Zareen Fasih, Aijaz Ahmad, Zulfiqar Ali.
Relationship between iron status, nutritional status and the feeding practices of infants and toddlers with iron deficiency anemia in different age group.
Pak J Pathol Jan ;13(1):15-21.

Objective:- To study the relaptionship between the iron status. nutritional status and the feeding practices of infants and toddlers with iron deficiency anemia in different age groups Method:-All infants and toddlers between the age of 4-36 months whose hemoglobin level was less than 110 g/L were enrolled in this prospective cros-ssectional study and their, Iron status (Serum iron, serum ferritin and TIBC), nutrition status and feeding practices (type of milk, onset of weaning diet) were evaluated. Results:- The mean concentration of hemoglobin and serum ferritin fell progressively with age The mean hemoglobin concentration was 8.1 gm/L ± 0.08, Haemoglobin level fell gradually with age and was lowest at 31-36 months age group. Thirty four percent of the anemic children had poor iron (serum ferritin concentration < 110 g/L) and were suffering from iron deficiency status. Serum ferritin level was lowest in 31-36 months age group, indicating that body stores of iron progressively decreased from four months onwards in situations where iron supplements were not started during early infancy. No association was seen between the protein energy nutritional status and iron status as 37.27% of the anemic children were healthy indicating that despite a normal growth a child can have severe iron deficiency status. 84% infants were exclusively fed human milk while 16% were given formula/fresh milk, Mean age of weaning was late and was 8.0 ± 3.1 months in breast fed and 9.0 ± 2.7 in bottle fed infants. Conclusion:-Infants and toddlers who are on prolonged breast feeding/formula or fresh milk and are not started on weaning food at 4-6 months of age have a higher chance of developing iron deficiency anemia, Therefore, it is strongly recommended to start iron supplements in high risk group at an early age and a good additional source of iron in the weaning food at 4-6 months of age to prevent iron deficiency anemia and hence psychomotor delay in infancy and childhood, As approximately 1/3 of the children with iron deficiency status were healthy and had a normal growth it is important to diagnose anemia in healthy children as studies have shown that iron deficiency anemia leads to psychomotor delay in infancy and childhood. Screening for iron deficiency in communities at risk (poor socio-economic status, prolonged breast feeding and late weaning) is suggested. Future studies are needed in Pakistani children to pick up the degree of psychomotor delay in children with iron deficiency anemia.

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