Tomas Walter

Effect of mild iron deficiency on infant mentaldevelopment scores

To evaluate the effects of short-term iron therapy on developmental test scores of infants with varying stages of iron deficiency, 37 infants, all 15 months of age, were tested with the Bayley Scales of Infant Development before and 11 days after beginning a trial of orally administered iron therapy. They were separated into three groups according to iron status: 12 controls, with normal iron nutrition; 11 with mild anemia, i.e., hemoglobin less than 11.0 gm/dl but greater than 8.5 gm/dl; and 15 with iron deficiency without anemia, i.e., Hgb greater than or equal to 11.0 gm/dl but at least one abnormal biochemical measure of iron nutrition (transferrin saturation, free erythrocyte protoporphyrin, or serum ferritin). The Mental Development Index was significantly lower in the anemic infants before treatment, as compared with that of normal controls. Improvement with iron therapy was also significant in those with anemia and in nonanemic patients with two or more biochemical indicators of iron deficiency. The rise in Mental Development Index was associated with improvement in attention span and cooperativeness. These findings suggest that mild iron deficiency has an effect on infant behavior that is rapidly reversible with iron therapy.

Iron status with different infant feeding regimens : relevance to screening and prevention of iron deficiency

The objective of this study was to evaluate the benefit of screening for anemia in infants in relation to their previous diet. The iron status of 854 nine-month-old infants on three different feeding regimens and on a regimen including iron dextran injection was determined by analysis of hemoglobin, serum ferritin, and erythrocyte protoporphyrin levels and of serum transferrin saturation. Infants were categorized as having iron deficiency if two or three of the three biochemical test results were abnormal and as having iron deficiency anemia if, in addition, the hemoglobin level was less than 110 gm/L. The prevalence of iron deficiency was highest in infants fed cow milk formula without added iron (37.5%), intermediate in the group fed human milk (26.5%), much lower in those fed cow milk formula with added iron (8.0%), and virtually absent in those injected with iron dextran (1.3%). The corresponding values for iron deficiency anemia were 20.2%, 14.7%, 0.6%, and 0%, respectively. The use of iron supplements is therefore justified in infants fed cow milk formula without added iron, even when there is no biochemical evidence of iron deficiency. The low prevalence of iron deficiency in the group fed iron-fortified formula appears to make it unnecessary to screen routinely for anemia in such infants. These results also support the recommendation that infants who are exclusively fed human milk for 9 months need an additional source of iron after about 6 months of age.

The Usefulness of Elemental Iron for Cereal Flour Fortification: a Sustain Task Force Report

Fortification of cereal flours may be a useful public health strategy to combat iron deficiency. Cereal flours that are used shortly after production (e.g., baking flour) can be fortified with soluble iron compounds, such as ferrous sulfate, whereas the majority of flours stored for longer periods is usually fortified with elemental iron powders to avoid unacceptable sensory changes. Elemental iron powders are less well absorbed than soluble iron compounds and they vary widely in their absorption depending on manufacturing method and physicochemical characteristics. Costs vary with powder type, but elemental iron powders are generally less expensive than ferrous sulfate. This review evaluates the usefulness of the different elemental iron powders based on results from in vitro studies, rat assays, human bioavailability studies, and efficacy studies monitoring iron status in human subjects. It concludes that, at the present time, only electrolytic iron powder can be recommended as an iron fortificant. Because it is only approximately half as well absorbed as ferrous sulfate, it should be added to provide double the amount of iron.

Prevention of iron-deficiency anemia: Comparison of high- and low-iron formulas in term healthy infants after six months of life

OBJECTIVES For bottle-fed babies or nursing infants who receive milk supplements, the American Academy of Pediatrics recommends the use of iron-fortified infant formula. Because these recommendations have not been universally adopted, the hematologic effects of currently available low-iron formulas need to be determined. STUDY DESIGN Healthy Chilean 6-month-old infants (without iron-deficiency anemia, born at term weighing > or 3.0 kg) who were totally or partially weaned from the breast were randomly allocated in a double-blind fashion to receive high-iron (n = 430) or low-iron formula (n = 405), containing an average of 12.7 mg/L or 2.3 mg/L, respectively, of elemental iron as ferrous sulfate. Iron status was determined at 12 months. RESULTS The prevalence of iron-deficiency anemia was not different in the high- and low-iron groups (2.8% versus 3.8%, p = 0.35). Nevertheless, infants receiving high-iron formula had somewhat higher levels of hemoglobin and serum ferritin, greater mean cell volumes, and lower erythrocyte protoporphyrin levels (p < 0.005). CONCLUSIONS Although high-iron formulas are more efficacious in improving iron status, currently available low-iron formulas may prevent iron-deficiency anemia in selected healthy, term infant populations with otherwise poor sources of dietary iron after 6 months of life. Formulas with relatively small amounts of iron appear to prevent iron-deficiency anemia. We speculate that the optimal level of iron fortification likely lies somewhere between the current levels in high- and low-iron formulas.

Anaemia and iron deficiency disease in children

Iron deficiency is the single most common nutritional disorder world-wide and the main cause of anaemia in infancy, childhood and pregnancy. It is prevalent in most of the developing world and it is probably the only nutritional deficiency of consideration in industrialised countries. In the developing world the prevalence of iron deficiency is high, and is due mainly to a low intake of bioavailable iron. However, in this setting, iron deficiency often co-exists with other conditions such as, malnutrition, vitamin A deficiency, folate deficiency, and infection. In tropical regions, parasitic infestation and haemoglobinopathies are also a common cause of anaemia. In the developed world iron deficiency is mainly a single nutritional problem. The conditions previously mentioned might contribute to the development of iron deficiency or they present difficulties in the laboratory diagnosis of iron deficiency.

Fine particulate matter and wheezing illnesses in the first year of life.

Background: Recent evidence implicates fine particulate matter (PM2.5), principally from vehicular exhaust, as a major cause of increased mortality and morbidity. However, there are limited data on the impact of PM2.5 on infant respiratory illnesses. Methods: We conducted a cohort study of 504 infants recruited at 4 months of age from primary health care units in southeastern Santiago, Chile. Project physicians followed infants through the first year of life via monthly check-ups and by appointments on demand. We obtained data for fine particulate matter, sulfur dioxide (SO2), and nitrogen dioxide (NO2) from the governmental monitoring network. Results: The most frequent diagnosis during follow-up was wheezing bronchitis, occurring 19.5 times per 100 infants per month. After adjusting for sex, socioeconomic level, family history of asthma, minimum temperature, and number of older siblings, we found that an increase of 10 μg/m3 of PM2.5 24-hour average was related to a 5% increase (95% confidence interval 0–9%) in the risk for wheezing bronchitis (1-day lag). This association was present for different lags, with a maximum observed for a 9-day lag (9%; 6–12%). No consistent association was detected with NO2 or SO2 ambient levels. Lower socioeconomic status and having older siblings were also associated with the risk of wheezing bronchitis. The association of PM2.5 and wheezing bronchitis was stronger among infants with a family history of asthma than among infants without. Conclusions: Air pollution in the form of fine particulates, mostly from vehicular exhaust, may adversely affect infants’ respiratory health with potential for chronic effects later in life.

Infancy: mental and motor development

In a prospective cohort study of 196 infants from birth to age 15 mo, the relationship of iron status to psychomotor development, the effect of a short-term trial of oral iron or placebo, and the effect of longer-term oral iron therapy was assessed. Development was assessed with the Bayley Scale of Infant Development in anemic, nonanemic, iron-deficient, and control children. Anemic infants had significantly lower indices than did control or nonanemic, iron-deficient infants. Control infants and nonanemic, iron-deficient infants performed comparably. No difference between the effect of oral administration of iron or placebo was noted after 10 d or 3 mo of iron therapy. A hemoglobin concentration of less than 105 g/L and anemia duration greater than 3 mo were correlated with significantly lower motor and mental scores, suggesting that when iron deficiency progresses to anemia, adverse influences in the performance of developmental tests appear and persist, despite iron therapy.

Effect of supplementation with an iron-fortified milk on incidence of diarrhea and respiratory infection in urban-resident infants.

To address the hypothesis that increased infectious morbidity is associated with iron supplementation, 783 randomly selected infants were provided with a powdered full fat cows milk (non-fortified group) and 872 with a powdered acidified full fat cows milk fortified with 15 mg of iron as ferrous sulfate (fortified group). All infants were followed from birth to 15 months of age with a monthly home visit by a nurse who recorded morbidity occurring during the previous 30 days. At 9 months of age, 15% of infants in each cohort were receiving breast milk only; data for these infants were segregated to make the third group. Episodes (mean +/- SD) of diarrhea/infant/year were 1.06 +/- 1.29, 1.14 +/- 1.37, and 0.82 +/- 1.04 for the fortified, non-fortified and breast-fed groups, respectively; the fortified and non-fortified bottle-fed groups had a very similar incidence of respiratory illness; 2.66 +/- 2.07 and 2.74 +/- 2.24 episodes/infant/year, respectively. The incidence of respiratory illness for both bottle-fed groups was significantly higher than that for the breast-fed group (2.22 +/- 1.84 respiratory episodes/infant/year). We conclude that for the infants the tested form of iron fortified milk, which is sufficient to lower iron deficiency anemia, does not result in an increased incidence of diarrhea or respiratory illness.

Prevention of iron deficiency by milk fortification. The Chilean experience.

Olivares, M., Walter, T., Hertrampf, E., Pizarro, F. and Stekel, A. (Hematology Unit, Institue of Nutrition and Food Technology, University of Chile, Santiago, Chile). Prevention of iron deficiency by milk fortification. The Chilean experience.

High absorption of fortification iron from current infant formulas.

BACKGROUND Estimations of iron absorption from infant formulas are based on 20-year-old data. Data about iron bioavailability from currently used infant formulas are scarce, considering that during the last decades, formulas have had modifications that could affect iron absorption. METHODS Bioavailability of isotopically labeled iron (55Fe and 59Fe) from several infant formulas administered to contraceptive-using women between the ages of 30 to 50 years was measured. Six infant formulas and one follow-on formula were compared with a powdered, whole cows milk, and the results were normalized to an absorption of 40% from a reference dose of iron. RESULTS Iron bioavailability from the infant formulas was consistently higher (19%), contrasting with the low value (4%) of the unmodified cows milk (p < 0.0001). Iron absorption of the follow-on formula was intermediate (13%). Formulas with 8 mg/l iron and one with 7 mg/l supply approximately 1 mg of absorbed iron, assuming a consumption of 750 ml/day of formula. This amount covers the iron needs of most infants during their period of greatest vulnerability. Formulas containing 12 mg/l iron would allow the absorption of approximately twice the infant iron requirements. CONCLUSIONS Current infant formulas have a high iron bioavailability, which is an appealing argument for lowering the level of iron fortification in these products.