Food iron absorption measured by an extrinsic tag

Calcium bioavailability and iron-calcium interaction in orange juice

We have determined the effects of orange juice on calcium bioavailability from CCM (a combination of CaCO3, citric acid, malic acid, 5:1:1, mol/mol/mol) and iron-calcium interaction by using whole body isotope retention techniques in rats. The mean calcium retention values from CCM were 42.8% from orange juice and 33.0% from water, a control. Orange juice significantly (p less than 0.05) improved calcium bioavailability. This enhancement of calcium absorption is independent of orange juice's pH and citric acid. Iron absorption from orange juice with CCM (36.7%) was also significantly higher than that from control (water) plus CCM (12.3%). Ascorbic acid at levels naturally present in orange juice failed to improve iron retention (12.3% vs 12.5%) from water plus CCM. In contrast, citric acid (at orange juice level) significantly (p less than 0.05) promoted iron absorption in the presence of CCM (8.0% vs 23.7%). The benefit of citric acid on iron-calcium interaction is enhanced by ascorbic acid. In the presence of both citric acid and ascorbic acid, at orange juice levels, iron absorption from water plus CCM (37.6%) was comparable to that from water without CCM (34.5%). These results show orange juice can deliver bioavailable calcium from CCM with minimal inhibition of iron absorption. Citric acid and ascorbic acid are likely the major orange juice components that contribute to the alleviation of iron absorption inhibition by CCM.

Duodenal iron proteins in idiopathic hemochromatosis

This study was undertaken to assess the relationship between iron absorption and the concentration of duodenal iron proteins in normal subjects and patients with idiopathic hemochromatosis (IH). Biopsies were obtained endoscopically from the duodenum in 17 normal subjects, 3 of whom were mildly iron deficient, and 7 patients with untreated IH. The absorption of both heme and nonheme iron was increased in IH despite a 20-fold elevation in serum ferritin. Immunoassays using MAb were used to measure transferrin, H-rich ferritin, and L-rich ferritin in mucosal samples. Mucosal transferrin concentrations in normal subjects did not correlate with either iron status or iron absorption, indicating that mucosal transferrin plays no physiological role in iron absorption. Mucosal transferrin was significantly lower in IH, presumably because of a decrease in mucosal transferrin receptors. Mucosal H and L ferritin concentrations were directly related to body iron stores and inversely related to iron absorption in normal subjects. In IH, mucosal H and L ferritin failed to increase in parallel with the serum ferritin, but were appropriate for the level of iron absorption. The relationship of mucosal H/L ferritin in IH did not differ from that observed in normal subjects. Our findings indicate that the major abnormality in duodenal iron proteins in IH is a parallel decrease in the concentration of H- and L-rich ferritin. It is not evident whether this is the result or the cause of the absorptive abnormality.

The effect of riboflavin deficiency in rats on the absorption and distribution of iron

1. Riboflavin may play a part in the transport of iron across the gastrointestinal mucosa. Fe absorption was measured in the rat by monitoring whole-body retention of a dose of 59Fe using a small-animal gamma-counter. 2. Female Norwegian Hooded rats were fed on a diet deficient in riboflavin (B2-) from 5 weeks of age. Control animals, fed on a complete diet (B2+), were weight-matched to rats fed on the B2- diet. After 7 weeks all rats were fed on a test meal extrinsically labelled with 59Fe and whole-body radioactivity measured for 15 d. 3. Riboflavin deficiency was associated with a reduction in the percentage of the dose absorbed and an increase in the rate of loss of Fe post absorption. 4. A smaller percentage of the absorbed dose was present in the livers of the riboflavin-deficient animals.

Iron absorption from fortified flat breads

1. Radio-iron absorption measurements were performed in healthy volunteer subjects to assess the availability of fortification Fe added to various bread products. 2. When ferrous sulphate was used as a fortifier, Fe absorption from a traditional Egyptian flat bread (Baladi) averaged only 16% of that observed with European bread. This difference was attributed to the high extraction flour used to prepare Baladi bread. 3. The inhibiting effect of Baladi bread was largely eliminated by adding EDTA to the flour before baking.

Solid phase immunoradiometric assay for porcine serum ferritin

1. A solid phase immunoradiometric assay using anti-serum coated polystyrene tubes, is described for the assay of porcine serum ferritin. 2. The mean concentration of ferritin in the serum of both male and female pigs (Sus scrofa) was 12.1 micrograms/l +/- 8.7 micrograms (range less than 1-35 micrograms/l) and no sex differences were observed in 40 pigs from 1 day to 4 years old. 3. Serum ferritin increased with increasing body iron stores in iron loaded pigs as assessed by hepatic iron concentration. 4. The assay is sensitive (detecting less than 1 microgram/l), reproducible, specific and it does not cross-react with human or rat ferritin.

[Bioavailability of minerals. 1. Determination methods]

Minerals have a important role in metabolism. Only a little is known on the recommended intake for maintenance of body function. Supplying depends on the bioavailability. Methods for experimental determination are described and limits and possibilities are discussed.

In vitro estimation of iron availability from a range of plant foods: influence of phytate, ascorbate and citrate

Plant foods were digested in vitro and the proportion of iron which diffused across a semi-permeable membrane was used as an index of Fe availability. The mean (with SEM) Fe diffusibility from a group of eighteen cereals, legumes and nuts was very low, 2.1 (0.25)%, whereas from a group of sixteen fruits and vegetables it was high, 31.7 (1.09)%. The difference between the two food groups was highly significant (P less than 0.001). The results for Fe diffusibility correlated well with literature values for the in vivo absorption of Fe from similar foods (r0.84, P less than 0.01). When phytate, citrate and ascorbate were added to selected foods in amounts corresponding to endogenous levels, only phytate and citrate gave the expected effects on Fe diffusibility. Ascorbate only enhanced Fe diffusibility to the expected extent when it was added in much larger amounts, not normally found in foods. When added to cereal foods, orange juice was found to enhance greatly Fe diffusibility even when its content of ascorbate was completely destroyed by boiling followed by prolonged storage. When citrate and ascorbate were added to cereal foods in amounts equivalent to those found in fresh orange juice, both enhanced Fe diffusibility but citrate was far more effective. It is concluded that phytate is a major inhibitor of Fe diffusibility in cereals, legumes and nuts. However, citrate rather than ascorbate would appear to be the major enhancer of Fe diffusibility from many fruits and vegetables. The implications of the present results are discussed in relation to the relative influence of phytate, citrate and ascorbate on dietary Fe availability.

Effect of dietary fiber on iron absorption in man

The binding of iron to different fibers suggest in vitro that dietary fibers might interfere with the bioavailability of iron in the diet. As it is difficult or impossible to translate in vitro studies to in vivo bioavailability and even to translate results from animal studies to man, it is necessary to study the effect of fiber in man. With the extrinsic tag method and two different radioiron tracers it is possible in the same subject to compare the iron absorption from a meal with and without a certain component of dietary fiber. With a standard reference dose of 3 mg iron it is possible to "calibrate" each subject which makes it possible to compare the absorption in different groups given different components of dietary fiber.

Effect of soya-bean protein on meat iron solubility and absorption in rats

1. Soya-bean proteins were used to replace 30 and 50% of the protein from 59Fe-labelled pigeon (Columba L.) and chicken meat, and the solubility of the meat 59Fe in vitro and its absorption in vivo in rats in the presence and absence of soya-bean proteins were measured. 2. Replacement of part of the chicken meat by soya-bean proteins reduced 59Fe solubility from chicken meat at all stages during simulated in vitro digestion. 3. 59Fe absorption from 59Fe-labelled chicken meat when given to both Fe-replete and Fe-deficient rats was reduced in the presence of soya-bean proteins but was unaffected by the presence of casein or bovine serum albumin. 59Fe-absorption from pigeon meat in the presence of soya-bean proteins was not reduced to the same extent as that from chicken meat. 4. There was no significant effect of soya-bean proteins on 59Fe-labelled haemoglobin Fe absorption in vivo in Fe-replete rats. 5. Absorption of 59Fe from the isolated haemoproteins from chicken meat was unaffected by soya-bean proteins but 59Fe absorption from the main non-haem-Fe fractions was strongly inhibited, particularly from haemosiderin.

Intrinsic mineral labeling of edible plants: methods and uses

The fate of minerals can be conveniently studied through intrinsic labeling techniques. The mineral of interest is biologically incorporated into the food in a form that can be distinguished analytically from the natural form of the element. Radiolabels have traditionally been used to study such problems as the uptake of minerals by plants, the gross and subcellular mineral distribution in plant tissues, the form and associations of the deposited mineral, and the bioavailability of minerals to animals and humans. The use of stable (nonradioactive) isotopes as a label offers the potential of safely studying bioavailability of minerals from individual foods in human population groups of all ages using foods processed in normal food handling and processing facilities.

Soy protein products and heme iron absorption in humans

Dual radioiron tags were used to measure both heme and nonheme iron absorption simultaneously from meat-containing meals in 76 healthy male volunteers. Partial substitution of beef with soy flour reduced the availability of nonheme iron but improved the percentage absorption of heme iron significantly (27 to 59% rise). In contradistinction three other powerful inhibitors of nonheme iron absorption, bran, tea, and desferrioxamine, had no appreciable effect on heme. Ascorbic acid (100 mg and 1000 mg in separate experiments) improved nonheme iron uptake markedly but also failed to alter the assimilation of heme. These studies demonstrate that the deleterious effects on iron nutrition of substituting soy protein for beef are partially offset by improved availability of the remaining heme iron as well as by an increase in the nonheme iron content of the meal.

Radiolabeled iron in soybeans: intrinsic labeling and bioavailability of iron to rats from defatted flour

Soybeans can be efficiently labeled with radiolabeled iron by supplying the iron via a nutrient culture medium as an iron salt or as a chelate. By using dual labeled iron and EDTA, it was determined that none of the chelator was transported to the shoots with the iron. Therefore, the use of chelated iron as the iron source in the nutrient medium should not affect assessments of bioavailability of iron from plants. Bioavailability (determined from whole-body retention curves of 59Fe in rats) of iron from defatted soy flour was relatively high and addition of vitamin C did not significantly enhance absorption of iron from defatted soy flour.

Bioavailability of iron to rats from processed soybean fractions determined by intrinsic and extrinsic labeling techniques

Intrinsic and extrinsic labeling techniques were used to measure iron bioavailability from soybean fractions (isolated soy protein, defatted flour, soy hulls, insoluble material and whey) by iron-depleted and non-iron-depleted rats. As expected, absorption of iron was higher in the iron-depleted than in the non-iron-depleted rats. In the iron-depleted group, significantly more iron was absorbed from soy whey than from other fractions. No other significant difference in iron absorption associated with iron source was observed. The higher absorption rate of iron from whey by the iron-depleted rats probably was related to a lower quantity of food consumed during the test meal by this group. Intrinsic and extrinsic labeling techniques produced similar assessments of bioavailability of iron.

The effects of organic acids, phytates and polyphenols on the absorption of iron from vegetables

1. Non-haem iron absorption from a variety of vegetable meals was studied in parous Indian Women, using the erythrocyte utilization of radioactive Fe method.

2. The studies were undertaken to establish whether Fe absorption could be correlatedwith the chemical composition of the foodstuff.

3. Addition of the following organic acids commonly found in vegetables, improved the geometric mean Fe absorption from a basic rice meal as follows: from 0·028 to 0·085 with 1 g citric acid, from 0·031 to 0·081 with 15 mg ascorbic acid, from 0·048 to 0·095 with 1 g L-malic acid, from 0·041 to 0·096 with 1 g tartaric acid. The only exception was oxalic acid; the addition of 1 g calciumoxalate to cabbage (Brassica oleraceae) was associated with some depression in Fe absorption from 0·320 to 0·195.

4. There was a marked inhibition of the geometric mean absorption when 500 mg tannic acid was added to a broccoli (Brassica oleraceae) meal (0·015v. 0·297). Sodium phytate (2 g) caused a similar, though less profound inhibition (0·035 to 0·152).

5. When 3 mg ferrous sulphate was added to different vegetables the geometric mean absorption varied widely. Vegetables of low Fe bioavailability were wheat germ (Triticum aestivum) 0·007, aubergine (Solanum melongena) 0·007, butter beans (Phaseolus lunatus) 0·012, spinach (Spinacea oleraceae) 0·014, brown lentils (Lens culinaris) 0·024, beetroot greens (Beta vulgaris) 0·024 and green lentils (Lens culinaris) 0·032. In contrast, bioavailability was moderate or good with carrot (Daucus carota) 0·098, potato (Solanum tuberosum) 0·115, beetroot (Beta vulgaris) 0·185, pumpkin (Cucurbita mixta) 0·206, broccoli 0·260, tomato (Lycopersicon esculentum) 0·224, cauliflower (Brassica oleraceae) 0·263, cabbage 0·320, turnip (Brassica rapa) 0·327 and sauerkraut 0·327.

6. All the vegetables associated with moderate or good Fe bioavailability contained appreciable amounts of one or more of the organic acids, malic, citric and ascorbic acids.

7. Poor Fe bioavailability was noted in vegetables with high phytate contents (e.g. wheat germ 0·007, butter beans 0·012, brown lentils 0·024 and green lentils 0·032).

8. The fact that a number of vegetables associated with low Fe-absorption turned bluish-black when Fe was added to them, suggested that the total polyphenol content in them was high. The vegetables included aubergine spinach, brown lentils, green lentils and beetroot greens. When the total polyphenol content in all the vegetables tested was formally measured, there was a significant inverse correlation (r 0·859, P < 0·001) between it and Fe absorption. The inverse correlation between the non-hydrolysable polyphenol content and Fe absorption wasr0·901 (P < 0·001).

9. The major relevance of these findings is the fact that the total absorption of non-haem-Fe from a mixed diet may be profoundly influenced by the presence of single vegetables with either marked enhancing or inhibiting effects on Fe bioavailability.

Iron requirements and bioavailability of dietary iron

Over the past few decades so much knowledge has been gained about iron needs, dietary iron availability and adequacy that it is now one of the best defined nutrients in these respects. Development of new, accurate methods for the measurement of both the losses of iron from the body and the absorption of iron from the diet has significantly contributed to this situation. Present knowledge of iron needs is summarized. Specific to iron are the much higher needs in women than in men and the great variation in needs between different women due to a marked physiological variation in menstrual iron losses and to the effects of pregnancies. Iron availability is discussed separately for heme and non-heme iron (the major type of food iron). Heme iron in small amounts is, on average, better absorbed than non-heme iron. The absorption of heme iron is influenced very little by the iron status of the subject and by the other food components in the diet with the exception of meat which stimulates absorption. On the other hand, the absorption of non-heme iron is markedly influenced both by the iron status of the subject and a great number of dietary factors. The absorption of iron from the diet is thus determined more by meal composition than by the amount of iron present in the diet. The great variation in absorption between different meals is illustrated and the importance of various factors influencing non-heme iron absorption is also demonstrated. Whilst the mode of food preparation itself influences iron absorption, meat or fish and ascorbic acid are some principal food constituents that enhance absorption of iron. On the other hand, several factors like tannins, phytates, phosphates, soya protein products and various "dietary" fibres have been reported to inhibit non-heme iron absorption. A consideration of the nutritional adequacy of iron high-lights the importance of methods of evaluation, particularly the usefulness of the "bioavailable nutrient density" (BND) approach for different meals; BND for iron represents the amount of iron absorbed per 1'000 kcal (4'180 kJ). The main problem in iron nutrition in Western countries today is that arising from the combination of a low-energy intake, especially in women having the highest iron needs, with a conservation in the choice of meals/meal composition. Provision of bioavailable dietary iron to meet needs has hence not been adjusted to "modern life".

Iron availability from infant food supplements

Radioiron absorption tests are performed in human volunteer subjects to measure iron absorption from five infant food supplements. These products included corn-soya-milk, corn-soy blend, wheat-soy blend, wheat protein concentrate blend, and whey-soy drink mix. In iron replete adult males, mean percentage absorption ranged from 0.6 to 1.4%. By relating these results to absorption from a reference dose of inorganic iron, it was estimated that iron-deficient infants would absorb between 1.7 and 4.1% of the iron contained in the infant foods. These results indicate that this fortification iron is poorly absorbed, and probably supplies only about half of the daily iron requirement for iron deficient children between 6 months and 3 yr of age.

The inhibitory effect of soy products on nonheme iron absorption in man

Radioiron absorption studies were performed in male volunteer subjects to determine the effect on nonheme iron absorption of various semipurified proteins. When egg albumen and casein were substituted in protein-equivalent quantities in a semisynthetic meal, similar mean absorptions of 2.5 and 2.7% were observed. In contrast, isolated soy protein reduced absorption sharply, to an average of 0.5%. When egg albumen in the semisynthetic meal was replaced with full fat soy flour, textured soy flour, and isolated soy protein, absorption fell from 5.5 to 1.0, 1.9, and 0.4%, respectively, indicating an inhibitory effect by a wide range of soy products. The effect of substituting textured soy flour for meat in a meal containing a hamburger, french fries, and a milkshake was also evaluated. With 3:1 and 2.1 ratios of meat to unhydrated textured soy flour, absorption decreased by 61 and 53%, respectively. The soy products tested in this study have a pronounced inhibitory effect on the absorption of nonheme iron.

Intrinsic labelling of chicken meat with stable isotopes of zinc, for intended use in human feeding studies: feasibility and design considerations

1. The feasibility of intrinsically labelling poultry meat with the stable isotopes 68Zn and 70Zn was investigated. 2. Chickens (1-d-old) were gavaged with solutions of 68Zn and 70Zn several times over a 42 d period. 3. Isotopic analysis of edible tissues has shown that they were significantly enriched with respect to the gavaged isotope and that the extent of isotopic enrichment achieved was sufficient to permit their use in human feeding experiments designed to investigate availability of native Zn from such food models. 4. The absolute efficiency of retention of the stable isotopes from gavage solutions in the edible tissues has been calculated to be 2-3% of the administered dose; methods have been suggested to enhance this value, based on considerations of utilization of dietary Zn.

Factors affecting iron balance

The availability of radioisotopes of iron led to the performance of physiologic studies of the absorption, excretion, and kinetics of iron. The effects of dietary constituents and intestinal secretions upon iron absorption have been thoroughly explored and have permitted the development of tools for nutritional studies in various geographic areas of the world. The basic mechanisms for regulation of iron absorption are not fully understood. However, the isolation and characterization of newer iron-binding proteins, the existence of mucosal receptors in which there is competition for iron-binding sites with other metals, and the identification of a number of animal models with genetic abnormalities of iron absorption provide promise for development in the foreseeable future. The means by which the body informs the intestine to increase or decrease iron absorption is poorly understood, and the abnormality in hemochromatosis and iron overloading disorders remains unexplained. Much has been learned in recent years regarding the structure of iron-containing proteins and the variations that exist in different species. Similar problems remain to be solved with regard to the intermediary metabolism of iron in red blood cell precursors and other cells in the body. It is postulated that the combined usage of physiologic, biochemical, and immunologic investigations will provide the basic information required.

Factors affecting the absorption of iron from Fe(III)EDTA

1. The modification of iron absorption from Fe(III)EDTA by agents known to promote or inhibit absorption was examined in 101 volunteer multiparous Indian women. Fe absorption from Fe(III)EDTA was compared with absorption of intrinsic food Fe in a further twenty-eight subjects. Finally the urinary excretion of radio-Fe after oral administration of 59Fe(III)EDTA was studied in twenty-four subjects and evidence of intraluminal exchange of Fe was examined. 2. Fe absorption from maize porridge fortified with Fe(III)EDTA was more than twice that from porridge fortified with FeSO4 . 7H2O. 3. Although bran decreased Fe absorption from FeSO4 . 7H2O approximately 11-fold, it had no significant effect on Fe absorption from Fe(III)EDTA. Nevertheless tea, which is a more potent inhibitor of Fe absorption, decreased absorption from Fe(III)EDTA 7-fold. 4. Fe absorption from Fe(III)EDTA given in water was only increased 40% by addition of 3 mol ascorbic acid/mol Fe but by 7-fold when the relative proportions were increased to 6:1. This enhancing effect was blunted when the Fe(III)EDTA was given with maize porridge. In these circumstances, an ascorbate:iron value of 3:1 (which doubles absorption from FeSO4 . 7H2O) produced no significant increase in Fe absorption, while a value of 6:1 produced only a 2 . 5-fold increase. 5. Fe absorption from Fe(III)EDTA was not altered by addition of maize porridge unless ascorbic acid was present. 6. Less than 1% of 59Fe administered as 59Fe(III)EDTA was excreted in the urine and there was no inverse relationship between Fe absorption and the amounts excreted (r 0 . 58, P less than 0 . 05). 7. Isotope exchange between 59Fe(III)EDTA and 59FeSO4 . 7H2O was demonstrated by finding a similar relative value for the two isotopes in urine and erythrocytes when the two labelled compounds were given together orally. This finding was confirmed by in vitro studies, which showed enhanced 59Fe solubilization from 59FeSO4 . 7H2O in maize porridge when unlabelled Fe(III)EDTA was added. 8. Although Fe absorption from Fe(III)EDTA was marginally higher it appeared to form a common pool with intrinsic food iron in most studies. It is postulated that the mechanism whereby Fe(III)EDTA forms a common pool with intrinsic food Fe differs from that occurring with simple Fe salts. When Fe is present in the chelated form it remains in solution and is relatively well absorbed because it is protected from inhibitory ligands. Simple Fe salts, however, are not similarly protected and are absorbed as poorly as the intrinsic food Fe. 9. It is concluded that Fe(III)EDTA may be a useful compound for food fortification of cereals because the Fe is well absorbed and utilized for haemoglobin synthesis. The substances in cereals which inhibit absorption of simple Fe salts do not appear to inhibit absorption of Fe from Fe(III)EDTA.

Interaction of vitamin C and iron

Food iron is absorbed by the intestinal mucosa from two separate pools of heme and nonheme iron. Heme iron, derived from hemoglobin and myoglobin, is well absorbed and relatively little affected by other foods eaten in the same meal. On the other hand, the absorption of nonheme iron, the major dietary pool, is greatly influenced by meal composition. Ascorbic acid is a powerful enhancer of nonheme iron absorption and can reverse the inhibiting effect of such substances as tea and calcium/phosphate. Its influence may be less pronounced in meals of high iron availability--those containing meat, fish, or poultry. The enhancement of iron absorption from vegetable meals is directly proportional to the quantity of ascorbic acid present. The absorption of soluble inorganic iron added to a meal increases in parallel with the absorption of nonheme iron, but ascorbic acid has a much smaller effect on insoluble iron compounds, such as ferric oxide or ferric hydroxide, which are common food contaminants. Ascorbic acid facilitates iron absorption by forming a chelate with ferric iron at acid pH that remains soluble at the alkaline pH of the duodenum. High cost and instability during food storage are the major obstacles to using ascorbic acid in programs designed to combat nutritional iron deficiency anemia.

Accurate analysis of stable isotopes 68Zn, 70Zn, and 58Fe in human feces with neutron activation analysis

Accurate isotopic analysis of human fecal samples is discussed in relation to mineral bioavailability studies of human subjects. It is shown that for bioavailability investigations of Zn and Fe, the method of neutron activation analysis is suitable for routine application to clinical experiments; and the human fecal samples resulting from diet suitably enriched in isotopes 70Zn and 58Fe can be routinely analyzed with relative precisions of about 1% for the isotopes 68Zn, 70Zn and 58Fe.

Importance of ascorbic acid in the absorption of iron from infant foods

The absorption of fortification iron from an infant milk formula and from 3 infant cereals was studied in 121 multiparous women. The mean absorption was less than 3.2% when no added ascorbic acid was present. The nature of the iron compound added to infant cereals did not seem to influence the amount absorbed. Absorption was significantly improved when ascorbic acid was added, the mean increase being threefold with an iron:ascorbic ratio of 1:1.5 molar and more than sixfold with a ratio of 1:3 molar (about 10 mg ascorbic acid per mg iron).

Iron absorption and loading in beta-thalassaemia intermedia

Iron absorption and rates of iron accumulation were analysed in a group of patients with beta-thalassaemia intermedia. Iron absorption was strikingly increased and there was a progressive iron loading with increasing age. Balance studies indicated that by the time many of these patients reach the third or fourth decades their total iron loads may be of a similar magnitude to those of transfusion-dependent beta-thalassaemia homozygotes. If these patients are to be protected from cardiac, hepatic, and endocrine complications of iron overload in middle life it will be necessary to reduce gastrontestinal iron absorption, starting from early childhood.

The measurement of food iron absorption in man. A methodological study on the measurement of dietary non-haem-Fe absorption when the subjects have a free choice of food items

1. The present study was considered as a first step to develop a method to measure food iron absorption from realistic common meals prepared and consumed by the subjects themselves in their own homes. The absorption of Fe from the meals was measured by means of the extrinsic-tag method modified to allow for a free choice of food items. 2. The mean Fe intake was 2.79 mg and the mean Fe absorption approximately 0.30 mg. The Fe status of the subjects corresponded to 31.5% absorption from a reference dose solution containing 3 mg elemental Fe as ferrous ascorbate. The variation in food Fe absorption obtained in this field study was found to be of the same magnitude as that obtained in studies performed under more controlled conditions as in the laboratory. 3. The conclusion was drawn that the proposed method could be used in realistic field studies aimed at, for example, explaining or preventing a high prevalence of deficiency. A suffciently long run-in period and a careful instruction of the subjects was considered essential for the design of future field studies.

Absorption from iron tablets given with different types of meals

The absorption of iron from tablets given with 5 types of meals was studied in 153 subjects. The meals were: a hamburger meal with beans and potatoes, a simple breakfast meal, a Latin American meal composed of black beans, rice and maize and two Southeast Asian meals composed of rice, vegetables and spices served with and without fish. The groups were directly compared by relating the absorption from the iron tablets to the absorption from a standardized reference dose of iron given on an empty stomach. The composition of meals with respect to content of meat or fish or the presence of large amounts of phytates seemed to have no influence on the absorption of iron from tablets. The absorption from iron tablets was about 40% higher when they were given with rice meals than when they were given with the other meals studied. The average decrease in absorption by meals was about 50-60% based on a comparison when tablets were given on an empty stomach. When tablets from which the iron was released more slowly were used, the absorption increased by about 30% except when they were given with rice meals, where the absorption was unchanged. The differences among the meals in their effect on the absorption of iron from tablets thus disappeared when the slow-release tablets were given.

Need for iron supplementation in infants on prolonged breast feeding

Iron status, as measured by blood counts and indices, serum iron, transferrin saturation, and serum ferritin values, was studied longitudinally in 56 infants on prolonged breast feeding, and compared to that of 29 infants receiving cow milk formula prepared at home and of 47 infants receiving a proprietary infant formula. The first two groups received no iron supplementation, whereas the proprietary formula was supplemented with iron. Although breast feeding was found to be sufficient to meet iron needs during the first 6 months of life, supplemental iron would be necessary during the second half of infancy in order to guarantee the optimal iron status.

Measurement of dietary cadmium absorption in humans

Total body counting was used to determine cadmium absorption in 14 healthy subjects and in 1 patient with an ileostomy. Breakfast was extrinsically tagged with 115mCdCl2, and a poorly absorbed marker, 51CrCl3, was added to determine the point of complete elimination of unabsorbed radiocadmium from the gastrointestinal tract. The 51Cr was not an ideal marker: fecal excretion of radiocadmium continued beyond the point at which chromium was completely eliminated from the body, Nevertheless, it was helpful in six subjects in identifying the presence of unabsorbed radiocadmium still in transit in the lumen of the gastrointestinal tract 3--5 wk after the test meal. The average body retention of radiocadmium determined between 7 and 14 d after the disappearance of the chromium marker from the body was 4.6 +/- 4.0% (SD), with a range of 0.7--15.6%. The biological half-time of absorbed radiocadmium in one of the subjects was 100 d.

Effect of a single ingestion of alcohol on iron absorption

The effect of alcohol on inorganic and organic iron absorption was studied in 70 subjects, using a whole-body counter technique. The mean iron absorption of a test dose was 24.44%, while in the presence of whisky, absorption fell to 9.73% (P less than 0.0001). Absorption of a test dose in the presence of whisky without alcohol was 10.14% (P less than 0.0001). The alcohol in whisky, therefore, was not responsible for the diminished iron absorption (P greater than 0.20). The absorption of the iron contained in wine with alcohol was 73.31 microgram and wine without alcohol was 67.50 microgram. The difference was not statistically significant (P greater than 0.20). The absorption of inorganic iron contained in a test meal was 165.55 microgram and was not changed in the presence of ethanol (151.35 microgram) (P greater than 0.10). However, the presence of ethanol affected the absorption of heme iron: 538.68 microgram compared with 442.41 microgram with ethanol (P less than 0.0001). These studies show that the acute ingestion of ethanol does not influence the absorption of inorganic iron, while it does diminish the absorption of the organic form.

Iron nutrition

This paper is a progress report on our present understanding of iron nutrition in man, particularly in developing countries. We will be concerned with the quantitative aspects of iron balance and in particular with the availability of dietary iron, the recognition of iron deficiency and its prevalence, the effects of iron deficiency on the well being of the individual, and the feasibility of modifying the iron balance of man by dietary means.

Iron absorption from a cereal-based meal containing cane sugar fortified with ascorbic acid

1. The feasibility of improving iron nutrition by fortifying cane sugar with ascorbic acid was studied.

2. The absorption of Fe added to maize-weal porridge was measured in 116 volunteer multiparous Indian women using the radio-Fe erythrocyte utilization method. The meals were fed with and without tea or coffee and with and without varying amounts of ascorbic acid.

3. The mean absorption of Fe from maize-meal porridge was very low (3.8 %), being even further reduced (2.1 %) when tea was drunk with the meal.

4. The addition of 50 or 100 mg ascorbic acid to maize-meal porridge caused approximately a 10-fold increase in Fe absorption. The increase was much less when tea was present, being 2-fold and 5-fold with 50 and 100 mg ascorbic acid respectively. The inhibitory effect of tea on Fe absorption could, however, be overcome by giving larger doses of ascorbic acid (250 and 500 mg).

5. When contaminating Fe (2.5 mg) in the form of labelled rust (Fe2O3) or ferric hydroxide was added to maize-meal porridge it was poorly absorbed (mean values were 0.01 % and 1.5 % respectively). The addition of 100 mg ascorbic acid increased the mean Fe absorption rates to 0.5 % and 6.7 % with Fe2O3 and Fe(OH)3 respectively. Fe(OH)3 was found to be absorbed about half as well as the intrinsic Fe present in maize-meal porridge.

6. It is concluded that ascorbic acid is capable of improving Fe absorption from a cereal source. It can partially overcome the inhibitory effect of tea and might be expected to facilitate the absorption of at least some forms of Fe that may contaminate food.

Absorption of 'fortification'iron. Bioavailability in man of different samples of reduced Fe, and prediction of the effects of Fe fortification

1. The first part of this study was designed to determine the increase in the amount of iron absorbed by hypothetical groups of subjects on the border-line of Fe deficiency when they were given meals fortified with ferrous sulphate. Two levels of Fe fortification were used (1.6 and 8.9 mg/meal) and the increase in the amount of Fe absorbed by the ‘border-line’ groups was 0.13 and 0.7 mg respectively.

2. Subjects which are on the border-line of Fe deficiency may be considered the target group of an Fe-fortification programme. Therefore the experimental model used can provide valuable information on the effects on the prevalence of Fe deficiency which can be expected when such a programme is introduced.

3. In the second part of the study, the bioavailability in man of reduced Fe with different physico-chemical properties was measured. Special emphasis was given to the relationship between the values obtained in vitro and in vivo.

4. The bioavailability was expressed as absorbability relative to that of ferrous sulphate. In four samples of hydrogen-reduced Fe the bioavailability ranged from 90 to 13%. The reduced-Fe products differed considerably with respect to solubility in hydrochloric acid (8–94% dissolved after 30 min), particle size distribution (91–1% < 7 μm) and reactive surface area (< 0.1–2.7 m2/g).

5. The relationships found between physico-chemical information and bioavailability indicated that reactive surface area and dissolution rate were better predictors of the bioavailability than the particle size.

Iron mobilization in the pregnant rat

Iron exchange in the pregnant rat was quantitated by repeated determinations of plasma iron turnover (PIT), transferrin iron distribution and measurements of storage iron and food iron utilization employing selective radio-iron probes. Despite a sixfold increase in PIT, intestinal absorption of iron accounted for 40% of the PIT throughout pregnancy, with variations not exceeding +/- 5%. Increased fetal requirements were efficiently compensated for by the mobilization of iron from maternal tissue stores and by increased absorption, and there was no subsequent reduction in iron supply to maternal tissues. Enhancement of iron absorption occurred in the absence of a reduction in serum iron levels or the size of iron stores. In view of the close correlation between PIT and rates of absorption it is postulated that iron absorption in the pregnant rat is regulated by PIT which in turn is determined by the rate of plasma iron clearance by the placenta and the maternal erythroid marrow.

Patterns of food iron absorption in iron-deficient white and indian subjects and in venesected haemochromatotic patients

The absorption of radioactive iron from a solution of ferrous ascorbate, and from a standard meal containing intrinsically labelled haemoglobin and wheat, was measured in 12 Indian housewives, 18 white hospital patients and 12 subjects with idiopathic haemochromatosis. Eight of the latter had been fully treated by multiple venesections, so that their serum ferritin concentrations were below 25 mug/1. Since the serum ferritin concentrations of the housewives and the hospital patients were comparable, their body iron stores were considered to be depleted to a similar degree. There were no significant differences between the absorptions of ferrous ascorbate or of the haem iron in the standard meal by each group, but the housewives and the hospital patients absorbed significantly less of the non-haem food iron. The mean non-haem food iron absorptions were 36.4%, 5.8% and 18.9% for the treated haemochromatotic subjects, the Indian housewives and the white hospital patients respectively. The discrepancies between the absorptions of the different forms of food iron were highlighted by calculating the ratios between them. The mean non-haem: haem food iron absorption ratio for the group of treated haemochromatotic subjects was 0.98, and for the Indian housewives only 0.18. The white hospital patients did not form a homogenous population: the ratios of the five males and three of the females were greater than 1.0, whereas those of the remaining 10 females were less than 0.5. The results of this study suggest that mal-absorption of non-haem iron from a meal containing bread, presumably due to a defect at the luminal level, may be an important factor in the pathogenesis of iron deficiency in some subjects. The abnormality appears to be particularly prevalent among Indian women living in Durban.

Studies on the fortification of cane sugar with iron and ascorbic acid

1. The feasibility of improving iron nutrition by fortifying cane sugar with Fe and ascorbic acid was studied. 2. It was found to be possible to add a number of Fe salts together with ascorbic acid to sugar without affecting its appearance or storage properties. 3. The absorption of Fe from fortified sugar eaten with maize-meal porridge or made into jam or biscuits was measured in ninety-four volunteer multiparous Indian women using the 59-Fe erythrocyte utlization method. 4. The absorption of Fe from sugar fortified with ascorbic acid and ferrous sulphate and eaten with maize-meal porridge was increased about twofold in the ratio, ascorbic acid:Fe was 10:1 by weight. If the ratio was increased to 20:2, Fe absorption was increased a further threefold. 5. Sugar fortified with soluble Fe salts, including FeSO4.7H2O, discoloured both tea and coffee; sugar fortified with ferric orthophosphate did not have this effect. 6. Fe from FePO4.H2O was poorly absorbed when added with sugar to maize-meal porridge, and also when added with adequate quantities of ascorbic acid. This form of Fe was absorbed much less well than was the intrinsic Fe present in the maize. 7. When sugar fortified with FePO4.H2O and ascorbic acid was added to maize-meal porridge before cooling or was made into jam there was a several-fold increase in the amount of Fe absorbed.