Iron Metabolism and Requirements in Early Childhood: Do We Know Enough?: A Commentary by the ESPGHAN Committee on Nutrition

Aggett, Peter; Agostoni, Carlo; Axelsson, Inge; Bresson, Jean‐Louis; Goulet, Olivier; Hernell, Olle; Koletzko, Berthold; Lafeber, Harry L.; Michaelsen, Kim F.; Micheli, Jean-Léopold; Rigo, Jacques; Szajewska, Hania; Weaver, Lawrence T.

doi:10.1097/00005176-200204000-00003

Cited by 119 publications

(100 citation statements)

References 59 publications

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“…The significantly higher prevalence of storage iron deficiency in the older compared with younger age groups (Table 3) suggests that the iron status of toddlers, in particular, should be monitored in this population. Unfortunately, our interpretation is limited by the cross-sectional nature of the survey design, however, and relies on the questioned assumption that haemoglobin and ferritin levels indicate identical iron status and iron stores across the 6-24 month age range (Sherriff et al, 1999;Aggett et al, 2002). The significantly higher average ferritin and significantly lower average haemoglobin levels among infants compared to toddlers in the current study certainly suggest that agerelated differences in these indices exist that are unrelated to iron status.…”

Section: Discussionmentioning

confidence: 68%

“…Particularly, because they were not associated with an age-related difference in rates of infection based on both C-reactive protein results and reported rates of infection in the month prior to the survey. Clearly iron status indices need to be interpreted with caution over the 6-24-month-old age range, as recently emphasised by others (Aggett et al, 2002). Nevertheless, an age-related decline in iron stores in this group of children is consistent with longitudinal and intervention studies, which generally show that ferritin levels decline across the 6-24 month age range when cows' milk or unfortified formula is fed, whereas they remain constant when children consume iron-fortified formula (Fuchs et al, 1993;Michaelsen et al, 1995;Daly et al, 1996;Gill et al, 1997;Oti-Boateng et al, 1998;Morely et al, 1999;Sherriff et al, 1999;Virtanen et al, 2001).…”

Section: Discussionmentioning

confidence: 96%

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

et al. 2003

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

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 96%

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

et al. 2003

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“…The WHO (World Health Organization) began directing efforts toward the understanding and control of nutritional anemia in 1949 (World Health Organization, 1950); however, even today, the world is still struggling with the deficiency (Aggett et al, 2002). In both industrialized and developing countries, iron deficiency (ID) is the most prevalent micronutrient deficiency (Milne, 2000).…”

Section: Introductionmentioning

confidence: 99%

Iron deficiency and anemia: disparity exists between children in American Samoa and children living within the US

2007

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Background/Objectives: Healthy People 2010 emphasizes elimination of health disparity and improvements in anemia and iron deficiency (ID). The study purpose was to (1) determine the prevalence of anemia, ID and ID anemia (IDA) in children living in American Samoa and (2) compare the prevalence to that found in children living in the United States. Subjects/Methods: A total of 211 children from American Samoa, aged 1-5 years of age, participated in this cross-sectional study. Prevalence of anemia, ID and IDA were determined and comparison made using data obtained from children living in the United States. Anemia was diagnosed as hemoglobin (Hb) o110.0 g/l, ID as erythrocyte protoporphyrin (EP) 470 mmol/mol heme and IDA as Hb o110.0 g/l and EP 470 mmol/mol heme. Results: Anemia, ID and IDA prevalence was 33, 70 and 33%, respectively. The results of children from the United States were as follows: anemia, 9%; ID, 10% and IDA, 2%. Within American Samoan children, ID is positively associated with being breastfed o6 months (Po0.05) and anemia and IDA with lower household income (Po0.05; Po0.01). Mean Hb was significantly lower (Po0.001) and mean EP was significantly higher (Po0.001) than those within children living in the United States. Conclusion: To meet Healthy People 2010 goals in children aged 1-2 years, the prevalence of ID in children living in American Samoa would need to decrease from 83 to 5% and in children aged 3-5 years from 59 to 1%. It is critical to ensure that populations within the United States and its territories are provided appropriate resources to promote health and prevent disease.

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“…The small Italian study by Pisacane et al (3) reporting improved iron nutriture among Italian infants who were exclusively breast-fed for 7 months or more requires replication. Even in low-and middle-income countries, iron deficiency can be prevented with iron supplementation alone starting at 4 months, thereby avoiding the displacement of breast milk and the nutritional inadequacies and risk of contamination of complementary foods in those settings.…”

Section: Exclusive Breast-feeding Response To Drs Kalhoff and Dubementioning

confidence: 98%

“…This is especially true considering the regulation of Fe metabolism in healthy, fully breastfed infants during the period of complementary feeding (3,7) .…”

Section: Madammentioning

confidence: 99%

Letters to the Editor

Kalhoff¹,

Dube

Kersting

2010

Public Health Nutr.

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Iron Metabolism and Requirements in Early Childhood: Do We Know Enough?: A Commentary by the ESPGHAN Committee on Nutrition

Cited by 119 publications

References 59 publications

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

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

Iron deficiency and anemia: disparity exists between children in American Samoa and children living within the US

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