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. 2020 Apr 6;4(1):e000635.
doi: 10.1136/bmjpo-2020-000635. eCollection 2020.

Maternal ethnicity and iron status in early childhood in Toronto, Canada: a cross-sectional study

Vinusha Gunaseelan  1   2 , Patricia C Parkin  1   2   3   4 , Gita Wahi  5 , Catherine S Birken  1   2   3   4 , Jonathon L Maguire  3   4   6   7   8 , Colin Macarthur  1   2   3   4 , Cornelia M Borkhoff  1   2   3 ; Members of the TARGet Kids! Collaboration
Collaborators, Affiliations

Maternal ethnicity and iron status in early childhood in Toronto, Canada: a cross-sectional study

Vinusha Gunaseelan et al. BMJ Paediatr Open. .

Abstract

Objectives: This study aimed to evaluate the association between maternal ethnicity and iron deficiency (ID) in early childhood, and to evaluate whether infant feeding practices linked to ID differ between maternal ethnic groups.

Methods: This was a cross-sectional study of healthy children 1-3 years of age. Adjusted multivariable logistic regression analyses were used to evaluate the association between maternal ethnicity and ID (serum ferritin <12 µg/L) and the association between maternal ethnicity and five infant feeding practices (breastfeeding duration; bottle use beyond 15 months; current formula use; daily cow's milk intake >2 cups; meat consumption).

Results: Of 1851 children included, 12.2% had ID. Compared with the European referent group, we found higher odds of ID among children of South Asian and West Asian/North African maternal ethnicities, and lower odds of ID among children of East Asian maternal ethnicity. Statistically significant covariates associated with higher odds of ID included longer breastfeeding duration and daily cow's milk intake >2 cups. Current infant formula use was associated with lower odds of ID. Children of South Asian maternal ethnicity had higher odds of bottle use beyond 15 months of age and lower odds of meat consumption.

Conclusions: We found increased odds of ID among children of South Asian and West Asian/Northern African maternal ethnicities. We found a higher odds of feeding practices linked to ID in children of South Asian maternal ethnicity, but not in children of West Asian/North African maternal ethnicity. Culturally tailored approaches to providing guidance to parents on healthy infant feeding practices may be important to prevent ID in early childhood.

Trial registration number: NCT01869530.

Keywords: early childhood; ethnicity; infant feeding; iron deficiency; serum ferritin.

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Conflict of interest statement

Competing interests: PCP reports receiving a grant from the Hospital for Sick Children Foundation during the conduct of the study. PCP reports receiving the following grants unrelated to this study: a grant from Canadian Institutes of Health Research (FRN # 115059) for an ongoing investigator-initiated trial of iron deficiency in young children, for which Mead Johnson Nutrition provides non-financial support (Fer-In-Sol liquid iron supplement) (2011–2017); and peer-reviewed grants for completed investigator-initiated studies from Danone Institute of Canada (2002–2004 and 2006–2009), Dairy Farmers of Ontario (2008–2010). CMB reports previously receiving a grant for a completed investigator-initiated study from the Sickkids Centre for Health Active Kids (CHAK) (2015–2016) involving the development and validation of a risk stratification tool to identify young asymptomatic children at risk for iron deficiency. JLM reports receiving an unrestricted research grant for a completed investigator-initiated study from the Dairy Farmers of Canada (2011–2012).

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