Iron and the Breastfed Infant

Friel, James K.; Qasem, Wafaa; Cai, Chenxi

doi:10.3390/antiox7040054

Cited by 34 publications

(31 citation statements)

References 66 publications

(103 reference statements)

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“…Recent studies have indicated that iron content in breast milk is low [12][13][14], and prolonged use of breast milk as the main food in infants might increase the risk of ID and IDA [15]. In Taiwan, the Ministry of Health and Welfare promotes the benefits of breastfeeding for a long period.…”

Section: Introductionmentioning

confidence: 99%

Iron Status of Infants in the First Year of Life in Northern Taiwan

Chen

Shih

et al. 2020

Nutrients

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Iron deficiency (ID) and iron deficiency anemia (IDA) typically occur in developing countries. Notably, ID and IDA can affect an infant’s emotion, cognition, and development. Breast milk is considered the best food for infants. However, recent studies have indicated that breastfeeding for more than six months increases the risk of ID. This study investigated the prevalence of ID and IDA, as well as the association between feeding type and iron nutritional status in northern Taiwan. A cross-sectional study was conducted on infants who returned to the well-baby clinic for routine examination from October 2012 to January 2014. Overall, 509 infants aged 1–12 months completed the iron nutritional status analysis, anthropometric measurement, and dietary intake assessment, including milk and complementary foods. The results revealed that 49 (10%) and 21 (4%) infants in their first year of life had ID and IDA, respectively, based on the World Health Organization criteria. Breastfed infants had a higher prevalence rate of ID and IDA than mixed-fed and formula-fed infants (p < 0.001). Regarding biomarkers of iron status, plasma hemoglobin (Hb), ferritin, and transferrin saturation (%) levels were significantly lower in ID and IDA groups. The prevalence of ID and IDA were 3.7% and 2.7%, respectively, in infants under six months of age, but increased to 20.4% and 6.6%, respectively, in infants above six months of age. The healthy group had a higher total iron intake than ID and IDA groups, mainly derived from infant formula. The total dietary iron intake was positively correlated with infants’ Hb levels. Compared with formula-fed infants, the logistic regression revealed that the odds ratio for ID was 2.157 (95% confidence interval [CI]: 1.369–3.399) and that for IDA was 4.196 (95% CI: 1.780–9.887) among breastfed infants (p < 0.001) after adjusted for all confounding factors (including gestational week, birthweight, sex, body weight percentile, body length percentile, age of infants, mothers’ BMI, gestational weight gain, education level, and hemoglobin level before delivery). In conclusion, our results determined that breastfeeding was associated with an increased the prevalence of ID and/or IDA, especially in infants above six months. This suggests that mothers who prolonged breastfeed after six months could provide high-quality iron-rich foods to reduce the prevalence of ID and IDA.

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Section: Introductionmentioning

confidence: 99%

Iron Status of Infants in the First Year of Life in Northern Taiwan

Chen

Shih

et al. 2020

Nutrients

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“…The largest effects were observed among mothers in the lower quantiles, suggesting that interventions to promote breastfeeding among lactating mothers may have more impact on Hb concentration of mothers at the lower end of the Hb distribution. These findings may appear puzzling because it is generally believed that lactating mothers tend to lose some iron to their infants, which may have a bearing on their Hb concentration 38,39 . Nevertheless, other evidence suggests that the iron contained in breast milk to children is not significant enough to deplete the iron level of the mother unless the mother is already anaemic 40 .…”

Section: Discussionmentioning

confidence: 99%

Differential effects of socio-demographic factors on maternal haemoglobin concentration in three sub-Saharan African Countries

Amugsi

Dimbuene

Kyobutungi

2020

Sci Rep

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Low Haemoglobin concentration (Hb) among women of reproductive age is a severe public health problem in sub-Saharan Africa. This study investigated the effects of putative socio-demographic factors on maternal Hb at different points of the conditional distribution of Hb concentration. We utilised quantile regression to analyse the Demographic and Health Surveys data from Ghana, Democratic Republic of the Congo (DRC) and Mozambique. In Ghana, maternal schooling had a positive effect on Hb of mothers in the 5th and 10th quantiles. A one-year increase in education was associated with an increase in Hb across all quantiles in Mozambique. Conversely, a year increase in schooling was associated with a decrease in Hb of mothers in the three upper quantiles in DRC. A unit change in body mass index had a positive effect on Hb of mothers in the 5th, 10th, 50th and 90th, and 5th to 50th quantiles in Ghana and Mozambique, respectively. We observed differential effects of breastfeeding on maternal Hb across all quantiles in the three countries. The effects of socio-demographic factors on maternal Hb vary at the various points of its distribution. Interventions to address maternal anaemia should take these variations into account to identify the most vulnerable groups.

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“…Given the low concentration of iron in mature breast milk ( 51 , 52 ) and low prevalence of breast-feeding in this population, we did not include iron intake from breast milk in our modeling. We did a sensitivity analysis by including estimated iron from breast milk in total iron intakes (assuming concentrations of 0.2 mg iron/L, 0.549 L milk/d, and 50% absorption of breast milk iron); this addition had no substantial effect on the prevalence of inadequate intake or effective coverage.…”

Section: Methodsmentioning

confidence: 99%

Micronutrient Fortification of Commercially Available Biscuits Is Predicted to Have Minimal Impact on Prevalence of Inadequate Micronutrient Intakes: Modeling of National Dietary Data From Cameroon

Haile

Luo

Vosti

et al. 2020

Current Developments in Nutrition

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Background Voluntarily-fortified snack products are increasingly available but are not necessarily formulated to meet known dietary nutrient gaps, so potential impacts on population micronutrient intake adequacy are uncertain. Objective We modeled the impacts of hypothetical micronutrient-fortified biscuits on inadequate micronutrient intake among children and women of reproductive age (WRA) in Cameroon. Methods In a nationally-representative survey stratified by macro-region (North, South, and Yaoundé/Douala), 24-h dietary recall data were collected from 883 children 12–59 mo and 912 WRA. We estimated usual nutrient intake by the National Cancer Institute (NCI) method for vitamin A (VA), folate, vitamin B12, zinc, and iron. We simulated the impact of biscuit fortification on prevalence of micronutrient intake below the estimated average requirement, given observed biscuit consumption, in the presence and absence of large-scale food fortification (LSFF) programs. Results Biscuit consumption in the prior 24 h by children and WRA, respectively, ranged from 4.5% and 1.5% in the South, to 20.7% and 5.9% in Yaoundé/Douala. In the absence of LSFF programs, biscuits fortified with retinol (600μg/100g), folic acid (300μg/100g), and zinc (8mg/100g) were predicted to reduce the prevalence of inadequacy among children by 10.3 ± 4.4, 13.2 ± 4.2 and 12.0 ± 6.1 percentage points, respectively, in Yaoundé/Douala. However, when existing VA-fortified oil, and folic acid and zinc-fortified wheat flour programs were considered, the additional impacts of fortified biscuits were reduced substantially. Micronutrient-fortified biscuits were predicted to have minimal impact on dietary inadequacy among WRA, with or without LSFF programs. Conclusions Given observed patterns of biscuit consumption in Cameroon, biscuit fortification is unlikely to reduce dietary inadequacy of studied micronutrients, except possibly for selected nutrients among children in urban areas in the absence of LSFF programs. As voluntary fortification becomes increasingly common, modeling studies may help guide efforts to ensure that fortified products align with public health goals.

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Iron and the Breastfed Infant

Cited by 34 publications

References 66 publications

Iron Status of Infants in the First Year of Life in Northern Taiwan

Iron Status of Infants in the First Year of Life in Northern Taiwan

Differential effects of socio-demographic factors on maternal haemoglobin concentration in three sub-Saharan African Countries

Micronutrient Fortification of Commercially Available Biscuits Is Predicted to Have Minimal Impact on Prevalence of Inadequate Micronutrient Intakes: Modeling of National Dietary Data From Cameroon

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