Diego Moretti

Swiss Distant University of Applied Sciences /University of Applied Sciences of Southern Switzerland · Health

Iron fortification of rice could be an effective strategy for reducing iron deficiency anemia in South Asia. We aimed to determine whether extruded rice grains fortified with micronized ground ferric pyrophosphate (MGFP) would increase body iron stores in children. In a double-blind, 7-mo, school-based feeding trial in Bangalore, India, iron-deplet...

Hepcidin regulation by competing stimuli such as infection and iron deficiency has not been studied in infants and it's yet unknown whether hepcidin regulatory pathways are fully functional in infants. In this cross-sectional study including 339 Kenyan infants aged 6.0±1.1 months (mean±SD), we assessed serum hepcidin-25, biomarkers of iron status a...

Background: Iron status is a determinant of physical performance, but training may induce both low-grade inflammation and erythropoiesis, exerting opposing influences on hepcidin and iron metabolism. To our knowledge, the combined effects on iron absorption and utilization during training have not been examined directly in humans. Objective: We...

Background: Iron fortification of rice is a promising strategy for improving iron nutrition. However, it is technically challenging because rice is consumed as intact grains, and ferric pyrophosphate (FePP), which is usually used for rice fortification, has low bioavailability. Objective: We investigated whether the addition of a citric acid/tri...

Background: Current guidelines to treat iron deficiency recommend daily provision of ferrous iron divided through the day to increase absorption. However, daily dosing and split dosing might increase serum hepcidin and decrease iron absorption from subsequent doses. Our study aim was to compare iron absorption from oral iron supplements given on c...

BACKGROUND: Iron deficiency without anaemia is a common health problem, especially in young menstruating women. The efficacy of the usually recommended oral iron supplementation is limited due to increased plasma hepcidin concentration, which reduces iron absorption and leads to side effects such as intestinal irritation. This observation raises th...

Increased iron loss may reduce the effectiveness of iron supplementation. The objective of this study was to determine if daily oral iron supplementation increases iron loss, measured using a stable isotope of iron (⁵⁸Fe). We enrolled and dewormed 24 iron‐depleted Kenyan children, 24–27 months of age, whose body iron was enriched and equilibrated w...

Background Guidelines to treat iron deficiency recommend daily provision of oral iron, but this may decrease fractional iron absorption and increase side effects. Our objective was to compare consecutive-day versus alternate-day iron supplementation. Methods In a double-masked, randomized, placebo-controlled trial, young Swiss women (n = 150; seru...

Purpose We examined iron absorption and its regulation during two common scenarios experienced by endurance athletes. Our aims were to: (i) compare the effects of preexercise versus postexercise iron intake on iron absorption; and (ii) compare the impact of training at altitude (1800 m) on iron absorption preexercise. Methods Male runners (n = 18)...

Background: Agronomic zinc biofortification of wheat by foliar application increases wheat zinc content and total zinc absorption in humans. Objective: To assess the effect of agronomically biofortified whole wheat flour (BFW) on plasma zinc (PZC) compared to a fortified control wheat (PHFW) and unfortified control wheat (CW) when integrated in...

Edible insects, such as mealworms (Tenebrio molitor larvae; TM) and crickets (Acheta domesticus; AD), are a sustainable, protein-dense novel food with a favorable amino acid profile, which might be an alternative to animal proteins. To assess the protein quality of TM and AD, we assessed the digestible indispensable amino acid scores (DIAAS), consi...

Guidelines generally recommend taking iron supplements in the morning away from meals and with ascorbic acid (AA) to increase iron absorption. However, there is little direct evidence on the effects of dietary factors and time of day on absorption from iron supplements. In iron‐depleted women (n = 34; median serum ferritin 19.4 μg/L), we administer...

Background: Iron deficiency without anaemia is highly prevalent and is particularly associated with fatigue, cognitive impairment, or poor physical endurance. Standard oral iron therapy often results in intestinal irritation with associated side effects and premature discontinuation of therapy, therefore, optimal oral iron therapy with sufficient...

In Chapter 6, Author name Magnus Domelöf has been changed to Magnus Domellöf. The error appears in the Table of Content, chapter opening page, and running heads throughout the chapter.

Oral iron supplementation is the first line of treatment for iron deficiency and iron deficiency anemia. Treatment schedules usually entail the daily provision of a total of 100–200 mg elemental Fe in single or in divided doses. Iron absorption from supplements is generally low, 5–25% when administered in fasting state, and 0.5–13% when consumed wi...

Background: Co-extrusion of ferric pyrophosphate (FePP) with solubilizers, citric acid/trisodium citrate (CA/TSC), or ethylenediaminetetraacetic acid (EDTA) sharply increases iron absorption. Whether this can protect against the inhibition of iron absorption by phytic acid (PA) is unclear. Sodium pyrophosphate (NaPP) may be a new enhancer of iron...

Background Edible insects have a low ecological footprint and could serve as an alternative dietary iron source. However, chitin, a major component of insects, avidly binds iron and might inhibit iron absorption. Objectives We aimed to measure fractional iron absorption (FIA) from Tenebrio molitor–based test meals with and without dechitinization,...

Objectives We developed a natural polyphenol supplement that strongly chelates iron in vitro and assessed its effect on non-heme iron absorption in patients with hereditary hemochromatosis (HH). Methods We performed in vitro iron digestion experiments to determine iron precipitation by 12 polyphenol-rich dietary sources, and formulated a polypheno...

Iron deficiency is a common health issue in active and athlete populations. Accordingly, research into iron status, regulation, absorption, and iron deficiency treatment strategies is increasing at a rapid rate. However, despite the increase in the quantity of research, various methodological issues need to be addressed as we progress our knowledge...

Iron deficiency and anemia are common in low- and middle-income countries. This is due to a poor dietary iron density and low iron absorption resulting from the high inhibitory phytic acid content in cereal and millet-based diets. Here, we report that a naturally occurring low phytic acid finger millet accession (571 mg 100 g⁻¹), stable across thre...

Background Hot extrusion is widely used to produce iron-fortified rice, but heating may increase resistant starch and thereby decrease iron bioavailability. Cold-extruded iron-fortified rice may have higher bioavailability but has higher iron losses during cooking. Thus, warm extrusion could have nutritional benefits, but this has not been tested....

Background Compared to infant cereals based on refined grains, an infant cereal containing whole grains (WG) and pulses with adequate amounts of ascorbic acid to protect against absorption inhibitors could be a healthier source of well-absorbed iron. However, iron absorption from such cereals is uncertain. Objective We measured iron bioavailabilit...

Background Plasma ferritin is a widely used indicator to detect iron deficiency, but the threshold ferritin that defines iron deficiency remains uncertain. Our aim was to define the ferritin concentration at which the body begins to upregulate iron absorption from the diet; this could provide a functionally-defined threshold of incipient iron defic...

Background Prevention of iron deficiency in African children is a public health priority. Current WHO/FAO estimations of iron requirements are derived from factorial estimates based on healthy, iron-sufficient “model” children using data derived mainly from adults. Objectives In this study, we aimed to quantify iron absorption, loss, and balance i...

Objectives Iron deficiency is estimated to affect up to 1.5–2 billion people worldwide. Edible insects can be a rich source of iron and may have a smaller environmental food print than other animal source foods. Mealworm (Tenebrio molitor) larvae are recognized as an edible insect, but iron bioavailability in humans has not been investigated. Chiti...

Anemia of inflammation is a hallmark of tuberculosis. Factors controlling iron metabolism during anemia of inflammation and its resolution are uncertain. Whether iron supplements should be given during anti-tuberculosis treatment to support Hb recovery is unclear. Before and during treatment of tuberculosis, we assessed iron kinetics, and changes i...

Background Long-term isotopic dilution measurements of body iron may allow quantification of basal body iron balance and iron gains during an iron intervention with higher precision and accuracy than conventional iron indices. Objectives We compared body iron balance before, during, and after oral iron supplementation in women in Benin and in Swit...

Genome wide studies have associated TMPRSS6 rs855791 (2321 C>T) with iron status and hepcidin. It is unclear whether this polymorphism affects iron absorption. In nonanemic Taiwanese women (n=79, 44 TT variant, 35 CC variant), we administered standardized rice-based test meals containing 4 mg of labeled 57Fe or 58Fe as FeSO4 on alternate days. Frac...

We report the first measurements of long‐term iron absorption and loss during iron supplementation in African children using a stable isotope of iron (⁵⁷Fe). After uniform labelling of body iron with ⁵⁷Fe, iron absorption is proportional to the rate of decrease in the ⁵⁷Fe tracer concentration, while iron loss is proportional to the rate of decreas...

Fractional iron absorption (FAFe) from ferrous fumarate (FeFum) and ferrous sulfate (FeSO4) in adults is generally comparable. While FeFum is commonly used to fortify infant foods, FAFe from FeFum in young children and infants may be decreased compared with FeSO4 and this effect has not been assessed in inhibitory vs noninhibitory meals. Previous s...

Iron deficiency and iron deficiency anemia (IDA) are major public health problems worldwide, especially in young women. Oral iron supplementation can be an effective strategy to treat and prevent IDA, but guidelines vary. Some experts recommend doses of 150–200 mg elemental iron per day, with the dose split through the day. However, recent studies...

Purpose A technological gap exists for the iron (Fe) fortification of difficult-to-fortify products, such as wet and acid food products containing polyphenols, with stable and bioavailable Fe. Fe picolinate, a novel food ingredient, was found to be stable over time in this type of matrix. The objective of this study was to measure the Fe bioavailab...

Bouillon cubes are widely consumed and when fortified with iron could contribute in preventing iron deficiency. We report the development (part I) and evaluation (current part II) of a novel ferric phytate compound to be used as iron fortificant in condiments such as bouillon. Ferric pyrophosphate (FePP), is the compound of choice due to its high s...

Micronutrient deficiencies affect up to 2 billion people and are the leading cause of cognitive and physical disorders in the developing world. Food fortification is effective in treating micronutrient deficiencies; however, its global implementation has been limited by technical challenges in maintaining micronutrient stability during cooking and...

Helicobacter pylori infection is common in low-income countries. It has been associated with iron deficiency and reduced efficacy of iron supplementation. Whether H. pylori infection affects iron absorption from fortified and biofortified foods is unclear. Our objective was to assess whether asymptomatic H. pylori infection predicts dietary iron bi...

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 benef...

Purpose: This study examined postexercise inflammatory, hepcidin, and iron absorption responses to endurance exercise performed in the morning versus the afternoon. Methods: Sixteen endurance-trained runners (10 male, 6 female) with serum ferritin (sFer) < 50 μg·L completed a 90-min running protocol (65% vV˙O2max) in the morning (AM), or the aft...

Background It is challenging to find an iron compound that combines good bioavailability with minimal sensory changes when added to seasonings or condiments. Ferric pyrophosphate (FePP) is currently used to fortify bouillon cubes, but its bioavailability is generally low. Previously, the addition of a stabilizer, sodium pyrophosphate (NaPP), improv...

Background: Limited data exist on human zinc absorption from wheat biofortified via foliar (FBW) or root (hydroponically fortified wheat, HBW) zinc application. Stable isotope labels added at point of consumption (extrinsic labeling) might not reflect absorption from native zinc obtained by intrinsic labeling. Objectives: We measured fractional...

Early childhood is characterised by high physiological iron demand to support processes including blood volume expansion, brain development and tissue growth. Iron is also required for other essential functions including the generation of effective immune responses. Adequate iron status is therefore a prerequisite for optimal child development, yet...

Iron deficiency and anemia are prominent contributors to the preventable disease burden worldwide. A substantial proportion of people with inadequate dietary iron rely on rice as a staple food, but fortification efforts are limited by low iron bioavailability. Furthermore, using high iron fortification dosages may not always be prudent in tropical...

Hepatic hepcidin synthesis is stimulated by inflammation but inhibited during iron deficiency anemia (IDA). In humans, the relative strength of these opposing signals on serum hepcidin and the net effect on iron absorption and systemic iron recycling is uncertain. In this prospective, 45-day study, in young women (n=46; age 18-49 years) with or wit...

Children in developing countries often face multiple micronutrient deficiencies. Introduction of zinc-fortified water can increase zinc intake, but additional recommendations are required to address overall diet nutrient adequacy. We developed and tested food-based recommendations (FBRs) that included zinc-fortified water for children aged between...

Objective: Many African infants receiving iron fortificants also receive antibiotics. Antibiotic efficacy against enteropathogens may be modified by high colonic iron concentrations. In this study, we evaluated the effect of antibiotics on the infant gut microbiome and diarrhoea when given with or without iron-containing micronutrient powders (MNP...

Iron deficiency anemia (IDA) is common among infants and iron fortification of complementary foods using micronutrient powders (MNPs) is an effective strategy to control IDA, but the iron dose is high (12.5 mg) and iron absorption is generally less than 10%, resulting in large increases in colonic iron. In controlled studies, iron‐containing MNPs c...

Global efforts to reduce iron deficiency anemia are hindered by the unreliability of current iron status biomarkers in the presence of infection and inflammation. We developed and evaluated a novel stable iron isotope method based on the dilution of labelled body iron to measure and quantify the efficacy of an iron intervention and to quantify iron...

Objective Zn deficiency and diarrhoea are prevalent and may coexist in children living in low-resource settings. Recently, a novel approach for delivering Zn via microbiologically treated, Zn-fortified water was shown to be effective in improving Zn status in West African schoolchildren. We assessed the effectiveness of Zn-fortified, microbiologica...

Zn status may affect fatty acid (FA) metabolism because it acts as a cofactor in FA desaturase and elongase enzymes. Zn supplementation affects the FA desaturases of Zn-deficient rats, but whether this occurs in humans is unclear. We evaluated the associations between baseline plasma Zn (PZn) concentration and plasma total phospholipid FA compositi...

Iron deficiency anemia (IDA) is considered one of the most prevalent micronutrient deficiencies worldwide. Iron absorption is naturally restricted, and monotonous plant-based diets rich in iron absorption inhibitors, as consumed in unprivileged settings in the third world, are considered an important etiologic risk factor for IDA. In contrast, a nu...

Background: Rice can be fortified with the use of hot or cold extrusion or coating, but the nutritional qualities of the resulting rice grains have never been directly compared. Objective: Using fortified rice produced by coating or hot or cold extrusion, we compared 1) iron and zinc absorption with the use of stable isotopes, 2) iron and zinc rete...

Children in developing countries often face multiple micronutrient deficiencies. Introduction of zinc-fortified water can increase zinc intake, but additional recommendations are required to address overall diet nutrient adequacy. We developed and tested food-based recommendations (FBRs) that included zinc-fortified water for children aged between...

Background: Whether consumption of prebiotics increases iron absorption in infants is unclear. Objective: We set out to determine whether prebiotic consumption affects iron absorption from a micronutrient powder (MNP) containing a mixture of ferrous fumarate and sodium iron EDTA (FeFum+NaFeEDTA) in Kenyan infants. Design: Infants (n = 50; aged 6–14...

Objective Iron-containing micronutrient powders (MNPs) reduce anaemia in African infants, but the current high iron dose (12.5 mg/day) may decrease gut Bifidobacteriaceae and Lactobacillaceae, and increase enteropathogens, diarrhoea and respiratory tract infections (RTIs). We evaluated the efficacy and safety of a new MNP formula with prebiotic gal...

Background: Hepcidin is the central systemic regulator of iron metabolism, but its quantification in biological fluids is challenging. Rapid, accurate and user-friendly methods are needed. Our aim was to assess the ability of hepcidin as measured by three different c-ELISA assays to predict iron bioavailability in humans. Methods: The three assa...

Background: Ready-to-use-therapeutic foods (RUTFs) high in lipid, protein, and iron are used to treat malnutrition. Lipids increase gastric residence time, which could increase iron absorption, particularly from poorly soluble iron compounds and in combination with phytase.Objectives: The objectives were to 1) assess the effect on iron absorption o...

Background: Milk has been suggested to increase zinc absorption. The effect of processing and the ability of milk to enhance zinc absorption from other foods has not been measured directly in humans. Objective: We aimed to assess zinc absorption from 1) milk undergoing various processing and preparatory steps and 2) from intrinsically labeled high-...

Rice fortification can be a viable approach to combat iron deficiency in rice‐consuming populations, but it is crucial to identify micronutrient formulations with high iron bioavailability and acceptable sensory properties. To date, ferric phosphates are the only iron compounds resulting in sensory acceptable iron fortified rice grains. We measured...

Objective Food composition databases are essential for estimating nutrient intakes in food consumption surveys. The present study aimed to evaluate the Mali food composition database (TACAM) for assessing intakes of energy and selected nutrients at population level. Design Weighed food records and duplicate portions of all foods consumed during on...

Background: Extruded rice grains are often cofortified with iron and zinc. However, it is uncertain if the addition of zinc to iron-fortified rice affects iron absorption and whether this is zinc-compound specific. Objective: We investigated whether zinc, added as zinc oxide (ZnO) or zinc sulfate (ZnSO4), affects human iron absorption from extru...

Background: The prevalence of iron-deficiency anemia (IDA) is high in infants in Sub-Saharan Africa. Exclusive breastfeeding of infants to 6 months of age is recommended by the World Health Organization, but breast milk is low in iron. Some studies suggest exclusive breastfeeding, although beneficial for the infant, may increase risk for IDA in re...

To the editor: Iron deficiency (ID) is a frequently seen adverse event in whole blood donors, ultimately leading to deferral for donation because of low hemoglobin (Hb) values.[1][1] In accordance with guidelines of regulatory agencies and to protect whole blood donors from developing ID and anemia

Background Iron deficiency prevalence rates frequently exceed 50 % in young children in low-income countries. The World Health Organization (WHO) recommended universal supplementation of young children where anaemia rates are >40 %. However, large randomized trials have revealed that provision of iron to young children caused serious adverse effect...

Background: Iron deficiency is common in obese subjects. This may be due to an increase in serum hepcidin and a decrease in iron absorption from adiposity-related inflammation. Objective: We evaluated whether weight and fat loss in obese subjects would decrease inflammation and serum hepcidin and thereby improve iron absorption. Design: We per...

Fe fortification of centrally manufactured and frequently consumed condiments such as bouillon cubes could help prevent Fe deficiency in developing countries. However, Fe compounds that do not cause sensory changes in the fortified product, such as ferric pyrophosphate (FePP), exhibit low absorption in humans. Tetra sodium pyrophosphate (NaPP) can...

Background The gut microbiome in childhood has been linked to inflammation and immune function, but very little is known about the differences in the gut microbiome comparing anemic and nonanemic infants and children in Sub‐Saharan Africa. Design In a cross sectional study in infants (4–6 month‐olds) and preschool children (2–5 yr‐olds) (n=134) in...

Background: Phytic acid (PA) is a major inhibitor of iron bioavailability from beans, and high PA concentrations might limit the positive effect of biofortified beans (BBs) on iron status. Low-phytic acid (lpa) bean varieties could increase iron bioavailability. Objective: We set out to test whether lpa beans provide more bioavailable iron than...

This chapter focuses on the bioavailability of mineral compounds and the methodologies used to assess the bioavailability of microencapsulated mineral formulations. One of the well-known nutritional deficiencies for the treatment of which microencapsulated compounds have been extensively investigated in recent years is iron deficiency and iron defi...

Background: To protect whole blood donors from developing iron deficiency and anemia, many blood banks require a minimum interval of 56 days between two donations. We aimed to assess whether the donation interval of 56 days is adequate in both new and regular donors to recover from changes in iron homeostasis. Methods: Fifty male whole blood donors...