Iron status of young children in Europe

Abstract

Iron deficiency (ID) is common in young children aged 6-36 mo. Although the hazards associated with iron deficiency anemia (IDA) are well known, concerns about risks associated with excess iron intake in young children are emerging. To characterize iron status in Europe, we describe the prevalence of ID, IDA, iron repletion, and excess stores with the use of published data from a systematic review on iron intake and deficiency rates, combined with other selected iron status data in young European children. Various definitions for ID and IDA were applied across studies. ID prevalence varied depending on socioeconomic status and type of milk fed (i.e., human or cow milk or formula). Without regard to these factors, ID was reported in 3-48% of children aged ≥12 mo across the countries. For 6- to 12-mo-old infants, based on studies that did not differentiate these factors, ID prevalence was 4-18%. IDA was <5% in most studies in Northern and Western Europe but was considerably higher in Eastern Europe (9-50%). According to current iron status data from a sample of healthy Western European children aged 12-36 mo, 69% were iron replete, and the 97.5th percentile for serum ferritin (SF) was 64.3 μg/L. In another sample, 79% of 24-mo-old children were iron replete, and the 97.5th percentile for SF was 57.3 μg/L. Average iron intake in most countries studied was close to or below the UK's Recommended Dietary Allowance. In conclusion, even in healthy European children aged 6-36 mo, ID is still common. In Western European populations for whom data were available, approximately three-quarters of children were found to be iron replete, and excess iron stores (SF >100 μg/L) did not appear to be a concern. Consensus on the definitions of iron repletion and excess stores, as well as on ID and IDA, is needed.

Keywords: Europe; cow milk; formula; human milk; iron deficiency; iron deficiency anemia; iron intake; iron repletion; young children.

FIGURE 1

Mean ± SD iron intakes in different European countries compared with the UK EAR and UK RDA (indicated by dashed horizontal lines) in infants aged 6–12 mo (A) and in children aged 12–36 mo (B). Error bars represent the pooled SDs of the included studies. Reproduced from reference with permission. EAR, Estimated Average Requirement; RDA, Recommended Dietary Allowance.

FIGURE 2

Distribution among food group consumers of mean daily iron intakes (A) and SF concentrations (B). Panel A: Total population (● n = 461); iron-fortified breakfast cereal–only (excluding all formula) consumers (◆ n = 322); formula consumers (▲ n = 95); and base diet (excluding all iron-fortified products) consumers (■ n = 44). Iron supplement users (n = 7) were excluded. The dashed line indicates the UK EAR (5.3 mg/d). Panel B: Total population (● n = 257), iron-fortified breakfast cereal–only (excluding all formula) consumers (◆ n = 173); formula consumers (▲ n = 51); and base diet (excluding all iron-fortified products) consumers (■ n = 33). Iron supplement users (n = 6) were excluded. SF cutoffs of 12 and 15 μg/L are indicated on the chart by the dashed lines. Reproduced from reference with permission. EAR, Estimated Average Requirement; SF, serum ferritin.