Haem iron intake in 12-36 month old children depleted in iron: case-control study

BMJ 1996;312:881-883 (6 April)

Papers

Haem iron intake in 12-36 month old children depleted in iron: case-control study

Michael Mira, director,^a Garth Alperstein, area paediatrician,^b Margaret Karr, research officer,^a Geetha Ranmuthugala, research student,^c Jane Causer, research medical officer,^a Anna Niec, dietitian,^b Anne-Marie Lilburne, dietitian ^b

^a Division of General Practice, Central Sydney Area Health Service, Balmain New South Wales 2041 Australia, ^b Community Health Services, Central Sydney Area Health Service, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050 Australia, ^c National Centre for Epidemiology and Population Health, Australian National University, Canberra Australia

Correspondence to: Professor Mira.

Abstract

Objective: To compare the intakes of haem and non-haem ironin iron depleted and iron replete children.
Design: Case-control study.
Setting: Early Childhood Centres and a long day care centrein Sydney, Australia.
Subjects: Children aged 12-36 months depleted in iron and controlsmatched for age and sex.
Mean outcome measures: Iron status by using plasma ferritinconcentration. A three day weighed dietary intake record completedby the parents. Risk factors for iron deficiency assessed byquestionnaire.
Results: Fifty six iron depleted and 68 iron replete childrenparticipated. The average daily intake ofhaem iron was significantlylower in the iron depleted group (t=2.392, P=0.018); there wasa tendency towards a lower average daily intake of non-haemiron (t=1.724, P=0.086) and vitamin C (t=1.921, P=0.057) foriron depleted children. Low intake ofhaem iron (<0.71 mg/day)was significantly associated with iron depletion with an oddsratio of 3.0 (P=0.005). The proportion of iron depleted childrenwho were given whole cows' milk before 12 months of age wasalmost double that of iron replete children; multivariate analysisshowed that both haem iron intake and age of introduction ofcows' milk were independently associated with iron depletion.
Conclusions: The results of this study show that, in young childrenin developed countries, a lower haem iron intake is a majorrisk factor for iron depletion; the introduction of whole cows'milk before 12 months is further confirmed as a risk factor.Parental education on nutrition should now focus on these twoaspects of nutrition for infants and young children.

Key messages

Iron deficiency is the most common nutritional deficiency worldwide
Iron deficiency may cause lowering of developmental scores and may impair behaviour
Iron depleted 1 and 2 year old children have lower haem iron intake
Introduction of cows' milk as the main milk drink should be delayed until after 12 months of age
Public health campaigns to reduce iron depletion and iron deficiency in preschool children should encourage adequate meat intake

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