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Original Research Communication |
1 From the Division of Human Nutrition and Epidemiology, Wageningen University, Wageningen, Netherlands (FTW, MAD, and CEW); the Nutrition Research and Development Centre, Bogor, Indonesia (FTW, MAD, and M); the Northern Ireland Centre for Diet and Health, School of Biomedical Sciences, University of Ulster, Coleraine, United Kingdom (DIT); and the Departments of Gastroenterology (CEW) and Internal Medicine (JWMVdM), University Medical Centre, Nijmegen, Netherlands.
Background: Deficiencies of iron and vitamin A are prevalent worldwide. Single-micronutrient supplementation is widely used to combat these deficiencies. However, micronutrient deficiencies often occur concurrently, and there are many interactions between micronutrients.
Objective: This study investigated interactions among 3 important micronutrients—iron, vitamin A, and zinc—when they are given as supplements.
Design: In a randomized, double-blind, placebo-controlled supplementation trial, 387 Indonesian infants aged 4 mo were supplemented 5 d/wk for 6 mo with 10 mg Fe, 10 mg Zn, 2.4 mg ß-carotene, 10 mg each of Fe and Zn, 10 mg Zn + 2.4 mg ß-carotene, or placebo. Complete data on micronutrient status, including hemoglobin, ferritin, retinol, zinc, and the modified relative dose response (a measure of liver retinol stores), were available from 256 infants at the end of the study.
Results: Iron-supplemented infants had significantly lower plasma retinol concentrations and a significantly higher prevalence of vitamin A deficiency, as defined by a plasma retinol concentration <0.70 µmol/L, than did the nonsupplemented infants. In contrast, the modified relative dose response of the iron-supplemented infants indicated greater liver stores of vitamin A. Iron supplementation improved iron status, and zinc supplementation improved zinc status, but ß-carotene supplementation did not significantly improve vitamin A status.
Conclusions: In this study, iron supplementation in infants with marginal vitamin A status led to lower plasma vitamin A concentrations and simultaneously to greater vitamin A liver stores. This implies a redistribution of retinol after iron supplementation, which might induce vitamin A deficiency. Therefore, iron supplementation in infants should be accompanied by measures to improve vitamin A status.
Key Words: Retinol • iron • zinc • ferritin • modified relative dose response • interaction • deficiency • supplementation • anemia
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