Does consuming ascorbate-rich fruits and fruit juices with meals improve iron bioavailability? A systematic review...

Several interventional studies have demonstrated that consuming vitamin C-rich fruits or fruit juices improves iron bioavailability.

This systematic review summarizes the effect of whole ascorbate-rich fruits on iron bioavailability parameters among females (aged 15-74 y) and children.

A systematic review and meta-analysis of interventions was performed, in which randomized controlled trials (RCTs) and controlled clinical trials were considered, with the main outcomes being iron absorption (percentage uptake) and serum ferritin. The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42024615527). Searches were conducted in December 2024 and updated in March 2026 in Scopus, Ovid Medical Literature Analysis and Retrieval System Online, clinicaltrials.gov, Cochrane Central Register of Controlled Trials, and the World Health Organization International Clinical Trials Registry Platform. Two independent reviewers screened titles/abstracts, full texts, extracted data, and assessed risk of bias and Grading of Recommendations Assessment, Development, and Evaluation certainty; conflicts were resolved by discussion to consensus.

After screening 2594 unique records, 15 RCTs (n = 1381; 806 interventions, 575 controls) met inclusion criteria. Including ascorbate-rich fruits in meals had a positive impact on serum ferritin [7 trials, n = 762; mean difference (MD) = 9.39 μg/L; P < 0.001; moderate certainty], hemoglobin (12 trials, n = 1141; MD = 1.34 g/L; P = 0.01; moderate certainty), serum transferrin receptor (6 studies; MD = -0.37 mg/L; P < 0.001; high certainty), and iron balance (1 trial; MD = 2.4; low certainty). A negative effect on body iron stores was observed (2 studies; MD = -0.29 mg/kg; P = 0.32; high certainty). No impact on iron absorption (3 studies; MD = 3.36%; P = 0.07, low certainty), plasma ferritin (4 studies; MD = -0.11 μg/L, P = 0.82; high certainty), or plasma transferrin receptor (3 studies; MD = 1.53 mg/L; very low certainty).

Consuming ascorbate-rich fruits or juices with meals probably increases serum ferritin and hemoglobin concentrations and slightly reduces serum transferrin receptors but shows little to no effect on iron absorption, plasma ferritin, or body iron stores.