Iron deficiency is one of the most common nutritional deficiencies worldwide with potentially dangerous consequences. This article summarises the current positions of the Nutrition Committee of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHTN N), the Nutrition Committee of the American Academy of Pediatrics and the Centers for Disease Control and Prevention on the role of iron in infant nutrition, with particular emphasis on recommendations on how to prevent iron deficiency.
Excessive iron intake-mineral absorption
There is no evidence that large iron stores are beneficial to the system. On the contrary, it appears that excessive iron intake can have negative effects. One of these is the competition for absorption between iron and other divalent ions (Mn, Co, Cu, Zn, Ca, Pb), as this occurs via the same DMTI transport mechanism.8 9 Two studies have shown that the use of modified milks with high iron content (>=7 >mg/l) adversely affects copper absorption.26 27 In contrast, no such effect has been shown for zinc.28 29
Other effects
Iron has prooxidant properties and theoretically excessive intake. could cause oxidative damage, but there are no data that such a risk exists in children. In adults, epidemiological studies suggest an association between cardiovascular disease and excessive iron intake.30 31
Iron preparations and infectious diseases
The relationship between the administration of iron preparations and the occurrence of infectious diseases has been debated for years. A recently published meta-analysis of 28 randomised trials involving 7892 children showed that the administration of iron preparations (orally, including in modified milk and cereal products, as well as parenterally) does not significantly increase the risk of infectious disease. Children receiving iron preparations showed only a slightly increased risk of diarrhoea (risk increase of 0.05 (95% CI 0.03-0.13) diarrhoea episode/child/year), but the analysis did not provide a basis for inferring the aetiology of the diarrhoea (infectious or as a side effect of iron preparations).32
The results of the first meta-analysis of its kind provide a basis for the safe use of iron preparations orally, parenteral, as well as in mixtures and cereal products for children without fear of increasing the risk of infection.
photo ojoimages
Primary prevention of iron deficiency
As iron deficiency can adversely and possibly irreversibly affect a child's development, prophylactic administration of iron in selected risk groups is recommended in many countries. Adequate dietary iron content is a major determinant of iron stores in infants and young children, as evidenced by the reduction in the incidence of iron deficiency anaemia due to improved infant nutrition.1
Primary prevention of iron deficiency in infants (<12 m) and preschool children (1-5 yrs) relies on adequate nutrition for the child.
