesity has been described. Cpefat/Cpefat mice have a missense mutation in carboxypeptidase E (CPE), a processing enzyme essential for production of biologically active endocrine and neuroendocrine peptides. We have reported previously that CPE activity was absent in the antrum of the stomach and that processing of progastrin to the amidated biologically active form of gastrin is reduced. Since gastrin is a major secretagogue for gastric acid secretion, the purpose of the present experiments was to examine gastric acid secretion in Cpefat/Cpefat mice. In addition, secretion of amidated gastrin in response to inhibition of acid secretion was tested in Cpefat/Cpefat. Both gastric acid and challenged gastrin secretion are reduced in Cpefat/Cpefat mice. We conclude that stomach CPE activity is essential for gastric secretory activity and for challenged gastrin release.

Iron stores in man in relation to diet and iron requirements

OBJECTIVE

To calculate iron stores in man and their rates of changes in relation to iron requirements and dietary iron intake and bioavailability.

METHOD

Newly established relationships between iron absorption from whole diets and serum ferritin (SF) and between SF and iron stores allow calculations of amounts of stored iron under different conditions (diets, losses) at stationary states when absorption equals losses. Rate of growth of stores can also be calculated. All calculations are based on observations and require no model assumptions.

RESULTS

Present calculations of iron stores agree with previously observed phlebotomy values. Differences in intake and bioavailability of dietary iron and in iron requirements had marked effects on amounts of stored iron. A wide range of diets was studied, from a hypothetical high-meat diet typical for early man to diets in developing countries. A new equation is given for the translation of SF into iron stores. Analyses of growth rate of stores under different conditions showed a fast growth from zero iron stores during the first year (reaching about 80% of final amounts) followed by a much slower rate for 2-3 y. A marked inertia was seen in rate of changes in iron stores that was more marked the closer stores were to their stationary states making it difficult to use SF to estimate short term changes in iron absorption in iron replete subjects.

CONCLUSIONS

Realistic Western-type diets with good bioavailability can cover iron requirements in most women and can restitute iron stores during lactation. The high prevalence of iron deficiency in menstruating Western women is thus mainly related to a further low bioavailability of iron in present diets. Present analyses also demonstrated an effective control of iron absorption preventing development of iron overload in otherwise healthy subjects even if the diet is fortified with iron and even if meat intake is high.

Effect of a mild infection on serum ferritin concentration--clinical and epidemiological implications

OBJECTIVES

To study the distribution of serum ferritin concentration in adolescent boys and girls with and without a preceding mild infection.

DESIGN

The prevalence of iron deficiency was studied in two representative samples. The first sample from 1990 comprised 207 boys and 220 girls. The second sample from 1994 included 620 boys and 624 girls. In total 1675 adolescents, 15-16 y old, 827 boys and 844 girls were studied.

RESULTS

A significant shift of serum ferritin concentration towards higher values was observed in those who reported an upper respiratory infection with fever during the preceding month (P<0.001). Significant differences were found between serum ferritin values in healthy, not infected adolescents and serum ferritin values in those with ongoing infection, both in boys and girls in the two materials (P < 0.01), and in those with a mild infection during the preceding three weeks.

CONCLUSIONS

The prevalence of recent infection should be included as information when trying to assess the prevalence of iron deficiency on the basis of serum ferritin measurements and when examining relationships between iron status and composition of the diet. The findings imply that differences in prevalence of iron deficiency between different studies might partly be explained by differences in prevalence of simple respiratory infections. The diagnostic sensitivity of the serum ferritin assay for iron deficiency, using conventional reference limits, decreases for subjects with recent such infections; similarly, there will be a decrease in the diagnostic specificity for haemochromatosis.

Iron absorption from the whole diet in men: how effective is the regulation of iron absorption?

Iron absorption from the whole diet, which contained a highly bioavailable form of iron, was measured for 5 d in 31 health men, including 12 blood donors. Nonheme iron in all meals was labeled with an extrinsic, inorganic radioiron tracer added in amounts to ensure uniform specific activity in all meals. Heme iron was labeled similarly by using hemoglobin biosynthetically labeled with another radioiron tracer. There was a good inverse relation between total absorption and concentration of serum ferritin up to approximately 60 micrograms/L. In subjects with serum ferritin > 60 micrograms/L there was no relation to iron absorption. At this serum ferritin concentration, absorption decreased to a level just sufficient to cover basal iron losses, implying that at a serum ferritin concentration > or = 60 micrograms/L no further accumulation of iron stores will occur by dietary iron absorption. The findings thus suggest that in normal subjects there is no risk of developing iron overload by iron absorption from the diet even if the diet is fortified. Similar findings were made previously in two studies in women, both of which indicated an effective control of absorption. At the same serum ferritin concentration the absorption per kilogram body weight was the same in men and women served identical diets with a high iron bioavailability. These new observations strongly suggest that translation of serum ferritin concentration into amounts of stored iron should be made with caution and that in subjects with high serum ferritin concentrations, other causes than increased iron stores should be considered. There was effective control of both heme- and nonheme-iron absorption but their relations to iron status were different.

Monitoring populations for DNA repair deficiency and for cancer susceptibility

The induction of a mutator phenotype has been hypothesized to cause the accumulation of multiple mutations in the development of cancer. Recent evidence suggests that the mutator phenotype is associated with DNA repair deficiencies. We have been using a challenge assay to study exposed populations to test our hypothesis that exposure to environmental toxicants induce DNA repair deficiency in somatic cells. In this assay, lymphocytes were irradiated in vitro to challenge cells to repair the radiation-induction DNA strand breaks. An increase of chromosome aberrations in the challenged cells from toxicant-exposed populations compared to nonexposed populations is used to indicate abnormal DNA repair response. From studies of cigarette smokers, butadiene-exposed workers, and uranium-exposed residents, the assay showed that these exposed populations had mutagen-induced abnormal DNA repair response. The phenomenon was also demonstrated using experimental animals. Mice were exposed in vivo to two different doses of N-methyl-N'-nitro-N-nitroso-guanidine (MNNG) and their lymphocytes were challenged with one dose of a radiomimetic chemical, bleomycin, in vitro. These challenged lymphocytes showed an MNNG dose-dependent increase of abnormal DNA repair response. In a population that was potentially exposed to teratogens--mothers having children with neural tube defects--lymphocytes from these mothers did not have the abnormal response in our assay. In studies with patients, we reported that lymphocytes from Down's syndrome patients have the abnormal DNA repair response. Lymphocytes from skin cancer-prone patients (epidermodysplasia verruciformis) have normal response to gamma-ray challenge but abnormal response to UV-light challenge. These patient studies also indicate that the challenge assay is useful in documenting the radiosensitivity of Down's syndrome and the UV sensitivity in EV patients. In most cases, the challenge assay is more sensitive in detecting biological effects than the standard chromosome aberration assay. Our series of studies indicates that the challenge assay can be used to document biological effects from exposure to mutagens and that the effect is an abnormal DNA repair response. This abnormality can increase the risk for development of cancer. The repair deficiency is currently being validated using a plasmid transfection (host-reactivation) assay. The need to integrate chromosome aberration and the challenge assays with other relevant assays for better documentation of biological effects and for more precise prediction of health risk will be presented. Our experience in using genetic polymorphism and host-reactivation assays will be discussed.

Iron absorption from the whole diet. Relation to meal composition, iron requirements and iron stores

OBJECTIVE

To validate a new method of measuring iron absorption from the whole diet over several days, to compare iron absorption from two types of diets and to relate iron absorption to iron requirements and iron stores.

DESIGN

Iron absorption from two diets was studied in 21 healthy young women. All non-haem iron in all meals was labelled to the same specific activity with an extrinsic radio-labelled iron tracer. Haem iron absorption was calculated from the amount of haem iron and absorption from a reference dose of iron.

RESULTS

Iron absorption was concordant with individual iron requirements measured from menstrual blood losses and body weights. Total iron absorption from one diet designed to be highly bioavailable, would cover iron requirements in about 94% of menstruating women. Iron absorption was reduced by half from a diet with less meat, more phytate and more calcium with main meals. This type of diet would cover iron requirements in only 65% of adult menstruating women. For both diets there was a marked reduction in iron absorption with increasing serum ferritin. Iron balance was not positive above a serum ferritin of about 60 micrograms/l.

CONCLUSIONS

Bioavailability of dietary iron is a key factor in iron nutrition. A diet with much lean meat, ascorbic acid and a low phytate content can cover iron requirements in most non-pregnant women. The powerful control of iron absorption implies that dietary iron overload cannot develop in normal subjects, even with diets having high iron content or high bioavailability.

Results of surveys to assess iron status in Europe

Many studies have been undertaken to assess the iron status of Europeans. However, differences in dietary patterns, methodology, contraceptive choice, and epidemiologic factors lead to confounding factors that need consideration as the data from available studies are reviewed.

Induction of deletion mutations by methoxyacetaldehyde in Chinese hamster ovary (CHO)-AS52 cells

We have reported previously that methoxyacetaldehyde (MALD), a metabolite of 2-methoxyethanol, induces gpt gene mutations in Chinese hamster ovary (CHO)-AS52 cells but not hprt gene mutations in the standard CHO-K1-BH4 cells. In addition, MALD induces chromosome aberrations in both CHO cell lines. The data presented suggest that MALD induces deletion-type mutations. In this study, we analyzed MALD-induced CHO-AS52 mutants for deletion-type mutations using the nested-polymerase chain reaction (nested-PCR) assay. Spontaneous CHO-AS52 mutants are used as untreated control. Ethylnitrosourea (ENU)-induced CHO-AS52 mutants are used as negative control for multilocus deletions since ENU is a potent inducer of point mutations. The results show that the frequency of MALD-induced mutants containing total deletion of the gpt gene is 42.4% which is 2.3-fold higher than that from spontaneous mutants (18.6%). The frequency of ENU-induced deletion mutation is 3%. The data substantiate our hypothesis that MALD induces major deletion mutations.

Iron balance in menstruating women

OBJECTIVES

To study factors determining iron balance in menstruating women by examining the relationships between total iron requirements, based on menstrual iron losses and basal iron losses, and serum ferritin concentration, transferrin saturation, blood haemoglobin concentration, bone marrow haemosiderin and absorption of iron from a test dose of ferrous sulphate (0.56 mg Fe).

SUBJECTS

The study was made in 203 women all aged 38 years, randomly selected from the census register of Göteborg. The study was originally made in 1968-69. Serum ferritin in frozen sera was first analysed in 1978. Reanalyses, calibrated to the International Standard 80/602, and studies on the effect of storage of sera, were made in 1992. This allowed a complete re-examination of the importance of different determinants of iron balance in women.

RESULTS

With increasing iron requirements there was an increase in iron absorption, and a decrease in serum ferritin concentration and transferrin saturation. Above a certain level of iron requirement there was a rather sudden decrease in haemoglobin concentration and in stainable iron in bone marrow smears, indicating the critical level of iron requirements in these women that could be balanced by an increased iron absorption from the present diet. This level represents the maximal adaptation to maintain iron balance in an iron-replete state that can be achieved with this diet and corresponds to a prevalence of iron deficiency of about 25%.

CONCLUSIONS

The continuous regulation of iron absorption from iron deficiency to iron repletion has a critical balance point determined by the properties of the diet.

Iron absorption from the whole diet: comparison of the effect of two different distributions of daily calcium intake

The possibility of reducing calcium inhibition of iron absorption by decreasing calcium intake in lunch and dinner meals, which provided the most dietary iron, was examined in 21 healthy female volunteers. During a 10-d period, nonheme iron in all meals was extrinsically labeled with radioisotopic iron to a uniform specific activity. Iron absorption from two identical 10-d periods was compared when meals were labeled with two different iron radioisotopes and when the same amount of calcium (937 mg) was distributed in two ways, in either mainly breakfast and late evening meals or more evenly in all meals. About 30-50% more iron was absorbed when no milk or cheese was served with lunch or dinner. The difference was statistically significant. Median iron requirements (1.61 mg/d) calculated from body weight and menstrual iron losses agreed with the mean value of median iron absorption in the two 10-d periods (1.54 mg/d), which supports the validity of the present method. A reasonable separation of calcium and iron intakes would improve iron nutrition.

Prevention of iron deficiency

This chapter discusses different methods to prevent iron deficiency--to reduce iron losses (e.g. reducing menstrual iron losses by using a contraceptive pill or combating of hookworm infestation) or to increase iron absorption. Iron absorption can be increased (1) by modifying the composition of meals--increasing the content of dietary factors enhancing iron absorption (e.g. meat and ascorbic acid) or reducing the content of factors inhibiting iron absorption such as phytate and iron-binding phenolic compounds, (2) by increasing the iron content of the diet by fortification with iron, or by (3) supplementation with iron tablets. Several factors to consider in the choice of strategy are discussed such as the importance of the bioavailability of the diet for the efficacy of iron fortification, the choice of vehicle for iron fortification that is compatible with the iron compound used, the feasibility to increase the bioavailability of the dietary iron by modification of the composition of the diet and the short time available in pregnancy to ensure a sufficient supply of the extra iron needed limiting the effective measures available to supplementation with iron tablets.

Duration of the inhibitory effect of calcium on non-haem iron absorption in man

We investigated the duration of the inhibitory effect of calcium from milk and cheese (340 mg) in a breakfast meal on non-haem iron absorption from a hamburger meal eaten 2 or 4 h after the breakfast. The effect of calcium on iron absorption was studied in 21 human subjects by using paired observations and a dual-radioisotope method (55Fe and 59Fe). No duration effect of calcium on iron absorption was observed in this study. The present findings offer an opportunity for theoretical improvement of iron nutrition by a redistribution of the daily intake of calcium to the meals with a minor iron content, i.e. breakfast and the evening meal.

Screening for iron deficiency: an analysis based on bone-marrow examinations and serum ferritin determinations in a population sample of women

Efficacy of different methods in screening for iron deficiency was re-examined in a randomly selected sample of 38-year-old women (n = 203) with known iron status based on absence/presence of stainable iron in bone-marrow smears. The study was made in 1968-69. Serum ferritin (SF) was determined in 1978 in frozen sera using the Ramco IRMA and, in 1992, samples were re-analysed using a RIA calibrated with the International Standard 80/602 for SF determination. The effect of storage on SF was calculated from a previously established relationship (courtesy of Dr Mark Worwood, Cardiff) between the results obtained with the Ramco assay and assays calibrated with IS 80/602. The distributions in iron replete and iron deficient women showed less overlap (diagnostic efficiency 91%) for SF than for other haematological parameters. The best discrimination was obtained at SF < 16 micrograms/l (specificity 98%; sensitivity 75%). Absence of iron stores was associated with signs of an iron deficient erythropoiesis, starting already at SF 25-40 micrograms/l. Use of multiple criteria to diagnose iron deficiency falsely reduces prevalence figures for iron deficiency.