Burke Rachel M, Rebolledo Paulina A, Aceituno Anna M, Revollo Rita, Iñiguez Volga, Klein Mitchel, Drews-Botsch Carolyn, Leon Juan S, Suchdev Parminder S
Department of Epidemiology, Rollins School of Public Health, Emory University, Claudia Nance Rollins Building, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA.
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
BMC Pediatr. 2018 Mar 12;18(1):107. doi: 10.1186/s12887-018-1066-2.
Iron deficiency (ID) is the most common micronutrient deficiency worldwide, with potentially severe consequences on child neurodevelopment. Though exclusive breastfeeding (EBF) is recommended for 6 months, breast milk has low iron content. This study aimed to estimate the effect of the length of EBF on iron status at 6 - 8 months of age among a cohort of Bolivian infants.
Mother-infant pairs were recruited from 2 hospitals in El Alto, Bolivia, and followed from one through 6 - 8 months of age. Singleton infants > 34 weeks gestational age, iron-sufficient at baseline, and completing blood draws at 2 and 6 - 8 months of age were eligible for inclusion (N = 270). Ferritin was corrected for the effect of inflammation. ID was defined as inflammation-corrected ferritin < 12 μg/L, and anemia was defined as altitude-corrected hemoglobin < 11 g/dL; IDA was defined as ID plus anemia. The effect of length of EBF (infant received only breast milk with no other liquids or solids, categorized as < 4, 4 - 6, and > 6 months) was assessed for ID, IDA, and anemia (logistic regression) and ferritin (Fer) and hemoglobin (Hb, linear regression).
Low iron status was common among infants at 6 - 8 months: 56% of infants were ID, 76% were anemic, and 46% had IDA. EBF of 4 months and above was significantly associated with ID as compared with EBF < 4 months (4 - 6 months: OR 2.0 [1.1 - 3.4]; > 6 months: 3.3 [1.0 - 12.3]), but not with IDA (4 - 6 months: OR 1.4 [0.8 - 2.4]; > 6 months: 2.2 [0.7 - 7.4]), or anemia (4 - 6 months: OR 1.4 [0.7 - 2.5]; > 6 months: 1.5 [0.7 - 7.2]). Fer and Hb concentrations were significantly lower with increasing months of EBF.
Results suggest a relationship between prolonged EBF and ID, but are not sufficient to support changes to current breastfeeding recommendations. More research is needed in diverse populations, including exploration of early interventions to address infant IDA.
缺铁是全球最常见的微量营养素缺乏症，可能对儿童神经发育产生严重后果。虽然建议纯母乳喂养6个月，但母乳中铁含量较低。本研究旨在评估玻利维亚一组婴儿中纯母乳喂养时长对6至8个月龄时铁状态的影响。
母婴对从玻利维亚埃尔阿尔托的两家医院招募，从1个月龄随访至6至8个月龄。单胎婴儿，胎龄>34周，基线时铁充足，且在2个月龄和6至8个月龄时完成血液检测者符合纳入标准（N = 270）。对铁蛋白进行炎症影响校正。缺铁定义为炎症校正后铁蛋白<12μg/L，贫血定义为海拔校正后血红蛋白<11g/dL；缺铁性贫血定义为缺铁加贫血。评估纯母乳喂养时长（婴儿仅接受母乳，无其他液体或固体食物，分为<4个月、4至6个月和>6个月）对缺铁、缺铁性贫血和贫血（逻辑回归）以及铁蛋白（Fer）和血红蛋白（Hb，线性回归）的影响。
6至8个月龄婴儿中铁状态低下很常见：56%的婴儿缺铁，76%的婴儿贫血，46%的婴儿患有缺铁性贫血。与纯母乳喂养<4个月相比，纯母乳喂养4个月及以上与缺铁显著相关（4至6个月：比值比[OR]2.0[1.1 - 3.4]；>6个月：3.3[1.0 - 12.3]），但与缺铁性贫血无关（4至6个月：OR 1.4[0.8 - 2.4]；>6个月：2.2[0.7 - 7.4]），也与贫血无关（4至6个月：OR 1.4[0.7 - 2.5]；>6个月：1.5[0.7 - 7.2]）。随着纯母乳喂养月数增加，铁蛋白和血红蛋白浓度显著降低。
结果表明纯母乳喂养时间延长与缺铁之间存在关联，但不足以支持改变当前的母乳喂养建议。需要在不同人群中开展更多研究，包括探索针对婴儿缺铁性贫血的早期干预措施。
