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

Abstract

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.

Contribution of iron status at birth to infant iron status at 9 months: data from a prospective maternal-infant birth cohort in China

“…We previously summarized 13 studies and reported the relations between breastfeeding> 6 months and infant iron status in this cohort and another larger cohort in northern China. 16 That paper and recent study of Chinese infants 17 show that, across a range of settings and measures of iron status, infants breast fed > 6 months are at increased risk of ID/IDA. The current analysis extends these observations by simultaneously considering other potential influences on iron status in later infancy, including iron status at birth.…”

“…In fact, a recent study in Taiwan found that ID and IDA were common in breast-fed infants as young as 4–6 months. 17 Taken together, these findings suggest a need for research specifically designed to inform recommendations on the optimal age and method of ID screening under current conditions in Chinese infants.…”

“…For instance, they did not consider feeding, although associations between feeding type and iron status of infants in the first year of life have been reported in cross-sectional studies. 16 , 17 Therefore, the aim of the present study was to consider multiple measures of iron status at birth and other factors that affect iron status at 9 months in an extensively characterized sample of healthy term infants from a prospective, longitudinal maternal-infant birth cohort. We expected that lower cord SF would predict poorer iron status later in infancy.…”

The Consequence of Excessive Consumption of Cow’s Milk: Protein-Losing Enteropathy with Anasarca in the Course of Iron Deficiency Anemia—Case Reports and a Literature Review

“…However, due to the greater availability of enriched infant formula, the increasing standard of living and the use of iron supplementation in infants who are exclusively breastfed after four months of age, recent years have seen a significant decrease in the incidence of iron deficiency. Nevertheless, it remains the most common dietary deficiency worldwide [ 1 , 2 , 3 , 4 ].…”

Determining the Actual Zinc and Iron Intakes in Breastfed Infants: Protocol for a Longitudinal Observational Study

“…When comparing the prevalence of zinc deficiency by feeding types, zinc deficiency was more prevalent among 4- to 6-month old breastfed infants compared with formula-fed infants (14.9% and 5.3% among breastfed and formula-fed infants, respectively) [ 6 ]. Regarding iron deficiency, the prevalence of iron deficiency among breastfed infants was found to be higher than among infants fed with formula in several studies [ 7 , 8 ]. A study on the iron status of infants in Bangkok showed that the prevalence of iron deficiency anemia in breastfed infants aged 1 year was 25.7%, which was higher than in formula-fed infants (2.7%) [ 9 ].…”