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The effect of food and nutrients on iron overload: what do we know so far?

European Journal of Clinical Nutrition volume 75, pages 1771–1780 (2021)Cite this article

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Abstract

There has been no established food and nutrition guidance for diseases characterized by the presence of iron overload (IOL) yet. Hepcidin is a hormone that diminishes iron bioavailability. Its levels increase in response to increased iron stores. Hence, IOL conditions could hypothetically trigger a self-regulatory mechanism for the reduction of the intestinal absorption of iron. In addition, some food substances may modulate intestinal iron absorption and may be useful in the dietary management of patients with IOL. This scoping review aimed to systematize studies that support dietary prescriptions for IOL patients. It was carried out according to the method proposed by the Joanna Briggs Institute and the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Although the need to restrict iron in the diet of individuals with hemochromatosis is quite clear, there is a consensus that IOL diminishes the rate of iron absorption. Reduced iron absorption is also present and has been reported in some diseases with transfusion IOL, in which serum hepcidin is usually high. The consumption of polyphenols and 6-shogaol seems to reduce iron absorption or serum ferritin concentration, while procyanidins do not cause any changes. Vitamin C deficiency is often found in IOL patients. However, vitamin C supplementation and alcohol consumption should be avoided not only because they increase iron absorption, but also because they provoke toxic oxidative reactions when the iron is excessive. Dietary approaches must consider the differences in the pathophysiology and treatment of IOL diseases.

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Fig. 1: Pathophysiological classification of iron overload (IOL).
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Acknowledgements

The authors thank the Brazilian Ministry of Health for encouraging scientific research on sickle cell disease between 2010 and 2014.

Funding

This study was funded 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).

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  1. Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil

    Juliana Omena, Cíntia Curioni, Cláudia dos Santos Cople-Rodrigues & Marta Citelli

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JO participated in the conception and design of the study and wrote the first draft of the manuscript. MC developed the concept and design of this study, supervised the writing of the manuscript, and revised the final version. CC and CSCR critically revised the manuscript and contributed to the writing of the manuscript. All authors were involved in the review and approved the final version of the manuscript.

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Correspondence to Marta Citelli.

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Omena, J., Curioni, C., Cople-Rodrigues, C.d.S. et al. The effect of food and nutrients on iron overload: what do we know so far?. Eur J Clin Nutr 75, 1771–1780 (2021). https://doi.org/10.1038/s41430-021-00887-5

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