Iron in breast milk and modified milk

The iron content of breast milk is approximately 0.3-0.5 mg/l.² The iron content of cow's milk is similar, but iron absorption from breast milk is approx. 5 times better than from cow's milk (50% vs. 10%)^.10 The iron content of milk mixtures varies from 1 mg/l (in non-iron-enriched milks) to 15 mg/l (in some iron-fortified formulas)^.11 As can be seen from Table 1, which presents recommendations for iron content in modified milks, including the most recent European guidelines developed by the Scientific Committee on Food, ¹¹ there is no consensus on the optimal concentration of iron in infant mixtures.

Table 1

Recommended iron concentrations in modified milks
Year	Recommendations	Min (mg/l)	Max (mg/l)
1977	ESPGHTN N	7	-
1981	Codex Alimentarius	1 mg / 100kcal	-
1991	European Union Directive	3	11
1998	Life Science Research Office	1,3	11
1999	American academy of Pediatrics	4	12
2003	Scientific Committee on Food
	Infant formula milk	0,3 mg / 100kcal	1,3 mg / 100kcal
	Follow-up milk	0,6 mg / 100kcal	1,7 mg / 100kcal
	Soy infant formulae	0.45 mg / 100kcal	1.9 mg / 100kcal
	Follow-on formulae	0.9 mg / 100kcal	2

Sources of iron

Table 2 shows the iron content of some foods^.3 Good sources of iron are pork liver, veal liver, chicken egg yolk, meat, and to a lesser extent green and yellow vegetables, fruit. The bioavailability of iron from foods varies and ranges from < 1 % do >25%. Haem iron, found in meat, poultry and fish, is absorbed 20-25%. The availability of non-haem iron, present in plant products and iron-enriched products, is worse, at about 5-10%^.12 Iron bioavailability increases in the presence of vitamin C-rich products. Iron-binding compounds, such as phytates present in cereal and soy products, impair iron absorption from the gastrointestinal tract.

Table 2

Iron content of breast milk and certain foods
Product		Iron (mg)
Breast milk	100ml	0,4
Pork liver	100 g	17
Veal liver	100 g	10
Beef meat	100 g	2,5-3,5
Apples	100 g	0,3
Potatoes	100 g	1
Spinach	100 g	3,9
Egg yolk	Art	0,95

Iron deficiency

Childhood iron deficiency is most common in infants during rapid growth (6-24 months of age) and is due to the gradual depletion of iron stores accumulated by the child during fetal life and a limited supply of this element in the infant's diet. The risk of iron deficiency depends on the diet. It is estimated that for exclusively breastfed infants, the risk of iron deficiency at 9-12 months of age is approximately 20 per cent, while for infants consuming iron-enriched modified milks it is approximately 8 per cent. The highest risk of approx. 30-40% is found in infants fed non-iron-enriched milk or unmodified cow's milk^.3 Infants born prematurely and children of diabetic mothers are also at risk of developing iron deficiency. The severity of iron deficiency can range from no physiological deficiency to iron deficiency anaemia impairing the function of multiple systems and organs^.1