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Effect of infant feeding practices on iron status in a cohort study of Bolivian infants
Rachel M Burke1, Paulina A Rebolledo2,3, Anna M Aceituno2
1Department of Epidemiology, Rollins School of Public Health, Emory University, Claudia Nance Rollins Building, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA. Rachel.m.burke@gmail.com.
Insights
Prolonged exclusive breastfeeding (EBF) beyond 4 months was linked to higher rates of iron deficiency (ID) in Bolivian infants. However, current breastfeeding guidelines remain supported, with further research needed on interventions for infant iron deficiency anemia (IDA).
Area of Science:
- Pediatrics
- Nutritional Science
- Public Health
Background:
- Iron deficiency (ID) is a global health concern, particularly impacting child neurodevelopment.
- Exclusive breastfeeding (EBF) is recommended for 6 months, despite breast milk's low iron content.
- This study investigated the association between EBF duration and infant iron status in Bolivia.
Purpose of the Study:
- To determine the effect of exclusive breastfeeding duration on iron status in infants aged 6-8 months.
- To assess the prevalence of iron deficiency (ID), iron deficiency anemia (IDA), and anemia in the study cohort.
- To analyze the relationship between EBF length and iron biomarkers (ferritin and hemoglobin).
Main Methods:
- Recruited mother-infant pairs in El Alto, Bolivia, from birth to 6-8 months.
- Included iron-sufficient singleton infants (N=270) with baseline and follow-up blood draws.
- Defined ID, anemia, and IDA using inflammation-corrected ferritin and altitude-corrected hemoglobin; assessed EBF duration (<4, 4-6, >6 months) using regression analyses.
Main Results:
- High prevalence of low iron status: 56% ID, 76% anemia, 46% IDA at 6-8 months.
- EBF of 4 months or longer was associated with increased odds of ID (OR 2.0-3.3) compared to <4 months.
- No significant association found between prolonged EBF and IDA or anemia; ferritin and hemoglobin levels decreased with longer EBF duration.
Conclusions:
- Prolonged exclusive breastfeeding may be linked to increased iron deficiency in infants.
- Findings do not warrant changes to current breastfeeding recommendations.
- Further research in diverse populations and exploration of early interventions for infant IDA are recommended.
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.
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