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Prevalence and predictors of iron deficiency in fully breastfed infants at 6 mo of age: comparison of data from 6 studies^1,2,3

¹ From the Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA (ZY, BL, SA-A, KHB, CMC, RJC, and KGD); the Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden (MD and OH); and the Department of Nutrition and Food Science, University of Ghana, Legon, Ghana (AL).

² No funding source was involved in this study.

³ Reprints not available. Address correspondence to KG Dewey, Program in International and Community Nutrition, Department of Nutrition, University of California, One Shields Avenue, Davis, CA 95616-8669. E-mail: kgdewey{at}ucdavis.edu.

Background: Iron deficiency (ID) can occur among exclusively breastfed infants before 6 mo of age.

Objective: The objective was to determine which subgroups of fully breastfed infants are at highest risk of ID.

Design: We assessed the prevalence of ID (ferritin < 12 µg/L) and iron deficiency anemia (IDA; ferritin < 12 µg/L and hemoglobin < 105 g/L) and risk factors associated with ID and IDA at 6 mo among 404 fully breastfed infants with a birth weight >2500 g from 6 studies in Ghana, Honduras, Mexico, and Sweden. Infants with an elevated C-reactive protein concentration (8%) were excluded.

Results: The percentages of infants with ID were 6% in Sweden, 17% in Mexico, 13–25% in Honduras, and 12–37% in Ghana. The percentages with IDA were 2% in Sweden, 4% in Mexico, 5–11% in Honduras, and 8–16% in Ghana. With data pooled, the key predictors of ID (20%) were male sex [adjusted odds ratio (AOR): 4.6; 95% CI: 2.5, 8.5] and birth weight 2500–2999 g (AOR: 2.4; 95% CI: 1.4, 4.3). The predictors of IDA (8%) were male sex (AOR: 7.6; 95% CI: 2.5, 23.0), birth weight of 2500–2999 g (AOR: 3.4; 1.5, 7.5), and weight gain above the median since birth (AOR: 3.4; 95% CI: 1.3, 8.6). The combination of birth weight 2500–2999 g or male sex had a sensitivity of 91% for identifying ID and of 97% for identifying IDA.

Conclusions: Among fully breastfed infants with a birth weight >2500 g, IDA is uncommon before 6 mo, but male infants and those with a birth weight of 2500–2999 g are at higher risk of ID and IDA.

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