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Risk factors for poor iron status in British toddlers: further analysis of data from the National Diet and Nutrition Survey of children aged 1.5–4.5 years

Published online by Cambridge University Press:  02 January 2007

CW Thane ,
CM Walmsley ,
CJ Bates ,
A Prentice  and
TJ Cole
CW Thane*
Affiliation:
MRC Human Nutrition Research, Downhams Lane, Milton Road, Cambridge CB4 1XJ, UK
CM Walmsley
Affiliation:
MRC Human Nutrition Research, Downhams Lane, Milton Road, Cambridge CB4 1XJ, UK
CJ Bates
Affiliation:
MRC Human Nutrition Research, Downhams Lane, Milton Road, Cambridge CB4 1XJ, UK
A Prentice
Affiliation:
MRC Human Nutrition Research, Downhams Lane, Milton Road, Cambridge CB4 1XJ, UK
TJ Cole
Affiliation:
MRC Human Nutrition Research, Downhams Lane, Milton Road, Cambridge CB4 1XJ, UK
*
*Corresponding author: Email [email protected]
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Abstract

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Objective

To examine risk factors for poor iron status in British toddlers.

Design

National Diet and Nutrition Survey (NDNS) of children aged 1.5–4.5 years.

Setting

Mainland Britain, 1992/93.

Subjects

Of the 1859 children whose parents or guardians were interviewed, a weighed dietary intake was provided for 1675, and a blood sample obtained from 1003.

Results

Mean haemoglobin (Hb) and ferritin levels were significantly lower in younger (1.5–2.5 years) than in older (3.5–4.5 years) children, with boys having significantly lower ferritin levels than girls. Poor iron status (Hb>110 g l−1, ferritin >10 μg l−1, or low values for both indices) was associated with lower socioeconomic and employment status. Iron status was directly associated with meat and fruit consumption and inversely with that of milk and milk products, after adjustment for age and gender. The latter association remained significant after further adjustment for sociodemographic variables, energy intake and body weight. Children consuming <400 g day−1 of milk and cream were less likely to consume foods in other groups, with those also consuming little meat, fish, fruit and nuts at greatest risk of poor iron status. Few associations were observed between poor iron status and individual nutrient intakes, and iron status was not associated with either iron intake or with consumption of a vegetarian diet.

Conclusions

Overdependence on milk, where it displaces iron-rich or iron-enhancing foods, may put toddlers at increased risk of poor iron status. However, this becomes non-significant when moderate-to-high amounts of foods known to enhance iron status (e.g. meat and/or fruit) are also consumed. Milk consumption in this age group should ideally be part of a mixed and balanced diet including all food groups, and particularly lean meat (or other iron-rich or fortified foods) and fruit. This is particularly relevant for households of lower socioeconomic and employment status.

Keywords

ToddlersIron statusRisk factorsMilk consumption
Type
Research Article
Information
Public Health Nutrition , Volume 3 , Issue 4 , December 2000 , pp. 433 - 440
Copyright
Copyright © CABI Publishing 2000

References

1: Department of Health. Weaning and the Weaning Diet. Report on Health and Social Subjects, No. 45. London: HMSO, 1994.Google Scholar
2: De Maeyer, E, Adiels-Tegman, M.The prevalence of anaemia in the world. World Health Stat. Q. 1985; 38: 302–16.Google ScholarPubMed
3: Viteri, FE. Iron: global perspective. Ending Hidden Hunger: a Policy Conference on Micronutrient Malnutrition, Atlanta, GA: Task for Child Survival and Development, 1992; 145–84.Google Scholar
4: Morbidity and Mortality Weekly Report (MMWR). Recommendations to Prevent and Control Iron Deficiency in the United States. Report No. 47 (RR-3). Atlanta, GA: US Department of Health and Human Sciences, CDC, 1998.Google Scholar
5: Weinburg, ED. Iron and susceptibility to infectious disease. Science 1974; 184: 952–6.CrossRefGoogle Scholar
6: Aukett, MA, Parks, YA, Scott, PH, Wharton, BA. Treatment with iron increases weight gain and psychomotor development. Arch. Dis. Child. 1986; 61: 849–57.CrossRefGoogle ScholarPubMed
7: Lozoff, B, Brittenham, GM, Wolf, AW, et al. Iron deficiency anemia and iron therapy effects on infant developmental test performance. Pediatrics 1987; 79: 981–95.CrossRefGoogle ScholarPubMed
8: Oski, FA. Iron deficiency in infancy and childhood. New Engl. J. Med. 1993; 329: 190–3.Google ScholarPubMed
9: Walter, T.Impact of iron deficiency on cognition in infancy and childhood. Eur. J. Clin. Nutr. 1993; 47: 307–16.Google ScholarPubMed
10: Brock, JH. Iron and immunity. J. Nutr. Immunol. 1993; 2: 47–106.CrossRefGoogle Scholar
11: Lansdown, R, Wharton, BA. Iron and mental and motor behaviour in children. In: Iron: Nutritional and Physiological Significance. The Report of the British Nutrition Foundation's Task Force. London: Chapman and Hall, 1995: 65–78.Google Scholar
12: Hurtado, EK, Claussen, AH, Scott, KG. Early childhood anemia and mild or moderate mental retardation. Am. J. Clin. Nutr. 1999; 69: 115–19.CrossRefGoogle ScholarPubMed
13: Florentino, RF, Guirriec, R. Prevalence of nutritional anemia in infancy and childhood with emphasis on developing countries. In: Steckel, A, ed. Iron Nutrition in Infancy and Childhood. New York: Nestlé/Raven Press, 1984; 61–74.Google Scholar
14: Gregory, JR, Collins, DL, Davies, PSW, Hughes, JM, Clarke, PC. National Diet and Nutrition Survey: Children Aged 1.5 to 4.5 years. Vol. 1: Report of the Diet and Nutrition Survey. London: HMSO, 1995.Google Scholar
15: WHO/UNICEF/UNU. Iron Deficiency: Indicators for Assessment and Strategies for Prevention. Geneva: World Health Organization, 1998.Google Scholar
16: Lawson, MS, Thomas, M, Hardiman, A.Iron status of Asian children aged 2 years living in England. Arch. Dis. Child. 1998; 78: 420–6.CrossRefGoogle ScholarPubMed
17: Worwood, M. Measurement of iron status. In: Iron: Nutritional and Physiological Significance. The Report of the British Nutrition Foundation's Task Force. London: Chapman and Hall, 1995: 23–32.Google Scholar
18: Worwood, M.The laboratory assessment of iron status – an update. Clin. Chim. Acta 1997; 259: 3–23.CrossRefGoogle ScholarPubMed
19: Taylor, PG, Martinez-Torres, C, Mendez-Castellano, H, et al. The relationship between iron deficiency and anemia in Venezuelan children. Am. J. Clin. Nutr. 1993; 58: 215–18.CrossRefGoogle ScholarPubMed
20: Fairweather-Tait, S, Hurrell, RF. Bioavailability of minerals and trace elements. Nutr. Res. Rev. 1996; 9: 295–324.CrossRefGoogle ScholarPubMed
21: Lynch, SR. Interaction of iron with other nutrients. Nutr. Rev. 1997; 55: 102–10.CrossRefGoogle ScholarPubMed
22: García-Casal, M, Layrisse, M, Solano, L, et al. Vitamin A and β-carotene can improve non-heme iron absorption from rice, wheat and corn by humans. J. Nutr. 1998; 128: 646–50.CrossRefGoogle Scholar
23: Fleming, AF. Haematological manifestations of malaria and other parasitic diseases. Clin. Haematol. 1981; 10: 983–1011.CrossRefGoogle ScholarPubMed
24: Adish, AA, Esrey, SA, Gyorkos, TW, Johns, T.Risk factors for iron deficiency in preschool children in northern Ethiopia. Public Health Nutr. 1999; 2: 243–52.CrossRefGoogle ScholarPubMed
25: Lawson, MS. Iron in infancy and childhood. In: Iron: Nutritional and Physiological Significance. The Report of the British Nutrition Foundation's Task Force. London: Chapman and Hall, 1995: 93–105.Google Scholar
26: Oti-Boateng, P, Seshadri, R, Petrick, S, Gibson, RA, Simmer, K.Iron status and dietary iron intake of 6–24-month-old children in Adelaide. J. Paediatr. Child Health 1998; 34: 250–3.CrossRefGoogle ScholarPubMed
27: Duggan, MB. Cause and cure for iron deficiency in toddlers. Health Visitor 1993; 66: 250–2.Google ScholarPubMed
28: Sanders, TAB. Vegetarian diets and children. Pediatr. Clin. North Am. 1995; 42: 955–65.CrossRefGoogle ScholarPubMed
29: Jackson, LS, Lee, K.The effect of dairy products on iron availability. Crit. Rev. Food Sci. Nutr. 1992; 31: 2559–70.CrossRefGoogle ScholarPubMed
30: Thomas, M, Goddard, E, Hickman, M, Hunter, P. 1992 General Household Survey. London: HMSO, 1994.Google Scholar
31: White, A, Davies, PSW. Feasibility Study for the National Diet and Nutrition Study of Children Aged 1.5 to 4.5 years. London: OPCS, 1994.Google Scholar
32: Schofield, WN, Schofield, C, James, WPT. Basal metabolic rate. Hum. Nutr. Clin. Nutr. 1985; 39C(Suppl. 1): 1–96.Google Scholar
33: Goldberg, GR, Black, AE, Jebb, SA, et al. Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-reporting. Eur. J. Clin. Nutr. 1991; 45: 569–81.Google Scholar
34: Gregory, J, Foster, K, Tyler, H, Wiseman, M. The Dietary and Nutritional Survey of British Adults. London: HMSO, 1990.Google Scholar
35: Macdiarmid, J, Blundell, J.Assessing dietary intake: who, what and why of under-reporting. Nutr. Res. Rev. 1998; 11: 231–53.CrossRefGoogle ScholarPubMed
36: Stevens, D.Epidemiology of hypochromic anaemia in young children. Arch. Dis. Child. 1991; 66: 886–9.5.CrossRefGoogle ScholarPubMed
37: Stevens, D.Screening toddlers for iron deficiency anaemia in general practice. No investigation can accurately separate normal from pathological [letter]. BMJ 1998; 316: 145.CrossRefGoogle ScholarPubMed
38: Hagman, U, Bruce, AÅ, Persson, L-Å, Samuelson, G, Sjölin, S.Food habits and nutrient intake in childhood in relation to health and socio-economic conditions: a Swedish multicentre study 1980–81. Acta Paediatr. Scand Suppl. 1986; 328: 1–56.CrossRefGoogle ScholarPubMed
39: Karr, M, Alperstein, G, Causer, J, Mira, M, Lammi, A, Fett, MJ. Iron status and anaemia in preschool children in Sydney. Aust. NZ J. Public Health 1996; 20: 618–22.CrossRefGoogle ScholarPubMed
40: Looker, AC, Dallman, PR, Carroll, MD, Gunter, EW and Johnson, CL. Prevalence of iron deficiency in the United States. J. Am. Med. Assoc. 1997; 277: 973–6.CrossRefGoogle ScholarPubMed
41: Grant, GA. Prevalence of iron deficiency in rural pre-school children in Northern Ireland. Br. J. Gen. Pract. 1990; 40: 112–13.Google ScholarPubMed
42: Owen, GM, Kram, KM, Garry, PJ, Lowe, JE, Lubin, AH. A study of nutritional status of preschool children in the United States 1968–1970. Pediatrics 1974; 53 (4) (Suppl. II): 597–646.CrossRefGoogle Scholar
43: Yip, R, Parvanta, I, Scanlon, K, Borland, EW, Russell, CM, Trowbridge, FL. Pediatric Nutrition Surveillance System – United States 1980–1991. Morb. Mortal. Weekly Rep. 1992; 41(SS-7): 1–24.Google ScholarPubMed
44: Sherry, B, Bister, D and Yip, R.Continuation of decline in prevalence of anemia in low-income children: the Vermont experience. Arch. Pediatr. Adolesc. Med. 1997; 151: 928–30.CrossRefGoogle ScholarPubMed
45: Rose, D, Habicht, J-P, Devaney, B.Household participation in the Food Stamp and WIC programs increases the nutrient intakes of preschool children. J. Nutr. 1998; 128: 548–55.CrossRefGoogle ScholarPubMed
46: Engelmann, MDM, Davidsson, L, Sandstrom, B, Walczyk, T, Hurrell, RF, Michaelsen, KF. The influence of meat on nonheme iron absorption in infants. Pediatr. Res. 1998; 43: 768–73.CrossRefGoogle ScholarPubMed
47: Shatrugna, V, Raman, L, Uma, K, Sujatha, T.Interaction between vitamin A and iron: effects of supplements in pregnancy. Int. J. Vitam. Nutr. Res. 1997; 67: 145–8.Google ScholarPubMed
48: Majia, LA, Hodges, RE, Arroyave, G, Viteri, F, Torun, B.Vitamin A deficiency and anemia in Central American children. Am. J. Clin. Nutr. 1977; 30: 1175–84.CrossRefGoogle ScholarPubMed