Breastfeeding exclusively and iron deficiency anemia during the first 6 months of age

Beyond WASH: Testing Additional Connections Between Household Water Insecurity and Child Nutrition Outcomes in Multi-Country Contexts

This study identifies multiple pathways connecting household water insecurity with child nutrition. Using nationally representative samples for 18 countries, we examine the mediating role of child's dietary diversity as a function of household water status, while also accounting for sanitation. We construct a latent household water insecurity score (HWI) and use Structural Equation approach to model underlying pathways. HWI affected child's HAZ score and hemoglobin both directly and indirectly, with a mediation from child feeding alongside effects from sanitation. Broadening the conception of household water insecurity and accommodating the indirect effects of water could improve explanations of child under-nutrition.

Infant Feeding Practices, Nutrition, and Associated Health Factors during the First Six Months of Life among Syrian Refugees in Greater Beirut, Lebanon: A Mixed Methods Study

The objective was to describe infant feeding practices, nutrition and related health aspects of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with infants under six months in July-October 2018 (N = 114). Additionally, eleven focus group discussions were conducted to explore supportive factors and barriers associated with early breastfeeding practices. The prevalence of pre-lacteal feeding was high (62.5%), whereas early initiation of breastfeeding was low (31%), and exclusive breastfeeding very low (24.6%). One-fifth of the infants were anemic (20.5%) and 9.6% were wasted. A significantly higher proportion of non-exclusively breastfed infants had a fever and took medicines than those who were exclusively breastfed. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and exclusive breastfeeding, along with receiving support from healthcare professionals and family members. Identified barriers included preterm delivery, pre-lacteal feeding, an at-risk waist circumference and moderate to severe depression among mothers, bottle feeding, early introduction of food, maternal health reasons, breastmilk substitutes' distribution, and misinformation offered by mothers-in-law. To address sub-optimal feeding practices documented among Syrian refugees, awareness on proper breastfeeding practices, maternal nutrition, and psychosocial support should be provided to mothers and family members alike.

Association of Infant Feeding Practices with Iron Status and Hematologic Parameters in 6-Month-Old Infants

Background: Infants’ feeding practices in the first 6 months of life and their association with iron status and hematologic parameters has not been well studied. We aim to evaluate this association. Methods: In a retrospective chart review, we identified 403 infants who received laboratory screening for anemia at 6-month visits. Infants were categorized into four groups according to feeding practices. Hematologic parameters and incidence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) were compared. Results: In total, 105 infants were breastfed (BF), 78 were breastfed with iron supplementation starting at 4 months (BI), 109 were mixed-fed (breast milk and formula) with or without iron supplementation (MF), and 111 were formula-fed (FF). The BF group had the highest incidence of anemia (38.1%), ID (28.6%), and IDA (17.1%) when compared with the other groups (p < 0.001). In multivariate logistic regression, BI, MF, and FF infants had 90.4%, 97.5%, and 96.9% decreased risk of IDA, respectively, with BF infants as a reference group. Conclusion: The incidence of anemia, ID, and IDA at age 6 months was higher in BF than FF or MF infants. However, iron supplements in BF infants starting at 4 months significantly reduced their ID and IDA incidence.

Prevalence of childhood anaemia in Brazil: still a serious health problem: a systematic review and meta-analysis

OBJECTIVE

To estimate the prevalence of anaemia in Brazilian children up to 83·9 months old.

DESIGN

Systematic review and meta-analysis, using databases PubMed, Scopus, SciELO, Lilacs, Google Scholar, Periódicos Capes, Arca, Biblioteca Virtual em Saúde, Microsoft Academic Search and Cochrane Library using search terms: anaemia, prevalence, child and Brazil. PROSPERO Registration number: CRD42020208818.

SETTING

Cross-sectional, cohort, case-control and intervention studies published between 2007 and 2020 were searched, excluding those who assessed children with an illness or chronic condition. The main outcome was anaemia prevalence. Random effects models based on the inverse variance method were used to estimate pooled prevalence measures. Sensitivity analyses removed studies with high contribution to overall heterogeneity.

PARTICIPANTS

From 6790 first screened, 134 eligible studies were included, totalling 46 978 children aged zero to 83·9 months analysed, with adequate regions representativeness.

RESULTS

Pooled prevalence of anaemia was 33 % (95 % CI 30, 35). Sensitivity analyses showed that withdrawal of studies that contributed to high heterogeneity did not influence national average prevalence.

CONCLUSIONS

Childhood anaemia is still a serious public health problem in Brazil, exposing 33 % of Brazilian children to the anaemia repercussions. The main limitation of the study is the estimation of national prevalence based on local surveys, but a large number of studies were included, with representation in all regions of the country, giving strength to the results. In Brazil, more public policies are needed to promote supplementation, fortification and access to healthy eating to reduce the high level of anaemia among children.

Anemia and Nutritional Status of Syrian Refugee Mothers and Their Children under Five Years in Greater Beirut, Lebanon

The objective was to assess the prevalence of anemia and nutritional status of mothers and children under five years among Syrian refugees in Lebanon and to identify nutritional deficiencies among pregnant, lactating, and non-pregnant non-lactating (NPNLM) mothers. A cross-sectional study was conducted among Syrian refugee mothers with children under five years in Greater Beirut, Lebanon (n = 433). Data on socio-economic status, maternal health, lifestyle characteristics, dietary intake, anthropometric measurements, and hemoglobin concentrations were collected. The prevalence of anemia was 21.7% among mothers and 30.5% among children. NPNLM with overweight/obesity and an at-risk waist circumference (WC) had 14.7-times and 10.9-times higher odds of anemia than mothers with normal WC and weight. Children of anemic mothers had 2.7-times and 4.4-times higher odds of total and mild anemia than those of non-anemic. Higher odds of mild anemia were found among children of lactating mothers than of NPNLM. A high percent energy intake of total fat and sugar was found among all mothers. Nutritional inadequacy was identified in higher proportions of lactating and pregnant mothers than NPNLM. Our findings highlighted the co-existence of overnutrition and anemia among Syrian refugee mothers and undernutrition among children from the same household. Culture-specific interventions are needed to support maternal nutrition, to ensure the health and wellbeing of their offspring.

Anemia and Contributing Factors in Severely Malnourished Infants and Children Aged between 0 and 59 Months Admitted to the Treatment Centers of the Amhara Region, Ethiopia: A Multicenter Chart Review Study

BACKGROUND

Anemia among severely malnourished children is a double burden that could make the treatment outcome of severe acute malnutrition (SAM) more unfavorable. The burden and the factors are, however, uncovered among children in the Amhara region. Therefore, the study was aimed at determining the prevalence of anemia and identifying contributing factors in severely malnourished children aged between 0 and 59 months admitted to the treatment centers of the Amhara region referral hospitals.

METHODS

A facility-based cross-sectional study was conducted that included 1,301 infants and children, who developed SAM and were admitted to the three referral hospitals of the Amhara region. Data were extracted using a data extraction checklist. The binary logistic regression analysis was employed to show an association between the dependent and independent variables. Multicollinearity was assessed using the variance inflation factor (VIF) and no problem was detected (overall VIF = 1.67). The presence of association was declared based on the p-value (≤0.05), and the adjusted odds ratio with its respective 95% confidence interval was used to report the direction, as well as the strength of association.

RESULTS

About 41.43% (95% CI: 38.78%-44.13%) of severely malnourished infants and children have developed anemia, of which around half (47%) of them were under six months old. Rural residence (AOR = 1.56; 95% CI: 1.14-2.12) and HIV infection (AOR = 2.00; 95% CI: 1.04-3.86) were significantly associated with higher odds of anemia. Furthermore, being exclusively breastfed (AOR = 0.57; 95% CI 0.39-0.83) remarkably reduced the likelihood of anemia.

CONCLUSIONS

This data confirms that anemia among severely malnourished infants and children is a public health problem in the Amhara region. Infants younger than six months were at a higher risk of anemia. Being a rural resident and contracting HIV infection have elevated the occurrence of anemia, whereas being exclusively breastfed decreased the risk. Therefore, the study gives an insight to policymakers and planners to strengthen the existing exclusive breastfeeding practice. Strategies being practiced to prevent HIV transmission and early detection, as well as treatment, should also be strengthened. Furthermore, mothers/caretakers of infants and children residing in the rural areas deserve special attention through delivering nutrition education.

Determining the Actual Zinc and Iron Intakes in Breastfed Infants: Protocol for a Longitudinal Observational Study

BACKGROUND

Zinc and iron deficiencies among breastfed infants during the first 6 months of life have been reported in previous studies. The amounts of zinc and iron intakes from breast milk are factors that contribute to the zinc and iron status of breastfed infants.

OBJECTIVE

This study aims to quantitatively determine zinc and iron intakes by breastfed infants during the first 4 months of life and to investigate the factors that predict zinc and iron status in breastfed infants.

METHODS

Pregnant women at 28 to 34 weeks of gestation were enrolled. Zinc and iron status during pregnancy was assessed. At delivery, cord blood was analyzed for zinc and iron levels. Participants and their babies were followed at 2 and 4 months postpartum. Maternal dietary intakes and anthropometric measurements were performed. The amount of breast milk intake was assessed using the deuterium oxide dose-to-mother technique. Breast milk samples were collected for determination of zinc and iron levels. The amount of zinc and iron consumed by infants was calculated. Zinc and iron status was determined in mothers and infants at 4 months postpartum.

RESULTS

A total of 120 pregnant women were enrolled, and 80 mother-infant pairs completed the study (56 provided full breastfeeding, and 24 provided breast milk with infant formula). All data are being managed and cleaned. Statistical analysis will be done.

CONCLUSIONS

This study will provide information on zinc and iron intakes in exclusively breastfed infants during the first 4 months of life and explore predictive factors and the possible association of zinc and iron intakes with infant growth and nutrient status.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/19119.

Nutritional status and intestinal parasites among young children from pastoralist communities of the Ethiopian Somali region

Pastoralist children in the Ethiopian Somali Regional State (ESRS) are at high risk for undernutrition and intestinal parasitic infections (IPIs). We assessed the nutritional status and its association with IPIs in 500 children <5 years of age in a clustered cross‐sectional study in Adadle district, ESRS. Stool samples were microscopically examined for IPIs and biomarkers for iron and vitamin A status, anthropometry, and food variety score (FVS) were assessed. Median (interquartile range [IQR]) FVS was 2.0 (2.0, 4.0), and 35% of children were exclusively breastfed up to age 6 months. Prevalence of stunting, wasting, underweight and mid‐upper arm circumference (MUAC) <12.5 cm was 30, 34, 40, and 16%, respectively. Median (IQR) haemoglobin, ferritin, and retinol‐binding protein concentrations were 9.5 g dL^‐1 (8.2, 10.9), 6.2 μg L^‐1 (4.0, 10.2), and 0.8 μmol L⁻¹ (0.67, 0.91), respectively. Prevalence of anaemia, iron, and vitamin A deficiency was 75, 91, and 30%, respectively. IPIs' prevalence was 47%; the most prevalent IPIs were Giardia lamblia (22%) and Ascaris lumbricoides (15%). Giardial infections but not A. lumbricoides increased the risk for MUAC <12.5 cm (adjusted odds ratio [aOR]: 3.50, 95% confidence interval [CI] [2.21, 5.54]). The odds for anaemia were 97% (aOR: 0.03, 95% CI [0.03, 0.07]) and 89% (aOR: 0.11, 95% CI [0.11, 0.23]) less for children with FVS >2 or with exclusive breastfeeding up to 6 months, respectively. Undernutrition and IPIs are alarmingly high in <5 years of age children in ESRS. Giardial infections and low nutritional adequacy of the diet seem to be major contributing factors to the precarious nutritional status and should be addressed by appropriate interventions.

Iron Status of Infants in the First Year of Life in Northern Taiwan

Iron deficiency (ID) and iron deficiency anemia (IDA) typically occur in developing countries. Notably, ID and IDA can affect an infant’s emotion, cognition, and development. Breast milk is considered the best food for infants. However, recent studies have indicated that breastfeeding for more than six months increases the risk of ID. This study investigated the prevalence of ID and IDA, as well as the association between feeding type and iron nutritional status in northern Taiwan. A cross-sectional study was conducted on infants who returned to the well-baby clinic for routine examination from October 2012 to January 2014. Overall, 509 infants aged 1–12 months completed the iron nutritional status analysis, anthropometric measurement, and dietary intake assessment, including milk and complementary foods. The results revealed that 49 (10%) and 21 (4%) infants in their first year of life had ID and IDA, respectively, based on the World Health Organization criteria. Breastfed infants had a higher prevalence rate of ID and IDA than mixed-fed and formula-fed infants (p < 0.001). Regarding biomarkers of iron status, plasma hemoglobin (Hb), ferritin, and transferrin saturation (%) levels were significantly lower in ID and IDA groups. The prevalence of ID and IDA were 3.7% and 2.7%, respectively, in infants under six months of age, but increased to 20.4% and 6.6%, respectively, in infants above six months of age. The healthy group had a higher total iron intake than ID and IDA groups, mainly derived from infant formula. The total dietary iron intake was positively correlated with infants’ Hb levels. Compared with formula-fed infants, the logistic regression revealed that the odds ratio for ID was 2.157 (95% confidence interval [CI]: 1.369–3.399) and that for IDA was 4.196 (95% CI: 1.780–9.887) among breastfed infants (p < 0.001) after adjusted for all confounding factors (including gestational week, birthweight, sex, body weight percentile, body length percentile, age of infants, mothers’ BMI, gestational weight gain, education level, and hemoglobin level before delivery). In conclusion, our results determined that breastfeeding was associated with an increased the prevalence of ID and/or IDA, especially in infants above six months. This suggests that mothers who prolonged breastfeed after six months could provide high-quality iron-rich foods to reduce the prevalence of ID and IDA.

Nutritional status of exclusive breastfed infants in the state of Pernambuco

INTRODUCTION

Exclusive breastfeeding (BF), after the sixth month of life, as a single food source is not recommended. It is believed that it is not possible to supply the caloric needs of protein, iron and vitamin without adequate food supplementation.

OBJECTIVE

To comparethe nutritional statusof children withexclusive breastfeeding(BF)for more than 6monthsversuschildren with otherbreastfeeding practices.

METHOD

Cross-sectionalexploratory studywith685children(39BF >6months and646with otherbreastfeeding practices).Situations ofanthropometricdeficit were considered by values< -2 in Z score, anemia evaluated by hemoglobin < 11 g/dL,and deficient/lowlevels ofvitamin A by serumretinol < 1.05 µmol/L.

RESULTS

There were nocases ofdeficitin the anthropometric ratios of weight/height, weight/age andbody mass index(BMI)among childrenBF > 6months,while the comparison group was approximately 0.5%. In theheight/ageratio,the deficitwasaround 2.6% in both groups.Inthe weight/height ratioand BMI,the resultsranged from28.7 to 31.9% foroverweight in group comparisson. TheaverageHb, serumretinol, weightand heightwere similarbetween thegroups.

DISCUSSION

The low prevalence (≤ 0.6%) of protein energy malnutrition in both groups represents a surprising finding, below the values found in reference to normal international reference, WHO standard.

CONCLUSION

Children who maintained BF after six months exhibited equivalent nutritional status to those of children with other breastfeeding practices.

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

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.

Iron Deficiency and Iron Deficiency Anemia in 3-5 months-old, Breastfed Healthy Infants

OBJECTIVE

To assess the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) in predominantly breastfed, 3-5-mo-old infants, born at term, with a birth weight ≥ 2.5 kg.

METHODS

The cross-sectional study was conducted in the outpatient department of a tertiary care center from January 2013 through December 2014.

INCLUSION CRITERIA

Age: 90-180 d, exclusively/predominantly breastfed, birth weight ≥ 2.5 kg and term gestation.

EXCLUSION CRITERIA

systemic illness, leucocytosis, leucopenia, thrombocytopenia, peripheral smear abnormality or iron supplementation. Blood sample was collected for complete blood count and ferritin assay. ID was defined as serum ferritin <12 μg/L. IDA was defined as ID plus Hb ≤ 10.5 g/dl.

RESULTS

Two hundred ninety six infants were initially recruited; 29 declined consent; 22 had leukocytosis, leucopenia or eosinophilia; 15 had thrombocytopenia; 15 samples were hemolyzed or insufficient. Finally, 215 infants were evaluated. The male-female ratio was 1.8:1. The mean birth weight was 2.9 (0.4) kg. The mean Hb was 10.8 (1.2) g/dl. The median serum ferritin was 44 μg/L (18, 120). The prevalence of ID at 3, 4 and 5 mo of age was 5.4%, 21.4% and 36.4%, while that of IDA was 4.6%, 16.7% and 11.4%, respectively.

CONCLUSIONS

The prevalence of ID at 4 and 5 mo of age in predominantly breastfed, term infants was 21.4% and 36.4%, respectively. The study generates evidence for considering iron supplementation for well-babies from 4 mo of age, instead of the currently recommended 6 mo by National Iron plus Initiative in India.

[Causes of iron deficiency in children]

Iron deficiency and iron deficiency anemia are common conditions worldwide affecting especially children. In developing countries, iron deficiency is caused by poor iron intake and parasitic infection. Poor iron intake linked to inadequate diets, low iron intestinal absorption, chronic blood losses and increased requirements are common causes in high-income countries.

Early deterioration of iron status among a cohort of Bolivian infants

Iron deficiency (ID) and iron deficiency anemia (IDA) are major contributors to infant and maternal morbidity worldwide. There is limited longitudinal data on iron status in young infants and on methods to adjust iron biomarkers for inflammation. We aimed to quantify the prevalence of inflammation-adjusted ID, anemia, and IDA over the first year in a cohort of Bolivian infants and their mothers. Healthy mother-infant dyads were recruited from two peri-urban hospitals. Infants provided three blood draws (2, 6-8, and 12-18 months; N = 160); mothers provided two blood draws (1 and 6-8 months postpartum [plus third anemia measurement at 12-18 months]; N = 250). Blood was analyzed for hemoglobin, ferritin, soluble transferrin receptor, C-reactive protein (CRP), and alpha(1)-acid glycoprotein (AGP). Iron biomarkers were adjusted for inflammation using CRP and AGP; hemoglobin cutoffs were adjusted for altitude. Inflammation (elevated CRP or AGP) was 17% among toddlers 12-18 months of age. ID (inflammation-adjusted ferritin) increased with age (<1%, 56%, and 79% at each blood draw), as did anemia and IDA (anemia: 70%, 76%, and 81%; IDA: <1%, 46%, and 68%). Maternal ID declined from the first to second assessment (39% vs. 27%). Inflammation-adjusted ID prevalence was up to 15 percentage points higher than unadjusted estimates. The high prevalence of ID, anemia, and IDA in this cohort of Bolivian infants beginning at 6-8 months of age suggests that early interventions may be necessary in vulnerable populations.

Minerals and Trace Elements in Human Breast Milk Are Associated with Guatemalan Infant Anthropometric Outcomes within the First 6 Months

BACKGROUND

Breast milk is the recommended source of nutrients for infant growth, but its adequacy to meet infants' mineral and trace element needs is unknown.

OBJECTIVES

We used breast-milk mineral and trace element concentrations of Guatemalan mothers at 3 lactation stages to estimate total daily intakes and to determine whether intakes were associated with early infant growth.

METHODS

In this cross-sectional study, breast-milk samples were collected from Mam-Mayan mothers during transitional (5-17 d, n = 56), early (18-46 d, n = 75), and established (4-6 mo, n = 103) lactation; z scores for weight (WAZ), length (LAZ), and head circumference (HCAZ) were measured. Concentrations of 11 minerals (calcium, potassium, magnesium, sodium, copper, iron, manganese, rubidium, selenium, strontium, and zinc) were analyzed by inductively coupled plasma-mass spectrometry (ICP-MS). WHO equations were used to calculate the estimated energy requirement, which was divided by the energy density of breast milk to estimate daily milk volume, and this number was multiplied by breast-milk mineral concentrations to estimate intakes. Principal component analyses identified clusters of minerals; principal components (PCs) were used in regression analyses for anthropometric outcomes.

RESULTS

Estimated breast-milk intakes during established lactation were insufficient to compensate for the lower milk sodium, copper, manganese, and zinc concentrations in male infants and the lower sodium, iron and manganese concentrations in female infants. Estimated intakes of calcium, magnesium, potassium, sodium, and selenium were below the Institute of Medicine Adequate Intake for both sexes at all 3 stages of lactation. In early lactation, multiple linear regressions showed that PC1 (calcium, magnesium, potassium, rubidium, and strontium intakes) was positively associated with WAZ, LAZ, and HCAZ. In established lactation, the same PC with sodium added was positively associated with all 3 anthropometric outcomes; a second PC (PC2: zinc, copper, and selenium intakes) was associated with WAZ and LAZ but not HCAZ.

CONCLUSIONS

Breast milk may be inadequate in selected minerals and trace elements where higher estimated intakes were associated with greater infant growth.

Iron deficiency among apparently healthy children aged 6 to 24 months in Ibadan, Nigeria

Iron deficiency remains a global public health challenge, with a higher burden in children in the tropics. When it occurs early in life, it may have long-term effects on neurodevelopment. The aims of this study were to assess the iron status of children aged 6-24 months, to determine the prevalence of iron deficiency and its associated factors in Ibadan, Nigeria. The authors conducted a cross-sectional study between March and June 2014. A total of 202 apparently healthy children aged between 6 and 24 months attending 2 major immunization clinics in Ibadan were included. A questionnaire was used to collect information on sociodemographic characteristics, pregnancy and birth history, and nutritional history. Physical examination was carried out on all the subjects, and serum ferritin level was determined using an enzyme-linked immunosorbent assay (ELISA) technique. Iron deficiency was defined using a cutoff value of <30 µg/L. Fifty-nine children (29.2%) had iron deficiency. No clinical features were found to be significantly associated with iron deficiency. Iron deficiency was associated with breastfeeding (P = .020) and younger age (P = .015) in the study population. One hundred and forty-three (70.8%) of the study participants had anemia, and 39 (19.3%) had iron deficiency anemia. The prevalence of iron deficiency among apparently healthy children aged 6-24 months in Ibadan, Nigeria, is high. There is the need for a national policy on routine screening for iron deficiency and iron supplementation for infants and young children as recommended by the World Health Organization.

Assessing the nutritional information for children younger than two years old available on popular websites

OBJECTIVE

To analyze whether the information found on popular Internet sites are in accordance with the steps recommended by the Food Guide for Children Younger than Two Years of the Ministry of Health (2010).

METHODS

Descriptive/comparative study, carried out between August and October 2014, which carried out a search for popular sites (for lay people) in Portuguese, containing information on nutrition of children younger than two years. The Google search engine was used. These findings were compared with the Food Guide for Children Younger than Two Years of the Ministry of Health (2010). It was verified whether the information shown on the websites was in accordance with the Guide.

RESULTS

A total of 50 sites were analyzed, including blogs, food company websites and websites specialized in child nutrition. Only 10% of those pages correctly showed every step of the Food Guide. The recommendations were: exclusive breastfeeding up to six months of life (80%); complementary feeding from six months of life (36%); baby food consistency according to the guide (48%); encouraging the consumption of fruits and vegetables daily (60%). Regarding the complementary feeding safety and hygiene, 26% contained correct information. Only 36% correctly warned about which foods should be avoided in the first years of life.

CONCLUSIONS

The information found on the sites is largely in disagreement with the Ministry of Health recommendations, which can lead to misconceptions in the nutritional care of the children younger than two years.

Prevalence of iron-deficiency anemia in children aged less than 60 months: A population-based study from the state of Minas Gerais, Brazil

OBJECTIVE: To identify the prevalence of iron-deficiency anemia in children aged less than 60 months and the conditioning factors in Minas Gerais, Brazil. METHODS: This cross-sectional study conducted from February 2007 to July 2008 in Minas Gerais included a random sample of 725 male and female children aged less than 60 months. A household survey was administered to the children's parents or guardians to collect socioeconomic, demographic, food security, and the child's anthropometric data. The hemoglobin level was determined by a portable hemoglobinometer. Anemia was considered present when hemoglobin levels were below 11.0 g/dL. Statistical analyses estimated the prevalence of anemia and its association with socioeconomic, demographic, and food security-related variables. The model was adjusted by multivariate logistic regression. The significance level was set at 5% (p<0.05). RESULTS: The prevalence of anemia was 37.4%. The greatest prevalence occurred in the age group 6 to 24 months (43.0%). The associated variables were being female (PR=1.43; p<0.026); age (PR=1.53; p<0.024); and not frequenting a daycare center (PR=2.41; p<0.001). In the multivariate regression model, the variables being female and not frequenting a daycare center remained in the model. CONCLUSION: The present population-based study found that in Minas Gerais, one-third (37.5%) of the children aged less than 60 months have iron-deficiency anemia. The results show that not frequenting a daycare center and being female are risk factors for anemia.