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Daily iron alone but not in combination with multimicronutrients increases plasma ferritin concentrations in
Sandhya Sankaranarayanan1, Juliawati Untoro, Juergen Erhardt
1Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA.
Insights
Iron supplements effectively treat iron deficiency in infants, even with inflammation. Iron alone improved iron status without worsening inflammation, making it a recommended intervention for public health concerns.
Area of Science:
- Pediatrics
- Public Health Nutrition
- Nutritional Immunology
Background:
- Iron deficiency is a significant public health issue in infants.
- Inflammation can affect iron status and treatment efficacy.
- Infant supplementation studies are crucial for understanding nutritional needs.
Purpose of the Study:
- To evaluate the effectiveness of iron supplements in infants with and without inflammation.
- To assess the impact of iron supplementation on iron status and inflammatory markers.
- To determine optimal iron supplementation strategies for vulnerable infant populations.
Main Methods:
- Prospective, nested case-control study involving 6- to 12-month-old infants.
- Intervention groups received elemental iron alone, iron with multimicronutrients, or placebo.
- Blood samples analyzed for ferritin, micronutrients, and inflammation markers (C-reactive protein, alpha-1 acid glycoprotein).
Main Results:
- Iron deficiency affected 33% of infants at baseline.
- Iron alone significantly increased ferritin levels, irrespective of inflammation status.
- Multimicronutrients with iron improved ferritin in non-inflamed infants; iron alone resolved deficiency without increasing inflammation.
Conclusions:
- Iron supplementation alone is effective in resolving iron deficiency in infants, even in the presence of inflammation.
- Iron alone is a recommended intervention for public health iron deficiency issues in breast-feeding infants.
- Multimicronutrients with iron showed benefits but were most effective in non-inflamed infants.
Abstract:
Iron deficiency is a public health problem in infancy. We assessed the efficacy of iron supplements in infants with inflammation on iron status and subsequent inflammation. This was a prospective, nested, case-control study of 6- to 12-mo-old infants participating in the International Research on Infant Supplementation study, Indonesia. Cases (n = 46) were selected on the basis of their inflammation status at baseline, C-reactive protein (>5 mg/L) or alpha-1 acid glycoprotein (>1 g/L); there were 44 controls without inflammation. Infants received 10 mg/d of elemental iron alone or in combination with multimicronutrients, or placebo. Blood samples were collected at baseline and at 6 mo for determinations of plasma ferritin, zinc, copper, retinol, beta-carotene, alpha-tocopherol, and inflammation status. Data on breast-feeding and acute respiratory infections (ARI) were collected daily. At baseline, 33% of infants had iron deficiency, and those with inflammation had lower retinol, beta-carotene, higher concentrations of copper and higher rates of ARI compared with controls. After 6 mo, compared with infants given placebo, ferritin concentration increased significantly in infants administered iron alone independently of inflammation status at baseline or at the end of the study. In those given multimicronutrients with iron, ferritin increased significantly in infants who did not have inflammation at baseline or at the end of the study compared with those given placebo. Consequently, iron alone resolved iron deficiency, whereas multimicronutrients reduced the deterioration of iron stores compared with placebo (chi(2), P < 0.05), without enhancing inflammation. Iron alone is recommended in populations in which iron deficiency is a public health problem despite the presence of inflammation in infants who are still breast-feeding.
