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Reducing Iron Deficiency in 18–36-months-old US Children: Is the Solution Less Calcium?

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Abstract

Objectives National surveys consistently identify iron deficiency (ID) in US children between 1 and 3 years of age, when the brain is rapidly developing and vulnerable to the effects of ID. However, controversy remains as to how best to recognize and prevent ID in young children, in part because of the multiple potential etiologies. The objective of this project was to assess ID in children and identify potential individual dietary predictors of status. Methods We examined three biomarkers of ID [soluble transferrin receptor (sTfR) and serum ferritin (SF), and body iron (calculated from sTfR and SF)] against parent-provided dietary calcium and iron intake for eight-three 18–36 month old children from middle class families. Results Using literature-based cutoffs, fourteen children (16.9 %) had at least one indicator of ID: low SF(<10 μg/l, 7.2 %), negative body iron (<0 mg/kg, 7.2 %) or elevated sTfR (>8.4 μg/ml, 13.2 %). All children consumed more than the Dietary Reference Intake (DRI) Estimated Average Requirement of 3 mg/d iron. The mean iron intake of children identified with ID approximated the Recommended Dietary Allowance of 7 mg/d. Most children (81 %) consumed above the DRI Adequate Intake of 500 mg/d of calcium. Calcium intakes were generally high and predicted lower body iron (p = 0.0005), lower SF (p = 0.0086) and higher sTfR (p = 0.0176). Conclusions for Practice We found rates of ID similar to US national averages. Dietary calcium intake predicted lower iron status more than deficits in iron intake. Teaching parents to balance calcium and iron intake in toddlers could be a strategy to prevent ID.

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Acknowledgments

This study was supported by Mead Johnson Nutrition. The authors thank the families of study participants as well as other study team members for assistance with data collection, blood processing and analysis.

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Authors and Affiliations

  1. Department of Dietetics and Nutrition, University of Kansas Medical Center, MS 4013, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA

    Elizabeth H. Kerling, Laura M. Souther, Debra K. Sullivan & Susan E. Carlson

  2. Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA

    Byron J. Gajewski

  3. Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA

    Michael K. Georgieff

Authors
  1. Elizabeth H. Kerling
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  2. Laura M. Souther
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  6. Susan E. Carlson
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Correspondence to Susan E. Carlson.

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Kerling, E.H., Souther, L.M., Gajewski, B.J. et al. Reducing Iron Deficiency in 18–36-months-old US Children: Is the Solution Less Calcium?. Matern Child Health J 20, 1798–1803 (2016). https://doi.org/10.1007/s10995-016-1982-4

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  • DOI: https://doi.org/10.1007/s10995-016-1982-4

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