Inhibition of iron absorption by calcium is modest in an iron-fortified, casein- and whey-based drink in Indian children and is easily compensated for by addition of ascorbic acid

• Published in: The Journal of nutrition Vol. 144; no. 11; p. 1703
• Main Authors: Walczyk, Thomas, Muthayya, Sumithra, Wegmüller, Rita, Thankachan, Prashanth, Sierksma, Aafje, Frenken, Leon G J, Thomas, Tinku, Kurpad, Anura, Hurrell, Richard F
• Format: Journal Article
• Language: English
• Published: United States 01-11-2014
• Subjects: Ascorbic Acid - chemistry; Ascorbic Acid - pharmacokinetics; Beverages - analysis; Calcium - pharmacokinetics; Caseins - chemistry; Child; Child Nutritional Physiological Phenomena; Cross-Over Studies; Dietary Supplements; Drug Interactions; Female; Humans; India; Iron - metabolism; Iron - pharmacokinetics; Male; Milk Proteins - chemistry; Whey Proteins; India
• ISSN: 1541-6100
• DOI: 10.3945/jn.114.193417

Calcium inhibits and ascorbic acid (AA) enhances iron absorption from iron-fortified foods. Absorption efficiency depends on iron status, although the interaction is unclear.
We investigated the ability of AA to overcome calcium-induced inhibition of iron absorption in children differing in iron status.
The effect of calcium (0, 100, and 200 mg/test meal) on iron absorption in the absence and presence of AA (0, 42.5, and 85 mg/test meal) from a casein/whey-based drink fortified with ferrous sulfate was assessed in a series of randomized crossover studies both in iron-replete (IR) Indian schoolchildren and in children with iron deficiency anemia (IDA) (6-11 y; n = 14-16/group) by using stable isotopes.
In the absence of calcium and AA, iron absorption from the casein/whey-based drink was 20% lower in IR children than in children with IDA. The addition of calcium reduced mean iron absorption by 18-27%, with the effect being stronger for high added calcium (P < 0.01). AA at a 2:1 or 4:1 molar ratio enhanced iron absorption by a factor of 2-4 and greatly overcompensated for the inhibitory effect of calcium on iron absorption in a dose-dependent manner (P < 0.001). The dose-response effect tended to be stronger (P < 0.1) in the IDA group, and iron status was of far less influence on iron absorption than the enhancing effect of AA.
When adding AA to iron-fortified milk products, care should be taken not to provide absorbable iron in excess of needs.