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This Article Free via Open Access: OA OA Full Text Full Text (PDF) OA All Versions of this Article: 90/4/1023    most recent ajcn.2009.27561v1 Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Cockell, K. A Articles by Lowell, H. PubMed PubMed Citation Articles by Cockell, K. A Articles by Lowell, H. Agricola Articles by Cockell, K. A Articles by Lowell, H.

Application of the Dietary Reference Intakes in developing a recommendation for pregnancy iron supplements in Canada^1,2,3

¹ From the Nutrition Research Division, Food Directorate (KAC) and the Office of Nutrition Policy and Promotion (DCM and HL), Health Products and Food Branch, Health Canada, Ottawa, Canada.

² Supported by Health Canada.

³ Address correspondence to KA Cockell, Nutrition Research Division, Food Directorate, Health Products and Food Branch, Health Canada, 2203E Banting Research Centre, 251 Sir Frederick Banting Driveway, Ottawa, ON, Canada K1A 0K9. E-mail: kevin_cockell{at}hc-sc.gc.ca.

Background: For many pregnant Canadian women, usual iron intakes from food appear to be inadequate compared with Dietary Reference Intake requirement estimates.

Objective: Dietary intake modeling was undertaken to determine an amount of iron supplementation that would confer acceptably low prevalence of apparently inadequate and apparently excessive intakes.

Design: The distribution of usual dietary iron intakes was estimated with the use of 24-h recalls from pregnant women aged 19–50 y in the Canadian Community Health Survey, Cycle 2.2. The prevalence of usual intakes below the Estimated Average Requirement for pregnancy (22 mg/d) or above the Tolerable Upper Intake Level (45 mg/d) was estimated. Iterative modeling with incremental iron supplement was performed to determine a suitable supplement amount. Because the sample of pregnant women was small (148 day 1 recalls), estimates of the tails of the distributions had large SDs, and supporting analyses based on intake data from nonpregnant women (4540 day 1 recalls) were made.

Results: Daily supplementation shifted the intake distribution curve without changing its shape. Supplementation with 16 mg iron/d was consistent with low (<3%) prevalence of apparently inadequate intakes. This amount of supplementation should not be associated with an increase in apparently excessive intakes by pregnant women in this population.

Conclusions: On the basis of Dietary Reference Intakes, an iron supplement of 16 mg/d throughout pregnancy is justified as both efficacious and safe for healthy women living in Canadian households. This does not preclude the need for therapeutic iron doses for some individuals on the basis of iron status. The method can be applied to other populations if suitable baseline iron intake data are available.