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WHO Recommendation, 2001
The evidence from one trial in Honduras demonstrates poorer iron status in infants exclusively breastfed for 6 months, versus 4 months followed by partial breastfeeding to 6 months, and this evidence is likely to apply to populations in which maternal iron status and infant endogenous stores are not optimal.
Iron deficiency anemia in Europe In a study of 11 sites*, prevalence at 12 months
was 2.3% No relationship to breastfeeding 0% in families with high socio-economic status Early introduction of cow’s milk was greatest risk
factor* Male C et al. Prevalence of iron deficiency in 12-mo-old infants from
11 European areas and influence of dietary factors on iron status
(Euro-Growth study), Acta Paediatrica 2001;90:492-498
Iron status at 12 monthsExclusive breast-
feeding**Exclusive breast-
feeding**
for 7 mo (n = 9) for <7 mo (n = 21)
Hb concentration, gm/L (SD) 11.7 (0.4) 10.9 (0.7)*
No. (%) of Hb concentration <110 gm/L 0 (0) 9 (43)
Mean serum ferritin, µg/L (SD) 17 (15) 12.3 (11.7)
No. (%) with serum ferritin level <10 µg/L 2 (22) 11 (52)
No. (%) with Hb >110 gm/L and serum ferritin level >10 µg/L
7 (78) 10 (48)
Hb, Hemoglobin.
Pisacane et al, Iron status in breast-fed infants. J.Pediatr 127:429-341, 1995 *t = 3.2; df = 28; p = 0.003. **No other milk or sources of iron
Latest review on iron and breastfeeding* Currently, the best evidence is that [avoidance of
iron deficiency] is achieved by prolonged breastfeeding, avoidance of unfortified formulas and cow's milk,
and the introduction of iron -fortified and vitamin C-
fortified weaning foods at approximately 6 months of age
*Griffin, I J; Abrams, S A. Iron and breastfeeding, Pediatric Clinics of
North America 2001;48:401-413
New Phd by Magnus Domellöf Iron requirements of term, breast-fed
infants. Umeå University, Sweden, 2001 First reference values for iron for (nearly)
exclusively breast-fed babies at 4 vs 6 mon Only one of five papers published so far
Interpretation Iron supplementation of iron-replete infants
from 6-9 months has no effect This suggests that at this age iron stores
down-regulate absorption No such mechanism appears to exist before
6 months of age
Impact of 6 months EBF on mother’s iron status* The additional burden of EBF for 6 compared to 4
months is about 0.5% of body stores Longer EBF leads to longer amenorrhea, saving
iron, especially for women with high menstrual blood loss
*Dewey, K G, et al. Effects of exclusive breastfeeding for four versus six months on maternal nutritional status and infant motor development: results of two randomized trials in Honduras. The
Journal of Nutrition 2001;131:262-267
Conclusions Breastfeeding exclusively for six months
appears to entail no risk of iron deficiency in infants: Among infants born at term, and In groups with high socio-economic status,
and When the mother’s iron status is adequate