Randomized, double-blind, placebo-controlled trial of an iron-fortified food product in female soldiers during military training: relations between iron status, serum hepcidin, and inflammation

Abstract

Iron status degrades in female soldiers during military training. Inflammation-mediated up-regulation of hepcidin, a key mediator of iron homeostasis, may be a contributing factor. We measured the efficacy of an iron-fortified food product for maintaining iron status in female soldiers during basic combat training (BCT) and examined relations between iron status, serum hepcidin concentrations, and inflammation. A randomized, double-blind, placebo-controlled trial was conducted. Volunteers received an iron-fortified food product (total dose = 56 mg Fe/d) or a placebo twice daily during the 9-wk BCT course. Iron-status indicators, serum hepcidin concentrations, and markers of inflammation were measured pre- and post-BCT. BCT affected iron status; serum ferritin concentrations decreased (P < or = 0.05), and concentrations of soluble transferrin receptor (sTfR) and hemoglobin and the red cell distribution width increased (P < or = 0.05). Consumption of the iron-fortified food product attenuated declines in iron status in iron-deficient anemic soldiers; a group-by-time interaction was observed for hemoglobin and sTfR concentrations (P < or = 0.05). Serum hepcidin concentrations were not affected by BCT; however, hepcidin concentrations were lower in iron-deficient anemic soldiers than in those with normal iron status (P < or = 0.05) and were positively associated with serum ferritin (P < or = 0.05) and C-reactive protein (P < or = 0.05) concentrations pre- and post-BCT. Twice-daily consumption of an iron-fortified food product improved iron status in iron-deficient anemic soldiers but not in iron-normal or iron-deficient nonanemic soldiers. Serum hepcidin concentrations were not affected by training but were associated with iron status and inflammation pre- and post-BCT. This trial was registered at clinicaltrials.gov as NCT01100905.