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Investigating the potential risk of untargeted daily oral iron supplementation in Cambodian women of reproductive age

University of British Columbia

Background: There is limited evidence regarding the potential risk of untargeted daily oral iron supplementation in women of reproductive age, especially in countries where genetic hemoglobinopathies are common and iron deficiency is not the major cause of anemia. Excess iron exposure can cause increased production of reactive oxygen species (ROS), which can lead to cellular (e.g. lipid, DNA) damage. Objective: The aim of this research was to retrospectively assess the effect of daily oral iron supplementation with 60 mg of elemental iron for 12 weeks, compared to placebo, on relative leukocyte telomere length (LTL) and mitochondrial DNA (mtDNA) content. Methods: In a double-blind randomized controlled trial, non-pregnant Cambodian women aged 18–45 years received 60 mg of elemental iron as ferrous sulphate (n = 201) or a placebo (n = 200) for 12 weeks. Relative LTL and mtDNA content were quantified in buffy coat collected at baseline and endline by monochrome multiplex quantitative polymerase chain reaction (MMqPCR) and the change in relative LTL and mtDNA content was determined. Results: Iron supplementation was not associated with an adjusted absolute or percent change in relative LTL after 12 weeks, compared to placebo (ß-coefficient: −0.04 [95% CI: −0.16, 0.08]; P = 0.50 and ß-coefficient: −0.96 [95% CI: −2.69, 0.77]; P = 0.28, respectively). However, iron supplementation was associated with a significantly smaller adjusted absolute and percent increase in mtDNA content after 12 weeks, compared to placebo (ß-coefficient: −11 [95% CI: −20, −2]; P = 0.02 and ß-coefficient: −11 [95% CI: −20, −1]; P = 0.02, respectively). Conclusions: Our findings suggest that daily oral iron supplementation with 60 mg of elemental iron for 12 weeks, as per the World Health Organization (WHO) global policy, may be associated with altered mitochondrial homeostasis. This is concerning and more research is needed to ascertain if there is potential risk associated with untargeted daily oral iron supplementation, to ultimately inform the safety of the WHO policy.

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2019-08-15

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/71306

Human Nutrition

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/