Effect of Helicobacter pylori Infection on Iron Absorption in Asymptomatic Adults Consuming Wheat Flour Fortified with Iron and Zinc

Helicobacter pylori infection could impair iron absorption from fortified products. The objective of the study was to determine the effect of H. pylori infection on iron absorption from asymptomatic adults consuming wheat flour fortified with iron and zinc. The C-13 urea breath test was used to assess H. pylori infection. Twenty-four H. pylori-positive and 26 H. pylori-negative volunteers completed the study. On day 1, the subjects were randomized to receive for breakfast bread fortified with either ferrous sulfate and zinc sulfate or ferrous fumarate and zinc oxide. Bread fortified with ferrous sulfate was labeled with Fe-59 as sulfate, and bread fortified with ferrous fumarate was labeled with Fe-55 as fumarate. On day 3, they received the other type of bread, with the respective tracers. On days 18-23, a proton pump inhibitor was administered to all subjects. On day 24, all subjects received bread fortified with ferrous fumarate and zinc oxide labeled with Fe-55 as fumarate. H. pylori prevalence was 77.6%. The geometric mean (+/- 1 SD) of iron absorption was significantly higher for ferrous sulfate than fumarate (6.9 +/- 2.9% vs. 0.5 +/- 3.5%, p < 0.001). The H. pylori-negative subjects absorbed significantly more iron from bread fortified with either ferrous sulfate (10.5 +/- 3.1% vs. 4.4 +/- 2.2%, p < 0.001) or ferrous fumarate (0.6 +/- 3.9% vs. 0.4 +/- 3.1%, p < 0.001). Iron absorption was not significantly different between groups after administration of a proton pump inhibitor (0.3 +/- 3.3% vs. 0.3 +/- 2.7%, p = 0.11). H. pylori infection has a negative effect on iron absorption in asymptomatic adults consuming iron- and zinc-fortified wheat flour.