Iron absorption in young Indian women: the interaction of iron status with the influence of tea and ascorbic

Prashanth Thankachan, Thomas Walczyk, Sumithra Muthayya, Anura V Kurpad, and Richard F Hurrell
ABSTRACT Background: Ascorbic acid (AA) enhances and tea inhibits iron absorption. It is unclear whether iron status influences the magnitude of this effect. Objective: We evaluated the influence of the iron status of young women on iron absorption from a rice meal with or without added tea or AA. Design: Two stable-isotope iron absorption studies were made in 2 groups of 10 subjects with iron deficiency anemia (IDA) and 10 subjects who were iron replete (control subjects). In study 1, the reference rice meal was fed alone or with 1 or 2 cups of black tea. In study 2, the reference meal was fed alone or with AA (molar ratio to iron, 2:1 or 4:1). Iron absorption was measured by the erythrocyte incorporation of 57Fe and 58Fe labels at 14 d. Results: Mean fractional iron absorption from the reference rice meal was 2.5 times as great in the IDA group as in the control group (P  0.05). The consumption of 1 or 2 cups of tea decreased iron absorption in the control subjects by 49% (P  0.05) or 66% (P  0.01), respectively, and in the IDA group by 59% or 67% (P  0.001 for both), respectively. AA (molar ratio to iron, 2:1 or 4:1) increased iron absorption by 270% or 343%, respectively, in control subjects and by 291% or 350%, respectively, in subjects with IDA (P  0.001). Conclusions: The inhibitory effect of tea and the enhancing effect of AA on iron absorption were similar in the 2 groups. Overall differences in iron absorption in the 2 groups, however, continued to be dictated by iron status. Am J Clin Nutr 2008;87:881– 6.

known (11–13). Polyphenolic compounds such as chlorogenic acids, monomeric flavonoids, and polyphenol polymerization products widely present in coffee and tea also strongly inhibit dietary nonheme-iron absorption (14 –16). The effects of ascorbic acid (AA) in dramatically improving iron absorption have consistently been observed (17–19). Heme iron found in animal foods is also an important iron source because of its high bioavailability (20). In addition, many studies have suggested that the enhancing effect of muscle tissue on iron absorption is due to cysteine-containing peptides (21–23). Another physiologic factor that plays a major role in the amount of iron absorbed is the iron status of a person. Several studies have reported an inverse relation between body iron stores and iron absorption: that is, more iron is absorbed in an iron-deficient state and less iron is absorbed in an iron-replete state (24 –26). Some reports on iron absorption showed it to be similar across a range of iron stores (26 –28). These studies used mainly iron-replete subjects but also subjects with low iron stores, and, hence, the extent to which iron absorption responds to the presence of enhancers or inhibitors in subjects with IDA is not clear. Such information is crucial to an understanding of how modifying dietary enhancers and inhibitors could improve iron status in malnourished populations. The present studies used stable-isotope techniques to study whether iron absorption from a rice meal with or without added tea or AA would differ between iron-deficient anemic women and women with normal iron status.

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It is estimated that 2 billion people worldwide are iron deficient, including 1 billion people who have iron deficiency anemia (IDA) (1). In India, 74% of the children 5 y old and 52% of young women have anemia (2). Young women are particularly vulnerable to iron deficiency because of their greater requirements of iron for menstruation and childbearing. Lower iron absorption could be a major mechanism by which nutritional iron deficiency affects populations (3). Plant-based diets commonly consumed in India and other developing countries contain an abundance of phytates and polyphenols that inhibit the absorption of dietary nonheme iron (4) by forming insoluble complexes, thereby making nonheme iron unavailable for absorption (5, 6). Nonheme iron constitutes 91% of the total iron present in the Indian diet (7). Individual dietary inhibitory and enhancing factors exert profound influences on iron absorption (8 –10). The potent inhibitory effect of phytic acid on nonheme-iron absorption is well

Subjects Two separate studies were performed in a total of 40 women aged 18 –35 y. Each study contained 10 IDA and 10 control subjects, who were recruited from among the staff and students of St John’s Medical College (Bangalore, India). All subjects were in good health, none were pregnant or lactating, and none
1 From the Division of Nutrition, St John’s Research Institute, St John’s National Academy of Health Sciences, Bangalore, India (PT, SM, and AVK), and the Human Nutrition Laboratory, Institute of Food Science and Nutrition, Swiss Federal Institute of Technology Zurich, Switzerland (TW and RFH). 2 Supported by the International Atomic Energy Agency, The Swiss Federal Institute of Technology, and St John’s National Academy of Health Sciences. 3 Reprints not available. Address correspondence to S Muthayya, Division of Nutrition, St John’s Research Institute, St John’s National Academy of Health Sciences, Bangalore, India. E-mail: Received August 1, 2007. Accepted for publication October 24, 2007.

Am J Clin Nutr 2008;87:881– 6. Printed in USA. © 2008 American Society for Nutrition


Food-grade L-AA was procured locally.1 0.1 0. .6 0.6 mg phytate. Preparation of tea and ascorbic acid solution A local brand of Indian tea (Taj Mahal. which was designed so that it contained small amounts of both enhancers and inhibitors of iron absorption (Table 1). water was added. AA.4 0. Finally.0 g/dL and measures of iron status (SF. Rice was added into this mixture.1 0.5 mg/L. Hindustan Lever Ltd. iron absorption from the meal. The experimental protocol was approved by the ethics committees of St John’s Medical College (Bangalore. chili powder.3 Carbohydrate g 46. India) was procured. The 4 test meals administered for each study are shown in Table 2. Reference meal A was always labeled with 57Fe. Test meals Test meal preparation and composition The reference meal consisted of a rice meal (tomato rice). Forty women were selected on the basis of their hemoglobin and iron status and the absence of inflammation or infection during the initial screening.ajcn.3 kcal 207 10 1 1 81 298 g 4. had a history of gastrointestinal or metabolic disorders. The strained tea was kept in a thermos flask until it was served. in the absence and presence of tea (1 or 2 cups) was assessed on consecutive days by the erythrocyte incorporation of 57 Fe and 58Fe over a 29-d period. At the close of study. ascorbic acid. reference meal.1 0. Turmeric. and zinc protoporphyrin concentrations Œ 40 mol/mol heme or soluble transferrin receptors (TfRs) Œ 8. Subjects who regularly consumed vitamin-mineral supplements discontinued the supplementation 2 wk before the start of the study. Mumbai. Switzerland). criteria for the control group were hemoglobin values Œ 12. In study 1. iron absorption from the meal.125 9 2 The reference meal also contained a total of 47. The total polyphenol content of tea was measured by using the FolinCicoalteau method (29) with gallic acid as a standard.8 0. in the absence and presence of AA (at molar ratios of 2:1 or 4:1 with iron) was studied.3 by guest on November 22. Iron absorption was based on the Downloaded from www. 2011 Day (meal type) 1 (A) Isotope label Tea study Ascorbic acid study 57 2 (B) 58 15 (A) 57 16 (C) 58 FeSO4 Test meal Test meal 300 mL water 300 mL water FeSO4 Test meal 150 mL water 150 mL tea Test meal 150 mL water 150 mL water AA at 2:1 molar ratio FeSO4 Test meal Test meal 300 mL water 300 mL water FeSO4 Test meal 300 mL tea Test meal 150 mL water 150 mL water AA at 4:1 molar ratio 1 Test meal composition is shown in Table 1.6 Iron mg 0.882 TABLE 1 Composition of the standard (reference) tomato rice meal1 Ingredients Amount Energy Protein g Rice Tomato Turmeric Chili powder Cooking oil Salt Total 1 THANKACHAN ET AL Fat g 0. Boiling nanopore water (1000 mL) was added to 10 g tea in a glass beaker. serum ferritin (SF) concentrations  12 g/L.0 g/dL. all IDA group subjects were supplemented with ferrous sulfate according to the standard of care. Depending on the type of test meal in study 2 (B or C). Oil was heated in a pan. Test meal A. and salt were added to the purée while it was constantly stirred. as shown in Table 2. Each subject was assigned to meals A and B or A and C on paired test days 1 and 2 and 15 and 16. One gram of the solution of isotope label containing 3 mg 57Fe or 58Fe iron was dispensed (sprayed) onto the surface of the test meal before administration. India) and the Swiss Federal Institute of Technology (Zurich.9 0. and they had been washed with filtered water and dried before use. 1 or 2 mL of the AA stock solution was pipetted into tared glasses. All ingredients were weighed out. Study design Each subject received 2 reference rice meals (meal A) and 2 test meals (one each of B and C) that were labeled with either 57Fe or 58Fe. which were then filled with ultrapure water to a final volume of 150 mL in each glass.0 0.0 9.1 9.1 5.1 0. in which each subject acted as her own control. and TfRs) in the normal range. and tomato purée was added and TABLE 2 Study design and test meal administration1 sautéed in the oil for 5 min.1 0. which was stirred over heat for a further 2 min. The criteria for the IDA group were hemoglobin values  11. and the mixture was left to infuse for 3 min on a magnetic stirrer before straining. None of the subjects had donated blood within 6 mo of the start of the study. Within each study. a randomized crossover study design was used.9 1.1 0. Written informed consent was obtained from all women after they were given a full oral and written description of the aims and procedures of the study and the associated risks.1 48. and kept frozen at 80 °C until use. and the mixture was cooked with constant stirring until done. The meal was prepared in a single large batch for all subjects in both studies. and a stock solution was prepared so that 1 mL of the stock solution corresponded with the 2:1 molar ratio and 2 mL of the stock solution corresponded with the 4:1 molar ratio.125 0. The added iron in test meals B and C was labeled with 58Fe.0 60 45 0. Each cup of black tea (150 mL) served with the test meals in study 1 contained 78 mg polyphenols. so that each pair of meal administrations always had reference meal A with test meal B or reference meal A with test meal C.1 1. All of the utensils used in the preparation and cooking were made of either aluminum or plastic. divided into individual weighed portions (200 g). zinc protoporphyrin.1 0. In study 2.

6% and 19. Bio-Rad) were analyzed within each run. Differences were considered significant at P  0.ajcn. Irvine. Mean fractional iron absorption from the reference meals in both studies was moderate to high. On all study days.7% in the IDA group and between 5. Bremen. Isotopic analysis of the blood samples The method used to analyze the enriched blood samples was similar to our previously described technique (31). Beckman Coulter.1-mol H2SO4/L solution.05. Briefly. All isotopic analysis was carried on a negative thermal ionization–mass spectrometer (MAT 262. body weight was measured to the nearest 0.2% and 9. Boulogne. Measurements were made in stored refrigerated blood within 1 d of collection. Comparisons of iron absorption between IDA and control subjects were made by using the unpaired Student’s t test. A venous blood sample was drawn 14 d after the second meal to measure isotopic composition. Chicago.1 kg (Soehnle. and height was measured to the nearest 1. The dose was calculated on the basis of the estimated amount of circulating iron in the subjects. No intake of food or fluids was allowed for 3 h thereafter. to measure isotopic composition. TX) in plasma samples. World Health Organization–traceable quality-control material (Ramco Laboratories) was processed with each batch of samples for validation of the SF assay.9% enrichment and 58Fe at 93. Iron concentrations were measured by isotope dilution–mass spectrometry against an iron standard prepared gravimetrically from an iron isotope reference material (IRM-014. NJ) and 3-level control material provided by the manufacturer. 2011 Subject characteristics and iron status Anthropometric and iron status measurements of the subjects in the 2 studies are summarized in Table 3. To account for intraindividual and interindividual variations in iron absorption. Calculations The amount of circulating label was calculated on the basis of the shift in the isotopic ratios and the amount of circulating iron in the blood.3 mg native nonheme iron (Table 2) and 3 mg of the added isotope label. Deerfield. This study design with 10 subjects per study group had 80% power to detect a significant difference of 50% in iron absorption between 2 test meals with a significance level of 0. the expected range of fractional iron absorption. After these measurements. Mean iron absorption from both reference meals . The administered dose was determined by weighing the test meal before and after the isotope label was sprayed onto the test meal. Germany). subjects consumed the first meal (A). The test meal containers were washed 3 times with 10 mL ultrapure water to ensure complete consumption of the meal and the isotope label. The shift in isotope ratios measured on day 15 was used as a new baseline for measurement of isotope ratio shifts on day 29. The second meal (B or C) was administered the next day (day 2) under identical conditions. Iron absorption values were logarithmically transformed for statistical analysis. Zinc protoporphyrin was measured in red blood cells after the cells were washed with normal saline with the use of a hematofluorometer (Aviv Biomedical. Assays were calibrated by using the standards provided by the manufacturer (Ramco Laboratories for SF and purified TfR solutions). BioRad. The measured AA content of the meal after cooking was negligible. IL). Lakewood. iron absorption from a given test meal (with added tea or AA solution) was normalized to iron absorption from the reference meal in each individual subject. CA). The second pair of reference and test meals (A and B or C) was administered on days 15 and 16. Measurements of hemoglobin and iron status Hemoglobin concentrations were measured in whole blood by using a Coulter counter (AcT Diff2. Statistical analysis All statistical analyses were conducted with SPSS statistical software (version 13. EU Institute of Reference Material.001 for both studies). All test meals were administered as a breakfast meal under supervision. and the attainable precision of the isotopic by guest on November 22. On day 1. Belgium). Geel. Krefeld. Dade. Iron absorption from reference and test meals Reference meal: effect of iron status All test meals contained 1. Murrhardt. absorption ratios were compared between study intervals by using a paired Student’s t test. 80% incorporation of the absorbed iron into erythrocytes was assumed. the age and anthropometric measures of the subjects were comparable in the IDA and control groups. Paired student’s t tests were used to test differences between iron absorption from the reference meal with or without tea or AA within the IDA and control groups.0 cm by using a stadiometer. Calculations were based on principles of dilution. Control materials (Lyphocheck. SPSS Inc. The observed shift in iron isotope ratios was converted to fractional iron absorption by using standard algorithms (31).2% enrichment: Chemgas. it ranged between 15. and all iron status indicators differed significantly between the groups (P  0. Within each study. 14 d after the second pair of meal administrations.4% in the control group. C-reactive protein was measured in plasma samples by using a particle-enhanced turbidimetric immunoassay (Dimension RXL Chemistry Analyzer. Finnigan MAT. Circulating iron was calculated on the basis of blood volume and hemoglobin concentration.IRON ABSORPTION IN YOUNG INDIAN WOMEN 883 erythrocyte incorporation of isotope labels 14 d after intake of the iron-labeled reference and test meals. and the nonmonoisotopic nature of the labels was taken into consideration (31). Germany) equipped with a multicollector system for simultaneous ion beam detection. The results are presented in Table 4 as geometric means and as absorption ratios. The isotopic composition of the iron in solution was determined by using negative thermal ionization–mass spectrometry. RESULTS Downloaded from www. A final blood sample was drawn on day 29. Stable-isotope labels The preparation of the isotopic labels was similar to the method described by Walczyk et al (30). the labels of [57Fe]-FeSO4 and [58Fe]-FeSO4 were prepared from isotopically enriched elemental iron (57Fe at 95. For identification of a dose-response effect. under conditions identical to those on days 1 and 2. Germany) with 3-level quality-control material (Liquichek. SF and TfRs were calculated by using commercial enzyme-linked immunosorbent assays (Ramco Laboratories. IL). Stafford. respectively.05. subjects reported to the laboratory in a fasted state. France) by dissolution in 0.

8) ] ] ] ] 0.93 2. 2 x SD and x SD in parentheses (all such values). However.3 1.2 12. 10. 26. 10. a dose-related inhibitory effect of tea.26) or 2 cups (P 0.001 0.9 Ascorbic acid study IDA group (n 10) 24.2 (39. respectively. 5P  0.77 0. the increased iron absorption remained in the IDA subjects even after the consumption of tea. Thus.7.001 0.7 10.5 (8.6 (3.1 (4.5 (4.8 (8.29).3 0.001.2 44. Absorption values within each study interval (B/A or C/A) are compared as absorption ratios normalized to iron absorption from the reference meal.87) of tea.52 by guest on November 22. 11.33 0. Test meal: effect of ascorbic acid When added to the meal at a molar ratio to iron of 2:1.2 1.35 1. 3.6) 42.1 (4. 31. 16.58 0.43. respectively. study 2.6.8 –3.7 0.001 for both). 14.3 7.5 3.7 10. 63. 11. Iron absorption from the reference meal consumed with 1 cup of tea was decreased by 59% (P  0. C-reactive protein. Student’s t test was performed on log-transformed values.22 0.4 2. 92.8 9.7) 19.03 (2.62.6 (0.05 97.6 5. A further increase in iron absorption was observed in both the groups with TABLE 4 Fractional iron absorption from the reference meal with or without tea and ascorbic acid (AA)1 IDA group Fractional iron absorption % Tea study Meal A: reference meal B: reference meal A: reference meal C: reference meal AA study Meal A: reference meal B: reference meal A: reference meal C: reference meal 1 Control group Fractional iron absorption % Iron absorption ratio Study and test meal Iron absorption ratio P P 150 mL black tea 300 mL black tea 18. Iron absorption was 1.2 1. x SD (all such values).5.2) 3.51 0.6 0.1 92. 81.98.4 (5.2 (12.18 0.5 (23.14.8 (22. 4 Values presented as geometric x.91 3.5 (2.7 13.8 (22.001 7.4 5.4. An absorption ratio 1 indicates an inhibiting effect of tea.2 1.3.6 6. 29.ajcn.3 1.05 for both).9 51.1.0) 5.2 (2.001) and 66% (P  0.153 0.52 0. study 1. x SD and x SD in parentheses.34 0.6 5. 11.3) 30.4.001 0.0.9) 5.0 2.1 33.2 Variable Age (y) Weight (kg) Height (m) BMI (kg/m2) Blood hemoglobin (g/dL) CRP (mg/L) Serum ferritin ( g/L)4 Serum transferrin receptor (mg/L) Whole-blood zinc protoporphyrin ( mol/mol heme) 1 2 Tea study.6 3.8 (35.04 18.56 0.8) 2.6.50 0.05 0. such a dose response was not observed in the IDA subjects (P 0.1. 33.8) 16.4 77. In the control subjects.5 Significantly different between IDA and control groups: 3P  0.01).73 182. in the same subjects.93 2.0 36.70 3. 57. 3 x SD (all such values).3 26.001 n 10 in both iron-deficient anemia (IDA) and control groups in each study.7 times as high in the IDA group as in the control group in studies 1 and 2 (P  0.4 1.04 21. a significantly higher inhibition of iron absorption was seen with consumption of 2 cups of tea than with that of 1 cup of tea (P  0.7.9 1.4)2 7.4 1.001 7.84) 3. whereas the magnitude of the inhibition was similar irrespective of iron status.1 1.1 44.55 0.7 (13.43 1.2 7.001) and 49% (P  0. 2011 (denoted as “A” in Table 4) was comparable in each of the iron status groups. A comparison of the absorption ratios in the IDA and control groups showed no significant between-group differences with the addition of either 1 cup (P 0.5) 56. an absorption ratio Œ1 indicates an enhancing effect of ascorbic acid.0 2.6) 9. Downloaded from www.5 5. 13. Consumption of 2 cups of tea with the reference meal decreased iron absorption by 67% (P  0.56) 6.29 0.3 9.75 Control group (n 10) 24. ascorbic acid study. 41. CRP.05).93 (0. expressed as a comparison of absorption ratios between the reference meal and the test meals.4) 16.3 2.05) in the IDA and control subjects.45 Control group (n 10) 23. was noted.99 0.05 18.1) ] ] ] ] 0.1 4.4 0.05 21. AA increased iron absorption by 291% in the IDA group and by 270% in the control group (P  0.05.7 0.0. 28.8) 1. 3.41 0. Test meal: effect of tea The addition of a tea drink to the reference meal resulted in a dramatic reduction in iron absorption in both iron status groups (Table 4).3) 2.9 7.4 50. .01 AA (2:1 molar ratio) AA (4:1 molar ratio) 15.66) 9.5.884 TABLE 3 Anthropometry and iron status indicators of the study groups1 THANKACHAN ET AL Tea study IDA group (n 10) 22.7 1.98) 24. 5.5 1.6 3.6 (8. respectively.

there are indications from other studies that the effects of enhancers and inhibitors are probably independent of iron status (26 –28). we observed a 50 –70% reduction in iron absorption with the addition of either 78 or 156 mg polyphenols in black tea to the rice meal. possibly because of the small sample size or a ceiling effect on absorption even at a molar ratio of 2:1. however. The Indian diet. Several studies have shown the inverse relation that exists between iron stores and nonheme-iron absorption in humans (24 –26). they ascribed this finding to the effective sequestration of a good proportion of the iron in unabsorbable tannin complexes.7) as high in IDA subjects than in control subjects in the present study. in the control subjects. Comparison of absorption ratios between the different iron status groups showed no significant differences in the enhancing effect of AA between IDA and controls. such as the present one. a dose effect of the 2 amounts of tea was observed. We thank the staff and students of St John’s Medical College and the College of Nursing for participating in this study. so as to stay in balance (27). With a more inhibitory meal. Therefore. Dietary modifications could perhaps be used to address the needs of irondeficient women in this population. absolute absorption values in the IDA group were significantly higher and proportional to the increase due to the lower iron status. 18. This suggests a stronger physicochemical interaction of polyphenols and iron in the gut for a given amount of tea in the IDA subjects. Downloaded from www. This is due to increases or decreases in iron absorption at the mucosal surface brought about by modulation of the expression of DMTI and other iron transport proteins according to the iron stores (38. was not observed in either of the iron status groups. long-term studies of the adaptability of iron absorption in response to enhancement of food components are clearly needed in the Indian context. All beverages reduced iron absorption depending on the content of total polyphenols. in the IDA group. The increase in absorption due to the addition of AA was similar in both iron status groups. this lack of dose-response effect might not have been seen. The strong enhancing effect of AA on iron absorption observed in the present study confirms previous evidence that AA increases iron absorption in a variety of meals (8. This strong interaction between iron and polyphenols in the tea within the gut lumen was irrespective of iron status. Overall differences in iron absorption in the 2 groups. in absolute terms. Our results confirm earlier findings that tea inhibits iron absorption to a considerable extent (14. respectively. Improving AA intake in the form of fruit and citrus juice in the diet could be a culturally relevant and practical approach to improving iron status in Indian populations. In those studies. One study carried out in Mexico. or uncooked hemoglobin. A dose-related effect between the 2 levels of AA intake. in association with meals with or without enhancers or inhibitors of iron absorption. the effects of different polyphenol-containing beverages on iron absorption from a bread meal were estimated by Hurrell et al (16) from the erythrocyte incorporation of radio-iron. is likely to make iron more available for absorption when supplemented with AA-rich foods. We thank Christophe Zeder and Sabine Renggli (Swiss Federal Institute of Technology Zurich) for their excellent technical assistance in sample prep¨ aration and thermal ionization–mass spectrometry measurements. the possibility that a dose effect was not observed because of an inadequate sample size cannot be disregarded. to which they adapted by absorbing less iron from the highbioavailability diet and more iron from the low-bioavailability diet. Our results also indicated that. Bangalore. have been criticized because they tend to exaggerate the effect of enhancers of iron absorption. which indicated that the enhancing effect is likely to be independent of iron status. However. DISCUSSION This study showed mean fractional iron absorption from the rice meal to be 17. 2011 . bread. Two studies done at the population level also showed that. adaptive responses were observed in iron-replete subjects given meals with low and high iron bioavailability.8 –3. in which limeade containing 25 mg AA was added twice daily to typical Mexican meals for 2 wk. 39). showed that iron absorption increased in iron-deficient women by as much as 345% (50). however. P  0. however.001 for both). India) in the conduct of the study and that of Tinku Thomas with statistical analysis are gratefully acknowledged.5 times (range: 1. As observed in study 1. In conclusion. the effects either were not seen or were far less than those seen in single-meal studies. Hepcidin is also thought to play a regulatory role in iron metabolism by directly affecting the ferroportin transporter within the mucosal basolateral membrane and by preventing iron efflux into the blood (40). This is consistent with earlier rice studies from other countries that have reported a range of iron absorption values from 0. fractional iron absorption in Indian women was relatively high from a simple rice by guest on November 22. the effect was significantly stronger with increasing severity of iron deficiency. with its abundance of phytate and polyphenolic compounds.1% (32–37). However.ajcn. which showed that body iron status primarily dictates the physiologic demand for iron. with the inhibition of black tea the greatest at 79 –94%. 51). AA supplementation taken with meals improved the children’s iron status (49. Fractional iron absorption. No significant dose-response effects of AA when added at molar ratios of 2:1 and 4:1 relative to iron on iron absorption were noted in either group—again. studies on the adaptive effects of greater AA intake on both iron absorption and status have the potential to develop future dietary interventions. In our study. proportional to the existing higher absorption in this group.0% in the control subjects. in children. there was no further inhibition of iron absorption with the consumption of Œ1 cup of tea. Single-meal studies. In the early 1970s. Amounts of only 20 mg polyphenols from black tea per meal reduced iron absorption by as much as 66%. Vani Amalrajan and Kiran Dwarkanath (St John’s Medical College. Long-term controlled trials have reported conflicting results with respect to changes in iron status after increasing dietary AA intake. 16). a rice meal. Disler et al (14) found a significant inhibitory effect of tea on iron absorption from iron salts (FeCl3 and FeSO4). 42– 45). In longterm studies. was higher in the IDA subjects consuming either amount of tea than in the control subjects. More recently. whereas.4% to 9.5% in the IDA subjects and 7. continued to be dictated by iron status. The assistance of Leena Sebastian. possibly because of the higher content of galloyl esters in black tea and possibly because the simple bread meal was devoid of any enhancers of iron absorption to counteract the polyphenols. The strong inhibitory effect of tea and the beneficial effects of AA on iron absorption were of a similar magnitude in iron-replete women and women with IDA. Iron absorption was increased to be 2.IRON ABSORPTION IN YOUNG INDIAN WOMEN 885 AA added at a molar ratio to iron of 4:1 (350% and 343%. which indicate more physiologic complexity (46 – 49). Higher iron absorption values have been reported in blood donors with low iron stores than in nondonors (41).

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