Abstract
The relationship between dietary intake, circulating hepcidin and iron status in free-living premenopausal women has not been explored. This cross-sectional study aimed to identify dietary determinants of iron stores after accounting for blood loss and to determine whether iron intake predicts iron stores independently of hepcidin in a sample of Australian women. Three hundred thirty eight women aged 18–50 years were recruited. Total intake and food sources of iron were determined via food frequency questionnaire; the magnitude of menstrual losses was estimated by self-report; and blood donation volume was quantified using blood donation records and self-reported donation frequency. Serum samples were analysed for ferritin, hepcidin and C-reactive protein concentrations. Linear regression was used to investigate associations. Accounting for blood loss, each 1 mg/day increase in dietary iron was associated with a 3% increase in iron stores (p = 0.027); this association was not independent of hepcidin. Hepcidin was a more influential determinant of iron stores than blood loss and dietary factors combined (R2 of model including hepcidin = 0.65; R2 of model excluding hepcidin = 0.17, p for difference <0.001), and increased hepcidin diminished the positive association between iron intake and iron stores. Despite not being the biggest contributor to dietary iron intake, unprocessed meat was positively associated with iron stores, and each 10% increase in consumption was associated with a 1% increase in iron stores (p = 0.006). No other dietary factors were associated with iron stores. Interventions that reduce hepcidin production combined with dietary strategies to increase iron intake may be important means of improving iron status in women with depleted iron stores.
Highlights
IntroductionIt has been estimated that in Australia, 12% of women aged between 16–44 years present with depleted iron stores (serum ferritin < 15 μg/L [2]) and are more likely to experience impaired physical performance [3]
Iron deficiency is the most prevalent nutritional disorder worldwide [1]
The prevalence of low iron stores in the absence of anaemia was 30% (n = 100), and an additional 7% (n = 22) presented with iron-deficiency anaemia
Summary
It has been estimated that in Australia, 12% of women aged between 16–44 years present with depleted iron stores (serum ferritin < 15 μg/L [2]) and are more likely to experience impaired physical performance [3]. Potentially impaired cognitive ability [4,5,6]. Iron homeostasis is maintained via intestinal absorption, with iron absorption increasing when iron status is impaired [7,8]. Absorption is determined in part by hepcidin, a peptide hormone produced by the liver in response to conditions including iron concentration [9]. Hepcidin regulates the export of iron into circulation by binding. When the iron concentration of the body is low, hepcidin production is suppressed, and iron absorption and cycling increase [9]
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