Iron status at 12 months of age - effects of body size, growth and diet in a population with high birth weight

Landspitali University Hospital and Department of Food Science, University of Iceland, Reykjavik, Iceland.
European Journal of Clinical Nutrition (Impact Factor: 2.95). 04/2003; 57(4):505-13. DOI: 10.1038/sj.ejcn.1601594
Source: PubMed

ABSTRACT To investigate effects of growth and food intake in infancy on iron status at the age of 12 months in a population with high birth weight and high frequency of breast-feeding.
In a longitudinal observational study infants' consumption and growth were recorded. Weighed 2 day food records at the ages of 6, 9 and 12 months were used to analyse food and nutrient intake.
Healthy-born participants were recruited from four maternity wards. Blood samples and growth data were collected from healthcare centres and food consumption data at home.
Newborn infants (n=180) were selected randomly according to the mother's domicile and 77% (n=138) participated, of them, 83% (n=114), or 63% of original sample, came in for blood sampling.
Every fifth child was iron-deficient (serum ferritin <12 microg/l and mean corpuscular volume<74 fl) and 2.7% were also anaemic (Hb<105 g/l). Higher weight gain from 0 to 12 months was seen in infants who were iron-deficient at 12 months (6.7+/-0.9 kg) than in non-iron-deficient infants (6.2+/-0.9 kg) (P=0.050). Serum transferrin receptors at 12 months were positively associated with length gain from 0 to 12 months (adjusted r(2)=0.14; P=0.045) and mean corpuscular volume negatively to ponderal index at birth (adjusted r(2)=0.14; P=0.019) and 12 months (adjusted r(2)=0.17; P=0.006). Iron-deficient infants had shorter breast-feeding duration (5.3+/-2.2 months) than non-iron-deficient (7.9+/-3.2 months; P=0.001). Iron status indices were negatively associated with cow's milk consumption at 9-12 months, significant above 460 g/day, but were positively associated with iron-fortified breakfast cereals, fish and meat consumption.
: In a population of high birth weight, iron deficiency at 12 months is associated with faster growth and shorter breast-feeding duration from 0 to 12 months of age. The results suggest that a diet of 9-12-month-olds should avoid cow's milk above 500 g/day and include fish, meat and iron-fortified breakfast cereals to improve iron status.

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    • "In addition to the above studies, a natural trial of iron fortification—that of formula supplementation of 7 mg/L in Western Europe—has not found significantly different rates of anemia when compared with formula fed infants in the United States (Male et al., 2001; Thorsdottir et al., 2003). Elsewhere, it has been suggested that the absence of a difference in risk of iron deficiency anemia between infants fed low iron and standard iron formula should be interpreted as evidence that US standard (12 mg/L) fortification is not harmful to infants (Singhal et al., 2000). "
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    ABSTRACT: Recently, there has been considerable debate regarding the appropriate amount of iron fortification for commercial infant formula. Globally, there is considerable variation in formula iron content, from 4 to 12 mg iron/L. However, how much fortification is necessary is unclear. Human milk is low in iron (0.2-0.5 mg/L), with the majority of infant iron stores accumulated during gestation. Over the first few months of life, these stores are depleted in breastfeeding infants. This decline has been previously largely perceived as pathological; it may be instead an adaptive mechanism to minimize iron availability to pathogens coinciding with complementary feeding. Many of the pathogens involved in infantile illnesses require iron for growth and replication. By reducing infant iron stores at the onset of complementary feeding, infant physiology may limit its availability to these pathogens, decreasing frequency and severity of infection. This adaptive strategy for iron regulation during development is undermined by the excess dietary iron commonly found in infant formula, both the iron that can be incorporated into the body and the excess iron that will be excreted in feces. Some of this excess iron may promote the growth of pathogenic, iron requiring bacteria disrupting synergistic microflora commonly found in breastfed infants. Evolutionarily, mothers who produced milk with less iron and infants who had decreased iron stores at the time of weaning may have been more likely to survive the transition to solid foods by having limited iron available for pathogens. Contemporary fortification practices may undermine these adaptive mechanisms and increase infant illness risk. Am. J. Hum. Biol. 00:000-000, 2013. © 2013 Wiley Periodicals, Inc.
    American Journal of Human Biology 01/2014; 26(1). DOI:10.1002/ajhb.22476 · 1.93 Impact Factor
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    • "The results indicate that the differences in mean corpuscular volume and ZPP may reflect physiological differences in the normal levels of these variables between the genders, but the differences in Hb and transferrin receptor seem to reflect increased true Fe deficiency in boys. Other studies have confirmed that gender may play a role in predisposition to Fe deficiency (Wharf et al. 1997; Sherriff et al. 1999; Thorsdottir et al. 2003; Miller et al. 2006). The mechanisms responsible for this difference are not yet known, but may involve gender differences in the expression of testosterone and oestrogen, which can both affect erythropoietin production , or physiological characteristics that differ between males and females such as lean body mass accretion during infancy, or size of Fe stores at birth. "
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    ABSTRACT: Fe deficiency is a common nutritional disorder during infancy, particularly in low-income countries. The Fe status of a breast-fed infant is strongly influenced by the body Fe content at birth, which is determined by factors that operate before birth (maternal Fe status before and during pregnancy; infant gestational age and birth weight) and at the time of delivery (the timing of umbilical cord clamping). Delaying the clamping of the umbilical cord for 2 min can increase body Fe content by approximately 33% (75 mg), and results in greater Fe stores at 6 months of age. After birth, male gender and a rapid rate of weight gain are associated with lower Fe status. During the first half of infancy dietary Fe requirements depend on Fe stores at birth. For an exclusively-breast-fed full-term normal-birth-weight infant with delayed umbilical cord clamping, whose mother had adequate Fe status during pregnancy, the Fe provided from stores and breast milk is sufficient for >/=6 months, but before this time higher-risk infants may become Fe deficient. Fe supplementation can be beneficial for high-risk infants, but can have adverse effects on growth and morbidity of Fe-replete infants. After 6 months most breast-fed infants will require complementary foods that are rich in Fe.
    Proceedings of The Nutrition Society 08/2007; 66(3):412-22. DOI:10.1017/S002966510700568X · 4.94 Impact Factor
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    • "A food frequency questionnaire for young children can be insufficient. Although the sample comes from an affluent well-nourished population, iron status is relatively poor in infancy (Thorsdottir et al., 2003) and early childhood (Gunnarsson et al., 2004), although it improves considerably when the children get older (at the age of 6 years) (Gunnarsson et al., 2005). For public health purposes, given the possible association between iron status in childhood and some aspects of motor and mental development (Gunnarsson et al., 2006), it is important to investigate and identify possible determinants for iron deficiency and depleted iron stores in such a well-nourished population. "
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    ABSTRACT: To investigate the associations of iron status at 6 years of age with dietary and other factors. In a cross-sectional study, children's dietary intakes (3-day weighed food record) were recorded, body size was measured and blood samples were taken near their sixth birthday. A sample of 188 children, from two previous studies (cohorts 1 and 2), was contacted, and 139 (74%) agreed to participate. Multiple regression analyses with dietary and other factors showed that meat and fish consumption, multivitamin/mineral supplement intake (both positively) and cow's milk product consumption (negatively) were associated with log serum ferritin (SF) (adjusted R (2)=0.125; P=0.028; n=129), and juices and residence (rural>urban) with haemoglobin (Hb) (adjusted R (2)=0.085; P=0.034; n=127). Of 21 multivitamin/mineral consumers, none had depleted iron stores compared to 21 iron-depleted of 108 non-consumers (P=0.024). Children living in rural areas (<10,000 inhabitants) (n=33) had higher mean corpuscular volume (MCV) (83.3+/-2.3 fl) than those living in urban areas (>10,000 inhabitants) (82.1+/-3.2 fl; n=103) (P=0.048). Multiple regression analyses with dietary and other factors and growth showed in cohort 1 that residence (rural>urban), weight gain 0-1years (negatively), and meat and fish intake (positively) were associated with Hb (adjusted R (2)=0.323; P=0.030; n=51), meat and fish (positively) with both log SF (adjusted R (2)=0.069; P=0.035; n=52) and MCV (adjusted R (2)=0.064; P=0.035; n=52), and in cohort 2 cow's milk product consumption (negatively) was associated with log SF (adjusted R (2)=0.119; P=0.017; n=41) and residence (rural>urban) with MCV (adjusted R (2)=0.102; P=0.025; n=41). Consumption of meat and fish and possibly also juices, as well as multivitamin/mineral intake might affect iron status in 6-year-old children positively, whereas cow's milk product consumption might affect iron status negatively. Slower growth in the first year of life and rural residence are positively related to iron status of 6-year-olds.
    European Journal of Clinical Nutrition 03/2007; 61(3):398-403. DOI:10.1038/sj.ejcn.1602529 · 2.95 Impact Factor
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