ferrous-fumarate and ferrous-sulfate

Approximately 600 million children of preschool and school age are anaemic worldwide. It is estimated that at least half of the cases are due to iron deficiency. Point-of-use fortification of foods with micronutrient powders (MNP) has been proposed as a feasible intervention to prevent and treat anaemia. It refers to the addition of iron alone or in combination with other vitamins and minerals in powder form, to energy-containing foods (excluding beverages) at home or in any other place where meals are to be consumed. MNPs can be added to foods either during or after cooking or immediately before consumption without the explicit purpose of improving the flavour or colour.. To assess the effects of point-of-use fortification of foods with iron-containing MNP alone, or in combination with other vitamins and minerals on nutrition, health and development among children at preschool (24 to 59 months) and school (five to 12 years) age, compared with no intervention, a placebo or iron-containing supplements.. In December 2016, we searched the following databases: CENTRAL, MEDLINE, Embase, BIOSIS, Science Citation Index, Social Science Citation Index, CINAHL, LILACS, IBECS, Popline and SciELO. We also searched two trials registers in April 2017, and contacted relevant organisations to identify ongoing and unpublished trials.. Randomised controlled trials (RCTs) and quasi-RCTs trials with either individual or cluster randomisation. Participants were children aged between 24 months and 12 years at the time of intervention. For trials with children outside this age range, we included studies where we were able to disaggregate the data for children aged 24 months to 12 years, or when more than half of the participants were within the requisite age range. We included trials with apparently healthy children; however, we included studies carried out in settings where anaemia and iron deficiency are prevalent, and thus participants may have had these conditions at baseline.. Two review authors independently assessed the eligibility of trials against the inclusion criteria, extracted data from included trials, assessed the risk of bias of the included trials and graded the quality of the evidence.. We included 13 studies involving 5810 participants from Latin America, Africa and Asia. We excluded 38 studies and identified six ongoing/unpublished trials. All trials compared the provision of MNP for point-of-use fortification with no intervention or placebo. No trials compared the effects of MNP versus iron-containing supplements (as drops, tablets or syrup).The sample sizes in the included trials ranged from 90 to 2193 participants. Six trials included participants younger than 59 months of age only, four included only children aged 60 months or older, and three trials included children both younger and older than 59 months of age.MNPs contained from two to 18 vitamins and minerals. The iron doses varied from 2.5 mg to 30 mg of elemental iron. Four trials reported giving 10 mg of elemental iron as sodium iron ethylenediaminetetraacetic acid (NaFeEDTA), chelated ferrous sulphate or microencapsulated ferrous fumarate. Three trials gave 12.5 mg of elemental iron as microencapsulated ferrous fumarate. Three trials gave 2.5 mg or 2.86 mg of elemental iron as NaFeEDTA. One trial gave 30 mg and one trial provided 14 mg of elemental iron as microencapsulated ferrous fumarate, while one trial gave 28 mg of iron as ferrous glycine phosphate.In comparison with receiving no intervention or a placebo, children receiving iron-containing MNP for point-of-use fortification of foods had lower risk of anaemia prevalence ratio (PR) 0.66, 95% confidence interval (CI) 0.49 to 0.88, 10 trials, 2448 children; moderate-quality evidence) and iron deficiency (PR 0.35, 95% CI 0.27 to 0.47, 5 trials, 1364 children; moderate-quality evidence) and had higher haemoglobin (mean difference (MD) 3.37 g/L, 95% CI 0.94 to 5.80, 11 trials, 2746 children; low-quality evidence).Only one trial with 115 children reported on all-cause mortality (zero cases; low-quality evidence). There was no effect on diarrhoea (risk ratio (RR) 0.97, 95% CI 0.53 to 1.78, 2 trials, 366 children; low-quality evidence).. Point-of-use fortification of foods with MNPs containing iron reduces anaemia and iron deficiency in preschool- and school-age children. However, information on mortality, morbidity, developmental outcomes and adverse effects is still scarce.

Topics: Anemia, Iron-Deficiency; Child; Child, Preschool; Dietary Supplements; Edetic Acid; Ferric Compounds; Ferrous Compounds; Food, Fortified; Humans; Iron; Micronutrients; Point-of-Care Systems; Powders; Trace Elements; Vitamins

A systematic review was conducted to analyze the tolerability of several oral iron supplements based on data obtained in available publications and to report the incidence of adverse effects (AEs) for each supplement both overall and gastrointestinal.. Electronic databases - Medline, the Cochrane Library, and Embase were searched for studies published up to January 2009. Clinical or observational studies reporting data on the tolerability of oral iron supplements were included. Results were described statistically and a quasi-binomial logistic regression model was developed to evaluate and compare the tolerability of the supplements studied.. For this review 111 studies were included, with data on 10,695 patients. Ferrous sulfate with mucoproteose had the lowest incidence of AEs (4.1% for overall AEs, 3.7% for gastrointestinal AEs [GAEs]) and was used as the reference supplement in the regression model. Incidence rates of overall AEs for the other supplements were 7.3% for iron protein succinylate [GAEs: 7%; OR for AE compared to the reference supplement, 1.96], 23.5% for ferrous glycine sulfate [GAEs: 18.5%; OR: 5.90], 30.9% for ferrous gluconate [GAEs: 29.9%; OR: 11.06], 32.3% for ferrous sulfate without mucoproteose [GAEs: 30.2%; OR: 11.21], and 47.0% for ferrous fumarate [GAEs: 43.4%; OR: 19.87]. The differences in incidence of AEs between extended-release ferrous sulfate with mucoproteose and all other supplements except iron protein succinylate were statistically significant at p < 0.001. These findings are subject to some limitations as the designs and methodologies of the studies included show heterogeneity among them that has partially been counteracted by the large sample size provided by the substantial number of trials, which is considered a strength in tolerability studies.. Extended-release ferrous sulfate with mucoproteose appears to be the best tolerated of the different oral iron supplements evaluated.

Topics: Anemia, Iron-Deficiency; Dietary Supplements; Ferric Compounds; Ferrous Compounds; Glycine; Humans; Metalloproteins; Succinates

Iron (Fe) encapsulation has the potential to help overcome several major challenges in Fe fortification of foods. It may decrease unwanted sensory changes in fortified products and reduce interactions of Fe with food components that lower Fe bioavailability. However, the effect of encapsulation per se on Fe bioavailability is a concern. Rat studies comparing encapsulated ferrous sulfate, ferric ammonium citrate, and ferrous fumarate to non-encapsulated compounds indicate that a ratio of capsule:substrate of > or = 60:40 may decrease the relative bioavailability (RBV) of the Fe by approximately 20%. At a ratio of capsule:substrate of < or = 50:50, the RBV of encapsulated ferrous sulfate appears to be similar to ferrous sulfate. Even minor changes in capsule composition may influence Fe bioavailability. Encapsulated ferrous fumarate given with ascorbic acid as a complementary food supplement and encapsulated ferrous sulfate fortified into salt have been shown to be efficacious in anemic children. For salt fortification, further refinements in Fe capsule design are needed to increase resistance to moisture and abrasion, while maintaining bioavailability. Studies evaluating the potential efficacy of encapsulated Fe in staple cereals (wheat and maize flours) are needed. A potential barrier to use of encapsulated forms of Fe in staple food fortification is the relatively low melting point of the capsules, which may cause unwanted sensory changes during food preparation. Research and development efforts to improve the quality of coatings and their resistance to high temperatures are ongoing. Process costs for encapsulation can be high, and unless they can be reduced, may limit applications. Further research is needed to determine which encapsulation technologies are most effective in ensuring iron bioavailability from encapsulated compounds.

Topics: Animals; Ascorbic Acid; Biological Availability; Capsules; Cote d'Ivoire; Edible Grain; Ferric Compounds; Ferrous Compounds; Food, Fortified; Ghana; Humans; Iodine; Iron Compounds; Liposomes; Morocco; Quaternary Ammonium Compounds; Rats; Sodium Chloride, Dietary; Taste

To compare the effect of Iberet Folic. This randomised controlled trial conducted from January 2018 until December 2018. Pregnant women below 34 weeks of gestation, with Hb concentration less than 11 g/dL and serum ferritin level less than 12 ug/L were randomised to receive either one tablet Zincofer. Hundred and thirty patients were recruited in this study with 68 patients in Iberet Folic group and 62 patients in Zincofer group. The change in the Hb and serum ferritin level from baseline to day 30 did not differ significantly between treatment groups. The mean (±SD) change from baseline to day 30 was 2.15 (±0.59) g/dL in the Iberet Folic group, and 1.98 (±0.49) in the Zincofer (p value = 0.08). Mean serum ferritin at day 30 was 17.2 (±3.68) ug/L and 16.7 (±4.28) ug/L with 8.44 (±3.41) and 8.55 (±3.50) difference, respectively (p = 0.86). Adverse events were comparable in between groups, with p value >0.05. GI intolerance and constipation were among the common side effects, occurred in 34.6 and 29.2% cases, respectively.. Zincofer

Topics: Adult; Anemia, Iron-Deficiency; Erythrocyte Indices; Female; Ferritins; Ferrous Compounds; Gastrointestinal Diseases; Hemoglobins; Humans; Parity; Pregnancy; Pregnancy Complications, Hematologic; Prospective Studies; Recurrence; Socioeconomic Factors

Animal studies suggest prebiotics can increase iron absorption, but results from human studies are equivocal.. In iron-depleted women, before (baseline) and after daily consumption of galacto-oligosaccharides (GOS) for 4 wk, we sought to assess fractional iron absorption (FIA) from an iron supplement given with and without single doses of GOS in test meals or water.. In all women (n = 34; median serum ferritin concentration = 16.4 µg/L), FIA from doses of 14 mg iron labeled with stable isotopes was measured in the following conditions at baseline: 1) FIA from ferrous fumarate (FeFum) in water given with and without 15 g GOS; 2) FIA from FeFum in a test meal given with and without 15 g GOS; 3) FIA from ferrous sulfate (FeSO4) in a test meal given without 15 g GOS. All subjects then consumed ∼15 g GOS daily for 4 wk. Then the following conditions were tested: 4) FIA from FeFum in a test meal with and without 15 g GOS; and 5) FIA from FeSO4 in a test meal with 15 g GOS. FIA was measured as erythrocyte incorporation of stable isotopes.. At baseline, GOS significantly increased FIA from FeFum when given with water (+61%; P < 0.001) and the meal (+28%; P = 0.002). After 4 wk of GOS consumption, GOS again significantly increased FIA from FeFum in the meal (+29%; P = 0.044). However, compared with baseline, consumption of GOS for 4 wk did not significantly enhance absorption from FeFum in the meal given without GOS. FIA from FeSO4 given with GOS in a meal after 4 wk of GOS consumption was not significantly greater than FIA from FeSO4 in a meal without GOS at baseline.. In iron-depleted women, GOS given with FeFum increases FIA, but 4 wk of GOS consumption did not enhance this effect. The study was registered at clinicaltrials.gov as NCT03325270.

Topics: Adult; Anemia, Iron-Deficiency; Dietary Supplements; Erythrocytes; Female; Ferritins; Ferrous Compounds; Galactose; Humans; Intestinal Absorption; Iron; Iron Isotopes; Meals; Oligosaccharides; Prebiotics; Young Adult

To compare the efficacy between supplementing ferrous fumarate and ferrous sulfate to carbonated beverages by recording the in vitro mineral loss and surface microhardness (SMH) changes in human enamel.. 120 enamel blocks each (from primary and permanent teeth) were uniformly prepared and the initial SMH was recorded. These enamel specimens were equally divided (n = 60) for their respective beverage treatment in Group 1 (2 mmol/L ferrous sulfate) and Group 2 (2 mmol/L ferrous fumarate). Each group was further divided into three subgroups as Coca-Cola, Sprite and mineral water (n= 10). The specimens were subjected to three repetitive cycles of respective treatment for a 5-minute incubation period, equally interspaced by 5-minute storage in artificial saliva. The calcium and phosphate released after each cycle were analyzed spectrophotometrically and the final SMH recorded.. The results were tested using student's t-test, one-way ANOVA and Wilcoxon signed rank test (P < 0.05). The spectrophotometric assessment of calcium and phosphate withdrawal found more loss with the supplementation of 2 mmol/L ferrous sulfate than ferrous fumarate (P < 0.005). Similarly, the mean surface microhardness reduction was less with the supplementation of 2 mmol/L ferrous fumarate than with ferrous sulfate (P < 0.005). Statistical comparisons revealed the maximum surface microhardness and mineral loss with primary enamel and the maximum loss produced in all groups by Coca-Cola (P < 0.005).

Topics: Beverages; Dental Enamel; Ferrous Compounds; Hardness Tests; Humans; In Vitro Techniques; Saliva; Spectrum Analysis; Surface Properties

Ferrous fumarate is recommended for the fortification of complementary foods based on similar iron absorption to ferrous sulfate in adults. Two recent studies in young children have reported that it is only 30% as well absorbed as ferrous sulfate. The objective of this study was to compare iron absorption from ferrous fumarate and ferrous sulfate in infants, young children and mothers.. Non-anemic Mexican infants (6-24 months), young children (2-5 years) and adult women were randomly assigned to receive either 4 mg Fe (women) or 2.5 mg Fe (infants and young children) as either [(57)Fe]-ferrous fumarate or [(58)Fe]-ferrous sulfate added to a sweetened drink based on degermed maize flour and milk powder. Iron absorption was calculated based on incorporation of isotopes into erythrocytes after 14 days.. Within each population group, no significant differences (P > 0.05) in iron absorption were found between ferrous fumarate and ferrous sulfate. Mean iron absorption from ferrous fumarate vs ferrous sulfate was 17.5 vs 20.5% in women (relative bioavailability (RBV) =86), 7.0 vs 7.2% in infants (RBV = 97) and 6.3 vs 5.9% in young children (RBV = 106).. Ferrous fumarate is as well absorbed as ferrous sulfate in non-anemic, iron sufficient infants and young children, and can be recommended as a useful fortification compound for complementary foods designed to prevent iron deficiency. Further studies are needed to clarify its usefulness in foods designed to treat iron deficiency.

Topics: Adult; Anemia, Iron-Deficiency; Beverages; Biological Availability; Child, Preschool; Dairy Products; Drug Evaluation; Female; Ferrous Compounds; Flour; Food, Fortified; Humans; Infant; Intestinal Absorption; Iron; Iron, Dietary; Linear Models; Mexico; Sweetening Agents; Zea mays

Helicobacter pylori infection could impair iron absorption from fortified products. The objective of the study was to determine the effect of H. pylori infection on iron absorption from asymptomatic adults consuming wheat flour fortified with iron and zinc. The (13)C urea breath test was used to assess H. pylori infection. Twenty-four H. pylori-positive and 26 H. pylori-negative volunteers completed the study. On day 1, the subjects were randomized to receive for breakfast bread fortified with either ferrous sulfate and zinc sulfate or ferrous fumarate and zinc oxide. Bread fortified with ferrous sulfate was labeled with (59)Fe as sulfate, and bread fortified with ferrous fumarate was labeled with (55)Fe as fumarate. On day 3, they received the other type of bread, with the respective tracers. On days 18-23, a proton pump inhibitor was administered to all subjects. On day 24, all subjects received bread fortified with ferrous fumarate and zinc oxide labeled with (55)Fe as fumarate. H. pylori prevalence was 77.6%. The geometric mean (±1 SD) of iron absorption was significantly higher for ferrous sulfate than fumarate (6.9 ± 2.9% vs. 0.5 ± 3.5%, p < 0.001). The H. pylori-negative subjects absorbed significantly more iron from bread fortified with either ferrous sulfate (10.5 ± 3.1% vs. 4.4 ± 2.2%, p < 0.001) or ferrous fumarate (0.6 ± 3.9% vs. 0.4 ± 3.1%, p < 0.001). Iron absorption was not significantly different between groups after administration of a proton pump inhibitor (0.3 ± 3.3% vs. 0.3 ± 2.7%, p = 0.11). H. pylori infection has a negative effect on iron absorption in asymptomatic adults consuming iron- and zinc-fortified wheat flour.

Topics: Adult; Bread; Diet; Female; Ferrous Compounds; Flour; Food, Fortified; Helicobacter Infections; Helicobacter pylori; Humans; Intestinal Absorption; Iron; Iron Radioisotopes; Male; Middle Aged; Proton Pump Inhibitors; Triticum; Zinc

Iron absorption in humans is highly variable even after iron status and dietary components that influence iron absorption are controlled for. Inherited factors may help explain this variance.. Our objective was to compare nonheme-iron absorption from a noninhibitory, stable-isotope-labeled test meal in preschool-aged children and their mothers.. We provided 72 test meals based on degermed maize flour and milk powder and fortified with [(57)Fe]ferrous fumarate or [(58)Fe]ferrous sulfate to healthy Mexican preschool children [n = 18; mean (+/-SD) age: 3.6 +/- 1.0 y] and their mothers [n = 18; mean (+/-SD) age: 28.0 +/- 5.2 y]. Iron absorption was calculated on the basis of incorporation of isotopes into erythrocytes after 14 d and was adjusted for differences in iron status.. There was a wide variation in iron absorption from the test meals: in the mothers and children, the median fractional absorption of ferrous sulfate was 22.55% (range: 1.65-54.83%) and 5.51% (range: 2.23-17.20%), respectively (P < 0.0001). After adjustment for serum ferritin, the significant difference in absorption between mothers and their children disappeared. Despite this broad range of iron absorption, corrected fractional iron absorption from the ferrous fumarate-fortified (r(2) = 0.582) and the ferrous sulfate-fortified test meals (r(2) = 0.557) was strongly correlated in mothers and their children (P < 0.0001). There was a striking positive correlation between the mean corrected fractional iron absorption from both test meals in mothers and their children (r(2) = 0.782, P < 0.0001). In regression analyses that included age, sex, and hemoglobin, the only significant predictor of corrected fractional iron absorption in children was corrected fractional iron absorption in their mothers (standardized beta = 0.884, P < 0.001).. Nonheme-iron absorption exhibits a strong familial tendency. After differences in meal matrix and serum ferritin are accounted for, these data suggest that inheritance and/or shared environmental factors explain most of the variance in dietary iron absorption.

Topics: Adult; Anemia, Iron-Deficiency; Animals; Child, Preschool; Diet; Erythrocytes; Female; Ferritins; Ferrous Compounds; Food, Fortified; Humans; Intestinal Absorption; Iron; Iron Isotopes; Iron, Dietary; Male; Mexico; Milk; Mothers; Reference Values; Young Adult; Zea mays

Ferrous fumarate is a common, inexpensive iron form increasingly used instead of ferrous sulfate as a food iron supplement. However, few data exist as to whether juices enhance iron absorption from ferrous fumarate.. We studied 21 children, ages 4.0 to 7.9 years using a randomized crossover design. Subjects consumed a small meal including a muffin containing 4 mg Fe as ferrous fumarate and either apple (no ascorbic acid) or orange juice (25 mg ascorbic acid). They were separately given a reference dose of Fe (ferrous sulfate) with ascorbic acid.. Iron absorption increased from 5.5% +/- 0.7% to 8.2% +/- 1.2%, P < 0.001 from the muffins given with orange juice compared with muffins given with apple juice. The absorption of ferrous fumarate given with orange juice and enhancement of absorption by the presence of juice were significantly positively related to height, weight, and age (P < 0.01 for each). Although iron absorption from ferrous fumarate given with apple juice was significantly inversely associated with the (log transformed) serum ferritin, the difference in absorption between juice types was not (P > 0.9).. These data demonstrate an overall benefit to iron absorption from ferrous fumarate provided with orange juice. The effect was age related such that in children older than 6 years of age, there was a nearly 2-fold increase in iron absorption from ferrous fumarate given with orange juice.

Topics: Ascorbic Acid; Beverages; Child; Child, Preschool; Citrus sinensis; Cross-Over Studies; Female; Ferritins; Ferrous Compounds; Fruit; Humans; Intestinal Absorption; Iron; Male; Malus; Plant Preparations

To determine whether low-income infants' adherence to nutritional supplementation with ferrous fumarate sprinkles was better than that with ferrous sulfate drops.. The study was a randomized clinical trial of healthy 6-month-old infants. Each infant received either a daily packet of sprinkles or a dropperful of liquid. Follow-up included alternating telephone and home visits biweekly for 3 months. Adherence was defined as high if the infant's caregiver reported supplement use on 5 to 7 days during the week before assessment. Side effects and caregiver attitude about supplements were secondary outcomes. Analyses were conducted using generalized estimating equations and chi(2) and Wilcoxon rank-sum tests.. A total of 150 of 225 eligible infants were enrolled. Adherence to supplementation was generally poor. High adherence ranged from 32% to 63% at any assessment in the subjects receiving drops, compared with 30% to 46% in those receiving sprinkles. The drops group was more likely to have at least four assessments with high adherence (22% vs 9.5%; P = .03). Caregivers of the drops infants were more likely to report greater than usual fussiness (P < .01); however, fussiness had no consistent impact on adherence.. The use of ferrous fumarate sprinkles rather than traditional ferrous sulfate drops did not improve adherence with daily iron supplementation in low-income infants.

Topics: Anemia, Iron-Deficiency; Attitude to Health; Caregivers; Dietary Supplements; Dosage Forms; Feasibility Studies; Female; Ferrous Compounds; Humans; Income; Infant; Male; Medication Adherence; Patient Acceptance of Health Care; Pilot Projects; Trace Elements; United States

Non-water-soluble iron compounds have been reported to be less well absorbed than ferrous sulfate in young children, and concern has been raised about their usefulness as food fortificants.. The objective was to evaluate the usefulness of ferrous fumarate and ferric pyrophosphate, compared with ferrous sulfate, in maintaining hemoglobin concentrations >105 g/L in Bangladeshi children.. Two hundred thirty-five children aged 7-24 mo (hemoglobin >105 g/L) were randomly assigned in a double-blind study to receive an infant cereal fortified with ferrous fumarate, ferric pyrophosphate, or ferrous sulfate. One serving of cereal (9.3 mg Fe; molar ratio of ascorbic acid to iron of 3:1) was consumed per day, 6 d/wk, for 9 mo. Blood samples were drawn at 4.5 and 9 mo.. Raw data were reformatted, and a "time to event" was calculated that corresponded to reaching the following thresholds: hemoglobin <105 g/L, plasma ferritin <12 microg/L, or plasma C-reactive protein >10 mg/L at baseline, 4.5 mo, or 9 mo. Data were censored when children did not reach the threshold or were lost to follow-up. A Kaplan-Meier approach was used to compare the 3 groups. No statistically significant differences were observed for hemoglobin <105 g/L (P = 0.943), plasma ferritin <12 microg/L (P = 0.601), or plasma C-reactive protein >10 mg/L (P = 0.508).. Contrary to earlier concerns, these results do not indicate differences in usefulness between water-soluble and non-water-soluble iron compounds in maintaining hemoglobin concentrations and preventing iron deficiency. These data will be important in the development of food-fortification strategies to combat anemia and iron deficiency in highly vulnerable population groups.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Bangladesh; C-Reactive Protein; Child, Preschool; Diphosphates; Female; Ferritins; Ferrous Compounds; Food, Fortified; Hemoglobins; Humans; Infant; Iron; Iron, Dietary; Male; Trace Elements

Iron supplementation is required by most dialysis patients receiving recombinant human erythropoietin. The efficacy of oral iron is variable in these patients, and many require the use of intravenous iron dextran to maintain adequate iron levels, defined as transferrin saturation greater than 20%, serum ferritin greater than 100 ng/mL, and serum iron greater than 80 micrograms/dL. To determine the efficacy of different oral iron preparations in maintenance of iron status, we prospectively studied 46 recombinant human erythropoietin-treated patients and randomized them to receive different oral iron preparations. These four preparations included Chromagen (ferrous fumarate; Savage Laboratories, Melville, NY), Feosol (ferrous sulfate; SmithKline Beecham, Inc, Pittsburgh, PA), Niferex (polysaccharide; Central Pharmaceuticals, Inc, Seymour, IN), or Tabron (ferrous fumarate; Parke-Davis, Morris Plains, NJ). All patients were prescribed approximately 200 mg of elemental iron daily of their assigned iron preparation with at least 100 mg ascorbic acid daily for 6 months. At baseline and bimonthly during the study, serum iron, transferrin saturation, ferritin, hematocrit, and recombinant human erythropoietin dose were monitored; in addition, compliance and side effects were recorded by patient interview. All patients were able to maintain target hematocrit during the 6 months of study. However, there were differences in the trends of serum iron, percent transferrin saturation, and ferritin when considered singly or in combination between the four groups of iron medications. The percent of laboratory values measured over the study period in each group that met the criteria of transferrin saturation more than 20% was greatest in the Tabron group (58%), followed by the Feosol (47%), Chromagen (33%), and Niferex (31%) groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Anemia; Anemia, Iron-Deficiency; Delayed-Action Preparations; Erythropoietin; Female; Ferrous Compounds; Hematocrit; Humans; Iron; Kidney Failure, Chronic; Male; Middle Aged; Patient Compliance; Polysaccharides; Prospective Studies; Recombinant Proteins; Renal Dialysis

Regular blood donors were enrolled in a double-blind, parallel group study to evaluate the side effects of two iron supplements, one containing both heme iron and non-heme iron (Hemofer, 2 tablets = 18 mg iron/day), the other non-heme iron only (Erco-Fer; 1 tablet = 60 mg iron/day). No differences were found between the two alternatives in regaining predonation iron status as measured by serum ferritin and hemoglobin levels. Despite this therapeutic equivalence, participants' symptom diaries showed substantial differences in the side effects for the two treatments. The frequency of constipation (p < 0.05) and the total incidence of all side effects (p < 0.01) were significantly higher for non-heme iron when compared with the heme iron-non-heme iron combination and a placebo. The study demonstrates that a low-dose iron supplement containing both heme iron and non-heme iron (Hemofer) has fewer side effects when compared with an equipotent, traditional non-heme iron supplement.

Topics: Adult; Analysis of Variance; Anemia, Hypochromic; Blood Donors; Double-Blind Method; Female; Ferritins; Ferrous Compounds; Hemoglobins; Humans; Male; Middle Aged

An evaluation was made into the usefulness of ferrous fumarate as an iron fortificant for an experimental chocolate drink powder targetted to children and adolescents. Organoleptically ferrous furmarate was acceptable when the chocolate drink powder was reconstituted in milk or water that was heated to less than 80 degrees. Unacceptable colour changes occurred, however, when boiling milk or water were used. In human Fe absorption studies when the Fe compounds were added to the chocolate drink immediately before consumption, ferrous fumarate was 3.31% absorbed compared with 2.82% for ferrous sulphate and 2.11% for ferric pyrophosphate. When the Fe compounds were processed during the manufacture of the chocolate drink powder, the absorption of ferrous furmarate was 5.27%, ferrous sulphate 2.62% and ferric pyrophosphate 0.55%. Ascorbic acid had little or no effect on the absorption of ferrous furmarate. It is concluded that food processing can influence the relative absorption of fortification Fe and that, if not reconstituted with boiling milk or water, ferrous fumarate could be a useful compound for the fortification of chocolate drink powders.

Topics: Adolescent; Ascorbic Acid; Beverages; Biological Availability; Cacao; Child; Diphosphates; Ferrous Compounds; Food Handling; Food, Fortified; Humans; Intestinal Absorption; Iron; Iron Radioisotopes

Long-term feeding of prebiotic galacto-oligosaccharides (GOS) increases iron absorption in African infants, but the underlying mechanism and how long GOS need to be fed to infants to achieve an increase in absorption is uncertain.. In Kenyan infants, we tested whether the addition of GOS to a single test meal would affect iron absorption from a micronutrient powder (MNP) containing ferrous sulfate (FeSO4) and another MNP containing ferrous fumarate (FeFum) and sodium iron ethylenediaminetetraacetate (NaFeEDTA).. In a randomized-entry, prospective crossover study, iron deficient (87%) and anemic (70%) Kenyan infants (n  = 23; mean ± SD age, 9.9 ± 2.1 months) consumed 4 stable iron isotope-labeled maize porridge meals fortified with MNPs containing 5 mg iron as FeFum + NaFeEDTA, or FeSO4, either without or with 7.5 g GOS. The primary outcome, fractional iron absorption (FIA), was assessed by erythrocyte incorporation of isotopic labels. Data were analyzed using a 2-way repeated-measures ANOVA.. There was no significant interaction between GOS and the iron compounds on FIA, and the addition of GOS did not have a significant effect on FIA. There was a statistically significant difference in FIA between the meals fortified with FeSO4 and with FeFum + NaFeEDTA (P  < 0.001).Given with GOS, FIA from FeSO4 was 40% higher than from FeFum + NaFeEDTA (P  < 0.001); given without GOS, it was 51% higher (P  < 0.01).. The addition of GOS to a single iron-fortified maize porridge test meal in Kenyan infants did not significantly increase iron absorption, suggesting long-term feeding of GOS may be needed to enhance iron absorption at this age. This study was registered at clinicaltrials.gov as NCT02666417.

Topics: Biological Transport; Female; Ferrous Compounds; Humans; Infant; Iron Isotopes; Kenya; Male; Micronutrients; Oligosaccharides; Prebiotics

Although acute consumption of high doses of prebiotic galacto-oligosaccharides (GOS) increases fractional iron absorption (FIA) from ferrous fumarate (FeFum), it is uncertain if low doses of GOS have this effect. Furthermore, whether GOS improve iron absorption from other commonly used iron compounds and whether ascorbic acid (AA) enhances the effect of GOS on iron absorption from FeFum is unclear.. In iron-depleted women [serum ferritin (SF) <30 μg/L], we assessed: 1) whether the acute enhancing effect of GOS on FeFum is dose dependent; 2) if GOS would affect FIA from ferrous sulfate (FeSO4) or ferric pyrophosphate (FePP); and 3) if AA and GOS given together enhance FIA from FeFum to a greater extent compared with GOS alone.. We recruited 46 women (mean age 22.0 y, mean BMI 21.3 kg/m2, median SF 17.1 μg/L), and measured FIA from 14 mg iron labeled with stable isotopes in the following conditions: 1) FIA from FeFum given with 3.5 g, 7 g GOS, and without GOS; 2) FIA from FeSO4 and FePP given with and without 15 g GOS; and 3) FIA from FeFum given with 7 g GOS with and without 93 mg AA. FIA was measured as erythrocyte incorporation of stable isotopes after 14 d. Comparisons were made using paired samples t-test or Wilcoxon rank sum test where appropriate.. Giving 7 g of GOS significantly increased FIA from FeFum (+26%; P = 0.039), whereas 3.5 g GOS did not (P = 0.130). GOS did not significantly increase FIA from FeSO4 (P = 0.998) or FePP (P = 0.059). FIA from FeFum given with GOS and AA was significantly higher compared with FeFum given with GOS alone (+30%; P <0.001).. In iron-depleted women, GOS does not increase FIA from FeSO4 or FePP, but it increases FIA from FeFum. Thus, a combination of FeFum and GOS may be a well-absorbed formula for iron supplements. The study was registered at clinicaltrials.gov as NCT03762148.

Topics: Anemia, Iron-Deficiency; Biological Transport; Cross-Over Studies; Diphosphates; Drug Administration Schedule; Female; Ferrous Compounds; Humans; Iron; Iron Isotopes; Prebiotics; Prospective Studies; Young Adult

The purpose of this study was to determine whether the enteric coating process affects growth performance, Fe bioavailability, and gene expression levels that maintain iron balance in the body. The test was divided into the control group, ferrous sulfate group, ferrous fumarate group, ferrous glycine chelate(1:1) (Fe-Gly(1:1)) group, ferrous glycine chelate(2:1) (Fe-Gly(2:1)) group, enteric-coated Fe-Gly(1:1) group, and enteric-coated Fe-Gly(2:1) group. The results showed that the growth performance of the rats in each iron supplement group was no significant difference among them. The results of serum biochemical indicators showed that the antioxidant capacity of the rats in the iron supplement group after enteric coating increased. The iron supplementation effect of Fe-Gly(1:1) and Fe-Gly(2:1) was better than that of ferrous sulfate, and the effect of Fe-Gly(1:1) after enteric coating was enhanced. The expression levels of IRP1 and IRP2 in the genes of enteric-coated Fe-Gly(1:1) and enteric-coated Fe-Gly(2:1) were significantly higher than those of ferrous sulfate. The expression levels of IRP1 and IRP2 in the protein of enteric-coated Fe-Gly(1:1) group were significantly higher than those in the Fe-Gly(1:1) group. The above results show that Fe-Gly can improve the bioavailability and antioxidant capacity of iron and reduce the iron output of feces after enteric coating.

Topics: Animals; Antioxidants; Biological Availability; Dietary Supplements; Ferrous Compounds; Homeostasis; Iron; Iron Regulatory Protein 1; Iron Regulatory Protein 2; Rats; Rats, Sprague-Dawley; Tablets, Enteric-Coated

In the US, 70% of pregnant women use an iron-containing prenatal supplement product; however, only 2.6% of pregnant women have iron-deficiency anemia and 16.3% are iron deficient. Yet, published data on the amounts and chemical forms of iron used in formulating these products are not available, although they are known to affect bioavailability. This information is especially important in comparing commercially available products with those that were tested in clinical trials. Our examination of nonprescription and prescription iron-containing prenatal supplement products in NIH's Dietary Supplement Label Database (DSLD) and DailyMed found the labeled amount of elemental iron ranged between 9 and 60 mg/serving in 148 nonprescription supplements and between 4.5 and 106 mg/serving in 101 prescription supplements. Ferrous fumarate was the preferred chemical form used in these products. In contrast, ferrous sulfate was the preferred chemical form of iron reported in the clinical trials summarized in a 2015 Cochrane Systematic review assessing the effects of daily oral iron supplements for pregnant women. Ferrous sulfate was not found on any prenatal supplement product label in the DSLD or DailyMed. The chemical forms of products on the market and those tested in clinical trials are dissimilar, and we believe this may have clinical implications. The findings raise several questions. Do outcomes in clinical trials correlate with the benefits and risks that might adhere to iron supplements with different iron formulations? Should the differences in chemical forms, their bioavailability, and safety profiles, be considered in greater depth when evaluating the effect of the various formulations on maternal iron nutriture? Should new clinical trials for pregnant and lactating women in the US use a form of iron not found in prenatal supplements sold in the US or should a more common form be used?

Topics: Biological Availability; Clinical Trials as Topic; Dietary Supplements; Female; Ferrous Compounds; Humans; Iron; Iron, Dietary; Pregnancy; Prenatal Care; Prenatal Nutritional Physiological Phenomena; Safety

Despite existent fortification initiatives in the Philippines, approximately 50% of the population still suffers from iron deficiency anemia (IDA), mainly in rural areas. Fortification of staple foods has been proved successful in China and Vietnam. Coconut spiced vinegar (SV) is an inexpensive, widely available, and culturally acceptable condiment in Filipino households; however, no technical evidence exists on its potential as fortification vehicle. This study aimed to physicochemically characterize and evaluate the consumer acceptability of SV fortified with ferrous sulfate (FS), ferrous fumarate (FF), or sodium iron ethylenediaminetetraacetate (NaFeEDTA) at 0.2 mg Fe/mL. Iron fortificants were added directly to SV, vortexed, and stored for analysis. A nonfortified SV served as a control. Physicochemical analyses (pH, titratable acidity, color, turbidity, and iron recovery) were conducted from 0 to 6 months postfortification. Consumer acceptability (9-point hedonic scale: color, appearance, aroma, sourness, and overall acceptability) was conducted using 1-month fortified vinegar in 96 students and 27 women. Iron recovery of fortified samples was high and similar (>97%) after 3 days of fortification and remained >87% at 6 months postfortification. All samples had minimum acidity of 5.31% and pH between 3.12 and 3.3. Color difference against the control followed the next order: SV-NaFeEDTA < SV-FS = SV-FF. Among students, acceptability of SV-FS and SV-FF were lower than the control and SV-NaFeEDTA for all attributes (P < 0.05) except aroma. In women, overall acceptability and aroma were not different among samples (P > 0.05). Overall, SV-NaFeEDTA had similar acceptability to the control, and was the most accepted fortified vinegar. SV-NaFeEDTA shows potential (in terms of physicochemical stability and consumer acceptability) to be used as an iron-delivery vehicle to address IDA.. The present study addresses the technical and organoleptic challenges of fortifying Filipino spiced vinegar with three iron sources. About 50% of the Filipino population (especially women and children) still suffers from iron deficiency, thus, more effective ways to deliver iron are needed. If successful, our study could pose as the base milestone for implementing mass iron fortification of spiced vinegar, given its frequent consumption and reach of all socioeconomic pockets of the Filipino population. Our aim is to improve the overall nutritional health of at-risk populations, and our study is one step closer to achieve this goal.

Topics: Acetic Acid; Adolescent; Adult; Anemia, Iron-Deficiency; Color; Edetic Acid; Female; Ferric Compounds; Ferrous Compounds; Food, Fortified; Humans; Iron; Male; Middle Aged; Odorants; Philippines; Sensation; Spices; Taste; Young Adult

This study aimed at investigating the effect of iron compounds used in whole wheat flour (WWF) fortification, both on rheological properties of the dough and on bread technological quality. Furthermore, bioaccessibility of iron (Fe), zinc (Zn) and calcium (Ca) in the final breads was determined. Rheological properties (mainly dough development time, stability, mixing tolerance index, resistance to extension and ratio number) of the dough and the technological quality of bread (mainly oven spring and cut opening) were altered. However, producing roll breads fortified with different iron compounds was still possible. NaFeEDTA (ferric sodium ethylene diamine tetra acetic acid) proved to be the most effective iron compound in the fortification of WWF, since it presented the highest levels of solubility (44.80%) and dialysability (46.14%), followed by microencapsulated ferrous fumarate (FFm). On the other hand, the microencapsulated ferrous sulfate (FSm) and reduced iron presented the lowest solubility (5.40 and 18.30%, respectively) and dialysability (33.12 and 31.79%, respectively). Zn dialysis was positively influenced by NaFeEDTA, FSm, and ferrous fumarate. As for Ca, dialysis was positively influenced by FSm and negatively influenced by FFm. The data indicated that there is a competitive interaction for the absorption of these minerals in whole wheat roll breads, but all studied minerals can be considered bioaccessible.

Topics: Biological Availability; Bread; Calcium; Dialysis; Edetic Acid; Ferric Compounds; Ferrous Compounds; Flour; Food Handling; Food, Fortified; Humans; Iron; Iron Compounds; Minerals; Rheology; Solubility; Triticum; Zinc

Although oral iron preparations are widely prescribed to prevent and to treat iron deficiency anemia in pregnancy, comparative data on their effects to the mother, fetus and placenta are limited. In this study, the effects of oral iron polymaltose complex (IPC), ferrous fumarate (FF) and ferrous sulfate (FS) were compared in anemic pregnant rats, their fetuses and placentas. Hematological variables and oxidative stress markers in the liver, heart and kidneys of the dams and fetuses as well as the markers for oxidative stress, inflammation and hypoxia in placentas were assessed. Pregnancy outcome was measured by number of fetuses, and by neonate and placental weight. All therapies were comparably effective in correcting anemia. FS and FF, but not IPC, resulted in liver damage in dams and oxidative stress in dams, fetuses and placentas. FS group presented the highest catalase and GPx levels in dams, fetuses and placentas. IPC, but not FF or FS, restored normal TNF-α and IL6 expression levels in placentas whereas FS-treated animals presented the highest cytokine levels, suggesting a local inflammatory reaction. Anemia-induced high levels of HIF-1α were partially lowered by IPC and FF but further elevated by FS. Most of the negative effects associated with IDA were resolved by IPC treatment. Especially FS treatment was found to elicit hepatic damage in the dams, oxidative stress in the dams, fetuses and placenta as well as inflammation and high levels of HIF-1α in the placenta. Pregnancy outcome of FFand FS-treated animals was worse than that of IPC-treated animals.

Topics: Administration, Oral; Anemia, Iron-Deficiency; Animals; Disease Models, Animal; Female; Ferric Compounds; Ferrous Compounds; Humans; Hypoxia-Inducible Factor 1, alpha Subunit; Inflammation Mediators; Interleukin-6; Oxidative Stress; Placenta; Pregnancy; Pregnancy Outcome; Rats, Sprague-Dawley; Tumor Necrosis Factor-alpha

In a number of Southeast Asian countries and China, fish sauce and soy sauce produced at the industrial level are fortified with iron. Unfortunately, the food producers and regulatory agencies implementing fortification programs do not always have the capacity to monitor the programs on an ongoing basis.. To assess a new portable device for the quantitative measurement of iron content of fortified sauces that could be used to control fortification levels.. The linearity, detection limits, and inter- and intraassay variability of this device were assessed on fish sauce and soy sauce fortified with ferrous sulfate, ferrous fumarate, and sodium iron ethylenediaminetetraacetate (NaFeEDTA); the accuracy of the results was determined by comparing them with the results obtained by atomic absorption spectrophotometry.. Measurements required a minimum incubation time of 1 hour for iron sulfate or iron fumarate and 24 hours for NaFeEDTA. Linearity of the results ranged from 2 to 10 mg iron/L for ferrous sulfate or ferrous fumarate and from 1 to 10 mg iron/L for NaFeEDTA, implying the need for proper dilution, as the iron contents of fortified sauce are usually in the range of 150 to 1,000 mg/L. Depending on incubation time, iron compounds, and sauces, the coefficient of variation (CV) of intraassay precision was between 1.5% and 7.6% and the CV of interassay precision was between 2.9% and 7.4%. Comparison with results from atomic absorption spectrophotometry showed high agreement between both methods, with R = 0.926 and R = 0.935 for incubation times of 1 hour and 24 hours, respectively. The Bland-Altman plots showed limits of agreement between the two methods of +/- 70 mg/L in the range of fortification levels tested (100 to 500 mg/L). CONCLUSIONS; This device offers a viable method for field monitoring of iron fortification of soy and fish sauces after incubation times of 1 hour for ferrous sulfate or ferrous fumarate and 24 hours for NaFeEDTA.

Topics: Edetic Acid; Ferric Compounds; Ferrous Compounds; Fish Products; Food Analysis; Food Industry; Food, Fortified; Humans; Iron; Sensitivity and Specificity; Soy Foods; Time Factors

Wheat and maize flour fortification is a preventive food-based approach to improve the micronutrient status of populations. In 2009, the World Health Organization (WHO) released recommendations for such fortification, with guidelines on the addition levels for iron, folic acid, vitamin B12, vitamin A, and zinc at various levels of average daily consumption. Iron is the micronutrient of greatest concern to the food industry, as some believe there may be some adverse interaction(s) in some or all of the finished products produced from wheat flour and maize meal.. To determine if there were any adverse interactions due to selection of iron compounds and, if differences were noted, to quantify those differences.. Wheat flour and maize meal were sourced in Kenya, South Africa, and Tanzania, and the iron compound (sodium iron ethylenediaminetetraacetate [NaFeEDTA], ferrous fumarate, or ferrous sulfate) was varied and dosed at rates according to the WHO guidelines for consumption of 75 to 149 g/day of wheat flour and > 300 g/day of maize meal and tested again for 150 to 300 g/day for both. Bread, chapatti, ugali (thick porridge), and uji (thin porridge) were prepared locally and assessed on whether the products were acceptable under industry-approved criteria and whether industry could discern any differences, knowing that differences existed, by academic sensory analysis using a combination of trained and untrained panelists and in direct side-by-side comparison.. Industry (the wheat and maize milling sector) scored the samples as well above the minimal standard, and under academic scrutiny no differences were reported. Side-by-side comparison by the milling industry did indicate some slight differences, mainly with respect to color, although these differences did not correlate with any particular iron compound.. The levels of iron compounds used, in accordance with the WHO guidelines, do not lead to changes in the baking and cooking properties of the wheat flour and maize meal. Respondents trained to measure against a set benchmark and/or discern differences could not consistently replicate perceived difference observations.

Topics: Bread; Edetic Acid; Ferric Compounds; Ferrous Compounds; Flour; Folic Acid; Food, Fortified; Guidelines as Topic; Humans; Iron Compounds; Iron, Dietary; Kenya; Meals; Micronutrients; South Africa; Surveys and Questionnaires; Tanzania; Triticum; Vitamin B 12; World Health Organization; Zea mays; Zinc

Plasma hepcidin appears to be a major regulator of iron absorption and homeostasis, but there are few data in humans.. 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.. 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.. 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).. 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.

Topics: Adolescent; Adult; Antimicrobial Cationic Peptides; Biological Availability; Biomarkers; Female; Ferritins; Ferrous Compounds; Hepcidins; Humans; Intestinal Absorption; Iron; Iron Isotopes; Iron, Dietary; Male; Patient Selection; Predictive Value of Tests; Young Adult

Determination of the iron state in commercially manufactured iron containing vitamins and dietary supplements is important for evaluation of pharmaceuticals quality. Mössbauer (nuclear gamma-resonance) spectroscopy was used for analyzing the iron state in commercial pharmaceutical products containing ferrous fumarate (FeC(4)H(2)O(4)), ferrous sulfate (FeSO(4)), ferrous bisglycinate chelate (Ferrochel) and ferrous iron (hydrolyzed protein chelate). Mössbauer parameters and the iron states were determined for iron compounds in the studied pharmaceuticals. Various ferric and ferrous impurities were found in all of the commercial products. The quantities of ferric impurities exceeded the FDA limitation of 2% in products containing ferrous fumarate. The quantities of ferric impurities exceeded 58% and 30% in products containing ferrous bisglycinate chelate and ferrous iron (hydrolyzed protein chelate), respectively. The presence of ferrous and ferric impurities was not related to the ageing of the vitamins and dietary supplements. Two pharmaceutical products contained major iron compounds, the Mössbauer parameters of which did not correspond to the ferrous fumarate or ferrous bisglycinate chelate claimed by the manufacturer.

Topics: Dietary Supplements; Drug Contamination; Ferrous Compounds; Glycine; Iron; Spectroscopy, Mossbauer; Vitamins

Nonheme-iron absorption requires an acidic milieu. Reduced gastric acid output as a consequence of Helicobacter pylori infection could be an important limiting factor for iron absorption.. We measured gastric acid output and iron absorption from a non-water-soluble iron compound (ferrous fumarate) and a water-soluble iron compound (ferrous sulfate) in children with and without H. pylori infection.. Gastric acid output was quantified before (basal acid output, or BAO) and after pentagastrin stimulation (stimulated acid output, or SAO) in 2-5-y-old children with iron deficiency anemia who were (n = 13) or were not (n = 12) infected with H. pylori. Iron absorption was measured by using a double-stable-isotope technique. H. pylori-infected children were studied before and after eradication therapy.. BAO and SAO were significantly lower in the H. pylori-infected children (0.2 +/- 0.2 and 1.6 +/- 0.9 mmol/h, respectively) than in the uninfected children (0.9 +/- 0.7 and 3.1 +/- 0.9 mmol/h, respectively; P = 0.01 and P < 0.005). BAO and SAO improved to 0.8 +/- 1.3 and 3.3 +/- 2.4 mmol/h, respectively, after therapy. Iron absorption from ferrous sulfate was significantly greater than that from ferrous fumarate both before (geometric : 19.7% compared with 5.3%; P < 0.0001) and after (22.5% compared with 6.4%; P < 0.0001) treatment in H. pylori-infected children. Corresponding values for uninfected children were 15.6% and 5.4%, respectively (P < 0.001; n = 12).. Iron absorption from ferrous fumarate was significantly lower than that from ferrous sulfate in both H. pylori-infected and uninfected Bangladeshi children. Treatment of H. pylori infection improved gastric acid output but did not significantly influence iron absorption. The efficacy of ferrous fumarate in iron fortification programs to prevent iron deficiency in young children should be evaluated.

Topics: Anemia, Iron-Deficiency; Bangladesh; Biological Availability; Child, Preschool; Female; Ferrous Compounds; Food, Fortified; Gastric Acid; Gastric Acidity Determination; Helicobacter Infections; Helicobacter pylori; Humans; Intestinal Absorption; Iron; Male; Treatment Outcome

Corn-masa flour flat bread tortillas are the main staple of Mexican and Central American populations. Due to high concentrations of inhibitors of iron absorption, the bioavailability from this matrix is unknown. We wanted to determine the most suitable fortificant that would efficaciously improve iron bioavailability. In tortillas prepared with commercial precooked, lime-treated, corn-masa flour, we examined the in vitro solubility of the following forms of iron: native iron with and without Na2EDTA, elemental reduced iron plus Na2EDTA, ferrous fumarate with and without Na2EDTA, bisglycine iron, ferrous sulfate and NaFeEDTA. We also examined the in vivo bioavailability in humans with double radioiron erythrocyte incorporation of ferrous fumarate with and without Na2EDTA, bisglycine iron, NaFeEDTA and native iron plus Na2EDTA, beans and rice. In vitro, solubility ranged from 1% in iron forms without Na2EDTA to 19.4% for NaFeEDTA. Forms of iron with Na2EDTA had intermediate values. In vivo radioiron studies showed that iron forms without Na2EDTA also had low bioavailability (< or =1%). NaFeEDTA had the highest bioavailability (5.3%). The bioavailability of all iron forms improved significantly when tested with Na2EDTA (<0.05). Adding Na2EDTA to ferrous fumarate increased bioavailability from 0.87% to 2.9% (P < 0.001). We conclude that NaFeEDTA is the form of iron best absorbed, but alternatively, ferrous fumarate plus Na2EDTA comprises a feasible option as a fortificant.

Topics: Adult; Biological Availability; Dialysis; Edetic Acid; Fabaceae; Female; Ferric Compounds; Ferrous Compounds; Flour; Food, Fortified; Glycine; Humans; Iron; Middle Aged; Solubility; Zea mays

Iron absorption from rice fortified with different iron fortificants, e.g., ferrous sulfate (FeS04), sodium iron EDTA (NaFeEDTA), ferrous fumarate (FeFum), and ferrous bisglycinate (FeBis) was determined using an in vitro enzymatic digestion method simulating conditions in the small intestine and an in vivo method using radioisotope techniques. The in vitro method showed that the percentage of dialyzable iron from NaFeEDTA (15.7 +/- 0.9) and FeS04-fortified rice (13.2 +/- 1.5) was significantly greater than that from FeFum (6.4 +/- 0.6; p < .05) and FeBis fortified rice (3.3 +/- 0.8; p < .05). Iron absorption in vivo was investigated from FeS04 and NaFeEDTA fortified rice with and without fish and vegetables in 10 borderline iron-deficient subjects. Iron absorption (mg) from NaFeEDTA fortified rice (0.44 +/- 0.11) was significantly greater than from FeS04-fortified rice (0.22 +/- 0.05; p < .05) and the unfortified rice (0.17 +/- 0.02; p < .05). Iron absorption (mg) from a meal consisting of iron-fortified rice, fish, and vegetables was significantly greater from NaFeEDTA (0.88 +/- 0.24) and FeS04 (0.67 +/- 0.10) -fortified rice than from the unfortified rice (0.41 +/- 0.08; p < .05). This study concluded that both NaFeEDTA and FeSO4 are effective iron fortificants for rice. The binder used in the study may have a significant role in the release of iron from iron-fortified rice for absorption. Further studies on the use of other binders to maximize iron release and minimize iron loss during cooking should be conducted to improve iron absorption from the fortified rice/rice-fish-vegetable meals. Results from this study can be used as a basis for food iron fortification programs as well as in the establishment of recommended dietary allowances for iron among Filipinos.

Topics: Adult; Anemia, Iron-Deficiency; Cooking; Digestion; Edetic Acid; Female; Ferric Compounds; Ferrous Compounds; Food, Fortified; Humans; Intestinal Absorption; Iron, Dietary; Male; Nutrition Policy; Oryza; Philippines; Radioisotope Dilution Technique

Fe absorption was measured in adult human subjects consuming different cereal foods fortified with radiolabelled FeSO4, ferrous fumarate or NaFeEDTA, or with radiolabelled FeSO4 or ferric pyrophosphate in combination with different concentrations of Na2EDTA. Mean Fe absorption from wheat, wheat-soyabean and quinoa (Chenopodium quinoa) infant cereals fortified with FeSO4 or ferrous fumarate ranged from 0.6 to 2.2%. For each infant cereal, mean Fe absorption from ferrous fumarate was similar to that from FeSO4 (absorption ratio 0.91-1.28). Mean Fe absorption from FeSO4-fortified bread rolls was 1.0% when made from high-extraction wheat flour and 5.7% when made from low-extraction wheat flour. Fe absorption from infant cereals and bread rolls fortified with NaFeEDTA was 1.9-3.9 times greater than when the same product was fortified with FeSO4. Both high phytate content and consumption of tea decreased Fe absorption from the NaFeEDTA-fortified rolls. When Na2EDTA up to a 1:1 molar ratio (EDTA:Fe) was added to FeSO4-fortified wheat cereal and wheat-soyabean cereal mean Fe absorption from the wheat cereal increased from 1.0% to a maximum of 5.7% at a molar ratio of 0.67:1, and from the wheat-soyabean cereal from 0.7% to a maximum of 2.9% at a molar ratio of 1:1. Adding Na2EDTA to ferric pyrophosphate-fortified wheat cereal did not significantly increase absorption (P > 0.05). We conclude that Fe absorption is higher from cereal foods fortified with NaFeEDTA than when fortified with FeSO4 or ferrous fumarate, and that Na2EDTA can be added to cereal foods to enhance absorption of soluble Fe-fortification compounds such as FeSO4.

Topics: Absorption; Adolescent; Adult; Bread; Delayed-Action Preparations; Edetic Acid; Edible Grain; Female; Ferrous Compounds; Food Additives; Food, Fortified; Humans; Iron Radioisotopes; Iron, Dietary; Male

Iron deficiency anemia is a relatively common illness that can arise from a number of different causes. Three ferrous salts are usually used in its treatment: ferrous fumarate, gluconate, and sulfate. They are administered orally and are relatively well tolerated. These hematinics have been studied by Mössbauer spectroscopy and X-ray powder diffraction, and can easily be distinguished by both techniques. It was found that the two ferrous sulfates studied (Eckerd and SmithKline Beckman Co.) most closely resemble the monohydrate by comparison of the X-ray powder pattern with those of the JCPDS. Both the ferrous fumarate (Femiron) and gluconate (Spring Valley) had approximately 10% ferric iron present. To the authors' knowledge, this is the first reported Mössbauer spectrum for ferrous fumarate.

Topics: Ferrous Compounds; Hematinics; Spectroscopy, Mossbauer; X-Ray Diffraction

16 patients with recurrent staphylococcal furunculosis but without anaemia had significantly lower serum iron concentrations than normal laboratory reference values, 8 controls with single furuncles, or 10 controls with acne conglobata. There were no significant differences in serum glucose or iron binding capacity between the groups studied. Furunculosis resolved after 3-4 weeks' treatment with iron supplements in all but 1 patient. The relation between iron and susceptibility to infection is unclear, but merits further investigation.

Topics: Adolescent; Adult; Blood Glucose; Child; Disease Susceptibility; Female; Ferrous Compounds; Furunculosis; Humans; Iron Deficiencies; Male; Prospective Studies; Recurrence; Staphylococcal Infections; Time Factors

Using a small-dose iron tolerance test (ITT) in mildly iron-deficient healthy adults, we have examined the phenomenon of mucosal block. First proposed and demonstrated by Hahn et al with radioiron, "mucosal block" describes diminished avidity for iron of the intestinal mucosa following an orally administered blocking dose. In the ITT, the index of absorption is an increase in plasma iron concentration, rather than retained radioactivity. The absorption of a blocked 10-mg test dose of iron was compared with that of a 10-mg control dose given to the same subject. Both 60- and 30-mg blocking doses of iron resulted in diminished absorption of the test dose. The refractory state of the intestine lasted as long as 24 hours.

Topics: Administration, Oral; Adult; Aged; Female; Ferrous Compounds; Humans; Intestinal Absorption; Intestinal Mucosa; Iron; Male; Middle Aged; Time Factors

Most discussions of iron therapy include a statement about the ineffectiveness of iron ingested simultaneously with antacids. This study was designed to determine whether or not antacids inhibit iron absorption. A small-dose iron tolerance test was used to compare absorption of iron with and without various antacids. Liquid antacid containing aluminum hydroxide and magnesium hydroxide did not significantly decrease iron absorption. Sodium bicarbonate and calcium carbonate caused the plasma iron increase to be 50% and 67% less than the control values, respectively. However, when calcium carbonate was present in a multivitamin-plus-minerals tablet, the plasma iron change was not significantly different from control trials. Presumably the competitive binding of iron by ascorbic acid in the vitamin pill allowed uninhibited absorption of the iron. Our results suggest that certain antacids may be combined with iron therapy without reducing the efficacy of the iron.

Topics: Adult; Aged; Aluminum Hydroxide; Antacids; Bicarbonates; Calcium Carbonate; Drug Combinations; Drug Interactions; Female; Ferrous Compounds; Humans; Intestinal Absorption; Iron; Iron Deficiencies; Magnesium Hydroxide; Male; Middle Aged; Simethicone; Sodium; Sodium Bicarbonate

Acute accidental iron poisoning is a common serious and potentially fatal intoxication in the young child. Approximately 1 per cent of such poisonings have a fatal outcome, and outcome is closely related to the early onset of coma or shock. Long-term prognosis is excellent for all survivors of the acute episode, although there are occasional obstructive complications occurring four to six weeks later.

Topics: Acute Disease; Animals; Cardiovascular Diseases; Central Nervous System Diseases; Child; Child, Preschool; Deferoxamine; Diagnosis, Differential; Emergencies; Ferrous Compounds; Gastric Lavage; Gastrointestinal Diseases; Humans; Infant; Ipecac; Iron; Prognosis; Risk; Time Factors; Triage

Ferrous fumarate (Fersamal) and ferrous carbonate (Ferrodic) may produce false-positive results with the orthotolidine tablet tests (Occultest and Hematest) if administered to patients being investigated for alimentary bleeding. Misleading results are also likely if the benzidine test is employed as a filter-paper procedure. Ferrous sulphate, gluconate, succinate, iron and ammonium citrate, and other preparations of iron have no influence on the modern tablet tests for occult alimentary bleeding.

Topics: Blood Chemical Analysis; Clinical Laboratory Techniques; Ferrous Compounds; Fumarates; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Iron; Occult Blood; Pharmacology

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Child; Ferrous Compounds; Humans; Infant; Iron