Prentice Andrew M, Mendoza Yery A, Pereira Dora, Cerami Carla, Wegmuller Rita, Constable Anne, Spieldenner Jörg
A.M. Prentice, D. Pereira, C. Cerami, and R. Wegmuller are with the Medical Research Council (MRC) Unit The Gambia, Fajara, Banjul, The Gambia. A.M. Prentice and R. Wegmuller are with the MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom. Y.A. Mendoza, A. Constable, and J. Spieldenner are with the Nestlé Research Centre, Lausanne, Switzerland. D. Pereira is with the Department of Pathology, University of Cambridge, Cambridge, United Kingdom. C. Cerami is with the Division of Infectious Diseases, Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Nutr Rev. 2017 Jan;75(1):49-60. doi: 10.1093/nutrit/nuw055.
In light of evidence that high-dose iron supplements lead to a range of adverse events in low-income settings, the safety and efficacy of lower doses of iron provided through biological or industrial fortification of foodstuffs is reviewed. First, strategies for point-of-manufacture chemical fortification are compared with biofortification achieved through plant breeding. Recent insights into the mechanisms of human iron absorption and regulation, the mechanisms by which iron can promote malaria and bacterial infections, and the role of iron in modifying the gut microbiota are summarized. There is strong evidence that supplemental iron given in nonphysiological amounts can increase the risk of bacterial and protozoal infections (especially malaria), but the use of lower quantities of iron provided within a food matrix, ie, fortified food, should be safer in most cases and represents a more logical strategy for a sustained reduction of the risk of deficiency by providing the best balance of risk and benefits. Further research into iron compounds that would minimize the availability of unabsorbed iron to the gut microbiota is warranted.
鉴于有证据表明高剂量铁补充剂在低收入环境中会导致一系列不良事件，本文对通过食品生物强化或工业强化提供的低剂量铁的安全性和有效性进行了综述。首先，将生产环节化学强化策略与通过植物育种实现的生物强化进行了比较。总结了对人体铁吸收和调节机制、铁促进疟疾和细菌感染的机制以及铁在改变肠道微生物群方面作用的最新见解。有强有力的证据表明，非生理量的补充铁会增加细菌和原生动物感染（尤其是疟疾）的风险，但在食物基质中提供较低量的铁，即强化食品，在大多数情况下应该更安全，并且通过提供最佳的风险和益处平衡，是持续降低缺铁风险的更合理策略。有必要进一步研究能将未吸收铁对肠道微生物群的可用性降至最低的铁化合物。
