The importance of bioavailability of dietary iron in relation to the expected effect from iron fortification.
BACKGROUND
The most common method of combating iron deficiency is iron fortification, especially in developing countries. However, few studies have shown a significant effect on iron status following iron fortification of low bioavailability diets.


OBJECTIVE
To investigate how iron fortification and dietary modifications affect iron absorption and rates of changes in iron stores.


METHODS
Research has made it possible to predict both iron absorption and the effects of iron fortification and diet modifications on iron stores using recently developed algorithms. Iron absorption and rate of change in iron stores were calculated from nine diets representing a broad range of iron bioavailability and iron contents. The calculations were related to the main target group for iron fortification, that is, women of reproductive age having empty stores but normal haemoglobin concentrations.


RESULTS
As the only measure, iron fortification has practically no effect on iron status if the original diet has low bioavailability. However, after dietary modifications such a diet shows a positive effect on iron stores. The combined action of fortification (6 mg/day) and modest bioavailability changes in a low bioavailability diet results approximately in 40 and 70% greater increases in iron stores than through iron fortification or dietary modification alone.


CONCLUSIONS
It is difficult to achieve good effects on iron status from iron fortification as the only measure if the diet has low bioavailability. Both dietary modifications as well as iron fortification are required to improve effectively the iron status of a population.
Hoppe
M
M
Department of Clinical Nutrition, Institute of Medicine, the Sahlgrenska Academy at Göteborg University, Sweden. Michael.Hoppe@nutrition.gu.se
Hulthén
L
L
Hallberg
L
L
D000465:Algorithms; D001205:Ascorbic Acid / Q000494:pharmacology; D001682:Biological Availability; D002118:Calcium / Q000494:pharmacology; D003906:Developing Countries; D005260:Female; D005527:Food, Fortified; D006801:Humans; D007408:Intestinal Absorption / Q000187:drug effects*; D007501:Iron / Q000097:blood* / Q000378:metabolism; D019266:Iron, Dietary / Q000493:pharmacokinetics*; D010833:Phytic Acid / Q000494:pharmacology; D013634:Tannins / Q000494:pharmacology
D019266:Iron, Dietary; D013634:Tannins; D010833:Phytic Acid; D007501:Iron; D001205:Ascorbic Acid; D002118:Calcium