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Abstract

Iron-fortified formula and iron-fortified/iron-rich complementary foods are usually considered an important part of preventing iron deficiency in infancy. However, the analysis by Kalhoff and Kersting and their colleagues of 2 dietary studies in Germany conducted 5 years apart show increases in iron deficiency that may be related to changes in complementary feeding.1Dube K. Schwartz J. Mueller M.J. Kalhoff H. Kersting M. Iron intake and iron status in breastfed infants during the first year of life.Clin Nutr. 2010; 29: 773-778Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar, 2Libuda L. Hilbig A. Berber-Al-Tawil S. Kalhoff H. Kersting M. Association between full breastfeeding, timing of complementary food introduction, and iron status in infancy in Germany: results of a secondary analysis of a randomized trial.Eur J Nutr. 2016; ([Epub ahead of print])https://doi.org/10.1007/s00394-016-1335-5Crossref Scopus (9) Google Scholar Iron deficiency anemia was rare, but consistent with what we reported, they found more iron deficiency in breastfed infants compared with formula-fed infants (21% vs 0%) in the earlier time period (2006-2009).1Dube K. Schwartz J. Mueller M.J. Kalhoff H. Kersting M. Iron intake and iron status in breastfed infants during the first year of life.Clin Nutr. 2010; 29: 773-778Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar However, in the second time period (2011-2013), there was more iron deficiency in both breastfed and formula-fed infants (36% and 30%, respectively) despite iron fortification.2Libuda L. Hilbig A. Berber-Al-Tawil S. Kalhoff H. Kersting M. Association between full breastfeeding, timing of complementary food introduction, and iron status in infancy in Germany: results of a secondary analysis of a randomized trial.Eur J Nutr. 2016; ([Epub ahead of print])https://doi.org/10.1007/s00394-016-1335-5Crossref Scopus (9) Google Scholar Kalhoff and Kersting postulate that this rise was related to the lower iron content of infant formula and lower meat content in baby foods. Their observation, if confirmed in larger studies, suggests that breastfed and formula-fed infants alike may need increased monitoring for iron deficiency, because concerns about giving excessive iron may lead to lower levels of iron fortification in formula and infant foods.3Kleinman R.E. Recommended iron levels for nutritional formulas for infants (0-12 months).J Pediatr. 2015; 167: S1-50Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Iron deficiency may well become more common in Europe and the US even as evidence mounts indicating poorer developmental and behavioral outcomes with iron deficiency with or without anemia.4East P. Delker E. Lozoff B. Delva J. Castillo M. Gahagan S. Associations among infant iron deficiency, childhood emotion and attention regulation, and adolescent behavior problems.Child Dev. 2017; https://doi.org/10.1111/cdev.12765Crossref PubMed Scopus (21) Google Scholar, 5Georgieff M.K. Long-term brain and behavioral consequences of early iron deficiency.Nutr Rev. 2011; 69: S43-8Crossref PubMed Scopus (179) Google Scholar, 6Fretham S.J.B. Carlson E.S. Georgieff M.K. The role of iron in learning and memory.Adv Nutr. 2011; 2: 112-121Crossref PubMed Scopus (159) Google Scholar Current hemoglobin screening detects anemia but not iron deficiency, however, and thus, protecting the developing child from too little or too much iron remains challenging. Breastfeeding or formula feeding and iron status in the second 6 months of life: A critical role for complementary feedingThe Journal of PediatricsVol. 187PreviewBreastfeeding or formula feeding in later infancy was correlated with the risk of developing iron deficiency anemia by Clark et al1 in a secondary analysis of an observational study in a large sample of Chinese infants. Surprisingly, the authors did not consider complementary feeding habits in the data analysis or interpretation, although it is a public health consensus that the iron content of complementary feeding addresses the high iron requirements during the second 6 months of life. Full-Text PDF