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Previously reported levels of iron absorption from common Southeast Asian meals composed of rice, vegetables, and spices were too low to be consistent with the known prevalence of iron deficiency. In the present paper the cause of the low absorption was systematically sought. Variables investigated comprised methodological errors, factors in the diet such as certain foodstuffs, or contaminants inhibiting the absorption and characteristics of the subjects accompanied by malabsorption of dietary iron. The latter was excluded by comparing the absorption from both wheat rolls and a composit rice meal in Thai and Swedish women using the absorption of a small dose of ferrous ascorbate as a common basis of comparison. Two main factors were identified as causing the low absorption in the previous studies: the homogenization of the labeled meals before serving and the use of rice flour instead of rice. Iron absorption from nonhomogenized meals of identical composition as studied previously was many times higher (on an average 0.16 mg) and was consistent with the actual prevalence of iron deficiency in lower socioeconomic groups of Thais mainly consuming the simple meals studied. Recent modifications of the method to measure nonheme iron absorption from composite meals have thus not only made the determination simpler but also more accurate.

A new radioisotope method to measure iron absorption from the whole diet was used in this study. The method is based on the concept that food iron is absorbed from two pools, the heme iron pool and the nonheme iron pool, which can be especially labeled with two radioiron isotopes given as hemoglobin and as an iron salt. The purpose of this study was to test the accuracy of this two-pool extrinsic tag method. The meals served were composed as an average of 6 wk consumption in the present material of 32 young enlisted men. The mean and total heme and nonheme iron absorption in all the 32 young men was 1.01+/-0.11. This figure agrees well with the mean daily losses expected for this group of subjects (1.0 mg). The conclusion can therefore be made that there are no major systematic errors of the present method to measure the total iron absorption from a mixed diet. In one series a comparison was made of the absorption of heme and nonheme iron from the meals. A significant correlation between the absorption of the two kinds of iron was found. However, a much greater fraction of the heme iron was absorbed (37%) than of the nonheme iron (5%). The absorption both from breakfast and lunch was in two series found to give a good prediction of the total daily nonheme iron absorption. One series was designed to compare the effect of two levels of iron fortification. There was a significant increase in iron absorption when the level of iron fortification of the meals was increased.

In earlier studies using the recently introduced extrinsic tag technique meals were carefully minced and mixed with the extrinsic tracer to ensure complete isotopic exchange. In the present paper the validity of simpler and more realistic techniques to label and serve composite meals was evaluated. Equal or almost equal absorption figures were found when mixing the label homogenously into a meal, adding it dropwise, or mixing it into the most bulky component of the meal. The necessity of serving the meals in a realistic way was underlined by the finding of higher absorption from a meal in which the components were served separately than from meals mixed before serving. The results of the present study indicate that the validity of using the reference dose as a basis for comparison of absorption data in different groups, was higher when serving the reference dose and the meals on consecutive days than when serving 2 weeks apart. This was true especially in women. The present findings imply that it is both necessary and possible to design simple labeling techniques that allow valid measurements of iron absorption from composite meals. Moreover, when determining the schedule of serving the meals and the reference doses the findings in the present paper must be carefully considered.

1. The present study was considered as a first step to develop a method to measure food iron absorption from realistic common meals prepared and consumed by the subjects themselves in their own homes. The absorption of Fe from the meals was measured by means of the extrinsic-tag method modified to allow for a free choice of food items. 2. The mean Fe intake was 2.79 mg and the mean Fe absorption approximately 0.30 mg. The Fe status of the subjects corresponded to 31.5% absorption from a reference dose solution containing 3 mg elemental Fe as ferrous ascorbate. The variation in food Fe absorption obtained in this field study was found to be of the same magnitude as that obtained in studies performed under more controlled conditions as in the laboratory. 3. The conclusion was drawn that the proposed method could be used in realistic field studies aimed at, for example, explaining or preventing a high prevalence of deficiency. A suffciently long run-in period and a careful instruction of the subjects was considered essential for the design of future field studies.

The increase in iron absorption was measured when different amounts of ferrous sulphate were added to rice-based South-East Asian meals. The study comprised 158 subjects--118 women and 40 men. Iron fortification of simple meals composed of rice, boiled vegetables, and a curry to a level of 5 mg of iron per meal increased the absorption by about 0.2 to 0.3 mg of iron per meal. The additionof fish to such a meal doubled the absorption increase at a fortification level of 5 mg per meal. This absorption increase was about the same as obtained with composite western-type meals containing fish or meat. The results indicate that iron fortification programs may be effective in countries with rice-based diets provided that there is a suitable vehicle available for fortification.