RECOMMENDED

NUTRIENT INTAKE FOR IRON

2005

SITI HAJAR BINTI MUSTAFFA MCL, P 62268

THE ROLE OF IRON IN HUMAN METABOLIC

PROCESSES

As a carrier of oxygen to the tissues from the lungs by red blood cell haemoglobin As a transport medium for electrons within cells As an integrated part of important enzyme systems in various tissues

Food Sources: Chicken,spinach,egg,wholemeal bread,lean beef meat, soya bean curd,fresh cockles Iron deficiency Impair work performance, IDA, preterm birth, LBW, maternal mortality, impaired cognitive development of infants, neonatal mortality

1)FACTOR AFFECTING IRON REQUIREMENT

The iron status of the subjects

The body iron stores regulator play an important part in regulating iron absorption ( absorption when stores are low & when they are high) During - iron balance (when absorption is smaller than losses) iron store 1st depleted (serum ferritin is lowered) which is successively associated with continuos in dietary iron absorption When iron store are depleted there will be a concomitant reduction in the concentration of Hb. This reduction is also associated with an increase in iron absorption

2) FACTOR AFFECTING IRON REQUIREMENT

Heam Iron( derived from Hb & myoglobin of flesh foods- meat,fish & poultry Better absorbed (soluble at the pH at small intestine) People absorbed 15-35% of heam iron they consumed (Insel et al 2003) Can be degraded & converted to nonheam iron if foods are cooked at high temperature for too long. Non-heam Iron( plant foods: bread,cereal,dark leafy vegetables & egg) Less easily absorbed by the body. Nonheme iron often contain phytates :bind to iron and carry it through the digestive tract unabsorbed. The foods with high iron content arent necessarily the best sources of iron. By weight, soybeans have roughly twice the iron of beef. But only about 7% of the iron in soybeans is absorbed. Spinach is also high in iron, but less than 2% of the iron in cooked spinach is absorbed (Scrimshaw 1991).

3)FACTOR AFFECTING IRON REQUIREMENT

Inhibitors Phytic acid (grains & legumes) Mineral : Calcium
(Hellberg1998 & Perales et. al 2006)*avoid consume high

Enhancers Ascorbic acid,(nonheme iron) Vitamin C 25 mg of ascorbic acid,1/3 glass of orange juice (Hallberg,1981) *possibly more if the meal contains many inhibitors of iron absorption (FAO 2002 &
Fidler et al 2009)

Beef (Hurrell et al 2006),Meat(FAO 2002) *associated with a lower prevalence of iron deficiency. Citric acid (Hallberg L &
Rossander-Hulten 1984)

levels of calcium (>40 mg) during meals that are intended to boost iron levels Soy protein: In infant foods containing soy proteins, the inhibiting effect can be overcome by the addition of sufficient amounts of ascorbic acid (FAO,2002) For instance, experiments have demonstrated that people absorb much less iron from bread when their meals include egg protein, tea, peppermint, chamomile, or coffee (Hurrell et
al 1999; Hurrell et al 1988).

4)FACTOR AFFECTING IRON REQUIREMENT Bioavailability

The absorption and utilization of a nutrient by the body /Kadar dan batas penyerapan suatu drug/nutrisi daripada bentuk dosej ke dalam ruang dalaman tubuh.(Dewan Bahasa & Pustaka) Diet contain smaller portions of meat + fish ,high pyhtates + some vegetarian meals each week : iron bioavailability 12% In vegetarians : bio-availability is usually , the absence of meat and fish and a high intake of phytate and polyphenols In countries or for certain groups in a population with a very high meat intake, the bio-availability may rather be around 18% The absorption of heam iron varies from 40% during iron deficiency to about 10% during iron repletion The absorption of non heam iron differs depending on the presence of other dietary components & physiological conditions It is important to adjust absorbed iron req according to different types of diet esp. in vulnerable group

SETTING IRON REQUIREMENTS (A

Physiological requirements
Basal iron losses Iron for growth Menstrual iron losses

DOPTED FROM FAO

2002)

The amount iron in the food+ its bioavalability

*Related to body surface area *A non-menstruating 55-kg women loses Total Absolute Requirements = about 0.8 mg Fe/day Requirement for growth + basal losses + man loses and a 70-kg menstrual losses (females only) about 1 mg The total amount lost Full-term infant, IR rise markedly 10% (diet of the poor or willis estimated at 14 after age vegetarian) 4-6 months & amount toweight/day g/kg body about 0.7-0.9 mg/day remaining g) 15% (western diet :during the(1mg = 1000part of the on meat)) depending first year. These requirements are therefore very high : relation to body size and energy intake

RECOMMENDED INTAKE FOR IRON : RNI MALAYSIA,2005

Malaysia (2005) Age group RNI(mg/day) % Bioavailability

a: Neonatal iron stores are sufficient to meet the iron 10 15 requirement for the 6 mons in full term baby, 4-6 mons Infants provided through breast milk 0-5months Supplementsa a Iron Reduce the Risk of Iron Deficiency Anemia in Marginally Low Birth Weight Infants (<2500g) 6-12 months 9 6 Berglund, Westrup, Domellf (2010). Pediatrics e874 -e883,(Department of Clinical Sciences, Ume University, Sweden) body iron need due to in basal iron This study established iron supplementation at 2 mg/kg per day losses , growth & in iron store from from 6 weeks to 6 months reduces this risk effectively, with no birth short-term adverse effects Total iron req: 0.93mg/day on morbidity or growth. consideration basal iron losses ,0.17mg/day & iron for growth 0.55mg/day Iron sources : breast milk & complementary food

Iron intakes required for children: median basal iron losses, and total absolute iron requirements (FAO 2002)
Body weight Age Group Mean Required Iron intakes for Growth Basal Iron losses Median Total Absolute Requirements Median 95th percentile

(Years) Children

(kg)

(mg/day)

(mg/day)

(mg/day) (mg/day)

0.5-1 1-3 4-6 7-10

9 13.3 19.2 28.1

0.55 0.27 0.23 0.32

0.17 0.19 0.27 0.39

0.72 0.46 0.50 0.71

0.93 0.58 0.63 0.89

Mean increase of wt from age 2 till onset of puberty averaged 2.5-2.75kg/yr Basal iron losses : 0.2-0.4mg/day

Malaysia (2005) Age group RNI(mg/day) % Bioavailability 10 Children TIR : 0.58mg/day TIR: 0.63mg/day TIR: 0.89mg/day 1 - 3 years 4 - 6 years 7 - 9 years 6 6 9 4 4 6 15

Iron intakes required for males & female (FAO 2002)

Body weight Age Group Mean Required Basal Iron Iron intakes losses for Growth Median Menstrual losses Total Absolute Requirements 95th percentile

Median

95th Median percentile

(Years) Males 11-14 15-17 18+ Females 11-14 b 11-14 15-17 18+

(kg) 45 64.4 75 46.1 46.1 56.4 62

(mg/day) (mg/day) (mg/day) (mg/day) 0.55 0.60 0.62 0.90 1.05 0.55 0.55 0.35 0.65 0.65 0.79 0.87 0.48 c 0.48 c 0.48 c 1.90 c 1.90 c 1.90 c

(mg/day) (mg/day) 1.17 1.50 1.05 1.20 1.68 1.62 1.46 1.46 1.88 1.37 1.40 3.27 3.10 2.94

Malaysia (2005) Age group RNI(mg/day) % Bioavailability 10 Boys 10-14 yrs 15-18 yrs Girls 10-14 yrs b 10-14 yrs 15-18 yrs 14 33 31 9 22 21 amount compared to boys at the same age (take consideration on the menstrual losses for every month) 15 19 10 12 15

b:non-menstruating

Malaysia (2005) Age group RNI(mg/day) % Bioavailability 10 Men 19-65 yrs >65 yrs Women 19-50 yrs
(Pre-menopausal)

15

14 14

9 9 TIR : 1.37mg/day

29 11 11

20 8 8

TIR : 2.94mg/day TIR : 1.13mg/day

51-65 yrs
(Menopausal)

>65 yrs

For men & menopausal women : to estimate TIR based on basal iron losses Menstruating women, the estimate TIR derived from basal iron losses (0.87mg/day)& menstrual loss( 1.90mg/day)

Iron requirements (mg) IRON REQUIREMENTS DURING PREGNANCY Foetus Placenta Expansion of maternal erythrocyte mass Basal iron losses Total iron requirement NET IRON BALANCE AFTER DELIVERY Contraction of maternal erythrocyte mass Maternal blood loss Net iron balance Net iron requirements for pregnancy if sufficient maternal iron stores are present (1040 - 200 = 840)

300 50 450 240 1040

+450 -250 +200 840

IRON REQUIRED DURING PREGNANCY

To increase the haemoglobin mass of the mother, which occurs in all healthy pregnant women who have sufficiently large iron stores or who are adequately supplemented with iron. The increased haemoglobin mass is directly proportional to the increased need for oxygen transport during pregnancy and is one of the important physiologic adaptations that occurs in pregnancy

Iron absorption during pregnancy is determined The amount of iron in the diet Its bio-availability (meal composition) The changes in iron absorption that occur during pregnancy

Malaysia (2005) Age group RNI(mg/day) % Bioavailability 10 Pregnancy 1st trimester 2nd trimester 3rd trimester e e e e e e 3rd trimester it may increase by up to about four times 15 1st trimester : iron needs remain at the level of replacing basal iron losses since there is no menstrual loss 2nd trimester: iron absorption is increased by about 50 percent

An adequate iron balance can be achieved if iron stores of 500 mg are available (uncommon to have iron stores of this size) e:It is recommended that iron supplements in tablet form be given to all pregnant mother because of the difficulties in correctly evaluating iron status in pregnancy with routine laboratory methods. In the non-anemic pregnant woman , daily supplement 100mg of iron given during 2nd half of pregnancy are adequate In anemic women higher doses are usually required

Malaysia (2005) Age group RNI(mg/day) % Bioavailability 10 Lactation 0-3 months 4-6 months 7-12 months 7-12 months h 15 15 15 32 10 10 10 21 15 In lactating women, the daily iron loss in milk is about 0.3 mg. Together with the basal iron losses of 0.8 mg, the total iron requirements during the lactation period amount to 1.1 mg/day.

h: Lactating women with menstruation

Malaysia 2005
Age group RNI(mg/day) % Bioavailability 10 a 9 6 6 9 15 19 14 33 31 14 14 Women 29 11 e e e 15 15 15 32
Age group Infants < 1 yrs Children 1 - 3 years 4 - 6 years 7 - 9 years Boys 10-12 yrs 13-15 yrs 16-19 yrs Girls 10-12 yrs 13-15 yrs 16-19 yrs Men 20-39 yrs 40-49 yrs 50-59 yrs >60 yrs Women 20-39 yrs 40-49 yrs 50-59 yrs >60 yrs Pregnancy 1st trimester 2nd trimester 3rd trimester Lactation 1st 6 mons 2nd 6 mons

Malaysia 1975
RDI (mg/day) none 10 10 10 10 18 18 10 24 28 9 9 9 9 28 28 9 9 g g g g g

15 a 6 4 4 6 10 12 9 22 21 9 9 20 8 e e e 10 10 10 21

Infants 0-5months 6-12 months Children 1 - 3 years 4 - 6 years 7 - 9 years Boys 10-14 yrs 15-18 yrs Girls 10-14 yrs b 10-14 yrs 15-18 yrs Men 19-65 yrs >65 yrs 19-50 yrs 51-65 yrs Pregnancy 1st trimester 2nd trimester 3rd trimester Lactation 0-3 months 4-6 months 7-12 months 7-12 months h

DISCUSSION
In RDI 1975, no recommended iron for infant Children 1-6 years RNI 2005 recommended lower than 10mg/day in RDI 1975 Adolescent , RNI 2005 for both boys & girls for all age groups are higher than the RDI 1975.This trend continued in the adult men & women Pregnancy, both RNI 2005 & RDI 1975 , no iron recommendation : iron supplement RDI 1975 no recommendation for lactating mother, RNI 2005 recommendation depending on bioavailability