Iron and malaria: absorption, efficacy and safety

Area of Science:

• Nutritional science
• Tropical medicine
• Parasitology

Background:

• Malaria significantly impairs iron absorption in women and children.
• Iron-fortified foods have shown efficacy in malaria-endemic regions despite parasitemia.
• Non-transferrin-bound iron (NTBI) is implicated in iron metabolism disruptions during malaria.

Purpose of the Study:

• To investigate the impact of iron supplementation versus fortified food on NTBI levels in malaria.
• To explore the potential risks of iron supplementation in malaria-endemic areas.
• To understand the role of NTBI in malaria pathogenesis and intestinal barrier integrity.

Main Methods:

• Single-meal, stable isotope studies were conducted.
• Iron absorption was measured in women and children.
• NTBI levels were assessed after consuming iron supplements and iron-fortified foods.

Main Results:

• Febrile malaria and asymptomatic parasitemia decrease iron absorption.
• Iron supplements, but not fortified foods, significantly increase plasma NTBI.
• NTBI may be utilized by malaria parasites in hepatocytes and sequester infected erythrocytes.

Conclusions:

• Iron-fortified foods appear safe and effective in malaria-endemic regions.
• Iron supplementation in high-transmission areas poses risks due to NTBI formation.
• NTBI's role in malaria pathogenesis may involve increased bacterial translocation from the gut.