Background And Relevant Pharmacokinetics

Iron Is an essential mineral found In the body In haem or non-haem form. The average human body contains 2-4 g of Iron. Although the metal exists In several oxidation states in nature, only the ferrous (Fe2+) and ferric (Fe3+) forms are stable in the aqueous environment of the body (Groff & Gropper 2000).

Iron is found in the body in: haemoglobin (65%); myoglobin (10%); enzymes (1-5%); the transport form, transferrin (0.05%); and the storage forms ferritin (4-9%) and haemosiderin (1-4%).

The haem form of iron is more soluble than the non-haem form and is absorbed 2-3 times more readily. It is absorbed via mucosal cells in the small intestine. Non-haem iron is bound to other substances in food, and must first be liberated by gastric secretions such as hydrochloric acid and pepsin. As such, absorption is best in the acidic environment of the stomach (Groff & Gropper 2000).

Clinical note— Factors affecting the absorption of iron

If the dietary intake of iron is adequate, it is often assumed that a patient's iron levels will be within the normal range. In practice, this is not always the case as absorption is significantly affected by a number of factors, thereby increasing or decreasing the amount of ingested dietary iron that reaches the systemic circulation.

Here is a brief summary of the main influences on absorption. SOLUBILITY ENHANCERS OF NON-HAEM IRON

• Acids (including ascorbic acid) aid solubility of non-haem iron, thus improving absorption; the addition of 20 mg ascorbic acid has been shown to increase non-haem iron absorption by 39% (Hallberg et al 2003).

• Meat stimulates digestive secretions, and breakdown products such as cysteine-containing peptides aid absorption (Hurrell et al 1988). The addition of red meat increases non-haem iron absorption by 85% (Hallberg et al 2003). This appears to be dose-dependent, as a recent study found that the addition of 60 g Danish pork meat three times daily improved the absorption of non-haem iron from 5.3% to 7.9% (Bach-Kristensen et al 2005) although addition of smaller amounts were not as effective (Baech et al 2003). Iron 735

• Alcohol appears to Improve Iron uptake. The consumption of up to two alcoholic drinks per day Is associated with reduced risk of Iron deficiency and more than two can increase the risk of iron overload (loannou et al 2004).

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