- G.M. Doorn van (1)
- G.S.M.J.E. Duchateau (1)
- I. Egli (1)
- J.T. Forman (1)
- L.G.J. Frenken (1)
- R.F. Hurrell (3)
- M. Jakel (1)
- D. Moretti (1)
- S. Muthayya (1)
- D.W. Swinkels (1)
- W. Theis (1)
- P. Winichagoon (1)
- C. Zeder (2)
- M.B. Zimmermann (3)
Relevance of dietary iron intake and bioavailability in the management of HFE hemochromatosis: a systematic review
Moretti, D. ; Doorn, G.M. van; Swinkels, D.W. ; Boonstra, A. - \ 2013
American Journal of Clinical Nutrition 98 (2013)2. - ISSN 0002-9165 - p. 468 - 479.
serum ferritin concentration - middle-aged women - hereditary hemochromatosis - idiopathic hemochromatosis - controlled-trial - nonheme iron - genetic hemochromatosis - venesection therapy - dual fortification - deficiency anemia
Background: Hereditary hemochromatosis (HH) leads to iron loading because of a disturbance in the negative-feedback mechanism between dietary iron absorption and iron status. The management of HH is achieved by repeated phlebotomies. Objective: We investigated whether HH patients would benefit from a diet with low iron intake and bioavailability. Design: We performed a systematic review of studies that linked iron bioavailability and status with dietary factors in subjects with diagnosed HH. Studies on heterozygotes for the HFE mutation were excluded. Results: No prospective, randomized study was reported. Nine studies that directly measured iron bioavailability from test meals in HH patients have been described as well as 3 small, prospective, longitudinal studies in HH patients. Eight cross-sectional studies were identified that investigated the effect of dietary composition on iron status. Calculations of iron bioavailability in HH were made by extrapolating data on hepcidin concentrations and their association with iron bioavailability. The potential reduction in the yearly amount of blood to be phlebotomized when restricting dietary iron absorbed was estimated in the 3 longitudinal studies and ranged between 0.5 and 1.5 L. This amount would be dependent on individual disease penetrance as well as the dietary intervention. Conclusions: Despite the limited quantitative evidence and the lack of randomized, prospective trials, dietary interventions that modify iron intake and bioavailability may affect iron accumulation in HH patients. Although this measure may be welcome in patients willing to contribute to their disease management, limited data exist on the clinical and quality of life benefit.
Iron deficiency up-regulates iron absorption from ferrous sulphate but not ferric pyrophosphate and consequently food fortification with ferrous sulphate has relatively greater efficacy in iron-deficient individuals
Zimmermann, M.B. ; Biebinger, R. ; Egli, I. ; Zeder, C. ; Hurrell, R.F. - \ 2011
British Journal of Nutrition 105 (2011)8. - ISSN 0007-1145 - p. 1245 - 1250.
controlled-trial - double-blind - dual fortification - body iron - hemochromatosis - iodine - salt - expression - children - schoolchildren
Fe absorption from water-soluble forms of Fe is inversely proportional to Fe status in humans. Whether this is true for poorly soluble Fe compounds is uncertain. Our objectives were therefore (1) to compare the up-regulation of Fe absorption at low Fe status from ferrous sulphate (FS) and ferric pyrophosphate (FPP) and (2) to compare the efficacy of FS with FPP in a fortification trial to increase body Fe stores in Fe-deficient children v. Fe-sufficient children. Using stable isotopes in test meals in young women (n 49) selected for low and high Fe status, we compared the absorption of FPP with FS. We analysed data from previous efficacy trials in children (n 258) to determine whether Fe status at baseline predicted response to FS v. FPP as salt fortificants. Plasma ferritin was a strong negative predictor of Fe bioavailability from FS (P <0·0001) but not from FPP. In the efficacy trials, body Fe at baseline was a negative predictor of the change in body Fe for both FPP and FS, but the effect was significantly greater with FS (P <0·01). Because Fe deficiency up-regulates Fe absorption from FS but not from FPP, food fortification with FS may have relatively greater impact in Fe-deficient children. Thus, more soluble Fe compounds not only demonstrate better overall absorption and can be used at lower fortification levels, but they also have the added advantage that, because their absorption is up-regulated in Fe deficiency, they innately ‘target’ Fe-deficient individuals in a population
Random serial sampling to evaluate efficacy of iron fortification: a randomized controlled trial of margarine fortification with ferric pyrophosphate or sodium iron edetate 1-3
Andersson, M. ; Theis, W. ; Zimmermann, M.B. ; Forman, J.T. ; Jakel, M. ; Duchateau, G.S.M.J.E. ; Frenken, L.G.J. ; Hurrell, R.F. - \ 2010
American Journal of Clinical Nutrition 92 (2010)5. - ISSN 0002-9165 - p. 1094 - 1104.
population pharmacokinetics - relative bioavailability - double-blind - transferrin receptor - dual fortification - whole diet - deficiency - absorption - iodine - salt
Background: Random serial sampling is widely used in population pharmacokinetic studies and may have advantages compared with conventional fixed time-point evaluation of iron fortification. Objective: Our objective was to validate random serial sampling to judge the efficacy of iron fortification of a low-fat margarine. Design: We conducted a 32-wk placebo-controlled, double-blind, iron-intervention trial in 18–40-y-old Swiss women (n = 142) with serum ferritin (SF) concentrations
Adiposity in women and children from transition countries predicts decreased iron absorption, iron deficiency and a reduced response to iron fortification
Zimmermann, M.B. ; Zeder, C. ; Muthayya, S. ; Winichagoon, P. ; Chaouki, N. ; Aeberli, I. ; Hurrell, R.F. - \ 2008
International Journal of Obesity 32 (2008)7. - ISSN 0307-0565 - p. 1098 - 1104.
serum transferrin receptor - nutrition transition - controlled-trial - double-blind - ferric pyrophosphate - dual fortification - school-children - united-states - normal-weight - obesity
Background: Overweight is increasing in transition countries, while iron deficiency remains common. In industrialized countries, greater adiposity increases risk of iron deficiency. Higher hepcidin levels in obesity may reduce dietary iron absorption. Therefore, we investigated the association between body mass index (BMI) and iron absorption, iron status and the response to iron fortification in populations from three transition countries (Thailand, Morocco and India). Methods: In Thai women (n=92), we examined the relationship between BMI and iron absorption from a reference meal containing 4 mg of isotopically labeled fortification iron. We analyzed data from baseline (n=1688) and intervention (n=727) studies in children in Morocco and India to look for associations between BMI Z-scores and baseline hemoglobin, serum ferritin and transferrin receptor, whole blood zinc protoporphyrin and body iron stores, and changes in these measures after provision of iron. Results: In the Thai women, 20% were iron deficient and 22% were overweight. Independent of iron status, a higher BMI Z-score was associated with decreased iron absorption (P=0.030). In the Indian and Moroccan children, 42% were iron deficient and 6.3% were overweight. A higher BMI Z-score predicted poorer iron status at baseline (P