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. 2018 Mar 12;18(1):107.
doi: 10.1186/s12887-018-1066-2.

Effect of infant feeding practices on iron status in a cohort study of Bolivian infants

Rachel M Burke  1 , Paulina A Rebolledo  2   3 , Anna M Aceituno  2 , Rita Revollo  4 , Volga Iñiguez  5 , Mitchel Klein  6 , Carolyn Drews-Botsch  6 , Juan S Leon  2 , Parminder S Suchdev  2   3   7
Affiliations

Effect of infant feeding practices on iron status in a cohort study of Bolivian infants

Rachel M Burke et al. BMC Pediatr. .

Abstract

Background: Iron deficiency (ID) is the most common micronutrient deficiency worldwide, with potentially severe consequences on child neurodevelopment. Though exclusive breastfeeding (EBF) is recommended for 6 months, breast milk has low iron content. This study aimed to estimate the effect of the length of EBF on iron status at 6 - 8 months of age among a cohort of Bolivian infants.

Methods: Mother-infant pairs were recruited from 2 hospitals in El Alto, Bolivia, and followed from one through 6 - 8 months of age. Singleton infants > 34 weeks gestational age, iron-sufficient at baseline, and completing blood draws at 2 and 6 - 8 months of age were eligible for inclusion (N = 270). Ferritin was corrected for the effect of inflammation. ID was defined as inflammation-corrected ferritin < 12 μg/L, and anemia was defined as altitude-corrected hemoglobin < 11 g/dL; IDA was defined as ID plus anemia. The effect of length of EBF (infant received only breast milk with no other liquids or solids, categorized as < 4, 4 - 6, and > 6 months) was assessed for ID, IDA, and anemia (logistic regression) and ferritin (Fer) and hemoglobin (Hb, linear regression).

Results: Low iron status was common among infants at 6 - 8 months: 56% of infants were ID, 76% were anemic, and 46% had IDA. EBF of 4 months and above was significantly associated with ID as compared with EBF < 4 months (4 - 6 months: OR 2.0 [1.1 - 3.4]; > 6 months: 3.3 [1.0 - 12.3]), but not with IDA (4 - 6 months: OR 1.4 [0.8 - 2.4]; > 6 months: 2.2 [0.7 - 7.4]), or anemia (4 - 6 months: OR 1.4 [0.7 - 2.5]; > 6 months: 1.5 [0.7 - 7.2]). Fer and Hb concentrations were significantly lower with increasing months of EBF.

Conclusions: Results suggest a relationship between prolonged EBF and ID, but are not sufficient to support changes to current breastfeeding recommendations. More research is needed in diverse populations, including exploration of early interventions to address infant IDA.

Keywords: Breastfeeding; Global health; Global nutrition; Infant nutrition; Iron deficiency; Micronutrients.

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Conflict of interest statement

Ethics approval and consent to participate

The protocol and instruments for this study were approved by the Emory University IRB (IRB00056127) and the Bolivian “Comité de Etica de la Investigación” (Research Ethics Committee). Mothers provided written informed consent in Spanish or Aymara.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Participant Flow. Of 2331 screened mother-infant pairs, 1336 were eligible for the parent study and 461 enrolled. A total of 343 singleton, non-early preterm infants provided samples at 2 months, with 291 infants iron-sufficient at baseline giving samples at 6 – 8 months, and 270 having complete data
Fig. 2
Fig. 2
Prevalence of Iron Deficiency and Iron Deficiency Anemia by Duration of Exclusive Breastfeeding (n = 270). The prevalence of iron deficiency was increased among infants who had longer durations of exclusive breastfeeding. A similar but less pronounced trend was noted for iron deficiency anemia
See this image and copyright information in PMC

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