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Iron absorption in adults with sickle cell anemia: a stable-isotope approach

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Abstract

Purpose

Iron absorption in sickle cell anemia (SCA) remains unclear and studies in adults with SCA are scarce. The aim of this study was to evaluate the iron absorption SCA adults and its association with iron status and hepcidin concentration.

Methods

SCA patients (n = 13; SCAtotal) and control participants (n = 10) ingested an oral stable iron isotope (57Fe). Iron absorption was measured by inductively coupled plasma mass spectrometry (ICP-MS) 14 days after isotope administration. Patients with ≥ 1000 ng/mL serum ferritin were considered to present iron overload (IO) (SCAio+; n = 3) and others classified without IO (SCAio-; n = 10).

Results

Iron absorption in the control group ranged from 0.3 to 26.5% (median = 0.9%), while it varied from 0.3 to 5.4% in SCAio+ (median = 0.5%) and from 0.3 to 64.2% in the SCAio- (median = 6.9%). Hepcidin median values were 14.1 ng/mL (3.0–31.9 ng/mL) in SCAio-, 6.2 ng/mL (3.3–7.8 ng/mL) in SCAio + and 6.2 ng/mL (0.6–9.3 ng/mL) in control. Iron absorption was associated with ferritin level (r = − 0.641; p = 0.018) and liver iron concentration (LIC; r = − 0.786; p = 0.036) in the SCAtotal group.

Conclusion

Our data suggest that SCAio- individuals may be at risk of developing primary IO. Simultaneously, secondary IO may induce physiological adaptation, resulting in reduced iron absorption. Further studies evaluating intestinal iron absorption using larger sample sizes should be conducted to help establish a safe nutrition approach to be adopted and to ensure the security of food-fortifying public policies for these patients.

Trial registration

This trial was registered at www.ensaiosclinicos.gov.br (Identifier RBR-4b7v8pt).

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors express their gratitude to the volunteers who participated in this study. They would also like to acknowledge the excellent technical assistance provided by Isis Rodrigues, Viviane F.Meneses, Clarice M. Carvalho, Elizabeth Pereira, Verônica Barbosa, and Valdilene L. Souza.

Funding

This study was supported by the Ministry of Health (process # 777022/2012); Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (process # 408401/2017-6); Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) (Finance Code 001); Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (process # E-26-010.100930/2018 and E-26/200.963/2022).

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Author notes

  1. Flávia Fioruci Bezerra and Vanessa Monteiro Voll have contributed equally to this work.

Authors and Affiliations

  1. Nutrition Institute, Rio de Janeiro State University, São Francisco Xavier Street, 524, 12144F, Maracanã, Rio de Janeiro, 20550-900, Brazil

    Juliana Omena¹, Flávia Fioruci Bezerra¹, Vanessa Monteiro Voll¹, Cláudia dos Santos Cople Rodrigues & Marta Citelli

  2. Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Bernardo Ferreira Braz & Ricardo Erthal Santelli

  3. National Institute of Science and Technology of Bioanalytics (INCTBio), Campinas, Brazil

    Bernardo Ferreira Braz & Ricardo Erthal Santelli

  4. School of Nutrition, University of the Republic, Montevideo, Uruguay

    Carmen Marino Donangelo

  5. Radiology Department, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil

    Gustavo Federico Jauregui

  6. Hematology Department, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil

    Andrea Soares Ribeiro

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  1. Juliana Omena¹
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Contributions

MC, JO, FFB, and CSCR designed the research; JO, MC, and VMV conducted the research; JO, VMV, MC, BFB and RES conducted the laboratory analysis; FFB and CMD helped to interpret the data and provided critical suggestions and comments; GFJ and ASR conducted the MRI procedures; JO, FFB and MC performed the statistical analysis, wrote the manuscript, and had primary responsibility for the final content. All authors read, contributed and approved the final manuscript. None of the authors declared any personal or financial conflict of interest.

Corresponding authors

Correspondence to Juliana Omena¹ or Marta Citelli.

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Ethical approval

The study was conducted in accordance with the Declaration of Helsinki principles. The Ethical Committee of Hemorio (419/17; 2.788.659) and Pedro Ernesto University Hospital (2.695.418) approved the study protocol. Written informed consent was obtained from each participant.

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The authors declare no conflicts of interest.

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Omena¹, J., Bezerra¹, F.F., Voll¹, V.M. et al. Iron absorption in adults with sickle cell anemia: a stable-isotope approach. Eur J Nutr (2024). https://doi.org/10.1007/s00394-024-03417-8

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