IRON NUTRITION DURING EARLY CHILDHOOD. Factors influencing iron status and iron intake

Abstract: The overall aim of this thesis was to describe the prevalence of iron deficiency (ID) and factors influencing iron status and iron intake among otherwise healthy children. The specific aim in paper I+II was to describe the prevalence of ID among 2 ½-year-old children in relation to intake of cow's milk and follow-on formula. The design in the first two papers were cross-sectional and 367 2 ½-year-old children participated. Data collection included blood samples in order to determine the child's iron status and the parents were asked to estimate the child's intake of cow's milk and follow-on formula. The results showed that ten percent of the children were iron deficient, with or without anaemia, and received iron treatment. Transferrin receptor levels were measured and 14% had elevated levels indicating an iron need in the cell. The intake of cow's milk was significantly higher among children with iron deficiency than among those with sufficient iron status. Eleven percent of the children with ID consumed follow-on formula compared to 43% of the iron-sufficient children.

The specific aims in paper III were to describe iron status, iron intake and possible influencing factors among one-year-old children. Ten percent of the participating children (n=90) were iron depleted and 2.2% had ID. Furthermore, 27% of the non-breast fed children had a daily iron intake below the Nordic Nutrition Recommendations. Twenty-five percent reported that they experienced feeding problems when the child was 12 months old and some stated that they had to manipulate the child in order to make it eat. The children with mothers reported an education < 9 years had significantly lower iron intake, lower Hb and lower MCV than children with mothers who had an education > 9 years. Information about iron rich food from the Child Health Service to the parents improved the child's iron status. The specific aim in paper IV was to elucidate mothers experiences concerning feeding situations. The design was qualitative and interviews with 18 mothers were conducted. The interviews were transcribed verbatim and analysed with content analysis. Two main categories were identified, positive or negative experiences. The mothers with positive experiences trusted the child's ability to regulate food intake and they describe the child as easy to interpret. Mothers with negative experiences describe their child as petulant and felt difficulties in interpret the child's signals. They had to control the child's food intake and one way was to manipulate the child with treats or reward in order to make the child eat.

In conclusion, ID still exists among healthy children in Sweden during early childhood. The children with ID drank more cow's milk than those with sufficient iron status. Fewer with ID received follow-on formula compared to those without ID. Low maternal education correlated with low iron intake. Twenty-seven percent of the children had an iron intake below recommendations. Iron fortified follow-on formula and porridge contributed with a large proportion of the total iron intake among one-year-old children. Information about iron rich food resulted in improved iron status.