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Maternal nutrition, infants and children

Iron status and linear growth: a prospective study in school-age children

European Journal of Clinical Nutrition volume 67, pages 646–651 (2013)Cite this article

Subjects

Abstract

Background:

Studies regarding the role of iron on linear growth have yielded heterogeneous results. Some trials indicate that iron supplementation of iron-replete infants leads to slower-length gain. However, little is known of the relation between iron status and linear growth in school-age children.

Methods:

We quantified plasma ferritin, mean corpuscular volume (MCV), and hemoglobin in 2714 children aged 5–12 years at recruitment into a cohort study. Height was measured periodically for a median of 30 months. Height-for-age Z-scores (HAZ) were calculated using the World Health Organization growth reference. Mixed effects models with restricted cubic splines were used to construct population HAZ-for-age growth curves for sex- and age-specific quartiles of each iron status indicator.

Results:

Ferritin and MCV were each inversely related to attained HAZ among boys after the adjustment for baseline age, baseline body mass index-for-age Z-score and socioeconomic status. There was a decreasing monotonic relation between quartiles of ferritin and estimated change in HAZ from ages 6 to 14 years (P trend=0.001); boys in the 4th quartile experienced a HAZ change that was 0.46 Z lower than that of boys in the 1st quartile (P=0.0006). Similarly, we observed smaller HAZ change among boys in the highest quartile of MCV in comparison with those in the 1st quartile (P trend=0.001). Hemoglobin was not related to linear growth in boys. None of the iron-status indicators were associated with linear growth in girls.

Conclusions:

Higher iron status, as indicated by ferritin and MCV, is related to slower linear growth in iron-replete school-age boys.

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References

  1. WHO. Guideline: intermittent iron supplementation in preschool and school-age children. World Health Organization: Geneva, 2011.

  2. Iannotti LL, Tielsch JM, Black MM, Black RE . Iron supplementation in early childhood: health benefits and risks. Am J Clin Nutr 2006; 84: 1261–1276.

    Article  CAS  Google Scholar 

  3. McCord JM . Iron, free radicals, and oxidative injury. J Nutr. 2004; 134: 3171S–3172SS.

    Article  CAS  Google Scholar 

  4. Lonnerdal B, Kelleher SL . Iron metabolism in infants and children. Food Nutr Bull 2007; 28: S491–S499.

    Article  Google Scholar 

  5. Dewey KG, Domellof M, Cohen RJ, Landa Rivera L, Hernell O, Lonnerdal B . Iron supplementation affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and Honduras. J Nutr 2002; 132: 3249–3255.

    Article  CAS  Google Scholar 

  6. Majumdar I, Paul P, Talib VH, Ranga S . The effect of iron therapy on the growth of iron-replete and iron-deplete children. J Trop Pediatr 2003; 49: 84–88.

    Article  CAS  Google Scholar 

  7. Capozzi L, Russo R, Bertocco F, Ferrara D, Ferrara M . Effect on haematological and anthropometric parameters of iron supplementation in the first 2 years of life. Risks and benefits. Hematology 2011; 16: 261–264.

    Article  CAS  Google Scholar 

  8. Silva DG, Franceschini Sdo C, Sigulem DM . Growth in non-anemic infants supplemented with different prophylactic iron doses. J Pediatr (Rio J) 2008; 84: 365–372.

    Article  Google Scholar 

  9. Lind T, Seswandhana R, Persson LA, Lonnerdal B . Iron supplementation of iron-replete Indonesian infants is associated with reduced weight-for-age. Acta Paediatr 2008; 97: 770–775.

    Article  CAS  Google Scholar 

  10. Ramakrishnan U, Nguyen P, Martorell R . Effects of micronutrients on growth of children under 5 y of age: meta-analyses of single and multiple nutrient interventions. Am J Clin Nutr 2009; 89: 191–203.

    Article  CAS  Google Scholar 

  11. Gahagan S, Yu S, Kaciroti N, Castillo M, Lozoff B . Linear and ponderal growth trajectories in well-nourished, iron-sufficient infants are unimpaired by iron supplementation. J Nutr 2009; 139: 2106–2112.

    Article  CAS  Google Scholar 

  12. Instituto Colombiano de Bienestar Familiar. Encuesta Nacional de la Situación Nutricional en Colombia (ENSIN) 2010, Available at http://www.icbf.gov.co/portal/page/portal/Descargas1/Resumenfi.pdf.

  13. Arsenault JE, Mora-Plazas M, Forero Y, Lopez-Arana S, Marin C, Baylin A et al. Provision of a school snack is associated with vitamin B-12 status, linear growth, and morbidity in children from Bogota, Colombia. J Nutr 2009; 139: 1744–1750.

    Article  CAS  Google Scholar 

  14. Office of the Mayor of Bogota. Estadisticas del sector educativo de Bogota 2005 y avances 2006. [Statistics of the educative sector of Bogota 2005 and advances 2006]. [ONLINE] 2006 [cited 2011 09/30/2011]; Available from ≤http://www.sedbogota.edu.co/AplicativosSED/Centro_Documentacion/anexos/publicaciones_2004_2008/estadisticas_05_avances_2006.pdf>.

  15. Lohman TG, Roche AF, Mortorell R . Anthropometric standardization reference manual. Human Kinetics Publishers: Champaign, Illinois, 1988.

    Google Scholar 

  16. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J . Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007; 85: 660–667.

    Article  Google Scholar 

  17. WHO. Physical status: the use and interpretation of anthropometry. World Health Organization: Geneva, 1995; 0512–3054.

  18. Lourenco BH, Villamor E, Augusto RA, Cardoso MA . Influence of early life factors on body mass index trajectory during childhood: a population-based longitudinal analysis in the Western Brazilian Amazon. Matern Child Nutr; e-pub ahead of print 1 October 2012.

  19. Durrleman S, Simon R . Flexible regression models with cubic splines. Stat Med 1989; 8: 551–561.

    Article  CAS  Google Scholar 

  20. Diggle P, Heagerty P, Liang K, Zeger S . Analysis of longitudinal data 2nd edn, Oxford University Press: Oxford, 2002.

    Google Scholar 

  21. Jaye DL, Waites KB . Clinical applications of C-reactive protein in pediatrics. Pediatr Infect Dis J 1997; 16: 735–746; quiz 46-7.

    Article  CAS  Google Scholar 

  22. Maslova E, Mora-Plazas M, Forero Y, Lopez-Arana S, Baylin A, Villamor E . Are vitamin A and iron deficiencies re-emerging in urban Latin America? A survey of schoolchildren in Bogota, Colombia. Food Nutr Bull 2009; 30: 103–111.

    Article  Google Scholar 

  23. Gibson S, Boyd A . Associations between added sugars and micronutrient intakes and status: further analysis of data from the National Diet and Nutrition Survey of Young People aged 4 to 18 years. Br J Nutr 2009; 101: 100–107.

    Article  CAS  Google Scholar 

  24. Cogswell ME, Looker AC, Pfeiffer CM, Cook JD, Lacher DA, Beard JL et al. Assessment of iron deficiency in US preschool children and nonpregnant females of childbearing age: National Health and Nutrition Examination Survey 2003-2006. Am J Clin Nutr 2009; 89: 1334–1342.

    Article  CAS  Google Scholar 

  25. Worwood M . Ferritin in human tissues and serum. Clin Haematol 1982; 11: 275–307.

    CAS  PubMed  Google Scholar 

  26. 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: 1035–1044.

    Article  CAS  Google Scholar 

  27. McCance KL, Heuther SE . Ch 26: alterations of erythrocyte function. In: Brashers VL, Rote NS eds. Pathophysiology: The Biologic Basis for Disease in Adults and Children 6 ed. Mosby Elsevier: Maryland Heights, Missouri, 2010, pp 996.

    Google Scholar 

  28. Knutson MD, Walter PB, Ames BN, Viteri FE . Both iron deficiency and daily iron supplements increase lipid peroxidation in rats. J Nutr 2000; 130: 621–628.

    Article  CAS  Google Scholar 

  29. Oppenheimer SJ . Iron and its relation to immunity and infectious disease. J Nutr 2001; 131: 616S–633SS, discussion 33S-35S.

    Article  CAS  Google Scholar 

  30. Tanner JM . The curve of growth. Fetus into Man. Massachusetts: Library of Congress Cataloging-in-Publication Data: Cambridge, 1990.

    Google Scholar 

  31. Arsenault JE, Mora-Plazas M, Forero Y, Lopez-Arana S, Baylin A, Villamor E . Hemoglobin concentration is inversely associated with erythrocyte folate concentrations in Colombian school-age children, especially among children with low vitamin B12 status. Eur J Clin Nutr 2009; 63: 842–849.

    Article  CAS  Google Scholar 

  32. Fleming RE, Bacon BR . Orchestration of iron homeostasis. N Engl J Med 2005; 352: 1741–1744.

    Article  CAS  Google Scholar 

  33. Falahi E, Akbari S, Ebrahimzade F, Gargari BP . Impact of prophylactic iron supplementation in healthy pregnant women on maternal iron status and birth outcome. Food Nutr Bull 2011; 32: 213–217.

    Article  Google Scholar 

  34. Zeleniuch-Jacquotte A, Zhang Q, Dai J, Shore RE, Arslan AA, Koenig KL et al. Reliability of serum assays of iron status in postmenopausal women. Ann Epidemiol 2007; 17: 354–358.

    Article  Google Scholar 

  35. Maes M, Scharpe S, Cooreman W, Wauters A, Neels H, Verkerk R et al. Components of biological, including seasonal, variation in hematological measurements and plasma fibrinogen concentrations in normal humans. Experientia 1995; 51: 141–149.

    Article  CAS  Google Scholar 

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Acknowledgements

The Bogotá School Children Cohort Study is sponsored by the ASISA Research Fund at the University of Michigan.

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Authors and Affiliations

  1. Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA

    W Perng & E Villamor

  2. Fundación para Investigación en Nutrición y Salud, FINUSAD, Bogotá, Colombia

    M Mora-Plazas & C Marin

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Correspondence to W Perng.

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Author Contributions

EV designed research; EV, MM-P and CM conducted research; WP analyzed data and wrote the paper; and WP has primary responsibility for final content. All authors read and approved the final manuscript.

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Perng, W., Mora-Plazas, M., Marin, C. et al. Iron status and linear growth: a prospective study in school-age children. Eur J Clin Nutr 67, 646–651 (2013). https://doi.org/10.1038/ejcn.2013.56

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