Iron Absorption in Iron-Deficient Women, Who Received 65 mg Fe with an Indonesian Breakfast, Is Much Better from NaFe(III)EDTA than from Fe(II)SO₄, with an Acceptable Increase of Plasma NTBI. A Randomized Clinical Trial.

Eka Ginanjar,Alida Harahap,Lilik Indrawati,Djumhana Atmakusumah,Ina Timan,Iswari Setianingsih,Joannes Marx

doi:10.3390/ph11030085

Abstract

Plasma non-transferrin-bound iron (NTBI) is potentially harmful due to the generation of free radicals that cause tissue damage in vascular and other diseases. Studies in iron-replete and iron-deficient subjects, receiving a single oral test dose of Fe(II)SO4 or NaFe(III)EDTA with water, revealed that FeSO4 was well absorbed when compared with NaFeEDTA, while only the Fe(II) compound showed a remarkable increase of NTBI. As NaFeEDTA is successfully used for food fortification, a double-blind randomized cross-over trial was conducted in 11 healthy women with uncomplicated iron deficiency. All subjects received a placebo, 6.5 mg FeSO4, 65 mg FeSO4, 6.5 mg NaFeEDTA, and 65 mg NaFeEDTA with a traditional Indonesian breakfast in one-week intervals. Blood tests were carried out every 60 min for five hours. NTBI detection was performed using the fluorescein-labeled apotransferrin method. Plasma iron values were highly increased after 65 mg NaFeEDTA, twice as high as after FeSO4. A similar pattern was seen for NTBI. After 6.5 mg of NaFeEDTA and FeSO4, NTBI was hardly detectable. NaFeEDTA was highly effective for the treatment of iron deficiency if given with a meal, inhibiting the formation of nonabsorbable Fe-complexes, while NTBI did not exceed the range of normal values for iron-replete subjects.

Highlights

Iron deficiency anemia (IDA) is a worldwide health problem, affecting about 2 billion people, in developing countries like Indonesia [1]
Mean transferrin saturation was 7.7% and serum ferritin was less than 20 μg/L These basic data were obtained from examination on minute 0 on the first day of the study when all subjects were only given the test meal: Group A received FeSO4 first, and Group B received NaFeEDTA first
In all three subjects with increased C-reactive protein (CRP), of whom the results were removed from the study, serum iron and non-transferrin-bound iron (NTBI) curves after iron ingestion were flat, even after the administration of 65 mg Fe as NaFeEDTA, and were no different from the 0 mg Fe placebo dose

Summary

Introduction

Iron deficiency anemia (IDA) is a worldwide health problem, affecting about 2 billion people, in developing countries like Indonesia [1]. About 20 years ago in Indonesia, 25–30% of the population (50 to 70 million subjects) suffered from IDA [2]. The management of iron deficiency by oral iron salts and food iron fortification were effective for raising plasma hemoglobin concentration in Indonesia as demonstrated by large family life surveys on anemia prevalence, estimated in 1997, 2000, and 2008 [3]. The prevalence of anemia decreased in all groups studied, e.g., in women >15 years from 36.0 to 26.6%. Iron deficiency anemia remains a health problem in Indonesia due to insufficient nutrient daily intake [4]

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