AIM:To understand the interactions between iron and zinc during absorption in iron-and zinc-deficient rats, and their consequences on intestinal oxidant-antioxidant balance. METHODS:Twenty-four weanling Wistar-Kyoto rats fed an iron-and zinc-deficient diet (< 6.5 mg Fe and 4.0 mg Zn/kg diet) for 4 wk were randomly divided into three groups (n = 8, each) and orally gavaged with 4 mg iron, 3.3 mg zinc, or 4 mg iron + 3.3 mg zinc for 2 wk. At the last day of repletion, 3 h before the animals were sacrificed, they received either 37 mBq of 55 Fe or 65 Zn, to study their localization in the intestine, using microautoradiography. Hemoglobin, iron and zinc content in plasma and liver were measured as indicators of iron and zinc status. Duodenal sections were used for immunochemical staining of ferritin and metallothionein. Duodenal homogenates (mitochondrial and cytosolic fractions), were used to assess aconitase activity, oxidative stress, functional integrity and the response of antioxidant enzymes. RESULTS:Concurrent repletion of iron-and zinc-deficient rats showed reduced localization of these minerals compared to rats that were teated with iron or zinc alone; these data provide evidence for antagonistic interactions. This resulted in reduced formation of lipid and protein oxidation products and better functional integrity of the intestinal mucosa. Further, combined repletion lowered iron-associated aconitase activity and ferritin expression, but significantly elevated metallothionein and glutathione levels in the intestinal mucosa. The mechanism of interactions during combined supplementation and its subsequent effects appeared to be due to through modulation of cytosolic aconitase, which in turn influenced the labile iron pool and metallothionein levels, and hence reduced intestinal oxidative damage. CONCLUSION:Concurrent administration of iron and zinc corrects iron and zinc deficiency, and also reduces the intestinal oxidative damage associated with iron supplementation.

The Integrated Child Development Services of India provides Supplementary Nutrition Program (SNP) to preschoolers. Using this platform, the current study examined the impact of diversifying a cereal/pulse-based SNPmeal with guava on iron status and cognitive development among 24-48 months old children. A three-arm, nonblinded, cluster-randomized controlled trial (CTRI/2014/09/004983) included 399 beneficiaries from 28 preschools in 16 villages in Telangana state, India. The villages were randomly assigned to receive 25 g of guava (guava group (GG)), banana (banana group (BG)), or cucumber (cucumber group (CG)) along with a SNP meal for 140 days. Nutrient biomarkers (iron status, plasma vitamin C, vitamin B 12 , and folate), cognitive development, anthropometric indicators (WAZ, HAZ, and WHZ), and morbidity were assessed at baseline and endline. A linear mixed model and a generalized estimating equation were applied to compare changes in outcomes across the groups. All outcome variables were comparable across groups at baseline. The iron to vitamin C molar ratio improved in the GG from 1:1.4 to 1:12 but remained unaltered in control groups. Higher hemoglobin (P = 0.002), serum ferritin (SF; P < 0.001), vitamin C (P = 0.047), and lower soluble transferrin receptor (sTfR; P < 0.001) causing decreased prevalence of iron deficiency (ID) (P = 0.003) were observed in the GG compared with BG and CG. Prevalence of acute respiratory infection (ARI) was lower in the GG (P = 0.035) versus controls. No impact was observed on cognitive development or growth. Thus, diversifying a cereal/pulse-based meal with guava increased meal vitamin C content, thereby reducing ID and ARI-related morbidity. This approach represents a valid and scalable strategy to address ID among young children.

Iron deficiency is the leading cause of anemia in India. In spite of implementation of a National iron supplementation programme of anemia control, the rate of decline in anemia prevalence has not been satisfactory. To address this issue, a National consultation meeting is being organized by the Ministry of Health and Family Welfare, Government of India, 23-24th April 2018, AIIMS, New Delhi. The purpose of the background document is to facilitate the deliberations of the above meeting. In this document, we discuss the latest progress in studies of iron metabolism, bioavailability, requirement and RDA for Indians. Hepcidin is a circulating peptide hormone secreted by the liver that plays a central role in coordinating the use and storage of iron with iron acquisition. Therefore, we considered it important to review and include trials on modulation of hepcidin during iron supplementation. Further, we made an attempt to review iron supplementation trials in Indian pregnant women and children to sequentially assess the basis for fixing iron dosage. Finally, we made an attempt to apply theoretical basis of computation of iron dose for the age/gender and physiological group for treatment of anemia due to iron deficiency. In the light of the role of hepcidin in iron nutrition, we consider it important to characterize the contextual determinants and establish the iron dosage. We believe that the systemic regulation may not allow the body to store adequate amounts of iron from oral doses in short duration of 100 days. Based on the biology of iron it appears that iron homeostasis leading to assimilation of storage of iron is a very slow process and may require practice of contextual food synergy systems to improve iron content (fortified foods) and bioavailability (vitamin C rich fruits) throughout life cycle.