Iron intake and iron status in breastfed infants during the first year of life.

BACKGROUND & AIMS: Breastfed infants may be at particular risk for iron deficiency because breast milk is low in iron. In a secondary analysis of data from a complementary feeding trial, indicators of iron status were examined, with particular focus on the development of iron status in those infants who were fully breastfed during the first 4 months of life. METHODS: In this retrospective analysis of data from a randomized controlled trial infants were stratified according to their predominant milk diet during the first 4 months of life, a subgroup of breastfed infants (group BM, n=53) were compared with a subgroup of infants fed (iron-fortified) formula (group F, n=23). Dietary iron intake and indicators of iron status were analysed at 4 months of age (during the full milk feeding period), and during the complementary feeding period at 7 and 10 months of age. RESULTS: Iron intake was low in the BM group, ranging below the Dietary Reference Intakes throughout the complementary feeding period, with the (estimated) bioavailable iron intake only just achieving the reference requirements. At 4 months, iron deficiency (ID, Ferritin <12.0 ng/mL) was observed in 3 infants in the BM group and in 1 infant in the F group; no infant developed iron deficiency anaemia (IDA, ID and Hb <10.5 g/dl). At 7 and at 10 months of age, iron status was adequate in all infants of the F group. In the BM group, at 7 (10) months of age, ID was diagnosed in 10 (11) infants and IDA was found in 2 (1) infants. CONCLUSIONS: Healthy infants, fully breastfed at 4 months of age, demonstrated ID in about 21% and IDA in up to 6% during the second half of infancy while fed according to the paediatric dietary guidelines. This finding supports the recommendation that supplementation with bioavailable iron via complementary foods should be started early (4-6 months of age) in order to prevent iron deficiency during infancy.

Dietary intake and plasma concentrations of PUFA and LC-PUFA in breastfed and formula fed infants under real-life conditions.

BACKGROUND: The breastfed infant is usually used as standard for formula feeding, also regarding long-chain polyunsaturated fatty acids (LC-PUFA). Here, plasma fatty acid concentrations in formula fed infants and the effects of LC-PUFA supplementation were investigated under real-life conditions. METHOD: Term healthy infants being fully milk fed until the age of 4 months were categorized as breast milk "BM" (n = 73) if consuming >95% of energy from breast milk or formula (F) if consuming >95% of energy from formula subdivided into formula without (F-) (n = 15) and with LC-PUFA supplementation (F+) (n = 15). Formula as marketed was chosen by the parents. Dietary fatty acids (FA) intake was calculated from continuous dietary records from 2 months of age onwards. Total plasma FA were analyzed at the age of 4 months with docosahexaenoic acid (DHA) as primary outcome. RESULTS: Dietary ratios of the polyunsaturated fatty acids (PUFA; linoleic acid/alpha-linolenic acid) were smaller in both F groups than in the BM group. Plasma DHA as % of total FA was similar in BM and F(+) but higher in BM in absolute amounts (mg/L). Plasma DHA as % of total FA in F(-) was higher than what might be supposed on the basis of dietary intake. CONCLUSION: Infants consuming present-day LC-PUFA-supplemented formula achieved plasma LC-PUFA concentrations similar to breastfed infants. In infants consuming non-LC-PUFA-supplemented formula, the favorable PUFA pattern of the formula may have supported n-3 LC-PUFA biosynthesis.

Complementary food with low (8%) or high (12%) meat content as source of dietary iron: a double-blinded randomized controlled trial.

BACKGROUND: To investigate whether a low meat content of complementary food as accepted by EU law increases the risk of well-nourished infants to develop iron deficiency during the complementary feeding period. METHODS: Term born, healthy infants were randomized into a 'High Meat' Group (HM, n = 48) receiving commercial baby jars with a meat content of 12% by weight (according to pediatric guidelines), and a 'Low Meat' Group (LM, n = 49) receiving meals as marketed (meat 8% by weight, the lowest level of EU law). Intervention was from 4 to 10 months of age. Dietary intake was recorded continuously, repeated blood samples were collected. RESULTS: Estimated intake of bioavailable iron conformed to reference requirements. In the primary analysis of the total sample, iron status was adequate before (4 months), during (7 months), and after (10 months) the intervention. A secondary analysis in the subgroup of infants fully breast-fed for 4-6 months demonstrated an increased risk of low Hb values with 10 months of age in the LM group. INTERPRETATION: Present day low meat content of complementary food does not significantly impair iron status in well-nourished infants but may increase the risk of developing marginal iron status in older infants after fully breast-feeding for 4-6 months, i.e., in the subgroup of infants with the lowest habitual iron intake.