Young children formula consumption and iron deficiency at 24 months in the general population: A national-level study

  • Anne-Sylvia Sacri
    Correspondence
    Corresponding author. Inserm UMR1153, Épidémiologie Périnatale, Obstétricale et Pédiatrique (ÉPOPé), Maternité de Port Royal, 53 avenue de l'Observatoire, 75014, Paris, France. Fax: +33143268979.
    Affiliations
    Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Inserm UMR 1153, Labex GR-Ex, Paris Descartes University, France

    Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants Malades Hospital, AP-HP, Paris Descartes University, Paris, France
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  • Alain Bocquet
    Affiliations
    Association Française de Pédiatrie Ambulatoire (AFPA), Talence, France

    Comité de Nutrition de la Société Française de Pédiatrie, Paris, France
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  • Mariane de Montalembert
    Affiliations
    Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Inserm UMR 1153, Labex GR-Ex, Paris Descartes University, France

    Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants Malades Hospital, AP-HP, Paris Descartes University, Paris, France
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  • Serge Hercberg
    Affiliations
    Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Nutritional Epidemiology Research Team (EREN), Inserm UMR 1153, Paris Descartes University, Sorbonne Paris Cité, France

    Département de Santé Publique, AP-HP, Hôpital Avicenne, Bobigny, France
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  • Laurent Gouya
    Affiliations
    Centre de Recherche sur l'inflammation, Inserm UMR 1149, Université Paris Diderot, ERL CNRS 8252, Faculté de Médecine Site Bichat, Paris, France
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  • Béatrice Blondel
    Affiliations
    Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Inserm UMR 1153, Labex GR-Ex, Paris Descartes University, France
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  • Amandine Ganon
    Affiliations
    Laboratoire CERBA, Saint-Ouen l’Aumône, France
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  • Pascale Hebel
    Affiliations
    Centre de Recherche pour l'Etude et l'Observation des Conditions de vie (CREDOC), Paris, France
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  • Catherine Vincelet
    Affiliations
    Centre Régional de Coordination des dépistages des Cancers Ile-de-France, Lieusaint, France
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  • Franck Thollot
    Affiliations
    AFPA, Essay Les Nancy, France
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  • Massimiliano Rallo
    Affiliations
    AFPA, Nantes, France
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  • Piotr Gembara
    Affiliations
    AFPA, Vichy, France
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  • Corinne Levy
    Affiliations
    Association Française de Pédiatrie Ambulatoire (AFPA), Talence, France

    Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), Saint-Maur des Fossés, France

    Université Paris Est, IMRB- GRC GEMINI, 94000, Créteil, France
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  • Martin Chalumeau
    Affiliations
    Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Inserm UMR 1153, Labex GR-Ex, Paris Descartes University, France

    Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants Malades Hospital, AP-HP, Paris Descartes University, Paris, France
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      Summary

      Background & aims

      Iron deficiency (ID) is considered the most frequent micronutrient deficiency in industrialized countries where strategies for its primary prevention vary widely and are insufficiently evaluated. We aimed to study the effectiveness for iron status of a national iron deficiency prevention strategy based on recommendations for young-child formula (YCF) use after age 12 months, taking into consideration other sources of iron and the family's socio-economic status.

      Methods

      In a cross-sectional observational study conducted in primary care pediatrician offices throughout France from 2016 to 2017, infants aged 24 months were consecutively included for a food survey and blood sampling. Associations between YCF consumption and serum ferritin (SF) level were studied by multivariable regression after adjustment on sociodemographic, perinatal and dietary characteristics, notably other intakes of iron.

      Results

      Among the 561 infants analyzed, the ID prevalence was 6.6% (37/561; 95% confidence interval [CI] 4.7–9.0). Daily iron intake excluding YCF and total daily iron intake including YCF were below the 5-mg/day recommended average requirements for 63% and 18% of children, respectively. ID frequency was significantly decreased (or SF level was independently higher) with any YCF consumption after age 10 months (odds ratio 0.15, 95% CI 0.07–0.31), current YCF consumption at age 24 months (median SF level 29 vs 21 μg/L if none), prolonged YCF consumption (28 μg/L if >12 months vs 17 μg/L if none), and increasing daily volume of YCF consumed at age 24 months from a small volume (e.g., 29 μg/L if <100 mL/day vs 21 μg/L if none).

      Conclusions

      Current or past YCF use was independently associated with a better iron status at age 24 months than non-use. The strategy recommending YCF use at weaning after age 12 months seems effective in the general population.

      ClinicalTrials.gov identifier

      NCT02484274.

      Keywords

      Abbreviations:

      AR (average requirements), EFSA (European Food and Security Authority), ID (iron deficiency), IFF (iron-fortified formula), SF (serum ferritin), YCF (young children formula)
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