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Nutritional Epidemiology

Risk of Infant Anemia Is Associated with Exclusive Breast-Feeding and Maternal Anemia in a Mexican Cohort1,2
Jareen K. Meinzen-Derr,* M. Lourdes Guerrero,y Mekibib Altaye,* Hilda Ortega-Gallegos,y Guillermo M. Ruiz-Palacios,y and Ardythe L. Morrow*3
* Center for Epidemiology and Biostatistics and Department of Pediatrics, University of Cincinnati College ofMedicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and yDepartamento de Infectologia, Instituto Nacional de Ciencias Medicas y Nutricion, Mexico, DF
ABSTRACT The WHO recommends exclusive breast-feeding (EBF) for the first 6 mo of life to decrease the burden of infectious disease. However, some are concerned about the effect of EBF .6 mo on iron status of children in developingcountries in which anemia is prevalent. This study examines the risk of anemia in relation to the duration of EBF and maternal anemia in a birth cohort studied between March 1998 and April 2003. All infant birth weights were $2.2 kg. All mothers received home-based peer counseling to promote EBF. Infant feeding data were collected weekly. Nurses measured hemoglobin (Hb) values every 3 mo. Hb wasmeasured in 183 infants at 9 mo of age. Anemia at 9 mo was defined as a Hb value ,100 g/L. EBF was defined by WHO criteria and ranged in duration from 0 to 31 wk. At 9 mo, Hb (mean 6 SEM) was 114 6 0.9 g/L; 23 children (12.5%) had Hb levels ,100 g/L. EBF .6 mo, but not EBF 4–6 mo, was associated with increased risk of infant anemia compared with EBF ,4 mo (odds ratio ¼ 18.4, 95% CI ¼ 1.9, 174.0).Maternal anemia was independently (P ¼ 0.03) associated with a 3-fold increased risk of infant anemia. These associations were not explained by confounding with other maternal or infant factors. By linear regression, a lower infant Hb at 9 mo was associated with increased EBF duration among mothers who had a history of anemia (b ¼ ÿ0.07, P ¼ 0.003), but not among mothers with no history of anemia.Infants who are exclusively breast-fed for .6 mo in developing countries may be at increased risk of anemia, especially among mothers with a poor iron status; greater attention to this issue is warranted. J. Nutr. 136: 452–458, 2006. KEY WORDS:  infant anemia  maternal anemia  exclusive breast-feeding

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Iron deficiency is the most commonnutrient deficiency and cause of anemia in childhood (1). Although prevalence rates of anemia among healthy term infants 6–18 mo of age are reported to be as low as 2–6% in Western Europe and the United States (2–4), iron deficiency anemia was shown to affect more than half of the children in some developing countries (5). In Mexico, 27% of children ,5 y old are anemic (6,7). A nationalprobabilistic survey of Mexican children reported the prevalence of anemia to be 13% at 6–11 mo of age, but as high as 49% among children 12–24 mo old (8). Varying degrees of anemia in young children are associated with poor cognitive outcomes (9–13). Anemia diagnosed at 8 or 9 mo of age has been associated with significantly lower achievement scores in 2nd grade children (14) and impaired motor developmentat 18 mo (15). Iron deficiency anemia was also shown to be significantly associated with mental retardation (16), decreased
1 Presented as part of the 11th conference for the International Society for Research in Human Milk and Lactation, October 4–8 2002, Mexico City, Mexico [Meinzen-Derr JK, Guerrero ML, Altaye M, Ruiz-Palacios GM, Morrow AL. Duration of exclusive breastfeeding and risk ofanemia in a cohort of Mexican infants. Adv Exp Med Biol. 2004;554:395-8]. 2 Supported by The National Institute of Child Health and Human Development HD13021. 3 To whom correspondence should be addressed. E-mail: Ardythe.Morrow@ cchmc.org.

activity, increased wariness or hesitance, and remaining in close proximity with caregivers (17). Although the iron in human milk is highly bioavailable (;50%...