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McLean NH, Haszard JJ, Daniels L, Taylor RW, Wheeler BJ, Conlon CA, Beck KL, von Hurst PR, Te Morenga LA, McArthur J, Paul R, Katiforis I, Brown KJ, Gash MC, Rowan MM, Casale M, Cox AM, Jones EA, Jupiterwala RM, Bruckner B, Fleming L, Heath ALM. Baby Food Pouches, Baby-Led Weaning, and Iron Status in New Zealand Infants: An Observational Study. Nutrients 2024; 16:1494. [PMID: 38794732 PMCID: PMC11124519 DOI: 10.3390/nu16101494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Iron deficiency in infants can impact development, and there are concerns that the use of baby food pouches and baby-led weaning may impair iron status. First Foods New Zealand (FFNZ) was an observational study of 625 New Zealand infants aged 6.9 to 10.1 months. Feeding methods were defined based on parental reports of infant feeding at "around 6 months of age": "frequent" baby food pouch use (five+ times per week) and "full baby-led weaning" (the infant primarily self-feeds). Iron status was assessed using a venepuncture blood sample. The estimated prevalence of suboptimal iron status was 23%, but neither feeding method significantly predicted body iron concentrations nor the odds of iron sufficiency after controlling for potential confounding factors including infant formula intake. Adjusted ORs for iron sufficiency were 1.50 (95% CI: 0.67-3.39) for frequent pouch users compared to non-pouch users and 0.91 (95% CI: 0.45-1.87) for baby-led weaning compared to traditional spoon-feeding. Contrary to concerns, there was no evidence that baby food pouch use or baby-led weaning, as currently practiced in New Zealand, were associated with poorer iron status in this age group. However, notable levels of suboptimal iron status, regardless of the feeding method, emphasise the ongoing need for paying attention to infant iron nutrition.
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Affiliation(s)
- Neve H. McLean
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (N.H.M.); (I.K.); (M.C.G.); (M.M.R.); (B.B.); (L.F.)
| | | | - Lisa Daniels
- Department of Medicine, University of Otago, Dunedin 9016, New Zealand; (L.D.); (R.W.T.); (J.M.); (A.M.C.)
| | - Rachael W. Taylor
- Department of Medicine, University of Otago, Dunedin 9016, New Zealand; (L.D.); (R.W.T.); (J.M.); (A.M.C.)
| | - Benjamin J. Wheeler
- Department of Women’s and Children’s Health, University of Otago, Dunedin 9016, New Zealand;
| | - Cathryn A. Conlon
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (C.A.C.); (K.L.B.); (P.R.v.H.); (R.P.); (K.J.B.); (M.C.); (E.A.J.); (R.M.J.)
| | - Kathryn L. Beck
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (C.A.C.); (K.L.B.); (P.R.v.H.); (R.P.); (K.J.B.); (M.C.); (E.A.J.); (R.M.J.)
| | - Pamela R. von Hurst
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (C.A.C.); (K.L.B.); (P.R.v.H.); (R.P.); (K.J.B.); (M.C.); (E.A.J.); (R.M.J.)
| | - Lisa A. Te Morenga
- Research Centre for Hauora and Health, Massey University, Wellington 6140, New Zealand;
| | - Jenny McArthur
- Department of Medicine, University of Otago, Dunedin 9016, New Zealand; (L.D.); (R.W.T.); (J.M.); (A.M.C.)
| | - Rebecca Paul
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (C.A.C.); (K.L.B.); (P.R.v.H.); (R.P.); (K.J.B.); (M.C.); (E.A.J.); (R.M.J.)
| | - Ioanna Katiforis
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (N.H.M.); (I.K.); (M.C.G.); (M.M.R.); (B.B.); (L.F.)
| | - Kimberley J. Brown
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (C.A.C.); (K.L.B.); (P.R.v.H.); (R.P.); (K.J.B.); (M.C.); (E.A.J.); (R.M.J.)
| | - Madeline C. Gash
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (N.H.M.); (I.K.); (M.C.G.); (M.M.R.); (B.B.); (L.F.)
| | - Madeleine M. Rowan
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (N.H.M.); (I.K.); (M.C.G.); (M.M.R.); (B.B.); (L.F.)
| | - Maria Casale
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (C.A.C.); (K.L.B.); (P.R.v.H.); (R.P.); (K.J.B.); (M.C.); (E.A.J.); (R.M.J.)
| | - Alice M. Cox
- Department of Medicine, University of Otago, Dunedin 9016, New Zealand; (L.D.); (R.W.T.); (J.M.); (A.M.C.)
| | - Emily A. Jones
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (C.A.C.); (K.L.B.); (P.R.v.H.); (R.P.); (K.J.B.); (M.C.); (E.A.J.); (R.M.J.)
| | - Rosario M. Jupiterwala
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (C.A.C.); (K.L.B.); (P.R.v.H.); (R.P.); (K.J.B.); (M.C.); (E.A.J.); (R.M.J.)
| | - Bailey Bruckner
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (N.H.M.); (I.K.); (M.C.G.); (M.M.R.); (B.B.); (L.F.)
| | - Liz Fleming
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (N.H.M.); (I.K.); (M.C.G.); (M.M.R.); (B.B.); (L.F.)
| | - Anne-Louise M. Heath
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (N.H.M.); (I.K.); (M.C.G.); (M.M.R.); (B.B.); (L.F.)
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Sandri BJ, Kim J, Lubach GR, Lock EF, Ennis-Czerniak K, Kling PJ, Georgieff MK, Coe CL, Rao RB. Prognostic Performance of Hematological and Serum Iron and Metabolite Indices for Detection of Early Iron Deficiency Induced Metabolic Brain Dysfunction in Infant Rhesus Monkeys. J Nutr 2024; 154:875-885. [PMID: 38072152 PMCID: PMC10942850 DOI: 10.1016/j.tjnut.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND The current pediatric practice of monitoring for infantile iron deficiency (ID) via hemoglobin (Hgb) screening at one y of age does not identify preanemic ID nor protect against later neurocognitive deficits. OBJECTIVES To identify biomarkers of iron-related metabolic alterations in the serum and brain and determine the sensitivity of conventional iron and heme indices for predicting risk of brain metabolic dysfunction using a nonhuman primate model of infantile ID. METHODS Simultaneous serum iron and RBC indices, and serum and cerebrospinal fluid (CSF) metabolomic profiles were determined in 20 rhesus infants, comparing iron sufficient (IS; N = 10) and ID (N = 10) infants at 2 and 4 mo of age. RESULTS Reticulocyte hemoglobin (RET-He) was lower at 2 wk in the ID group. Significant IS compared with ID differences in serum iron indices were present at 2 mo, but Hgb and RBC indices differed only at 4 mo (P < 0.05). Serum and CSF metabolomic profiles of the ID and IS groups differed at 2 and 4 mo (P < 0.05). Key metabolites, including homostachydrine and stachydrine (4-5-fold lower at 4 mo in ID group, P < 0.05), were altered in both serum and CSF. Iron indices and RET-He at 2 mo, but not Hgb or other RBC indices, were correlated with altered CSF metabolic profile at 4 mo and had comparable predictive accuracy (area under the receiver operating characteristic curve scores, 0.75-0.80). CONCLUSIONS Preanemic ID at 2 mo was associated with metabolic alterations in serum and CSF in infant monkeys. Among the RBC indices, only RET-He predicted the future risk of abnormal CSF metabolic profile with a predictive accuracy comparable to serum iron indices. The concordance of homostachydrine and stachydrine changes in serum and CSF indicates their potential use as early biomarkers of brain metabolic dysfunction in infantile ID.
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Affiliation(s)
- Brian J Sandri
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States; Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
| | - Jonathan Kim
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Gabriele R Lubach
- Harlow Center for Biological Psychology, University of Wisconsin, Madison, WI, United States
| | - Eric F Lock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Kathleen Ennis-Czerniak
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Pamela J Kling
- Division of Neonatology, Department of Pediatrics, University of Wisconsin, Madison, WI, United States
| | - Michael K Georgieff
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States; Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
| | - Christopher L Coe
- Harlow Center for Biological Psychology, University of Wisconsin, Madison, WI, United States
| | - Raghavendra B Rao
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States; Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States.
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Papež J, Labounek R, Jabandžiev P, Česká K, Slabá K, Ošlejšková H, Aulická Š, Nestrašil I. Multivariate linear mixture models for the prediction of febrile seizure risk and recurrence: a prospective case-control study. Sci Rep 2023; 13:17372. [PMID: 37833343 PMCID: PMC10576023 DOI: 10.1038/s41598-023-43599-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Our goal was to identify highly accurate empirical models for the prediction of the risk of febrile seizure (FS) and FS recurrence. In a prospective, three-arm, case-control study, we enrolled 162 children (age 25.8 ± 17.1 months old, 71 females). Participants formed one case group (patients with FS) and two control groups (febrile patients without seizures and healthy controls). The impact of blood iron status, peak body temperature, and participants' demographics on FS risk and recurrence was investigated with univariate and multivariate statistics. Serum iron concentration, iron saturation, and unsaturated iron-binding capacity differed between the three investigated groups (pFWE < 0.05). These serum analytes were key variables in the design of novel multivariate linear mixture models. The models classified FS risk with higher accuracy than univariate approaches. The designed bi-linear classifier achieved a sensitivity/specificity of 82%/89% and was closest to the gold-standard classifier. A multivariate model assessing FS recurrence provided a difference (pFWE < 0.05) with a separating sensitivity/specificity of 72%/69%. Iron deficiency, height percentile, and age were significant FS risk factors. In addition, height percentile and hemoglobin concentration were linked to FS recurrence. Novel multivariate models utilizing blood iron status and demographic variables predicted FS risk and recurrence among infants and young children with fever.
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Affiliation(s)
- Jan Papež
- Department of Pediatrics, Faculty of Medicine and University Hospital, Masaryk University, Brno, Czech Republic
- Department of Pediatric Neurology, Faculty of Medicine and University Hospital, Masaryk University, Černopolní 9, Brno, 612 00, Czech Republic
| | - René Labounek
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Masonic Institute for the Developing Brain, 2025 East River Parkway, Minneapolis, MN, 55414, USA
| | - Petr Jabandžiev
- Department of Pediatrics, Faculty of Medicine and University Hospital, Masaryk University, Brno, Czech Republic
| | - Katarína Česká
- Department of Pediatric Neurology, Faculty of Medicine and University Hospital, Masaryk University, Černopolní 9, Brno, 612 00, Czech Republic
| | - Kateřina Slabá
- Department of Pediatrics, Faculty of Medicine and University Hospital, Masaryk University, Brno, Czech Republic
| | - Hana Ošlejšková
- Department of Pediatric Neurology, Faculty of Medicine and University Hospital, Masaryk University, Černopolní 9, Brno, 612 00, Czech Republic
| | - Štefania Aulická
- Department of Pediatric Neurology, Faculty of Medicine and University Hospital, Masaryk University, Černopolní 9, Brno, 612 00, Czech Republic.
- Ondrej Slaby Research Group, Central European Institute of Technology, Masaryk University, Brno, Czech Republic.
| | - Igor Nestrašil
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Masonic Institute for the Developing Brain, 2025 East River Parkway, Minneapolis, MN, 55414, USA.
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Kim HH, Lee EJ, Kim JK. Rapid increase in the body mass index of very preterm infants is a risk factor for iron deficiency during infancy. Sci Rep 2023; 13:15526. [PMID: 37726416 PMCID: PMC10509161 DOI: 10.1038/s41598-023-42531-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023] Open
Abstract
Iron deficiency (ID) in very preterm infants born at 28-32 weeks of gestational age (GA) can lower mental and motor test scores. This study aimed to determine whether the rapid growth of very preterm infants might be associated with ID. Among 134 very preterm born between January 2014 and December 2020 at Jeonbuk National University Hospital and discharged home, 93 were included in this study. Rapid BMI increase (RBI) was defined as a z-score difference of > 1 standard deviation between birth and 8 months. ID occurred in 23 of 93 (24.7%) infants at 8 months of corrected age (CA). ID was more common in the RBI group (50%) than in the non-RBI group (18.7%). In the multivariate logistic regression corrected for GA, infants small for gestational age (SGA) (odds ratio [OR] 6.06, 95% confidence interval [CI] 1.34-30.21) and RBI by z-score (OR 4.26, 95% CI 1.28-14.65) were identified as independent risk factors for ID at 8 months of CA. Conclusively, both SGA and RBI in the early life of very preterm were risk factors for ID at 8 months of CA.
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Affiliation(s)
- Hyun Ho Kim
- Department of Pediatrics, Jeonbuk National University School of Medicine, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
- Department of Statistics and Data Science, Korea National Open University, Seoul, South Korea
| | - Eun Jee Lee
- College of Nursing, Research Institute of Nursing Science, Jeonbuk National University, Jeonju, South Korea
| | - Jin Kyu Kim
- Department of Pediatrics, Jeonbuk National University School of Medicine, Jeonju, South Korea.
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea.
- Department of Pediatrics, Jeonbuk National University Children's Hospital, 20 Geonjiro, Jeonju, 54907, South Korea.
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Rao RB, Lubach GR, Ennis-Czerniak KM, Lock EF, Kling PJ, Georgieff MK, Coe CL. Reticulocyte Hemoglobin Equivalent has Comparable Predictive Accuracy as Conventional Serum Iron Indices for Predicting Iron Deficiency and Anemia in a Nonhuman Primate model of Infantile Iron Deficiency. J Nutr 2023; 153:148-157. [PMID: 36913448 PMCID: PMC10196609 DOI: 10.1016/j.tjnut.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/05/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Infantile iron deficiency (ID) causes anemia and compromises neurodevelopment. Current screening relies on hemoglobin (Hgb) determination at 1 year of age, which lacks sensitivity and specificity for timely detection of infantile ID. Low reticulocyte Hgb equivalent (RET-He) indicates ID, but its predictive accuracy relative to conventional serum iron indices is unknown. OBJECTIVES The objective was to compare diagnostic accuracies of iron indices, red blood cell (RBC) indices, and RET-He for predicting the risk of ID and IDA in a nonhuman primate model of infantile ID. METHODS Serum iron, total iron binding capacity, unsaturated iron binding capacity, transferrin saturation (TSAT), Hgb, RET-He, and other RBC indices were determined at 2 wk and 2, 4, and 6 mo in breastfed male and female rhesus infants (N = 54). The diagnostic accuracies of RET-He, iron, and RBC indices for predicting the development of ID (TSAT < 20%) and IDA (Hgb < 10 g/dL + TSAT < 20%) were determined using t tests, area under the receiver operating characteristic curve (AUC) analysis, and multiple regression models. RESULTS Twenty-three (42.6%) infants developed ID and 16 (29.6%) progressed to IDA. All 4 iron indices and RET-He, but not Hgb or RBC indices, predicted future risk of ID and IDA (P < 0.001). The predictive accuracy of RET-He (AUC = 0.78, SE = 0.07; P = 0.003) for IDA was comparable to that of the iron indices (AUC = 0.77-0.83, SE = 0.07; P ≤ 0.002). A RET-He threshold of 25.5 pg strongly correlated with TSAT < 20% and correctly predicted IDA in 10 of 16 infants (sensitivity: 62.5%) and falsely predicted possibility of IDA in only 4 of 38 unaffected infants (specificity: 89.5%). CONCLUSIONS RET-He is a biomarker of impending ID/IDA in rhesus infants and can be used as a hematological parameter to screen for infantile ID.
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Affiliation(s)
- Raghavendra B Rao
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA.
| | - Gabriele R Lubach
- Harlow Center for Biological Psychology, University of Wisconsin, Madison, WI, USA
| | | | - Eric F Lock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Pamela J Kling
- Division of Neonatology, Department of Pediatrics, University of Wisconsin, Madison, WI, USA
| | - Michael K Georgieff
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Christopher L Coe
- Harlow Center for Biological Psychology, University of Wisconsin, Madison, WI, USA
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Brichta CE, Godwin J, Norlin S, Kling PJ. Impact and interactions between risk factors on the iron status of at-risk neonates. J Perinatol 2022; 42:1103-1109. [PMID: 35132153 DOI: 10.1038/s41372-022-01318-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/29/2021] [Accepted: 01/11/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Examine interactions between perinatal risk factors for congenital iron deficiency (ID) using two cohorts. STUDY DESIGN Iron status in a composite 767-member cord blood cohort and a NICU cohort of 257 infants < 33 weeks of gestation or small for gestational age (SGA). Risks for ID were examined. Cord ferritin levels < 84 µg/L defined congenital ID. Serum ferritin < 70 µg/L defined infantile ID at one-month. RESULTS 31% of the cord cohort had congenital ID; risks summative (p < 0.0015). 16% of the NICU cohort had infantile ID; risks not summative. However, 32% had ID if the ferritin threshold was 100 µg/L. Being both preterm (p < 0.0001) and SGA (p < 0.05) negatively impacted cord iron status. Maternal hypertension was a novel predictor of iron status (p = 0.023 in preterm cord; p < 0.0025 in NICU). CONCLUSION Summing risks in term and understanding compounding risks in preterm infants can improve screening and management of ID in at-risk infants.
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Affiliation(s)
- Christine E Brichta
- Pediatrics, University of Wisconsin, Madison, WI, USA.,UnityPoint Health Meriter, Madison, WI, USA
| | - Jennie Godwin
- Pediatrics, Children's Mercy and University of Kansas and formerly, Pediatrics, University of Wisconsin, Madison, WI, USA
| | | | - Pamela J Kling
- Pediatrics, University of Wisconsin, Madison, WI, USA. .,UnityPoint Health Meriter, Madison, WI, USA.
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Akomo P, Bahwere P, Balaluka B, Collins S, Singhal A, Tomkins A. Reply to I Potani et al. Adv Nutr 2022; 13:970-972. [PMID: 35641237 PMCID: PMC9156381 DOI: 10.1093/advances/nmac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peter Akomo
- From VALID Nutrition, Derry Duff, Bantry, Co. Cork, Ireland
| | - Paluku Bahwere
- Epidemiology, Biostatistics, Clinical Research, School of Public Health, Free University of Brussels, Belgium
| | - Bisimwa Balaluka
- Catholic University of Bukavu, South-Kivu, Democratic Republic of the Congo
| | - Steve Collins
- From VALID Nutrition, Derry Duff, Bantry, Co. Cork, Ireland
| | - Atul Singhal
- Population, Policy and Practice programme, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Andrew Tomkins
- Faculty of Population Health Sciences of University College London and Institute for Global Health, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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Sandri BJ, Kim J, Lubach GR, Lock EF, Guerrero C, Higgins L, Markowski TW, Kling PJ, Georgieff MK, Coe CL, Rao RB. Multiomic Profiling of Iron Deficient Infant Monkeys Reveals Alterations in Neurologically Important Biochemicals in Serum and CSF Prior to the Onset of Anemia. Am J Physiol Regul Integr Comp Physiol 2022; 322:R486-R500. [PMID: 35271351 DOI: 10.1152/ajpregu.00235.2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The effects of iron deficiency (ID) during infancy extend beyond the hematologic compartment and include short- and long-term adverse effects on many tissues including the brain. However, sensitive biomarkers of iron-dependent brain health are lacking in humans. OBJECTIVE To determine whether serum and CSF biomarkers of ID-induced metabolic dysfunction are concordant in the pre/early anemic stage of ID prior to anemia in a nonhuman primate model of infantile IDA. METHODS Paired serum and CSF specimens were collected from iron-sufficient (IS; n = 12) and ID (n = 7) rhesus infants at 4-months (pre-anemic period) and 6-months of age (anemic). Hematological, metabolomic, and proteomic profiles were generated via HPLC/MS at both time points to discriminate serum bio markers of ID-induced brain metabolic dysfunction. RESULTS We identified 227 metabolites and 205 proteins in serum. Abnormalities indicating altered liver function, lipid dysregulation, and increased acute phase reactants were present in ID. In CSF, we measured 210 metabolites and 1,560 proteins with changes in ID infants indicative of metabolomic and proteomic differences indexing disrupted synaptogenesis. Systemic and CSF proteomic and metabolomic changes were present and concurrent in the pre-anemic and anemic periods. CONCLUSIONS Multiomic serum and CSF profiling uncovered pathways disrupted by ID in both the pre-anemic and anemic stages of infantile IDA, including evidence for hepatic dysfunction and activation of acute phase response. Parallel changes observed in serum and CSF potentially provide measurable serum biomarkers of ID that reflect at-risk brain processes prior to progression to clinical anemia.
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Affiliation(s)
- Brian J Sandri
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States.,Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
| | - Jonathan Kim
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Gabriele R Lubach
- Harlow Center for Biological Psychology, University of Wisconsin, Madison, WI, United States
| | - Eric F Lock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Candace Guerrero
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN, United States
| | - LeeAnn Higgins
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN, United States
| | - Todd W Markowski
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN, United States
| | - Pamela J Kling
- Division of Neonatology, Department of Pediatrics, University of Wisconsin, Madison, WI, United States
| | - Michael K Georgieff
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States.,Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
| | - Christopher L Coe
- Harlow Center for Biological Psychology, University of Wisconsin, Madison, WI, United States
| | - Raghavendra B Rao
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States.,Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
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Hanieh S, Braat S, Tran TD, Ha TT, Simpson JA, Tuan T, Fisher J, Biggs BA. Child linear growth trajectories during the first three years of life in relation to infant iron status: a prospective cohort study in rural Vietnam. BMC Nutr 2022; 8:14. [PMID: 35164876 PMCID: PMC8845254 DOI: 10.1186/s40795-022-00505-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 01/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background Early childhood growth patterns have long-term consequences for health and disease. Little is known about the interplay between growth and iron status during childhood. We explored the interplay between linear growth and iron status during early childhood, by assessing child growth trajectories between 6 and 36 months (m) of age in relation to infant iron status at 6 months of age. Methods A cohort study of infants born to women who had previously participated in a cluster randomized controlled trial of antenatal micronutrient supplementation, conducted in rural Vietnam. The relationship between child linear growth trajectories and infant iron status (ferritin concentration) was examined using latent growth curve modeling. Primary outcomes were height for age z scores (HAZ) and growth trajectory between 6 and 36 m of age. Results A total of 1112 infants were included in the study. Mean [SD] HAZ scores decreased over time from –0·58 [0·94] at 6 m, to –0·97 [0·99] at 18 m, to –1·14 [0·89] at 36 m of age. There was a steep linear decline in the HAZ scores between 6 and 18 m of age, followed by a slower linear decline from 18 to 36 m of age. Ferritin concentration at 6 m of age was inversely associated with HAZ score at 6 m of age (-0·145, 95% CI [-0.189, -0.101]). There was no association between infant ferritin at 6 m of age and child growth trajectory between 6 and 36 m of age. Conclusions Iron status at six months of age did not influence a child’s later linear growth trajectory in this cohort of rural Vietnamese children. Longitudinal studies with repeated ferritin and height measurements are required to better delineate this relationship and inform public health interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00505-y.
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Gedfie S, Getawa S, Melku M. Prevalence and Associated Factors of Iron Deficiency and Iron Deficiency Anemia Among Under-5 Children: A Systematic Review and Meta-Analysis. Glob Pediatr Health 2022; 9:2333794X221110860. [PMID: 35832654 PMCID: PMC9272181 DOI: 10.1177/2333794x221110860] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background. Iron deficiency anemia is a common health problem that affects children under the age of five. Children’s cognitive performance is impaired by iron deficiency, which impacts their psychomotor development. Therefore, the aim of this study was to determine the global prevalence and associated factors of iron deficiency and iron deficiency anemia among under-5 children. Methods. Relevant publications published till March 30, 2021 were identified in databases such as Medline/PubMed, Science Direct, Popline, EMBASE, African Journals Online, Scopus, and Google Scholar. The STATA version 11 software was utilized for the analysis. To determine the level of heterogeneity, I2 test statistics were used. To detect publication bias, funnel plots analysis and the Egger weighted regression test were used. Results. The global pooled prevalence of iron deficiency anemia and iron deficiency was 16.42% (95% CI: 10.82, 22.01) and 17.95% (95% CI: 13.49, 22.41), respectively. Age less than 2 years (OR = 1.26; 95% CI: 1.14, 1.38) and living in a large family size (OR = 1.38; 95% CI: 1.18, 1.58) were associated with iron deficiency anemia. Children born from anemic mother, low birth weight, and do not drink iron fortified milk (OR = 1.20; 95% CI: 1.05, 1.36), (OR = 1.15; 95% CI: 1.01, 1.36) and (OR = 1.28; 95% CI: 1.10, 1.46), respectively were associated factors of iron deficiency in under-5 children. Conclusion. The prevalence of iron deficiency anemia and iron deficiency was significant across the globe, particularly in Asia and Africa. Therefore, regular screening and treatment of iron deficiency and iron deficiency anemia are required especially in high-risk children to reduce their complication. PROSPERO registration number: CRD42021267060
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Affiliation(s)
- Solomon Gedfie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Woldiya University, Woldiya, Ethiopia
| | - Solomon Getawa
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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11
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Prevalence and associated factors of iron deficiency in Spanish children aged 1 to 11 years. Eur J Pediatr 2021; 180:2773-2780. [PMID: 33759019 DOI: 10.1007/s00431-021-04037-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 01/01/2023]
Abstract
Iron deficiency (ID) is the most common nutritional deficiency affecting children worldwide. Most traditional laboratory parameters to assess ID can be altered by infections or other inflammatory states, including obesity. The aims of this study were to determine the prevalence of ID in healthy children and to analyse associated factors, avoiding potential confounding factors through the use of serum transferrin receptor (sTfR), reticulocyte haemoglobin content and sTfR/log ferritin index. A cross-sectional population-based study was conducted on 951 children aged 1 to 11 years in Almería (Spain). ID was detected in 7.7% of children and iron deficiency anaemia in 0.9%. Multivariate analysis identified the following as independent risk factors: age under 5 years (OR: 2.2, 95% CI: 1.35-3.6); excessive consumption of cow's milk and dairy products (OR: 1.87, 95% CI: 1.13-3.1); and insufficient consumption of vegetables (OR: 2.7, 95% CI: 1.2-6.1).Conclusions: Using a combination of iron status parameters with greater discriminatory power than classical measures, this study detected a considerable iron deficiency prevalence in Spanish children. Younger children and specific dietary habits exhibit a particular risk for ID, so special attention should be paid to this population. What is Known: • Iron deficiency remains the most prevalent nutritional deficit worldwide, and children aged under 3 years are the most vulnerable to this condition. • Accurate assessment of iron status, based on a combination of biochemical indicators, can often be complicated. What is New: • Iron deficiency continues to present a health problem in Spanish children aged 1 to 11 years, considering the serum transferrin receptor and reticulocyte haemoglobin content for diagnosis. • Excessive consumption of dairy products and low consumption of vegetables are independent risk factors for iron deficiency.
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12
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Speich C, Brittenham GM, Cercamondi CI, Zeder C, Nkosi-Gondwe T, Phiri KS, Moretti D, Zimmermann MB. Isotopic measurement of iron requirements in sub-Saharan African children. Am J Clin Nutr 2021; 114:986-996. [PMID: 34113969 DOI: 10.1093/ajcn/nqab161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/19/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Prevention of iron deficiency in African children is a public health priority. Current WHO/FAO estimations of iron requirements are derived from factorial estimates based on healthy, iron-sufficient "model" children using data derived mainly from adults. OBJECTIVES In this study, we aimed to quantify iron absorption, loss, and balance in apparently healthy 5- to 7-y-old children living in rural Africa. METHODS We directly measured long-term iron absorption and iron loss in a 2-y observational study in Malawian children (n = 48) using a novel stable iron isotope method. RESULTS Of the 36 children with height-for-age and weight-for-age z scores ≥-2, 13 (36%) were iron deficient (soluble transferrin receptor >8.3 mg/L) and 23 were iron sufficient. Iron-deficient children weighed more than iron-sufficient children [mean difference (95% CI): +2.1 (1.4, 2.7) kg; P = 0.01]. Mean iron losses did not differ significantly between iron-deficient and iron-sufficient children and were comparable to WHO/FAO median estimates of 19 µg/(d × kg). In iron-sufficient children, median (95% CI) dietary iron absorption was 32 (28, 34) µg/(d × kg), comparable to WHO/FAO-estimated median requirements of 32 µg/(d × kg). In iron-deficient children, absorption of 28 (25, 30) µg/(d × kg) was not increased to correct their iron deficit, likely because of a lack of bioavailable dietary iron. Twelve children (25%) were undernourished (underweight, stunted, or both). CONCLUSIONS Our results suggest that WHO/FAO iron requirements are adequate for healthy iron-sufficient children in this rural area of Malawi, but iron-deficient children require additional bioavailable iron to correct their iron deficit.
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Affiliation(s)
- Cornelia Speich
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
| | - Gary M Brittenham
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Colin I Cercamondi
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
| | - Christophe Zeder
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
| | - Thandile Nkosi-Gondwe
- Training and Research Unit of Excellence, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kamija S Phiri
- Training and Research Unit of Excellence, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Diego Moretti
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland.,Nutrition Group, Health Department, Swiss Distance University of Applied Sciences, Regensdorf, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
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13
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The critical roles of iron during the journey from fetus to adolescent: Developmental aspects of iron homeostasis. Blood Rev 2021; 50:100866. [PMID: 34284901 DOI: 10.1016/j.blre.2021.100866] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 12/12/2022]
Abstract
Iron is indispensable for human life. However, it is also potentially toxic, since it catalyzes the formation of harmful oxidative radicals in unbound form and may facilitate pathogen growth. Therefore, iron homeostasis needs to be tightly regulated. Rapid growth and development require large amounts of iron, while (especially young) children are vulnerable to infections with iron-dependent pathogens due to an immature immune system. Moreover, unbalanced iron status early in life may have effects on the nervous system, immune system and gut microbiota that persist into adulthood. In this narrative review, we assess the critical roles of iron for growth and development and elaborate how the body adapts to physiologically high iron demands during the journey from fetus to adolescent. As a first step towards the development of clinical guidelines for the management of iron disorders in children, we summarize the unmet needs regarding the developmental aspects of iron homeostasis.
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14
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Imdad A, Ehrlich JM, Catania J, Tanner-Smith E, Smith A, Tsistinas O, Bhutta ZA. Effect of consumption of animal milk compared to infant formula for non-breastfed/mixed-fed infants 6-11 months of age: a systematic review (protocol). BMJ Open 2021; 11:e046370. [PMID: 33579775 PMCID: PMC7883848 DOI: 10.1136/bmjopen-2020-046370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Prevalence rates of breastfeeding remain low even though the World Health Organization (WHO) and the American Academy of Pediatrics recommend exclusive breast feeding for the first 6 months of life in combination with appropriate complementary feeding beyond six 6 months of age. There have been several studies that address the implication of drinking animal milk and/or infant formula on children's health and development when breast feeding is not offered during the first year of life. Vast improvements have been made in infant formula design, which may increase its benefits compared with animal's milk. The objective of this review is therefore to synthesise the most recent evidence on the effects of the consumption of animal milk compared with infant formula in non-breastfed or mixed breastfed infants aged 6-11 months. METHODS AND ANALYSIS We will conduct a systematic review and meta-analysis of studies that assessed the effect of animal milk compared with formula or mixed-fed (breastmilk and formula) on infants aged 6-11 months. The primary outcomes of interest include anaemia, gastrointestinal blood loss, weight for age, height for age and weight for height. We will include randomised and non-randomised studies with a control group. We will use the Cochrane risk of bias tools to assess the risk of bias. We will use meta-analysis to pool findings if the identified studies are conceptually homogenous and data are available from more than one study. We will assess the overall quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. ETHICS AND DISSEMINATION This is a systematic review, so no patients will be directly involved in the design or development of this study. The findings from this systematic review will be disseminated to relevant patient populations and caregivers and will guide the WHO's recommendations on formula consumption versus animal milk in infants aged 6-11 months. TRIAL REGISTRATION NUMBER CRD42020210925.
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Affiliation(s)
- Aamer Imdad
- Department of Pediatrics; Division of Pediatric Gastroenterology, Hepatology and Nutrition, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Joseph Catania
- School of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Abigail Smith
- Health Sciences Library, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Olivia Tsistinas
- Health Sciences Library, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Zulfiqar Ahmed Bhutta
- Institute for Global Health and Development, The Aga Khan University, Karachi, Sindh, Pakistan
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15
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Vehapoglu A, Ozgurhan G, Ustabas Kahraman F, Cakın ZE, Sumbul B. Association between Consumption of Cow's Milk and Iron Deficiency Anemia in Children: Are There Roles for Hepcidin-25/Ferroportin? A Case-Control Study. Pediatr Hematol Oncol 2020; 37:676-686. [PMID: 32705943 DOI: 10.1080/08880018.2020.1782547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Systemic iron homeostasis is regulated by the interaction of the peptide hormone, hepcidin and the iron exporter, ferroportin. The objective was to investigate the relationship between the consumption of cow's milk and iron deficiency anemia in children 2-10 years old and its association with the hepcidin-25 and ferroportin concentrations. The study population consisted of 187 prepubescent children of similar ideal body weight (IBW:90-120%); 82 children with iron deficiency anemia (37girls and 45boys; 4.27 ± 0.28 years) and 105 (47girls and 58boys; 4.25 ± 0.34 years) healthy age-sex-matched controls. Serum fasting hepcidin-25/ferroportin concentrations were measured by enzyme immunoassay in all subjects. Mean cow's milk consumption in the anemic group (373 ± 248 mL/d) tended to be higher than that in the control group (320 ± 226 mL/d), but the result was not statistically significant (p = 0.063).The mean hepcidin-25 level was significantly higher in the anemic group (19.5 ± 18.4 ng/mL) than in the healthy controls (11.0 ± 10.7, p < 0.001). The mean ferroportin level was lower in the anemic group (21.04 ± 5.74 ng/mL) than in the healthy controls (22.68 ± 4.77 ng/ml, p = 0.037). Consuming cow's milk was not associated with IDA in prepubertal children, provided that it was adequately supplemented with iron-enriched foods. We observed a significant increase in hepcidin-25 levels and a decrease in ferroportin levels in children with iron deficiency anemia compared with healthy controls. Children who consumed more cow's milk had higher levels of hepcidin-25. Iron deficiency anemia is not a concern when cow's milk is given to children if the complementary foods are rich in iron.
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Affiliation(s)
- Aysel Vehapoglu
- Department of Pediatrics, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey
| | - Gamze Ozgurhan
- Department of Pediatrics, Süleymaniye Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Feyza Ustabas Kahraman
- Department of Pediatrics, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey
| | - Zeynep Ebru Cakın
- Department of Pediatrics, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey
| | - Bilge Sumbul
- Department of Infectious Diseases and Clinical Microbiology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
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16
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Faysal W, Zaidi ARZ, Al-Abdi S, Alhumaid S, AlShehery MZ, Al Mutair A. Hospital-Based Prevalence of Iron Deficiency Anemia among Pre-School Children in Dubai. Cureus 2020; 12:e10894. [PMID: 33194463 PMCID: PMC7654558 DOI: 10.7759/cureus.10894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Iron deficiency anemia (IDA) is an internationally recognized leading cause of disability and contributes to childhood morbidity and mortality. The prevalence of IDA is higher in developing countries, especially in Arab countries, compared to the west. METHODS To assess the prevalence of IDA, we analyzed the data of children aged between one to five years seen at Dr. Sulaiman Al-Habib Medical Group's tertiary care hospital in Dubai, United Arab Emirates (UAE) from 2016 to 2018. RESULTS We found a high occurrence of IDA in male children and non-Emirati children. CONCLUSION Appropriate screening and iron supplementation are required to see a decline in the rate of IDA. Further nationwide studies are required to identify the highly prevalent and high-risk areas of IDA in the UAE.
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Affiliation(s)
- Wafaa Faysal
- Pediatrics, Dr. Sulaiman Al Habib Medical Group, Dubai, ARE
| | - Abdul Rehman Z Zaidi
- Internal Medicine, Dr. Sulaiman Al Habib Medical Group, Riyadh, SAU
- Internal Medicine, Alfaisal University, Riyadh, SAU
| | - Sameer Al-Abdi
- Pediatrics, King Abdulaziz Hospital, Ministry of the National Guard-Health Affairs, Al-Ahsa, SAU
| | | | | | - Abbas Al Mutair
- Internal Medicine, Dr. Sulaiman Al Habib Medical Group, Riyadh, SAU
- Internal Medicine, University of Wollongong, Wollongong, AUS
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17
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Al Sulayyim HJ, Al Omari A, Badri M. An assessment for diagnostic and therapeutic modalities for management of pediatric Iron defficiency Anemia in Saudi Arabia: a crossectional study. BMC Pediatr 2019; 19:314. [PMID: 31488081 PMCID: PMC6727491 DOI: 10.1186/s12887-019-1704-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/30/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction Iron deficiency anemia (IDA) is a global public health issue that affect more than 2 billion individuals worldwide. However evidence for optimal management of IDA is lacking. Methods To assess the diagnostic criteria and therapeutic modalities for pediatric IDA employed by physicians in a major public healthcare facility in Riyadh, a validated questionnaire including demographic data and patient case-scenarios related to diagnosis and treatment of IDA was employed. Robust regression analysis was used to identify factors associated with overall score of participants. Results Of the 166 physicians surveyed 147(88.6%) were included in the study. Wide variability was observed in IDA diagnosis and therapy practises. For nutritional IDA, only 15.6% recommended no other laboratory tests in addition to CBC. The majority preferred treatment with ferrous sulfate (77.6%) divided into two doses (57.1%), but the total daily elemental iron doses varied widely from 2 to 6 mg/kg. For intravenous iron, 42.9% recommended iron dextran, 32.7% iron sucrose, and 13.4% would continue oral iron. Of all assessed factors, median score was significantly highest in pediatric hematologists compared with pediatricians, family medicine specialists and GPs; p = 0.007, and those work in tertiary care compared with those in primary care; p = 0.043. However, in multivariate robust regression analysis, overall score was only significantly associated with professional qualification [pediatric hematologist β = 13.71,95%CI 2.48–24.95, p = 0.017; pediatrician β = 1.77,95%C (− 6.05–9.59, p = 0.66; family medicine β = 2.66,95%CI-4.30-9.58, p = 0.45 compared with general practitioner]. Conclusion Wide variations exist among physicians in diagnosis and treatment of pediatric IDA. Intervention programs and national guidelines are urgently needed.
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Affiliation(s)
- Hadi J Al Sulayyim
- Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Ali Al Omari
- Division of Pediatric, Department of Oncology, King Abdulla Specialized Children Hospital, King Abdulla International Medical Research Centre, Riyadh, Saudi Arabia
| | - Motasim Badri
- Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
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18
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Armitage AE, Moretti D. The Importance of Iron Status for Young Children in Low- and Middle-Income Countries: A Narrative Review. Pharmaceuticals (Basel) 2019; 12:E59. [PMID: 30995720 PMCID: PMC6631790 DOI: 10.3390/ph12020059] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/09/2019] [Accepted: 04/12/2019] [Indexed: 12/21/2022] Open
Abstract
Early childhood is characterised by high physiological iron demand to support processes including blood volume expansion, brain development and tissue growth. Iron is also required for other essential functions including the generation of effective immune responses. Adequate iron status is therefore a prerequisite for optimal child development, yet nutritional iron deficiency and inflammation-related iron restriction are widespread amongst young children in low- and middle-income countries (LMICs), meaning iron demands are frequently not met. Consequently, therapeutic iron interventions are commonly recommended. However, iron also influences infection pathogenesis: iron deficiency reduces the risk of malaria, while therapeutic iron may increase susceptibility to malaria, respiratory and gastrointestinal infections, besides reshaping the intestinal microbiome. This means caution should be employed in administering iron interventions to young children in LMIC settings with high infection burdens. In this narrative review, we first examine demand and supply of iron during early childhood, in relation to the molecular understanding of systemic iron control. We then evaluate the importance of iron for distinct aspects of physiology and development, particularly focusing on young LMIC children. We finally discuss the implications and potential for interventions aimed at improving iron status whilst minimising infection-related risks in such settings. Optimal iron intervention strategies will likely need to be individually or setting-specifically adapted according to iron deficiency, inflammation status and infection risk, while maximising iron bioavailability and considering the trade-offs between benefits and risks for different aspects of physiology. The effectiveness of alternative approaches not centred around nutritional iron interventions for children should also be thoroughly evaluated: these include direct targeting of common causes of infection/inflammation, and maternal iron administration during pregnancy.
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Affiliation(s)
- Andrew E Armitage
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DS, UK.
| | - Diego Moretti
- Laboratory of Human Nutrition, Institute of Food Nutrition and Health, Department of Health Sciences and Technology, ETH Zürich, CH-8092 Zürich, Switzerland.
- Nutrition Group, Health Department, Swiss Distance University of Applied Sciences, CH-8105 Regensdorf, Switzerland.
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19
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Obbagy JE, English LK, Psota TL, Wong YP, Butte NF, Dewey KG, Fox MK, Greer FR, Krebs NF, Scanlon KS, Stoody EE. Complementary feeding and micronutrient status: a systematic review. Am J Clin Nutr 2019; 109:852S-871S. [PMID: 30982869 DOI: 10.1093/ajcn/nqy266] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/11/2018] [Accepted: 08/14/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Proper nutrition during early life is critical for growth and development. OBJECTIVES The aim was to describe systematic reviews conducted by the Nutrition Evidence Systematic Review team for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer the following: What is the relation between 1) timing of introduction of complementary foods and beverages (CFBs) or 2) types and/or amounts of CFBs consumed and micronutrient status (iron, zinc, vitamin D, vitamin B-12, folate, and fatty acid status)? METHODS A literature search identified articles from developed countries published from January 1980 to July 2016 that met the inclusion criteria. Data were extracted and risk of bias assessed. Evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded. RESULTS Nine articles addressed the timing of CFB introduction and 31 addressed types or amounts or both of CFBs. Moderate evidence suggests that introducing CFBs at age 4 mo instead of 6 mo offers no advantages or disadvantages in iron status among healthy full-term infants. Evidence is insufficient on the timing of CFB introduction and other micronutrient status outcomes. Strong evidence suggests that CFBs containing iron (e.g., meat, fortified cereal) help maintain adequate iron status or prevent deficiency in the first year among infants at risk of insufficient iron stores or low intake. Benefits for infants with sufficient iron stores (e.g., infant formula consumers) are less clear. Moderate evidence suggests that CFBs containing zinc (e.g., meat, fortified cereal) support zinc status in the first year and CFB fatty acid composition influences fatty acid status. Evidence is insufficient with regard to types and amounts of CFBs and vitamin D, vitamin B-12, and folate status, or the relation between lower-iron-containing CFBs and micronutrient status. CONCLUSIONS Several conclusions on CFBs and micronutrient status were drawn from these systematic reviews, but more research that addresses specific gaps and limitations is needed.
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Affiliation(s)
| | | | | | | | - Nancy F Butte
- USDA, Agricultural Research Service, Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, CA
| | | | - Frank R Greer
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Nancy F Krebs
- Department of Pediatrics, University of Colorado School of Medicine, Denver, CO
| | | | - Eve E Stoody
- USDA, Food and Nutrition Service, Alexandria, VA
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20
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Armitage AE, Agbla SC, Betts M, Sise EA, Jallow MW, Sambou E, Darboe B, Worwui A, Weinstock GM, Antonio M, Pasricha SR, Prentice AM, Drakesmith H, Darboe MK, Kwambana-Adams BA. Rapid growth is a dominant predictor of hepcidin suppression and declining ferritin in Gambian infants. Haematologica 2019; 104:1542-1553. [PMID: 30733275 PMCID: PMC6669141 DOI: 10.3324/haematol.2018.210146] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/31/2019] [Indexed: 12/18/2022] Open
Abstract
Iron deficiency and iron deficiency anemia are highly prevalent in low-income countries, especially among young children. Hepcidin is the major regulator of systemic iron homeostasis. It controls dietary iron absorption, dictates whether absorbed iron is made available in circulation for erythropoiesis and other iron-demanding processes, and predicts response to oral iron supplementation. Understanding how hepcidin is itself regulated is therefore important, especially in young children. We investigated how changes in iron-related parameters, inflammation and infection status, seasonality, and growth influenced plasma hepcidin and ferritin concentrations during infancy using longitudinal data from two birth cohorts of infants in rural Gambia (n=114 and n=193). This setting is characterized by extreme seasonality, prevalent childhood anemia, undernutrition, and frequent infection. Plasma was collected from infants at birth and at regular intervals, up to 12 months of age. Hepcidin, ferritin and plasma iron concentrations declined markedly during infancy, with reciprocal increases in soluble transferrin receptor and transferrin concentrations, indicating declining iron stores and increasing tissue iron demand. In cross-sectional analyses at 5 and 12 months of age, we identified expected relationships of hepcidin with iron and inflammatory markers, but also observed significant negative associations between hepcidin and antecedent weight gain. Correspondingly, longitudinal fixed effects modeling demonstrated weight gain to be the most notable dynamic predictor of decreasing hepcidin and ferritin through infancy across both cohorts. Infants who grow rapidly in this setting are at particular risk of depletion of iron stores, but since hepcidin concentrations decrease with weight gain, they may also be the most responsive to oral iron interventions.
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Affiliation(s)
- Andrew E Armitage
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Schadrac C Agbla
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Modupeh Betts
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa
| | - Ebrima A Sise
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa
| | - Momodou W Jallow
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa
| | - Ellen Sambou
- WHO Collaborating Center for New Vaccines Surveillance, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa
| | - Bakary Darboe
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa
| | - Archibald Worwui
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa
| | | | - Martin Antonio
- WHO Collaborating Center for New Vaccines Surveillance, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa
| | - Sant-Rayn Pasricha
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK.,Walter and Eliza Hall Institute for Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, The University of Melbourne, VIC, Melbourne, Australia
| | - Andrew M Prentice
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa
| | - Hal Drakesmith
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK.,Haematology Theme, Oxford Biomedical Research Centre, Oxford, UK
| | - Momodou K Darboe
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa
| | - Brenda Anna Kwambana-Adams
- WHO Collaborating Center for New Vaccines Surveillance, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia, Africa .,NIHR Global Health Research Unit on Mucosal Pathogens, Division of Infection and Immunity, University College London, London, UK
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Abstract
Iron deficiency (ID) is common in young children aged 6-36 mo. Although the hazards associated with iron deficiency anemia (IDA) are well known, concerns about risks associated with excess iron intake in young children are emerging. To characterize iron status in Europe, we describe the prevalence of ID, IDA, iron repletion, and excess stores with the use of published data from a systematic review on iron intake and deficiency rates, combined with other selected iron status data in young European children. Various definitions for ID and IDA were applied across studies. ID prevalence varied depending on socioeconomic status and type of milk fed (i.e., human or cow milk or formula). Without regard to these factors, ID was reported in 3-48% of children aged ≥12 mo across the countries. For 6- to 12-mo-old infants, based on studies that did not differentiate these factors, ID prevalence was 4-18%. IDA was <5% in most studies in Northern and Western Europe but was considerably higher in Eastern Europe (9-50%). According to current iron status data from a sample of healthy Western European children aged 12-36 mo, 69% were iron replete, and the 97.5th percentile for serum ferritin (SF) was 64.3 μg/L. In another sample, 79% of 24-mo-old children were iron replete, and the 97.5th percentile for SF was 57.3 μg/L. Average iron intake in most countries studied was close to or below the UK's Recommended Dietary Allowance. In conclusion, even in healthy European children aged 6-36 mo, ID is still common. In Western European populations for whom data were available, approximately three-quarters of children were found to be iron replete, and excess iron stores (SF >100 μg/L) did not appear to be a concern. Consensus on the definitions of iron repletion and excess stores, as well as on ID and IDA, is needed.
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Affiliation(s)
| | - Simone R Eussen
- Nutricia Advanced Medical Nutrition, Nutricia Research, Utrecht, Netherlands
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22
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Early Life Protein Intake: Food Sources, Correlates, and Tracking across the First 5 Years of Life. J Acad Nutr Diet 2017; 117:1188-1197.e1. [DOI: 10.1016/j.jand.2017.03.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/21/2017] [Indexed: 11/19/2022]
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Sacri AS, Hercberg S, Gouya L, Levy C, Bocquet A, Blondel B, Vincelet C, Hebel P, Vinatier I, de Montalembert M, Barros H, Le Strat Y, Chalumeau M. Very low prevalence of iron deficiency among young French children: A national cross-sectional hospital-based survey. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28466606 DOI: 10.1111/mcn.12460] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/27/2017] [Accepted: 03/29/2017] [Indexed: 01/05/2023]
Abstract
Although iron deficiency (ID) is considered the most frequent micronutrient deficiency in industrialized countries and is associated with impaired neurodevelopment when occurring in early years, accurate recent estimations of its prevalence are lacking. Our objective was to estimate ID prevalence and associated sociodemographic markers in young children in France. The Saturn-Inf national cross-sectional hospital-based survey recruited 3,831 French children <6 years old between 2008 and 2009 to assess lead poisoning prevalence and to establish a biobank. This secondary analysis measured serum ferritinemia (SF) in sera kept frozen at -80 °C for children with sufficient serum aliquots and C-reactive protein <10 mg/L. For the 657 participating children (17% of the Saturn-Inf study), the median age was 3.9 years (interquartile range: 2.2-5.1); 52% were boys. The median SF was 44 μg/L (interquartile range: 28-71). ID prevalence was 2.8% (95% confidence interval [1.7, 4.7]) and 3.2% (95% confidence interval [2.0, 5.1]) with an SF threshold of 10 and 12 μg/L, respectively. Low SF was significantly associated (p < .05) with mother being a migrant (32 vs. 45 μg/L for a mother born in France) or unemployed (37 vs. 50 μg/L for a mother employed). In this first national cross-sectional hospital-based study in France, ID prevalence was much lower than that in other French and European studies performed in underprivileged populations but close to the lowest values observed in other population-based studies in Europe.
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Affiliation(s)
- Anne-Sylvia Sacri
- INSERM UMR1153, Centre de Recherche en Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), équipe Épidémiologie Périnatale, Obstétricale et Pédiatrique (ÉPOPé), Labex GR-Ex, Université Paris Descartes, Paris, France.,Service de Pédiatrie Générale et Maladies Infectieuses, Hôpital Necker-Enfants malades, AP-HP, Université Paris Descartes, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Serge Hercberg
- INSERM UMR1153, Centre de Recherche en Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Université Paris Descartes, Paris, France.,Département de Santé Publique, AP-HP, Hôpital Avicenne, Bobigny, Paris, France
| | - Laurent Gouya
- Centre de recherche sur l'inflammation, INSERM UMR 1149, Université Paris Diderot; ERL CNRS 8252, Faculté de Médecine site Bichat, Paris, France
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), Paris, France.,Université Paris Est, IMRB- GRC GEMINI, Paris, France
| | - Alain Bocquet
- Association Française de Pédiatrie Ambulatoire (AFPA), Talence, France.,Comité de nutrition de la Société Française de Pédiatrie, Paris, France
| | - Béatrice Blondel
- INSERM UMR1153, Centre de Recherche en Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), équipe Épidémiologie Périnatale, Obstétricale et Pédiatrique (ÉPOPé), Labex GR-Ex, Université Paris Descartes, Paris, France
| | | | - Pascale Hebel
- Centre de Recherche pour l'Etude et l'Observation des Conditions de vie (CREDOC), Paris, France
| | | | - Mariane de Montalembert
- INSERM UMR1153, Centre de Recherche en Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), équipe Épidémiologie Périnatale, Obstétricale et Pédiatrique (ÉPOPé), Labex GR-Ex, Université Paris Descartes, Paris, France.,Service de Pédiatrie Générale et Maladies Infectieuses, Hôpital Necker-Enfants malades, AP-HP, Université Paris Descartes, Paris, France
| | - Henrique Barros
- Department of Clinical Epidemiology, Predictive Medicine and Public Health University of Porto Medical School, Porto, Portugal
| | | | - Martin Chalumeau
- INSERM UMR1153, Centre de Recherche en Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), équipe Épidémiologie Périnatale, Obstétricale et Pédiatrique (ÉPOPé), Labex GR-Ex, Université Paris Descartes, Paris, France.,Service de Pédiatrie Générale et Maladies Infectieuses, Hôpital Necker-Enfants malades, AP-HP, Université Paris Descartes, Paris, France
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24
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McCarthy EK, Ní Chaoimh C, Kenny LC, Hourihane JO, Irvine AD, Murray DM, Kiely ME. Iron status, body size, and growth in the first 2 years of life. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28449384 DOI: 10.1111/mcn.12458] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/03/2017] [Accepted: 03/19/2017] [Indexed: 12/13/2022]
Abstract
Rapid growth in infancy has been shown to adversely affect iron status up to 1 year; however the effect of growth on iron status in the second year of life has been largely unexplored. We aimed to investigate the impact of growth and body size in the first 2 years on iron status at 2 years. In the prospective, maternal-infant Cork BASELINE Birth Cohort Study, infant weight and length were measured at birth, 2, 6, 12, and 24 months and absolute weight (kg) and length (cm) gain from 0 to 2, 0 to 6, 0 to 12, 6 to 12, 12 to 24, and 0 to 24 months were calculated. At 2 years (n = 704), haemoglobin, mean corpuscular volume, and serum ferritin (umbilical cord concentrations also) were measured. At 2 years, 5% had iron deficiency (ferritin < 12 μg/L) and 1% had iron deficiency anaemia (haemoglobin < 110 g/L + ferritin < 12 μg/L). Weight gain from 6 to 12, 0 to 24, and 12 to 24 months were all inversely associated with ferritin concentrations at 2 years but only the association with weight gain from 12 to 24 months was robust after adjustment for potential confounders including cord ferritin (adj. estimate 95% CI: -4.40 [-8.43, -0.37] μg/L, p = .033). Length gain from 0 to 24 months was positively associated with haemoglobin at 2 years (0.42 [0.07, 0.76] g/L, p = .019), only prior to further adjustment for cord ferritin. To conclude, weight gain in the second year was inversely associated with iron stores at 2 years, even after accounting for iron status at birth. Further examinations of iron requirements, dietary intakes, and growth patterns in children in the second year of life in high-resource settings are warranted.
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Affiliation(s)
- Elaine K McCarthy
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.,The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Carol Ní Chaoimh
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.,The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Louise C Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.,Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Jonathan O'B Hourihane
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Alan D Irvine
- Department of Clinical Medicine, Trinity College, Dublin, Ireland.,Department of Paediatric Dermatology, Our Lady's Children's Hospital, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - Deirdre M Murray
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Mairead E Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.,The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
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25
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McCarthy EK, Ní Chaoimh C, Hourihane JO, Kenny LC, Irvine AD, Murray DM, Kiely M. Iron intakes and status of 2-year-old children in the Cork BASELINE Birth Cohort Study. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27501864 DOI: 10.1111/mcn.12320] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/26/2016] [Accepted: 02/23/2016] [Indexed: 01/08/2023]
Abstract
Young children are at risk of iron deficiency and subsequent anaemia, resulting in long-term consequences for cognitive, motor and behavioural development. This study aimed to describe the iron intakes, status and determinants of status in 2-year-old children. Data were collected prospectively in the mother-child Cork BASELINE Birth Cohort Study from 15 weeks' gestation throughout early childhood. At the 24-month assessment, serum ferritin, haemoglobin and mean corpuscular volume were measured, and food/nutrient intake data were collected using a 2-day weighed food diary. Iron status was assessed in 729 children (median [IQR] age: 2.1 [2.1, 2.2] years) and 468 completed a food diary. From the food diary, mean (SD) iron intakes were 6.8 (2.6) mg/day and 30% had intakes < UK Estimated Average Requirement (5.3 mg/day). Using WHO definitions, iron deficiency was observed in 4.6% (n = 31) and iron deficiency anaemia in five children (1.0%). Following an iron series workup, five more children were diagnosed with iron deficiency anaemia. Twenty-one per cent had ferritin concentrations <15 µg/L. Inadequate iron intakes (OR [95% CI]: 1.94 [1.09, 3.48]) and unmodified cows' milk intakes ≥ 400 mL/day (1.95 [1.07, 3.56]) increased the risk of low iron status. Iron-fortified formula consumption was associated with decreased risk (0.21 [0.11, 0.41] P < 0.05). In this, the largest study in toddlers in Europe, a lower prevalence of low iron status was observed than in previous reports. Compliance with dietary recommendations to limit cows' milk intakes in young children and consumption of iron-fortified products appears to have contributed to improved iron status at two years.
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Affiliation(s)
- Elaine K McCarthy
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Ireland.,The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Ireland
| | - Carol Ní Chaoimh
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Ireland.,The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Ireland
| | - Jonathan O'B Hourihane
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Ireland
| | - Louise C Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Ireland.,Department of Obstetrics and Gynaecology, University College Cork, Ireland
| | - Alan D Irvine
- Department of Clinical Medicine, Trinity College, Dublin, Ireland.,Department of Paediatric Dermatology, Our Lady's Children's Hospital, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - Deirdre M Murray
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Ireland
| | - Mairead Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Ireland.,The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Ireland
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26
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Kerling EH, Souther LM, Gajewski BJ, Sullivan DK, Georgieff MK, Carlson SE. Reducing Iron Deficiency in 18-36-months-old US Children: Is the Solution Less Calcium? Matern Child Health J 2016; 20:1798-803. [PMID: 26987860 DOI: 10.1007/s10995-016-1982-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives National surveys consistently identify iron deficiency (ID) in US children between 1 and 3 years of age, when the brain is rapidly developing and vulnerable to the effects of ID. However, controversy remains as to how best to recognize and prevent ID in young children, in part because of the multiple potential etiologies. The objective of this project was to assess ID in children and identify potential individual dietary predictors of status. Methods We examined three biomarkers of ID [soluble transferrin receptor (sTfR) and serum ferritin (SF), and body iron (calculated from sTfR and SF)] against parent-provided dietary calcium and iron intake for eight-three 18-36 month old children from middle class families. Results Using literature-based cutoffs, fourteen children (16.9 %) had at least one indicator of ID: low SF(<10 μg/l, 7.2 %), negative body iron (<0 mg/kg, 7.2 %) or elevated sTfR (>8.4 μg/ml, 13.2 %). All children consumed more than the Dietary Reference Intake (DRI) Estimated Average Requirement of 3 mg/d iron. The mean iron intake of children identified with ID approximated the Recommended Dietary Allowance of 7 mg/d. Most children (81 %) consumed above the DRI Adequate Intake of 500 mg/d of calcium. Calcium intakes were generally high and predicted lower body iron (p = 0.0005), lower SF (p = 0.0086) and higher sTfR (p = 0.0176). Conclusions for Practice We found rates of ID similar to US national averages. Dietary calcium intake predicted lower iron status more than deficits in iron intake. Teaching parents to balance calcium and iron intake in toddlers could be a strategy to prevent ID.
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Affiliation(s)
- Elizabeth H Kerling
- Department of Dietetics and Nutrition, University of Kansas Medical Center, MS 4013, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Laura M Souther
- Department of Dietetics and Nutrition, University of Kansas Medical Center, MS 4013, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Byron J Gajewski
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, MS 4013, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | | | - Susan E Carlson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, MS 4013, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
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Iron intakes of Australian infants and toddlers: findings from the Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Program. Br J Nutr 2015; 115:285-93. [PMID: 26571345 DOI: 10.1017/s0007114515004286] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Fe deficiency remains the most common nutritional deficiency worldwide and young children are at particular risk. Preventative food-based strategies require knowledge of current intakes, sources of Fe, and factors associated with low Fe intakes; yet few data are available for Australian children under 2 years. This study's objectives were to determine intakes and food sources of Fe for Australian infants and toddlers and identify non-dietary factors associated with Fe intake. Dietary, anthropometric and socio-demographic data from the Melbourne Infant Feeding, Activity and Nutrition Trial Program were analysed for 485 infants (mean age: 9·1 (sd 1·2) months) and 423 toddlers (mean age: 19·6 (sd 2·6) months) and their mothers. Dietary intakes were assessed via 24-h recalls over 3 non-consecutive days. Prevalence of inadequate Fe intake was estimated using the full probability approach. Associations between potential non-dietary predictors (sex, breast-feeding status, age when introduced to solid foods, maternal age, maternal education, maternal employment status and mother's country of birth) and Fe intakes were assessed using linear regression. Mean Fe intakes were 9·1 (sd 4·3) mg/d for infants and 6·6 (sd 2·4) mg/d for toddlers. Our results showed that 32·6 % of infants and 18·6 % of toddlers had inadequate Fe intake. Main food sources of Fe were Fe-fortified infant formula and cereals for infants and toddlers, respectively. Female sex and current breast-feeding were negatively associated with infant Fe intakes. Introduction to solid foods at or later than 6 months was negatively associated with Fe intake in toddlers. These data may facilitate food-based interventions to improve Australian children's Fe intake levels.
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28
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Nkulikiyinka R, Binagwaho A, Palmer K. The changing importance of key factors associated with anaemia in 6‐ to 59‐month‐old children in a sub‐Saharan African setting where malaria is on the decline: analysis of the Rwanda Demographic and Health Survey 2010. Trop Med Int Health 2015; 20:1722-32. [DOI: 10.1111/tmi.12604] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | | | - Katie Palmer
- London School of Hygiene and Tropical Medicine London UK
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29
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Prevalence and determinants of anaemia among children aged 0–59 months in a rural region of Armenia: a case–control study. Public Health Nutr 2015; 19:1260-9. [DOI: 10.1017/s1368980015002451] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveDespite the trend of increasing prevalence of childhood anaemia in Armenia, no studies exploring its risk factors have been conducted in the country. The present study aimed to investigate the prevalence and determinants of childhood anaemia in rural Armenia.DesignBlood Hb level was measured among a representative sample of children using the HemoCue Hb201+ analyser. The revealed cases with anaemia were compared with randomly selected non-anaemic controls. Mothers of cases and controls were interviewed. Logistic and linear regression models were fitted to identify the risk factors of anaemia and low Hb level, respectively.SettingTalin communities, Aragatsotn Province, Armenia.SubjectsChildren under 5 years of age in Talin region.ResultsOf the 729 studied children, 32·4 % were anaemic with 14·7 % having moderate/severe anaemia. Infants were the most affected group with 51·1 % being anaemic before 6 months and 67·9 % at 6–12 months of age. Fitted regression models identified the following predictors of anaemia: younger age, male gender, shorter birth length, anaemia during pregnancy, lower meal frequency per day, lack of meat in the diet, using dung cakes for heating and living in a community that received an incomplete set of nutrition interventions.ConclusionsThe study identified several modifiable risk factors that could be targeted to reduce childhood anaemia in rural Armenia and, possibly, in rural areas in other low-/middle-income countries. The suggested interventions include prevention and treatment of anaemia during pregnancy, provision of adequate complementary feeding to children with inclusion of meat in their daily diet and reduction of their exposure to biomass fuel smoke.
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Al Hawsawi ZM, Al-Rehali SA, Mahros AM, Al-Sisi AM, Al-Harbi KD, Yousef AM. High prevalence of iron deficiency anemia in infants attending a well-baby clinic in northwestern Saudi Arabia. Saudi Med J 2015; 36:1067-70. [PMID: 26318463 PMCID: PMC4613630 DOI: 10.15537/smj.2015.9.11844] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 07/08/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine the prevalence of iron deficiency anemia (IDA) in infants aged 6-24 months attending the well-baby clinic in primary health care centers (PHCCs). METHODS This cross-sectional epidemiological study was conducted in the Northwestern region of Saudi Arabia from April 2013 to January 2014 in 5 randomly selected PHCCs. The sample size comprised 500 infants, with 100 infants screened from each PHCC. Blood samples were obtained for estimation of hemoglobin and serum ferritin levels. RESULTS Out of 500 infants, 246 (49%) cases had IDA with a mean age of 15.4 ± 6.5 months, with 130 (53%) males, and 116 (47%) females (p=0367). Out of 274 Saudi infants, 126 (51%) cases were diagnosed as IDA. CONCLUSION Iron deficiency anemia is very common in Saudi infants aged 6-24 months. A national program directed for primary prevention and early discovery of IDA in Saudi infants is recommended at PHCCs system. Iron supplementation is to be given at early infancy with universal screening of hemoglobin and ferritin estimation to all infants at 12 months of age.
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Affiliation(s)
- Zakaria M Al Hawsawi
- Department of Pediatrics, Madinah Maternity & Children's Hospital, Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia. E-mail:.
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31
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Health effects of cow’s milk consumption in infants up to 3 years of age: a systematic review and meta-analysis. Public Health Nutr 2015; 19:293-307. [DOI: 10.1017/s1368980015001354] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo summarize the best available evidence regarding the short- and long-term health effects of cow’s milk intake in healthy, full-term infants up to 3 years of age.DesignWe conducted a systematic review and meta-analysis.SettingWe searched MEDLINE (via PubMed), EMBASE and the Cochrane Library between 1960 and July 2013 and manually reviewed reference lists of pertinent articles. Two researchers independently reviewed abstracts and full-text articles and extracted relevant data.SubjectsWe included (randomized/non-randomized) controlled trials and observational studies.ResultsWe included data from twenty-three studies (one randomized controlled trial, four non-randomized controlled trials, eight case–control studies and ten cohort studies) for the evidence synthesis. Pooled results of four studies revealed a higher risk of Fe-deficiency anaemia for infants consuming cow’s milk compared with those consuming follow-on formula (relative risk=3·76; 95 % CI 2·73, 5·19). For type 1 diabetes mellitus, six out of seven case–control studies did not show a difference in the risk of developing this disease based on the age of introduction of cow’s milk. We did not find negative associations for other health effects.ConclusionsCow’s milk consumption in infancy is associated with an increased risk of developing Fe-deficiency anaemia. Limiting cow’s milk consumption may be important to ensure an adequate Fe intake for infants and toddlers. High-quality patient information for caregivers is needed on how infants’ Fe requirements can be met.
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Eussen S, Alles M, Uijterschout L, Brus F, van der Horst-Graat J. Iron Intake and Status of Children Aged 6-36 Months in Europe: A Systematic Review. ANNALS OF NUTRITION AND METABOLISM 2015; 66:80-92. [DOI: 10.1159/000371357] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/02/2014] [Indexed: 11/19/2022]
Abstract
Background: Iron deficiency is the most common nutritional disorder in the world. Young children are particularly vulnerable to the consequences of iron deficiency because of their rapidly developing brain. This review evaluates the prevalence of inadequate iron intake and iron deficiency (anaemia) in European children aged 6-36 months. Summary: Computerized searches for relevant articles were performed in November 2013. A total of 7,297 citations were screened and 44 studies conducted in 19 European countries were included in this review. In both infants (6-12 months) and young children (12-36 months), the mean value of iron intakes in most countries was close to the RDA. Nevertheless, proportions of inadequate intakes were considerable, ranging from about 10% in the Netherlands up to 50% in Austria, Finland and the United Kingdom. The prevalence of iron deficiency varied between studies and was influenced by children's characteristics. Two to 25% of infants aged 6-12 months were found to be iron deficient, with a higher prevalence in those who were socially vulnerable and those who were drinking cow's milk as a main type of drink in their first year of life. In children aged 12-36 months, prevalence rates of iron deficiency varied between 3 and 48%. Prevalence of iron deficiency anaemia in both age groups was high in Eastern Europe, as high as 50%, whereas the prevalence in Western Europe was generally below 5%. Key Messages: In most European countries, mean iron intakes of infants and children aged 6 to 36 months were found to be close to the RDA. Nevertheless, high proportions of inadequate intakes and high prevalence rates of iron deficiency were observed. Health programs should (keep) focus(ing) on iron malnutrition by educating parents on food choices for their children with iron-rich and iron-fortified foods, and encourage iron supplementation programmes where iron intakes are the lowest.
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Arvas A, Gür E, Doğan D. Hemoglobin cut-off values in healthy Turkish infants. World J Pediatr 2014; 10:343-7. [PMID: 24599615 DOI: 10.1007/s12519-014-0468-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/07/2012] [Indexed: 10/25/2022]
Abstract
BACKGROUND Anemia is a widespread public health problem associated with an increased risk of morbidity and mortality. This study was undertaken to determine the cut-off value of hemoglobin for infant anemia. METHODS A cross-sectional retrospective study was carried out at well-baby clinics of a tertiary care hospital. A total of 1484 healthy infants aged between 4 to 24 months were included in the study. The relationship of hemoglobin (Hb) levels with mother age, birth weight, weight gain rate, feeding, and gender was evaluated. RESULTS The Hb levels were assessed in four age groups (4 months, 6 months, 9-12 months, and 15-24 months) and the cut-off values of Hb were determined. Hb cut-off values (5th percentile for age) were detected as 97 g/L and 93 g/L at 4 months and 6 months, respectively. In older infants, the 5th percentile was 90.5 g/L and 93.4 g/L at 9-12 months and 15-24 months, respectively. The two values were lower than the World Health Organization criteria for anemia, which could partly due to the lack of information on iron status in our population. However, this difference highlights the need for further studies on normal Hb levels in healthy infants in developing countries. Hb levels of females were higher in all age groups; however, a statistically significant difference was found in gender in only 6 month-old infants. No statistically significant difference was found among Hb levels, mother's age, birth weight, weight gain rate, and nutritional status. CONCLUSION Hb cut-off values in infants should be re-evaluated and be compatible with growth and development of children in that community.
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Affiliation(s)
- Ahmet Arvas
- Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey,
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Williams PG. The benefits of breakfast cereal consumption: a systematic review of the evidence base. Adv Nutr 2014; 5:636S-673S. [PMID: 25225349 PMCID: PMC4188247 DOI: 10.3945/an.114.006247] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
There have been no comprehensive reviews of the relation of breakfast cereal consumption to nutrition and health. This systematic review of all articles on breakfast cereals to October 2013 in the Scopus and Medline databases identified 232 articles with outcomes related to nutrient intake, weight, diabetes, cardiovascular disease, hypertension, digestive health, dental and mental health, and cognition. Sufficient evidence was available to develop 21 summary evidence statements, ranked from A (can be trusted to guide practice) to D (weak and must be applied with caution). Breakfast cereal consumption is associated with diets higher in vitamins and minerals and lower in fat (grade B) but is not associated with increased intakes of total energy or sodium (grade C) or risk of dental caries (grade B). Most studies on the nutritional impact are cross-sectional, with very few intervention studies, so breakfast cereal consumption may be a marker of an overall healthy lifestyle. Oat-, barley-, or psyllium-based cereals can help lower cholesterol concentrations (grade A), and high-fiber, wheat-based cereals can improve bowel function (grade A). Regular breakfast cereal consumption is associated with a lower body mass index and less risk of being overweight or obese (grade B). Presweetened breakfast cereals do not increase the risk of overweight and obesity in children (grade C). Whole-grain or high-fiber breakfast cereals are associated with a lower risk of diabetes (grade B) and cardiovascular disease (grade C). There is emerging evidence of associations with feelings of greater well-being and a lower risk of hypertension (grade D), but more research is required.
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Phillips AK, Roy SC, Lundberg R, Guilbert TW, Auger AP, Blohowiak SE, Coe CL, Kling PJ. Neonatal iron status is impaired by maternal obesity and excessive weight gain during pregnancy. J Perinatol 2014; 34:513-8. [PMID: 24651737 PMCID: PMC4074453 DOI: 10.1038/jp.2014.42] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/30/2013] [Accepted: 02/13/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Maternal iron needs increase sixfold during pregnancy, but obesity interferes with iron absorption. We hypothesized that maternal obesity impairs fetal iron status. STUDY DESIGN Three hundred and sixteen newborns with risk factors for infantile iron deficiency anemia (IDA) were studied to examine obesity during pregnancy and neonatal iron status. Erythrocyte iron was assessed by cord blood hemoglobin (Hb), zinc protoporphyrin/heme (ZnPP/H) and reticulocyte-ZnPP/H, and storage iron by serum ferritin. RESULT Women with body mass index (BMI) ⩾ 30 kg m(-)(2), as compared with non-obese women, delivered larger offspring with higher reticulocyte-ZnPP/H and lower serum ferritin concentrations (P<0.05 for both). With increasing BMI, the estimated body iron was relatively lower (mg kg(-)(1)) and the ratio of total Hb-bound iron (mg) per total body iron (mg) increased. Maternal diabetes compromised infant iron status, but multivariate analysis demonstrated that obesity was an independent predictor. CONCLUSION Obesity during pregnancy and excessive weight gain are independent risk factors for iron deficiency in the newborn.
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Affiliation(s)
- Alyssa K. Phillips
- School of Medicine and Public Health, University of Wisconsin, Madison WI
- Department of Pediatrics, University of Wisconsin, Madison WI
| | - Sheila C. Roy
- School of Medicine and Public Health, University of Wisconsin, Madison WI
| | - Rebecca Lundberg
- School of Medicine and Public Health, University of Wisconsin, Madison WI
| | - Theresa W. Guilbert
- School of Medicine and Public Health, University of Wisconsin, Madison WI
- Department of Pediatrics, University of Wisconsin, Madison WI
| | | | - Sharon E. Blohowiak
- School of Medicine and Public Health, University of Wisconsin, Madison WI
- Department of Pediatrics, University of Wisconsin, Madison WI
| | - Christopher L. Coe
- Department of Psychology, University of Wisconsin, Madison WI
- Harlow Center for Biological Psychology, University of Wisconsin, Madison WI
| | - Pamela J. Kling
- School of Medicine and Public Health, University of Wisconsin, Madison WI
- Department of Pediatrics, University of Wisconsin, Madison WI
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Prevalence and risk factors of iron deficiency in healthy young children in the southwestern Netherlands. J Pediatr Gastroenterol Nutr 2014; 58:193-8. [PMID: 24145621 DOI: 10.1097/mpg.0000000000000216] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Iron deficiency (ID) and iron deficiency anemia (IDA), during the first years of life, are associated with delayed motor and neurological development. Many studies evaluated iron status without an assessment of an acute-phase protein to identify infection. Because most indicators of iron status are influenced by infection, these data may underestimate the ID prevalence. A food consumption survey in the Netherlands showed that the mean iron intake of children ages 2 to 3 years was below the advised adequate intake of 7 mg/day. The aim of the study was to investigate iron status in a well-defined, healthy population of young children in the southwestern region of the Netherlands and to identify risk factors for ID. METHODS We conducted a multicenter, observational study in healthy children ages 0.5 to 3 years. We defined ID as ferritin <12 μg/L and IDA when, in addition, hemoglobin was <110 g/L. Children with elevated C-reactive protein levels (>5 mg/L) or underlying causes for anemia were excluded. Parents filled in a questionnaire to identify risk factors for ID. RESULTS We included 400 children in the study. ID and IDA were detected in 18.8% and 8.5% of the children, respectively. The present use of formula and the visit of preschool/day care were associated with a lower prevalence of ID, and a high intake of cow's milk was associated with a higher prevalence of ID, after adjustment for age. CONCLUSIONS ID is present in 18.8% of healthy children ages 0.5 to 3 years and living in the southwestern region of the Netherlands. The present visit of preschool/day care and the use of formula are associated with a reduced risk of ID, whereas a high intake of cow's milk is associated with an increased risk of ID.
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Tijhuis MJ, Doets EL, Vonk Noordegraaf‐Schouten M. Extensive literature search and review as preparatory work for the evaluation of the essential composition of infant and follow‐on formulae and growing‐up milk. ACTA ACUST UNITED AC 2014. [DOI: 10.2903/sp.efsa.2014.en-551] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- MJ Tijhuis
- Pallas health research and consultancy the Netherlands
| | - EL Doets
- Pallas health research and consultancy the Netherlands
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Iron deficiency and anemia in iron-fortified formula and human milk-fed preterm infants until 6 months post-term. Eur J Nutr 2013; 53:1263-71. [PMID: 24292818 DOI: 10.1007/s00394-013-0629-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 11/20/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE An iron intake of >2 mg/kg/d is recommended for preterm infants. We hypothesized that human milk (HM)-fed preterm infants require iron supplementation after discharge, whereas iron-fortified formulae (IFF; 0.8-1.0 mg iron/100 ml) may provide sufficient dietary iron until 6 months post-term. METHODS At term age, 3 and 6 months post-term, ferritin (μg/l) was measured in 92 IFF-fed infants (gestational age (median (interquartile range)) 30.7 (1.4) weeks, birth weight 1,375 (338) gram) and 46 HM-fed infants (gestational age 30.0 (1.7) weeks, birth weight 1,400 (571) gram). Iron intake (mg/kg/d) between term age and 6 months post-term was calculated. RESULTS Iron was supplemented to 71.7% of HM-fed and 83.7% of IFF-fed infants between term age and 3 months post-term and to 13% of HM-fed and 0% of IFF-fed infants between 3 and 6 months post-term. IFF-fed infants had an iron intake from supplements and formula of 2.66 (1.22) mg/kg/d between term age and 3 months post-term and 1.19 (0.32) mg/kg/d between 3 and 6 months post-term. At 3 and 6 months post-term, the incidence of ferritin <12 μg/l was higher in HM-fed compared to IFF-fed infants (23.8 vs. 7.8% and 26.3 vs. 9.5%, P < 0.02). CONCLUSION This observational study demonstrates that ferritin <12 μg/l is more prevalent in HM-fed infants until 6 months post-term. This may be due to early cessation of additional iron supplementation. We speculate that additional iron supplementation is not necessary in preterm infants fed IFF (0.8-1.0 mg iron/100 ml), as they achieve ferritin ≥12 μg/l without additional iron supplements between 3 and 6 months post-term.
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Bortolini GA, Vitolo MR, Gubert MB, Santos LMP. Early cow's milk consumption among Brazilian children: Results of a national survey. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2013. [DOI: 10.1016/j.jpedp.2013.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bortolini GA, Vitolo MR, Gubert MB, Santos LMP. Early cow's milk consumption among Brazilian children: results of a national survey. J Pediatr (Rio J) 2013; 89:608-13. [PMID: 24035873 DOI: 10.1016/j.jped.2013.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 04/26/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE to assess the intake, frequency, and type of milk consumed by Brazilian children younger than 60 months of age. METHODS this was a cross-sectional study, which used secondary data from the National Demographic and Health Survey of 2006-2007. Data from 4,817 children under the age of 60 months were used. All analyses were performed with expanded samples. The dietetic survey assessed the previous day's consumption, and estimates were made through univariate analysis, presented as a percentage. RESULTS on the day prior to the survey, breast milk was consumed by 91% of the children younger than six months of age, by 61.5% of the children aged 6 to 12 months, and by 34.8% of the children aged 13 to 24 months. Among the children who had received other types of milk, cow's milk was consumed by 62.4% of the children younger than six months, by 74.6% of the children aged 6 to 12 months, and by approximately 80% of the children older than 12 months. Infant formulas were consumed by 23% of the children younger than six months of age, by 9.8% of the children aged 6 to 12 months, and by less than 1% of the older children. Soy milk consumption varied from 14.6% to 20% among the investigated ages. Non-breast milk consumption before the age of six months was more frequent in children living in the Northeastern and Southern regions. CONCLUSION the results of the present study demonstrated that most children received cow's milk prematurely as a substitute for breast milk, highlighting the importance of the development of public policies to promote, protect, and support breastfeeding in all regions of Brazil, aiming at reversing the observed scenario.
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Quinn EA. Too much of a good thing: Evolutionary perspectives on infant formula fortification in the United States and its effects on infant health. Am J Hum Biol 2013; 26:10-7. [DOI: 10.1002/ajhb.22476] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/24/2013] [Accepted: 09/26/2013] [Indexed: 12/12/2022] Open
Affiliation(s)
- Elizabeth A. Quinn
- Department of Anthropology; Washington University in St. Louis; St. Louis, Missouri 63130
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Scientific Opinion on nutrient requirements and dietary intakes of infants and young children in the European Union. EFSA J 2013. [DOI: 10.2903/j.efsa.2013.3408] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Thorisdottir AV, Gunnarsdottir I, Palsson GI, Gretarsson SJ, Thorsdottir I. Iron status and developmental scores in 6-year-olds highlights ongoing need to tackle iron deficiency in infants. Acta Paediatr 2013; 102:914-9. [PMID: 23772831 DOI: 10.1111/apa.12316] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 05/15/2013] [Accepted: 06/10/2013] [Indexed: 11/30/2022]
Abstract
AIM To investigate iron status and developmental scores at 6 years of age in a population with decreased prevalence of iron deficiency in infancy. Iron status at 6 years and tracking from 12 months were also studied. METHODS Children (n = 143) born in Iceland in 2005 were followed up at the age of six. Motor and verbal development was assessed by a parental questionnaire, and iron status was assessed by Hb, MCV and serum ferritin (SF). Iron depletion was defined as SF <15 μg/L and deficiency as MCV <76 fL and SF <15 μg/L. RESULTS Iron depletion was observed in 5.6% of 6-year-olds, and 1.4% were iron deficient. Self-help (subset in motor development) differed by -4.14 (95% CI = -7.61, -0.67), between those iron depleted at 12 months (n = 6) and those nondepleted (n = 102), adjusted for maternal education. The combined motor developmental score seemed lower in iron depleted infants, although of borderline significance (p = 0.066). MCV concentration tracked from 12 months to 6 years (r = 0.31, p < 0.002), but Hb and SF did not. CONCLUSION Improved iron status at 12 months and 6 years has diminished the public health threat associated with iron depletion in the population studied, but iron depletion and development still associate weakly. Action to prevent iron depletion in infancy remains important.
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Affiliation(s)
- Asa Vala Thorisdottir
- Unit for Nutrition Research; Faculty of Food Science and Nutrition; School of Health Sciences; University of Iceland & Landspitali - University Hospital of Iceland; Reykjavik Iceland
| | - Ingibjorg Gunnarsdottir
- Unit for Nutrition Research; Faculty of Food Science and Nutrition; School of Health Sciences; University of Iceland & Landspitali - University Hospital of Iceland; Reykjavik Iceland
| | - Gestur I. Palsson
- Children's Hospital; Landspitali - University Hospital of Iceland; Reykjavik Iceland
| | | | - Inga Thorsdottir
- Unit for Nutrition Research; Faculty of Food Science and Nutrition; School of Health Sciences; University of Iceland & Landspitali - University Hospital of Iceland; Reykjavik Iceland
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Thorne CJ, Roberts LM, Edwards DR, Haque MS, Cumbassa A, Last AR. Anaemia and malnutrition in children aged 0-59 months on the Bijagós Archipelago, Guinea-Bissau, West Africa: a cross-sectional, population-based study. Paediatr Int Child Health 2013; 33:151-60. [PMID: 23930727 PMCID: PMC5412965 DOI: 10.1179/2046905513y.0000000060] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Childhood malnutrition is the leading risk factor for the global burden of disease. Guinea-Bissau is a politically unstable country with high levels of childhood malnutrition and mortality. AIM To determine the nutritional status of children on three remote islands of the Bijagós Archipelago, Bubaque, Rubane and Soga, and to identify factors associated with malnutrition and anaemia in this population in order to provide a baseline for future public health interventions. METHODS A cross-sectional, population-based, door-to-door household survey of randomly selected households was undertaken to collect data on children aged 0-59 months (n = 872). Dietary information was collected using a validated questionnaire. Anthropometric measurements were collected using World Health Organization techniques. Capillary blood samples were analysed using a Hemocue®, with anaemia defined as Hb<11 g/dl. RESULTS The prevalences of stunted, wasted and underweight children were 21.8%, 9.4% and 3.7%, respectively. These figures indicate moderate chronic malnutrition. The significant predictor variables for stunting were: age in months (OR 1.03), rural residence (OR 2.32), anaemia (OR 3.55) and residence on Soga island (OR 0.44). Stunting was more prevalent in males (25.4%) than in females (18.6%) (P = 0.03). The prevalence of anaemia was 80.2%. Age (OR 0.96), male gender (OR 1.81) and stunting (OR 2.87) were significant predictors. The Minimum Acceptable Diet was achieved by only 8.7% of children. CONCLUSION The prevalence of malnutrition on the Bijagós Archipelago is less than half that on the mainland. This study is the first to determine the prevalence of anaemia in Guinea-Bissau, which, at 80.2%, is of severe public health concern. Future research should focus on the aetiology of stunting and anaemia, especially the contribution of infectious diseases and mother-child interaction. Iron supplementation should be strongly considered in this population.
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Affiliation(s)
- C. J. Thorne
- School of Clinical and Experimental Medicine, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, UK
| | - L. M. Roberts
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, UK
| | - D. R. Edwards
- School of Clinical and Experimental Medicine, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, UK
| | - M. S. Haque
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, UK
| | - A. Cumbassa
- Hospital Regional de Bubaque ‘Marcelino Banca’, Bubaque, Bijagós Archipelago, Guinea-Bissau
| | - A. R. Last
- Clinical Research Department, London School of Hygiene and Tropical Medicine, UK
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Domellöf M, Thorsdottir I, Thorstensen K. Health effects of different dietary iron intakes: a systematic literature review for the 5th Nordic Nutrition Recommendations. Food Nutr Res 2013; 57:21667. [PMID: 23858301 PMCID: PMC3710934 DOI: 10.3402/fnr.v57i0.21667] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 04/24/2013] [Accepted: 06/11/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The present literature review is part of the NNR5 project with the aim of reviewing and updating the scientific basis of the 4th edition of the Nordic Nutrition Recommendations (NNR) issued in 2004. OBJECTIVE The objective of this systematic literature review was to assess the health effects of different intakes of iron, at different life stages (infants, children, adolescents, adults, elderly, and during pregnancy and lactation), in order to estimate the requirement for adequate growth, development, and maintenance of health. METHODS The initial literature search resulted in 1,076 abstracts. Out of those, 276 papers were identified as potentially relevant. Of those, 49 were considered relevant and were quality assessed (A, B, or C). An additional search on iron and diabetes yielded six articles that were quality assessed. Thus, a total of 55 articles were evaluated. The grade of evidence was classified as convincing (grade 1), probable (grade 2), suggestive (grade 3), and inconclusive (grade 4). RESULTS There is suggestive evidence that prevention or treatment of iron deficiency (ID) and iron deficiency anemia (IDA) improves cognitive, motoric, and behavioral development in young children, and that treatment of IDA improves attention and concentration in school children and adult women. There is insufficient evidence to show negative health effects of iron intakes in doses suggested by the NNR 4. There is insufficient evidence to suggest that normal birth weight, healthy, exclusively breast-fed infants need additional dietary iron before 6 months of life in the Nordic countries. An iron concentration of 4-8 mg/L in infant formulas seems to be safe and effective for normal birth weight infants. There is probable evidence that iron supplements (1-2 mg/kg/day) given up to 6 months of age to infants with low birth weight (<2,500 g) prevents IDA and possibly reduce the risk of behavioral problems later on. There is probable evidence that ID and IDA in pregnant women can be effectively prevented by iron supplementation at a dose of 40 mg/day from week 18-20 of gestation. There is probable evidence that a high intake of heme iron, but not total dietary, non-heme or supplemental iron, is associated with increased risk of type 2 diabetes (T2D) and gestational diabetes. CONCLUSIONS Overall, the evidence does not support a change of the iron intakes recommended in the NNR 4. However, one could consider adding recommendations for infants below 6 months of age, low birth weight infants and pregnant women.
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Affiliation(s)
- Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Inga Thorsdottir
- Unit for Nutrition Research, School of Health Sciences, University of Iceland and Landspitali National University Hospital of Iceland, Reykjavik, Iceland
| | - Ketil Thorstensen
- Department of Medical Biochemistry, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Thorisdottir AV, Gunnarsdottir I, Thorsdottir I. Revised infant dietary recommendations: the impact of maternal education and other parental factors on adherence rates in Iceland. Acta Paediatr 2013; 102:143-8. [PMID: 23134449 DOI: 10.1111/apa.12081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 10/18/2012] [Accepted: 11/01/2012] [Indexed: 11/27/2022]
Abstract
AIM Revised infant dietary recommendations from the Icelandic Nutrition Council (Nutrition: the first twelve months. Reykjavík, Iceland: The Icelandic Nutrition Council, 2003) are outlined in a booklet provided during free postnatal care. These focus on increasing the duration of exclusive and total breastfeeding and reducing cow's milk consumption. This study explored whether maternal education and other parental factors affected whether mothers followed the recommendations. METHODS Mothers of randomly selected healthy infants (n = 200) completed questionnaires on body mass index (BMI), age, education (basic, medium and higher), household income, smoking and parental factors. Dietary data were collected during home visits by a researcher (0-4 months) and through monthly food records completed by parents or caregivers (5-12 months). RESULTS Each maternal education level increased breastfeeding duration by 0.72 months (95% CI = 0.04, 1.39) and reduced cow's milk consumption by 36.7 mL/day (95% CI = -70.11, -3.03), when adjusted for maternal BMI, age, smoking and family income. Maternal education was not associated with duration of exclusive breastfeeding. Duration of exclusive and total breastfeeding was inversely associated with maternal BMI, B = -0.10 (95% CI = -0.16, -0.05) and -0.13 (95% CI = -0.23, -0.03), respectively. CONCLUSION Mothers with higher education appear to have adapted more easily to the revised recommendations on infant diet, particularly when their infants are 6-12 months old. Higher maternal BMI was associated with shorter duration of both exclusive and total breastfeeding.
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Affiliation(s)
- Asa Vala Thorisdottir
- Unit for Nutrition Research; Faculty of Food Science and Nutrition; School of Health Sciences; University of Iceland & Landspítali - The National University Hospital of Iceland; Reykjavik; Iceland
| | - Ingibjorg Gunnarsdottir
- Unit for Nutrition Research; Faculty of Food Science and Nutrition; School of Health Sciences; University of Iceland & Landspítali - The National University Hospital of Iceland; Reykjavik; Iceland
| | - Inga Thorsdottir
- Unit for Nutrition Research; Faculty of Food Science and Nutrition; School of Health Sciences; University of Iceland & Landspítali - The National University Hospital of Iceland; Reykjavik; Iceland
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Zongo U, Zoungrana SL, Savadogo A, Traoré AS. Nutritional and Clinical Rehabilitation of Severely Malnourished Children with <i>Moringa oleifera Lam</i>. Leaf Powder in Ouagadougou (Burkina Faso). ACTA ACUST UNITED AC 2013. [DOI: 10.4236/fns.2013.49128] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Metabolomic analysis of cerebrospinal fluid indicates iron deficiency compromises cerebral energy metabolism in the infant monkey. Neurochem Res 2012; 38:573-80. [PMID: 23269483 DOI: 10.1007/s11064-012-0950-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 12/14/2012] [Accepted: 12/17/2012] [Indexed: 01/05/2023]
Abstract
Iron deficiency anemia affects many pregnant women and young infants worldwide. The health impact is significant, given iron's known role in many body functions, including oxidative and lipid metabolism, protein synthesis and brain neurochemistry. The following research determined if (1)H NMR spectroscopy-based metabolomic analysis of cerebrospinal fluid (CSF) could detect the adverse influence of early life iron deficiency on the central nervous system. Using a controlled dietary model in 43 infant primates, distinct differences were found in spectra acquired at 600 MHz from the CSF of anemic monkeys. Three metabolite ratios, citrate/pyruvate, citrate/lactate and pyruvate/glutamine ratios, differed significantly in the iron deficient infant and then normalized following the consumption of dietary iron and improvement of clinical indices of anemia in the heme compartment. This distinctive metabolomic profile associated with anemia in the young infant indicates that CSF can be employed to track the neurological effects of iron deficiency and benefits of iron supplementation.
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Iron status of one-year-olds and association with breast milk, cow's milk or formula in late infancy. Eur J Nutr 2012; 52:1661-8. [PMID: 23212531 DOI: 10.1007/s00394-012-0472-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 11/21/2012] [Indexed: 01/14/2023]
Abstract
PURPOSE Studies on iron status in infancy and early childhood have shown contradicting results concerning prolonged breast-feeding and cow's milk intake. The aim of the present study was to investigate associations between iron status among one-year-olds and feeding, with focus on the type of milk. METHODS Randomly selected healthy infants were prospectively investigated until 1 year of age in two cohorts born 1995-1996 (n = 114) and 2005 (n = 140). Information on birth data, feeding and growth until 12 months and iron status at 12 months was collected. Data from the two cohorts were pooled and the infants categorized into three groups according to their predominant milk consumption at 9 months of age, that is, breast milk, cow's milk or follow-on formula. RESULTS The prevalence of iron deficiency was highest in the cow's milk group and lowest in the follow-on formula group. According to a linear model, adjusted for gender, birth weight and exclusive breast-feeding duration, cow's milk consumption was negatively associated with serum ferritin (SF) and formula positively, but breast milk not. Predicted SF (μg/l) = 11.652(intercept) - 5.362(boy) + 0.005 × birth weight (g) + 2.826(exclusively breastfed ≥ 4 months) + 0.027 × formula (ml) - 0.022 × cow's milk (ml) + 0.005 × breast milk (ml). Correction for other dietary factors did not change these results. CONCLUSION In this pooled analysis, cow's milk intake in late infancy associated negatively, and follow-on formula positively, with iron status. Prolonged partial breast-feeding does not seem to be of importance for iron status. Fortified food seems to improve iron status in late infancy.
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Jonsdottir OH, Thorsdottir I, Hibberd PL, Fewtrell MS, Wells JC, Palsson GI, Lucas A, Gunnlaugsson G, Kleinman RE. Timing of the introduction of complementary foods in infancy: a randomized controlled trial. Pediatrics 2012; 130:1038-45. [PMID: 23147979 PMCID: PMC9923596 DOI: 10.1542/peds.2011-3838] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To increase knowledge on iron status and growth during the first 6 months of life. We hypothesized that iron status would be better in infants who received complementary foods in addition to breast milk compared with those exclusively breastfed. METHODS One hundred nineteen healthy term (≥37 weeks) singleton infants were randomly assigned to receive either complementary foods in addition to breast milk from age 4 months (CF) or to exclusive breastfeeding for 6 months (EBF). Dietary data were collected by 3-day weighed food records, and data on iron status and growth were also collected. RESULTS One hundred infants (84%) completed the trial. Infants in the CF group had higher mean serum ferritin levels at 6 months (P = .02), which remained significant when adjusted for baseline characteristics. No difference was seen between groups in iron deficiency anemia, iron deficiency, or iron depletion. The average daily energy intake from complementary foods of 5-month-olds in the CF group was 36.8 kJ per kg body weight. Infants in both groups grew at the same rate between 4 and 6 months of age. CONCLUSIONS In a high-income country, adding a small amount of complementary food in addition to breast milk to infants' diets from 4 months of age does not affect growth rate between 4 and 6 months, but has a small and positive effect on iron status at 6 months. The biological importance of this finding remains to be determined.
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Affiliation(s)
- Olof H. Jonsdottir
- Unit for Nutrition Research, Landspitali, The National University Hospital of Iceland and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland;,Address correspondence to Olof H. Jonsdottir, BSc, Unit for Nutrition Research, Landspitali National University Hospital of Iceland, Eiriksgata 29; IS-101 Reykjavik, Iceland. E-mail:
| | - Inga Thorsdottir
- Unit for Nutrition Research, Landspitali, The National University Hospital of Iceland and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Patricia L. Hibberd
- Division of Global Health, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Mary S. Fewtrell
- Childhood Nutrition Research Centre, University College London Institute of Child Health, London, United Kingdom
| | - Jonathan C. Wells
- Childhood Nutrition Research Centre, University College London Institute of Child Health, London, United Kingdom
| | - Gestur I. Palsson
- Children’s Hospital, Landspitali, The National University Hospital of Iceland, and
| | - Alan Lucas
- Childhood Nutrition Research Centre, University College London Institute of Child Health, London, United Kingdom
| | - Geir Gunnlaugsson
- Directorate of Health and Reykjavik University, Reykjavik, Iceland; and
| | - Ronald E. Kleinman
- Department of Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
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