Iron status and intake of older infants fed formula vs cow milk with cereal

Fuchs, George J.; Farris, Rosanne P.; DeWier, M; Hutchinson, Sharon; Warrier, R. P.; Doucet, H; Suskind, Robert M.

doi:10.1093/ajcn/58.3.343

Cited by 58 publications

(55 citation statements)

References 18 publications

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“…Clearly iron status indices need to be interpreted with caution over the 6-24-month-old age range, as recently emphasised by others (Aggett et al, 2002). Nevertheless, an age-related decline in iron stores in this group of children is consistent with longitudinal and intervention studies, which generally show that ferritin levels decline across the 6-24 month age range when cows' milk or unfortified formula is fed, whereas they remain constant when children consume iron-fortified formula (Fuchs et al, 1993;Michaelsen et al, 1995;Daly et al, 1996;Gill et al, 1997;Oti-Boateng et al, 1998;Morely et al, 1999;Sherriff et al, 1999;Virtanen et al, 2001). It is also consistent with the observed dietary iron intakes in our study which were markedly lower in the 12-24 month than 6-11.9-month-old children (8.4 vs 4.6 mg/day) (Soh et al, 2001).…”

Section: Discussionsupporting

confidence: 62%

Iron deficiency and risk factors for lower iron stores in 6–24-month-old New Zealanders

et al. 2003

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Objectives: To determine the prevalence of biochemical iron deficiency and identify factors associated with ferritin levels among 6-24-month-old urban South Island New Zealand children. Design: Cross-sectional survey conducted from May 1998 to March 1999. Setting: The cities of Christchurch, Dunedin and Invercargill. Subjects: A total of 323 randomly selected 6-24-month-old children participated (response rate 61%) of which 263 provided a blood sample. Methods: A complete blood cell count, zinc protoporphyrin, serum ferritin and C-reactive protein were measured on nonfasting venipuncture blood samples, 3-day weighed food records and general questionnaire data were collected. Results: Among children with C-reactive proteino10 mg/l (n ¼ 231), 4.3% had iron deficiency anaemia, 5.6% had iron deficiency without anaemia, and 18.6% had depleted iron stores, when a ferritin cutoff of r12 g/l was used. Age (negative), sex (girls4boys), ethnicity (Caucasian4non-Caucasian), weight-for-age percentiles (negative) and birth weight (positive) were associated with ferritin after adjusting for infection and socioeconomic status. When current consumption of iron fortified formula and 4500 ml of cows' milk per day were included, these were associated with a 22% increase and 25% decrease in ferritin, respectively (R 2 ¼ 0.28). Conclusions: The presence of suboptimal iron status (29%) among young New Zealand children is cause for concern, even though severe iron deficiency is rare, because children with marginal iron status are at risk of developing severe iron deficiency if exposed to a physiological challenge.

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Section: Discussionsupporting

confidence: 62%

Iron deficiency and risk factors for lower iron stores in 6–24-month-old New Zealanders

et al. 2003

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“…The duration of cow's milk feeding in the first year has been associated negatively with iron status in other studies (Mills, 1990;Tunnessen & Oski, 1987). Tunnessen and Oski (1987) concluded that the main factor responsible for iron inadequacy in infants receiving cow's milk from 6 months of age was the low content of iron rather than gastrointestinal bleeding in infants caused by cow's milk proteins, which has been suggested elsewhere (Fuchs et al, 1993). The negative effect of cow's milk on iron status has also been attributed to its calcium content, as calcium has been shown to inhibit iron absorption in single meal studies (Cook et al, 1991;Hallberg et al, 1991), but whether the effect of calcium on iron absorption persists in a complete diet has been questioned (Reddy & Cook, 1997).…”

Section: Discussionmentioning

confidence: 71%

“…Infants who had either serum ferritin or MCV or both indices above these cut-off points were classified as not being iron-deficient. The cut-off value for Hb of 105 g=l has been used and deemed to be appropriate for this age group (Michaelsen et al, 1995;Siimes et al, 1984), as well as the cut-off value for MCV of 74 fl (Fuchs et al, 1993;Gill et al, 1997). The value for serum ferritin of 12 mg=l is according to WHO criteria (INACG et al, 1998;WHO, 2001).…”

Section: Food Recordsmentioning

confidence: 99%

“…It is of great concern and theoretical interest how the frequent use of cow's milk for infants in the latter half of the first year (Atladottir & Thorsdottir, 2000) affects the iron status at the age of 12 months in this population of high birth weight with a high frequency of breast-feeding. On the other hand, cow's milk is known to negatively influence the iron status in infants (Fuchs et al, 1993). As usual, the slow introduction of other food items during the latter half of the first year is recommended, such as meat and fish, which both have been shown to be positively associated with iron status in infancy (Engelmann et al, 1998a).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2003

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Objective: 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. Design: 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. Setting: 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. Subjects: Newborn infants (n ¼ 180) were selected randomly according to the mother's domicile and 77% (n ¼ 138) participated, of them, 83% (n ¼ 114), or 63% of original sample, came in for blood sampling. Results: Every fifth child was iron-deficient (serum ferritin < 12 mg=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 AE 0.9 kg) than in non-iron-deficient infants (6.2 AE 0.9 kg) (P ¼ 0.050). Serum transferrin receptors at 12 months were positively associated with length gain from 0 to 12 months (adjusted r 2 ¼ 0.14; P ¼ 0.045) and mean corpuscular volume negatively to ponderal index at birth (adjusted r 2 ¼ 0.14; P ¼ 0.019) and 12 months (adjusted r 2 ¼ 0.17; P ¼ 0.006). Irondeficient infants had shorter breast-feeding duration (5.3 AE 2.2 months) than non-iron-deficient (7.9 AE 3.2 months; P ¼ 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. Conclusions: 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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“…The children were also divided into being iron-depleted or not, with SF below or above 12 mg/l. The cutoff value for Hb of 105 g/l has been used and deemed to be appropriate for infants (Siimes et al, 1984;Michaelsen et al, 1995), as well as the cutoff value for MCV of 74 fl for infants and young children (Hercberg et al, 1987;Fuchs et al, 1993;Gill et al, 1997) The value for SF of 12 mg/l is according to the WHO criteria (INACG et al, 1998;WHO, 2001). Since SF is a phase reactant, parents were urged not to bring their children to blood sampling if they were ill or had been ill the last couple of days, also an experienced paediatrician evaluated their health and CRP was measured when appropriate.…”

Section: Blood Samplesmentioning

confidence: 99%

Iron status in 2-year-old Icelandic children and associations with dietary intake and growth

2004

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Objective: To investigate the effects of food and nutrient intake at 2 y and growth from birth on iron status at 2 y in a population with high birth weight. Design: In a cross-sectional study, children's food consumption and body size measurements were recorded and blood samples taken. Weighed 3-day food records were used to analyse food and nutrient intake. Setting: Children were recruited from across Iceland from the Icelandic National Registry by the University of Iceland, Computing Services. The children in the sample were born over a 1-y period. Subjects: Parents of randomly selected 2-year-old children (n¼130) were contacted, and 72% (n¼94) participated. Blood samples were analysed in 76% (n¼71) of participating children. Results: In total, 9% of the children were iron-deficient (serum ferritin (SF)o12 mg/l and mean corpuscular volume (MCV) o74 fl) and 1.4% were also anaemic (Hbo105 g/l), while 27% of children were iron-depleted (SFo12 mg/l). Iron status indices were negatively associated with cow's milk consumption. Half of children consuming4500 g cow's milk/day (n¼10) were irondeficient, while one child in 58 consumingo500 g cow's milk/day had iron deficiency (Po0.001). In multiple regression analyses, also biscuits and crackers consumption was positively associated with MCV. Weight gain from birth to 2 y was negatively associated with SF (adjusted R 2 ¼0.15; P¼0.002; n¼58). Iron-depleted children were heavier than children not irondepleted (14.771.3 vs 13.871.7 kg; P¼0.043), had higher BMI (17.771.5 vs 16.771.4 kg/m 2 ; P¼0.028) and gained more weight from birth (11.271.3 vs. 10.071.6 kg; P¼0.011). Conclusions:The results suggest that cow's milk consumption above 500 g/day should be avoided at the age of 2 y for better iron status. Iron depletion at 2 y is associated with faster growth from birth.

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Iron status and intake of older infants fed formula vs cow milk with cereal

Cited by 58 publications

References 18 publications

Iron deficiency and risk factors for lower iron stores in 6–24-month-old New Zealanders

Iron deficiency and risk factors for lower iron stores in 6–24-month-old New Zealanders

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

Iron status in 2-year-old Icelandic children and associations with dietary intake and growth

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