This publication on the assessment of iron bioavailability was developed as part of the IAEA’s continuing efforts to transfer knowledge and technology in the use of stable isotope techniques in nutrition. It provides information on the theoretical background and practical application of state of the art methodology to measure human iron absorption and dietary iron bioavailability using stable (non- radioactive) isotopes. These techniques can be used to guide fortifi cation and food based strategies to combat iron defi ciency, which remains unacceptably high among infants, children and women of childbearing age in developing countries. IAEA HUMAN HEALTH SERIES IAEA HUMAN HEALTH SERIES No. 21 Assessment of Iron Bioavailability in Humans Using Stable Iron Isotope Techniques INTERNATIONAL ATOMIC ENERGY AGENCY VIENNA ISBN 978–92–0–126510–4 ISSN 2075–3772 RELATED PUBLICATIONS IAEA HUMAN HEALTH SERIES PUBLICATIONS DUAL ENERGY X RAY ABSORPTIOMETRY FOR BONE MINERAL The mandate of the IAEA human health programme originates from Article II of DENSITY AND BODY COMPOSITION ASSESSMENT its Statute, which states that the “Agency shall seek to accelerate and enlarge the IAEA Human Health Series No. 15 contribution of atomic energy to peace, health and prosperity throughout the world”. STI/PUB/1479 (118 pp.; 2011) The main objective of the human health programme is to enhance the capabilities of ISBN 978–92–0–110610–0 Price: €50.00 IAEA Member States in addressing issues related to the prevention, diagnosis and treatment of health problems through the development and application of nuclear techniques, within a framework of quality assurance. Publications in the IAEA Human Health Series provide information in the areas INTRODUCTION TO BODY COMPOSITION ASSESSMENT USING of: radiation medicine, including diagnostic radiology, diagnostic and therapeutic nuclear THE DEUTERIUM DILUTION TECHNIQUE WITH ANALYSIS OF URINE medicine, and radiation therapy; dosimetry and medical radiation physics; and stable SAMPLES BY ISOTOPE RATIO MASS SPECTROMETRY isotope techniques and other nuclear applications in nutrition. 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Information may be provided via the IAEA web site, by mail at the address given above, or by email to: [email protected]. www.iaea.org/books ASSESSMENT OF IRON BIOAVAILABILITY IN HUMANS USING STABLE IRON ISOTOPE TECHNIQUES The following States are Members of the International Atomic Energy Agency: AFGHANISTAN GHANA NIGERIA ALBANIA GREECE NORWAY ALGERIA GUATEMALA OMAN ANGOLA HAITI PAKISTAN ARGENTINA HOLY SEE PALAU ARMENIA HONDURAS PANAMA AUSTRALIA HUNGARY PAPUA NEW GUINEA AUSTRIA ICELAND PARAGUAY AZERBAIJAN INDIA PERU BAHRAIN INDONESIA PHILIPPINES BANGLADESH IRAN, ISLAMIC REPUBLIC OF POLAND BELARUS IRAQ PORTUGAL BELGIUM IRELAND QATAR BELIZE ISRAEL REPUBLIC OF MOLDOVA BENIN ITALY ROMANIA BOLIVIA JAMAICA RUSSIAN FEDERATION BOSNIA AND HERZEGOVINA JAPAN RWANDA BOTSWANA JORDAN SAUDI ARABIA BRAZIL KAZAKHSTAN SENEGAL BULGARIA KENYA SERBIA BURKINA FASO KOREA, REPUBLIC OF SEYCHELLES BURUNDI KUWAIT SIERRA LEONE CAMBODIA KYRGYZSTAN SINGAPORE CAMEROON LAO PEOPLE’S DEMOCRATIC SLOVAKIA CANADA REPUBLIC SLOVENIA CENTRAL AFRICAN LATVIA SOUTH AFRICA REPUBLIC LEBANON SPAIN CHAD LESOTHO SRI LANKA CHILE LIBERIA SUDAN CHINA LIBYA SWEDEN COLOMBIA LIECHTENSTEIN SWITZERLAND CONGO LITHUANIA SYRIAN ARAB REPUBLIC COSTA RICA LUXEMBOURG TAJIKISTAN CÔTE D’IVOIRE MADAGASCAR THAILAND CROATIA MALAWI THE FORMER YUGOSLAV CUBA MALAYSIA REPUBLIC OF MACEDONIA CYPRUS MALI TUNISIA CZECH REPUBLIC MALTA TURKEY DEMOCRATIC REPUBLIC MARSHALL ISLANDS UGANDA OF THE CONGO MAURITANIA UKRAINE DENMARK MAURITIUS UNITED ARAB EMIRATES DOMINICA MEXICO UNITED KINGDOM OF DOMINICAN REPUBLIC MONACO GREAT BRITAIN AND ECUADOR MONGOLIA NORTHERN IRELAND EGYPT MONTENEGRO UNITED REPUBLIC EL SALVADOR MOROCCO OF TANZANIA ERITREA MOZAMBIQUE UNITED STATES OF AMERICA ESTONIA MYANMAR URUGUAY ETHIOPIA NAMIBIA UZBEKISTAN FINLAND NEPAL VENEZUELA FRANCE NETHERLANDS VIETNAM GABON NEW ZEALAND YEMEN GEORGIA NICARAGUA ZAMBIA GERMANY NIGER ZIMBABWE The Agency’s Statute was approved on 23 October 1956 by the Conference on the Statute of the IAEA held at United Nations Headquarters, New York; it entered into force on 29 July 1957. The Headquarters of the Agency are situated in Vienna. Its principal objective is “to accelerate and enlarge the contribution of atomic energy to peace, health and prosperity throughout the world’’. IAEA HUMAN HEALTH SERIES No. 21 ASSESSMENT OF IRON BIOAVAILABILITY IN HUMANS USING STABLE IRON ISOTOPE TECHNIQUES INTERNATIONAL ATOMIC ENERGY AGENCY VIENNA, 2012 COPYRIGHT NOTICE All IAEA scientific and technical publications are protected by the terms of the Universal Copyright Convention as adopted in 1952 (Berne) and as revised in 1972 (Paris). The copyright has since been extended by the World Intellectual Property Organization (Geneva) to include electronic and virtual intellectual property. Permission to use whole or parts of texts contained in IAEA publications in printed or electronic form must be obtained and is usually subject to royalty agreements. Proposals for non-commercial reproductions and translations are welcomed and considered on a case-by-case basis. Enquiries should be addressed to the IAEA Publishing Section at: Marketing and Sales Unit, Publishing Section International Atomic Energy Agency Vienna International Centre PO Box 100 1400 Vienna, Austria fax: +43 1 2600 29302 tel.: +43 1 2600 22417 email: [email protected] http://www.iaea.org/books © IAEA, 2012 Printed by the IAEA in Austria September 2012 STI/PUB/1544 Cover photo courtesy of Eugenia Quintana IAEA Library Cataloguing in Publication Data Assessment of iron bioavailability in humans using stable iron isotope techniques. — Vienna : International Atomic Energy Agency, 2012. p. ; 24 cm. — (IAEA human health series, ISSN 2075–3772 ; no. 21) STI/PUB/1544 ISBN 978–92–0–126510–4 Includes bibliographical references. 1. Public health — Developing countries. 2. Iron — Bioavailability. 3. Iron deficiency anemia. I. International Atomic Energy Agency. II. Series. IAEAL 12–00764 FOREWORD The prevalence of iron deficiency is unacceptably high globally, in particular among infants, children and women of childbearing age in developing countries. Effective, food based strategies to combat iron deficiency are, therefore, urgently needed. As only a fraction of dietary iron is absorbed and utilized, access to data on iron bioavailability from foods, diets and iron fortificants is crucial in the development of food fortification strategies and interventions based on dietary diversification. The IAEA assists Member States in their efforts to develop evidence based interventions to combat iron deficiency by fostering the use of stable isotope techniques to evaluate iron bioavailability. During the past 20 years, the IAEA has contributed to the development and transfer of technical expertise in the use of stable isotope techniques to address micronutrient deficiencies in Member States through support to national and regional nutrition projects via the technical cooperation programme and coordinated research projects addressing priority areas in nutrition. Based on stable