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

acid1–3
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.
SUBJECTS AND METHODS

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INTRODUCTION

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: sumithra@iphcr.res.in. 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

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had a history of gastrointestinal or metabolic disorders. 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. 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. Within each study.1 0.6 Iron mg 0.0 9. in which each subject acted as her own control. Finally. Food-grade L-AA was procured locally. ascorbic acid. and TfRs) in the normal range.1 1. which were then filled with ultrapure water to a final volume of 150 mL in each glass.3 kcal 207 10 1 1 81 298 g 4. Test meals Test meal preparation and composition The reference meal consisted of a rice meal (tomato rice). which was designed so that it contained small amounts of both enhancers and inhibitors of iron absorption (Table 1). 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. and kept frozen at 80 °C until use.4 0. The 4 test meals administered for each study are shown in Table 2.882 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. India) and the Swiss Federal Institute of Technology (Zurich. Reference meal A was always labeled with 57Fe. The added iron in test meals B and C was labeled with 58Fe. all IDA group subjects were supplemented with ferrous sulfate according to the standard of care.1 0. Oil was heated in a pan. in the absence and presence of AA (at molar ratios of 2:1 or 4:1 with iron) was studied. In study 1. Iron absorption was based on the Downloaded from www. Turmeric.0 g/dL.1 0. so that each pair of meal administrations always had reference meal A with test meal B or reference meal A with test meal C. criteria for the control group were hemoglobin values Œ 12.3 Carbohydrate g 46. which was stirred over heat for a further 2 min. Hindustan Lever Ltd. The experimental protocol was approved by the ethics committees of St John’s Medical College (Bangalore. All of the utensils used in the preparation and cooking were made of either aluminum or plastic. In study 2. 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. and the mixture was cooked with constant stirring until done. iron absorption from the meal. Forty women were selected on the basis of their hemoglobin and iron status and the absence of inflammation or infection during the initial screening. 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. Switzerland).0 0. The strained tea was kept in a thermos flask until it was served.1 0.1 9. and tomato purée was added and TABLE 2 Study design and test meal administration1 sautéed in the oil for 5 min.6 mg phytate. and the mixture was left to infuse for 3 min on a magnetic stirrer before straining. 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. Each cup of black tea (150 mL) served with the test meals in study 1 contained 78 mg polyphenols. serum ferritin (SF) concentrations  12 g/L. and zinc protoporphyrin concentrations Œ 40 mol/mol heme or soluble transferrin receptors (TfRs) Œ 8. 1 or 2 mL of the AA stock solution was pipetted into tared glasses. India) was procured.8 0.1 48. zinc protoporphyrin. Preparation of tea and ascorbic acid solution A local brand of Indian tea (Taj Mahal. as shown in Table 2. Test meal A.1 5.6 0.ajcn. water was added. The total polyphenol content of tea was measured by using the FolinCicoalteau method (29) with gallic acid as a standard. Depending on the type of test meal in study 2 (B or C).0 g/dL and measures of iron status (SF. The criteria for the IDA group were hemoglobin values  11.9 0.1 0.0 60 45 0. divided into individual weighed portions (200 g). a randomized crossover study design was used. and salt were added to the purée while it was constantly stirred. Mumbai. The meal was prepared in a single large batch for all subjects in both studies. and they had been washed with filtered water and dried before use. All ingredients were weighed out.1 0. reference meal. iron absorption from the meal. At the close of study. Rice was added into this mixture. chili powder.org by guest on November 22.9 1. . Each subject was assigned to meals A and B or A and C on paired test days 1 and 2 and 15 and 16.3 0.125 9 2 The reference meal also contained a total of 47.5 mg/L. Boiling nanopore water (1000 mL) was added to 10 g tea in a glass beaker. AA.1 0.125 0.1 0. Subjects who regularly consumed vitamin-mineral supplements discontinued the supplementation 2 wk before the start of the study. None of the subjects had donated blood within 6 mo of the start of the study.

To account for intraindividual and interindividual variations in iron absorption.2% and 9. the labels of [57Fe]-FeSO4 and [58Fe]-FeSO4 were prepared from isotopically enriched elemental iron (57Fe at 95. The measured AA content of the meal after cooking was negligible. Lakewood. Zinc protoporphyrin was measured in red blood cells after the cells were washed with normal saline with the use of a hematofluorometer (Aviv Biomedical.05. Mean fractional iron absorption from the reference meals in both studies was moderate to high. The shift in isotope ratios measured on day 15 was used as a new baseline for measurement of isotope ratio shifts on day 29. respectively. Measurements were made in stored refrigerated blood within 1 d of collection. C-reactive protein was measured in plasma samples by using a particle-enhanced turbidimetric immunoassay (Dimension RXL Chemistry Analyzer. Boulogne. subjects reported to the laboratory in a fasted state.9% enrichment and 58Fe at 93. IL). The administered dose was determined by weighing the test meal before and after the isotope label was sprayed onto the test meal. 2011 Subject characteristics and iron status Anthropometric and iron status measurements of the subjects in the 2 studies are summarized in Table 3.05. Chicago. Deerfield. Briefly.org by guest on November 22. and height was measured to the nearest 1. SPSS Inc. Finnigan MAT. 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. BioRad. The test meal containers were washed 3 times with 10 mL ultrapure water to ensure complete consumption of the meal and the isotope label. Iron absorption values were logarithmically transformed for statistical analysis. The results are presented in Table 4 as geometric means and as absorption ratios.7% in the IDA group and between 5.0 cm by using a stadiometer. and all iron status indicators differed significantly between the groups (P  0. Geel. Irvine. Statistical analysis All statistical analyses were conducted with SPSS statistical software (version 13. and the attainable precision of the isotopic analysis. body weight was measured to the nearest 0. After these measurements. to measure isotopic composition. Stafford. Mean iron absorption from both reference meals . subjects consumed the first meal (A). Beckman Coulter. No intake of food or fluids was allowed for 3 h thereafter.6% and 19. Krefeld. World Health Organization–traceable quality-control material (Ramco Laboratories) was processed with each batch of samples for validation of the SF assay. France) by dissolution in 0. The observed shift in iron isotope ratios was converted to fractional iron absorption by using standard algorithms (31).1 kg (Soehnle. under conditions identical to those on days 1 and 2. TX) in plasma samples.3 mg native nonheme iron (Table 2) and 3 mg of the added isotope label. Belgium). Bio-Rad) were analyzed within each run. NJ) and 3-level control material provided by the manufacturer. 80% incorporation of the absorbed iron into erythrocytes was assumed. For identification of a dose-response effect. 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. Stable-isotope labels The preparation of the isotopic labels was similar to the method described by Walczyk et al (30). Germany) with 3-level quality-control material (Liquichek.4% in the control group. A final blood sample was drawn on day 29. Differences were considered significant at P  0. CA). Calculations were based on principles of dilution.001 for both studies). 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. Iron absorption from reference and test meals Reference meal: effect of iron status All test meals contained 1. the age and anthropometric measures of the subjects were comparable in the IDA and control groups. Germany) equipped with a multicollector system for simultaneous ion beam detection. Germany). Dade. Isotopic analysis of the blood samples The method used to analyze the enriched blood samples was similar to our previously described technique (31). A venous blood sample was drawn 14 d after the second meal to measure isotopic composition. 14 d after the second pair of meal administrations.ajcn. The second pair of reference and test meals (A and B or C) was administered on days 15 and 16. All isotopic analysis was carried on a negative thermal ionization–mass spectrometer (MAT 262. 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. Bremen. absorption ratios were compared between study intervals by using a paired Student’s t test. Murrhardt. On day 1.1-mol H2SO4/L solution. The isotopic composition of the iron in solution was determined by using negative thermal ionization–mass spectrometry. On all study days. Iron concentrations were measured by isotope dilution–mass spectrometry against an iron standard prepared gravimetrically from an iron isotope reference material (IRM-014. Circulating iron was calculated on the basis of blood volume and hemoglobin concentration. SF and TfRs were calculated by using commercial enzyme-linked immunosorbent assays (Ramco Laboratories. it ranged between 15. All test meals were administered as a breakfast meal under supervision. The second meal (B or C) was administered the next day (day 2) under identical conditions. The dose was calculated on the basis of the estimated amount of circulating iron in the subjects. EU Institute of Reference Material. Control materials (Lyphocheck. Measurements of hemoglobin and iron status Hemoglobin concentrations were measured in whole blood by using a Coulter counter (AcT Diff2. and the nonmonoisotopic nature of the labels was taken into consideration (31). RESULTS Downloaded from www. IL). Assays were calibrated by using the standards provided by the manufacturer (Ramco Laboratories for SF and purified TfR solutions).IRON ABSORPTION IN YOUNG INDIAN WOMEN 883 erythrocyte incorporation of isotope labels 14 d after intake of the iron-labeled reference and test meals. Comparisons of iron absorption between IDA and control subjects were made by using the unpaired Student’s t test. Within each study.2% enrichment: Chemgas.

such a dose response was not observed in the IDA subjects (P 0.93 2.5. in the same subjects.6) 42. 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. Iron absorption was 1.2 (2.05 for both).1.1 44.3 1.4 (5.6 (0.4 2.2 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.58 0.4 0.4 77. Downloaded from www.9 51.8) 1. .55 0.8) 2.6 0.01 AA (2:1 molar ratio) AA (4:1 molar ratio) 15.51 0.2 1.05).0 2.6.62. AA increased iron absorption by 291% in the IDA group and by 270% in the control group (P  0.2 1.98. An absorption ratio 1 indicates an inhibiting effect of tea.8 (22.7 times as high in the IDA group as in the control group in studies 1 and 2 (P  0. 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 18.41 0.7 (13.52 52.001 0.75 Control group (n 10) 24. 2 x SD and x SD in parentheses (all such values).7 1.0 36. study 1.14.45 Control group (n 10) 23.9 7.2 12.26) or 2 cups (P 0.56 0.2) 3. 63. Iron absorption from the reference meal consumed with 1 cup of tea was decreased by 59% (P  0.1 4.001 0.ajcn. expressed as a comparison of absorption ratios between the reference meal and the test meals. 10.6) 9.0.8 (22.001 for both).03 (2.1 (4.4 50. 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).77 0.04 21.4.1) ] ] ] ] 0.4. x SD (all such values).3 1.7 13.5.98) 24. However.1 (4. 3.84) 3.5.4 1. 57. 11.22 0.17 0. 2011 (denoted as “A” in Table 4) was comparable in each of the iron status groups.001 7.1.18 0.2 44. respectively.6 5. In the control subjects.8) ] ] ] ] 0.9) 5.7. 31.6 (8.6 3. C-reactive protein. a dose-related inhibitory effect of tea.3 9.01).2 (12.5 (2.7 10. 81.3 26. Thus. Test meal: effect of ascorbic acid When added to the meal at a molar ratio to iron of 2:1.29 0. 13.1 1. ascorbic acid study. 41. an absorption ratio Œ1 indicates an enhancing effect of ascorbic acid.29). 29.5 5. 11.org by guest on November 22.5.5 1. the increased iron absorption remained in the IDA subjects even after the consumption of tea.05.7 1.001 n 10 in both iron-deficient anemia (IDA) and control groups in each study.66) 9.3.0) 5.7.9 1.70 3. x SD and x SD in parentheses.6 5.8 9.001) and 49% (P  0.7.6 6.34 0.153 0.05 0. 33.93 (0.0.5 (4.001 0. 3 x SD (all such values).05 21.43 1. 26.884 TABLE 3 Anthropometry and iron status indicators of the study groups1 THANKACHAN ET AL Tea study IDA group (n 10) 22.8 (8.4) 16.8 –3. 14.6 3. 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. 11.001.9 Ascorbic acid study IDA group (n 10) 24.1 92.3) 30. Absorption values within each study interval (B/A or C/A) are compared as absorption ratios normalized to iron absorption from the reference meal.05) in the IDA and control subjects. 16.4)2 7.2 (39.5 3. 92. whereas the magnitude of the inhibition was similar irrespective of iron status.04 18.0 2.33 0.99 0.001 7. respectively. 3.5 Significantly different between IDA and control groups: 3P  0.5) 56. 28.43.5 (23.50 0.1 33. Student’s t test was performed on log-transformed values.56) 6.91 3.35 1.87) of tea. was noted.05 18.3 7. Consumption of 2 cups of tea with the reference meal decreased iron absorption by 67% (P  0.3 2. 10.73 182.7 0.001) and 66% (P  0. CRP. 4 Values presented as geometric x.93 2.2 1.6. 5.4 5.6 (3.3 0.8 (35.7 10.2 7.4 1. respectively. 5P  0.8) 16.3) 2.52 0. study 2.05 97.7) 19.5 (8.

AA supplementation taken with meals improved the children’s iron status (49. Two studies done at the population level also showed that. India) in the conduct of the study and that of Tinku Thomas with statistical analysis are gratefully acknowledged. Bangalore. The assistance of Leena Sebastian. As observed in study 1.1% (32–37). however. such as the present one. A dose-related effect between the 2 levels of AA intake. was higher in the IDA subjects consuming either amount of tea than in the control subjects. However. The Indian diet.ajcn. adaptive responses were observed in iron-replete subjects given meals with low and high iron bioavailability. was not observed in either of the iron status groups. 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. possibly because of the small sample size or a ceiling effect on absorption even at a molar ratio of 2:1. In conclusion. so as to stay in balance (27). continued to be dictated by iron status. This strong interaction between iron and polyphenols in the tea within the gut lumen was irrespective of iron status. Higher iron absorption values have been reported in blood donors with low iron stores than in nondonors (41). Long-term controlled trials have reported conflicting results with respect to changes in iron status after increasing dietary AA intake. Disler et al (14) found a significant inhibitory effect of tea on iron absorption from iron salts (FeCl3 and FeSO4). The increase in absorption due to the addition of AA was similar in both iron status groups. 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. One study carried out in Mexico. Dietary modifications could perhaps be used to address the needs of irondeficient women in this population. in children. with the inhibition of black tea the greatest at 79 –94%. 39). DISCUSSION This study showed mean fractional iron absorption from the rice meal to be 17. 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. in association with meals with or without enhancers or inhibitors of iron absorption. 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. Single-meal studies. Our results also indicated that. More recently. bread. This is consistent with earlier rice studies from other countries that have reported a range of iron absorption values from 0. is likely to make iron more available for absorption when supplemented with AA-rich foods. there was no further inhibition of iron absorption with the consumption of Œ1 cup of tea. All beverages reduced iron absorption depending on the content of total polyphenols. fractional iron absorption in Indian women was relatively high from a simple rice meal.5 times (range: 1. Downloaded from www. showed that iron absorption increased in iron-deficient women by as much as 345% (50). the effects either were not seen or were far less than those seen in single-meal studies. studies on the adaptive effects of greater AA intake on both iron absorption and status have the potential to develop future dietary interventions. Overall differences in iron absorption in the 2 groups. absolute absorption values in the IDA group were significantly higher and proportional to the increase due to the lower iron status. 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. 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). with its abundance of phytate and polyphenolic compounds. in which limeade containing 25 mg AA was added twice daily to typical Mexican meals for 2 wk. This suggests a stronger physicochemical interaction of polyphenols and iron in the gut for a given amount of tea in the IDA subjects. 18. We thank the staff and students of St John’s Medical College and the College of Nursing for participating in this study. 2011 . in absolute terms. 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. Several studies have shown the inverse relation that exists between iron stores and nonheme-iron absorption in humans (24 –26).0% in the control subjects. respectively. Vani Amalrajan and Kiran Dwarkanath (St John’s Medical College. they ascribed this finding to the effective sequestration of a good proportion of the iron in unabsorbable tannin complexes.4% to 9. or uncooked hemoglobin. the possibility that a dose effect was not observed because of an inadequate sample size cannot be disregarded. however. to which they adapted by absorbing less iron from the highbioavailability diet and more iron from the low-bioavailability diet. In longterm studies. 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. 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. 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. have been criticized because they tend to exaggerate the effect of enhancers of iron absorption. In the early 1970s. long-term studies of the adaptability of iron absorption in response to enhancement of food components are clearly needed in the Indian context.5% in the IDA subjects and 7. Comparison of absorption ratios between the different iron status groups showed no significant differences in the enhancing effect of AA between IDA and controls. In our study. Fractional iron absorption.8 –3. which showed that body iron status primarily dictates the physiologic demand for iron. the effect was significantly stronger with increasing severity of iron deficiency. Our results confirm earlier findings that tea inhibits iron absorption to a considerable extent (14. In those studies. which indicated that the enhancing effect is likely to be independent of iron status. this lack of dose-response effect might not have been seen. P  0. However. a rice meal. however.IRON ABSORPTION IN YOUNG INDIAN WOMEN 885 AA added at a molar ratio to iron of 4:1 (350% and 343%. Amounts of only 20 mg polyphenols from black tea per meal reduced iron absorption by as much as 66%.7) as high in IDA subjects than in control subjects in the present study. 51). whereas. which indicate more physiologic complexity (46 – 49). a dose effect of the 2 amounts of tea was observed. 42– 45).001 for both). there are indications from other studies that the effects of enhancers and inhibitors are probably independent of iron status (26 –28). in the IDA group.org by guest on November 22. in the control subjects. 16). With a more inhibitory meal. Iron absorption was increased to be 2. Therefore. proportional to the existing higher absorption in this group.

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