European Journal of Nutrition

, Volume 49, Issue 1, pp 11–18 | Cite as

Complementary food with low (8%) or high (12%) meat content as source of dietary iron: a double-blinded randomized controlled trial

  • Katharina Dube
  • Jana Schwartz
  • Manfred J. Mueller
  • Hermann Kalhoff
  • Mathilde Kersting
Original Contribution



To investigate whether a low meat content of complementary food as accepted by EU law increases the risk of well-nourished infants to develop iron deficiency during the complementary feeding period.


Term born, healthy infants were randomized into a ‘High Meat’ Group (HM, n = 48) receiving commercial baby jars with a meat content of 12% by weight (according to pediatric guidelines), and a ‘Low Meat’ Group (LM, n = 49) receiving meals as marketed (meat 8% by weight, the lowest level of EU law). Intervention was from 4 to 10 months of age. Dietary intake was recorded continuously, repeated blood samples were collected.


Estimated intake of bioavailable iron conformed to reference requirements. In the primary analysis of the total sample, iron status was adequate before (4 months), during (7 months), and after (10 months) the intervention. A secondary analysis in the subgroup of infants fully breast-fed for 4–6 months demonstrated an increased risk of low Hb values with 10 months of age in the LM group.


Present day low meat content of complementary food does not significantly impair iron status in well-nourished infants but may increase the risk of developing marginal iron status in older infants after fully breast-feeding for 4–6 months, i.e., in the subgroup of infants with the lowest habitual iron intake.


Infants Iron status Complementary food Meat Hemoglobin Breast milk 

List of abbreviations

BA iron

Bioavailable iron


Breast milk


Dortmund Intervention Trial for Optimization of Infant Nutrition


Dietary reference intake








Iron deficiency


Iron deficiency anemia




Mean cell hemoglobin


Mean cell volume


Randomized controlled trial


Standard deviation


Total energy expenditure


Soluble transferrin-receptor


Zinc protoporphyrin



We thank the two pediatricians from Pediatric Clinic, Dortmund, Germany, for medical examination and blood sampling. The authors’ were responsible as follows: M.K. and H.K. for design of the study; K.D. and J.S. conduction of the study and data collection; K.D. draft of the manuscript and statistical analysis; M.K., H.K. and M.J.M. supervision. The study was supported by the Central Marketing Organization of German Agricultural Economics (CMA). Study food was provided by Hipp GmbH and Co. Vertrieb KG and Nestlé Nutrition GmbH. Laboratory analysis of iron biomarkers was performed at the Laborgemeinschaft Dr. Eberhard & Partner, Dortmund, Germany.

Conflict of interest statement

All authors have no conflict of interest.


  1. 1.
    Aggett PJ, Agostini C, Goulet O et al (2001) The nutritional and safety assessment of breast milk substitutes and other dietary products for infants: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 32:256–258CrossRefGoogle Scholar
  2. 2.
    Lozoff B, Beard J, Connor J, Barbara F, Georgieff M, Schallert T (2006) Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr Rev 64:S34–S43 (discussion S72–S91)CrossRefGoogle Scholar
  3. 3.
    Agostoni C, Riva E, Giovannini M (2007) Functional ingredients in the complementary feeding period and long-term effects. In: Agostoni C, Brunser O (eds) Issues in complementary feeding. Vevey/S. Karger AG, Basel, pp 123–138CrossRefGoogle Scholar
  4. 4.
    Domellof M, Cohen RJ, Dewey KG, Hernell O, Rivera LL, Lonnerdal B (2001) Iron supplementation of breast-fed Honduran and Swedish infants from 4 to 9 months of age. J Pediatr 138:679–687CrossRefGoogle Scholar
  5. 5.
    German Nutrition Society (2000) Compilation of the D-A-CH reference values for nutrient intake (German). D-A-CH, FrankfurtGoogle Scholar
  6. 6.
    Institute of Medicine (2001) Dietary reference intakes. National Academy Press, WashingtonGoogle Scholar
  7. 7.
    Dewey KG (2001) Nutrition, growth, and complementary feeding of the breastfed infant. Pediatr Clin North Am 48:87–104CrossRefGoogle Scholar
  8. 8.
    Hopkins D, Emmett P, Steer C, Rogers I, Noble S, Emond A (2007) Infant feeding in the second 6 months of life related to iron status: an observational study. Arch Dis Child 92:850–854CrossRefGoogle Scholar
  9. 9.
    Dewey KG, Chaparro CM (2007) Session 4: mineral metabolism and body composition iron status of breast-fed infants. Proc Nutr Soc 66:412–422CrossRefGoogle Scholar
  10. 10.
    Agostoni C, Decsi T, Fewtrell M et al (2008) Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 46:99–110CrossRefGoogle Scholar
  11. 11.
    The Commission of the European Communities (1996) Commission Directive 96/5/EC, Euratom of 16 February 1996 on processed cereal-based foods and baby foods for infants and young children. Official Journal L 049, 28 02 1996, 1996:0017–0028Google Scholar
  12. 12.
    Schwartz J, Dube K, Sichert-Hellert W et al (2009) Modification of dietary polyunsaturated fatty acids via complementary food enhances n-3 LC-PUFA synthesis in healthy infants—a double blinded randomized controlled trial. Arch Dis ChildGoogle Scholar
  13. 13.
    Michaelsen KF, Milman N, Samuelson G (1995) A longitudinal study of iron status in healthy Danish infants: effects of early iron status, growth velocity and dietary factors. Acta Paediatr 84:1035–1044CrossRefGoogle Scholar
  14. 14.
    Kersting M (2001) Feeding the healthy infant. Food- and meal-based recommendations (German). Monatsschr Kinderheilkd 149:4–10CrossRefGoogle Scholar
  15. 15.
    German Society of Pediatrics and Adolescent Medicine (2006) Healthy nutrition for my baby (German)Google Scholar
  16. 16.
    Souci SW, Fachmann W, Kraut H (2000) Food composition and nutrition tables (German), 6 edn edn. Medpharm Scientific Publishers, StuttgartGoogle Scholar
  17. 17.
    Schoen S, Sichert-Hellert W, Kersting M (2009) Validation of energy requirement equations for estimation of breast milk consumption in infants. Public Health Nutrition (in press)Google Scholar
  18. 18.
    Sichert-Hellert W, Kersting M, Chadha C, Schaefer R, Kroke A (2007) German food composition database for dietary evaluations in children and adolescents. J Food Comp Anal 20:63–70CrossRefGoogle Scholar
  19. 19.
    Hertrampf E, Olivares M, Pizarro F, Walter T (1998) High absorption of fortification iron from current infant formulas. J Pediatr Gastroenterol Nutr 27:425–430CrossRefGoogle Scholar
  20. 20.
    Monsen ER (1988) Iron nutrition and absorption: dietary factors which impact iron bioavailability. J Am Diet Assoc 88:786–790Google Scholar
  21. 21.
    Bosscher D, Van Cauwenbergh R, Van der Auwera JC, Robberecht H, Deelstra H (2002) Calcium, iron and zinc availability from weaning meals. Acta Paediatr 91:761–768CrossRefGoogle Scholar
  22. 22.
    Cook JD, Reddy MB, Burri J, Juillerat MA, Hurrell RF (1997) The influence of different cereal grains on iron absorption from infant cereal foods. Am J Clin Nutr 65:964–969Google Scholar
  23. 23.
    Davidsson L, Kastenmayer P, Szajewska H, Hurrell RF, Barclay D (2000) Iron bioavailability in infants from an infant cereal fortified with ferric pyrophosphate or ferrous fumarate. Am J Clin Nutr 71:1597–1602Google Scholar
  24. 24.
    Lonnerdal B, Kelleher SL (2007) Iron metabolism in infants and children. Food Nutr Bull 28:S491–S499Google Scholar
  25. 25.
    van Rheenen PF, de Moor LT, Eschbach S, Brabin BJ (2008) A cohort study of haemoglobin and zinc protoporphyrin levels in term Zambian infants: effects of iron stores at birth, complementary food and placental malaria. Eur J Clin Nutr 62:1379–1387Google Scholar
  26. 26.
    Vazquez Lopez MA, Carracedo A, Lendinez F, Munoz FJ, Lopez J, Munoz A (2006) The usefulness of serum transferrin receptor for discriminating iron deficiency without anemia in children. Haematologica 91:264–265Google Scholar
  27. 27.
    Punnonen K, Irjala K, Rajamaki A (1997) Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood 89:1052–1057Google Scholar
  28. 28.
    Fewtrell MS, Morgan JB, Duggan C et al (2007) Optimal duration of exclusive breastfeeding: what is the evidence to support current recommendations? Am J Clin Nutr 85:635S–638SGoogle Scholar
  29. 29.
    WHO (2001a) Global strategy for infant and young child feeding—the optimal duration of exclusive breastfeeding. World Health Organization, GenevaGoogle Scholar
  30. 30.
    Gartner LM, Morton J, Lawrence RA et al (2005) Breastfeeding and the use of human milk. Pediatrics 115:496–506CrossRefGoogle Scholar
  31. 31.
    Hurrell RF, Reddy MB, Juillerat M, Cook JD (2006) Meat protein fractions enhance nonheme iron absorption in humans. J Nutr 136:2808–2812Google Scholar
  32. 32.
    Hicks PD, Zavaleta N, Chen Z, Abrams SA, Lonnerdal B (2006) Iron deficiency, but not anemia, upregulates iron absorption in breast-fed Peruvian infants. J Nutr 136:2435–2438Google Scholar
  33. 33.
    Domellof M (2007) Iron requirements, absorption and metabolism in infancy and childhood. Curr Opin Clin Nutr Metab Care 10:329–335CrossRefGoogle Scholar
  34. 34.
    Engelmann MD, Sandstrom B, Michaelsen KF (1998) Meat intake and iron status in late infancy: an intervention study. J Pediatr Gastroenterol Nutr 26:26–33CrossRefGoogle Scholar
  35. 35.
    Morgan J, Taylor A, Fewtrell M (2004) Meat consumption is positively associated with psychomotor outcome in children up to 24 months of age. J Pediatr Gastroenterol Nutr 39:493–498CrossRefGoogle Scholar
  36. 36.
    Krebs NF, Westcott JE, Butler N, Robinson C, Bell M, Hambidge KM (2006) Meat as a first complementary food for breastfed infants: feasibility and impact on zinc intake and status. J Pediatr Gastroenterol Nutr 42:207–214Google Scholar
  37. 37.
    Schuemann K, Ettle T, Szegner B, Elsenhans B, Solomons NW (2007) On risks and benefits of iron supplementation recommendations for iron intake revisited. J Trace Elem Med Biol 21:147–168CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Katharina Dube
    • 1
  • Jana Schwartz
    • 1
  • Manfred J. Mueller
    • 2
  • Hermann Kalhoff
    • 3
  • Mathilde Kersting
    • 1
  1. 1.Research Institute of Child Nutrition DortmundUniversity of BonnDortmundGermany
  2. 2.University of KielKielGermany
  3. 3.Pediatric ClinicDortmundGermany

Personalised recommendations