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Cited by 241Iron Metabolism and DisordersErythropoietin and Anemia TreatmentTrace Elements in Health

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Iron absorption from supplements is greater with alternate day than with consecutive day dosing in iron-deficient anemic women

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Stoffel, Nicole U., Zeder, Christophe, Brittenham, Gary M., Moretti, Diego, Zimmermann, Michael B.·2020·Haematologica
DOI 10.3324/haematol.2019.220830PMC PMC7193469
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Abstract

In iron-depleted women without anemia, oral iron supplements induce an increase in serum hepcidin (SHep) that persists for 24 hours, decreasing iron absorption from supplements given later on the same or next day. Consequently, iron absorption from supplements is highest if iron is given on alternate days. Whether this dosing schedule is also beneficial in women with iron-deficiency anemia (IDA) given high-dose iron supplements is uncertain. The primary objective of this study was to assess whether, in women with IDA, alternate-day administration of 100 and 200 mg iron increases iron absorption compared to consecutive-day iron administration. Secondary objectives were to correlate iron absorption with SHep and iron status parameters. We performed a cross-over iron absorption study in women with IDA (n=19; median hemoglobin 11.5 mg/dL; mean serum ferritin 10 mg/L) who received either 100 or 200 mg iron as ferrous sulfate given at 8 AM on days 2, 3 and 5 labeled with stable iron isotopes 57Fe, 58Fe and 54Fe; after a 16-day incorporation period, the other labeled dose was given at 8 AM on days 23, 24 and 26 (days 2, 3 and 5 of the second period). Iron absorption on days 2 and 3 (consecutive) and day 5 (alternate) was assessed by measuring erythrocyte isotope incorporation. For both doses, SHep was higher on day 3 than on day 2 (P

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Figure 1 Study design. SHep: serum hepcidin; RBC: red blood cells.
Figure 1 Study design. SHep: serum hepcidin; RBC: red blood cells.CC BY-NC · PubMed Central
Figure 2 Serum hepcidin in iron-deficient anemic women. In women with iron deficiency anemia (IDA) who received 100 mg and 200 mg oral iron supplements on consecutive (day 3) and alternate days (day 5), serum hepcidin increases at 24 hours (h) and returns to baseline by 48 h .
Figure 2 Serum hepcidin in iron-deficient anemic women. In women with iron deficiency anemia (IDA) who received 100 mg and 200 mg oral iron supplements on consecutive (day 3) and alternate days (day 5), serum hepcidin increases at 24 hours (h) and returns to baseline by 48 h .CC BY-NC · PubMed Central
Figure 3 Iron absorption in iron-deficient anemic women. (A) Fractional iron absorption from 100 and 200 mg oral iron doses was higher during alternate day dosing (day 5) compared to consecutive day dosing (day 3); (B) Total iron absorption from 100 and 200 mg oral iron doses was higher during alternate day dosing (day 5) compared to consecutive day dosing (day 3).
Figure 3 Iron absorption in iron-deficient anemic women. (A) Fractional iron absorption from 100 and 200 mg oral iron doses was higher during alternate day dosing (day 5) compared to consecutive day dosing (day 3); (B) Total iron absorption from 100 and 200 mg oral iron doses was higher during alternate day dosing (day 5) compared to consecutive day dosing (day 3).CC BY-NC · PubMed Central
Figure 4 Serum hepcidin and transferrin saturation profiles in iron-deficient anemic women. (A) Serum hepcidin (Shep) profile during alternate day dosing (day 5) and consecutive day dosing (day 3) with 100 and 200 mg oral iron; (B) Transferrin saturation profile (TSAT) during alternate day dosing (day 5) and consecutive day dosing (day 3) with 100 and 200 mg oral iron.
Figure 4 Serum hepcidin and transferrin saturation profiles in iron-deficient anemic women. (A) Serum hepcidin (Shep) profile during alternate day dosing (day 5) and consecutive day dosing (day 3) with 100 and 200 mg oral iron; (B) Transferrin saturation profile (TSAT) during alternate day dosing (day 5) and consecutive day dosing (day 3) with 100 and 200 mg oral iron.CC BY-NC · PubMed Central

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Metadata

Authors
Stoffel, N. U., Zeder, C., Brittenham, G. M., Moretti, D., & Zimmermann, M. B.
Affiliations
  • ETH Zurich (CH)
  • Columbia University (US)
Corresponding author
Stoffel, Nicole U.
ORCID
Venue
Haematologica
Publisher
Ferrata Storti Foundation (Haematologica)
Published
2019-08-14
Volume
105
Issue
5
Pages
1232-1239
ISSN
  • 0390-6078 (ISSN-L)
  • 1592-8721
DOI
10.3324/haematol.2019.220830
PMC
PMC7193469
OpenAlex
W2967031988
Cited by
241
References
30
Citations by year
2026: 38 · 2025: 35 · 2024: 30 · 2023: 53 · 2022: 40 · 2021: 15 · 2020: 28 · 2019: 2
FWCI
15.02
Type
journal article
Language
en
Open access
Locations
  • Haematologica (publishedVersion)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
  • Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
  • Health Sciences › Nursing › Nutrition and Dietetics › Trace Elements in Health
Keywords
iron absorption, iron deficiency anemia, alternate-day dosing, oral iron supplementation, ferrous sulfate, hepcidin, iron status, erythrocyte iron incorporation, iron stable isotopes, women
MeSH terms
Female, Humans, Iron, Switzerland, Cross-Over Studies, Anemia, Iron-Deficiency, Dietary Supplements, Hepcidins

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