Severe iron-deficiency anaemia and feeding practices in young children

Abstract

Objectives: Fe-deficiency anaemia (IDA) occurs in 1-2 % of infants in developed countries, peaks at 1-3 years of age and is associated with later cognitive deficits. The objectives of the present study were to describe the characteristics of young children with severe IDA and examine modifiable risk factors in a developedcountry setting. Design: Two prospective samples: a national surveillance programme sample and a regional longitudinal study sample. Setting: Canada, 2009-2011. Subjects: Two samples of young children recruited from community-based healthcare practices: a national sample with severe anaemia (Hb < 80 g/l) due to Fe deficiency and a regional sample with non-anaemic Fe sufficiency. Results: Children with severe IDA (n 201, mean Hb 55·1 g/l) experienced substantial morbidity (including developmental delay, heart failure, cerebral thrombosis) and health-care utilization (including a 42 % hospitalization rate). Compared with children with Fe sufficiency (n 597, mean Hb 122·4 g/l), children with severe IDA consumed a larger volume of cow's milk daily (median 1065 ml v. 500 ml, P < 0·001) and were more likely to be using a bottle during the day (78 % v. 43 %, OR = 6·0; 95 % CI 4·0, 8·9) and also in bed (60 % v. 21 %, OR = 6·5; 95 % CI 4·4, 9·5). Conclusions: Severe IDA is associated with substantial morbidity and may be preventable. Three potentially modifiable feeding practices are associated with IDA: (i) cow's milk consumption greater than 500 ml/d; (ii) daytime bottle use beyond 12 months of age; and (iii) bottle use in bed. These feeding practices should be highlighted in future recommendations for public health and primarycare practitioners.

Maternal ethnicity and iron status in early childhood in Toronto, Canada: a cross-sectional study

“…Five infant feeding practices were a priori identified as covariates,5–9 and included as secondary outcomes: breastfeeding duration; bottle use beyond 15 months of age; current infant formula use; daily cow’s milk intake greater than two cups (500 mL); meat consumption (including red meat, poultry, fish, shellfish and eggs) in the last 3 days. Prolonged bottle use is associated with ID 5 13.…”

“…Prolonged bottle use is associated with ID 5 13. Research suggests that a child’s lack of self-regulation of milk intake with a bottle can lead to excessive daily consumption of cow’s milk, which in turn can lead to ID due to the low absorbable iron content in cow’s milk 5 8. Children who were never breastfed were classified as having a breastfeeding duration of 0 months, and children currently breastfeeding were classified as having a breastfeeding duration equal to their current age.…”

“…For infants 1–3 years of age, several feeding practices have been linked to iron status including duration of breastfeeding, bottle use, volume of cow’s milk consumed, consumption of meat and meat alternatives, and use of formula 5–9. Few studies have explored the relationship between maternal ethnicity, iron status and feeding practices in young children in developed countries such as Canada, the UK and the USA 10–16.…”

Iron deficiency screening for children at 18 months: a cost-utility analysis

“…We defined children at high risk as those with 2 or more risk factors for iron deficiency (younger age [12-36 mo], longer breast-feeding duration, high body mass index z-score and drinking > 500 mL of cow's milk daily) ( Table 1). [26][27][28][29][30][31][32][33][34] Iron deficiency was defined as a serum ferritin level less than 12 µg/L 2,35 in the base-case analysis and as a serum ferritin level less than 18 µg/L in the sensitivity analysis; the latter cut-off was derived from our recent analysis of data from the OptEC study (Appendix 1, Supplemental Table S1, available at www.cmajopen.ca/ content/7/4/E689/suppl/DC1). 13…”

Inadequacies in the Treatment of Iron Deficiency Anemia Among Children Registered in the National Program of Iron Supplementation in Florianopolis, Santa Catarina, Brazil

“…3 Iron deficiency anemia has a considerable impact on children´s health, especially in the first two years of life, as it has been associated with motor capacity damage, learning impairments, behavioral changes, and reduced immunological capacity. [4][5] Despite its severity and accumulated knowledge on its etiology, anemia prevails as a serious public health problem in Brazil. 6 Efforts by various international and national organizations to develop guidelines and policies for preventing and reducing iron deficiency anemia in children, including Iron Supplementation Programs and Food Fortification programs, do not seem to achieve the expected effectiveness.…”