Brittenham Gary M
Division of Pediatric Hematology, Department of Pediatrics, Columbia University, New York, NY, USA.
Nestle Nutr Inst Workshop Ser. 2012;70:117-27. doi: 10.1159/000337674.
This review considers the safety of iron supplementation and fortification for the prevention and correction of iron deficiency in malaria-endemic areas, with a focus on potential means whereby provision of additional iron might heighten the risks of malaria and other infections. Iron deficiency itself may increase the risk of morbidity and mortality from malaria and other infections. The available evidence indicates that iron interventions are safe in settings without endemic malaria, and, with adequate health care, in regions with high transmission of malaria and other infections. Without regular surveillance and treatment of malaria and other infections, iron supplementation of individuals who are iron deficient seems safe, but individuals who are iron replete may have an increased risk of adverse outcomes. The mechanisms responsible for harmful effects with iron supplementation have not been established. These are likely to include the effects of (a) increased amounts of absorbed iron, with the production of plasma non-transferrin-bound iron, (b) increased amounts of iron in the gastrointestinal tract, with effects on gastrointestinal structural integrity and on gut microflora, and (c) the complex immune effects of iron interventions. Iron fortification appears to be generally safe, although more data from malaria-endemic areas are needed.
本综述探讨了在疟疾流行地区补充铁剂和强化铁元素以预防和纠正缺铁的安全性，重点关注补充额外铁元素可能增加疟疾及其他感染风险的潜在方式。缺铁本身可能会增加患疟疾和其他感染的发病风险及死亡风险。现有证据表明，在没有疟疾流行的地区，以及在疟疾和其他感染高传播地区且有足够医疗保健的情况下，铁干预措施是安全的。如果没有对疟疾和其他感染进行定期监测和治疗，对缺铁个体补充铁剂似乎是安全的，但铁储备充足的个体可能会有更高的不良后果风险。补充铁剂产生有害影响的机制尚未明确。这些机制可能包括：（a）吸收的铁量增加，产生血浆非转铁蛋白结合铁；（b）胃肠道中铁含量增加，影响胃肠道结构完整性和肠道微生物群；（c）铁干预措施的复杂免疫效应。铁强化似乎总体上是安全的，不过仍需要来自疟疾流行地区的更多数据。
