Milman Nils Thorm
Department of Clinical Biochemistry, Naestved Hospital, University College Zealand, DK-4700 Naestved, Denmark. Email:
Gastroenterology Res. 2021 Apr;14(2):66-80. doi: 10.14740/gr1366. Epub 2021 Apr 21.
Genetic hemochromatosis causes iron overload by excess absorption of dietary iron, due to a decreased expression of hepcidin. The objective was to elaborate dietary recommendations that can reduce intestinal iron absorption in hemochromatosis patients, based on our present knowledge of the iron contained in nutrients and the mechanisms of iron uptake. This is a narrative review. Literature search in PubMed and Google Scholar of papers dealing with iron absorption from the diet was conducted. Most important proposed dietary recommendations are: 1) Choose a varied vegetarian, semi-vegetarian or flexitarian diet. A "veggie-lacto-ovo-poultry-pescetarian" diet seems optimal. Avoid iron enriched foods and iron supplements. 2) Eat many vegetables and fruits, at least 600 g per day. Choose protein rich pulses and legumes (e.g., kidney- and soya beans). Fresh fruits should be eaten between meals. 3) Abstain from red meat from mammals and choose the lean, white meat from poultry. Avoid processed meat, offal and blood containing foods. Eat no more than 200 g meat from poultry per week. Choose fish, eggs, vegetables and protein rich legumes the other days. Eat fish two to four times a week as main course, 350 - 500 g fish per week, of which half should be fat fish. 4) Choose whole grain products in cereals and bread. Avoid iron enriched grains. Choose non-sourdough, yeast-fermented bread with at least 50% whole grain. 5) Choose vegetable oils, and low-fat dairy products. 6) Eat less sugar and salt. Choose whole foods and foods with minimal processing and none or little added sugar or salt. 7) Quench your thirst in water. Drink green- or black tea, coffee, or low-fat milk with the meals, alternatively water or non-alcoholic beer. Fruit juices must be consumed between meals. Abstain from alcoholic beverages. Drink soft drinks, non-alcoholic beer, or non-alcoholic wine instead. These advices are close to the official Danish dietary recommendations in 2021. In the management of hemochromatosis, dietary modifications that lower iron intake and decrease iron bioavailability may provide additional measures to reduce iron uptake from the foods and reduce the number of phlebotomies. However, there is a need for large, prospective, randomized studies that specifically evaluate the effect of dietary interventions.
遗传性血色素沉着症会因铁调素表达降低导致膳食铁吸收过多，从而引起铁过载。目的是根据我们目前对营养素中铁含量及铁吸收机制的了解，制定能减少血色素沉着症患者肠道铁吸收的饮食建议。这是一篇叙述性综述。我们在PubMed和谷歌学术上检索了有关饮食中铁吸收的文献。最重要的饮食建议如下：1）选择多样化的素食、半素食或弹性素食饮食。“蔬菜-乳-蛋-禽-鱼素食”饮食似乎最为理想。避免食用富含铁的食物和铁补充剂。2）多吃蔬菜和水果，每天至少600克。选择富含蛋白质的豆类（如芸豆和大豆）。新鲜水果应在两餐之间食用。3）不吃哺乳动物的红肉，选择禽肉中的瘦肉、白肉。避免食用加工肉类、动物内脏和含血食物。每周食用禽肉不超过200克。其他日子选择鱼类、蛋类、蔬菜和富含蛋白质的豆类。每周吃两到四次鱼作为主菜，每周350 - 500克鱼，其中一半应为富含脂肪的鱼类。4）选择全谷物谷物产品和面包。避免食用富含铁的谷物。选择非酸面团、酵母发酵且全麦含量至少50%的面包。5）选择植物油和低脂乳制品。6）少吃糖和盐。选择天然食品以及加工最少、不添加或很少添加糖或盐的食品。7）以水止渴。用餐时饮用绿茶、红茶、咖啡或低脂牛奶，也可选择水或无酒精啤酒。果汁必须在两餐之间饮用。避免饮用酒精饮料。可饮用软饮料、无酒精啤酒或无酒精葡萄酒代替。这些建议与丹麦2021年的官方饮食建议相近。在血色素沉着症的管理中，降低铁摄入量并减少铁生物利用度的饮食调整可能为减少食物中铁的吸收以及减少放血次数提供额外措施。然而，需要进行大型、前瞻性、随机研究来具体评估饮食干预的效果。
