Effect of pancreatic enzyme supplements on iron absorption
W. T. Zempsky, B. J. Rosenstein, J. A. Carroll and F. A. Oski
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
Iron deficiency has been reported in one third of patients with cystic
fibrosis. There are data that suggest that iron absorption is increased
with exocrine pancreatic deficiency and that administration of pancreatic
enzymes may impair oral iron absorption. We compared oral iron absorption
over a 3-hour period in the presence and absence of exogenous pancreatic
enzymes in 13 stable young-adult patients with cystic fibrosis and 9
age-matched control patients. Although none of the patients with cystic
fibrosis had a hemoglobin level less than 119 g/L, serum ferritin levels
were less than 25 micrograms/L in 5 of the 13 patients, and the mean
corpuscular volume was significantly lower in the patient group (86.1 +/-
2.7 vs 90.9 +/- 5 fL). Baseline mean serum iron levels were higher in
controls (18.9 +/- 5.9 mumol/L) than in patients (11.9 +/- 6.3 mumol/L).
There was no difference in iron absorption in the absence of exogenous
pancreatic enzymes. Significant impairment of iron absorption was detected
in both patients with cystic fibrosis and controls after administration of
a preparation of pancreatic enzymes. There was an inverse relationship
between iron stores, as measured by serum ferritin, and iron absorption.
These findings suggest that long-term consumption of pancreatic enzymes by
patients with cystic fibrosis may contribute to iron deficiency.
