Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland.
Department of General Routine and Emergency Analysis, Institute of Clinical Chemistry, University Hospital of Zurich, Zurich, Switzerland.
Swiss Med Wkly. 2024 Feb 19;154:3635. doi: 10.57187/s.3635.
Iron deficiency without anaemia is a common health problem, especially in young menstruating women. The efficacy of the usually recommended oral iron supplementation is limited due to increased plasma hepcidin concentration, which reduces iron absorption and leads to side effects such as intestinal irritation. This observation raises the question of how low-dose iron therapy may affect plasma hepcidin levels and whether oral iron intake dose-dependently affects plasma hepcidin production.
Fifteen non-anaemic women with iron deficiency (serum ferritin ≤30 ng/ml) received a single dose of 0, 6, 30, or 60 mg of elemental oral iron as ferrous sulfate on different days. Plasma hepcidin was measured before and seven hours after each dose.
Subjects had an average age of 23 (standard deviation = 3.0) years and serum ferritin of 24 ng/ml (interquartile range = 16-27). The highest mean change in plasma hepcidin levels was measured after ingesting 60 mg of iron, increasing from 2.1 ng/ml (interquartile range = 1.6-2.9) to 4.1 ng/ml (interquartile range = 2.5-6.9; p < 0.001). Iron had a significant dose-dependent effect on the absolute change in plasma hepcidin (p = 0.008), where lower iron dose supplementation resulted in lower plasma hepcidin levels. Serum ferritin levels were significantly correlated with fasting plasma hepcidin levels (R2 = 0.504, p = 0.003) and the change in plasma hepcidin concentration after iron intake (R2 = 0.529, p = 0.002).
We found a dose-dependent effect of iron supplementation on plasma hepcidin levels. Lower iron dosage results in a smaller increase in hepcidin and might thus lead to more efficient intestinal iron absorption and fewer side effects. The effectiveness and side effects of low-dose iron treatment in women with iron deficiency should be further investigated. This study was registered at the Swiss National Clinical Trials Portal (2021-00312) and ClinicalTrials.gov (NCT04735848).
缺铁而不贫血是一种常见的健康问题，尤其是在年轻的经期女性中。由于血浆中hepcidin 浓度增加，通常推荐的口服铁补充剂的疗效有限，这会降低铁的吸收，并导致肠道刺激等副作用。这一观察结果提出了一个问题，即低剂量铁疗法如何影响血浆 hepcidin 水平，以及口服铁摄入量是否剂量依赖性地影响血浆 hepcidin 的产生。
15 名非贫血的缺铁女性（血清铁蛋白≤30ng/ml）在不同天分别服用 0、6、30 或 60mg 元素口服硫酸亚铁。在每次剂量前后 7 小时测量血浆 hepcidin。
受试者的平均年龄为 23 岁（标准差=3.0），血清铁蛋白为 24ng/ml（四分位距=16-27）。摄入 60mg 铁后，血浆 hepcidin 水平的平均变化最大，从 2.1ng/ml（四分位距=1.6-2.9）增加到 4.1ng/ml（四分位距=2.5-6.9；p<0.001）。铁对血浆 hepcidin 绝对变化有显著的剂量依赖性影响（p=0.008），其中较低的铁剂量补充导致较低的血浆 hepcidin 水平。血清铁蛋白水平与空腹血浆 hepcidin 水平显著相关（R2=0.504，p=0.003），与铁摄入后血浆 hepcidin 浓度的变化显著相关（R2=0.529，p=0.002）。
我们发现铁补充剂对血浆 hepcidin 水平有剂量依赖性影响。较低的铁剂量导致 hepcidin 的增加较小，可能导致更有效的肠道铁吸收和更少的副作用。缺铁女性低剂量铁治疗的有效性和副作用应进一步研究。本研究在瑞士国家临床试验注册平台（2021-00312）和 ClinicalTrials.gov（NCT04735848）注册。
