Community

and International

Nutrition

Iron Bioavailability from Diets Consumed by

Different Socioeconomic Strata of the
Venezuelan Population1-2
PETER G. TAYLOR, HERNN MNDEZ-CASTELLANOS,*
CARLOS MARTINEZ-TORRES,
WERNER JAFFE,*
MERCEDES LPEZ DE BLANCO,* MARITZA LANDAETA-JIMNEZ,*
IRENE LEETS, ELEONORA TROPPER, JOSRAMREZ,
MARIA DE LAS NIEVES GARCA CASAL AND MIGUEL LAYRISSE3

Centro de Medicina Experimental, Instituto Venezolano de Investigaciones Cient-ficas(MC)

and *Fundacredesa, Altamira, Caracas, Venezuela

INDEXING KEY WORDS:

absorption Venezuela
iron diet

humans

Since 1972, when the extrinsic tag method was

first used to measure the absorption of dietary heme
and nonheme iron (Cook et al. 1972, Layrisse and
Martinez-Torres
1972), much information has been
accumulated on iron absorption from meals and diets
consumed in different regions of the world (Layrisse
et al. 1990).
The Proyecto Venezuela was a national survey on
growth, nutrition, and the family, conducted between
0022-3166/95 $3.00 1995 American Institute of Nutrition.
Manuscript received 6 October 1993. Initial review completed

Supported in part by Consejo Nacional de Investigaciones Cien

t-ficasy Tecnolgicas (CONICIT), Venezuela, the United Nations
University and the International Atomic Energy Agency.
2The costs of publication of this article were defrayed in part by
the payment of page charges. This article must therefore be hereby
marked "advertisement" in accordance with 18 USC section 1734
solely to indicate this fact.
3To whom correspondence

2 December

1860

should be addressed.

1993. Revision accepted 4 November

1994.

Downloaded from jn.nutrition.org by guest on June 28, 2014

1978 and 1985, that included 38,200 subjects from

different socioeconomic
strata of all regions of
Venezuela (Mndez-Castellano et al. 1985, MndezCastellano and Mndez1986). Partial results of this
survey showing the iron absorption
from seven
typical diets consumed by subjects from socioeco
nomic strata (SES) I-III and V were published previ
ously (Fossi et al. 1987, Layrisse et al. 1988 and 1990).
The present study provides additional information on
iron absorption from typical diets consumed by the
Venezuelan working class (SES IV), for comparison
with the iron absorption from the seven diets previ
ously published, but with more test subjects in each
group. These results complement the existing data on
diets from different parts of the world.
It has generally been assumed that the time of day
at which a meal is consumed does not affect its iron
bioavailability. Our studies were always conducted in
the morning after an overnight fast, irrespective of
whether the test food consumed was a breakfast-,
lunch- or supper-type meal. If the time of food con
sumption affects iron bioavailability, this would com
plicate the comparison of results. Absorption results
of experiments in which the meals were given in the
morning after an overnight fast, or at the customary
time of day are presented here.

ABSTRACT The iron bioavailability from three typical

diets consumed by socioeconomic stratum IV (SES IV
working class) of the Venezuelan population was deter
mined by the extrinsic label method. Although the iron
content of the SES IV diets was about the same (250
/mol/d)as that of upper (SES I-III) and lower (SES V)
socioeconomic strata diets, iron-replete subjects ab
sorbed 43 and 61% more iron from the SES I-III diets
than from the SES IV and V diets, respectively, and
absorption from the main meal of the SES I-IIIdiets was
100% greater. However, iron deficient subjects absorbed
about the same amount of iron (45 /imol/d) from the
SES IV diets as from the SES I-III diets. The SES I-III
diets contained more iron absorption enhancers (as
corbic acid and meat protein) and less of the inhibitor
phytate, than the SES IV and V diets. Iron absorption
from the meals of four diets consumed at different times
during the day was also measured. There was no sig
nificant difference in the percentage iron absorption from
the same meals eaten in the morning after an overnight
fast, and when eaten at the customary time of day. J.
Nutr. 125: 1860-1868, 1995.

DIETARY IRON BIOAVAILABILITY IN VENEZUELA

MATERIALS AND METHODS

participated in these studies. They were in apparent

good health and the low hemoglobin concentrations
of some subjects did not interfere with their daily
work. Results from previous studies on 104 subjects
are also included for comparative
purposes. Only
volunteers from SES V were selected to simplify com
parison of the results and because it is much more
difficult to find iron-deficient subjects in the higher
socioeconomic strata. Although a lack of adaptation
of SES V subjects to an SES I-III diet for example, may
affect results, it was considered more important to
match groups to be compared according to their iron
status, which does exert a very profound effect on
iron absorption. The protocol was approved by the
Committee for the Protection of Human Subjects Par
ticipating in Clinical Investigations of the Instituto
Venezolano de Investigaciones Cient-ficas. Blood he
moglobin concentration,
packed red cell volume
(microhematocrit),
serum iron concentration (Interna
tional Committee for Standardization in Hematology
1978a), unsaturated
iron-binding capacity (Interna
tional Committee for Standardization in Hematology
1978b), and serum ferritin concentration measured by
immunoradiometric
assay (Miles et al. 1974) or by
enzyme-linked
immunosorbent
assay (Flowers et al.
1986) were tested in each subject.
Preparation of radioactive material. The extrinsically labeled food for each meal was prepared by
mixing radioactive iron with the food vehicle ac
cording to the technique described previously (Cook
et al. 1972, Layrisse and Martinez-Torres
1972). Ap
proximately 25 kBq of 59Fe or 74 kBq of 55Fe (Du Pont
NEN Products, Wilmington, DE) was used in each
test. The reference dose of 54 /moliron as ferrous
sulfate was prepared as published (Layrisse et al.
1969).
Iron absorption. All meals were administered in
the morning after an overnight fast, except those
included in the time-of-day studies, which were con
sumed at the customary time (0800, 1200, or 1700 h).
Breakfast was given on d 1 and lunch on d 2. Blood
was drawn 15 d later to determine the hmatologie
characteristics
of the subjects and to measure the
radioactivity in blood samples. The subjects were fed
supper on d 15 and given the reference dose of iron on
d 16. Blood was drawn again on d 30 to measure
radioactivity.
Duplicate 10-mL blood samples together with the
radioactive food and reference standard doses were
prepared for radioactive counting using the technique
of Dern and Hart (1961a and 1961b). Radioactivity
was measured in a liquid scintillation spectrometer.
Triplicate samples of the food administered
were
counted simultaneously
with the blood samples. Iron
absorption from the food was calculated from the 59Fe
and 55Fe activity in the subject's blood, using an
estimate of blood volume based on sex, weight, and
height (Nadler et al. 1962).

Downloaded from jn.nutrition.org by guest on June 28, 2014

Diets. As part of Proyecto Venezuela, typical diets

were established from a survey of 4661 families from
different socioeconomic strata and geographical areas
of Venezuela (Fossi and Alvarez 1991). Families were
chosen at random, and the nature of their food intake
was derived from both interviews and actual weighing
of the food at three visits over 24 h, on two different
days. Diets, representative of those which would be
consumed by a typical individual from a given so
cioeconomic
stratum, were established from these
data, taking into account the most commonly con
sumed food items, the most common combinations of
these items in a meal, and the average weight of each
food item consumed at a given meal.
For the first part of this study, three typical diets
(IV-1, rV-2, and IV-3) consumed by SES IV were pre
pared with the following principal ingredients: IV-1 Breakfast: corn bread, margarine, white cheese, coffee,
milk, sugar. Lunch: black beans, rice, fried plantain,
papaya. Supper: chicken, potato, salad (carrot and
tomato), wheat bread, carbonated
drink; IV-2 Breakfast: corn bread, ham, coffee, milk, sugar.
Lunch: soup (potato and other root vegetables),
minced beef, rice, salad (carrot, tomato, and cabbage),
banana. Supper: spaghetti,
tomato
sauce, white
cheese, mayonnaise, wheat bread, carbonated drink;
IV-3 - Breakfast: white wheat bread, ham, coffee,
milk, sugar. Lunch: fish, potato, fried plantain, rice,
salad (carrot), melon. Supper: corn bread, egg, cheese.
Table 1 shows the nutritional content of these
three SES IV diets, compared to previously reported
diets, two from SES I-III, and five from SES V (Layrisse et al. 1990). The mean levels of iron absorption
inhibitors and enhancers in the diets are shown in
Table 2. In terms of the variety of foods consumed,
the SES V diets were much more monotonous, the
typical diet from a geographical area being consumed
on an almost daily basis, whereas the SES IV and I-III
diets were consumed by a given family every 2-3 d or
more. Tables 1 and 2 differ in that Table 2 defines the
main meal of the day as that which contains the most
meat. This is lunch in eight of the 10 diets, and
supper in diets IV-1 and V-l.
In the second part of the study, four of the abovementioned diets were selected to determine if iron
absorption from a given meal would be affected by the
time of day at which the meal was eaten. Three
typical diets consumed by the lower socioeconomic
stratum of various regions of Venezuela (diets V-2, V4, and V-5, corresponding to Yaracuy, Sucre and Zulia
States, respectively), and one diet by the middle to
upper classes (diet I-III-1) of the capital, Caracas, were
chosen. The nutritional
content of these diets is
shown in Table 1.
Subjects. One hundred forty-nine subjects from
rural areas of Trujillo and MridaStates voluntarily

1861

1862

TAYLOR ET AL.

TABLE 1
socioeconomicDiet

mealSES

Nutritional content of diets consumed by the different Venezuelan

food
energykj246934902641860025912934275082752532

acid\unol05270527061306130570

I-IIII-III-lBreakfastLunchSupperTotalI-III-2BreakfastLunchSupperTotalMean2BreakfastLunchSupperTotalSES

Downloaded from jn.nutrition.org by guest on June 28, 2014

613218
0.945.0

1.04.1

6.235.4

1564
0.535.4

4.892.9

2782695

0.217.9

1.47.1

8.324.8

178
610570

17.76.6

12.054.1

548445
4.175.7

3.419.7

8.176.4

12233
6.242.3

9.8177.1

1632444476722389449264134993042918226204712250398352568

5.212.90.022.034.98.521.50.030.08.519.320.047.89.9

3.77.025.118.250.37.02.231.941.19.312.47.028.77.8

22.62.022.812.637.414.37.112.233.620.323.112.956.312.2

27891756532910827128263831638332993

6103986246001017108034603460282

24.30.00.015.515.59.530.00.039.59.57.00.01

11.117.0160.755.9233.626.2

IVrv-iBreakfastLunchSupperTotalrv-2BreakfastLunchSupperTotalIV-3BreakfastLunchSupperTotalMeanBreakfastLunchSupperTotalSES

514326
1.513.6

0.813.2

5.417.7

8122
3.212.3

8.4105.7

3382594

6.814.0

6.619.0

5.312.6

4792
8623
9.15.2

29.373.9

1939488

7.037.5

7.240.0

0.242.5

19307
20305
5.223.8

12.0209.2

155253630013691922821972335269172232331319330228546ProteinAnimalg11.944.913.870.613.745.222.080.912.8

6.310.14.317.331.78.413.04.225.67.816.211.935.9Vegetableg9.52.73.7,3.97.55.410.423.38.5

6.37.915.021.544.47.313.117.638.05.916.912.335.1Fatg22.443.732.898.910.027.116.753.816.2

7.011.724.622.458.711.813.218.643.613.625.612.852.0Carbohydrateg766366205105658925991

22101116136353101901032949598125318Ascorbic

1051673321217565611901620162strata1IronHeme\unol0.717

7.90.00.022.022.00.016.40.016.40.011.80.01

14.625.2123.4127.9276.539

VV-lBreakfastLunchSupperTotalIV-2BreakfastLunchSupperTotalV-3BreakfastLunchSupperTotalTotal

DIETARY IRON BIOAVAILABILITY IN VENEZUELA

1863

TABLE 1 (continued)
Nutritional content of diets consumed by the different Venezuelan socioeconomic strata1
V-4BreakfastLunchSupperTotalV-5BreakfastLunchSupperTotalMeanBreakfastLunchSupperTotal100027622837659925402996205975952122

2892858

1.214.3

0.512.0

0.720.0

14104
3199
4.1
1462858

2.711.6

1.913.7

3.218.9

5104
5829
4.5 3.9 113.6
14295
2647838

2.133.5

2.632.4

1.750.9

11233
19.9 3.4 83.9
4693.119.311.533.98.818.513.040.37.6
6.24.97.98.020.8737.38.923.56.7
4.29.511.521.942.913.225.318.657.112.0
3.332112972411051005726287
21033657393036803685
550.07.00.07.00.026.40.026.40.015.4
19.1139.553.9212.526.3104.856.1188.6
224.5 3.48.015.016:4
'The compositions of the SES I-III and V diets were published previously (Layrisse et al. 1990).
2Values are means SEMof the diets consumed by each socioeconomic group.

the nonheme iron content of a given diet represented

the about 90% of that really consumed (Fossi and
Alvarez 1991). The amount of additional heme iron
consumed was negligible. Therefore, the nonheme
fraction of the total iron intake and the absorption
values were adjusted by dividing the experimental
data by 0.9.
The total nonheme and heme iron absorption
results were also adjusted in subjects with normal
iron status, because approximately 90% of the total
iron absorbed by the gastrointestinal mucosa is incor
porated into the red cells in these subjects, whereas in
iron deficient subjects close to 100% is incorporated

TABLE 2
Inhibitors and enhancers of iron absorption in the diets consumed by different Venezuelan socioeconomic strata1
Socioeconomic
stratumI-UI

contentn

acid\imol570

\imol2
Main meal3
dietIV
Total

443

128 40
219

52
160605
790

0
744
560

0
570
0170

0
238
53100

Main meal
dietV
Total

115

118 31
233

334
1570
454561

33
165
107117

72
304
105199

0
120
1784

77
58
17
Main meal
129 16
151
1411 334Tannate34588 212EnhancersAscorbic
Total dietIron
242 38InhibitorsPhytatelunol277
232 55Meat2g200
84 17
'Values are means SEMfor the diets consumed by the different strata shown in Table 1. The compositions of the SES I-III and V diets
were published previously (Layrisse et al. 1990|.
2"Meat" as an iron absorption enhancer may be beef, fish, or chicken, depending on the diet.
3The main meal is that which contains meat, generally lunch, but may be also supper.

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It is important to note that although these experi

ments were conducted over a period of years, the
radiolabeling of food, its consumption, the taking of
blood and its preparation for radioactive counting
were conducted using the same protocols in all ex
periments.
Calculations. The three meals for a given diet un
derstandably do not include all of the food eaten
during the day. Additional food is consumed between
meals, but on such an irregular basis that ex
perimental quantification of the contribution to di
etary iron is virtually impossible. From the Proyecto
Venezuela survey data, it was calculated that in fact

TAYLOR ET AL.

1864

paired data was used to compare the iron absorption

results, except those of Table 4, for which the t test
for paired data was used. Geometric means were cal
culated for all absorption data and the serum ferritin
concentration.

RESULTS
Table 1 shows the nutritional content of the three
typical diets consumed by SES IV, compared with the

higher (SES I-III) and lower strata (SES V). The energy
intake was more than 9 MJ/d for subjects consuming
all three diets. Animal protein represented more than
50% of the total protein in the main meal of the day,
i.e., that which contains the most meat (see Materials
and Methods). The mean total iron content of the SES
IV diets (233 imol)was similar to that of the SES I-III
and V diets. Heme iron represented about 10% of the
total iron in the SES IV diets.
The principal iron absorption enhancers of a diet
are protein and ascorbic acid. The mean levels of both
meat and ascorbic acid in the SES IV diets were only
half those measured in the SES I-III diets (Table 2).
With respect to the iron absorption inhibitors, the
SES IV and V diets contained approximately twice as
much phytate as the SES I-III diets. On the other
hand, the SES IV diets contained much less tannate
than both the SES I-III diets, which included coffee,
and the SES V diets, in which black beans were a
principal component.
Table 3 shows the nonheme iron absorption by
subjects fed the SES IV diets. The reference dose
absorption results, as well as the hematological vari
ables, indicated that the three groups were not well
matched in terms of their iron status. Therefore, their
dietary iron absorption results could not be compared
directly. To normalize the absorption results, the iron
absorption percentage for each individual was divided
by the mean reference dose absorption of all the
individuals in the three diet groups, then multiplied
by the reference dose absorption of that particular
individual. In general, the SES IV subjects absorbed a
relatively high percentage of the iron present in the
different meals, for example, 16.6 and 22.0% from
two of the three main meals. This was probably due
to the large proportion of iron-deficient subjects par
ticipating in these studies, over 50% in all three

TABLE 3
Nonheme

iron

absorption

from

three

typical

diets

consumed

by socioeconomic

stratum

IV1

iron absorption2'3Reference
of
DietIV-

1Number

IV-2

rv-3

subjectsn

15Blood

(2 a, 13 9)
12
(2 , 10 9)
12
(2 <J, 11 9)

hemoglobin8/L130

transferrin
saturation%

ferritinS/L

Breakfast

Main meal dose4%

Second meal

23 3Serum

14 1Nonheme3.2 1.4ab

16.6 1.2

7.2 1.2

127 5

30 4

17 1

22.0 1.1a

7.8 1.4

119 4

27 4

17 1

12.6 1.2a

14.6 1.3

4Serum

9.7 1.2a
13.9 l.lb

36.7 1.3

Values are means SEM.

2A11 meals were consumed in the morning after an overnight fast.
3Values in the same column with the same letter are significantly different (P < 0.05).
4Percentage absorption from the reference dose of ferrous sulfate. The iron absorption results were normalized according to the reference
dose absorption

of the individual

seeResults].

Downloaded from jn.nutrition.org by guest on June 28, 2014

(Bothwell et al. 1979). Heme iron absorption was

calculated according to the equation y = 3.34 x-49,
where y is the percentage absorption of heme iron and
x is the measured percentage absorption from the
reference dose (Taylor et al. 1988).
Iron status classification. The iron status of the
subjects was classified as one of the following three
groups: 1) Normal subjects: both serum ferritin con
centration and transferrin saturation within normal
limits (>12 ng/L and >16%, respectively); 2) moderate
iron deficiency: both serum ferritin concentration and
transferrin saturation within normal limits. Iron ab
sorption from the reference dose of 54 ^mol of iron as
ferrous sulfate increased above 35% and the nonheme
iron absorption from meals approximately twice that
observed in normal subjects (Martinez-Torres
et al.
1987); 3) overt iron deficiency: either transferrin satu
ration or ferritin concentration or both below normal
limits.
Chemical analysis. The total iron content of the
vegetable foods and meat was determined by the
digestion method (Bothwell et al. 1979), nonheme
iron by the method of Schricker et al. (1982), phytate
by the method of Haug and Lantzch (1982), and
tannate by the method of Price and Butler (1977).
Statistical analysis. The Student's t test for un

DIETARY IRON BIOAVAILABILITY IN VENEZUELA

1865

TABLE 4
Nonheme iron absorption

from the meals of four diets consumed in the morning or at the usual time of day
by different groups of subjects1

of

transferrin

dose327.2

DietAV-2BAV-4BAV-5BAI-III-lBNumber
subjects111218191217912n|5d,|5d,(Od,(2d,(5d,(5d,(Ic,(3d,69)79)189)179)79)129)89)99)Blood
hemoglobing/L135
saturation%29
ferritinMg/L30
7130

329

135

1.34.2

6.1

4.8

3126
3128

324
326

123
119

1.35.1

1.27.8

6.5
10.6

3.6
4.2

3126
7131

326
627

121
120

1.36.2

1.28.7

16.4
22.3

3.5
2.7

5126
3134

329
426

135
116

1.14.8

1.33.1

19.2
13.4

6.3
9.7

1.128.5

1.132.9

1.133.0

1.2
1Breakfast4.51.4Lunch6.0 "t1.21.31.21.21.11.21.21.2Supper7.4
1.31.21.41.21.21.31.31.3Reference

4Serum

'Values are means SEM.

2The diets shown are V-2, V-4, and V-5 consumed by SES V, and I-III-2 consumed by SES I-III (see Table 1). Iron absorption was compared
between one group (A) of subjects who consumed the meal in the morning, and a second group (B) who consumed the same meal at the
customary time of day. No significant difference was observed (P < 0.05) between A and B for any meal of any of the four diets.
^Percentage absorption from the reference dose of ferrous sulphate. The iron absorption results were normalized according to the reference
dose absorption

of the individual

(see Results).

groups tested. Absorption of iron from breakfast was

greater in the second and third diets, which both
contained ham. The percentage iron absorption was
greatest from the meat-containing
main meal except
diet rV-3 (12.6%), which contained fish. Prolonged
boiling in the preparation of the fish may have af
fected its absorption-enhancing
properties. The sub
jects also absorbed a relatively large percentage of the
iron contained in the second meal of all three diets
(7.2-14.6%).
The nonheme iron absorption from the meals of
four regional diets (shown in Table 1) was compared
when the meals were eaten in the morning or at the
customary time during the day (Table 4). The ab
sorption data were normalized as explained above for

Table 3. Although there was no obvious effect of the

time of day on iron absorption from the meals, a
slight tendency toward a higher percentage iron ab
sorption by the subjects was noted in three meals
when the meal was given at the customary time of
day rather than in the morning. Two of these meals
were lunches and also the principal meal of the day
for their respective diets. Therefore, because they rep
resent the most important dietary iron contribution,
two of the lunches (diets V-4 and V-5) were chosen for
further study. The results of Table 4 were obtained by
comparing the iron absorption from meals eaten at
different times of day by different groups of subjects.
In Table 5, the same subjects were fed both meals to
eliminate
intersubject
variation.
No significant

TABLE 5
Nonheme iron absorption

from the lunches of two diets consumed by the same subjects in the morning or at noon1
iron absorption
consumed3At
from lunch

Diet2V-4

of
subjectsn11

hemoglobing/L135

transferrin
saturation%38

ferritinW/L34

breakfast
time}5.1

time'o4.9
lunch

1.3
4
1
1.4
|4d, 79)
8
33 4Serum
9.9 1.3
12 (5d, 79)Blood
139 4Serum
19 1Nonheme 10.4 1.3At
'Values are means SEM.
2The diets shown are V-4 and V-5 consumed by SES V (see Table 1).
3No significant difference (P < 0.05) was found for either diet in the iron absorption from the lunch meal consumed in the morning,

V-5Number

compared with noon.

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4Serum

TAYLOR ET AL.

1866

DISCUSSION
The results presented here indicate that the iron
absorption from a given meal is not affected by the
time of day at which it is eaten. The sole qualification
to this conclusion is that the results were obtained
with a 4-h fast prior to the meal. Most reports, in
which meals were given in the morning after an
overnight fast, have been based on the assumption
that the time of day does not affect iron absorption
(Cook and Monsen 1975, Gillody et al. 1984, Hallberg
and Rossander 1982, Layrisse et al. 1990), and the
present study confirms the validity of the as
sumption.
The comparison of iron absorption results from the
different diets in Table 6 reveals an interesting point.
The total amount of iron absorbed from the SES IV
diets by normal subjects (mean 14.3 /mol)was almost
as low as that from the SES V diet (mean 12.7 /mol).
Neither meets the mean daily physiological iron re
quirements for men (mean 16.1-17.9 /mol/d),and is
considerably below the >21.4 /mol/d calculated for
women (FAO/WHO 1988). A different situation ex
isted when the iron bioavailability to deficient sub
jects was measured. In this case, the amount of iron
absorbed from the SES IV diets matched the SES I-III
diets, and indicated that in terms of bioavailable iron
for deficient subjects, SES IV diets may be superior to
those consumed by SES V. The overall bioavailability
of iron from the three groups of diets depends on the
levels in the different meals of the iron absorption
inhibitors and enhancers summarized
in Table 2.

TABLE 6
Total iron intake and absorption

from diets consumed by different socioeconomic

strata of Venezuela*

absorption3'4'5Main
of
DietI-IIIIVVNumbersubjectsa1411

status2NormalModerate

ironintake3

24.8239.2
21.4

915

deficiency
Overt
deficiencyNormal

8
1680

Moderate deficiency
Overt
deficiencyNormal

257.1 7.1

2631Iron

Moderate deficiency
Overt deficiencyMean

262.5 12.5

Breakfast1.1

meal\imol16.4

meal3.0

21.2ab31.4

20.5a6.2

66.6ab40.2

21.2C
23.2C
69.3C
22.7d4.8
9.3
41.6
65.5e14.3

30.5
20.28.0

21.8a
22.1ab
70.0a
25.9
17.1 23.0ce
42.3 75.5d
3.4 30.2
21.8 22.3
19.8
6^3.021.
49.6
64.0f12.7

3.4
21.21.2

26.4
21.18.4
19.6b
20.4b
60.0b
20.0
16.2 20.7C
4.6 20.7e
23.4 62.3cd
2.5 20.9
24.5 63.6ef
2.1 21.8Iron 18.2 20.5Second 4.1 21.2fTotal620.5

2.5 24.8
1.8
22.71.4

'Part of the results for the SES I-III and V diets were published previously (Layrisse et al. 1990). Values are means SEM.
^Subjects were classified according to their serum ferritin concentration, transferrin saturation, and absorption from the reference dose of
ferrous sulphate. See Materials and Methods.
3A11 meals were consumed in the morning after
^he mean dietary iron intakes and iron absorption
included in the three basic meals. See Materials and
5Values for iron absorption in the same column
^Total iron absorbed from the 3 meals.

an overnight fast.
results were adjusted to account for additional nonheme iron elements of the diet not
Methods. The intake and absorption figures include both heme and nonheme iron.
with the same letter are significantly different [P < 0.05).

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difference was observed in the absorption of iron from

the two lunches when consumed in the morning or at
noon.
Table 6 shows the mean iron content of the SES IV
diets and the amount absorbed by test subjects in
micromoles, and compares these results to those of
the SES I-III and V diets. The results are adjusted to
include an additional 10% of dietary iron consumed
during the day besides the three meals (see Materials
and Methods), to allow comparison with other total
daily diets. Absorption results from 83/137 subjects
consuming the SES V diets, and 21/34 of those con
suming the SES I-III diets have been published previ
ously (Fossi et al. 1987, Layrisse et al. 1988 and 1990).
In those groups in which the number of subjects
permitted comparison (t test), no statistical difference
was observed that would invalidate pooling of the
data. The results are classified according to the iron
status of the subjects tested. As may be expected, in
all three SES groups, the iron-deficient subjects ab
sorbed approximately
twice as much iron from the
same diet as did the iron-replete (normal) subjects.
Although the three SES group main meals contained
the same quantity of iron (approximately 125 /mol),
the amount absorbed by normal subjects from the SES
I-III meal (16.4 /mol)was twice that from the SES IV
and V meals (8.0 and 8.4 /mol).The main meal
represented 80, 56 and 66% of the total iron absorbed
by normal subjects from the SES I-III, IV, and V diets,
respectively. The higher percentage for the SES I-III
main meal may have been related to a low inhibitor
and high enhancer content (see Table 2).

DIETARY IRON BIOAVAILABILITY IN VENEZUELA

term to define the bioavailable nutrition density of a

diet. The existence of this group of subjects suggests
that the regulatory mechanisms controlling nonheme
iron absorption may be more susceptible to signs of
incipient iron deficiency than those parameters that
may be presently measured in the blood as indicators
of iron status.
These results form a partial response to a proposal
made by a FAO-WHO joint expert consultation report
(1988), concerning the accumulation of data on world
diets. The levels of dietary iron absorption inhibitors
and enhancers, along with the absorption results of
SES rV, add to data already accumulated on SES I-III
and V (Layrisse et al. 1990).
These Venezuelan diets may be classified according
to their iron bioavailability
into one of the three
groups established by the FAO-WHO report (FAOWHO 1988). This report classified diets qualitatively
in terms of their general content (cereals, beans, meat,
fish, ascorbic acid, etc.), and also according to the
percentage of iron absorbed from them by an irondeficient subject. In a previous paper, we extended
this classification to include the quantities of meat,
phytate, and ascorbic acid typically found in the three
categories (Layrisse et al. 1990).
In the main meal of a low iron bioavailability diet,
the phytate content is above 750 /mol,while meat
and ascorbic acid are usually below 50 g and 170
/mol,respectively. In iron-deficient subjects, the per
centage absorption of nonheme iron is about 4%, and
total iron absorption from the daily diet is less than
180 /mol.The typical diets consumed by the lower

socioeconomic strata of Asia and Africa, and some

Latin American countries (Acosta et al. 1984), but not
the Venezuelan diets described here, belong to this
category. The low absorption from these diets ex
plains the high prevalence of iron deficiency anemia
in subjects of all ages.
In the intermediate
bioavailability
diets, the
phytate content of the main meal is also high, but the
intake of meat and ascorbic acid is more than 50 g
and 170 /mol, respectively. In subjects with iron
deficiency, the nonheme iron absorption is -8% from
the main meal, and total iron absorption from the
daily diet is from 180 to 360 /mol.Iron deficiency
anemia is generally found only in the more vulnerable
populations, i.e., children and menstruating
women.
The Venezuelan SES IV and V diets may be placed in
this category, along with those consumed by the
lower-middle and lower socioeconomic strata of San
tiago City, Chile (Acosta et al. 1994).
Finally, the Venezuelan SES I-III diets may be
placed in the high iron bioavailability category, the
main meal being low in phytate but high in meat
(>100 g) and ascorbic acid (>285 /mol),along with
diets consumed in industrialized countries (Hallberg
and Rossander 1982, Rossander et al. 1979). Irondeficient individuals absorb -15% of the nonheme
iron from the main meal, and more than 360 /molof
total iron daily from these diets. The prevalence of
iron deficiency anemia is low and limited to children
<3 y of age and women with hypermenorrhagia.

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1867

1868

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