REVIEW URRENT C OPINION
Meeting iron needs for infants and children Staffan Berglund and Magnus Domello¨f
Purpose of review Iron deficiency early in life is associated with impaired neurological development. This study reviews the latest research on how to best meet iron requirements in infants and children. Recent findings There is concurrent evidence that delayed cord clamping is well tolerated and improves infant iron stores. Iron supplements or enriched complementary foods starting before 6 months of life do not reduce iron deficiency prevalence in low-risk populations. However, for low birth weight infants, iron supplements before 6 months of life have long-term benefits. Iron deficiency anaemia (IDA) during the second half year of life is rare in countries with high compliance to iron-rich complementary foods, but remains a major problem globally. In high-risk populations, iron supplementation reduces IDA and possibly improves growth. However, increased risk of infections is a concern and optimal preventive strategies have not yet been determined. Finally, there is concurrent evidence that iron supplementation of anaemic school-aged children reduces IDA and possibly improves neuropsychological outcomes. Summary Interventions for prevention of iron deficiency should be prioritized in risk groups. However, the unclear long-term benefits and possible risk of adverse effects, particularly increased infections in developing countries, prompt further large-scale, double-blinded trials. Keywords children, infants, iron, iron deficiency
INTRODUCTION
MATERIALS AND METHOD
Iron deficiency is the most common micronutrient deficiency in the world and causes approximately half of the two billion cases of anaemia worldwide. Infants and children are, due to their rapid growth, at a particular risk of iron deficiency or iron deficiency anaemia (IDA). This is of concern, as iron is essential for neurodevelopment, and iron deficiency may impair brain development. There is a well verified association between iron deficiency and impaired neuropsychological performance in infants and children and irreversible impairment has been suggested, at least when IDA occurs in infancy [1–3]. However, this association has been difficult to confirm in randomized controlled trials due to the needs of large sample sizes and long follow-up time. Instead, a majority of previous and present intervention trials focus on short-term laboratory outcomes, causing limitations when results are translated to recommendations. The last decade of research in the field has added important knowledge of possible adverse effects of iron supplements, underscoring the importance of evidencebased interventions to compare benefits and risks of interventions [4].
In the present review, we summarize the most recent publications related to iron interventions in infants, toddlers and school-age children. We performed a MEDLINE search for trials published between 1 June 2012 and 30 November 2013 and reviewed the results with a particular focus on randomized controlled trials (RCTs) and meta-analyses.
IRON REQUIREMENTS DURING THE FIRST 6 MONTHS OF LIFE Breast milk has a low content of iron but a high iron bioavailability. Through a well developed physiological shift of iron between stores and heme-bound iron, the total body iron at birth is generally Department of Clinical Sciences, Pediatrics, Umea˚ University, Umea˚, Sweden Correspondence to Staffan Berglund, MD, PhD, Department of Clinical Sciences, Pediatrics, Umea˚ University, SE-901 85 Umea˚, Sweden. Tel: +46 090 7852370; fax: +46 090 123728; e-mail: staffan.ber [email protected] Curr Opin Clin Nutr Metab Care 2014, 17:267–272 DOI:10.1097/MCO.0000000000000043
1363-1950 ß 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
www.co-clinicalnutrition.com
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Paediatrics
KEY POINTS Delayed cord clamping improves iron stores in infants. Low birth weight infants (
Meeting iron needs for infants and children Staffan Berglund and Magnus Domello¨f
Purpose of review Iron deficiency early in life is associated with impaired neurological development. This study reviews the latest research on how to best meet iron requirements in infants and children. Recent findings There is concurrent evidence that delayed cord clamping is well tolerated and improves infant iron stores. Iron supplements or enriched complementary foods starting before 6 months of life do not reduce iron deficiency prevalence in low-risk populations. However, for low birth weight infants, iron supplements before 6 months of life have long-term benefits. Iron deficiency anaemia (IDA) during the second half year of life is rare in countries with high compliance to iron-rich complementary foods, but remains a major problem globally. In high-risk populations, iron supplementation reduces IDA and possibly improves growth. However, increased risk of infections is a concern and optimal preventive strategies have not yet been determined. Finally, there is concurrent evidence that iron supplementation of anaemic school-aged children reduces IDA and possibly improves neuropsychological outcomes. Summary Interventions for prevention of iron deficiency should be prioritized in risk groups. However, the unclear long-term benefits and possible risk of adverse effects, particularly increased infections in developing countries, prompt further large-scale, double-blinded trials. Keywords children, infants, iron, iron deficiency
INTRODUCTION
MATERIALS AND METHOD
Iron deficiency is the most common micronutrient deficiency in the world and causes approximately half of the two billion cases of anaemia worldwide. Infants and children are, due to their rapid growth, at a particular risk of iron deficiency or iron deficiency anaemia (IDA). This is of concern, as iron is essential for neurodevelopment, and iron deficiency may impair brain development. There is a well verified association between iron deficiency and impaired neuropsychological performance in infants and children and irreversible impairment has been suggested, at least when IDA occurs in infancy [1–3]. However, this association has been difficult to confirm in randomized controlled trials due to the needs of large sample sizes and long follow-up time. Instead, a majority of previous and present intervention trials focus on short-term laboratory outcomes, causing limitations when results are translated to recommendations. The last decade of research in the field has added important knowledge of possible adverse effects of iron supplements, underscoring the importance of evidencebased interventions to compare benefits and risks of interventions [4].
In the present review, we summarize the most recent publications related to iron interventions in infants, toddlers and school-age children. We performed a MEDLINE search for trials published between 1 June 2012 and 30 November 2013 and reviewed the results with a particular focus on randomized controlled trials (RCTs) and meta-analyses.
IRON REQUIREMENTS DURING THE FIRST 6 MONTHS OF LIFE Breast milk has a low content of iron but a high iron bioavailability. Through a well developed physiological shift of iron between stores and heme-bound iron, the total body iron at birth is generally Department of Clinical Sciences, Pediatrics, Umea˚ University, Umea˚, Sweden Correspondence to Staffan Berglund, MD, PhD, Department of Clinical Sciences, Pediatrics, Umea˚ University, SE-901 85 Umea˚, Sweden. Tel: +46 090 7852370; fax: +46 090 123728; e-mail: staffan.ber [email protected] Curr Opin Clin Nutr Metab Care 2014, 17:267–272 DOI:10.1097/MCO.0000000000000043
1363-1950 ß 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
www.co-clinicalnutrition.com
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Paediatrics
KEY POINTS Delayed cord clamping improves iron stores in infants. Low birth weight infants (
