The influence of hepcidin on benefits and risks of iron supplementation in Bangladeshi children
Leila Larson, PhD, MPH
BACKGROUND: Hepcidin is the best predictor of iron absorption from food or supplements, and hepcidin concentrations may indicate which individuals are responsive to iron supplementation. In individuals with high hepcidin, absorption of iron is reduced which may lead to more iron progressing to the colon where it can feed pathogenic activity and increase diarrhea. GAP: Studies to examine the influence of hepcidin on the benefits and risks of iron supplementation in various forms are needed to inform public health interventions. HYPOTHESES: (1) Compared to placebo, effects of 3 months of supplementation with iron syrup and iron-containing multiple micronutrient powders (MNPs) on hemoglobin and ferritin concentration at end of intervention and 9 months later will be larger in children with lower compared to higher baseline hepcidin concentrations. (2) Compared to placebo, effects of 3 months of supplementation with iron syrup and iron-containing MNPs on incidence of diarrhea will be smaller in children with lower compared to higher baseline hepcidin concentrations. (3) Effect modification from baseline hepcidin will be larger for children receiving MNPs compared to those receiving iron syrup. METHODS: Serum hepcidin will be measured in a subsample of 600 8 month-old children enrolled in a three-arm, double-blind, double-dummy, individually randomized controlled trial examining the efficacy of 3 months of universal supplementation with iron syrup, iron-containing MNPs, or placebo in children living in Bangladesh. RESULTS: Pending IMPACT: Ultimately, the proposed work intends to explore whether hepcidin can be used to inform public policy on the benefits and risks of an iron supplementation programs in various contexts.