The Efficacy and Safety of Vitamin C for Iron Supplementation in Adult Patients With Iron Deficiency Anemia: A Randomized Clinical Trial

IMPORTANCE

It remains uncertain whether vitamin C routinely used with oral iron supplements is essential for patients with iron deficiency anemia (IDA).

OBJECTIVE

To compare the equivalence and assess the safety of oral iron supplements plus vitamin C or oral iron supplements alone in patients with IDA.

DESIGN, SETTING, AND PARTICIPANTS

This single-center, open-label, equivalence randomized clinical trial was conducted from January 1, 2016, to December 30, 2017, in Huashan Hospital, Fudan University. Adult patients with newly diagnosed IDA were enrolled. Participants were randomly assigned (1:1) to the oral iron supplements plus vitamin C group or the oral iron supplements-only group. Data analysis was performed from March to December 2018.

INTERVENTIONS

Patients were randomized to receive a 100-mg oral iron tablet plus 200 mg of vitamin C or a 100-mg iron tablet alone every 8 hours daily for 3 months.

MAIN OUTCOMES AND MEASURES

The primary outcome was the change in hemoglobin level from baseline to 2 weeks of treatment, and an equivalence margin of 1 g/dL in hemoglobin was chosen for the demonstration of comparable efficacy. Secondary outcomes included the change in the reticulocyte percentage after 2 weeks of treatment, the increase in hemoglobin level after 4 weeks of treatment, the increase in serum ferritin level after 8 weeks of treatment, and adverse events.

RESULTS

Among the 440 randomized patients (220 each in the oral iron supplements plus vitamin C group and iron-only group; 426 women [96.8%]; mean [SD] age, 38.3 [11.7] years), all were assessed for the primary outcome, and 432 (98.2%) completed the trial. From baseline to the 2-week follow-up, the mean (SD) change in hemoglobin level was 2.00 (1.08) g/dL in the oral iron supplements plus vitamin C group and 1.84 (0.97) g/dL in the oral iron supplements-only group (between-group difference, 0.16 g/dL; 95% CI, -0.03 to 0.35 g/dL), thus meeting the criteria for equivalence. The mean (SD) change in serum ferritin level from baseline to 8-week follow-up was 35.75 (11.52) ng/mL in the vitamin C plus iron group and 34.48 (9.50) ng/mL in the iron-only group (between-group difference, 1.27 ng/mL; 95% CI, -0.70 to 3.24 ng/mL; P = .21). There were no significant differences between the 2 groups regarding the rates of adverse events (46 [20.9%] vs 45 [20.5%]; difference, 0.4%; 95% CI, -6.7% to 8.5%; P = .82). No patient withdrew because of adverse events.

CONCLUSIONS AND RELEVANCE

Among patients with IDA, oral iron supplements alone were equivalent to oral iron supplements plus vitamin C in improving hemoglobin recovery and iron absorption. These findings suggest that on-demand vitamin C supplements are not essential to take along with oral iron supplements for patients with IDA.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02631668.

Structure, dissolution, and plant uptake of ferrous/zinc phosphates

Development of slow release fertilizers by tuning dissolution kinetics can reduce the environmental impact of (micro) nutrients added to crops. Mixed metal compounds may have different dissolution kinetics and plant uptake than single metal compounds. In this study, mixed Fe(II)/Zn(II) phosphates (0-100 at% Zn) were prepared by aqueous precipitation and their structural characteristics and dissolution kinetics in a sand column were measured as model for divalent metal and phosphate release in soil. Three minerals were identified, namely vivianite (Fe₃(PO₄)₂·8H₂O) at 0-20 at% Zn, phosphophyllite (Zn₂Fe(PO₄)₂·4H₂O) at 20-79 at% Zn, and hopeite (Zn₃(PO₄)₂·4H₂O) at 79-100 at% Zn. The Fe-rich materials had high SSA of 42-64 m² g^-1, which decreased to ≤4 m² g^-1 for ≥79 at% Zn. The Fe K-edge and Zn K-edge XANES spectroscopy measurements show that the samples had comparable local structure and contained 13-72% of Fe as Fe(III) due to partial oxidation. In the sand column, Zn(II) and Fe(II) phosphates dissolved near-congruently at steady state (>7 h), whereas mixed Fe(II)/Zn(II) phosphates showed preferential release of Zn over P and Fe, likely due to reprecipitation of Fe. Pot experiments demonstrate that Zn from Fe(II)/Zn(II) phosphates is absorbed by bird's eye chili plants (C. annuum), in agreement with the preferential dissolution of Zn(II). These results may provide insight into the dissolution of other divalent metals, which not only aids in the growth of plants and resulting foodstuff but ultimately leads to reductions in environmental contamination.

Use of a Probiotic to Enhance Iron Absorption in a Randomized Trial of Pediatric Patients Presenting with Iron Deficiency

OBJECTIVE

To evaluate the efficacy of low dose ferrous sulfate for the treatment of iron deficiency and if the probiotic Lactobacillus plantarum 299v (LP299v) enhances treatment.

STUDY DESIGN

This randomized, double-blinded, controlled trial of the treatment of iron deficiency in children compared the use of low-dose ferrous sulfate (1-3 mg/kg/day), with or without probiotic (LP299v).

RESULTS

Serum ferritin level increased in all children from a baseline of 23.7 ng/mL to 45.4 ng/mL after 6-8 weeks of treatment. There was no significant difference in the increase in serum ferritin in children taking the probiotic LP299v compared with controls (23.2 vs 20.0 ng/mL, respectively). Additionally, an increase in ferritin level was not significantly associated with probiotic use when controlling for other factors, including child weight and dosing. Overall, the treatments were well-tolerated, with mild side effects.

CONCLUSIONS

Treatment with low-dose ferrous sulfate is well-tolerated and effective in correcting iron deficiency in children. However, the probiotic LP299v did not enhance treatment. Further attention should examine the dose-response effect in children, including an alternate day dosing schedule.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01617044.

Comparison Study of Iron Bioaccessibility from Dietary Supplements and Microencapsulated Preparations

Iron deficiency is the most common form of malnutrition. Factors responsible for this so-called "hidden hunger" include poor diet, increased micronutrient needs and health problems such as diseases and infections. Body iron status can be increased by the intake of dietary supplements and fortified food. The aim of the present study was to compare iron bioaccessibility from commercial nutritional supplements and iron microcapsules. A comparison study was performed under conditions mimicking gastric and gastrointestinal digestion. A preparation of encapsulated ferrous sulphate or lactate and vitamin C, in a formula, showed bioaccessibility factors of up to 100% when digested individually, and around 60% in the presence of a food matrix. The degree of oxidation of the ferrous ions differed, depending on the type of preparation, the presence of vitamin C and the food matrix. The highest percentage content of ferrous ion, in the soluble fractions after gastrointestinal digestion, was shown by the preparation containing microencapsulated ferrous lactate or ferrous sulphate and vitamin C. Encapsulation seems to limit the interaction of iron with the food matrix and protect it against oxidation, thus making it more accessible for intestinal uptake.

A new ferrous diflunisal complex and its effects on biopools of labile iron

Drugs bearing metal-coordinating moieties can alter biological metal distribution. In this work, a complex between iron(II) and diflunisal was prepared in the solid state, exhibiting the following composition: [Fe(diflunisal)₂(H₂O)₂], (Fe(dif)₂). The ability of diflunisal to alter labile pools of both plasmatic and cellular iron was investigated in this work. We found out that diflunisal does not increase the levels of redox-active iron in plasma of iron overloaded patients. However, diflunisal efficiently carries iron into HeLa or HepG2 cells, inducing an iron-catalyzed oxidative stress.

Design of Tumor Microenvironment-Responsive Drug-Drug Micelle for Cancer Radiochemotherapy

Concomitant radiochemotherapy is a major therapeutic strategy for treating malignant tumors. However, the greatest challenge is how to improve the therapeutic effect of radiochemotherapy to achieve the proper synergetic chemo-/radiotherapy for the tumor. In this study, ferrocenium (antitumor effect) and nitroimidazole (hypoxic cell radiosensitization) conjugates were synthesized to form amphiphilic ferrocenium-hexane-nitroimidazole (Fe-NI), which can self-assemble in aqueous solution. The Fe-NI micelles successfully encapsulate the hydrophobic chemotherapy drug doxorubicin (DOX) and are modified with hyaluronic acid (HA) by electrostatic interactions to form HA-Fe-NIs-DOX micelles. HA-Fe-NIs-DOX micelles rapidly release DOX under tumor hypoxia and a high glutathione (GSH) environment and achieve a synergetic chemo-/radiotherapy for the tumor based on the properties of nitroimidazoles and ferrocenes. The biodistribution results obtained in vivo reveal an effective accumulation in the tumor. The HA-Fe-NIs-DOX micelles show a significant radiosensitizing effect on the tumors, and the combination of chemotherapy and radiotherapy is realized for the treatment of tumor in vitro and in vivo. These findings illustrate that HA-Fe-NIs micelles are a promising candidate, which enhances the antitumor effects as a DOX delivery system, owing to the synergistic mechanisms of antitumor agents and chemo-/radiotherapy.

Evaluation of iron transport from ferrous glycinate liposomes using Caco-2 cell model

Background

Iron fortification of foods is currently a strategy employed to fight iron deficiency in countries. Liposomes were assumed to be a potential carrier of iron supplements.

Objective

The objective of this study was to investigate the iron transport from ferrous glycinate liposomes, and to estimate the effects of liposomal carriers, phytic acid, zinc and particle size on iron transport using Caco-2 cell models.

Methods

Caco-2 cells were cultured and seeded in DMEM medium. Minimum essential medium was added to the basolateral side. Iron liposome suspensions were added to the apical side of the transwell.

Results

The iron transport from ferrous glycinate liposomes was significantly higher than that from ferrous glycinate. In the presence of phytic acid or zinc ion, iron transport from ferrous glycinate liposomes and ferrous glycinate was evidently inhibited, and iron transport decreased with increasing phytic acid concentration. Iron transport was decreased with increase of particle size increasing of ferrous glycinate liposome.

Conclusion

Liposomes could behave as more than a simple carrier, and iron transport from liposomes could be implemented via a mechanism different from the regulated non-heme iron pathway.

Toxicological profile of IQG-607 after single and repeated oral administration in minipigs: An essential step towards phase I clinical trial

IQG-607 is an anti-tuberculosis drug candidate, with a promising safety and efficacy profile in models of tuberculosis infection both in vitro and in vivo. Here, we evaluated the safety and the possible toxic effects of IQG-607 after acute and 90-day repeated administrations in minipigs. Single oral administration of IQG-607 (220 mg/kg) to female and male minipigs did not result in any morbidity or mortality. No gross lesions were observed in the minipigs at necropsy. Repeated administration of IQG 607 (65, 30, or 15 mg/kg), given orally, for 90 days, in both male and female animals did not cause any mortality and no significant body mass alteration. Diarrhea and alopecia were the clinical signs observed in animals dosed with IQG-607 for 90 days. Long-term treatment with IQG-607 did not induce evident alterations of blood cell counts or any hematological parameters. Importantly, the repeated schedule of administration of IQG-607 resulted in increased cholesterol levels, increased glucose levels, decrease in the globulin levels, and increased creatinine levels over the time. Most necropsy and histopathological alterations of the organs from IQG-607-treated groups were also observed for the untreated group. In addition, pharmacokinetic parameters were evaluated. IQG-607 represents a potential candidate molecule for anti-tuberculosis drug development programs. Its promising in vivo activity and mild to moderate toxic events detected in this study suggest that IQG-607 represents a candidate for clinical development.

Iron Absorption from Two Milk Formulas Fortified with Iron Sulfate Stabilized with Maltodextrin and Citric Acid

Background: Fortification of milk formulas with iron is a strategy widely used, but the absorption of non-heme iron is low. The purpose of this study was to measure the bioavailability of two iron fortified milk formulas designed to cover toddlers’ nutritional needs. These milks were fortified with iron sulfate stabilized with maltodextrin and citric acid. Methods: 15 women (33–47 years old) participated in study. They received on different days, after an overnight fast, 200 mL of Formula A; 200 mL of Formula B; 30 mL of a solution of iron and ascorbic acid as reference dose and 200 mL of full fat cow’s milk fortified with iron as ferrous sulfate. Milk formulas and reference dose were labeled with radioisotopes ⁵⁹Fe or ⁵⁵Fe, and the absorption of iron measured by erythrocyte incorporation of radioactive Fe. Results: The geometric mean iron absorption corrected to 40% of the reference dose was 20.6% for Formula A and 20.7% for Formula B, versus 7.5% of iron fortified cow’s milk (p < 0.001). The post hoc Sheffé indeed differences between the milk formulas and the cow’s milk (p < 0.001). Conclusion: Formulas A and B contain highly bioavailable iron, which contributes to covering toddlers’ requirements of this micronutrient.

Oral iron absorption test should not be performed with iron drops containing ferric iron

INTRODUCTION

In an oral iron absorption test (OIAT), the rise in plasma iron concentration after oral ingestion of iron is a measure of intestinal iron absorption. We describe results of the OIAT using two different formulations of oral iron drops.

METHODS

The study included all patients who had an OIAT performed at the Department of Internal Medicine, Farsø, Aalborg University Hospital, Denmark, from 1 January 2013 to 17 June 2014 (n = 24) using ferrous iron drops "Glycifer" and from 18 June to 3 November 2014 (n = 17) using ferric iron drops "Medic". A venous blood sample was drawn before and then 90, 180 and 240 min. after the intake of 9 ml iron drops of the "Glycifer" brand (270 mg ferrous iron) or the intake of 11 ml iron drops of the "Medic" brand (264 mg ferric iron).

RESULTS

The patient characteristics (ferrous versus ferric iron drops) were similar in terms of gender, age, haemoglobin, ferritin and previous gastric bypass surgery. The fasting baseline plasma iron concentration was median 5 μmol/l in both groups (p = 0.4). The maximum plasma iron concen-tration increase from baseline after oral intake of the iron drops was median 2 μmol/l (range: 0-8 μmol/l) in the group given ferric iron drops and 48 μmol/l (range: 14-78 μmol/l) when ferrous iron drops were used (p < 0.001).

CONCLUSION

OIAT performed with ferrous or ferric iron drops showed very different results with a lack of plasma iron concentration increase after ingestion of ferric iron drops.

FUNDING

none.

TRIAL REGISTRATION

not relevant.

Accumulation and elimination of iron oxide nanomaterials in zebrafish (Danio rerio) upon chronic aqueous exposure

A 52-day continuous semi-static waterborne exposure (test media renewed daily) regimen was employed to investigate the accumulation and elimination profiles of two iron oxide nanomaterials (nano-Fe2O3 and nano-Fe3O4) in zebrafish (Danio rerio). Adult zebrafish were exposed to nanomaterial suspensions with initial concentrations of 4.0 and 10.0 mg/L for 28 days and then were moved to clean water for 24 days to perform the elimination experiment. Fe content was measured in fish body and feces to provide data on accumulation and elimination of the two iron oxide nanomaterials in zebrafish. The experiment revealed that: (1) high accumulation of nano-Fe2O3 and nano-Fe3O4 were found in zebrafish, with maximum Fe contents, respectively, of 1.32 and 1.25 mg/g for 4.0 mg/L treatment groups and 1.15 and 0.90 mg/g for 10.0 mg/L treatment groups; (2) accumulated nanoparticles in zebrafish can be eliminated efficiently (the decrease of body burden of Fe conforms to a first-order decay equation) when fish were moved to nanoparticle-free water, and the elimination rates ranged from 86% to 100% by 24 days post-exposure; and (3) according to analysis of Fe content in fish excrement in the elimination phase, iron oxide nanomaterials may be adsorbed via the gastrointestinal tract, and stored for more than 12days.

Ferroportin mediates the intestinal absorption of iron from a nanoparticulate ferritin core mimetic in mice

The ferritin core is composed of fine nanoparticulate Fe(3+) oxohydroxide, and we have developed a synthetic mimetic, nanoparticulate Fe(3+) polyoxohydroxide (nanoFe(3+)). The aim of this study was to determine how dietary iron derived in this fashion is absorbed in the duodenum. Following a 4 wk run-in on an Fe-deficient diet, mice with intestinal-specific disruption of the Fpn-1 gene (Fpn-KO), or littermate wild-type (WT) controls, were supplemented with Fe(2+) sulfate (FeSO4), nanoFe(3+), or no added Fe for a further 4 wk. A control group was Fe sufficient throughout. Direct intestinal absorption of nanoFe(3+) was investigated using isolated duodenal loops. Our data show that FeSO4 and nanoFe(3+) are equally bioavailable in WT mice, and at wk 8 the mean ± SEM hemoglobin increase was 18 ± 7 g/L in the FeSO4 group and 30 ± 5 g/L in the nanoFe(3+) group. Oral iron failed to be utilized by Fpn-KO mice and was retained in enterocytes, irrespective of the iron source. In summary, although nanoFe(3+) is taken up directly by the duodenum its homeostasis is under the normal regulatory control of dietary iron absorption, namely via ferroportin-dependent efflux from enterocytes, and thus offers potential as a novel oral iron supplement.

Kinetics absorption characteristics of ferrous glycinate in SD rats and its impact on the relevant transport protein

Ferrous glycinate (Fe-Gly) maintains high bioavailability in animals, but its exact absorption mechanism is still unknown. Here, we studied on the absorption kinetics of ferrous glycinate and its impact on the relevant transport protein in Sprague-Dawley (SD) rats. A total of 72 SD rats (male, BW 100 ± 6.25 g) were randomly allotted to three treatments. These treatments were perfused with 1 mL of normal saline, ferrous sulfate (FeSO4), and ferrous glycinate (71.35 mg/L as iron) separately. Four rats were selected from each treatment for collection of blood from the tails at certain times (15, 30, 45, 60, 75, 90, 120, 240, and 360 min) after gavage. Moreover, other six rats selected from each treatment were slaughtered for sampling after gavage at 2, 4, and 6 h to evaluate the expression of intestinal transport protein. Pharmacokinetic parameters of iron were determined by one-compartmental analysis. Compared with FeSO4, the peak plasma concentration of iron (C max) is higher in the rats given gavage with Fe-Gly (P < 0.05). Four hours after gavage with Fe-Gly, the expression of divalent metal transporter 1 (DMT1) in the duodenum is significantly decreased (P < 0.05), but the expression of ferroportin 1 (Fpn1) is significantly increased (P < 0.05). This study indicates that Fe-Gly as iron sources can be absorbed more and utilized faster than FeSO4, and they had different effects on the expression of intestinal transport protein.

Nanoceria-triggered synergetic drug release based on CeO(2) -capped mesoporous silica host-guest interactions and switchable enzymatic activity and cellular effects of CeO(2)

Herein, a pH stimuli-responsive vehicle for intracellular drug delivery using CeO2 capped mesoporous silica nanoparticles (MSN) is reported. β-Cyclodextrin-modified CeO2 nanoparticles could cap onto ferrocene-functionalized mesoporous silica through host-guest interactions. After internalization into A549 cells by a lysosomal pathway, the ferrocenyl moieties are oxidized to ferrocenium ions by CeO2 lids, which could trigger the uncapping of the CeO2 and cause the drugs release. Because of the pH-dependent toxicity, the CeO2 here behaves as a multi-purpose entity that not only acts as a lid but also exhibits a synergistic antitumor effect on cancer cells. Meanwhile, the cell protective effect of CeO2 nanoparticles alone is demonstrated, which ensures that the dissolved CeO2 nanoparticles can be non-toxic to normal cells.

Comparative study of the oral absorption of microencapsulated ferric saccharate and ferrous sulfate in humans

PURPOSE

Our objective was to compare the absorption of microencapsulated ferric saccharate (MFS) and ferrous sulfate (FS) in a fortified milk product, using a crossover design.

METHODS

Seventeen non-iron-deficient healthy adults from both sexes participated in the study. On each intervention day (days 1 and 8), after an overnight fast, the volunteers consumed one type of product (test or control) and blood sampling was carried out at different times. The interventions days were separated by 7-day washout periods. This study was double blinded, crossover and randomized for nature of the test meals. The primary outcomes of the study were total serum iron and transferrin saturation.

RESULTS

No significant differences could be observed in serum iron concentration during the 6-h postprandial study due to the type of milk product consumed, and there was neither an effect of time nor an interaction between the type of milk product and time. Transferrin saturation significantly increased after the intake of both products (P < 0.005), reaching a peak value between hours 2 and 4. No significant differences were detected between MFS and FS, indicating that iron absorption from MFS is equivalent to absorption from FS.

CONCLUSIONS

MFS is a new ingredient that allows the fortification of a wide range of food products, including heat-processed and non-acidic products with similar absorption to FS, designed to produce neither organoleptic changes nor off-color development during storage of fortified food.

Mutually exclusive alterations in secondary metabolism are critical for the uptake of insoluble iron compounds by Arabidopsis and Medicago truncatula

The generally low bioavailability of iron in aerobic soil systems forced plants to evolve sophisticated genetic strategies to improve the acquisition of iron from sparingly soluble and immobile iron pools. To distinguish between conserved and species-dependent components of such strategies, we analyzed iron deficiency-induced changes in the transcriptome of two model species, Arabidopsis (Arabidopsis thaliana) and Medicago truncatula. Transcriptional profiling by RNA sequencing revealed a massive up-regulation of genes coding for enzymes involved in riboflavin biosynthesis in M. truncatula and phenylpropanoid synthesis in Arabidopsis upon iron deficiency. Coexpression and promoter analysis indicated that the synthesis of flavins and phenylpropanoids is tightly linked to and putatively coregulated with other genes encoding proteins involved in iron uptake. We further provide evidence that the production and secretion of phenolic compounds is critical for the uptake of iron from sources with low bioavailability but dispensable under conditions where iron is readily available. In Arabidopsis, homozygous mutations in the Fe(II)- and 2-oxoglutarate-dependent dioxygenase family gene F6'H1 and defects in the expression of PLEIOTROPIC DRUG RESISTANCE9, encoding a putative efflux transporter for products from the phenylpropanoid pathway, compromised iron uptake from an iron source of low bioavailability. Both mutants were partially rescued when grown alongside wild-type Arabidopsis or M. truncatula seedlings, presumably by secreted phenolics and flavins. We concluded that production and secretion of compounds that facilitate the uptake of iron is an essential but poorly understood aspect of the reduction-based iron acquisition strategy, which is likely to contribute substantially to the efficiency of iron uptake in natural conditions.

[Pharmacokinetics of iron medication and efficacy of therapy with oral iron supplementation]

The pharmacokinetics of iron oral medication in was studied in patients with liver cirhorosis. In patients with hepatocellular insufficiency and high level of gepsidin found a decrease of the iron absorption constant, which led to a change in pharmacokinetic parameters. Tests on the absorption of iron have been conducted in 25 patients with liver cirrhosis, 36% of them showed a decrease of iron absorption, which led to the decrease in the efficiency of subsequent iron therapy. Found that elevated levels of gepsidin that lead to violation of iron metabolism and absorption and reduce the effectiveness of the treatment of iron deficiency.

Acute copper supplementation does not inhibit non-heme iron bioavailability in humans

To measure the effect of acute copper (Cu) administration, given as an aqueous solution, on the absorption of iron (Fe), 29 healthy adult women participated in two iron absorption studies. Subjects received 0.5 mg of Fe, as ferrous sulfate, alone or with Cu, as copper sulfate, at 0.5:1, 1:1, or 2:1 Cu/Fe molar ratios (study I) or at 4:1, 6:1, or 8:1 Cu/Fe molar ratios (study II) as an aqueous solution on days 1, 2, 14, and 15 of the study. Fe absorption was assessed by erythrocyte incorporation of iron radioisotopes (55)Fe and (59)Fe. Geometric mean (range +/- SD) absorption of Fe alone or at 0.5:1, 1:1, 2:1 Cu/Fe molar ratios were 34.4% (17.3-68.5%), 40.9% (24.9-67.2%), 48.3% (24.8-94.1%), and 50.2% (25.3-99.5%), respectively (ANOVA, p = 0.12). Geometric mean (range +/- SD) absorption of Fe alone or at 4:1, 6:1, 8:1 Cu/Fe molar ratios were 28.7% (12.1-67.9%), 21.5% (6.5-71.5%), 29.6% (10.3-85.4%), and 36.5% (18.3-73.1%), respectively (ANOVA, p = 0.16). In conclusion, combined Cu and Fe administration in an aqueous solution does not inhibit Fe bioavailability. This information could help in the design of rational guidelines for copper and iron supplementation programs. Our results support the hypothesis that divalent metal transporter 1 is not physiologically relevant for copper absorption in humans.

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.

Stabilized-solubilized ferric pyrophosphate as a new iron source for food fortification. Bioavailability studies by means of the prophylactic-preventive method in rats

The purpose of the present work was to evaluate the iron bioavailability of a new ferric pyrophosphate salt stabilized and solubilized with glycine. The prophylactic-preventive test in rats, using ferrous sulfate as the reference standard, was applied as the evaluating methodology both using water and yogurt as vehicles. Fifty female Sprague-Dawley rats weaned were randomized into five different groups (group 1: FeSO(4); group 2: pyr; group 3: FeSO(4) + yogurt; group 4: pyr + yogurt and group 5: control). The iron bioavailability (BioFe) of each compound was calculated using the formula proposed by Dutra-de-Oliveira et al. where BioFe % = (HbFef - HbFei) x 100/ToFeIn. Finally, the iron bioavailability results of each iron source were also given as relative biological value (RBV) using ferrous sulfate as the reference standard. The results showed that both BioFe % and RBV % of the new iron source tested is similar to that of the reference standard independently of the vehicle employed for the fortification procedure (FeSO(4) 49.46 +/- 12.0% and 100%; Pyr 52.66 +/- 15.02% and 106%; FeSO(4) + yogurth 54.39 +/- 13.92% and 110%; Pyr + yogurt 61.97 +/- 13.54% and 125%; Control 25.30 +/- 6.60, p < 0.05). Therefore, the stabilized and soluble ferric pyrophosphate may be considered as an optimal iron source for food fortification.

[Effects of ascorbic acid and citric acid on iron bioavailability in an in vitro digestion/ Caco-2 cell culture model]

OBJECTIVE

To study the effects of ascorbic acid and citric acid on iron bioavailability using an in vitro digestion/Caco-2 cell culture model and evaluate the validity of this cell model.

METHODS

This model combined in vitro digestion technique with Fe uptake by Caco-2 cells by utilizing an inserted ring attached to a dialysis membrane to simulate the gastrointestinal environment to allow simultaneous food digestion and uptake processes. Ferritin formation in the Caco-2 cells was measured as the indicator of Fe uptake by exposing Caco-2 cells to the digests containing Fe plus ascorbic acid or citric acid.

RESULTS

When Fe concentration in the digest was below 100 micromol/L, ferritin formation increased with the Fe concentration in the digest. The iron digest containing ascorbic acid exhibited a significant increase in ferritin formation relative to the iron digest containing citric acid. The model was more sensitive to lower iron concentrations when ascorbic acid was present in the digest, while wider range of iron concentration could be assessed by addition of citric acid.

CONCLUSIONS

The in vitro digestion/ Caco-2 cell culture model is a valuable tool for iron bioavailability assessment. Ascorbic acid has a stronger effect than citric acid in promoting iron bioavailability.

Comparison of iron uptake from reduced iron powder and FeSO4 using the Caco-2 cell model: effects of ascorbic acid, phytic acid, and pH

The reduced iron powder has considerable potential for use as an iron fortificant because it does not change organoleptically during storage or food preparation for cereal flour, and its bioavailability is scarcely influenced by iron absorption inhibitors in foods. The objective of this article is to study the effects of ascorbic acid, phytic acid, and pH on iron uptake from reduced iron powder (43 microm) and FeSO 4, and to compare iron bioavailability of reduced iron powders among four selected granularity levels. The cell ferritin formation is used as a marker of iron uptake. Obviously, iron uptake of reduced iron powder is increased with decreasing of powder granularity and is much lower than FeSO 4 when the size is above 43 microm, but significantly higher at 40-60 nm. In the presence of ascorbic acid or phytic acid, Caco-2 cell iron absorption from reduced iron powder (43 microm) is significantly higher than that from FeSO 4. And iron uptake of Caco-2 cells is decreased with increasing of pH from 5.5 to 7.5. Moreover, the decrease trend is more obvious for reduced iron powder than for FeSO 4. Our results indicated that iron bioavailability of reduced iron powder by intestinal enterocytes is similar to that of iron salts, and reduced iron powder is more excellent than FeSO 4 as food fortificant, especially at ultramicroscopic granularity.

Bioavailability of heme iron in biscuit filling using piglets as an animal model for humans

The objective of this work was to evaluate the bioavailability of heme iron added to biscuit filling. It comprised two stages: first, the development of the heme iron enriched biscuit filling; second, the evaluation of the bioavailability of the mineral in fattening piglets. Two groups were selected randomly and fed: a) Low iron feed and biscuits with heme iron supplemented filling; b) Normal feed (with ferrous sulphate). Weight and blood parameters were measured every fifteen days. Averages were compared after duplicate analyses. The filling had a creamy appearance, chocolate taste and smell, appropriate spreadability, heme iron content of 2.6 mg per gram and a shelf-life of a month. The heme iron supplemented pigs registered a greater (P<0.05) weight gain (27.8% more than the control group). Mortality in the heme iron group was 10%, compared to 50% in the control group. The amount of iron measured in the different compartment was greater in the heme group (3315 mg) than in the control group (2792 mg). However, the amount of iron consumed in the latter was greater. We show that an acceptable product with high heme iron content can be formulated, suitable for use as biscuit filling. The heme iron supplement produced better weight increase and lesser mortality in fattening pigs. The bioavailability of heme iron was 23% greater (P<0.05) compared to ferrous sulphate.

Tissue iron distribution and urinary mineral excretion vary depending on the form of iron (FeSO4 or NaFeEDTA) and the route of administration (oral or subcutaneous) in rats given high doses of iron

Sodium iron ethylenediaminetetraacetate (NaFeEDTA) has considerable promise as an iron fortificant in food. However, effects of administering high levels of NaFeEDTA on tissue iron distribution and mineral excretion are not well understood. The objectives of this study were to assess nonheme iron distribution in the body and urinary excretion of Ca, Mg, Cu, Fe, and Zn after daily administration of high levels of iron to rats over 21 days. Iron was either given orally with food or injected subcutaneously, as either FeSO 4 or NaFeEDTA. Selected tissues were collected for nonheme iron analysis. Estimated total body nonheme iron levels were similar in rats fed NaFeEDTA or FeSO 4, but the tissue distribution was different: it was 53% lower in the liver and 86% higher in the kidneys among rats fed NaFeEDTA than among those fed FeSO 4. In contrast, body nonheme iron was 3.2-fold higher in rats injected with FeSO 4 than in rats injected with NaFeEDTA. Administering NaFeEDTA orally elevated urinary Cu, Fe, and Zn excretion compared with FeSO 4 (1.41-, 11.9-, and 13.9-fold higher, respectively). We conclude that iron is dissociated from the EDTA complex prior to or during intestinal absorption. A portion of intact FeEDTA may be absorbed via a paracellular route at high levels of intake but is mostly excreted in the urine. Metal-free EDTA may be absorbed and cause elevated urinary excretion of Fe, Cu, and Zn.

A comparative study of iron bioavailability from cocoa supplemented with ferric pyrophosphate or ferrous fumarate in rats

BACKGROUND

Food iron fortification can be a good strategy to prevent iron deficiency. Iron bioavailability from cocoa powder enriched with ferric pyrophosphate encapsulated in liposomes or ferrous fumarate was assessed in rats.

METHODS

Three groups of rats consumed during 28 days either a control diet or two diets prepared with ferric pyrophosphate- or ferrous fumarate-enriched cocoa powder as the unique source of iron. Body weight and food intake were monitored and last-week feces were collected. On day 28, animals were sacrificed and livers and spleens were removed. Hemoglobin and total iron binding capacity (TIBC) were determined.

RESULTS

There were no significant differences in body weight and food intake. Apparent iron absorption and % absorption/intake were significantly lower in rats consuming enriched cocoa compared to the control group, without significant differences due to the iron form. Enriched cocoa groups showed significantly lower spleen iron content and concentration than the control. Liver iron was lower in the ferric pyrophosphate group compared to the other two groups. Hemoglobin and TIBC values showed a deficient iron status in ferric pyrophosphate rats.

CONCLUSION

Cocoa powder is a good vehicle for iron fortification when enriched with ferrous fumarate compared to ferric pyrophosphate encapsulated in liposomes.

Effects of dietary factors on iron uptake from ferritin by Caco-2 cells

Biofortification of staple foods with iron (Fe) in the form of ferritin (Ft) is now possible, both by conventional plant breeding methods and transgenic approaches. Ft-Fe from plants and animals is absorbed well (25-30%) by human subjects, but little is known about dietary factors affecting its absorption. We used human intestinal Caco-2 cells and compared Fe absorption from animal Ft and FeSO4 to determine the effects of inhibitors and enhancers, such as phytic acid, ascorbic acid, tannic acid, calcium and heme. When postconfluent cells were coincubated with 59Fe-labeled (1 microM) FeSO4 and dietary factors, at different molar ratios of dietary factor to Fe (phytic acid:Fe, 10:1; ascorbic acid:Fe, 50:1; tannic acid:Fe, 50:1; calcium:Fe, 10:1 and hemin:Fe, 10:1), all inhibited uptake from FeSO4, except ascorbate, confirming earlier studies. In contrast, these dietary factors had little or no effect on Fe uptake from undigested Ft or Ft digested in vitro at pH 4, except tannins. However, results after in vitro digestion of Ft at pH 2 were similar to those obtained for FeSO4. These results suggest that Fe uptake occurs from both undigested as well as digested Ft but, possibly, via different mechanisms. The Fe-Ft stability shown here could minimize Fe-induced oxidation of Fe-supplemented food products.

NaFeEDTA fortified soy sauce showed higher iron absorption rate in Chinese females

OBJECTIVE

NaFeEDTA was considered as a promising iron fortificant for controlling iron deficiency anemia. Soy sauce is a suitable food carrier for iron fortification and is a popular condiment in China. Iron absorption rates of NaFeEDTA and FeSO4 were observed and compared in adult female subjects.

METHODS

The stable isotope tracer method was used in Chinese females consuming a typical Chinese diet. Ten healthy young Chinese women were selected as subjects in the 15-day study. A plant-based diet was used based on the dietary pattern of adult women in the 1992 National Nutrition Survey. Six milligram of 54Fe in 54FeSO4 soy sauce and 3 mg 58Fe in Na58FeEDTA soy sauce were given to the same subjects in two days. Food samples and fecal samples were collected and analyzed.

RESULTS

Iron absorption rates of NaFeEDTA and FeSO4 were 10.51% +/- 2.83 and 4.73% +/- 2.15 respectively. The 58Fe (NaFeEDTA) absorption was significantly higher than that of 54Fe (FeSO4) (P < 0.01). The iron absorption rate from NaFeEDTA was 1.2 times higher than that from FeSO4 in Chinese adult women consuming a typical Chinese diet.

CONCLUSION

The higher absorption rate of NaFeEDTA suggested that NaFeEDTA would be a better iron fortificant used in soy sauce for the controlling of iron deficiency anemia in China.

The validation of using serum iron increase to measure iron absorption in human subjects

The objectives of the present study were to study the correlation between the change in serum Fe and Fe absorption when administering 100 mg Fe (as FeSO4) orally, and to study the correlation between the absorption from a 3 mg and a 100 mg Fe (as FeSO4) dose. The study was conducted in a group of eleven male blood donors, without any evident infection, who had given blood 8 weeks before the study. On three consecutive mornings the subjects were served a wheat roll fortified with Fe. On the first 2 d the roll was fortified with 3 mg Fe labelled with 59Fe; on day 3 the roll was fortified with 100 mg Fe labelled with 55Fe. The serum Fe response to the 100 mg dose was followed for 6 h. Fe absorption was measured by whole-body counting. High correlations were seen between the absorption of Fe and the change in serum Fe after 100 mg Fe (r2 0·94, P>0·001), between the absorption from 3 mg and 100 mg Fe (r2 0·88, P>0·001), and between the absorption from 3 mg Fe and change in serum Fe after 100 mg Fe (r2 0·90, P>0·001). This strengthens the evidence that it is possible to use the change in serum Fe as a measure of Fe absorption, e.g. when establishing the relative bioavailability for Fe powders. The results also imply that the induced serum Fe increase following 100 mg Fe added to a food could predict the Fe absorption of a small dose of Fe added to the same meal.

Iron absorption from ferrous fumarate in adult women is influenced by ascorbic acid but not by Na2EDTA

Ascorbic acid and Na2EDTA enhance Fe absorption from the water-soluble Fe compound FeSO4but their effect on poorly water-soluble Fe compounds such as ferrous fumarate is less well established. In the present study, the effects of ascorbic acid and Na2EDTA on Fe absorption from ferrous fumarate were evaluated in adult women (ten women/study) from the erythrocyte incorporation of Fe stable isotopes (57Fe or58Fe) 14 d after administration. Two separate studies were made with test meals of Fe-fortified infant cereal (5 mg Fe/meal). Data were evaluated by pairedttests and the results are presented as geometric means. In study 1a, the comparison between Fe absorption from ferrous fumarate- and FeSO4-fortified cereal showed that adult women absorb Fe as well from ferrous fumarate as from FeSO4(3·0 and 3·1 % respectively,P=0·85). After addition of Na2EDTA (Na2EDTA:fortification Fe molar ratio of 1:1), Fe absorption from FeSO4was significantly higher than from ferrous fumarate (5·3v. 3·3 % respectively,P<0·01; study 1b). In study 2, Fe absorption was compared from ferrous fumarate-fortified meals with and without ascorbic acid added at a 4:1 molar ratio (relative to fortification Fe) and the results showed that ascorbic acid increased Fe absorption from ferrous fumarate significantly (6·3v. 10·4 %,P=0·02). The results of the present studies show that Fe absorption from ferrous fumarate is enhanced by ascorbic acid but not by Na2EDTA, thus emphasising that not all findings from Fe absorption studies made with FeSO4can be extrapolated to Fe compounds with different solubility properties.

Electrolytic iron or ferrous sulfate increase body iron in women with moderate to low iron stores

Commercial elemental iron powders (electrolytic and reduced iron), as well as heme iron supplements, were tested for efficacy in improving the iron status of women. In a randomized, double-blind trial, 51 women with moderate to low iron stores received daily for 12 wk: 1) placebo, 2) 5 mg iron as heme iron or 50 mg iron as 3) electrolytic iron, 4) reduced iron, or 5) FeSO(4). Treatments were provided in 2 capsules (heme carrier) and 3 wheat rolls (other iron sources). Differences in iron status, food nonheme iron absorption, and fecal properties were evaluated. Body iron, assessed from the serum transferrin receptor:ferritin ratio, increased significantly more in subjects administered FeSO(4) (127 +/- 29 mg; mean +/- SEM) and electrolytic (115 +/- 37 mg), but not the reduced (74 +/- 32 mg) or heme (65 +/- 26 mg) iron forms, compared with those given placebo (2 +/- 19 mg). Based on body iron determinations, retention of the added iron was estimated as 3.0, 2.7, 1.8, and 15.5%, in the 4 iron-treated groups, respectively. Iron treatments did not affect food iron absorption. The 50 mg/d iron treatments increased fecal iron and free radical-generating capacity in vitro, but did not affect fecal water cytotoxicity. In subjects administered FeSO(4), fecal water content was increased slightly but significantly more than in the placebo group. In conclusion, electrolytic iron was approximately 86% as efficacious as FeSO(4) for improving body iron, but the power of this study was insufficient to detect any efficacy of the reduced or heme iron within 12 wk. With modification, this methodology of testing higher levels of food fortification for several weeks in healthy women with low iron stores has the potential for economically assessing the efficiency of iron compounds to improve iron status.

Vesicular transport of fe and interaction with other metal ions in polarized Caco2 cell monolayers

Two aspects of the mechanisms by which iron is absorbed by the intestine were studied in the Caco2 cell model, using 59Fe(II)-ascorbate. Data showing the importance of vesicular processes and cycling of apotransferrin (apoTf) to uptake and overall transport of Caco2 cell monolayers (or basolateral 59Fe release) were obtained by comparing effects of: a) adding apoTf to the basal chamber; b) adding vesicular transport inhibitors; or c) cooling to 4 degrees C. These showed that apoTf may be involved in as much as half of Fe transfer across the basolateral membrane, and that vesicular processes may also play a role in non-apoTf-dependent Fe transport. Studies were initiated to examine potential interactions of other metal ions with Fe(II) via DMT1. Kinetic data showed a single, saturable process for uptake of Fe(II) that was pH dependent and had a Km of 7 microM. An excess of Mn(II) and Cu(I) over Fe(II) of 200: 1 (microM: microM) in 1 mM ascorbate markedly inhibited Fe uptake. The kinetics were not competitive. Km increased and Vmax decreased. We conclude that vesicular transport, involving endo- and exocytosis at both ends of the enterocyte, is a fundamental aspect of intestinal iron absorption and that DMT1 may function as a transporter not just for divalent but also for monovalent metal ions.

Bioavailability studies of stabilized iron (II) sulfate by means of the prophylactic-preventive method

The bioavailability of stabilized ferrous sulfate was studied by means of the prophylactic-preventive test in rats. For comparative purposes, ferrous sulfate was used as reference standard. The test was performed in male weaned rats during 3 weeks, which were randomized into three groups of ten animals each. A control group received a basal diet of low iron content while the other groups received the same diet added with iron at a dose of 15 mg/kg as FeSO4 7H2O and stabilized ferrous sulfate, respectively. Individual hemoglobin concentrations and weights were determined at the beginning and at the end of the study, and food intake was daily registered. Iron bioavailability (BioFe) of each source was calculated as the ratio between the amount of iron incorporated into hemoglobin during the treatment and the total iron intake per animal. A relative biological value was obtained as the ratio between the BioFe of stabilized ferrous sulfate and the reference standard given a value of 96%. Stabilized ferrous sulfate showed a high bioavailability, and when it is used to fortify dairy products as cheese and fluid milk in a dose of 15-20 mg of iron per kilogram, it behaved inertly in relation to the sensorial properties of the fortified food. These results suggest that this iron compound is a promising source to be use in food fortification.

An irradiated electrolytic iron fortificant is poorly absorbed by humans and is less responsive than FeSO4 to the enhancing effect of ascorbic acid

Despite extensive use, information on the bioavailability of elemental iron powders to humans, as influenced by dose and other dietary constituents, is limited. Three experiments were conducted to assess the absorption of electrolytic iron powder relative to FeSO4, as affected by iron dose and by ascorbic or phytic acid. Iron absorption by 56 volunteers was measured from a farina cereal breakfast radiolabeled with 59FeSO4 or an electrolytic 55Fe powder irradiated by neutron activation. Absorption was determined from whole-body counting (59Fe) and blood isotope incorporation 2 wk later. Absorption of iron from the irradiated electrolytic powder was 5-15% that of FeSO4. Ascorbic acid (approximately 160 mg) enhanced iron absorption from FeSO4 by almost 4-fold but only doubled absorption from electrolytic iron (P for interaction < 0.01). Phytic acid from wheat bran inhibited iron absorption from FeSO4 and electrolytic iron by 73 and 50%, respectively (P for interaction, NS). Compared with 3 mg, a 20-mg dose reduced fractional absorption from FeSO4, but not electrolytic iron (P for interaction < 0.0001). Despite a much higher bioavailability (50% relative to FeSO4) of this same electrolytic iron when tested previously in a pig model, the bioavailability of the irradiated electrolytic iron was poor in humans. The diminished influence of ascorbic acid on the absorption of less soluble iron sources such as elemental iron powders may be an important consideration when choosing iron fortificants.

Ferrus calcium citrate is absorbed better than iron bisglycinate in patients with Crohn's disease, but not in healthy controls

Our purpose was to compare the absorption of iron bisglycinate and ferrous calcium citrate in volunteers using an oral iron tolerance test. Twenty volunteers, 10 healthy controls and 10 with stable Crohn's disease, agreed to participate in the study. All were given 50 mg of elemental iron as iron bisglycinate or ferrous calcium citrate. Serum iron levels were monitored for 4 hr. After a week, each received the other regimen. Using the area under the curve as indicator, the oral iron absorption test revealed that absorption of iron post-ingestion of ferrous calcium citrate was better than after ingestion of iron bisglycinate for the group as a whole (P < 0.03). Volunteers with Crohn's disease absorbed ferrous calcium citrate better than iron bisglycinate (P=0.005). No difference was noted in the absorption of either preparation by healthy volunteers. Ferrus calcium citrate is apparently more effective than iron bisglycinate in patients with Crohn's disease.

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.

Iron bioavailability from fortified petit suisse cheese determined by the prophylactic-preventive method

In this research, we measured the iron bioavailability of ferrous gluconate stabilized with glycine (SFG) when it is used to fortify petit suisse cheese using the prophylactic-preventive method in rats. Three groups of male, weaned rats received a basal diet (control diet; 5.2 ppm Fe), a reference standard diet (SO4Fe; 9.2 ppm Fe), and a basal diet using iron-fortified petit suisse cheese as the iron source (cheese diet; 8.8 ppm Fe) for 22 d. The iron bioavailability was calculated as the ratio between the mass of iron incorporated into hemoglobin and the total iron intake per animal during the treatment. These values (BioFe) were 68% and 72% for SFG and ferrous sulfate, respectively. The value of the Relative Biological Value (RBV) was 95% for SFG in petit suisse cheese. These results show that according to this method, the iron bioavailability from industrial fortified petit suisse cheese can be considered as a high bioavailability rate.

Absorption of iron from recombinant human lactoferrin in young US women

BACKGROUND

Lactoferrin is a major protein component of human milk, and it binds iron with high affinity. Because the human small intestine has receptors for lactoferrin, a role for it in iron absorption has been suggested.

OBJECTIVE

The objective was to study the absorption of iron from extrinsically labeled purified recombinant human lactoferrin produced in rice and to compare it with the absorption of iron from ferrous sulfate.

DESIGN

On 2 occasions 4 wk apart, healthy young women (n = 20) were fed a standardized meal supplemented in randomized order with 59Fe as lactoferrin or as ferrous sulfate. Ten subjects received lactoferrin that had been heat-treated, and 10 subjects received untreated lactoferrin. Iron absorption was measured in a whole-body counter after 14 and 28 d and also was measured by red blood cell incorporation after 28 d.

RESULTS

The difference in whole-body iron absorption between heat-treated (24.6 +/- 20.8%; n = 10) and untreated (16.2 +/- 4.4%; n = 10) lactoferrin was not significant. The difference in whole-body iron absorption between the groups given lactoferrin (20.4 +/- 15.3%; n = 20) or ferrous sulfate (18.8 +/- 13.2%; n = 20) also was not significant. Serum ferritin and iron absorption were inversely correlated in subjects when they received either lactoferrin or ferrous sulfate, which suggested that iron is absorbed from the 2 sources by a similar mechanism.

CONCLUSIONS

Iron is equally well absorbed from lactoferrin (whether heat-treated or untreated) and ferrous sulfate. Thus, iron provided by dietary lactoferrin is likely to be well utilized in human adults.

Cooking and Fe Fortification Have Different Effects on Fe Bioavailability of Bread and Tortillas

OBJECTIVE

To identify iron sources for wheat- (WF) and corn-flour (CF) fortification taking into account the effect of cooking.

METHODS

Sixty-six Fe-depleted rats were replete with various Fe sources. Fe bioavailability and utilization in wheat bread (WB) and corn tortillas (CT) fortified with various Fe sources was assessed after the depletion and repletion periods.

RESULTS

Baking decreased the phytates content of WF by 97%. Improvements in Hb and FeHb were greater in rats fed unfortified WB than in those fed unfortified WF. Fe fortification had no benefit. In contrast, phytates content was unchanged by tortilla preparation, but fortification improved iron availability. Iron bioavailability indicators were best in rats fed CT fortified with ferrous sulfate and NaFe(III)EDTA than in those fed unfortified CT or CT plus reduced Fe.

CONCLUSION

We concluded that baking WF bread improved the bioavailability of native Fe with no further effect of fortification. Pan-cooking of lime-treated CF did not improve Fe bioavailability, but addition of Ferrous sulfate or NaFe(III)EDTA did it, despite the high phytate and calcium content of tortillas.

Firstin vivo MRI assessment of a self-assembled metallostar compound endowed with a remarkable high field relaxivity

{Fe[Gd(2)bpy(DTTA)(2)(H(2)O)(4)](3)}(4-) is a self-assembled, metallostar-structured potential MRI contrast agent, with six efficiently relaxing Gd(3+) centres confined into a small molecular space. Its proton relaxivity is particularly remarkable at very high magnetic fields (r(1) = 15.8 mM(-1) s(-1) at 200 MHz, 37 degrees C, in H(2)O). Here we report the first in vivo MRI feasibility study, complemented with dynamic gamma scintigraphic imaging and biodistribution experiments using the (153)Sm-enriched compound. Comparative MRI studies have been performed at 4.7 T in mice with the metallostar and the small molecular weight contrast agent gadolinium(III)-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetate ([Gd(DOTA)(H(2)O)](-) = GdDOTA). The metallostar was well tolerated by the animals at the concentrations of 0.0500 (high dose) and 0.0125 (low dose) mmol Gd kg(-1) body weight; (BW). The signal enhancement in the inversion recovery fast low angle shot (IR FLASH) images after the high-dose metallostar injection was considerably higher than after GdDOTA injection (0.1 mmol Gd kg(-1) BW), despite the higher dose of the latter. The high-dose metallostar injection resulted in a greater drop in the spin-lattice relaxation time (T(1)), as calculated from the inversion recovery true fast imaging with steady-state precession (IR TrueFISP) data for various tissues, than the GdDOTA or the low dose metallostar injection. In summary, these studies have confirmed that the approximately four times higher relaxivity measured in vitro for the metallostar is retained under in vivo conditions. The pharmacokinetics of the metallostar was found to be similar to that of GdDOTA, involving fast renal clearance, a leakage to the extracellular space in the muscle tissue and no leakage to the brain. As expected on the basis of its moderate molecular weight, the metallostar does not function as a blood pool agent. The dynamic gamma scintigraphic studies performed in Wistar rats with the metallostar compound having (153)Sm enrichment also proved the renal elimination pathway. The biodistribution experiments are in full accordance with the MR and scintigraphic imaging. At 15 min post-injection the activity is primarily localized in the urine, while at 24 h post-injection almost all radioactivity is cleared from tissues and organs.

Iron absorption from soybean ferritin in nonanemic women

BACKGROUND

Dietary ferritin, a protein cage around an iron mineral, is an underestimated source of bioavailable iron. Plant ferritin, the most common dietary ferritin, has not been studied. Iron from animal ferritin is absorbed as well as is iron from FeSO4 in women.

OBJECTIVE

The objective was to examine iron absorption from purified soybean ferritin.

DESIGN

Healthy, nonanemic women (n = 16) were fed a standardized meal (bagel, cream cheese, and apple juice) containing 1 microCi 59Fe/meal as FeSO4 or (extrinsically labeled) as iron-free soybean ferritin reconstituted with the high phosphate characteristic of plant ferritin (iron:phosphorus = 4:1). Iron-free, apo-soybean ferritin was prepared (with the use of thioglycolic acid and extensive dialysis) from purified ferritin. In a randomized crossover design, the other labeled meal, which contained FeSO4 or ferritin, was given after 4 wk. The subjects received 140 microg Fe as ferritin (2.5 mg) or as FeSO4. After 28 d, whole-body 59Fe and 59Fe in red blood cells were measured before and after dosing.

RESULTS

There was no significant difference in whole-body iron absorption from soybean ferritin (29.9 +/- 19.8%) and that from FeSO4 (34.3 +/- 23.6%) or in iron absorption calculated from red blood cell incorporation (33.0 +/- 20.1% for soybean ferritin and 35.3 +/- 23.4% for FeSO4), which confirmed previous results with animal ferritin that was mineralized and labeled similarly. An inverse relation was observed between serum ferritin and iron absorption from both ferritin and FeSO4, which suggested that sensors regulating iron absorption respond similarly to iron provided as ferrous salts or as ferritin mineral.

CONCLUSION

Iron from soybean ferritin is well absorbed and may provide a model for novel, utilizable, plant-based forms of iron for populations with a low iron status.

Resorption and tolerance of the high doses of ferrous sulfate and ferrous gluconate in the patients on peritoneal dialysis

Background/Aim. Iron supplementation plays a crucial role in peritoneal dialysis (PD) patients. Oral iron substitution is more convenient than intravenous therapy in PD patients, but impaired absorption and adverse effects may be limiting factors for oral treatment. The aim of this study was to compare the absorption and side effects of high doses ferrous sulphate and ferrous gluconate in PD patients. Methods. Blood samples were taken from 29 PD patients at baseline, as well as 2, 4 and 8 hours after oral intake of 4 ferrous sulphate tablets (containing 105 mg elemental iron per tablet). The test was repeated using 8 ferrous gluconate drinkable ampoules (containing 50 mg elemental iron per ampoule). Results. The maximal increase in serum iron level during the test with iron sulphate was 113.51?103.37% versus the initial values of 183.87?37.38% during the ferrous gluconate test. The maximal values of serum iron after the intake of ferrous sulphate were 26.23?9.95 ?mol/l versus 30.97?8.65 ?mol/l after the intake of ferrous gluconate. There was a statistically significant difference between these two groups. Six patients showed an increase in serum iron of more than 300% after a high ferrous gluconate dose, while in 15 of the patients serum iron increased between 100% and 300%, and in 8 of the patients serum iron levels increased by less than 100%. Side effects occurred more frequently after the intake of ferrous sulphate than ferrous gluconate. Conclusion. High doses of oral iron were well absorbed and tolerated in PD patients. Ferrous gluconate was better absorbed and tolerated than ferrous sulphate, thus we recommend it for oral iron supplementation in PD patients.

Comparison of the efficacy of wheat-based snacks fortified with ferrous sulfate, electrolytic iron, or hydrogen-reduced elemental iron: randomized, double-blind, controlled trial in Thai women

BACKGROUND

Although elemental iron powders are widely used to fortify cereal products, little data exist on their efficacy in humans.

OBJECTIVE

We compared the efficacy of wheat-based snacks fortified with ferrous sulfate, electrolytic iron, or hydrogen-reduced iron in Thai women with low iron stores.

DESIGN

A double-blind intervention was conducted in 18-50-y-old women (n = 330) randomly assigned into 4 groups to receive either no fortification iron or 12 mg Fe/d for 6 d/wk for 35 wk as ferrous sulfate, electrolytic iron, or hydrogen-reduced iron in a baked, wheat-flour-based snack. Snacks were not consumed with meals, and consumption was monitored. At baseline, 20 wk, and 35 wk, hemoglobin status and iron were measured and the groups were compared.

RESULTS

Between baseline and 35 wk, geometric mean serum ferritin (SF) increased significantly in all 3 groups receiving iron (P < 0.01), and geometric mean serum transferrin receptor (TfR) decreased significantly in the groups receiving ferrous sulfate and electrolytic iron (P < 0.05). Calculated mean (+/-SD) body iron stores increased from 1.5 +/- 2.8 to 5.4 +/- 2.9 mg/kg in the ferrous sulfate group, from 1.5 +/- 3.5 to 4.4 +/- 3.6 mg/kg in the electrolytic iron group, and from 1.3 +/- 3.2 to 3.2 +/- 4.3 mg/kg in the hydrogen-reduced iron group (P < 0.01 for all 3 groups) but did not change significantly in the control group.

CONCLUSIONS

Ferrous sulfate, electrolytic iron, and hydrogen-reduced iron, fortified into wheat-based snacks, significantly improved iron status. On the basis of the change in body iron stores during the 35-wk study, the relative efficacy of the electrolytic and hydrogen-reduced iron compared with ferrous sulfate was 77% and 49%, respectively.

[Fractional utilization of reduced iron powder in Chinese child bearing age women with dual stable isotopes]

OBJECTIVE

To study the utilization of reduced iron powder in child-bearing-age women with traditional Chinese food.

METHODS

20 health child-bearing-age women were randomly divided into two groups. With ferrous sulfate as control, the utilization of reduced iron was measured using dual stable isotopes.

RESULTS

The fractional utilization of iron in ferrous sulfate was 5.8%, while in reduced iron powder was 2.1%. The rates of absorbed iron incorporated into hemoglobin were 70.1% and 91.3% respectively. The differences were statistic significant.

CONCLUSION

With traditional Chinese food, the utilization of reduced iron in child-bearing-age women was 2.1%, and the rate of absorbed iron incorporated into red blood cells was 91.3%.

Are we giving too much iron? Low-dose iron therapy is effective in octogenarians

PURPOSE

Elderly patients are vulnerable to the dose-dependent adverse effects of iron replacement therapy. Our study examines whether low-dose iron therapy can efficiently resolve iron-deficiency anemia in patients over the age of 80 years and reduce adverse effects.

SUBJECTS AND METHODS

Ninety hospitalized patients with iron-deficiency anemia were randomized to receive elemental iron in daily doses of 15 mg or 50 mg as liquid ferrous gluconate or 150 mg of ferrous calcium citrate tablets for 60 days. Thirty control patients without anemia were given 15 mg of iron for 60 days. A 2-hour iron absorption test was performed after the initial dose. Hemoglobin and ferritin levels were measured on day 1, 30, and 60 after initiating therapy. Each patient completed a weekly questionnaire regarding drug-induced adverse effects.

RESULTS

Serum iron rose significantly in the anemic patients beginning 15 minutes after the first dose but not in nonanemic patients. Two months of iron treatment significantly increased hemoglobin and ferritin concentrations similarly in all 3 groups of iron-deficiency anemia patients (for example, hemoglobin levels rose from 10.0 g/dL to 11.3 g/dL with 15 mg/d of iron therapy and from 10.2 g/dL to 11.6 g/dL with 150 mg/d). Abdominal discomfort, nausea, vomiting, changes in bowel movements, and black stools were significantly more common at higher iron doses.

CONCLUSIONS

Low-dose iron treatment is effective in elderly patients with iron-deficiency anemia. It can replace the commonly used higher doses and can significantly reduce adverse effects.

Iron absorption and oxidant stress during erythropoietin therapy in very low birth weight premature infants: a cohort study

Background

Iron supplementation may be associated with oxidative stress particularly in premature infants. Our purpose was to examine 1) early supplemental iron during treatment with erythropoietin (EPO) and oxidative stress; 2) enhanced iron absorption during EPO in those infants receiving human milk. Therefore, we determined the effect of erythropoietin plus supplemental iron intakes (4 mg/kg/d) on antioxidant status and iron incorporation.

Methods

Ten very-low-birth-weight infants who were enterally fed and receiving either human milk or formula were followed for 4 weeks during erythropoietin therapy; blood and urine were collected at 3 times; baseline, 2 and 4 weeks later. Once oral feeds commenced the study protocol was initiated. After baseline blood collection, a dose of Fe⁵⁷ was administered. Two weeks later, a dose of Fe⁵⁸ was administered as ferrous chloride to determine the effect of human-milk or formula on iron incorporation into RBCs.

Results

Infants started the study at 35 ± 13 days. Incorporation of isotope into RBCs did not differ between formula fed for Fe⁵⁷ (mean incorporation 8 ± 2.9 n = 3) compared to human-milk fed infants (8.7 ± 5 n = 7) nor for Fe⁵⁸ (6 ± 2.7 n = 3 vs. 8.6 ± 5 n = 7). Tissue damage measured by malondialdehyde in plasma and F-2 – isoprostanes in urine, did not differ by feed or over time. Neither ability to resist oxidative stress/nor RBC superoxide dismutase differed according to feed or over time.

Conclusion

Data suggest that during erythropoietin therapy antioxidant defence in VLBW infants are capable of dealing with early supplemental iron during treatment with EPO.

Enhancers of iron absorption: ascorbic acid and other organic acids

Ascorbic acid (AA), with its reducing and chelating properties, is the most efficient enhancer of non-heme iron absorption when its stability in the food vehicle is ensured. The number of studies investigating the effect of AA on ferrous sulfate absorption far outweighs that of other iron fortificants. The promotion of iron absorption in the presence of AA is more pronounced in meals containing inhibitors of iron absorption. Meals containing low to medium levels of inhibitors require the addition of AA at a molar ratio of 2:1 (e.g., 20 mg AA: 3 mg iron). To promote absorption in the presence of high levels of inhibitors, AA needs to be added at a molar ratio in excess of 4:1, which may be impractical. The effectiveness of AA in promoting absorption from less soluble compounds, such as ferrous fumarate and elemental iron, requires further investigation. The instability of AA during food processing, storage, and cooking, and the possibility of unwanted sensory changes limits the number of suitable food vehicles for AA, whether used as vitamin fortificant or as an iron enhancer. Suitable vehicles include dry-blended foods, such as complementary, precooked cereal-based infant foods, powdered milk, and other dry beverage products made for reconstitution that are packaged, stored, and prepared in a way that maximizes retention of this vitamin. The consumption of natural sources of Vitamin C (fruits and vegetables) with iron-fortified dry blended foods is also recommended. Encapsulation can mitigate some of the AA losses during processing and storage, but these interventions will also add cost. In addition, the bioavailability of encapsulated iron in the presence/absence of AA will need careful assessment in human clinical trials. The long-term effect of high AA intake on iron status may be less than predicted from single meal studies. The hypothesis that an overall increase of dietary AA intake, or fortification of some foods commonly consumed with the main meal with AA alone, may be as effective as the fortification of the same food vehicle with AA and iron, merits further investigation. This must involve the consideration of practicalities of implementation. To date, programs based on iron and AA fortification of infant formulas and cow's milk provide the strongest evidence for the efficacy of AA fortification. Present results suggest that the effect of organic acids, as measured by in vitro and in vivo methods, is dependent on the source of iron, the type and concentration of organic acid, pH, processing methods, and the food matrix. The iron absorption-enhancing effect of AA is more potent than that of other organic acids due to its ability to reduce ferric to ferrous iron. Based on the limited data available, other organic acids may only be effective at ratios of acid to iron in excess of 100 molar. This would translate into the minimum presence/addition of 1 g citric acid to a meal containing 3 mg iron. Further characterization of the effectiveness of various organic acids in promoting iron absorption is required, in particular with respect to the optimal molar ratio of organic acid to iron, and associated feasibility for food application purposes. The suggested amount of any organic acid required to produce a nutritional benefit will result in unwanted organoleptic changes in most foods, thus limiting its application to a small number of food vehicles (e.g., condiments, beverages). However, fermented foods that already contain high levels of organic acid may be suitable iron fortification vehicles.

The relative bioavailability in humans of elemental iron powders for use in food fortification

BACKGROUND

Bioavailability data in humans of elemental iron powders is limited although elemental iron is a common form of iron when used as a fortificant.

AIM OF THE STUDY

The relative bioavailability (RBV) of seven elemental iron powders, five commercially available and two developmental are evaluated. In addition, one commercial electrolytic iron powder given with ascorbic acid (AA) was examined.

METHODS

Based on a validated method this double-blinded randomized crossover study included three groups of male blood donors (n = 3*16) who were served rolls fortified with different elemental iron powders or ferrous sulfate (FeSO(4)) nine weeks apart. Blood samples were drawn every hour for six hours. RBV was obtained by comparing the increase in serum iron concentration induced by the elemental iron with the increase induced by FeSO(4).

RESULTS

All elemental iron powders studied were significantly less well absorbed compared to FeSO(4). The electrolytic iron given with 50-mg AA was as well absorbed as FeSO(4) (molar ratio = 1:6, AA:Fe). The mean RBVs of the iron powders were: electrolytic (A-131, RBV = 0.65); electrolytic (Electrolytic, RBV = 0.59); carbonyl (Ferronyl, RBV = 0.58); H-reduced (AC- 325, RBV = 0.56); H-reduced (Hi-Sol, RBV = 0.50); carbonyl (CF, RBV = 0.37); reduced (Atomet 95SP, RBV = 0.36). The reduced iron was distinguished by having significantly lower RBV (0.36) although no significant overall ranking was possible.

CONCLUSION

Based on a validated method this doubleblinded cross-over study in humans showed that the evaluated elemental iron powders currently available for commercial use are significantly less well absorbed compared to FeSO(4). The results indicate that the reduced iron powder was absorbed to a lower extent compared to the other iron powders and only 36% compared to FeSO(4). Ascorbic acid seems to improve the bioavailability of elemental iron even though a rather low molar ratio is used. Thus, if confirmed, this enhancing effect of ascorbic acid on elemental iron when used as a fortificant could be used by co-fortifying them.

Iron absorption by human subjects from different iron fortification compounds added to Thai fish sauce

OBJECTIVES

(a) To measure iron absorption by human subjects from citric acid stabilized fish sauce fortified with ferrous sulfate, ferric ammonium citrate or ferrous lactate and (b) to identify the effect of added citric acid (3 g/l) on iron absorption from ferrous sulfate fortified fish sauce.

DESIGN

Iron absorption from the intrinsically labeled compounds was determined via erythrocyte incorporation of isotopic labels ((57)Fe and (58)Fe) using a randomized crossover design. In three separate absorption studies, 10 adult women each consumed a basic test meal of rice and vegetable soup seasoned with isotopically labeled, iron fortified fish sauce.

RESULTS

Iron absorption was significantly lower from ferrous lactate and from ferric ammonium citrate fortified fish sauce than from ferrous sulfate fortified fish sauce. Fractional iron absorption (geometric mean; -1s.d., +1s.d.) was 8.7(3.6; 21.4)% for ferrous lactate compared to 13.0(5.4; 31.4)% from ferrous sulfate, P = 0.003 (study 1) and 6.0(2.5; 14.3)% from ferric ammonium citrate relative to 11.7(4.4; 30.7)% from ferrous sulfate, P < 0.001, in study 2. Citric acid added at a molar ratio of approximately 2.5 to iron had no effect on iron absorption from ferrous sulfate (study 3). Iron absorption in the presence of citric acid was 14.1(6.4; 30.8)% compared to 12.0(5.8; 24.7)% in its absence (P = 0.26).

CONCLUSIONS

Iron absorption was 50-100% higher from ferrous sulphate fortified fish sauce than from fish sauce fortified with ferric ammonium citrate or ferrous lactate. In the presence of citric acid as a chelator, ferrous sulfate would appear to be a useful fortificant for fish sauce.

SPONSORSHIP

International Atomic Energy Agency (IAEA), Vienna, Austria.

Simple Method for Precognition of Drug Interaction between Oral Iron and Phenolic Hydroxyl Group-containing Drugs

In the present study, we devised a simple method for detecting the drug interaction between oral iron preparations and phenolic hydroxyl group-containing drugs, using the coloring reaction as indicator, due to the formation of complexes or chelates. In the method, oral iron preparations and test drugs in amounts as much as single dose for adults were added to 10 ml of purified water to make sample suspensions for testing. Thirty minutes after mixing an oral iron suspension and a test drug suspension, the change of color in the mixture was observed macroscopically and graded as 0 to 3, with a marked color change judged as grade 3 and no color change as grade 0. Screening of 14 test drugs commonly used orally was carried out. When using sodium ferrous citrate preparations as oral iron, 5 were classified as grade 3, 2 as grade 2, 4 as grade 1, and 3 as grade 0, respectively. To verify usefulness of the method, the interactions suggested by screening were pharmacokinetically assessed by measuring serum concentrations of the drug in mice. When a levodopa or droxidopa preparation, judged as grade 3 in screening, was concomitantly administered with an iron preparation, a significant reduction in bioavailability of the test drug was observed, indicating possible drug interaction between the test drug and oral iron. Combined administration of an acetaminophen preparation, judged as grade 1, and oral iron preparation showed no influence on the bioavailability of the test drug, implying no detectable interactions between them. In conclusion, the simple method devised in the present study is useful for precognition of drug interactions between oral iron preparations and phenolic hydroxyl group-containing drugs, and the drugs with a higher grade in screening may induce drug interactions with oral iron.

[Treatment of iron deficiency anaemia in pregnant, puerperal and gynaecological patients--different drugs, different approaches]

According to WHO about 50 per cent of women of fertile age have iron deficiency anaemia (IDA). Iron loss > 80 mg per month, with menstruation in 22 per cent of women cause a negative iron balance in the course of time. About 40 per cent of women have data of prelatent iron deficiency still before conception, and if the demands of occured pregnancy are added, IDA is quickly reached. Over 30 per cent of puerperal women are affected by anaemia.

PURPOSE

To make a pharmacoeconomic assessment of peroral antianaemic drugs used for treatment of IDA in pregnant, puerperal and gynaecologically ill women.

MATERIALS

There are presented- daily intake of drugs, number of drug package taken, the price of a drug package, value of treatment a month, reimbursement of the drugs below: Ferro Gradumet, Maltofer Fol, Sorbifer Durules, Tot'hema, Legofer, Ferro-Folgamma, Tardiferon.

RESULTS

The survey made and the data of own studies show that the most important in treatment of IDA are the choice of iron- containing drug and the correct therapeutic approach. The choice of peroral iron- containing therapy is determined by: high "patient compliance"--good tolerance, independence on food intake, once daily intake, low frequency of adverse effects and treatment with low price (economic effect).

CONCLUSION

The most suitable for treatment of IDA in pregnant and puerperal women are Maltofer Fol and Sorbifer Durules. Maltofer Fol is with the best correlation price: "patient compliance". Tot'hema and Legofer have a good tolerance, a few adverse effects, but they are with high price. Ferro folgamma has not a high "patient compliance" and it has comparatively high price. Ferro gradumet has a low price and low "patient compliance".