Transcript Do exclusively breast-fed infants need supplemental iron?

Do exclusively breast-fed infants
need supplemental iron?
By
Ted Greiner, PhD
WHO Recommendation, 2001
The evidence from one trial in Honduras
demonstrates poorer iron status in infants
exclusively breastfed for 6 months, versus
4 months followed by partial breastfeeding
to 6 months, and this evidence is likely to
apply to populations in which maternal
iron status and infant endogenous stores
are not optimal.
Iron deficiency anemia in Europe
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In a study of 11 sites*, prevalence at 12 months
was 2.3%
No relationship to breastfeeding
0% in families with high socio-economic status
Early introduction of cow’s milk was greatest risk
factor
* Male C et al. Prevalence of iron deficiency in 12-mo-old infants from
11 European areas and influence of dietary factors on iron status
(Euro-Growth study), Acta Paediatrica 2001;90:492-498
Iron status at 12 months
Exclusive breast- Exclusive breastfeeding**
feeding**
for 7 mo (n = 9)
for <7 mo (n = 21)
11.7 (0.4)
10.9 (0.7)*
0 (0)
9 (43)
Mean serum ferritin, µg/L (SD)
17 (15)
12.3 (11.7)
No. (%) with serum ferritin level <10 µg/L
2 (22)
11 (52)
No. (%) with Hb >110 gm/L and serum
ferritin level >10 µg/L
Hb, Hemoglobin.
7 (78)
10 (48)
Hb concentration, gm/L (SD)
No. (%) of Hb concentration <110 gm/L
Pisacane et al, Iron status in breast-fed infants. J.Pediatr 127:429-341, 1995
*t = 3.2; df = 28; p = 0.003. **No other milk or sources of iron
Latest review on iron and
breastfeeding*
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Currently, the best evidence is that [avoidance of
iron deficiency] is achieved by
prolonged breastfeeding,
avoidance of unfortified formulas and cow's milk,
and
the introduction of iron -fortified and vitamin Cfortified weaning foods at approximately 6
months of age
*Griffin, I J; Abrams, S A. Iron and breastfeeding, Pediatric Clinics of
North America 2001;48:401-413
New Phd by Magnus Domellöf
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Iron requirements of term, breast-fed
infants. Umeå University, Sweden, 2001
First reference values for iron for (nearly)
exclusively breast-fed babies at 4 vs 6 mon
Only one of five papers published so far
Regulation of non-heme iron
absorption
Effect of iron supplementation on
Hb
Interpretation
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Iron supplementation of iron-replete infants
from 6-9 months has no effect
This suggests that at this age iron stores
down-regulate absorption
No such mechanism appears to exist before
6 months of age
Effect of iron supplementation on
iron deficiency anemia
Loss in height gain due to iron
supplementation
Effect of iron supplementation on
diarrhea prevalence
New suggested cutoffs for infant
iron deficiency
Impact of 6 months EBF on
mother’s iron status*
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The additional burden of EBF for 6 compared to 4
months is about 0.5% of body stores
Longer EBF leads to longer amenorrhea, saving
iron, especially for women with high menstrual
blood loss
*Dewey, K G, et al. Effects of exclusive breastfeeding for four versus six
months on maternal nutritional status and infant motor
development: results of two randomized trials in Honduras. The
Journal of Nutrition 2001;131:262-267
Conclusions
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Breastfeeding exclusively for six months
appears to entail no risk of iron deficiency
in infants:
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Among infants born at term, and
In groups with high socio-economic status,
and
When the mother’s iron status is adequate
Conclusions (cont.)
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Under these conditions, iron
supplementation in exclusively breastfed
infants under six months of age:
May lead to reduced growth or increased
susceptibility to infection, and thus
Should NOT be given routinely, but
ONLY when there is hematological
evidence of iron deficiency.