原花青素对遗传性血色素沉着症和代谢性铁过载综合征患者膳食铁吸收的影响：一项交叉双盲随机对照试验。

Effect of procyanidin on dietary iron absorption in hereditary hemochromatosis and in dysmetabolic iron overload syndrome: A crossover double-blind randomized controlled trial.

机构信息

Internal Medicine Department, University Hospital Clermont-Ferrand, F-63003, France.

Université Clermont Auvergne, INRA, UNH, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand, France.

出版信息

Clin Nutr. 2020 Jan;39(1):97-103. doi: 10.1016/j.clnu.2019.02.012. Epub 2019 Feb 11.

DOI:10.1016/j.clnu.2019.02.012

PMID:30792142

Abstract

BACKGROUND & AIMS: Type I hereditary hemochromatosis (HH) and dysmetabolic iron overload syndrome (DIOS) are the two most prevalent iron overload diseases. Although many food components, particularly polyphenols, reduce iron bioavailability, there is no clinically validated nutritional strategy to reduce food-iron absorption in patients with these diseases. We aimed to determine whether supplementation with 100 mg of procyanidins during a meal reduces dietary iron absorption in patients with HH or DIOS.

METHODS

20 HH and 20 DIOS patients were enrolled in a double-blind three-period crossover randomized study. Basal serum iron level was measured following an overnight fast. Each patient consumed a standardized test iron-rich meal containing 43 mg of iron with two capsules of placebo or procyanidin supplementation. Each period was separated by a 3-day wash-out period. The primary objective was a reduction of dietary iron absorption, assessed by a reduction of serum-iron area under the curve (AUC) corrected for baseline serum iron.

RESULTS

All patients completed the study. The meal and the procyanidin supplements were well tolerated. In both HH and DIOS patients, the iron-rich meal induced a significant increase of serum iron compared with baseline at 120, 180, 240 min, from 8 to 9.1% (p = 0.002, 0.001 and 0.003, respectively) in DIOS and from 15.8 to 25.7% (p < 0.001) in HH. Iron absorption was 3.5-fold higher in HH than in DIOS (p < 0.001). Procyanidin supplementation did not significantly modify iron absorption in DIOS (AUC of added iron 332.87 ± 649.55 vs 312.61 ± 678.61 μmol.h/L, p = 0.916) or in HH (1168.62 ± 652.87 vs 1148.54 μmol.h/L ± 1290.05, p = 0.917).

CONCLUSIONS

An iron-rich test meal led to a marked increase in iron absorption in HH but a mild increase in DIOS. Procyanidin supplementation does not significantly reduce dietary iron absorption in either disease. CLINICAL TRIAL REGISTRY: clinicaltrials.gov (NCT03453918).

摘要

背景与目的

I 型遗传性血色素沉着症（HH）和代谢性铁过载综合征（DIOS）是两种最常见的铁过载疾病。尽管许多食物成分，特别是多酚，会降低铁的生物利用度，但目前还没有经过临床验证的营养策略来减少这些疾病患者的食物铁吸收。我们旨在确定在进餐时补充 100mg 原花青素是否会降低 HH 或 DIOS 患者的膳食铁吸收。

方法

20 名 HH 和 20 名 DIOS 患者参加了一项双盲三周期交叉随机研究。空腹一夜后测量基础血清铁水平。每位患者均服用含 43mg 铁的标准化高铁膳食，同时服用安慰剂或原花青素补充剂两胶囊。每个时期之间间隔 3 天的洗脱期。主要目的是通过校正基础血清铁的血清铁 AUC 减少来评估膳食铁吸收的减少。

结果

所有患者均完成了研究。膳食和原花青素补充剂均耐受良好。在 HH 和 DIOS 患者中，富含铁的膳食在 120、180 和 240 分钟时与基线相比均显著增加血清铁，从 8%增加到 9.1%（p=0.002、0.001 和 0.003，分别）在 DIOS 中，从 15.8%增加到 25.7%（p<0.001）在 HH 中。HH 患者的铁吸收比 DIOS 患者高 3.5 倍（p<0.001）。原花青素补充剂并未显著改变 DIOS 患者的铁吸收（添加铁的 AUC 为 332.87±649.55μmol.h/L 与 312.61±678.61μmol.h/L，p=0.916）或 HH 患者（1168.62±652.87μmol.h/L 与 1148.54±1290.05μmol.h/L，p=0.917）。