Prevalencia de la deficiencia de hierro en lactantes sanos de 12 meses de edad

Does the fortified milk with high iron dose improve the neurodevelopment of healthy infants? Randomized controlled trial

Background

Since iron plays an important role in several physiological processes, its deficiency but also overload may harm the development of children. The aim was to assess the effect of iron–fortified milk on the iron biochemical status and the neurodevelopment of children at 12 months of age.

Methods

Randomized controlled trial conducted in 133 Spanish children, allocated in two groups to receive formula milk fortified with 1.2 or 0.4 mg/100 mL of iron between 6 and 12 months of age. Psychomotor (PDI) and Mental (MDI) Development Index were assessed by the Bayley Scales before and after the intervention. Maternal obstetrical and psychosocial variables were recorded. The biochemical iron status of children was measured and data about breastfeeding, anthropometry and infections during the first year of life were registered.

Results

Children fortified with 1.2 mg/100 mL of iron, compared with 0.4 mg/100 mL, showed higher serum ferritin (21.5 vs 19.1 μg/L) and lower percentage of both iron deficiency (1.1 to 5.9% vs 3.8 to 16.7%, respectively, from 6 to 12 months) and iron deficiency anemia (4.3 to 1.1% vs 0 to 4.2%, respectively, from 6 to 12 months) at the end of the intervention. No significant differences were found on neurodevelopment from 6 to 12 months between children who received high dose of Fe compared with those who received low dose.

Conclusion

Despite differences on the iron status were observed, there were no effects on neurodevelopment of well–nourished children in a developed country after iron supplementation with doses within dietary recommendations. Follow–up studies are needed to test for long–term neurodevelopmental improvement.

Trial registration

Retrospectively registered in ClinicalTrials.gov with the ID: NCT02690675.

Serum hepcidin levels, iron status, and HFE gene alterations during the first year of life in healthy Spanish infants

The aims of this study were to describe hepcidin levels and to assess their associations with iron status and the main variants in the HFE gene in healthy and full-term newborns during the first year of life, as a longitudinal study conducted on 140 infants. Anthropometric and biochemical parameters, hepcidin, hemoglobin (Hb), serum ferritin (SF), transferrin saturation (TS), mean corpuscular volume (MCV), and C-reactive protein (CRP), were assessed in 6- and 12-month-olds. Infants were genotyped for the three main HFE variants: C282Y, H63D, and S65C. Hepcidin levels increased from 6 to 12 months of age (43.7 ± 1.5 to 52.0 ± 1.5 ng/mL; p < 0.001), showing higher levels in infants with better iron status compared to those with iron deficiency (ID) (44.8 ± 1.5 vs 37.9 ± 1.3 ng/mL, p < 0.018, and 54.3 ± 1.5 vs 44.0 ± 1.4 ng/mL, p < 0.038, in 6- and 12-month-olds, respectively). In multivariate linear regression models, iron status was found to be associated with hepcidin levels in infants with wild-type HFE gene (p = 0.046 and p = 0.048 in 6- and 12-month-olds, respectively). However, this association was not found in HFE-alteration-carrying infants. Hepcidin levels increased in healthy infants during the first year of life and were positively associated with iron levels only in infants with wild-type HFE gene, a situation that requires further investigation.

Adequacy of Usual Vitamin and Mineral Intake in Spanish Children and Adolescents: ENALIA Study

Background: The National Dietary Survey on the Child and Adolescent Population in Spain (ENALIA) provides data to assess the usual micronutrient intake among Spanish infants, children, and adolescents. Methods: Cross-sectional survey (November 2012-July 2014) of a representative sample of Spanish children and adolescents (six months-17 years) (n = 1862). Dietary information was collected using two non-consecutive one-day food diaries (six months-10 years old) or two 24 h dietary recalls (11 years and older) separated by at least 14 days. Estimates were calculated using the Iowa State University method and PC-SIDE software (version 1.0, department of statistics, center for agricultural and rural development, Ames, IA, USA) to account for within- and between-person variation. Results: Usual intake of vitamin D was insufficient in practically all individuals. Vitamin E, folate, and calcium were insufficient, especially from nine years of age, and magnesium and iodine from 14 years of age. The percentage of subjects with insufficient intakes was higher among females. Sodium intake was excessive in a considerable percentage of the population, especially in males, and it increased with age. Finally, over half of children under four years of age had zinc usual intakes that exceeded the Tolerable Upper Level. Conclusion: Vitamin and mineral intake in Spain should be improved, especially in late childhood and adolescence. Nutritional intervention and educational strategies are needed to promote healthy eating habits and correct micronutrient inadequacies in Spanish children and adolescents.

Age of introduction of first complementary feeding for infants: a systematic review

Background

Despite a World Health Organization recommendation for exclusive breastfeeding of all full-term infants to 6 months of age, it is not clear what the health implications may be. Breast milk alone may not meet the nutrition needs for all growing infants, leaving them at risk for deficiencies. The objective of this study was to investigate the relationship between moderate (4 months) versus late (6 months) introduction of complementary foods to the full-term breastfed infant on iron status and growth.

Methods

An electronic search of peer-reviewed and gray-literature was conducted for randomized control trials (RCTs) and observational studies related to the timing of introduction of complementary foods. Iron status and growth data from the relevant RCTs were analyzed using RevMan 5.2.11.

Results

Three RCTs and one observational study met the inclusion criteria. Meta-analysis showed significantly higher hemoglobin levels in infants fed solids at 4 months versus those fed solids at 6 months in developing countries [mean difference [MD]: 5.0 g/L; 95 % CI: 1.5, 8.5 g/L; P = 0.005]. Meta-anaysis also showed higher serum ferritin levels in the 4-month group in both developed and developing countries [MD: 26.0 μg/L; 95 % CI: -0.1, 52.1 μg/L, P = 0.050], [MD: 18.9 μg/L; 95 % CI: 0.7, 37.1 μg/L, P = 0.040]. Short follow-up periods and small sample sizes of the included studies were the major limitations.

Conclusions

RCT evidence suggests the rate of iron deficiency anemia in breastfed infants could be positively altered by introduction of solids at 4 months.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-015-0409-5) contains supplementary material, which is available to authorized users.

[Evaluation of diet and nutrient intake in children under three years old. ALSALMA pilot study]

OBJECTIVE

The present study evaluates energy and nutrient intake in Spanish children under three years of age, and compares the results with the current recommendations in order to identify possible inadequate nutrient intake.

PATIENTS AND METHODS

A cross-sectional pilot study. The mothers completed a diet diary for four non-consecutive days, recording the products and amounts consumed by their children. Nutrient intake was calculated, and the results were compared with the dietary reference intakes (DRI) for each age group.

RESULTS

A total of 188 children (93 boys and 95 girls) aged 0-6 (n=41), 7-12 (n=24), 13-24 (n=57), and 25-36 months (n=66) were included. Statistically significant differences in DRI were observed for most of the nutrients analyzed. Protein intake, in particular was 376% of DRI in children between 1-3 years of age. By age groups, 96% of the children aged 7-12 months, 88% of the children aged 13-24 months, and 97% of the children aged 25-36 months showed protein intakes more than two-fold DRI.

CONCLUSIONS

Nutrient intake differed from the DRI, particularly as regards proteins. A new study is required to determine whether the observed study deviations could be representative of the national population of this age group, as well as the possible effects on child health.

Nutritional risk factors for iron-deficiency anaemia in children 12-24 months old in the area of Thessalia in Greece

Iron-deficiency anaemia (IDA) is a common problem all over the world, which mainly attacks pregnant women, infants and children. The main objectives were to assess the prevalence of IDA in children 12-24 months old in the area of Thessalia located in the central part of Greece and to identify, by means of a simple questionnaire, its nutritional risk factors. The research was applied as a cross-sectional and case-control study. In the first part of the study, the haemoglobin (Hb) levels were estimated by a mobile photometer analyser in 938 children (approximately one-third of the total children population). In the second part, children with Hb?<?11 g/dl were compared with their random selected healthy controls in haematological, anthropometric and nutritional parameters. The estimated laboratory values were Hb, haematocrit, mean corpuscular volume, mean corpuscular Hb, mean corpuscular Hb concentration, zinc protoporphyrin, serum iron, serum ferritin, transferring saturation, total iron binding capacity and Hb electrophoresis. Finally, 75 children (34 boys, 41 girls; mean age 17.51+/-3.5 months), who were found to have IDA, constituted the case group while 75 healthy children constituted the control group. The studied nutritional variables through the application of a standardized food frequency questionnaire were: duration of breast feeding, milk that the child drinks during the research, age of solid food introduction, child's health status according to the mother's point of view, child's appetite and frequency of bread, cereals, meat, fish, egg, legumes, chocolate, marmalade, vegetables, fruit and tea intake. The prevalence of IDA in the region was 7.99%. The carriers of b-thalassaemia (2.13%) were excluded from the study. Significant statistical difference has been observed between the two groups (P?<?0.001) in all haematological and anthropometric parameters except head circumference (P?=?0.85). Concerning the nutritional indices the two groups were statistically different (P?<?0.001) in the following: the cases were breastfed less, were drinking fresh cow's milk and tea, were eating meat, vegetables and fruit less often, had a bad appetite and were more likely to get sick. In conclusion, the prevalence of IDA in this area of Greece is approximately similar to other areas in the developed world. The application of simple food frequency questionnaires for the detection of the nutritional IDA risk factors could prognose and prevent anaemia.