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Iron requirements of term, breast-fed infants: a study in Sweden and Honduras
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2001. , 55 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 759
National Category
Pediatrics
Identifiers
URN: urn:nbn:se:umu:diva-96893ISBN: 91-7305-129-2 (print)OAI: oai:DiVA.org:umu-96893DiVA: diva2:769097
Public defence
2001-11-30, Tandläkarhögskolan Umeå, sal B, 9 tr., Umeå universitet, Umeå, 09:00
Opponent
Supervisors
Projects
digitalisering@umu
Note

Diss. (sammanfattning) Umeå : Umeå universitet, 2001

Available from: 2015-01-22 Created: 2014-12-05 Last updated: 2015-04-08Bibliographically approved
List of papers
1. Iron supplementation affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and Honduras.
Open this publication in new window or tab >>Iron supplementation affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and Honduras.
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2002 (English)In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 132, no 11, 3249-3255 p.Article in journal (Refereed) Published
Abstract [en]

Iron supplements are often prescribed during infancy but their benefits and risks have not been well documented. We examined whether iron supplements affect growth or morbidity of breast-fed infants. Full-term infants in Sweden (n = 101) and Honduras (n = 131) were randomly assigned to three groups at 4 mo of age: 1) placebo from 4 to 9 mo; 2) placebo from 4 to 6 mo and iron supplements [1 mg/(kg. d)] from 6 to 9 mo; or 3) iron supplements from 4 to 9 mo. All infants were exclusively or nearly exclusively breast-fed to 6 mo and continued to be breast-fed to at least 9 mo. Growth was measured monthly and morbidity data were collected every 2 wk. Among the Swedish infants, gains in length and head circumference were significantly lower in those who received iron than in those given placebo from 4 to 9 mo. The same effect on length was seen in Honduras, but only at 4-6 mo among those with initial hemoglobin (Hb) > or =110 g/L. There was no significant main effect of iron supplementation on morbidity, nor any significant interaction between iron supplementation and site, but for diarrhea (with both sites combined), there was an interaction between iron supplementation and initial Hb. Among infants with Hb < 110 g/L at 4 mo, diarrhea was less common among those given iron than in those given placebo from 4-9 mo, whereas the opposite was true among those with Hb > or = 110 g/L (P < 0.05). We conclude that routine iron supplementation of breast-fed infants may benefit those with low Hb but may present risks for those with normal Hb.

Place, publisher, year, edition, pages
The American Society for Nutritional Sciences, 2002
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-34999 (URN)12421836 (PubMedID)
Available from: 2010-06-29 Created: 2010-06-29 Last updated: 2017-12-12Bibliographically approved
2. Iron supplementation of breast-fed Honduran and Swedish infants from 4 to 9 months of age.
Open this publication in new window or tab >>Iron supplementation of breast-fed Honduran and Swedish infants from 4 to 9 months of age.
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2001 (English)In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 138, no 5, 679-687 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The objective was to study the effects of iron supplementation on hemoglobin and iron status in 2 different populations. Study design: In a randomized, placebo-controlled, masked clinical trial, we assigned term Swedish (n = 101) and Honduran (n = 131) infants to 3 groups at 4 months of age: (1) iron supplements, 1 mg/kg/d, from 4 to 9 months, (2) placebo, 4 to 6 months and iron, 6 to 9 months, and (3) placebo, 4 to 9 months. All infants were breast-fed exclusively to 6 months and partially to 9 months. RESULTS: From 4 to 6 months, the effect of iron (group 1 vs 2 + 3) was significant and similar in both populations for hemoglobin, ferritin, and zinc protoporphyrin. From 6 to 9 months, the effect (group 2 vs group 3) was significant and similar at both sites for all iron status variables except hemoglobin, for which there was a significant effect only in Honduras. In Honduras, the prevalence of iron deficiency anemia at 9 months was 29% in the placebo group and 9% in the supplemented groups. In Sweden, iron supplements caused no reduction in the already low prevalence of iron deficiency anemia at 9 months (<3%). CONCLUSION: Iron supplementation from 4 to 9 months or 6 to 9 months significantly reduced iron deficiency anemia in Honduran breast-fed infants. The unexpected hemoglobin response at 4 to 6 months in both populations suggests that regulation of hemoglobin synthesis is immature at this age.

Place, publisher, year, edition, pages
Elsevier, 2001
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-35040 (URN)10.1067/mpd.2001.112895 (DOI)11343043 (PubMedID)
Available from: 2010-07-02 Created: 2010-07-02 Last updated: 2017-12-12Bibliographically approved
3. Iron absorption in breast-fed infants: effects of age, iron status, iron supplements, and complementary foods.
Open this publication in new window or tab >>Iron absorption in breast-fed infants: effects of age, iron status, iron supplements, and complementary foods.
2002 (English)In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 76, no 1, 198-204 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Iron supplements are often recommended for older breast-fed infants, but little is known about factors affecting iron absorption from human milk or supplements. OBJECTIVE: We investigated the effects of age, iron status, and iron intake on iron absorption in healthy, term, breast-fed infants. DESIGN: Twenty-five infants were randomly assigned to receive either 1) iron supplements (1 mg x kg(-1) x d(-1)) from 4 to 9 mo of age, 2) placebo from 4 to 6 mo and iron supplements from 6 to 9 mo, or 3) placebo from 4 to 9 mo. Infants were exclusively breast-fed to 6 mo and partially breast-fed to 9 mo of age. Iron absorption was assessed by giving (58)Fe with mother's milk at 6 and 9 mo. Blood samples were obtained at 4, 6, and 9 mo, and complementary food intake was recorded at 9 mo. RESULTS: At 6 mo, mean (+/-SD) fractional iron absorption from human milk was relatively low (16.4 +/- 11.4%), with no significant difference between iron-supplemented and unsupplemented infants. At 9 mo, iron absorption from human milk remained low in iron-supplemented infants (16.9 +/- 9.3%) but was higher (P = 0.01) in unsupplemented infants (36.7 +/- 18.9%). Unexpectedly, iron absorption at 9 mo was not correlated with iron status but was significantly correlated with intake of dietary iron, including supplemental iron. CONCLUSIONS: Changes in the regulation of iron absorption between 6 and 9 mo enhance the infant's ability to adapt to a low-iron diet and provide a mechanism by which some, but not all, infants avoid iron deficiency despite low iron intakes in late infancy.

Place, publisher, year, edition, pages
American Society for Clinical Nutrition, 2002
Keyword
Infants, human milk, breast milk, nonheme-iron absorption, stable isotopes, iron status, dietary iron intake, complementary food, iron supplements, dietary regulator, adaptation
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-35001 (URN)12081835 (PubMedID)
Available from: 2010-06-29 Created: 2010-06-29 Last updated: 2017-12-12Bibliographically approved
4. Sex differences in iron status during infancy.
Open this publication in new window or tab >>Sex differences in iron status during infancy.
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2002 (English)In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 110, no 3, 545-552 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: It is commonly assumed that there is no difference in iron status between male and female infants, despite a lack of studies addressing this question. OBJECTIVE: To study sex differences in different measures of iron status in infants. METHODS: At 4 months of age, 263 term, breastfed infants (121 Swedish and 142 Honduran) were randomized to receive iron supplements or placebo until 9 months of age. Blood samples at 4, 6, and 9 months of age were analyzed for hemoglobin (Hb), mean cell volume (MCV), zinc protoporphyrin (ZPP), plasma ferritin, and transferrin receptors (TfR). RESULTS: At 4, 6, and 9 months, boys had significantly lower Hb, MCV, and ferritin and higher ZPP and TfR than girls. At 9 months, boys had a 10-fold higher risk of being classified as having iron deficiency anemia. The differences at 9 months in MCV (71.6 vs 75.1 fL) and ZPP (59 vs 49 micro mol/mol heme) remained significant after controlling for iron supplementation, site, growth variables, and other possible confounders. For ferritin, there was a remaining sex difference at 9 months among Swedish (29 vs 53 micro g/L) but not Honduran infants. For Hb and TfR, sex differences at 9 months were larger in unsupplemented infants, especially in those with a birth weight of <3500 g. CONCLUSIONS: There are substantial sex differences in Hb and other indicators of iron status during infancy. Some of these may be genetically determined, whereas others seem to reflect an increased incidence of true iron deficiency in boys.

Place, publisher, year, edition, pages
American Academy of Pediatrics, 2002
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-35000 (URN)12205258 (PubMedID)
Available from: 2010-06-29 Created: 2010-06-29 Last updated: 2017-12-12Bibliographically approved
5. The diagnostic criteria for iron deficiency in infants should be reevaluated.
Open this publication in new window or tab >>The diagnostic criteria for iron deficiency in infants should be reevaluated.
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2002 (English)In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 132, no 12, 3680-3686 p.Article in journal (Refereed) Published
Abstract [en]

Diagnostic criteria for iron deficiency (ID) and iron deficiency anemia (IDA) in infants are poorly defined. Our aim was to establish appropriate cut-off values for hemoglobin (Hb), plasma ferritin, erythrocyte mean cell volume (MCV), zinc protoporphyrin (ZPP) and soluble transferrin receptors (TfR) in infancy. Exclusively breast-fed infants (n = 263) in Honduras and Sweden were randomly assigned to receive iron supplementation or placebo, and blood samples were obtained at 4, 6 and 9 mo of age. Reference ranges were determined using three different approaches for defining iron-replete infants. The usefulness of several variables for predicting the Hb response to iron was evaluated. We found the following 2 SD cut-off values in iron-replete infants: Hb <105 g/L at 4-6 mo and <100 g/L at 9 mo; ZPP >75 micro mol/mol heme at 4-6 mo and >90 micro mol/mol heme at 9 mo; ferritin <20 micro g/L at 4 mo, <9 micro g/L at 6 mo and <5 micro g/L at 9 mo; and TfR >11 mg/L at 4-9 mo. The Hb response to iron was not a useful definition of IDA at 4 mo of age. Hb, MCV and ZPP at 6 mo as well as growth variables predicted the Hb response at 6-9 mo, but ferritin and TfR at 6 mo did not. We conclude that there is need for a reevaluation of the definitions of ID and IDA in infants.

Place, publisher, year, edition, pages
The American Society for Nutritional Sciences, 2002
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-34998 (URN)12468607 (PubMedID)
Available from: 2010-06-29 Created: 2010-06-29 Last updated: 2017-12-12Bibliographically approved

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