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Randomized double-blind controlled trial on the effects on iron status in the first year between a no added iron and
D P Tuthill1, M Cosgrove, F Dunstan
1Department of Child Health, University of Wales College of Medicine, Cardiff, UK. david_tuthill@uhw-tr.wales.nhs.uk
Insights
Infant formula without added iron is safe for the first 3 months. This study found no difference in iron status for infants fed no-added-iron formula versus standard iron-fortified formula.
Area of Science:
- Pediatric Nutrition
- Iron Metabolism in Infants
- Infant Formula Composition
Background:
- Emerging research questions the necessity and safety of iron supplementation in infant formulas before weaning.
- Potential adverse effects of iron fortification in early infancy warrant investigation.
Purpose of the Study:
- To test the hypothesis that infant formula does not require added iron in the first three months of life.
- To evaluate the impact of a no-added-iron formula on infant iron status.
Main Methods:
- A double-blind controlled trial involving healthy term infants.
- Randomization to either a new no-added-iron formula or a standard iron-fortified formula for 3 months.
- Iron status assessment at 3 and 12 months using blood counts, reticulocytes, and serum ferritin, with a breastfed group as reference.
Main Results:
- No significant differences in hemoglobin, mean cell volume, or ferritin levels were observed between the no-added-iron and standard formula groups at 3 and 12 months.
- The proportion of infants with low hemoglobin or ferritin did not differ between the two formula groups.
Conclusions:
- Using a "no added iron" infant formula for the first 3 months did not negatively impact infant iron status at 3 or 12 months.
- The routine fortification of infant formulas with iron during the initial months of life requires further evaluation.
Unlabelled:
Recent research has not only questioned the necessity of iron supplementation in human milk substitutes prior to weaning, but also suggested some potential adverse effects. This study investigated the hypothesis that infant formula need not contain added iron in the first 3 mo. Healthy term infants were recruited into a double-blind controlled trial and randomized to receive either a new no added iron formula (New; <0.1 mg Fe 100 ml(-1)) or a standard formula (Standard; 0.5 mg Fe 100 ml(-1)) for the first 3 mo of life. A breastfed reference group was also studied. Iron status was assessed at 3 and 12 mo from heel-prick capillary blood samples evaluated by full blood-count analysis, including reticulocytes and serum ferritin. In total, 149 infants were entered (51 New, 49 Standard, 49 breastfed) with no differences between the groups in gender distribution, birthweight, gestation or numbers completing the study. There were no significant differences between the principal outcome measures: mean values for haemoglobin, mean cell volume and ferritin, between the two formula-fed groups, and the proportion with a haemoglobin level <11 g dl(-1) or ferritin <10 microg l(-1) did not differ.
Conclusion:
The use of a "no added iron" infant formula in place of an iron-fortified formula during the first 3 mo of life did not clinically affect iron status at 3 and 12 mo of age. The universal supplementation of formulae with iron during this initial period needs further consideration.
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