Laboratory of Human Nutrition, ETH Zurich, Switzerland.
Pediatric Department, Msambweni County Referral Hospital, Msambweni, Kenya.
Am J Clin Nutr. 2020 Oct 1;112(4):1132-1141. doi: 10.1093/ajcn/nqaa174.
In adults, oral iron doses increase plasma hepcidin (PHep) for 24 h, but not for 48 h, and there is a circadian increase in PHep over the day. Because high PHep decreases fractional iron absorption (FIA), alternate day iron dosing in the morning may be preferable to consecutive day dosing. Whether these effects occur in infants is uncertain.
Using stable iron isotopes in Kenyan infants, we compared FIA from morning and afternoon doses and from consecutive, alternate (every second day) and every third day iron doses.
In prospective studies, we measured and compared FIA and the PHep response from 1) meals fortified with a 12-mg iron micronutrient powder given in the morning or afternoon (n = 22); 2) the same given on consecutive or alternate days (n = 21); and 3) a 12-mg iron supplement given on alternate days or every third day (n = 24).
In total, 65.7% of infants were anemic. In study 1, PHep did not differ between morning and afternoon (P = 0.072), and geometric mean FIA-SD, +SD did not differ between the morning and afternoon doses [15.9 (8.9, 28.6) and 16.1 (8.7, 29.8), P = 0.877]. In study 2, PHep was increased 24 h after oral iron (P = 0.014), and mean FIA ±SD from the baseline dose [23.3 (10.9)] was greater than that from the consecutive day dose (at 24 h) [20.1 (10.4); P = 0.042] but did not differ from the alternate day dose (at 48 h) [20.9 (13.4); P = 0.145]. In study 3, PHep was not increased 48 and 72 h after oral iron (P = 0.384), and the geometric mean FIA-SD, +SD from doses given at baseline, alternate days, and every third day did not differ [12.7 (7.3, 21.9), 13.8 (7.8, 24.2), and 14.8 (8.8, 24.8), respectively; P = 0.080].
In Kenyan infants given 12 mg oral iron, morning and afternoon doses are comparably absorbed, dosing on consecutive days increases PHep and modestly decreases iron absorption compared with alternate day dosing, and dosing on alternate days or every third day does not increase PHep or decrease absorption. This trial was registered at clinicaltrials.gov as NCT02989311 and NCT03617575.
在成年人中，口服铁剂会在 24 小时内增加血清水杨酸（PHep），但不会在 48 小时内增加，并且 PHep 在一天中存在昼夜节律性增加。由于高 PHep 会降低铁的分数吸收率（FIA），因此早上隔日补铁可能比连续日剂量更可取。这些影响是否发生在婴儿身上尚不确定。
我们使用肯尼亚婴儿的稳定铁同位素，比较了早上和下午剂量以及连续、隔日（每两天一次）和每三天一次铁剂量的 FIA。
在前瞻性研究中，我们测量并比较了 1）早餐中添加 12 毫克铁微量营养素粉末的早餐或下午（n=22）；2）相同的连续或隔日剂量（n=21）；3）隔日或每三天给予 12 毫克铁补充剂（n=24）的 FIA 和 PHep 反应。
总共 65.7%的婴儿贫血。在研究 1 中，早上和下午的 PHep 没有差异（P=0.072），并且早上和下午剂量之间的几何平均 FIA-SD，+SD也没有差异[15.9（8.9，28.6）和 16.1（8.7，29.8），P=0.877]。在研究 2 中，口服铁后 24 小时 PHep 升高（P=0.014），并且从基线剂量开始的平均 FIA±SD[23.3（10.9）]大于连续日剂量（24 小时）[20.1（10.4）；P=0.042]，但与隔日剂量（48 小时）无差异[20.9（13.4）；P=0.145]。在研究 3 中，口服铁后 48 和 72 小时 PHep 未增加（P=0.384），并且从基线、隔日和每三天剂量给予的几何平均 FIA-SD，+SD没有差异[12.7（7.3，21.9），13.8（7.8，24.2）和 14.8（8.8，24.8）；P=0.080]。
在给予 12 毫克口服铁的肯尼亚婴儿中，早上和下午剂量的吸收相当，与隔日剂量相比，连续日剂量会增加 PHep 并适度降低铁吸收，而隔日或每三天剂量不会增加 PHep 或降低吸收。这项试验在 clinicaltrials.gov 上注册为 NCT02989311 和 NCT03617575。
