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Summary: This study assessed the effectiveness of multivitamins (MV) with iron as prophylaxis against iron deficiency (ID) and anemia in infancy. The study was a double-blind, randomized trial at 2 urban primary care clinics. Subjects included healthy, full-term infants enrolled at their 6-month well-child visit. Parents administered MV, either with iron or without iron, by mouth daily for 3 months. At 9 months of age, 28.3% of 310 had either anemia or ID without anemia. Among infants with any adherence, anemia was found in 11.1% of the iron group and 21.7% in the noniron group (RR=0.5, 95% CI=0.3-1.0). Iron deficiency without anemia was found in 18.5% of the iron group; 14.4% of the noniron group (p=0.46). When administered daily starting at age 6 months, standard-dose multivitamins with iron appear to reduce anemia prevalence at 9 months of age.
Clin Pediatr. 2001;40:549-554
Introduction
Iron deficiency is the most common nutrient deficiency and cause of anemia in childhood.1 In the United States, iron deficiency affects 700,000 children aged 1-2 years, while iron deficiency anemia (IDA) affects 240,000.2 The prevalence of IDA ranges from 20% to 25% among young low-income children.3,4 This occurs in Boston despite nearly universal use of iron-supplemented foods from the Supplemental Nutrition Program for Women, Infants, and Children (WIC). Local surveillance data show that the prevalence of anemia among children at the Boston Medical Center (BMC) and Upham's Corner Health Center (UCHC) WIC offices are 23% and 19%, respectively (Anne Pearson, personal communication, Massachusetts WIC Program, Department of Public Health, April 12, 1998).
Iron deficiency has been associated with long-term cognitive impairment.5,6 Several clinical trials have demonstrated reduced Bayley scores among iron-deficient infants.7-17 In some studies, deficits were reparable with iron repletion,7,12 in others, persistent despite repletion.7,10,11,13,14 Iron deficiency has also been associated with other sequelae beyond cognitive impairment.15,18-23
Past attempts at prevention have emphasized supplementation of cereal and formula through public health strategies, as opposed to clinical interventions.24,25 Engelmann et a126 reported that infants fed a high-- meat diet had a smaller decline in hemoglobin than those fed a low-- meat diet. However, Childs et a127 found no improvement in iron status in high-risk infants after education to promote beneficial dietary practices.
Recognizing reports of widespread use of vitamin supplements among preschool...