Effect of Helicobacter pylori Infection on Iron Absorption in Asymptomatic Adults Consuming Wheat Flour Fortified with Iron and Zinc

Abstract

Helicobacter pylori infection could impair iron absorption from fortified products. The objective of the study was to determine the effect of H. pylori infection on iron absorption from asymptomatic adults consuming wheat flour fortified with iron and zinc. The (13)C urea breath test was used to assess H. pylori infection. Twenty-four H. pylori-positive and 26 H. pylori-negative volunteers completed the study. On day 1, the subjects were randomized to receive for breakfast bread fortified with either ferrous sulfate and zinc sulfate or ferrous fumarate and zinc oxide. Bread fortified with ferrous sulfate was labeled with (59)Fe as sulfate, and bread fortified with ferrous fumarate was labeled with (55)Fe as fumarate. On day 3, they received the other type of bread, with the respective tracers. On days 18-23, a proton pump inhibitor was administered to all subjects. On day 24, all subjects received bread fortified with ferrous fumarate and zinc oxide labeled with (55)Fe as fumarate. H. pylori prevalence was 77.6%. The geometric mean (±1 SD) of iron absorption was significantly higher for ferrous sulfate than fumarate (6.9 ± 2.9% vs. 0.5 ± 3.5%, p < 0.001). The H. pylori-negative subjects absorbed significantly more iron from bread fortified with either ferrous sulfate (10.5 ± 3.1% vs. 4.4 ± 2.2%, p < 0.001) or ferrous fumarate (0.6 ± 3.9% vs. 0.4 ± 3.1%, p < 0.001). Iron absorption was not significantly different between groups after administration of a proton pump inhibitor (0.3 ± 3.3% vs. 0.3 ± 2.7%, p = 0.11). H. pylori infection has a negative effect on iron absorption in asymptomatic adults consuming iron- and zinc-fortified wheat flour.

Asymptomatic Helicobacter Pylori Infection in Preschool Children and Young Women Does Not Predict Iron Bioavailability from Iron-Fortified Foods

“…However, these study results differ from those in the study by Lopez de Romana et al [19] in which the effect of H. pylori infection (assessed using the 13 C urea breath test) on iron absorption was compared in iron-sufficient asymptomatic adults, 24 who were H. pylori -positive and 26 who were H. pylori -negative. They consumed wheat flour-based test meals fortified with radiolabeled ferrous sulfate or ferrous fumarate.…”

“…Our findings suggest that asymptomatic H. pylori infection in preschool children and young women does not have a significant effect on fractional iron absorption from iron compounds commonly used as food fortificants. Two previous studies assessed iron absorption in humans with H. pylori infection using iron isotope techniques, and have produced equivocal results [19,20]. This study is consistent with the previous study in Bangladeshi children [20].…”

“…Studies examining iron absorption during H. pylori infection have produced equivocal results. Two studies in adults with H. pylori infection reported impaired iron absorption from a test meal or an iron dose [18,19]. In contrast, in a study in Bangladeshi children, there was no significant difference in iron absorption before and after treatment of H. pylori infection, although the H. pylori positive children had impaired gastric acid production [20].…”

Iron-deficiency Anemia Caused by a Proton Pump Inhibitor

“…The iron agent was nonheme iron, which requires gastric acid for absorption. The effect of iron agents in patients using PPIs is in fact poor (12), and the rate of biological iron absorption is worse with the administration of ferrous fumarate than ferrous sulfate (13). Therefore, the administration of ferrous fumarate may have been a cause of the patient's unresponsiveness to treatment in the present case.…”

Iron for Africa—Report of an Expert Workshop

“…North African countries do not experience malaria and are less exposed to parasites [25], but they experience a high and possibly growing prevalence of Helicobacter pylori , especially in Algeria, but also in Egypt and Morocco [26]. A recent meta-analysis concluded on a plausible link between Helicobacter pylori infection and ID [27] but studies that have measured iron absorption in individuals with Helicobacter pylori infection have produced mixed results [28,29,30,31], and the role of Helicobacter pylori in the etiology of ID in Africa remains uncertain.…”