Iron differs from other minerals because iron balance in the human body is regulated by absorption only because there is no physiologic mechanism for excretion. On the basis of intake data and isotope studies, iron bioavailability has been estimated to be in the range of 14-18% for mixed diets and 5-12% for vegetarian diets in subjects with no iron stores, and these values have been used to generate dietary reference values for all population groups. Dietary factors that influence iron absorption, such as phytate, polyphenols, calcium, ascorbic acid, and muscle tissue, have been shown repeatedly to influence iron absorption in single-meal isotope studies, whereas in multimeal studies with a varied diet and multiple inhibitors and enhancers, the effect of single components has been, as expected, more modest. The importance of fortification iron and food additives such as erythorbic acid on iron bioavailability from a mixed diet needs clarification. The influence of vitamin A, carotenoids, and nondigestible carbohydrates on iron absorption and the nature of the "meat factor" remain unresolved. The iron status of the individual and other host factors, such as obesity, play a key role in iron bioavailability, and iron status generally has a greater effect than diet composition. It would therefore be timely to develop a range of iron bioavailability factors based not only on diet composition but also on subject characteristics, such as iron status and prevalence of obesity.

Iron deficiency is commonly assumed to cause half of all cases of anemias, with hereditary blood disorders and infections such as hookworm and malaria being the other major causes. In countries ranked as low, medium, and high by the Human Development Index, we conducted a systematic review of nationally representative surveys that reported the prevalence of iron deficiency, iron deficiency anemia, and anemia among pre-school children and non-pregnant women of reproductive age. Using random effects meta-analyses techniques, data from 23 countries for pre-school children and non-pregnant women of reproductive age was pooled, and the proportion of anemia attributable to iron deficiency was estimated by region, inflammation exposure, anemia prevalence, and urban/rural setting. For pre-school children and non-pregnant women of reproductive age, the proportion of anemia associated with iron deficiency was 25.0% (95% CI: 18.0, 32.0) and 37.0% (95% CI: 28.0, 46.0), respectively. The proportion of anemia associated with iron deficiency was lower in countries where anemia prevalence was >40%, especially in rural populations (14% for pre-school children; 16% for non-pregnant women of reproductive age), and in countries with very high inflammation exposure (20% for pre-school children; 25% for non-pregnant women of reproductive age). Despite large heterogeneity, our analyses suggest that the proportion of anemia associated with iron deficiency is lower than the previously assumed 50% in countries with low, medium, or high Human Development Index ranking. Anemia-reduction strategies and programs should be based on an analysis of country-specific data, as iron deficiency may not always be the key determinant of anemia.

The effects of different polyphenol-containing beverages on Fe absorption from a bread meal were estimated in adult human subjects from the erythrocyte incorporation of radio-Fe. The test beverages contained different polyphenol structures and were rich in either phenolic acids (chlorogenic acid in coffee), monomeric flavonoids (herb teas, camomile (Matricaria recutita L.)), vervain (Verbena officinalis L.), lime flower (Tilia cordata Mill.), pennyroyal (Mentha pulegium L.) and peppermint (Mentha piperita L.), or complex polyphenol polymerization products (black tea and cocoa). All beverages were potent inhibitors of Fe absorption and reduced absorption in a dose-dependent fashion depending on the content of total polyphenols. Compared with a water control meal, beverages containing 20–50 mg total polyphenols/serving reduced Fe absorption from the bread meal by 50–70 %, whereas beverages containing 100–400 mg total polyphenols/serving reduced Fe absorption by 60–90 %. Inhibition by black tea was 79–94 %, peppermint tea 84 %, pennyroyal 73 %, cocoa 71 %, vervain 59 %, lime flower 52 % and camomile 47 %. At an identical concentration of total polyphenols, black tea was more inhibitory than cocoa, and more inhibitory than herb teas camomile, vervain, lime flower and pennyroyal, but was of equal inhibition to peppermint tea. Adding milk to coffee and tea had little or no influence on their inhibitory nature. Our findings demonstrate that herb teas, as well as black tea, coffee and cocoa can be potent inhibitors of Fe absorption. This property should be considered when giving dietary advice in relation to Fe nutrition.

Background: Phytic acid in cereal-based and legume-based complementary foods inhibits iron absorption. Low iron absorption from cereal porridges contributes to the high prevalence of iron deficiency in infants from developing countries. Objective: The objective was to measure the influence of phytic acid degradation on iron absorption from cereal porridges. Design: An exogenous phytase was used to fully degrade phytic acid during the manufacture of 9 roller-dried complementary foods based on rice, wheat, maize, oat, sorghum, and a wheat-soy blend. Iron absorption from the phytate-free and native phytate porridges prepared with water or milk (wheat only) was measured in adult humans with an extrinsic-label radioiron technique. Ascorbic acid was added to some porridges. Results: When the foods were reconstituted with water, dephytinization increased iron absorption from rice porridge from 1.73% to 5.34% (P < 0.001), from oat from 0.33% to 2.79% (P < 0.0001), from maize from 1.80% to 8.92% (P < 0.0001), from wheat from 0.99% to 11.54% (P < 0.0001), from the wheat-soy blend without ascorbic acid from 1.15% to 3.75% (P < 0.005), and from the wheat-soy blend with ascorbic acid from 2.40% to 8.46% (P < 0.005). Reconstituting wheat porridge with milk instead of water markedly decreased or completely removed the enhancing effect of dephytinization on iron absorption in the presence and absence of ascorbic acid. Dephytinization did not increase iron absorption from high-tannin sorghum porridge reconstituted with water but increased iron absorption from low-tannin sorghum porridge by ≈2-fold (P < 0.01). Conclusions: Phytate degradation improves iron absorption from cereal porridges prepared with water but not with milk, except from high-tannin sorghum.

Phytic acid is a potent inhibitor of native and fortification iron absorption and low absorption of iron from cereal- and/or legume-based complementary foods is a major factor in the etiology of iron deficiency in infants. Dephytinization of complementary foods or soy-based infant formulas is technically possible but, as phytic acid is strongly inhibitory at low concentrations, complete enzymatic degradation is recommended. If this is not possible, the phytic acid to iron molar ratio should be decreased to below 1:1 and preferably below 0.4:1. Complete dephytinization of cereal- and legume-based complementary foods has been shown to increase the percentage of iron absorption by as much as 12-fold (0.99% to 11.54%) in a single-meal study when the foods were reconstituted with water. The addition of milk, however, inhibits iron absorption and overcomes the enhancing effect of phytic acid degradation. Dephytinization can therefore be strongly recommended only for cereal/legume mixtures reconstituted with water, especially low-cost complementary foods destined for infants in developing countries. In countries where infant cereals are consumed with milk, ascorbic acid addition can more easily be used to overcome the negative effect of phytic acid on iron absorption. Similarly with soy-based infant formulas, especially if manufactured from low-phytate isolates, ascorbic acid can be used to ensure adequate iron absorption.

Common beans are a staple food and the major source of iron for populations in Eastern Africa and Latin America. Bean iron concentration is high and can be further increased by biofortification. A major constraint to bean iron biofortification is low iron absorption, attributed to inhibitory compounds such as phytic acid (PA) and polyphenol(s) (PP). We have evaluated the usefulness of the common bean as a vehicle for iron biofortification. High iron concentrations and wide genetic variability have enabled plant breeders to develop high iron bean varieties (up to 10 mg/100 g). PA concentrations in beans are high and tend to increase with iron biofortification. Short-term human isotope studies indicate that iron absorption from beans is low, PA is the major inhibitor, and bean PP play a minor role. Multiple composite meal studies indicate that decreasing the PA level in the biofortified varieties substantially increases iron absorption. Fractional iron absorption from composite meals was 4%–7% in iron deficient women; thus the consumption of 100 g biofortified beans/day would provide about 30%–50% of their daily iron requirement. Beans are a good vehicle for iron biofortification, and regular high consumption would be expected to help combat iron deficiency (ID).