Do exclusively breast-fed infants need supplemental iron?

By

Ted Greiner, PhD

WHO Recommendation, 2001

The evidence from one trial in Honduras demonstrates poorer iron status in infants exclusively breastfed for 6 months, versus 4 months followed by partial breastfeeding to 6 months, and this evidence is likely to apply to populations in which maternal iron status and infant endogenous stores are not optimal.  

Iron deficiency anemia in Europe In a study of 11 sites*, prevalence at 12 months

was 2.3% No relationship to breastfeeding 0% in families with high socio-economic status Early introduction of cow’s milk was greatest risk

factor* Male C et al. Prevalence of iron deficiency in 12-mo-old infants from

11 European areas and influence of dietary factors on iron status

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

Iron status at 12 monthsExclusive breast-

feeding**Exclusive breast-

feeding**

for 7 mo (n = 9) for <7 mo (n = 21)

Hb concentration, gm/L (SD) 11.7 (0.4) 10.9 (0.7)*

No. (%) of Hb concentration <110 gm/L 0 (0) 9 (43)

Mean serum ferritin, µg/L (SD) 17 (15) 12.3 (11.7)

No. (%) with serum ferritin level <10 µg/L 2 (22) 11 (52)

No. (%) with Hb >110 gm/L and serum ferritin level >10 µg/L

7 (78) 10 (48)

Hb, Hemoglobin.    

Pisacane et al, Iron status in breast-fed infants. J.Pediatr 127:429-341, 1995 *t = 3.2; df = 28; p = 0.003. **No other milk or sources of iron

Latest review on iron and breastfeeding* Currently, the best evidence is that [avoidance of

iron 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 6 months of age

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

North America 2001;48:401-413

New Phd by Magnus Domellöf Iron requirements of term, breast-fed

infants. Umeå 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

Regulation of non-heme iron absorption

Effect of iron supplementation on Hb

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

Effect of iron supplementation on iron deficiency anemia

Loss in height gain due to iron supplementation

Effect of iron supplementation on diarrhea prevalence

New suggested cutoffs for infant iron deficiency

Impact of 6 months EBF on mother’s 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

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 mother’s iron status is adequate

Conclusions (cont.) Under these conditions, iron

supplementation in exclusively breastfed infants under six months of age:

May lead to reduced growth or increased susceptibility to infection, and thus

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

evidence of iron deficiency.