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Iron supplementation strategies in the developing world remain controversial because of fears of exacerbating prevalent infectious diseases. Understanding the conditions in which iron will be absorbed and incorporated into erythrocytes is therefore important. We studied Gambian children with either postmalarial or nonmalarial anemia, who were given oral iron supplements daily for 30 days. Supplements administered on days 1 and 15 contained the stable iron isotopes (57)Fe and (58)Fe, respectively, and erythrocyte incorporation was measured in blood samples drawn 14 days later. We investigated how the iron-regulatory hormone hepcidin and other inflammatory/iron-related indices, all measured on the day of isotope administration, correlated with erythrocyte iron incorporation. In univariate analyses, hepcidin, ferritin, C-reactive protein, and soluble transferrin receptor (sTfR) strongly predicted incorporation of (57)Fe given on day 1, while hepcidin, ferritin, and sTfR/log ferritin correlated with (58)Fe incorporation. In a final multivariate model, the most consistent predictor of erythrocyte isotope incorporation was hepcidin. We conclude that under conditions of competing signals (anemia, iron deficiency, and infection), hepcidin powerfully controls use of dietary iron. We suggest that low-cost point-of-care hepcidin assays would aid iron supplementation programs in the developing world.

Original publication

DOI

10.1182/blood-2011-11-391219

Type

Journal article

Journal

Blood

Publication Date

23/02/2012

Volume

119

Pages

1922 - 1928

Keywords

Anemia, Iron-Deficiency, Antimalarials, Antimicrobial Cationic Peptides, C-Reactive Protein, Child, Preschool, Drug Administration Schedule, Enzyme-Linked Immunosorbent Assay, Erythrocytes, Ferritins, Gambia, Hepcidins, Humans, Infant, Iron Isotopes, Iron, Dietary, Malaria, Falciparum, Multivariate Analysis, Predictive Value of Tests, Receptors, Transferrin, Time Factors, Treatment Outcome