Bioavailability in man of iron in human milk and Cow's milk in relation to their calcium contents

Iron absorption from human milk and cow's milk was compared in the same subjects using two radio-iron tracers and extrinsic labeling of the iron. Previously observed higher iron absorption from human milk was confirmed as 19.5 +/- 17.3% (mean +/- SD) in cow's milk versus 48.0 +/- 25.5% in human milk; mean individual absorption ratio was 0.39 +/- 0.18 (p less than 0.0001). Cow's milk has a several times higher content of calcium, recently established to be a potent inhibitor of iron absorption. Adding calcium chloride to human milk in amounts to equate the calcium content of cow's milk significantly reduced iron absorption [39.1 +/- 17.8% (mean +/- SD) versus 21.3 +/- 10.6%]; mean individual absorption ratio with or without added calcium was 0.58 +/- 0.12 (mean +/- SD) (p less than 0.0001). Differences in calcium content could explain at least 70% of the difference in iron bioavailability between milks. It is suggested that the remaining 30% difference may mainly be an artifact related to inhomogeneous radioiron-labeling of milk iron compounds, especially in human milk, and that the main difference in true iron absorption between human and cow's milk is related to their different calcium contents. The rather high fractional iron absorption from human milk can be explained by its low iron content. There is nothing to indicate that human milk contains any enhancer of iron absorption. The marked inhibiting effect of calcium on iron absorption should be considered in the design of infant formulas to achieve an optimal balance in the contents of calcium and iron.