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Iron and vitamin D status in breastfed infants and their mothers

  • Kang, Yu Sun (Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Kim, Joon Hwan (Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Ahn, Eun Hee (Department of Obstetrics, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Yoo, Eun-Gyong (Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Kim, Moon Kyu (Department of Pediatrics, Yonsei University College of Medicine)
  • Received : 2014.06.27
  • Accepted : 2014.10.21
  • Published : 2015.08.10

Abstract

Purpose: We assessed the relationships between iron and vitamin D statuses in breastfed infants and their mothers and evaluated the determinants of iron and vitamin D deficiencies in breastfed infants. Methods: Seventy breastfed infants aged 4-24 months and their mothers participated in this study from February 2012 to May 2013. Complete blood counts, total iron binding capacity, and levels of C-reactive protein, iron, ferritin, calcium, phosphate, alkaline phosphatase, and 25-hydroxyvitamin D (25(OH)D) in infants and their mothers were measured. Results: A history of maternal prepregnancy anemia was associated with lower ferritin and 25(OH)D levels in both infants and their mothers. The 25(OH)D level of infants correlated with maternal 25(OH) D levels. The independent risk factors for iron deficiency in breastfed infants were the duration of breastfeeding (odds ratio [OR], 6.54; 95% confidence interval [CI], 1.09-39.2; P=0.04) and infant body weight (OR, 2.65; 95% CI, 1.07-6.56; P=0.04). The determinants for vitamin D deficiency were the infant's age (OR, 0.15; 95% CI, 0.02-0.97; P=0.046) and maternal 25(OH)D level (OR, 0.74; 95% CI, 0.59-0.92; P=0.01). Conclusion: A maternal history of prepregnancy anemia requiring iron therapy was associated with lower current ferritin and 25(OH)D levels in both infants and their mothers. Therefore, physicians should monitor not only iron but also vitamin D levels in infants who are breastfed by mothers who had prepregnancy anemia.

Keywords

References

  1. Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev 2002;(1):CD003517.
  2. De Pee S, Bloem MW, Sari M, Kiess L, Yip R, Kosen S. The high prevalence of low hemoglobin concentration among Indonesian infants aged 3-5 months is related to maternal anemia. J Nutr 2002;132:2215-21. https://doi.org/10.1093/jn/132.8.2215
  3. Morton RE, Nysenbaum A, Price K. Iron status in the first year of life. J Pediatr Gastroenterol Nutr 1988;7:707-12. https://doi.org/10.1097/00005176-198809000-00015
  4. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012;129:e827-41. https://doi.org/10.1542/peds.2011-3552
  5. Rios E, Lipschitz DA, Cook JD, Smith NJ. Relationship of maternal and infant iron stores as assessed by determination of plasma ferritin. Pediatrics 1975;55:694-9.
  6. Hussain MA, Gaafar TH, Laulicht M, Hoffebrand AV. Relation of maternal and cord blood serum ferritin. Arch Dis Child 1977;52:782-4. https://doi.org/10.1136/adc.52.10.782
  7. Zavaleta N, Nombera J, Rojas R, Hambraeus L, Gislason J, Lonnerdal B. Iron and lactoferrin in milk of anemic mothers given iron supplements. Nutr Res 1995;15:681-90. https://doi.org/10.1016/0271-5317(95)00035-H
  8. Henderson A. Vitamin D and the breastfed infant. J Obstet Gynecol Neonatal Nurs 2005;34:367-72. https://doi.org/10.1177/0884217505276157
  9. Ziegler EE, Hollis BW, Nelson SE, Jeter JM. Vitamin D deficiency in breastfed infants in Iowa. Pediatrics 2006;118:603-10. https://doi.org/10.1542/peds.2006-0108
  10. Grant CC, Stewart AW, Scragg R, Milne T, Rowden J, Ekeroma A, et al. Vitamin D during pregnancy and infancy and infant serum 25-hydroxyvitamin D concentration. Pediatrics 2014;133:e143-53. https://doi.org/10.1542/peds.2013-2602
  11. Wagner CL, Greer FR; American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 2008;122:1142-52. https://doi.org/10.1542/peds.2008-1862
  12. Lozoff B, De Andraca I, Castillo M, Smith JB, Walter T, Pino P. Behavioral and developmental effects of preventing iron-deficiency anemia in healthy full-term infants. Pediatrics 2003;112:846-54.
  13. Dube K, Schwartz J, Mueller MJ, Kalhoff H, Kersting M. Iron intake and iron status in breastfed infants during the first year of life. Clin Nutr 2010;29:773-8. https://doi.org/10.1016/j.clnu.2010.05.002
  14. Guyatt GH, Oxman AD, Ali M, Willan A, McIlroy W, Patterson C. Laboratory diagnosis of iron-deficiency anemia: an overview. J Gen Intern Med 1992;7:145-53. https://doi.org/10.1007/BF02598003
  15. Huh SY, Gordon CM. Vitamin D deficiency in children and adolescents: epidemiology, impact and treatment. Rev Endocr Metab Disord 2008;9:161-70. https://doi.org/10.1007/s11154-007-9072-y
  16. Dijkhuizen MA, Wieringa FT, West CE, Muherdiyantiningsih, Muhilal. Concurrent micronutrient deficiencies in lactating mothers and their infants in Indonesia. Am J Clin Nutr 2001;73:786-91.
  17. Ministry of Health & Welfare; Korea Centers for Disease Control and Prevention. Korea Health Statistics 2009: Korea National Health and Nutrition Examination Survey (KNHANES IV-3). Cheongwon: Ministry of Health & Welfare, Korea Centers for Disease Control and Prevention, 2010.
  18. Yoon JH, Park CS, Seo JY, Choi YS, Ahn YM. Clinical characteristics and prevalence of vitamin D insufficiency in children less than two years of age. Korean J Pediatr 2011;54:298-303. https://doi.org/10.3345/kjp.2011.54.7.298
  19. Yoon JW, Kim SW, Yoo EG, Kim MK. Prevalence and risk factors for vitamin D deficiency in children with iron deficiency anemia. Korean J Pediatr 2012;55:206-11. https://doi.org/10.3345/kjp.2012.55.6.206
  20. Sigman M, Lonnerdal B. Response of rat mammary gland transferrin receptors to maternal dietary iron during pregnancy and lactation. Am J Clin Nutr 1990;52:446-50. https://doi.org/10.1093/ajcn/52.3.446
  21. Katsumata S, Katsumata-Tsuboi R, Uehara M, Suzuki K. Severe iron deficiency decreases both bone formation and bone resorption in rats. J Nutr 2009;139:238-43. https://doi.org/10.3945/jn.108.093757
  22. Atkinson MA, Melamed ML, Kumar J, Roy CN, Miller ER 3rd, Furth SL, et al. Vitamin D, race, and risk for anemia in children. J Pediatr 2014;164:153-8.e1.
  23. Alon DB, Chaimovitz C, Dvilansky A, Lugassy G, Douvdevani A, Shany S, et al. Novel role of 1,25(OH)(2)D(3) in induction of erythroid progenitor cell proliferation. Exp Hematol 2002;30:403-9. https://doi.org/10.1016/S0301-472X(02)00789-0
  24. World Health Organization. Iron deficiency anaemia: assessment, prevention and control: a guide for programme managers. Geneva: World Health Organization, 2001.
  25. Brotanek JM, Gosz J, Weitzman M, Flores G. Iron deficiency in early childhood in the United States: risk factors and racial/ethnic disparities. Pediatrics 2007;120:568-75. https://doi.org/10.1542/peds.2007-0572
  26. Nead KG, Halterman JS, Kaczorowski JM, Auinger P, Weitzman M. Overweight children and adolescents: a risk group for iron deficiency. Pediatrics 2004;114:104-8. https://doi.org/10.1542/peds.114.1.104
  27. Pinhas-Hamiel O, Newfield RS, Koren I, Agmon A, Lilos P, Phillip M. Greater prevalence of iron deficiency in overweight and obese children and adolescents. Int J Obes Relat Metab Disord 2003;27:416-8. https://doi.org/10.1038/sj.ijo.0802224
  28. Raj S, Faridi M, Rusia U, Singh O. A prospective study of iron status in exclusively breastfed term infants up to 6 months of age. Int Breastfeed J 2008;3:3. https://doi.org/10.1186/1746-4358-3-3
  29. Meinzen-Derr JK, Guerrero ML, Altaye M, Ortega-Gallegos H, Ruiz-Palacios GM, Morrow AL. Risk of infant anemia is associated with exclusive breast-feeding and maternal anemia in a Mexican cohort. J Nutr 2006;136:452-8. https://doi.org/10.1093/jn/136.2.452
  30. Calvo EB, Galindo AC, Aspres NB. Iron status in exclusively breastfed infants. Pediatrics 1992;90:375-9.
  31. Saadi HF, Dawodu A, Afandi B, Zayed R, Benedict S, Nagelkerke N, et al. Effect of combined maternal and infant vitamin D supplementation on vitamin D status of exclusively breastfed infants. Matern Child Nutr 2009;5:25-32. https://doi.org/10.1111/j.1740-8709.2008.00145.x
  32. Dawodu A, Agarwal M, Hossain M, Kochiyil J, Zayed R. Hypovitaminosis D and vitamin D deficiency in exclusively breast-feeding infants and their mothers in summer: a justification for vitamin D supplementation of breast-feeding infants. J Pediatr 2003;142:169-73. https://doi.org/10.1067/mpd.2003.63
  33. Ala-Houhala M, Koskinen T, Parviainen MT, Visakorpi JK. 25-Hydroxyvitamin D and vitamin D in human milk: effects of supplementation and season. Am J Clin Nutr 1988;48:1057-60. https://doi.org/10.1093/ajcn/48.4.1057
  34. Wagner CL, Hulsey TC, Fanning D, Ebeling M, Hollis BW. Highdose vitamin D3 supplementation in a cohort of breastfeeding mothers and their infants: a 6-month follow-up pilot study. Breastfeed Med 2006;1:59-70. https://doi.org/10.1089/bfm.2006.1.59
  35. Ganz T. Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation. Blood 2003;102:783-8. https://doi.org/10.1182/blood-2003-03-0672

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