Perspectives on iron absorption

Abstract

Newly established relationships between dietary iron absorption and serum ferritin and between serum ferritin and iron stores permit calculation of amounts of stored iron under different conditions at steady states when absorption equals losses. The rate of growth of stores can also be calculated. All calculations are based on observations and require no model assumptions. Present analyses demonstrated an effective control of iron absorption preventing development of iron overload in otherwise healthy subjects even if the diet is fortified with iron and even if meat intake is high. There are strong relationships between iron requirements, bioavailability of dietary iron, and amounts of stored iron. Our observations that a reduction in iron stores and a calculated decrease of hemoglobin iron had the same increasing effect on iron absorption suggest that the control of iron absorption is mediated from a common cell, which may register both size of iron stores and hemoglobin iron deficit. We suggest that the hepatocyte is that cell. Nutritional iron deficiency is especially critical in menstruating women, in the latter third of pregnancy, during adolescence for both girls and boys, and in the weaning period from 4 to 6 months to 2 years of age. The body possesses remarkable, potential control systems of probable very ancient origin capable of preventing both iron deficiency and iron overload. Present problems with iron deficiency being the most frequent deficiency disorder are related to nonbiological changes in our societies over the most recent 10,000 years. This perspective on iron homeostasis or iron balance is mainly based on studies in humans of clinical and epidemiological observations, trying to understand why iron deficiency is the most frequent deficiency disorder in the world in spite of the ingenious mechanisms in the body that should prevent it. Withdrawal of iron fortification of flour in Sweden in 1994 led to a significant increase in iron deficiency (defined as serum ferritin < 16 g/L) in 15- to 16-year-old girls examined, from 39.3 to 50.4%, and after elimination of possible confounding factors such as effect of common infections. Addition of powdered red meat to weaning foods increased iron absorption three times and up to the level required to meet the high iron requirements during weaning.