Effect of infant feeding practices on iron status in a cohort study of Bolivian infants

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Abstract

Background

Iron deficiency (ID) is the most common micronutrient deficiency worldwide, with potentially severe consequences on child neurodevelopment. Though exclusive breastfeeding (EBF) is recommended for 6 months, breast milk has low iron content. This study aimed to estimate the effect of the length of EBF on iron status at 6 – 8 months of age among a cohort of Bolivian infants.

Methods

Mother-infant pairs were recruited from 2 hospitals in El Alto, Bolivia, and followed from one through 6 – 8 months of age. Singleton infants > 34 weeks gestational age, iron-sufficient at baseline, and completing blood draws at 2 and 6 – 8 months of age were eligible for inclusion ( N = 270). Ferritin was corrected for the effect of inflammation. ID was defined as inflammation-corrected ferritin < 12 μg/L, and anemia was defined as altitude-corrected hemoglobin < 11 g/dL; IDA was defined as ID plus anemia. The effect of length of EBF (infant received only breast milk with no other liquids or solids, categorized as < 4, 4 – 6, and > 6 months) was assessed for ID, IDA, and anemia (logistic regression) and ferritin (Fer) and hemoglobin (Hb, linear regression).

Results

Low iron status was common among infants at 6 – 8 months: 56% of infants were ID, 76% were anemic, and 46% had IDA. EBF of 4 months and above was significantly associated with ID as compared with EBF < 4 months (4 – 6 months: OR 2.0 [1.1 – 3.4]; > 6 months: 3.3 [1.0 – 12.3]), but not with IDA (4 – 6 months: OR 1.4 [0.8 – 2.4]; > 6 months: 2.2 [0.7 – 7.4]), or anemia (4 – 6 months: OR 1.4 [0.7 – 2.5]; > 6 months: 1.5 [0.7 – 7.2]). Fer and Hb concentrations were significantly lower with increasing months of EBF.

Conclusions

Results suggest a relationship between prolonged EBF and ID, but are not sufficient to support changes to current breastfeeding recommendations. More research is needed in diverse populations, including exploration of early interventions to address infant IDA.

Electronic supplementary material

The online version of this article (10.1186/s12887-018-1066-2) contains supplementary material, which is available to authorized users.

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Most cited references 24

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Combined measurement of ferritin, soluble transferrin receptor, retinol binding protein, and C-reactive protein by an inexpensive, sensitive, and simple sandwich enzyme-linked immunosorbent assay technique.

Juergen Erhardt, John Estes, Christine M Pfeiffer … (2004)

The measurement of vitamin A (VA) and iron status is very important in the assessment of nutritional deficiencies. The objective of this research was to develop a sandwich ELISA technique for the simultaneous measurement of ferritin, soluble transferrin receptor, retinol binding protein, and C-reactive protein (CRP) as indicators for VA and iron status. The inclusion of CRP as marker of infection allows for more accurate interpretation of VA and iron status. This is accomplished in a 30-microL serum or plasma sample using an ELISA with different capture and detection antibodies and different dilutions of the sample. Commercially available clinical serum controls were used for calibration purposes. The developed assays were compared to commercially available traditional tests. Regression coefficients comparing both assays were better than 0.84 (P < 0.001). Using a limited sample set, the sandwich ELISA assay produced very similar specificity and sensitivity compared to traditional methods when common cutoff values were applied. Intra- and interassay variability was between 5 and 14% for all tests. The cost of the materials for all 5 measurements decreases to less than $1/sample if a large number of samples is analyzed. Due to the low cost, high throughput, and comparability to traditional tests, this procedure has several advantages for assessing VA and iron status in population surveys.

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Long-Lasting Neural and Behavioral Effects of Iron Deficiency in Infancy

Betsy Lozoff, John Beard, James Connor … (2006)

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The assessment of newborn iron stores at birth: a review of the literature and standards for ferritin concentrations.

J A Widness, Vadlamudi Raghavendra Rao, J. Long … (2006)

Serum ferritin measurements are used in clinical populations to estimate total body iron stores and the risk of subsequent iron deficiency or overload. The lack of normative newborn serum ferritin concentration data between 23 and 41 weeks has led to difficulty in establishing the incidence and degree of abnormal iron status in the neonatal period. The primary objective of this review was to summarize the maternal and gestational factors that determine ferritin concentrations in full-term and pre-term newborn infants and to generate comprehensive reference values. The secondary objective was to assess serum ferritin concentrations in newborn infants at risk for abnormal fetal iron metabolism, including maternal diabetes mellitus, intrauterine growth restriction and maternal smoking during pregnancy. Serum ferritin and gestational age data at birth from 457 low-risk pre-term and term infants of 23-41 weeks gestation obtained from 35 published studies reviewed from a period of 25 years and from recently collected data from our centers were assessed by regression analysis. Slopes and intercepts of the high-risk groups were compared with the standard curve. Umbilical cord serum ferritin concentrations increased with advancing gestational age, from a mean of 63 mug/l at 23 weeks to 171 mug/l at 41 weeks gestation (p < 0.001). The infants of diabetic mothers had a lower intercept than the control infants (p < 0.001). Iron deficiency and overload have been implicated in neurodevelopmental impairments. Normative cord serum ferritin data may permit a more precise assessment of infants who are at risk for abnormal iron status at birth.

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Author and article information

Contributors

Rachel M. Burke: Rachel.m.burke@gmail.com

Paulina A. Rebolledo: preboll@emory.edu

Anna M. Aceituno: anna.m.aceituno@gmail.com

Rita Revollo: ritarevollom@hotmail.com

Volga Iñiguez: volgavir@yahoo.com

Mitchel Klein: mklein@emory.edu

Carolyn Drews-Botsch: cdrews@emory.edu

Juan S. Leon: juan.leon@emory.edu

Parminder S. Suchdev: psuchde@emory.edu

Journal

Journal ID (nlm-ta): BMC Pediatr

Journal ID (iso-abbrev): BMC Pediatr

Title: BMC Pediatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2431

Publication date (Electronic): 12 March 2018

Publication date PMC-release: 12 March 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 107

Affiliations

[1 ]ISNI 0000 0001 0941 6502, GRID grid.189967.8, Department of Epidemiology, Rollins School of Public Health, , Emory University, ; Claudia Nance Rollins Building, 1518 Clifton Rd. NE, Atlanta, GA 30322 USA

[2 ]ISNI 0000 0001 0941 6502, GRID grid.189967.8, Hubert Department of Global Health, Rollins School of Public Health, , Emory University, ; Atlanta, GA USA

[3 ]ISNI 0000 0001 0941 6502, GRID grid.189967.8, Emory School of Medicine, ; Atlanta, GA USA

[4 ]Servicio Departamental de Salud, La Paz, Bolivia

[5 ]ISNI 0000 0001 1955 7325, GRID grid.10421.36, Instituto de Biotecnología y Microbiología, , Universidad Mayor de San Andrés, ; La Paz, Bolivia

[6 ]ISNI 0000 0001 2163 0069, GRID grid.416738.f, Nutrition Branch, , Centers for Disease Control & Prevention, ; Atlanta, GA USA

Article

Publisher ID: 1066

DOI: 10.1186/s12887-018-1066-2

PMC ID: 5848561

PubMed ID: 29530004

SO-VID: efaee4a2-74b6-4a24-ae66-6cac00917dee

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 18 January 2017

Date accepted : 15 February 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000060, National Institute of Allergy and Infectious Diseases;

Award ID: 1K01AI087724-01

Award ID: U19-AI057266

Funded by: FundRef http://dx.doi.org/10.13039/100000097, National Center for Research Resources;

Award ID: UL1 TR000454

Funded by: Emory + Children's Pediatric Center

Award ID: Seed Grants Program

Funded by: FundRef http://dx.doi.org/10.13039/100005627, Thrasher Research Fund;

Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health;

Award ID: HD052460-01

Award ID: T32AI074492

Award Recipient : Rachel M. Burke Paulina A. Rebolledo

Custom metadata

ScienceOpen disciplines: Pediatrics

Keywords: micronutrients,iron deficiency,global nutrition,infant nutrition,global health,breastfeeding

Data availability:

ScienceOpen disciplines: Pediatrics

Keywords: micronutrients, iron deficiency, global nutrition, infant nutrition, global health, breastfeeding

Effect of infant feeding practices on iron status in a cohort study of Bolivian infants

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Most cited references 24

Combined measurement of ferritin, soluble transferrin receptor, retinol binding protein, and C-reactive protein by an inexpensive, sensitive, and simple sandwich enzyme-linked immunosorbent assay technique.

Long-Lasting Neural and Behavioral Effects of Iron Deficiency in Infancy

The assessment of newborn iron stores at birth: a review of the literature and standards for ferritin concentrations.

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