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Tomosugi N, Koshino Y, Ogawa C, Maeda K, Shimada N, Tomita K, Daimon S, Shikano T, Ryu K, Takatani T, Sakamoto K, Ueyama S, Nagasaku D, Nakamura M, Ra S, Nishimura M, Takagi C, Ishii Y, Kudo N, Takechi S, Ishizu T, Yanagawa T, Fukuda M, Nitta Y, Yamaoka T, Saito T, Imayoshi S, Omata M, Oshima J, Onozaki A, Ichihashi H, Matsushima Y, Takae H, Nakazawa R, Ikeda K, Tsuboi M, Konishi K, Kato S, Ooura M, Koyama M, Naganuma T, Ogi M, Katayama S, Okumura T, Kameda S, Shirai S. Oral Iron Absorption of Ferric Citrate Hydrate and Hepcidin-25 in Hemodialysis Patients: A Prospective, Multicenter, Observational Riona-Oral Iron Absorption Trial. Int J Mol Sci 2023; 24:13779. [PMID: 37762085 PMCID: PMC10531220 DOI: 10.3390/ijms241813779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 08/27/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Oral ferric citrate hydrate (FCH) is effective for iron deficiencies in hemodialysis patients; however, how iron balance in the body affects iron absorption in the intestinal tract remains unclear. This prospective observational study (Riona-Oral Iron Absorption Trial, R-OIAT, UMIN 000031406) was conducted at 42 hemodialysis centers in Japan, wherein 268 hemodialysis patients without inflammation were enrolled and treated with a fixed amount of FCH for 6 months. We assessed the predictive value of hepcidin-25 for iron absorption and iron shift between ferritin (FTN) and red blood cells (RBCs) following FCH therapy. Serum iron changes at 2 h (ΔFe2h) after FCH ingestion were evaluated as iron absorption. The primary outcome was the quantitative delineation of iron variables with respect to ΔFe2h, and the secondary outcome was the description of the predictors of the body's iron balance. Generalized estimating equations (GEEs) were used to identify the determinants of iron absorption during each phase of FCH treatment. ΔFe2h increased when hepcidin-25 and TSAT decreased (-0.459, -0.643 to -0.276, p = 0.000; -0.648, -1.099 to -0.197, p = 0.005, respectively) in GEEs. FTN increased when RBCs decreased (-1.392, -1.749 to -1.035, p = 0.000) and hepcidin-25 increased (0.297, 0.239 to 0.355, p = 0.000). Limiting erythropoiesis to maintain hemoglobin levels induces RBC reduction in hemodialysis patients, resulting in increased hepcidin-25 and FTN levels. Hepcidin-25 production may prompt an iron shift from RBC iron to FTN iron, inhibiting iron absorption even with continued FCH intake.
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Affiliation(s)
- Naohisa Tomosugi
- Division of Systems Bioscience for Drug Discovery, Project Research Center, Medical Research Institute, Kanazawa Medical University, Kahoku 920-0293, Ishikawa, Japan
| | | | - Chie Ogawa
- Maeda Institute of Renal Research Musashikosugi, Kawasaki 211-0063, Kanagawa, Japan;
| | - Kunimi Maeda
- Maeda Institute of Renal Research Shakujii, Nerima 177-0041, Tokyo, Japan;
| | | | - Kimio Tomita
- The Chronic Kidney Disease Research Center, Tomei Atsugi General Hospital, Atsugi 243-8571, Kanagawa, Japan;
| | - Shoichiro Daimon
- Department of Nephrology, Daimon Clinic for Internal Medicine, Nonoichi 921-8802, Ishikawa, Japan;
| | - Tsutomu Shikano
- Kyoto Okamoto Memorial Hospital, Kuze 613-0034, Kyoto, Japan; (T.S.); (K.R.)
| | - Kazuyuki Ryu
- Kyoto Okamoto Memorial Hospital, Kuze 613-0034, Kyoto, Japan; (T.S.); (K.R.)
| | - Toru Takatani
- Nephrology Division, Tojinkai Hospital, Fushimi 612-8026, Kyoto, Japan;
| | - Kazuya Sakamoto
- Department of Urology, Tomakomai Nisshou Hospital, Tomakomai 053-0803, Hokkaido, Japan;
| | - Satonori Ueyama
- Jinaikai Ueyama Hospital, Kagoshima 890-0073, Kagoshima, Japan;
| | | | | | - Shibun Ra
- Noheji Clinic, Noheji 039-3152, Aomori, Japan;
| | | | | | - Yoji Ishii
- Nozatomon Clinic, Himeji 670-0011, Hyogo, Japan;
| | | | | | - Takashi Ishizu
- Department of Nephrology, Tsukuba Central Hospital, Ushiku 300-1211, Ibaraki, Japan; (T.I.); (T.Y.)
| | - Takamoto Yanagawa
- Department of Nephrology, Tsukuba Central Hospital, Ushiku 300-1211, Ibaraki, Japan; (T.I.); (T.Y.)
| | | | - Yutaka Nitta
- The Department of Nephrology, Saiseikai Shimonoseki General Hospital, Shimonoseki 759-6603, Yamaguchi, Japan; (Y.N.); (T.Y.)
| | - Takayuki Yamaoka
- The Department of Nephrology, Saiseikai Shimonoseki General Hospital, Shimonoseki 759-6603, Yamaguchi, Japan; (Y.N.); (T.Y.)
| | - Taku Saito
- Saito Memorial Hospital, Kawaguchi 332-0034, Saitama, Japan; (T.S.); (S.I.)
| | - Suzuko Imayoshi
- Saito Memorial Hospital, Kawaguchi 332-0034, Saitama, Japan; (T.S.); (S.I.)
| | - Momoyo Omata
- Department of Internal Medicine, Hachioji Azumacho Clinic, Hachioji-shi 192-0082, Tokyo, Japan;
| | - Joji Oshima
- Kubojima Clinic, Kumagaya 360-0831, Saitama, Japan;
| | - Akira Onozaki
- Tokatsu-Clinic Hospital, Matsudo 271-0067, Chiba, Japan;
| | | | | | | | | | - Koichi Ikeda
- Tokatsu Clinic Koiwa, Edogawa 133-0056, Tokyo, Japan;
| | - Masato Tsuboi
- Kaikoukai Anjo Kyoritsu Clinic, Anjo 446-0065, Aichi, Japan;
| | | | - Shouzaburo Kato
- Nishi Interchange Clinic for Internal Medicine and Dialysis, Kanazawa 921-8001, Ishikawa, Japan;
| | - Maki Ooura
- Maro Clinic, Tanabe 646-0004, Wakayama, Japan;
| | | | - Tsukasa Naganuma
- Department of Nephrology, Yamanashi Prefectural Central Hospital, Kofu 400-0027, Yamanashi, Japan;
| | - Makoto Ogi
- Department of Internal Medicine, Yuurinkouseikai Fuji Hospital, Gotemba 412-0043, Shizuoka, Japan;
| | | | | | - Shigemi Kameda
- Joetsu General Hospital, Joetsu 943-8507, Niigata, Japan;
| | - Sayuri Shirai
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University Yokohama Seibu Hospital, Yokohama 241-0811, Kanagawa, Japan;
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Pagliosa CM, Vieira FGK, Dias BV, Brognoli Franco VK, Ramos HP, da Silva EL. Ilex paraguariensis (A. St.-Hil.) leaf infusion decreases iron absorption in patients with hereditary hemochromatosis: a randomized controlled crossover study. Food Funct 2021; 12:7321-7328. [PMID: 34173816 DOI: 10.1039/d1fo00482d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This study proposed to investigate the effect of Ilex paraguariensis infusion on the absorption of non-heme iron in hereditary hemochromatosis (HH) patients with the HFE genotype. A two-way randomized, controlled, crossover trial was conducted on patients, aged 29-69 years, undergoing maintenance therapy. Fourteen HFE-HH patients ingested a meal containing 11.4 mg iron and 200 mL either of water (control) or of Ilex paraguariensis leaf infusion. The beverages were offered in random order, at intervals separated by a washout period of 7 days. Active surveillance showed no adverse effects. Blood samples were drawn shortly before and 1, 2, 3, and 4 h after the meal for serum iron measurement. A significant reduction in the postprandial serum iron was observed for HH patients after intake of the Ilex paraguariensis infusion (area under the curve (AUC) expressed as mean ± SEM: 173.3 ± 44.7 μmol h-1 L-1) compared to water (1449.4 ± 241.5 μmol h-1 L-1) (p < 0.001). In summary, intake of Ilex paraguariensis leaf infusion significantly inhibited the absorption of iron in patients with HH and, therefore, should be considered as a potential adjuvant for iron overload control.
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Affiliation(s)
- Cristiane Manfé Pagliosa
- Post-graduate Program in Nutrition, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Brazil.
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Delimont NM, Nickel S. Salivary cystatin SN is a factor predicting iron bioavailability after phytic acid rich meals in female participants. Int J Food Sci Nutr 2020; 72:559-568. [PMID: 33179561 DOI: 10.1080/09637486.2020.1846164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Phytic acid is an inhibitor of iron bioavailability, but it has been suggested that individuals may adapt to phytic acid over time, and that the salivary protein, cystatin SN, may be involved. This study evaluated the relationship between human cystatin SN levels and iron bioavailability after a phytic acid rich meal. Three groups of ten women consumed meals with: (1) 500 mg phytate sprinkles, (2) 500 mg phytate capsules, or (3) no phytic acid. Iron bioavailability was measured by the mealtime percentage of maximum iron recovery; cystatin SN was measured pre-and post-meal by enzyme-linked immunosorbent assay. Pre-to-post meal cystatin SN was positively correlated with improved iron bioavailability in group 1. Pre-to-post meal cystatin SN was correlated with improved iron absorption in groups 1 and 2. Cystatin SN recovery after phytic acid rich meals may be a physiological factor predicting iron bioavailability.
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Affiliation(s)
| | - Sarah Nickel
- Department of Medical Laboratory Sciences, Wichita State University, Wichita, KS, USA
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Delimont N, Nickel S. Food Pattern Modeling as an Alternative Assessment Method to Multiday Dietary Recalls for Iron-Related Nutrients: A Proof-of-Concept Study. Nutrients 2020; 12:E1911. [PMID: 32605218 PMCID: PMC7401284 DOI: 10.3390/nu12071911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 12/03/2022] Open
Abstract
There are barriers to in-depth memory-based dietary assessment techniques in community-based research. Food pattern modeling may be an alternative method to traditional assessment techniques. The objective of this study was to pilot a comparison of food pattern modeling to 24 h diet recalls for predicting hematological outcomes of iron status. Data from 3-24 h dietary recalls in 27 women were analyzed by two methods: mean dietary intake estimates or food pattern modeling. Food pattern modeling was used to determine the total inventory of foods consumed with iron, phytate, or ascorbic acid or iron-phytate ratios. Each variable was analyzed for its relationship to hemoglobin, ferritin, and acute iron absorption from a meal challenge study by creating receiver operating characteristic (ROC) curves. There were no differences in ROC curves or diagnostic accuracies between food pattern modeling or mean dietary intake estimates for iron, vitamin C, phytate, or phytate-iron ratios for estimating hemoglobin or ferritin values (p > 0.05). Food pattern modeling was inferior to mean dietary estimates for acute iron absorption, suggesting that more detailed methods may be necessary for studies with sensitive or acute dietary measurement outcomes. Food pattern modeling for total iron, vitamin C, phytate, and phytate-iron ratios may be comparable to detailed memory-based recalls for larger studies assessing the impact of foods on iron status.
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Affiliation(s)
- Nicole Delimont
- School of Nursing, Wichita State University, Wichita KS 67260, USA
| | - Sarah Nickel
- Department of Medical Laboratory Sciences, Wichita State University, Wichita, KS 67260, USA;
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Sang-Ngoen D, Hutchinson C, Satheannoppakao W, Tipayamongkholgul M. Dietary Iron Intake and Availability in Hill Tribe and Urban Women, Chiang Rai Province, Northern Thailand. Ecol Food Nutr 2020; 59:399-419. [PMID: 32129676 DOI: 10.1080/03670244.2020.1737041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Data were collected as part of a cross-sectional study. The objectives were to compare dietary intakes of iron and enhancers and inhibitors of non-heme iron absorption in hill tribe and urban women of Chiang Rai province, northern Thailand, and compare iron- and vitamin C- containing foods sold in markets in both settings. Dietary data were collected using three 24- hour recalls from 128 women aged 19-50 years (hill tribe: n = 65; urban n = 63), and proportions of low-, medium- and high-iron/vitamin C containing foods were surveyed in local markets. Hill tribe women consumed less iron, animal protein, vitamin C and calcium, but market availability of iron/vitamin C foods was similar. Future interventions should focus on food choice modification, to improve intakes of iron and foods that enhance its absorption, especially among hill tribe women.
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Affiliation(s)
- Doungtawan Sang-Ngoen
- Department of Nutrition, Faculty of Public Health, Mahidol University , Bangkok, Thailand
| | - Carol Hutchinson
- Department of Nutrition, Faculty of Public Health, Mahidol University , Bangkok, Thailand
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Bries AE, Wang C, Agbemafle I, Wels B, Reddy MB. Assessment of Acute Serum Iron, Non-Transferrin-Bound Iron, and Gastrointestinal Symptoms with 3-Week Consumption of Iron-Enriched Aspergillus oryzae Compared with Ferrous Sulfate. Curr Dev Nutr 2019; 3:nzz127. [PMID: 32154497 PMCID: PMC7053575 DOI: 10.1093/cdn/nzz127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/23/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Iron deficiency anemia (IDA) is a widespread nutritional deficiency, and iron supplementation, especially with ferrous sulfate (FeSO4), is the most common strategy to treat IDA; however, compliance is often poor with daily FeSO4 owing to negative side effects. In a previous study, iron from iron-enriched Aspergillus oryzae [Ultimine® Koji Iron (ULT)] was absorbed similarly to FeSO4. OBJECTIVES The main objective of this study was to assess the safety of consuming ULT in terms of increasing non-transferrin-bound iron (NTBI) and gastrointestinal distress. METHODS Young female participants (n = 16) with serum ferritin <40 μg/L were randomly assigned to a double-blind, 9-wk crossover study with a 3-wk placebo/washout period between treatments. Oral FeSO 4 and ULT supplements containing 65 mg Fe were administered daily for 21 consecutive days. On day 1, serum iron (SI), percentage transferrin saturation (%TS), and NTBI were measured for 8 h on the first day of iron consumption. Changes in biochemical indicators were evaluated after 3 wk consumption. Side effects questionnaires were completed weekly on 2 randomly selected weekdays and 1 weekend day for the entire study. RESULTS SI, %TS, and NTBI were all markedly higher during hours 2-8 (P < 0.001) with FeSO4 than with ULT. Oxidative stress, inflammatory, and kidney and liver function markers remained unchanged with both supplementations compared with placebo. Changes in iron status markers were not significantly different among the 3 treatments. Individual or global side effects were not significantly different among all treatments. Even when common side effects of nausea, constipation, and diarrhea were combined, FeSO4 treatment had a significantly higher effect than ULT (P = 0.04) and placebo (P = 0.004) only at week 3, but the difference was not significant between ULT and placebo. CONCLUSIONS Low NTBI production and fewer common gastrointestinal side effects with ULT suggest that it is a safe oral iron supplement to treat IDA. This trial was registered at clinicaltrials.gov as NCT04018300.
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Affiliation(s)
- Amanda E Bries
- Department of Food Sciences and Human Nutrition, Iowa State University, Ames, IA, USA
| | - Chong Wang
- Department of Statistics, Iowa State University, Ames, IA, USA
| | - Isaac Agbemafle
- Department of Food Sciences and Human Nutrition, Iowa State University, Ames, IA, USA
| | - Brian Wels
- State Hygienic Laboratory, University of Iowa, Ankeny, IA, USA
| | - Manju B Reddy
- Department of Food Sciences and Human Nutrition, Iowa State University, Ames, IA, USA
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Niknezhad SV, Najafpour Darzi G, Kianpour S, Jafarzadeh S, Mohammadi H, Ghasemi Y, Heidari R, Shahbazi MA. Bacteria-assisted biogreen synthesis of radical scavenging exopolysaccharide-iron complexes: an oral nano-sized nutritional supplement with high in vivo compatibility. J Mater Chem B 2019; 7:5211-5221. [PMID: 31364687 DOI: 10.1039/c9tb01077g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Microbial exopolysaccharides (EPSs) have recently served as an efficient substrate for the production of biocompatible metal nanoparticles (NPs) given their favorable stabilizing and reducing properties due to the presence of polyanionic functional groups in their structure. In the present work, Pantoea sp. BCCS 001 GH was used to produce EPS-stabilized biogenic Fe NPs as a complex through a novel biosynthesis reaction. Physicochemical characterization of the EPS-Fe complex was performed, indicating high thermal stability, desirable magnetic properties due to the uniform distribution of the Fe NPs with the average size of ∼10 nm and spherical shape within the EPS matrix. In addition, the in vivo toxicity of the EPS-stabilized Fe NPs was evaluated to investigate their potential for the treatment of iron deficiency anemia. Biological blood parameters and organ histology studies confirmed very high safety of the biosynthesized composite, making EPS-Fe a suitable candidate with an economical and environment friendly synthesis method for a wide spectrum of potential fields in medicine.
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Affiliation(s)
- Seyyed Vahid Niknezhad
- Department of Chemical Engineering, Faculty of Engineering, Noshirvani University of Technology, Babol, Iran and Pharmaceutical Sciences Research Centre, Shiraz University of Medical Sciences, P.O. Box 71345-1583, Shiraz, Iran
| | - Ghasem Najafpour Darzi
- Department of Chemical Engineering, Faculty of Engineering, Noshirvani University of Technology, Babol, Iran
| | - Sedigheh Kianpour
- Pharmaceutical Sciences Research Centre, Shiraz University of Medical Sciences, P.O. Box 71345-1583, Shiraz, Iran
| | - Sina Jafarzadeh
- Department of Chemical and Petroleum Engineering, Sharif University of Technology, P.O. Box 11365-11155, Tehran, Iran
| | - Hamidreza Mohammadi
- Pharmaceutical Sciences Research Centre, Shiraz University of Medical Sciences, P.O. Box 71345-1583, Shiraz, Iran
| | - Younes Ghasemi
- Pharmaceutical Sciences Research Centre, Shiraz University of Medical Sciences, P.O. Box 71345-1583, Shiraz, Iran and Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, P.O. Box 71345-1583, Shiraz, Iran
| | - Reza Heidari
- Pharmaceutical Sciences Research Centre, Shiraz University of Medical Sciences, P.O. Box 71345-1583, Shiraz, Iran
| | - Mohammad-Ali Shahbazi
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki FI-00014, Finland. and Department of Pharmaceutical Nanotechnology, School of Pharmacy, Zanjan University of Medical Sciences, 45139-56184, Zanjan, Iran
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Delimont NM, Katz BB, Fiorentino NM, Kimmel KA, Haub MD, Rosenkranz SK, Tomich JM, Lindshield BL. Salivary Cystatin SN Binds to Phytic Acid In Vitro and Is a Predictor of Nonheme Iron Bioavailability with Phytic Acid Supplementation in a Proof of Concept Pilot Study. Curr Dev Nutr 2019; 3:nzz057. [PMID: 31218272 PMCID: PMC6571437 DOI: 10.1093/cdn/nzz057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/18/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Acute phytic acid intake has been found to decrease iron bioavailability; however, repeated phytic acid consumption leads to iron absorption adaptation. Salivary proline-rich proteins (PRPs) have been shown to inhibit iron chelation to tannins and may mediate similar iron absorption adaptation with phytic acid intake. OBJECTIVES The objectives of this study were to determine whether salivary proteins bind to phytic acid in vitro, and to explore a proof of concept in a pilot study that examined the impact of 4-wk, daily phytic acid supplementation on individuals' iron status, bioavailability, and salivary PRP concentrations. METHODS High-performance liquid chromatography (HPLC) and matrix-assisted laser desorption/ionization-time of flight were used to characterize in vitro salivary protein-phytic acid interactions. Nonanemic women (n = 7) consumed 350 mg phytic acid supplements 3 times daily for 4 wk, and meal challenges were employed to determine iron bioavailability, iron status, and salivary protein concentrations before and after supplementation periods. Enzyme-linked immunosorbent assay (ELISA) analysis of purified protein fractions and participant saliva identified proteins bound to phytic acid. RESULTS In vitro salivary protein-phytic acid interaction identified cystatin SN, a non-proline rich salivary protein, as the specific bound protein to phytic acid. Iron bioavailability (P = 0.32), hemoglobin (P = 0.72), and serum ferritin (P = 0.08) concentrations were not reduced from week 0 to week 4 after phytic acid supplementation. Basic PRPs and cystatin SN concentrations were positively correlated with iron bioavailability at week 4. CONCLUSIONS Overall, results suggest that phytic acid binds to the non-PRP cystatin SN and that salivary protein production may improve iron bioavailability with phytic acid consumption.
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Affiliation(s)
- Nicole M Delimont
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, Manhattan, KS, USA
| | - Benjamin B Katz
- Biotechnology and Proteomics Core Lab, Kansas State University, Manhattan, KS, USA
| | - Nicole M Fiorentino
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, Manhattan, KS, USA
| | - Katheryne A Kimmel
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, Manhattan, KS, USA
| | - Mark D Haub
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, Manhattan, KS, USA
| | - Sara K Rosenkranz
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, Manhattan, KS, USA
| | - John M Tomich
- Biotechnology and Proteomics Core Lab, Kansas State University, Manhattan, KS, USA
| | - Brian L Lindshield
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, Manhattan, KS, USA
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Ginanjar E, Indrawati L, Setianingsih I, Atmakusumah D, Harahap A, Timan IS, Marx JJM. Iron Absorption in Iron-Deficient Women, Who Received 65 mg Fe with an Indonesian Breakfast, Is Much Better from NaFe(III)EDTA than from Fe(II)SO₄, with an Acceptable Increase of Plasma NTBI. A Randomized Clinical Trial. Pharmaceuticals (Basel) 2018; 11:ph11030085. [PMID: 30201907 PMCID: PMC6161297 DOI: 10.3390/ph11030085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/04/2018] [Accepted: 09/07/2018] [Indexed: 12/14/2022] Open
Abstract
Plasma non-transferrin-bound iron (NTBI) is potentially harmful due to the generation of free radicals that cause tissue damage in vascular and other diseases. Studies in iron-replete and iron-deficient subjects, receiving a single oral test dose of Fe(II)SO4 or NaFe(III)EDTA with water, revealed that FeSO4 was well absorbed when compared with NaFeEDTA, while only the Fe(II) compound showed a remarkable increase of NTBI. As NaFeEDTA is successfully used for food fortification, a double-blind randomized cross-over trial was conducted in 11 healthy women with uncomplicated iron deficiency. All subjects received a placebo, 6.5 mg FeSO4, 65 mg FeSO4, 6.5 mg NaFeEDTA, and 65 mg NaFeEDTA with a traditional Indonesian breakfast in one-week intervals. Blood tests were carried out every 60 min for five hours. NTBI detection was performed using the fluorescein-labeled apotransferrin method. Plasma iron values were highly increased after 65 mg NaFeEDTA, twice as high as after FeSO4. A similar pattern was seen for NTBI. After 6.5 mg of NaFeEDTA and FeSO4, NTBI was hardly detectable. NaFeEDTA was highly effective for the treatment of iron deficiency if given with a meal, inhibiting the formation of nonabsorbable Fe-complexes, while NTBI did not exceed the range of normal values for iron-replete subjects.
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Affiliation(s)
- Eka Ginanjar
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia.
| | - Lilik Indrawati
- Department of Clinical Pathology, Faculty of Medicine, University of Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia.
| | | | - Djumhana Atmakusumah
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia.
| | - Alida Harahap
- Eijkman Institute for Molecular Biology, Jakarta 10430, Indonesia.
| | - Ina S Timan
- Department of Clinical Pathology, Faculty of Medicine, University of Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia.
| | - Joannes J M Marx
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands.
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10
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Reddy MB, Armah SM, Stewart JW, O'Brien KO. Iron Absorption from Iron-Enriched Aspergillus oryzae Is Similar to Ferrous Sulfate in Healthy Female Subjects. Curr Dev Nutr 2018; 2:nzy004. [PMID: 30019027 PMCID: PMC6041945 DOI: 10.1093/cdn/nzy004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/26/2017] [Accepted: 01/11/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Iron deficiency anemia (IDA) remains a global health issue, affecting mainly children and adolescent and pregnant women. Because of problems associated with current iron compounds used in both supplementation and fortification areas, there is an emerging interest in new natural iron sources to combat IDA. OBJECTIVE The objective of this study was to compare the iron absorption of iron-enriched Aspergillus oryzae [Aspiron (ASP)] with FeSO4 in humans. METHODS Iron absorption was assessed using stable isotope and serum iron response methods after oral intake of iron by healthy women in 2 separate studies. In the first study, ASP was intrinsically labelled with 58Fe into a dry form containing 8% iron. Subjects (n = 16, 18-35 y) were randomly assigned to consume liquid semipurified meals labelled with 2 stable iron isotopes, 57FeSO4 (10 mg) and ASP containing 2 mg 58Fe and 8 mg natural abundance iron, in 2 visits. Isotope enrichment was measured 2 wk after the last meal was eaten. In the second study, 17 subjects were randomly assigned to consume a test meal with 3 iron supplements during 3 separate visits: FeSO4, 10 mg Fe, and ASP in 2 iron doses, 10 mg and 20 mg. Changes in serum iron were measured at regular intervals for 4 h after supplementation. RESULTS The first study showed that the difference in iron absorption from FeSO4 and ASP was not significant (17.18% ± 14.2% compared to 15.14% ± 12.3%; P = 0.07). The results of the second study suggested that the iron from ASP was released slowly compared to FeSO4 and the area under the curve did not reflect the absorption of ASP iron, but rather the rate of iron release. CONCLUSIONS Iron-enriched A. oryzae has high relative bioavailability and may cause lower iron surges into the blood compared to FeSO4.
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Affiliation(s)
- Manju B Reddy
- Department of Food Sciences and Human Nutrition, Iowa State University, Ames, IA
| | - Seth M Armah
- Department of Food Sciences and Human Nutrition, Iowa State University, Ames, IA
| | - Jeanne W Stewart
- Department of Food Sciences and Human Nutrition, Iowa State University, Ames, IA
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K N L, Venkataranganna M, Gowtham Raj G, Patil H, Dave H. Augmentation of antioxidant and iron(III) chelation properties of tertiary mixture of bioactive ligands. J Trace Elem Med Biol 2018; 45:114-124. [PMID: 29173467 DOI: 10.1016/j.jtemb.2017.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/22/2017] [Accepted: 10/05/2017] [Indexed: 01/08/2023]
Abstract
The excess of iron in plasma and cellular compartment pose direct and indirect toxic effects. In the present investigation, we proposed additive function of nutritional bioactive ligands in combination which has shown enhanced antioxidant and iron(III) chelation property. The optimal interaction and in vitro antioxidant activity of tertiary mixture comprising of curcumin+quercetin+gallic acid was validated by central composite design (CCD) based on ferric reducing antioxidant power assay (FRAP). The additive denticity of nutritional bioactive ligands was investigated by UV-vis, FTIR & MALDI-TOF-MS analysis, which has given substantial evidence for the formation of tris-bidentate [curcumin-quercetin-gallic acid-Fe(III)] co-ordination complex. The in vivo proof of concept of the hypothesis was tested in iron intoxicated male wistar rats intoxicated with iron dextran. Co-administration curcumin+quercetin+gallic acid (CQG) exhibit dose dependent response & found effective in subsiding acute iron intoxication both at plasma and cellular level, evaluated by studies including serum ferritin, ICP-OES, lipid peroxidation and histopathology studies among others. Thus, we conclude that in vitro and in vivo studies supported our hypothesis to deduce additive function nutritional ligands to counteract direct and indirect effects of iron(III).
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Affiliation(s)
- Lokesh K N
- Ramaiah Institute of Technology, Bangaluru, 560054, Karnataka, India; Visvesvaraya Technological University, Belgavi, 590018, Karnataka, India.
| | | | - Gunti Gowtham Raj
- Connexios Life Sciences Pvt Ltd, Bangaluru, 560078, Karnataka, India
| | - Hansraj Patil
- Connexios Life Sciences Pvt Ltd, Bangaluru, 560078, Karnataka, India
| | - Hardik Dave
- Connexios Life Sciences Pvt Ltd, Bangaluru, 560078, Karnataka, India
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Delimont NM, Fiorentino NM, Kimmel KA, Haub MD, Rosenkranz SK, Lindshield BL. Long-Term Dose-Response Condensed Tannin Supplementation Does Not Affect Iron Status or Bioavailability. Curr Dev Nutr 2017; 1:e001081. [PMID: 29955679 PMCID: PMC5998780 DOI: 10.3945/cdn.117.001081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/24/2017] [Accepted: 09/10/2017] [Indexed: 01/05/2023] Open
Abstract
Background: Repeated phytic acid consumption leads to iron absorption adaptation but, to the best of our knowledge, the impact of repeated tannin consumption has not yet been established. Salivary proline-rich proteins (PRPs) may improve iron absorption by precipitating tannins. Objectives: This study aimed to determine the effect of long-term, dose-response condensed tannin supplementation on iron bioavailability and status and to assess the effect of salivary proteins on iron bioavailability during prolonged condensed tannin consumption. A secondary objective was to assess astringency as a potential marker for adaptation to tannins and iron bioavailability. Methods: Eleven nonanemic women were enrolled in a double-blind 3-dose crossover trial. Three (1.5, 0.25, or 0.03 g) condensed tannin supplements were consumed 3 times/d for 4 wk in random order, with 2-wk washouts in between. Meal challenges were employed before and after supplementation to assess iron bioavailability, iron status, salivary PRP changes, and astringency. Results: Tannin supplementation in any dose did not change iron bioavailability at any dose (P > 0.82) from weeks 0 to 4. Hemoglobin (P = 0.126) and serum ferritin (P = 0.83) were unchanged by tannin dose from weeks 0 to 4. There were significant correlations among tannin supplementation and iron bioavailability, basic proline-rich proteins (bPRPs) (r = 0.366, P = 0.003), and cystatin production (r = 0.27, P = 0.03). Astringency ratings did not change significantly within or between tannin doses (P > 0.126), but there were negative relations among bPRP (r < -0.32, P < 0.21), cystatin production (r < -0.2, P < 0.28), and astringency ratings. Conclusions: Condensed tannin consumption did not affect iron bioavailability or status regardless of the supplementation period in premenopausal nonanemic women. Correlation analyses suggest that bPRPs and cystatins are associated with improved iron bioavailability and that lower ratings of astringency may predict improved iron absorption with repeated tannin consumption.
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Affiliation(s)
- Nicole M Delimont
- Department of Food, Nutrition, Dietetics, and Health, Kansas State University, Manhattan, KS
| | - Nicole M Fiorentino
- Department of Food, Nutrition, Dietetics, and Health, Kansas State University, Manhattan, KS
| | - Katheryne A Kimmel
- Department of Food, Nutrition, Dietetics, and Health, Kansas State University, Manhattan, KS
| | - Mark D Haub
- Department of Food, Nutrition, Dietetics, and Health, Kansas State University, Manhattan, KS
| | - Sara K Rosenkranz
- Department of Food, Nutrition, Dietetics, and Health, Kansas State University, Manhattan, KS
| | - Brian L Lindshield
- Department of Food, Nutrition, Dietetics, and Health, Kansas State University, Manhattan, KS
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Bohn T, Carriere F, Day L, Deglaire A, Egger L, Freitas D, Golding M, Le Feunteun S, Macierzanka A, Menard O, Miralles B, Moscovici A, Portmann R, Recio I, Rémond D, Santé-Lhoutelier V, Wooster TJ, Lesmes U, Mackie AR, Dupont D. Correlation between in vitro and in vivo data on food digestion. What can we predict with static in vitro digestion models? Crit Rev Food Sci Nutr 2017; 58:2239-2261. [DOI: 10.1080/10408398.2017.1315362] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- T. Bohn
- Luxembourg Institute of Health, Strassen, Luxembourg
| | | | - L. Day
- Agresearch, Palmerston North, New Zealand
| | | | - L. Egger
- Agroscope, Institute for Food Sciences, Bern, Switzerland
| | | | - M. Golding
- Massey University, Palmerston North, New Zealand
| | | | | | | | | | - A. Moscovici
- Technion—Israel Institute of Technology, Haifa, Israel
| | - R. Portmann
- Agroscope, Institute for Food Sciences, Bern, Switzerland
| | | | | | | | - T. J. Wooster
- Nestlé Research Centre, Nestec S.A., Lausanne, Switzerland
| | - U. Lesmes
- Technion—Israel Institute of Technology, Haifa, Israel
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A review of iron studies in overweight and obese children and adolescents: a double burden in the young? Eur J Nutr 2016; 55:2179-97. [PMID: 26883916 DOI: 10.1007/s00394-016-1155-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 01/06/2016] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The connection between iron and excessive adiposity has received much research interest. Although children and adolescents have unique developmental phases and nutritional demands, to date, reviews of iron in the overweight (OW) and obese (OB) have combined studies of children and adults or have focussed on adults. PURPOSE The aim of this review was to critically evaluate studies of the relationship between iron and OW and obesity in children and adolescents, with emphasis on iron status, oral iron response, dietary intake and systemic inflammatory markers. METHODS A PubMed search was conducted to identify relevant articles published up to December 2015. Combinations of the following keywords were used: iron, OW, OB, children, adolescents, diet, hepcidin, inflammation, fortification, supplementation, weight loss, trace elements, obesity, iron deficiency (ID), minerals. RESULTS AND CONCLUSION A higher prevalence of ID, or risk of ID, among OW and OB children and adolescents has been consistently observed. Chronic inflammation caused by excessive adiposity offers a plausible explanation for this finding, rather than dietary factors. However, future studies must employ screening for the presence of both acute and chronic infections and inflammatory conditions and report other factors such as pubertal status. Intervention studies, although few, indicate that OW and OB children and adolescents have reduced response to oral iron. Further trials are needed to explore the connection between body fat mass, inflammatory proteins and iron absorption, together with the effect of weight loss on iron status in iron-deficient OW and OB children and adolescents.
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Armah SM, Boy E, Chen D, Candal P, Reddy MB. Regular Consumption of a High-Phytate Diet Reduces the Inhibitory Effect of Phytate on Nonheme-Iron Absorption in Women with Suboptimal Iron Stores. J Nutr 2015; 145:1735-9. [PMID: 26041677 DOI: 10.3945/jn.114.209957] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/15/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND High phytate (HP) consumption is a concern in developing countries because of the high prevalence of iron deficiency in these countries. OBJECTIVE We investigated whether habitual consumption of an HP diet reduces the inhibitory effect of phytate on nonheme-iron absorption. METHODS Thirty-two nonanemic females, 18-35 y of age, with normal body mass index but with suboptimal iron stores (serum ferritin, ≤30 μg/L), were matched for serum ferritin concentration and randomly assigned to HP and low-phytate (LP) groups, in a parallel design study. Each subject consumed HP or LP foods with at least 2 of their daily meals for 8 wk, resulting in a change in phytate intake (from 718 to 1190 mg/d in the HP group and 623 to 385 mg/d in the LP group). The serum iron response over 4 h after a test meal containing 350 mg of phytate was measured at baseline and postintervention. Ferritin, transferrin receptor, and hepcidin concentrations were measured at baseline and 8 wk. RESULTS Twenty-eight subjects completed the study (n = 14 per group). The serum iron response to the test meal increased in the HP group at postintervention, resulting in a 41% increase in the area under the curve (AUC; P < 0.0001). However, no effect was observed in the LP group (21% decrease in AUC; P = 0.76). The postintervention serum iron response was lower (P < 0.0001) in the LP group than in the HP group after controlling for the baseline serum iron response and hepcidin concentration, reflecting in a 64% lower AUC. CONCLUSIONS We found that habitual consumption of an HP diet can reduce the negative effect of phytate on nonheme-iron absorption among young women with suboptimal iron stores. Future studies are needed to explore possible mechanisms. This trial was registered at clinicaltrials.gov as NCT02370940.
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Affiliation(s)
- Seth M Armah
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA; and
| | - Erick Boy
- HarvestPlus/International Food Policy Research Institute, Washington, DC
| | - Dan Chen
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA; and
| | - Priscila Candal
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA; and
| | - Manju B Reddy
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA; and
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Wawer AA, Harvey LJ, Dainty JR, Perez-Moral N, Sharp P, Fairweather-Tait SJ. Alginate inhibits iron absorption from ferrous gluconate in a randomized controlled trial and reduces iron uptake into Caco-2 cells. PLoS One 2014; 9:e112144. [PMID: 25391138 PMCID: PMC4229116 DOI: 10.1371/journal.pone.0112144] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 10/10/2014] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED Previous in vitro results indicated that alginate beads might be a useful vehicle for food iron fortification. A human study was undertaken to test the hypothesis that alginate enhances iron absorption. A randomised, single blinded, cross-over trial was carried out in which iron absorption was measured from serum iron appearance after a test meal. Overnight-fasted volunteers (n = 15) were given a test meal of 200 g cola-flavoured jelly plus 21 mg iron as ferrous gluconate, either in alginate beads mixed into the jelly or in a capsule. Iron absorption was lower from the alginate beads than from ferrous gluconate (8.5% and 12.6% respectively, p = 0.003). Sub-group B (n = 9) consumed the test meals together with 600 mg calcium to determine whether alginate modified the inhibitory effect of calcium. Calcium reduced iron absorption from ferrous gluconate by 51%, from 11.5% to 5.6% (p = 0.014), and from alginate beads by 37%, from 8.3% to 5.2% (p = 0.009). In vitro studies using Caco-2 cells were designed to explore the reasons for the difference between the previous in vitro findings and the human study; confirmed the inhibitory effect of alginate. Beads similar to those used in the human study were subjected to simulated gastrointestinal digestion, with and without cola jelly, and the digestate applied to Caco-2 cells. Both alginate and cola jelly significantly reduced iron uptake into the cells, by 34% (p = 0.009) and 35% (p = 0.003) respectively. The combination of cola jelly and calcium produced a very low ferritin response, 16.5% (p < 0.001) of that observed with ferrous gluconate alone. The results of these studies demonstrate that alginate beads are not a useful delivery system for soluble salts of iron for the purpose of food fortification. TRIAL REGISTRATION ClinicalTrials.gov NCT01528644.
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Affiliation(s)
- Anna A. Wawer
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Linda J. Harvey
- Institute of Food Research, Norwich, Norfolk, United Kingdom
| | - Jack R. Dainty
- Institute of Food Research, Norwich, Norfolk, United Kingdom
| | | | - Paul Sharp
- King's College London, London, United Kingdom
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Pereira DIA, Bruggraber SFA, Faria N, Poots LK, Tagmount MA, Aslam MF, Frazer DM, Vulpe CD, Anderson GJ, Powell JJ. Nanoparticulate iron(III) oxo-hydroxide delivers safe iron that is well absorbed and utilised in humans. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2014; 10:1877-86. [PMID: 24983890 PMCID: PMC4228177 DOI: 10.1016/j.nano.2014.06.012] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/18/2014] [Accepted: 06/19/2014] [Indexed: 12/14/2022]
Abstract
Iron deficiency is the most common nutritional disorder worldwide with substantial impact on health and economy. Current treatments predominantly rely on soluble iron which adversely affects the gastrointestinal tract. We have developed organic acid-modified Fe(III) oxo-hydroxide nanomaterials, here termed nano Fe(III), as alternative safe iron delivery agents. Nano Fe(III) absorption in humans correlated with serum iron increase (P < 0.0001) and direct in vitro cellular uptake (P = 0.001), but not with gastric solubility. The most promising preparation (iron hydroxide adipate tartrate: IHAT) showed ~80% relative bioavailability to Fe(II) sulfate in humans and, in a rodent model, IHAT was equivalent to Fe(II) sulfate at repleting haemoglobin. Furthermore, IHAT did not accumulate in the intestinal mucosa and, unlike Fe(II) sulfate, promoted a beneficial microbiota. In cellular models, IHAT was 14-fold less toxic than Fe(II) sulfate/ascorbate. Nano Fe(III) manifests minimal acute intestinal toxicity in cellular and murine models and shows efficacy at treating iron deficiency anaemia. FROM THE CLINICAL EDITOR This paper reports the development of novel nano-Fe(III) formulations, with the goal of achieving a magnitude less intestinal toxicity and excellent bioavailability in the treatment of iron deficiency anemia. Out of the tested preparations, iron hydroxide adipate tartrate met the above criteria, and may become an important tool in addressing this common condition.
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Affiliation(s)
- Dora I A Pereira
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom.
| | | | - Nuno Faria
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Lynsey K Poots
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Mani A Tagmount
- Department of Nutritional Science and Toxicology, University of California, Berkeley, CA, USA
| | - Mohamad F Aslam
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - David M Frazer
- Iron Metabolism Laboratory, QIMR Berghofer Medical Research Institute, PO Royal Brisbane Hospital, Brisbane, Australia
| | - Chris D Vulpe
- Department of Nutritional Science and Toxicology, University of California, Berkeley, CA, USA
| | - Gregory J Anderson
- Iron Metabolism Laboratory, QIMR Berghofer Medical Research Institute, PO Royal Brisbane Hospital, Brisbane, Australia
| | - Jonathan J Powell
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom
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Potential of phytase-mediated iron release from cereal-based foods: a quantitative view. Nutrients 2013; 5:3074-98. [PMID: 23917170 PMCID: PMC3775243 DOI: 10.3390/nu5083074] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 07/01/2013] [Accepted: 07/17/2013] [Indexed: 12/23/2022] Open
Abstract
The major part of iron present in plant foods such as cereals is largely unavailable for direct absorption in humans due to complexation with the negatively charged phosphate groups of phytate (myo-inositol (1,2,3,4,5,6)-hexakisphosphate). Human biology has not evolved an efficient mechanism to naturally release iron from iron phytate complexes. This narrative review will evaluate the quantitative significance of phytase-catalysed iron release from cereal foods. In vivo studies have shown how addition of microbially derived phytases to cereal-based foods has produced increased iron absorption via enzyme-catalysed dephosphorylation of phytate, indicating the potential of this strategy for preventing and treating iron deficiency anaemia. Despite the immense promise of this strategy and the prevalence of iron deficiency worldwide, the number of human studies elucidating the significance of phytase-mediated improvements in iron absorption and ultimately in iron status in particularly vulnerable groups is still low. A more detailed understanding of (1) the uptake mechanism for iron released from partially dephosphorylated phytate chelates, (2) the affinity of microbially derived phytases towards insoluble iron phytate complexes, and (3) the extent of phytate dephosphorylation required for iron release from inositol phosphates is warranted. Phytase-mediated iron release can improve iron absorption from plant foods. There is a need for development of innovative strategies to obtain better effects.
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Contreras C, Barnuevo MD, Guillén I, Luque A, Lázaro E, Espadaler J, López-Román J, Villegas JA. Comparative study of the oral absorption of microencapsulated ferric saccharate and ferrous sulfate in humans. Eur J Nutr 2013; 53:567-74. [PMID: 23892521 DOI: 10.1007/s00394-013-0565-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 07/15/2013] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Carlos Contreras
- Cátedra de Fisiología del Ejercicio, Departamento de Ciencias de la Salud, Universidad Católica San Antonio, Campus de los Jerónimos s/n, 30107, Guadalupe, Murcia, Spain
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Powell JJ, Cook WB, Hutchinson C, Tolkien Z, Chatfield M, Pereira DI, Lomer MC. Dietary fortificant iron intake is negatively associated with quality of life in patients with mildly active inflammatory bowel disease. Nutr Metab (Lond) 2013; 10:9. [PMID: 23320878 PMCID: PMC3568053 DOI: 10.1186/1743-7075-10-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 01/11/2013] [Indexed: 12/13/2022] Open
Abstract
Background Iron deficiency anaemia and oral iron supplementation have been associated negatively with quality of life, and with adverse effects, respectively, in subjects with inflammatory bowel disease (IBD). Hence, the risk-benefit ratio of oral iron is not understood in this patient group. The present case–control study investigated whether dietary iron intake impacts on quality of life in IBD patients. Methods Quality of life, habitual dietary iron intakes and iron requirements were assessed in 29 patients with inactive or mildly active IBD as well as in 28 healthy control subjects. Results As expected, quality of life was worse in IBD patients as a whole in comparison to healthy controls according to EuroQol score and EuroQol VAS percentage (6.9 ± 1.6 vs 5.3 ± 0.6; p< 0.0001 and 77 ± 14% vs 88 ± 12%; p=0.004 respectively). For IBD subjects, 21/29 were iron deplete based upon serum iron responses to oral iron but, overall, were non-anaemic with mean haemoglobin of 13.3 ± 1.5 g/dL, and there was no difference in their quality of life compared to 8/29 iron replete subjects (Hb 14.0 ± 0.8 g/dL). Interestingly, total dietary iron intake was significantly negatively associated with quality of life in IBD patients, specifically for non-haem iron and, more specifically, for fortificant iron. Moreover, for total non-haem iron the negative association disappeared when fortificant iron values were subtracted. Finally, further sub-analysis indicated that the negative association between (fortificant) dietary iron intake and quality of life in IBD patients is driven by findings in patients with mildly active disease rather than in patients with quiescent disease. Conclusions Iron deficiency per se (i.e. without concomitant anaemia) does not appear to further affect quality of life in IBD patients with inactive or mildly active disease. However, in this preliminary study, dietary iron intake, particularly fortificant iron, appears to be significantly negatively associated with quality of life in patients with mildly active disease.
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Affiliation(s)
- Jonathan J Powell
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK.
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Iron requirements based upon iron absorption tests are poorly predicted by haematological indices in patients with inactive inflammatory bowel disease. Br J Nutr 2011; 107:1806-11. [PMID: 22152498 DOI: 10.1017/s0007114511004971] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Fe deficiency and Fe-deficiency anaemia are common in patients with inflammatory bowel disease (IBD). Traditional clinical markers of Fe status can be skewed in the presence of inflammation, meaning that a patient's Fe status can be misinterpreted. Additionally, Fe absorption is known to be down-regulated in patients with active IBD. However, whether this is the case for quiescent or mildly active disease has not been formally assessed. The present study aimed to investigate the relationship between Fe absorption, Fe requirements and standard haematological indices in IBD patients without active disease. A group of twenty-nine patients with quiescent or mildly active IBD and twenty-eight control subjects undertook an Fe absorption test that measured sequential rises in serum Fe over 4 h following ingestion of 200 mg ferrous sulphate. At baseline, serum Fe, transferrin saturation, non-transferrin-bound Fe (NTBI), ferritin and soluble transferrin receptor were all measured. Thereafter (30-240 min), only serum Fe and NTBI were measured. Fe absorption did not differ between the two groups (P = 0·9; repeated-measures ANOVA). In control subjects, baseline haematological parameters predicted Fe absorption (i.e. Fe requirements), but this was not the case for patients with IBD. Fe absorption is normal in quiescent or mildly active IBD patients but standard haematological parameters do not accurately predict Fe requirements.
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Bokhari F, Derbyshire EJ, Hickling D, Li W, Brennan CS. A randomized trial investigating an iron-rich bread as a prophylaxis against iron deficiency in pregnancy. Int J Food Sci Nutr 2011; 63:461-7. [DOI: 10.3109/09637486.2011.634790] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Bokhari F, Derbyshire E, Li W, Brennan CS, Stojceska V. A study to establish whether food-based approaches can improve serum iron levels in child-bearing aged women. J Hum Nutr Diet 2011; 25:95-100. [PMID: 21749488 DOI: 10.1111/j.1365-277x.2011.01185.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Iron-deficiency anaemia is particularly prevalent in pregnancy. The present study aimed to determine whether functional bread containing teff flour (i.e. naturally rich in iron) could be an alternative way of improving iron status. However, before testing whether its consumption can improve pregnancy iron status, the bio-availability of iron was determined in a sample of nonpregnant women. METHODS Fifty-eight women (20-50 years) were recruited from the University. Blood samples were taken at baseline to assess iron status and participants were screened to account for other factors affecting iron status. Twenty-four participants (haemoglobin 9.5-14.0g dL(-1) ) were recruited to take part in the intervention and allocated to five groups: (i) control bread (CB); (ii) teff bread (TB); (iii) TB+level 1 phytase (TB+P1); (iv) TB+level 2 phytase (TB+P2); or (v) a supplement containing 10 mg of ferrous sulphate. Venous blood samples were taken before the intervention and after 180-210min, aiming to determine changes in serum iron. RESULTS Consuming three or four slices of TB provided statistically significantly more iron (7.6mg) than CB (5.1mg) (P<0.001). Because participants were fasted, serum iron levels declined in all bread groups (average -1.5μm), although the smallest reduction was observed in the TB+P2 group (-0.3 μm). The area-under-the-curve from baseline to 210min was lower in the TB+P2 (-78.8μmol min L(-1) ) group compared to the other bread interventions, indicating higher levels of iron absorption in this group. CONCLUSIONS The results obtained in the present study show that TB consumption may help to maintain serum iron levels, especially when phytase is added. The findings from the study also demonstrate there may be potential to further improve the bio-availability of iron from non-haem food sources.
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Affiliation(s)
- F Bokhari
- Department of Food and Tourism Management, Hollings Faculty, Manchester Metropolitan University, Manchester, UK
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Influences of sleep and the circadian rhythm on iron-status indices. Clin Biochem 2010; 43:1323-8. [DOI: 10.1016/j.clinbiochem.2010.08.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 08/16/2010] [Accepted: 08/18/2010] [Indexed: 11/17/2022]
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The iron-chelating potential of silybin in patients with hereditary haemochromatosis. Eur J Clin Nutr 2010; 64:1239-41. [PMID: 20628405 DOI: 10.1038/ejcn.2010.136] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Milk thistle contains silybin, which is a potential iron chelator. We aimed to determine whether silybin reduced iron absorption in patients with hereditary haemochromatosis. In this crossover study, on three separate occasions, 10 patients who were homozygous for the C282Y mutation in the HFE gene (and fully treated) consumed a vegetarian meal containing 13.9 mg iron with: 200 ml water; 200 ml water and 140 mg silybin (Legalon Forte); or 200 ml tea. Blood was drawn once before, then 0.5, 1, 2, 3 and 4 h after the meal. Consumption of silybin with a meal resulted in a reduction in the postprandial increase in serum iron (AUC±s.e.) compared with water (silybin 1726.6±346.8 versus water 2988.8±167; P<0.05) and tea (silybin 1726.6±346.8 versus tea 2099.3±223.3; P<0.05). In conclusion, silybin has the potential to reduce iron absorption, and this deserves further investigation, as silybin could be an adjunct in the treatment of haemochromatosis.
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Shivakumar H, Vaka SRK, Murthy SN. Albumin microspheres for oral delivery of iron. J Drug Target 2009; 18:36-44. [DOI: 10.3109/10611860903156393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zimmermann MB, Troesch B, Biebinger R, Egli I, Zeder C, Hurrell RF. Plasma hepcidin is a modest predictor of dietary iron bioavailability in humans, whereas oral iron loading, measured by stable-isotope appearance curves, increases plasma hepcidin. Am J Clin Nutr 2009; 90:1280-7. [PMID: 19740974 DOI: 10.3945/ajcn.2009.28129] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Plasma hepcidin appears to be a major regulator of iron absorption and homeostasis, but there are few data in humans. OBJECTIVES With the use of iron stable isotopes, we aimed to determine whether circulating hepcidin predicts dietary iron bioavailability, to quantify the amount of absorbed iron after oral iron loading, and to measure the plasma hepcidin response. DESIGN In the first study, young women (n = 98) with an iron status varying from iron deficiency anemia to iron sufficiency (women with serum ferritin concentrations 25-40 microg/L were not included) were given stable isotope-labeled test meals (n = 196) containing ferrous sulfate, ferrous fumarate, or ferric pyrophosphate, after which plasma hepcidin and iron bioavailability were measured. In the second study, iron-sufficient men (n = 4) were given 3.8- and 60-mg oral doses of labeled ferrous sulfate. The stable isotope appearance curve was determined, and the plasma hepcidin response was measured over 6 h. RESULTS In study 1, plasma hepcidin and plasma ferritin were strongly correlated (r = 0.79, P < 0.001). Plasma hepcidin significantly, but modestly, predicted iron bioavailability from ferrous sulfate and ferrous fumarate (r = -0.51 and -0.46, respectively; P < 0.0001) but not from ferric pyrophosphate (r = -0.30, P = 0.056, respectively). In study 2, the 3.8-mg dose increased mean circulating absorbed iron to a peak of 0.42 micromol/L at 60 min but did not increase plasma hepcidin, The 60-mg dose increased mean circulating absorbed iron to a peak of 5.9 micromol/L at 120 min and produced an approximately 30% increase in mean plasma hepcidin at 6 h (P < 0.01). CONCLUSIONS Plasma hepcidin is only a modest predictor of dietary iron bioavailability in humans. Oral iron loading, measured by stable-isotope appearance curves, increases circulating hepcidin.
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Affiliation(s)
- Michael B Zimmermann
- Human Nutrition Laboratory, The Swiss Federal Institute of Technology, Zürich, Switzerland.
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Gabriel FR, Suen VM, Marchini JS, Dutra de Oliveira JE. Ingestion of ferrous sulfate increases ferremia in patients with short bowel syndrome. Nutrition 2009; 25:1115-9. [DOI: 10.1016/j.nut.2009.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 01/18/2009] [Accepted: 01/20/2009] [Indexed: 10/20/2022]
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31
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Abstract
In nutritional epidemiology, it is often assumed that nutrient absorption is proportional to nutrient intake. For several nutrients, including non-haem Fe, this assumption may not hold. Depending on the nutrients ingested with non-haem Fe, its availability for absorption varies greatly. Therefore, using Fe intake to examine associations between Fe and health can impact upon the validity of findings. Previous algorithms that adjust Fe intakes for dietary factors known to affect absorption have been found to underestimate Fe absorption and, in the present study, perform poorly on independent dietary data. We have designed a new algorithm to adjust Fe intakes for the effects of ascorbic acid, meat, fish and poultry, phytate, polyphenols and Ca, incorporating not only absorption data from test meals but also current understanding of Fe absorption. In so doing, we have created a robust and universal Fe algorithm with potential for use in large cohorts. The algorithm described aims not to predict Fe absorption but available Fe in the gut, a measure we believe to be of greater use in epidemiological research. Available Fe is Fe available for absorption from the gastrointestinal tract, taking into account enhancing or inhibiting effects of dietary modifiers. Our algorithm successfully estimated average Fe availability in test meal data used to construct the algorithm and, unlike other algorithms tested, also provided plausible predictions when applied to independent dietary data. Future research is needed to evaluate the extent to which this algorithm is useful in epidemiological research to relate Fe to health outcomes.
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Hutchinson C, Conway RE, Bomford A, Hider RC, Powell JJ, Geissler CA. Post-prandial iron absorption in humans: comparison between HFE genotypes and iron deficiency anaemia. Clin Nutr 2008; 27:258-63. [PMID: 18276042 DOI: 10.1016/j.clnu.2007.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Revised: 12/11/2007] [Accepted: 12/14/2007] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS Measurement of serum iron increase after ingestion of a meal could be an efficient method of comparing post-prandial iron absorption between groups of individuals. We determined whether the rise in post-prandial serum iron is increased in fully treated patients with hereditary haemochromatosis (HFE C282Y+/+; HH) compared to iron deficiency anaemia (IDA), iron-replete heterozygous subjects (HFE C282Y+/-) and iron-replete controls (HFE C282Y-/-). METHODS Serum iron increase was measured over 4h after a meal containing 13.1 mg non-haem iron. RESULTS Post-prandial increase in serum iron was similar in treated HH versus IDA (P=0.54), but greater than control subjects (P<0.0001). In five HH patients, using (58)Fe as a tracer, the rate of iron absorption was increased (P<0.05) and serum non-transferrin bound iron showed a tendency to increase (P=0.06). Serum iron curves did not differ for heterozygous subjects and controls (P=0.65). CONCLUSIONS Using the serum iron method we found a comparable increase in post-prandial iron absorption in treated HH and IDA compared with controls. While post-prandial iron absorption in the group heterozygous for the C282Y mutation was modestly increased relative to controls, this difference was not statistically significant.
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Affiliation(s)
- Carol Hutchinson
- The Iron Metabolism Interdisciplinary Research Group, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9HN, UK
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Singh M, Sanderson P, Hurrell RF, Fairweather-Tait SJ, Geissler C, Prentice A, Beard JL. Iron bioavailability: UK Food Standards Agency workshop report. Br J Nutr 2007; 96:985-90. [PMID: 17092392 DOI: 10.1017/bjn20061894] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The UK Food Standards Agency convened a group of expert scientists to review current research investigating factors affecting iron status and the bioavailability of dietary iron. Results presented at the workshop show menstrual blood loss to be the major determinant of body iron stores in premenopausal women. In the presence of abundant and varied food supplies, the health consequences of lower iron bioavailability are unclear and require further investigation.
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Affiliation(s)
- Mamta Singh
- Food Standards Agency, Aviation House, 125 Kingsway, London WC2B 6NH, UK.
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