Year : 2009 | Volume
: 52 | Issue : 2 | Page : 182--184
Iron deficiency anemia in infants aged 12-15 months in Ahwaz, Iran
Seyed Mehdi Monajemzadeh, Mohammad Reza Zarkesh
Pediatric Unit, Golestan Hospital, Jondishapour University of Medical Sciences, Ahwaz, Iran
Seyed Mehdi Monajemzadeh
Pediatric Unit, Golestan Hospital, Jondishapour University of Medical Sciences, Ahwaz
Background: Iron deficiency anemia (IDA) is one of the most common nutritional problems in the world, especially in developing countries. Infants aged between 4 and 24 months are among the population groups that are most affected by iron deficiency (ID). The aim of this study was to investigate the prevalence of ID and IDA in infants aged 12-15 months, living in Ahwaz, southwest of Iran. Materials and Methods: One hundred and twenty-six infants participated in the study. The mean corpuscular volume and hemoglobin (Hb), serum ferritin and hematocrit levels were measured. Anemia was defined when Hb <11g/dL and ID when ferritin <12µg/mL. Results: The prevalence of ID and IDA was 31.7 and 26.2%, respectively. The tendency to have IDA in infants fed with cow«SQ»s milk and infants who did not receive ferrous sulfate was higher than in the other subjects. Conclusion: ID and IDA are common among infants aged 12-15 months living in Ahwaz, Iran. Maintenance of exclusive breastfeeding up to the 4-6th month of life and iron supplementation for the target group is needed.
|How to cite this article:|
Monajemzadeh SM, Zarkesh MR. Iron deficiency anemia in infants aged 12-15 months in Ahwaz, Iran.Indian J Pathol Microbiol 2009;52:182-184
|How to cite this URL:|
Monajemzadeh SM, Zarkesh MR. Iron deficiency anemia in infants aged 12-15 months in Ahwaz, Iran. Indian J Pathol Microbiol [serial online] 2009 [cited 2020 Jun 3 ];52:182-184
Available from: http://www.ijpmonline.org/text.asp?2009/52/2/182/48911
Iron deficiency (ID) and iron deficiency anemia (IDA) are considered the major public health problems and the most common nutritional deficiency around the world due to their high prevalence, effects on development and growth, resistance to infections and association with the mortality of infants younger than 2 years. 
There is an estimate that 25% of the world population is affected by ID, the population groups most affected being infants aged between 4 and 24 months, school-age children, female adolescents, pregnant women and nurturing mothers.  Infants and young children have a high risk for developing ID because they have a high demand for iron during the period of rapid growth. 
The global disease burden distribution of IDA is greatly concentrated in sub-Saharan Africa and Asia.  In the Islamic Republic (IR) of Iran, about 30-50 percent of women and children have IDA.  The present study was conducted to determine the prevalence of IDA in infants aged 12-15 months living in Ahwaz, Iran.
Materials and Methods
This study was a cross-sectional study of the prevalence of IDA in infants aged 12-15 months living in Ahwaz, Iran. We chose this range of age because parents try, in this age, to feed their children by meal and not milk. From April 2006 to March 2007, 126 healthy infants attending the pediatric clinic of a tertiary hospital affiliated to the University of Medical Sciences were recruited. A detailed physical examination was carried out for all the participants. Blood samples were obtained. Hemoglobin (Hb) and mean corpuscular volume (MCV) were analyzed on a Coulter Counter (Sysmex K-1000 and Sysmex XE 2100, Kobe, Japan). The concentration of serum ferritin was measured using radioimmunoassay.
All tests were analyzed at the same laboratory. The criteria for IDA were Hb 
Children with a history of chronic disease or conditions in the family leading to malabsorption, such as celiac disease, were excluded from study.
The socioeconomic status of study group was relatively the same as acquired via the questionnaire.
The study protocol was approved by the Institutional Review Board of our local University of Medical Sciences and written informed consent was obtained from all parents before blood tests.
The statistical analysis was performed using SPSS, version 13 (SPSS Inc., Chicago, IL, USA). Values were tested for statistical significance using the χ2 test. A P -value of P > 1). [Table 1] shows the indices of iron status of the participants. Among the participants studied, 33 cases (26.2%) suffered from IDA, 40 persons (31.7%) had ID without anemia and 54 cases (42.9%) had anemia.
The mean Hb, MCV, Hct and ferritin in girls was significantly higher than in boys (11.51g/dL, 76.68fL, 34.89%, 33.54µg/L vs. 10.88g/dL, 72.42fL, 33.27%, 22.52µg/L; P P = 0.015).
The infants birth orders in 126 cases were as follows: 76 (60.3%) of the cases were first child of the family, 28 (22.2%) were second child, 10 (7.9%) were third child, eight (6.3%) were fourth child and four (3.2%) were fifth child of the family. There was no significant difference between IDA and infants birth order ( P > 0.05). Educational level of the mother did not have an effect on the iron status of her infant. In the analysis of feeding habits, we found that 100 (79.4%) of the infants were exclusively breastfed up to 6 months, 24 (19%) were fed with formula milk and two (1.6%) of the infants were fed with cow's milk. The tendency to have IDA was 27% in infants exclusively breastfed, 16.7% in infants fed with formula milk and 100% in infants fed with cow's milk and the difference was statistically significant ( P = 0.033). The tendency to have IDA in infants fed with solid food before 6 months was higher than in infants in whom the solid food was introduced after 6 months of life (50% vs. 25%, respectively), but the difference was not statistically significant ( P > 0.05).
Among the infants, 86 cases received ferrous sulfate irregularly, 27 cases regularly and 13 cases never received ferrous sulfate. The incidence of IDA in the first group was 26.7%, in the second group was 3.7% and in the third group was 69.2%. The difference between IDA and ferrous sulfate administration was statistically significant ( P  Although conditions such as malaria, nutritional deficiencies of folate and vitamin B12 as well as human immunodeficiency virus and other chronic diseases can play a role in the causal path of anemia. The literature suggests that ID is responsible for about 50% of the cases of anemia in young children and pregnant women in developing countries. 
IDA is a leading cause of infant morbidity and mortality worldwide.  Several studies have indicated that even moderate anemia (Hb ,,
We found that the prevalence of ID, IDA and iron sufficient anemia in infants aged 12-15 months was 31.7, 26.2 and 42.9%, respectively, which is disturbingly high.
In 42.9% of our cases, there was anemia but not ID and it is reasonable to search any possible underlying abnormality such as thalassemia.
The reason as to why girls had more mean Hb than boys was not clear for us and more studies should be performed to find possible reasons for this gender difference.
The prevalence of ID in our study was higher than the average of 7% in the developed EU countries,  Sweden (19%)  or Iceland (20%).  One reason for such a high prevalence of IDA in Ahwaz may be the fact that feeding with cow's milk is still common practice. It is known that cow's milk is the main dietary risk factor for ID in infancy. ,,, Cow's milk has the same iron content as breast milk, but its bioavailability is too low.  The second reason might be that ferrous sulfate is not used as a regular program for prevention of IDA in infants. Medicine supplementation is very efficient in preventing and controlling anemia. In Danish infants aged 9 months, the prevalence of ID and IDA was near to zero because of the direct program for prevention of IDA. 
We found that socioeconomic variables such as infant's birth order, educational level of the mother and introduction to solid food did not have an effect on iron status. The results of Vendt et al. 's study also showed that there was no relationship between iron status and age and educational level of the mother, introduction to solid food and living in an urban or rural area.  But, some of their results are in contrast with ours. According to our data, male gender and cow's milk feeding are associated with IDA. Gender apparently plays an important role in infant's iron status.  We found that boys had a tendency to have lower ferritin concentration than girls and the difference was statistically significant. The other authors have reported a similar sex difference. ,,
Nearly 80% of our infants were exclusively breastfed up to 6 months. The tendency to have IDA was 27% in this group, which is higher than in infants fed with formula milk (16.7%). According to our study, formula feeding is slightly protective against ID. Therefore, infants beyond the age of 6 months should have high iron formula or iron-fortified food. Our results are similar to those found by Vendt et al. in their study. 
ID and IDA are common in infants aged 12-15 months living in Ahwaz, Southwest of Iran. Special attention should be paid to initiation of complementary feeding with iron-rich foods and ferrous sulfate drops. Directed program for early discovery and prevention of IDA of infancy should be planned in the healthcare system in Ahwaz.
|1||DeMayer EM. Preventing and controlling iron deficiency anemia through primary care. Genebra: OMS; 1989.|
|2||Yip R. The epidemiology of childhood iron deficiency: evidence for improving iron nutrition among US children. In: Dobbing J, editor. Brain, behavior and iron in the infant diet. Virginia (USA): Springer-Verlag; 1992. p. 27-39.|
|3||Aggett PJ, Agostoni C, Axelsson I, Bresson JL, Goulet O, Hernell O, et al . Iron metabolism and requirements in early childhood: Do we know enough? A commentary by the ESPGHAN Committee on nutrition.J Pediatr Gastroenterol Nutr 2002;34:337-45.|
|4||Stoltzfus RJ. Update on Issues Related to Iron Deficiency and Anemia Control. Report of the 2003 International Nutritional Anemia Consultive Group: Integrating Programs to Move Iron Deficiency Anemia Control Forward Symposium. Marrakech, Morocco: International Life Sciences Institute; 2003.|
|5||Hazavehei SM, Jalili Z, Heydarnia AR, Faghihzadeh S. Application of the PRECEDE model for controlling iron-deficiency anemia among children aged 1-5, Kerman, Iran. Promot Educ 2006;13:173-7.|
|6||Lanzkowsky PH. Manual of pediatric hematology and oncology. 4 th ed. California: Elsevier Academic Press; 2005. p. 39-40.|
|7||Yip R. The challenge of improving iron nutrition: Limitations and potentials of major intervention approaches. Eur J Clin Nutr 1997;51:S16-24.|
|8||Stoltzfus RJ, Mullany L, Black RE. Iron deficiency anemia. In: Ezzati M, Lopez D, Rodgers A, Murray CJ, editors. Comparative quantification of health risks: Global and regional burden of disease attributable to selected major risk factors. Vol. 1. Geneva: World Health Organization; 2004. p. 163-208.|
|9||World Health Organization. Malnutrition: The global picture. Geneva: The Organization; 2000.|
|10||Grantham-McGregor S, Ani C. A review of studies on the effect of iron deficiency on cognitive development in children. J Nutr 2001;131:649S-68S.|
|11||Pollitt E. Iron deficiency and cognitive function. Ann Rev Nutr 1993;13:521-37.|
|12||Lozoff B, Jimenez MD, Hagen J, Mollen E, Wolf AW. Poorer behavioral and developmental outcome more than 10 years after treatment for iron deficiency in infancy. Pediatrics 2000;105:E51.|
|13||Male C, Persson LA, Freeman V, Guerra A, van't Hof MA, Haschke F. Prevalence of iron deficiency in 12-mo-old infants from 11 European areas and influence of dietary factors on iron status (Euro-Growth Study). Acta Paediatr 2001;90:492-8.|
|14||Lind T, Lφnnerdal B, Persson LA, Stenlund H, Tennefors C, Hernell O. Effects of weaning cereals with different phytate contents on hemoglobin, iron stores, and serum zinc: A randomized intervention in infants from 6 to 12 mo of age. Am J Clin Nutr 2003;78:168-75.|
|15||Thorsdottir I, Gunnarsson BS, Atladottir H, Michaelsen KF, Palsson G. Iron status at 12 months of age-effects of body size, growth and diet in population with high birth weight. Eur J Clin Nutr 2003;57:505-13.|
|16||Booth IW, Aukett MA. Iron deficiency anemia in infancy and early childhood. Arch Dis Child 1997;76:549-54.|
|17||Michaelsen KF, Milman N, Samuelson G. A longitudinal study of iron status in healthy Danish infants: Effects of early iron status, growth velocity and dietary factors. Acta Paediatr 1995;84:1035-44.|
|18||Queiroz Sde S, Torres MA. Iron deficiency anemia in children. J Pediatr 2000;76:S298-304.|
|19||Vendt N, Grünberg H, Leedo S, Tillmann V, Talvik T. Prevalence and causes of iron deficiency anemia in infants aged 9 to 12 months in Estonia. Medicina (Kaunas) 2007;43:947-52.|
|20||Domellφf M, Lφnnerdal B, Dewey KG, Cohen RJ, Rivera LL, Hernell O. Sex differences in iron status during infancy. Pediatrics 2002;110:545-52.|