Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001) / Chapter Skim
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9 Iron
9 Iron
Pages 290-393
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From page 290... ...
for iron. The components of iron requirement used as factors in the mocleling include basal iron losses, menstrual losses, fetal requirements in pregnancy, increased requirement cluring growth for the expansion of blood volume, anci/or increased tissue and storage iron.
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The concentration of myoglobin in muscle is drastically reduced in tissue iron deficiency, thus limiting the rate of diffusion of oxygen from erythrocytes to mitochondria (Dallman, 1986a)
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From page 292... ...
Heme iron is highly bioavailable and little affected by clietary factors. Nonheme iron absorption clepencis on the solubilization of predominately ferric food iron in the acid milieu of the stomach (Raja et al., 1987; Wollenberg and Rummel, 1987)
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The cluoclenal mucosal cells involved in iron absorption are formed in the crypts of Lieberkuhn. They then migrate up the villi becoming functional iron-absorbing cells only when they reach the tips of the villi.
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The iron content of hemosiclerin is variable but generally higher than that of ferritin. While all cells are capable of storing iron, the cells of the liver, spleen, and bone marrow are the primary iron storage sites in humans.
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These basal losses may drop to 0.5 mg/ciay in iron deficiency and may be as high as 2 mg/ciay in iron overload (Bothwell et al., 1979~. Menstrual iron losses are quite variable.
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These authors conclucleci that "tissue factors" such as reduced mitochondrial enzyme activity, decreaseci number of mitochonciria, and altered morphology of the mitochonciria might be responsible for impaired muscle function. Cognitive Development and Intellectual Performance Studies of iron deficiency anemia and behavior in the developing human and in animal models suggest persistent functional changes.
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From page 297... ...
Current thinking about the impact of early iron deficiency anemia attributes some role for "functional isolation," a paradigm in which the normal interaction between stimulation and learning from the physical and social environment is altered (Pollitt et al., 1993; Strupp and Levitsky, 1995)
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, < 110 g/L (third trimester) , and a serum ferritin concentration < 12 1lg/L (CDC, 1989; IOM, 1990)
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From page 299... ...
reported that premature labor was four times more frequent in women with serum ferritin concentrations below 20 ~g/L than in those with higher ferritin concentrations, irrespective of hemoglobin concentration. High hemoglobin concentrations at the time of delivery are also associated with adverse pregnancy outcomes, such as the newborn infant being small for gestational age (Yip, 2000~.
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From page 300... ...
Although there were no differences between the supplemented and unsupplementeci women in cord blood iron inclexes at both 3 and 6 months of age, the children born to iron-supplementeci women haci significantly higher serum ferritin concentrations. Furthermore, it was reported that Apgar scores were significantly higher in infants born to supplementeci mothers.
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From page 301... ...
A similar relationship is present in children in that each 1 ~g/L of serum ferritin is indicative of an iron store of about 0.14 mg/kg (Finch and Huebers, 1982~. When the serum ferritin concentration falls below 12 HAL, the iron stores are totally clepleteci.
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From page 302... ...
Thus, serum ferritin concentration may fall within the normal range in inclivicluals who have no iron stores. Elevated serum ferritin concentrations are also associated with increased ethanol consumption (Leggett et al., 1990; Osler et al., 1998)
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It is less precise than the serum ferritin concentration. About 30 to 40 percent of inclivicluals with iron deficiency anemia have TIBCs that are not elevated (Ravel, 1989~.
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Because commercial assays for sTfR have become available only recently, there is a lack of data relating iron intake to sTfR concentration, as well as relating sTfR concentration to functional outcomes. This indicator may prove to be very useful in identifying
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From page 305... ...
After supplemental iron tablets (60 mg/day) or a placebo were provided to a group of women with mild anemia for 3 months, the women were characterized as having iron deficiency anemia based on a change in hemoglobin concentration in response to the iron supplement that was greater than that which occurred with the placebo.
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The ferritin model employs a combination of serum ferritin concentration, erythrocyte protoporphyrin concentration, and transferrin saturation. The presence of two or more abnormal indicators of iron status is indicative of iron deficiency.
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Instead, the physiological requirement for absorbed iron can be calculated by factorial mocleling of each of the components of iron requirement (basal losses, menstrual losses, and accretion)
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From page 308... ...
Green, University of Witwatersranci, Johannesburg, South Africa, personal communication, 2000) showed that within the substucly groups, body weight was an important explanatory variable for basal iron loss; the other very important variable was magnitude of iron stores.
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Menstrual iron losses have been estimated in a number of studies (Beaton, 1974) (see review by Hefnawi and Yacout, 1978)
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310 DIETARY REFERENCE INTAKES TABLE 9-4 Iron Balance Studies in Adults Average Iron Average Balance Reference Study Group Duration Intake (mg/d)
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The calculation of clietary requirements must be baseci on the maintenance of a well-clefineci iron status. This has been accomplished by setting the neeci for the maintenance of a minimal iron store (serum ferritin concentration cutoff of 15 ~g/L)
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Other organic acids including citric acid, lactic acid, and malic acid have not been stuclieci as thoroughly as ascorbic acid, but they also have some enhancing effects on nonheme iron absorption (Gillooly et al., 1983~. Animal Tissues.
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When preschool children consumed mean calcium intakes of 502 or 1,180 mg/ciay, no difference was observed in the erythrocyte incorporation of iron (Ames et al., 1999~. Despite the significant reduction of iron absorption by calcium in single meals, little effect has been observed on serum ferritin concentrations in supplementation trials with supplement levels ranging from 1,000 to 1,500 mg/ciay of calcium (Dalton et al., 1997; Minihane and Fairweather-Tait, 1998; Sokoll and Dawson-Hughes, 1992~.
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The selection of this criterion for acloquate iron balance is critical to determining the EAR because iron absorption is controlleci primarily by the size of iron stores. As iron stores rise, the percentage of clietary iron absorption and apparent bioavailability fall (Cook et al., 1974~.
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After correcting nonheme iron values (to a serum ferritin concentration of 15 ~g/L) , the bioavailability of nonheme iron in self-selecteci diets was 16.8 percent ~ t34 ~g/L .
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From page 316... ...
that reflects the observed mean iron intake of infants principally feci human milk. At birth, the normal full-term infant has a considerable enclowment of iron and a very high hemoglobin concentration.
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Because the early, inappropriate ingestion of cow milk is associated with a higher risk of iron deficiency anemia, it would be prudent to monitor iron status of any infants ingesting cow milk. If anemia is detected, it should be treated with an appropriate close of medicinal iron.
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318 DIETARY REFERENCE INTAKES TABLE 9-5 Iron Concentration in Human Milk Milk Estimated Maternal Concen- Iron Intake Study Intake Stage of tration of Infants Reference Group (mg/d) Lactation (mg/L)
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, it is appropriate to make provision for the maintenance and development of moclest iron stores in early life, even though requirements for older children, adolescents, and adults do not make provision for iron storage as a part of requirement. For infants over the age of 6 months, it becomes both feasible and desirable to model the factorial components of absorbed iron requirements to set the Estimated Average Requirement (EAR)
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, the meclian hemoglobin concentration as 120 g/L, and the iron content of hemoglobin as 3.39 mg/g (Smith and Rios, 1974) , then the amount of iron utilized for increase in hemoglobin mass can also be estimated:
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Total Requirement for Absorbed Iron. Median total iron deposition (hemoglobin mass + nonstorage iron + iron storage)
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, may continue. Iron absorption averaged 14.8 percent in human milk (Abrams et al., 1997~.
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0.1~. Iron EAR and RDA Summary, Ages 7 through I2 Months The EAR has been set by mocleling the components of iron requirements, estimating the requirement for absorbed iron at the
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The model is presented for males and females though gender is ignored in deriving the EAR for young children because the gender differences are sufficiently small. The major components of iron need for young children are: · basal iron losses; · increase in hemoglobin mass; · increase in tissue (nonstorage iron)
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Basal Losses. Basal iron losses for children, aged 1.5 to 8.5 years, were derived from the total body iron losses directly measured from adult men (Green et al., 1968)
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. c Hemoglobin concentrations estimates from Beaton et al.
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Dietary Iron Bioavailability. Based on a heme iron intake of 11 percent of total iron for children 1 to 8 years old, the upper limit of absorption is 18 percent (see "Factors Affecting the Iron Requirement Algorithms for Estimating Dietary Iron Bioavailability" and Appendix Table I-2.
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for Young Children Requirement for Absorbed Iron (mg/d) Dietary Reference Intakesa (mg/d)
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From page 329... ...
Iron EAR and RDA Summary, Ages ~ through ~ Years The EAR has been set by mocleling the components of iron requirements, estimating the requirement for absorbed iron at the fiftieth percentile, and with use of an upper limit of 18 percent iron absorption and rounding (see Table 9-8 and Appendix Table IBM. EAR for Children 1-3 years 4-8 years 3.0 mg/day of iron 4.1 mg/day of iron The RDA has been set by mocleling the components of iron requirements, estimating the requirement for absorbed iron at the ninety-seven and one-half percentile, and with use of an upper limit of 18 percent iron absorption and rounding (see Table 9-8 and Appendix Table IBM.
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The major physiological event occurring in this age group is puberty. The associated physiological processes that have major impacts on iron requirements are the growth spurt in both sexes, menarche in girls, and the major increase in hemoglobin concentrations in boys.
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Estimation of the net iron utilization for increasing hemoglobin mass necessitates estimation of the rate of increase in blood volume and estimation of the rate of change in hemoglobin concentration. Blood volume is taken as approximately 75 mL/kg in boys and 66 mL/kg in girls (Hawkins, 1964~.
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From page 332... ...
b 13 53.5 0.75 0.64 0.003 0 (0.45) b 14 53.4 0.75 0.14 0.001 0 0.45 15 56.9 0.80 0.14 0.001 0 0.45 16 55.6 0.78 0.14 0.001 0 0.45 17 60.0 0.83 0.15 0.001 0 0.45 18 58.0 0.81 0.10 0 0 0.45 a Summation of the median iron components and dividing by 18 percent bioavailability does not yield values that are equivalent to the 50th and 97.5th percentile data shown in Appendix Table I-3.
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From page 333... ...
. The median need for absorbed iron associated with increase in weight in both sexes is Tissue iron = Weight gain (kg/year)
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From page 334... ...
Menstrual Losses. Iron losses in the menses can be calculated when the average blood loss, the average hemoglobin concentration, and concentration of iron in hemoglobin (3.39 mg/g)
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The measurement can therefore reasonably be assumed to reflect "usual losses". Blood losses per menstrual cycle were converted into estimated daily iron losses averaged over the whole menstrual cycle.
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Discussion on menstrual iron losses prior to 14
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The upper limit of dietary iron absorption was estimated to be 18 percent and used to set the EAR baseci on the fiftieth percentile of absorbed iron requirements (see "Factors Affecting the Iron Requirement Algorithms for Estimating Dietary Iron Bioavailability"~. Estimation of the Variability of Requirements.
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From page 338... ...
. Iron EAR and RDA Summary, Ages 9 through 18 Years The EAR has been set by modeling the components of iron requirements, estimating the requirement for absorbed iron at the fiftieth percentile, and with use of an upper limit of 18 percent iron absorption and rounding (see Appendix Tables I-3 and Inn.
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From page 339... ...
In the United States, the average age of menarche is about 12.5 years. It is reasonable to assume that by age 14 almost all girls will have started to menstruate, and hence the estimates of iron requirements should include menstrual losses at that time.
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From page 340... ...
The upper limit of dietary iron absorption was estimated to be 18 percent (see "Factors Affecting the Iron Requirement Algorithms for Estimating Dietary Iron Bioavailability"~. Using this value, the EAR is 6 mg/day ( 1.08 mg/day .
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From page 341... ...
Factorial mocleling is again used to estimate the requirement for absorbed iron. Iron requirements for women were estimated by using the customary two-component model: Iron requirement= basal losses + menstrual losses.
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From page 342... ...
. The upper limit of dietary iron absorption was estimated to be 18 percent (see "Factors Affecting the Iron Requirement Algorithms for Estimating Dietary Iron Bioavailability"~.
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Thus with increasing age, the only adjustment macle to the EAR was the reduction associated with menopause. Iron EAR and RDA Summary, Ages I 9 Years and older The EAR has been set by mocleling the components of iron requirements, estimating the requirement for absorbed iron at the fiftieth percentile, and with use of an upper limit of 18 percent iron absorption and rounding (Appenclix Tables I-3 and Inn.
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From page 344... ...
A for Women 19-30 years 31-50 years 51-70 years > 70 years 8 mg/day of iron 8 mg/day of iron 8 mg/day of iron 8 mg/day of iron 18 mg/day of iron 18 mg/day of iron 8 mg/day of iron 8 mg/day of iron Pregnancy Evidence Considered in Estimating the Average Requirement Factorial mocleling is used to estimate meclian requirements of pregnant women (see "Selection of Indicators for Estimating the Requirement for Iron Factorial Mocleling") with use of the equation: Requirement for absorbed iron = basal losses + iron deposited in fetus and related tissues + iron utilized in expansion of hemoglobin mass.
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From page 345... ...
Evidence is neecleci concerning the functional significance of using a somewhat lower cut-off for final hemoglobin concentration. In this connection, it is to be recognizeci that by using a high hemoglobin concentration, the efficiency of dietary iron utilization is being targeted given that iron absorption is strongly affected by body iron status (Beaton, 2000~.
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Dietary Iron Bioavailability. The upper limit of clietary iron absorption is approximately 25 percent during the second and third trimesters (Barrett et al., 1994~.
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2.0 (190) 5.6 TABLE 9-16 Dietary Iron Requirement During Pregnancy Absorbed Iron Absorption Requirement Stage of Gestation Requirement (mg/d)
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approach; · variability of blood iron baseci on variation in hemoglobin concentration (SD of about 9 g/L) ignoring variation in blood volume; and · variation baseci on the responses to level of iron supplementation.
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Until menstruation resumes, assumed to be after 6 months of exclusive breast fouling, meclian iron neecis cluring lactation are estimated as the sum of iron secretion in human milk and basal iron losses calculated for nonpregnant, nonlactating women (0.896 mg/ciay)
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From page 350... ...
, which are known to reduce menstrual blood loss. Although many studies have clocumenteci lower menstrual blood losses among women using oral contraceptives, only one study actually allowoci estimation of the magnitude of reduction, compared to expected loss.
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From page 351... ...
Meat and fish also enhance the absorption of nonheme iron. Therefore, nonheme iron absorption is lower for those consuming vegetarian cliets than for those eating nonve~etarian cliets (Hunt and Rou~heaci, 19991.
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Blood donors have lower serum ferritin concentrations than nonclonors (Milman and Kirchhoff, 1991a, l991b)
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The prevalence of apparently inacloquate intakes is estimated through an assessment of the estimated distribution of usual intakes and by applying risk tables (Appendix Tables I-5, I-6, I-7) derived from the estimated requirement distributions and compared with the estimated prevalence of inacloquate iron status baseci on serum ferritin concentration (see Table 14-1~.
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Intakes (%) < 15 1lg/L < 10 1lg/L 1-3 y, both 10.9 + 4.0 < 5 26 13 4-8 y,both 13.0+3.9 <5 6 9-13 y Male 17.9 + 5.7 < 5 < 5 Female 14.1 + 4.2 < 5 8 14-18 y Male 20.1 + 6.9 < 5 < 5 Female 13.4 + 5.1 10 15 19-30 y Male 19.6 + 6.8 < 5 15 Female 13.2 + 4.1 < 5 13 31-50 y Male 19.6 + 6.8 < 5 < 5 Female 12.7 + 4.6 15-20 16 51-70 y Male 16.9 + 6.3 < 5 < 5 Female 12.3 + 4.1 < 5 < 5 71+ y Male 16.1 + 7.1 < 5 < 5 Female 12.4 + 4.9 < 5 < 5 NOTE: Data are limited to individuals who provided complete and reliable Day 1 dietary intake records.
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From page 355... ...
. The prevalence of inadequate iron intakes for premenopausal women is approximately 20 percent and the prevalence of low serum ferritin concentration is 13 to 16 percent, prevalences indicating that the additional iron requirements due to menstrual losses are not being met in this group of women.
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From page 356... ...
surveys are available to estimate iron intakes (Appenclix Tables C-18, C-l9, D-3, Ebb. Data from these surveys indicate that the meclian ciaily intake of clietary iron by men is approximately 16 to 18 mg/ciay, and the meclian intake by pre- and postmenopausal women is approximately 12 ma/ clay.
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From page 357... ...
High intakes of iron supplements have been associated with reduced zinc absorption as measured by changes in serum zinc concentrations after closing (Fung et al., 1997; Meaclows et al., 1983; O'Brien et al., 2000; Solomons, 1986; Solomons and Jacob, 1981; Solomons et al., 1983)
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From page 358... ...
Secondary Iron Overload. Secondary iron overload occurs when the body iron stores are increased as a consequence of parenteral iron administration, repeated blood transfusions, or hematological clisorclers that increase the rate of iron absorption.
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From page 359... ...
Inclivicluals who are heterozygous for hemochromatosis manifest minor phenotypic expression, usually a slight to moderate increase in serum ferritin concentrations and transferrin saturation (Bulb et al., 1996~. Iron stores are modestly increased but do not continue to rise significantly with increasing age, and the pathological features of homozygous hemochromatosis do not occur.
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From page 360... ...
Supplem Reference Sample Size Study Group Iron (me Coplin et al., 1991 Ferrous sulfate 18-40 y 50 n = 38 women nonpregnant women Randomized double blind, cross-over trial Bis-glycino Fe II 18-40 y 50 (chelated Fe) b nonpregnant women n= 38 women Brock et al., 1985 Ferrous sulfate 18-39 y 50 n = 272 women and menC nonpregnant women Single-blind, parallel group study Ferrous sulfate in wax matrix 18-39 y prep (control group)
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From page 361... ...
IRON CtS, 361 Dose of Supplemental Iron (mg/d) When Taken Duration Results/Comments 50 t women t women t women t women 50 50 50 60 Before 2 wk breakfast Before 8 wk breakfast Before 8 wk breakfast Not indicated 4 wk Not indicated 4 wk 25/38 GI problemsa 7 abdominal pain 10 bloating 13 constipation 9 diarrhea 12 nausea 2 wk 23/38 GI problems 9 abdominal pain 9 bloating 13 constipation 7 diarrhea 9 nausea No placebo control 53 abdominal discomfortd 26 nausead 5 vomiting 47 constipationd 26 diarrhead 25 abdominal discomfort 11 nausea 3 vomiting 18 constipation 13 diarrhea Wax matrix coating was used to help minimize GI distress GI side effects 14% all GI side effected 4% nausea 10% gastric pain 20% constipationd 19% diarrhea GI side effects 25% all GI side effected 6% nausea 19% gastric pain 35% constipationd 37% diarrhea continued
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From page 362... ...
105 Blot et al., 1981 Elemental iron 27.5 + 4.5 y 105 n = 132 pregnant women Lokken and Birkeland, Ferrous fumarate 18-28 y 120 1979 n= 19 Double-blind, cross-over Hallberg et al., 1966c (I) Placebo Blood donors n= 195 Ferrous sulfate Blood donors 222 n= 198 Hallberg et al., 1966c (II)
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From page 363... ...
IRON 363 Dose of Supplemental Iron (mg/d) When Taken Duration Results/Comments 120 (60 mg Before 8.5 wk 63/546 (11%)
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From page 364... ...
Another prospective cohort study reported an association between high serum ferritin concentrations and carotid vascular disease (Kiechl et al., 1997~. However, several other large prospective cohort studies failed to demonstrate a significant relationship between serum ferritin concentrations and increased risk for CHD (Aronow and Ahn, 1996; Frey and Kricler, 1994; Magnusson et al., 1994; Manttari et al., 1994; Stampfer et al., 1993)
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From page 365... ...
Several studies suggest that the serum ferritin concentration is directly correlated with the risk for CHD. However, serum ferritin concentrations are affected by several factors other than clietary iron intake.
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From page 366... ...
L = blood leukocyte count, Fe = serum iron, Ch = total cholesterol, BM = body mass, Hb = hemoglobin concentration, Alc = alcohol intake, AA-1 = Apolipoprotein A-1, Hyp = hypertension. d amount provided as mean concentrations.
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age, other coronary 250 cases No association was observed between risk factors 222 controls serum ferritin concentration and (p = 0.08) f risk of myocardial infarction (in 32 of }8 M)
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From page 368... ...
b MI = myocardial infarction, CHD = coronary heart disease. c BP = blood pressure, Ch = total cholesterol, S = smoking.
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From page 369... ...
was not statistically significant Transferrin saturation inversely related to CHD; not related to MI Transferrin saturation is not related to CHD or MI risk in men or women Transferrin saturation was inversely but not significantly associated with CHD mortality No significant association between transferrin saturation and ischemic heart disease c S = smoking, Alc = alcohol intake, CAD = coronary artery disease, G = blood glucose, Ch = total cholesterol, BMI = body mass index, BP = blood pressure. Alar ase come b Adjusted for These Factors C Relative Risk and Associations CHD Age, systolic BP, Ch, S
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From page 370... ...
nature of the relationship between serum ferritin concentration and CHD risk remain to be determined. Cancer.
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From page 371... ...
association found in women No clear association between total iron binding capacity and IHD c BP = blood pressure, Ch = total cholesterol, S = smoking, HDL = high density lipoprotein cholesterol, Fe = serum iron, Hb = hemoglobin concentration, BMI = body mass index, Alc = alcohol intake. ysis of these ciata showoci a significant positive correlation between transferrin saturation and cancer risk for both men and women (Stevens et al., 1994~.
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From page 372... ...
There is no doubt that iron accumulation in the liver is a risk factor for hepatocellular carcinoma in patients with hemochromatosis. However, the evidence for a relationship between clietary iron intake and cancer, particularly colon cancer, in the general population is inconclusive.
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From page 373... ...
Moreover, no clifferences were found in the serum ferritin concentrations between inclivicluals who fell in the lower and upper quartiles for total clietary iron intake in the Third National Health and Nutrition Examination Survey (NHANES III) (Appendix Table Hey.
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From page 374... ...
Four of these withdrawals occurred cluring the nonheme-containing iron treatment and one occurred just after changing from the nonheme-containing iron treatment to the placebo. To estimate a LOAEL for total iron intake, the LOAEL for supplemental ferrous fumarate intake of 60 mg/ciay for Swedish men and women was acicleci to 11 mg/ciay, the estimated mean iron intake from food in women from six European countries (Van cle Vijver et al., 1999)
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From page 375... ...
Identification of a NOVEL and a LOAEL. No adverse GI effects were reported when 1-month-olci infants were supplemented with ~ ma/ clay of nonheme iron for up to 1 year (Farquhar, 1963)
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From page 376... ...
Similarly, no significant adverse GI effects were reported when 124 infants 11 to 14 months of age were supplemented with 3 mg/kg body weight/day (approximately 30 mg/day) of nonheme iron for 3 months (Reeves and Yip, 1985~.
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From page 377... ...
A UL for subpopulations such as persons with hereditary hemochromatosis can not be cletermineci until information on the relationship between iron intake and the risk of adverse effects from excess iron stores becomes available. A body of experimental evidence suggests that intermittent closing (once or twice per week)
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From page 378... ...
RESEARCH RECOMMENDATIONS FOR IRON · Determination of the significance of high ferritin concentration. · Investigation of the effect of iron absorption and clieta~y iron on phenotypic expressions in individuals with hereditary hemochromatosis.
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From page 379... ...
1996. Three-year follow-up shows no association of serum ferritin levels with incidence of new coronary events in 577 persons aged 2 62 years.
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From page 380... ...
Applications of the two-pool extrinsic tag method to measure heme and non-heme iron absorption from the whole diet. ~ Clin Invest 53:247255.
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From page 381... ...
1974. Serum ferritin as a measure of iron stores in normal subjects.
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From page 382... ...
1975. The effect of tea on iron absorption.
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From page 383... ...
1999. Diabetes and serum ferritin concentration among U.S.
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From page 384... ...
2000. Prediction of dietary iron absorption: An algorithm for calculating absorption and bioavailability of dietary iron.
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From page 385... ...
Nonheme-iron absorption, fecal ferritin excretion, and blood indexes of iron status in women consuming controlled lactoovovegetarian diets for 8 weeks.
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From page 386... ...
1997. Body iron stores and the risk of carotid atherosclerosis: Prospective results from the Bruneck Study.
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From page 387... ...
l991b. The influence of blood donation on iron stores assessed by serum ferritin and hemoglobin in a population survey of 1,359 Danish women.
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From page 388... ...
1994. Body iron stores and risk of colonic neoplasia.
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From page 389... ...
1995. Body iron stores, dietary iron intake and coronary heart disease mortality.
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From page 390... ...
1994. Body iron stores and the risk of coronary heart disease.
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From page 391... ...
1995. Body iron stores and mortality due to cancer and ischaemic heart disease: A 17-year follow-up study of elderly men and women.
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From page 392... ...
1987. Dependence of intestinal iron absorption on the valency state of iron.
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From page 393... ...
2000. Significance of an abnormally low or high hemoglobin concentration during pregnancy: Special consideration of iron nutrition.
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