Breast Feeding Iron

8/8/2019 Breast Feeding Iron

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Do exclusively breast-fed infants

need supplemental iron?

ByTed Greiner, PhD


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WHO Recommendation, 2001

The evidence from one trial in Honduras

demonstrates poorer iron status in infantsexclusively breastfed for 6 months, versus

4 months followed by partial breastfeeding

to 6 months, and this evidence is likely toapply to populations in which maternal

iron status and infant endogenous stores

are not optimal.


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Iron deficiency anemia in Europe

In a study of 11 sites*, prevalence at 12 monthswas 2.3%

No relationship to breastfeeding

0% in families with high socio-economic status

Early introduction of cows milk was greatest riskfactor

* Male C et al. Prevalence of iron deficiency in 12-mo-old infants from11 European areas and influence of dietary factors on iron status

(Euro-Growth study),Acta Paediatrica 2001;90:492-498


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Iron status at 12 monthsExclusive breast-

feeding**

Exclusive breast-

feeding**

for 7 mo (n = 9) for


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Latest review on iron and

breastfeeding*

Currently, the best evidence is that [avoidance ofiron deficiency] is achieved by

prolonged breastfeeding,

avoidance of unfortified formulas and cow's milk,and

the introduction of iron -fortified and vitamin C-fortified weaning foods at approximately 6months of age

*Griffin, I J; Abrams, S A. Iron and breastfeeding,Pediatric Clinics of

North America 2001;48:401-413


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New Phd by Magnus Domellf

Iron requirements of term, breast-fed

infants. Ume 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


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Regulation of non-heme iron

absorption


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Interpretation

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


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Effect of iron supplementation on

iron deficiency anemia


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Loss in height gain due to iron

supplementation


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Effect of iron supplementation on

diarrhea prevalence


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New suggested cutoffs for infant

iron deficiency


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Impact of 6 months EBF on

mothers iron status*

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


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Conclusions

Breastfeeding exclusively for six months

appears to entail no risk of iron deficiency

in infants:

Among infants born at term, and

In groups with high socio-economic status,

and

When the mothers iron status is adequate


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Conclusions (cont.)

Under these conditions, ironsupplementation in exclusively breastfed

infants under six months of age:

May lead to reduced growth or increasedsusceptibility to infection, and thus

Should NOT be given routinely, but ONLY when there is hematological

evidence of iron deficiency.

Breast Feeding Iron

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