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A cohort study of haemoglobin and zinc protoporphyrin levels in term Zambian infants: effects of iron stores at birth, complementary food and placental malaria

European Journal of Clinical Nutrition volume 62, pages 1379–1387 (2008)Cite this article

Abstract

Objective:

To examine zinc-protoporphyrin (ZPP) and haemoglobin levels, and to determine predictors of iron deficiency anaemia (IDA) in Zambian infants.

Subjects and methods:

Ninety-one women and their normal birth weight (NBW) infants were followed bi-monthly during the first 6 months of life, and iron status, food intake, malaria parasitaemia and growth were monitored. At 4 months, the infants were divided into two groups, and the data were analysed according to whether or not they were exclusively breastfed.

Results:

Almost two-third of infants were born with low iron stores as defined by ZPP levels, and this proportion increased with age. Over 50% had developed IDA by 6 months. Exclusive breastfeeding at 4 months could be a protective factor for IDA (odds ratio (OR): 0.2; 95% confidence interval (CI): 0.0–1.1). Exclusively breastfed infants had higher haemoglobin values at 4 and 6 months (mean difference 0.6; 95% CI: 0.1–1.2 g/dl and mean difference 0.9; 95% CI: 0.2–1.7 g/dl, respectively), compared with infants with early complementary feeding. In univariate analysis, past or chronic placental malaria appeared to be a predictor of IDA at 4 and 6 months, but the significance was lost in multivariate analysis.

Conclusions:

Zambian NBW infants are born with low iron stores and have a high risk to develop IDA in the first 6 months of life. Continuation of exclusive breastfeeding after 4 months is associated with a reduction of anaemia. The effect of placental malaria infection on increased risk of infant IDA could not be proven.

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Acknowledgements

We thank the management board of Mpongwe Mission Hospital for their hospitality; and maternity and laboratory staff for their assistance. This study received financial support from the Amsterdam–Liverpool Programme for research in Tropical Child Health and from the Bemmel Support Group.

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Authors and Affiliations

  1. Department of Paediatrics, Paediatric Gastroenterology, University Medical Centre, Groningen, The Netherlands

    P F van Rheenen

  2. University of Amsterdam, Amsterdam, The Netherlands

    L T T de Moor & S Eschbach

  3. Emma Children's Hospital – Academic Medical Centre, Amsterdam, The Netherlands

    B J Brabin

  4. Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK

    B J Brabin

  5. Royal Liverpool Children's Hospital NHS Trust, Alder Hey, Liverpool, UK

    B J Brabin

Authors
  1. P F van Rheenen
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  2. L T T de Moor
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  4. B J Brabin
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Corresponding author

Correspondence to P F van Rheenen.

Additional information

Guarantor: PF van Rheenen.

Contributors: PFvR and BJB were responsible for the study idea and design. Both contributed to the analysis and interpretation of the data and to the writing of the paper. LTTdM and SE collected the data.

Competing interests

None declared.

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van Rheenen, P., de Moor, L., Eschbach, S. et al. 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, 1379–1387 (2008). https://doi.org/10.1038/sj.ejcn.1602862

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