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Breastfeeding, Mixed, or Formula Feeding at 9 Months of Age and the Prevalence of Iron Deficiency and Iron Deficiency Anemia in Two Cohorts of Infants in China.
J Pediatr 2017; 181:56-61JPed

Abstract

OBJECTIVE

To assess associations between breastfeeding and iron status at 9 months of age in 2 samples of Chinese infants.

STUDY DESIGN

Associations between feeding at 9 months of age (breastfed as sole milk source, mixed fed, or formula fed) and iron deficiency anemia (IDA), iron deficiency, and iron sufficiency were determined in infants from Zhejiang (n = 142) and Hebei (n= 813) provinces. Iron deficiency was defined as body iron < 0 mg/kg, and IDA as iron deficiency + hemoglobin < 110 g/L. Multiple logistic regression assessed associations between feeding pattern and iron status.

RESULTS

Breastfeeding was associated with iron status (P < .001). In Zhejiang, 27.5% of breastfed infants had IDA compared with 0% of formula-fed infants. The odds of iron deficiency/IDA were increased in breastfed and mixed-fed infants compared with formula-fed infants: breastfed vs formula-fed OR, 28.8 (95% CI, 3.7-226.4) and mixed-fed vs formula-fed OR, 11.0 (95% CI, 1.2-103.2). In Hebei, 44.0% of breastfed infants had IDA compared with 2.8% of formula-fed infants. With covariable adjustment, odds of IDA were increased in breastfed and mixed-fed groups: breastfed vs formula-fed OR, 78.8 (95% CI, 27.2-228.1) and mixed-fed vs formula-fed OR, 21.0 (95% CI, 7.3-60.9).

CONCLUSIONS

In both cohorts, the odds of iron deficiency/IDA at 9 months of age were increased in breastfed and mixed-fed infants, and iron deficiency/IDA was common. Although the benefits of breastfeeding are indisputable, these findings add to the evidence that breastfeeding in later infancy identifies infants at risk for iron deficiency/IDA in many settings. Protocols for detecting and preventing iron deficiency/IDA in breastfed infants are needed.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT00642863 and NCT00613717.

Authors+Show Affiliations

Center for Human Growth and Development, University of Michigan, Ann Arbor, MI.Department of Pediatrics, Peking University First Hospital, Beijing, China.Department of Child Health Care, Zhejiang University Children's Hospital, Hangzhou, China.Department of Pediatrics, Peking University First Hospital, Beijing, China.Department of Child Health Care, Zhejiang University Children's Hospital, Hangzhou, China.Department of Pediatrics, Peking University First Hospital, Beijing, China.Department of Child Health Care, Zhejiang University Children's Hospital, Hangzhou, China.Department of Child Health Care, Zhejiang University Children's Hospital, Hangzhou, China.Center for Human Growth and Development, University of Michigan, Ann Arbor, MI.Center for Human Growth and Development, University of Michigan, Ann Arbor, MI; Department of Pediatrics and Communicable Diseases, CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI.

Pub Type(s)

Comparative Study
Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27836288

Citation

Clark, Katy M., et al. "Breastfeeding, Mixed, or Formula Feeding at 9 Months of Age and the Prevalence of Iron Deficiency and Iron Deficiency Anemia in Two Cohorts of Infants in China." The Journal of Pediatrics, vol. 181, 2017, pp. 56-61.
Clark KM, Li M, Zhu B, et al. Breastfeeding, Mixed, or Formula Feeding at 9 Months of Age and the Prevalence of Iron Deficiency and Iron Deficiency Anemia in Two Cohorts of Infants in China. J Pediatr. 2017;181:56-61.
Clark, K. M., Li, M., Zhu, B., Liang, F., Shao, J., Zhang, Y., ... Lozoff, B. (2017). Breastfeeding, Mixed, or Formula Feeding at 9 Months of Age and the Prevalence of Iron Deficiency and Iron Deficiency Anemia in Two Cohorts of Infants in China. The Journal of Pediatrics, 181, pp. 56-61. doi:10.1016/j.jpeds.2016.10.041.
Clark KM, et al. Breastfeeding, Mixed, or Formula Feeding at 9 Months of Age and the Prevalence of Iron Deficiency and Iron Deficiency Anemia in Two Cohorts of Infants in China. J Pediatr. 2017;181:56-61. PubMed PMID: 27836288.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Breastfeeding, Mixed, or Formula Feeding at 9 Months of Age and the Prevalence of Iron Deficiency and Iron Deficiency Anemia in Two Cohorts of Infants in China. AU - Clark,Katy M, AU - Li,Ming, AU - Zhu,Bingquan, AU - Liang,Furong, AU - Shao,Jie, AU - Zhang,Yueyang, AU - Ji,Chai, AU - Zhao,Zhengyan, AU - Kaciroti,Niko, AU - Lozoff,Betsy, Y1 - 2016/11/08/ PY - 2016/06/07/received PY - 2016/08/25/revised PY - 2016/10/12/accepted PY - 2016/11/12/pubmed PY - 2017/6/16/medline PY - 2016/11/13/entrez KW - breastfeeding KW - feeding KW - human KW - iron deficiency SP - 56 EP - 61 JF - The Journal of pediatrics JO - J. Pediatr. VL - 181 N2 - OBJECTIVE: To assess associations between breastfeeding and iron status at 9 months of age in 2 samples of Chinese infants. STUDY DESIGN: Associations between feeding at 9 months of age (breastfed as sole milk source, mixed fed, or formula fed) and iron deficiency anemia (IDA), iron deficiency, and iron sufficiency were determined in infants from Zhejiang (n = 142) and Hebei (n= 813) provinces. Iron deficiency was defined as body iron < 0 mg/kg, and IDA as iron deficiency + hemoglobin < 110 g/L. Multiple logistic regression assessed associations between feeding pattern and iron status. RESULTS: Breastfeeding was associated with iron status (P < .001). In Zhejiang, 27.5% of breastfed infants had IDA compared with 0% of formula-fed infants. The odds of iron deficiency/IDA were increased in breastfed and mixed-fed infants compared with formula-fed infants: breastfed vs formula-fed OR, 28.8 (95% CI, 3.7-226.4) and mixed-fed vs formula-fed OR, 11.0 (95% CI, 1.2-103.2). In Hebei, 44.0% of breastfed infants had IDA compared with 2.8% of formula-fed infants. With covariable adjustment, odds of IDA were increased in breastfed and mixed-fed groups: breastfed vs formula-fed OR, 78.8 (95% CI, 27.2-228.1) and mixed-fed vs formula-fed OR, 21.0 (95% CI, 7.3-60.9). CONCLUSIONS: In both cohorts, the odds of iron deficiency/IDA at 9 months of age were increased in breastfed and mixed-fed infants, and iron deficiency/IDA was common. Although the benefits of breastfeeding are indisputable, these findings add to the evidence that breastfeeding in later infancy identifies infants at risk for iron deficiency/IDA in many settings. Protocols for detecting and preventing iron deficiency/IDA in breastfed infants are needed. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00642863 and NCT00613717. SN - 1097-6833 UR - https://www.unboundmedicine.com/medline/citation/27836288/Breastfeeding_Mixed_or_Formula_Feeding_at_9_Months_of_Age_and_the_Prevalence_of_Iron_Deficiency_and_Iron_Deficiency_Anemia_in_Two_Cohorts_of_Infants_in_China_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3476(16)31174-X DB - PRIME DP - Unbound Medicine ER -