Related Experiment Video
Updated: Jul 5, 2025
Author Spotlight: Developing a Point-of-Care Hemoglobin Estimation Method for Anemia Management
Published on: January 19, 2024
Iron deficiency in healthy, term infants aged five months, in a pediatric outpatient clinic: a prospective study
Nur Aida Adnan1,2, Emer Breen3, Chin Aun Tan4
1Pediatric Department, Hospital Tunku Azizah, Kuala Lumpur, Malaysia.
Insights
Iron deficiency (ID) and iron deficiency anemia (IDA) were found in Malaysian infants by 5 months of age. Exclusive breastfeeding was linked to ID, suggesting early iron-rich food introduction is crucial.
Area of Science:
- Pediatrics
- Nutritional Science
- Public Health
Background:
- Iron deficiency (ID) is a significant concern in Malaysian children.
- The prevalence of ID in infants under 6 months was previously unknown.
- This study aimed to determine ID and iron deficiency anemia (IDA) rates in healthy, term infants under 6 months.
Purpose of the Study:
- To investigate the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) in healthy, term infants younger than 6 months.
- To identify factors associated with ID and IDA in this population.
- To inform early feeding guidelines for infants.
Main Methods:
- A prospective longitudinal pilot study involving 91 mother-infant pairs in Kuala Lumpur, Malaysia.
- Mothers completed questionnaires, and maternal/infant blood samples (full blood count, ferritin, CRP) were collected at 3 and 5 months.
- Infant anthropometry was measured, and univariate analysis identified factors associated with ID and IDA.
Main Results:
- No infants had ID or IDA at 3 months; by 5 months, 5.9% had ID and 2.4% had IDA.
- Infant ferritin levels significantly declined from 3 to 5 months (p < 0.001).
- Exclusive breastfeeding until 5 months was significantly associated with ID (p = 0.008). 14.3% of exclusively breastfed infants developed ID.
Conclusions:
- Iron deficiency occurs in exclusively breastfed term infants by 5 months of age.
- Early introduction of iron-rich foods is recommended for exclusively breastfed infants.
- A high prevalence of wasting (10.2%) indicates potential calorie deficits requiring attention.
Background:
Iron deficiency (ID) is prevalent in Malaysian children. The incidence of ID in infants under 6 months of age is unknown. Our aim was to determine the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) in healthy, term infants aged below 6 months in our hospital population.
Methods:
A prospective longitudinal pilot study of mother-infant pairs was conducted on infants receiving routine immunizations in a mother and child clinic at a university hospital, in Kuala Lumpur, Malaysia. Mothers completed standardized questionnaires at 3- and 5-month postnatal visits. Maternal and infant full blood count, ferritin, and C-reactive protein (CRP) levels were measured at 3 months and for the infants repeated at 5 months. Infant anthropometric measurements were obtained at both visits. We conducted a univariate analysis to identify factors associated with ID and IDA.
Results:
Altogether, 91 mother-infant pairs were enrolled, with 88 completing the study. No infant had ID or IDA at 3 months; the lowest ferritin level was 16.6 µg/L. At 5 months, 5.9% (5/85) of infants had ID, and 2.4% (2/85) had IDA. Median (interquartile range) infant ferritin levels significantly declined from 113.4 (65.0-183.6) µg/L at 3 months to 50.9 (29.2-70.4) µg/L at 5 months, p < 0.001. Exclusive breastfeeding until 3 or 5 months was significantly associated with ID at 5 months (p = 0.020, and p = 0.008, respectively) on univariate analysis. The drop in ferritin between 3-5 months was significantly associated with weight and length gains between 0-3 months (p = 0.018, p = 0.009, respectively). Altogether, 14.3% of infants exclusively breastfed until 5 months developed ID. At 5 months, 3.4% of infants were underweight, 1.1% stunted, and 10.2% wasted.
Conclusions:
In exclusively breastfed term infants, ID occurred by 5 months. Early introduction of iron-rich foods should be considered in exclusively breastfed babies. A high prevalence of wasting suggests a calorie deficit in this population and will lead to stunting if not addressed.
