Complementary food with low (8%) or high (12%) meat content as source of dietary iron: a double-blinded randomized controlled trial
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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.
KeywordsInfants Iron status Complementary food Meat Hemoglobin Breast milk
List of abbreviations
- BA iron
Dortmund Intervention Trial for Optimization of Infant Nutrition
Dietary reference intake
Iron deficiency anemia
Mean cell hemoglobin
Mean cell volume
Randomized controlled trial
Total energy expenditure
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.
- 5.German Nutrition Society (2000) Compilation of the D-A-CH reference values for nutrient intake (German). D-A-CH, FrankfurtGoogle Scholar
- 6.Institute of Medicine (2001) Dietary reference intakes. National Academy Press, WashingtonGoogle Scholar
- 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.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
- 15.German Society of Pediatrics and Adolescent Medicine (2006) Healthy nutrition for my baby (German)Google Scholar
- 16.Souci SW, Fachmann W, Kraut H (2000) Food composition and nutrition tables (German), 6 edn edn. Medpharm Scientific Publishers, StuttgartGoogle Scholar
- 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
- 20.Monsen ER (1988) Iron nutrition and absorption: dietary factors which impact iron bioavailability. J Am Diet Assoc 88:786–790Google Scholar
- 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.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.Lonnerdal B, Kelleher SL (2007) Iron metabolism in infants and children. Food Nutr Bull 28:S491–S499Google Scholar
- 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.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.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.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.WHO (2001a) Global strategy for infant and young child feeding—the optimal duration of exclusive breastfeeding. World Health Organization, GenevaGoogle Scholar
- 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.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
- 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