Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
Centre for Studies in Primary Care, Queen's University, Kingston, Ontario, Canada.
JAMA Netw Open. 2020 Jul 1;3(7):e208603. doi: 10.1001/jamanetworkopen.2020.8603.
Iron deficiency (ID) has the greatest prevalence in early childhood and has been associated with poor developmental outcomes. Previous research examining associations of income and food insecurity (FI) with ID is inconsistent.
To examine the association of family income and family risk of FI with iron status in healthy young children attending primary care.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included 1245 children aged 12 to 29 months who attended scheduled primary care supervision visits from 2008 to 2018 in Toronto, Canada, and the surrounding area.
Family income and risk of FI were collected from parent-reported questionnaires. Children whose parents provided an affirmative response to the 1-item FI screen on the Nutrition Screening Tool for Every Toddler or at least 1 item on the 2-item Hunger Vital Sign FI screening tool were categorized as having family risk of FI.
Iron deficiency (serum ferritin level <12 ng/mL) and ID anemia (IDA; serum ferritin level <12 ng/mL and hemoglobin level <11.0 g/dL). All models were adjusted for age, sex, birth weight, body mass index z score, C-reactive protein level, maternal education, breastfeeding duration, bottle use, cow's milk intake, and formula feeding in the first year.
Of 1245 children (595 [47.8%] girls; median [interquartile range] age, 18.1 [13.3-24.0] months), 131 (10.5%) were from households with a family income of less than CAD $40 000 ($29 534), 77 (6.2%) were from families at risk of FI, 185 (14.9%) had ID, and 58 (5.3%) had IDA. The odds of children with a family income of less than CAD $40 000 having ID and IDA were 3 times higher than those of children in the highest family income group (ID: odds ratio [OR], 3.08; 95% CI, 1.66-5.72; P < .001; IDA: OR, 3.28; 95% CI, 1.22-8.87; P = .02). Being in a family at risk of FI, compared with all other children, was not associated with ID or IDA (ID: OR, 0.43; 95% CI, 0.18-1.02; P = .06; IDA: OR, 0.16; 95% CI, 0.02-1.23; P = .08).
In this study, low family income was associated with increased risk of ID and IDA in young children. Risk of FI was not a risk factor for ID or IDA. These findings suggest that targeting income security may be more effective than targeting access to food to reduce health inequities in the prevention of iron deficiency.
缺铁症（ID）在儿童早期最为普遍，与发育不良的结果有关。先前研究检查了收入和粮食不安全（FI）与 ID 的关联，但结果不一致。
研究家庭收入和家庭 FI 风险与健康的幼儿铁状态之间的关联。
设计、地点和参与者：本横断面研究包括 2008 年至 2018 年期间在加拿大多伦多及其周边地区接受定期初级保健监督就诊的 1245 名 12 至 29 个月龄的儿童。
家庭收入和 FI 风险通过父母报告的问卷调查收集。父母对营养筛查工具中每一个幼儿的 1 项 FI 筛查或至少 2 项饥饿关键体征 FI 筛查工具中的 1 项回答为肯定的儿童被归类为有家庭 FI 风险。
缺铁症（血清铁蛋白水平 <12ng/mL）和 ID 贫血（IDA；血清铁蛋白水平 <12ng/mL 且血红蛋白水平 <11.0g/dL）。所有模型均调整了年龄、性别、出生体重、体重指数 z 评分、C 反应蛋白水平、母亲教育程度、母乳喂养持续时间、奶瓶使用、牛奶摄入和婴儿配方奶喂养在第一年的情况。
在 1245 名儿童（595 名[47.8%]女孩；中位数[四分位间距]年龄，18.1[13.3-24.0]个月）中，131 名（10.5%）来自家庭收入低于 40000 加元（29534 美元）的家庭，77 名（6.2%）来自有 FI 风险的家庭，185 名（14.9%）患有 ID，58 名（5.3%）患有 IDA。家庭收入低于 40000 加元的儿童发生 ID 和 IDA 的可能性是家庭收入最高组儿童的 3 倍（ID：比值比[OR]，3.08；95%置信区间[CI]，1.66-5.72；P<0.001；IDA：OR，3.28；95%CI，1.22-8.87；P=0.02）。与其他所有儿童相比，处于 FI 风险家庭的儿童 ID 或 IDA 的发生风险无差异（ID：OR，0.43；95%CI，0.18-1.02；P=0.06；IDA：OR，0.16；95%CI，0.02-1.23；P=0.08）。
在这项研究中，低收入家庭与幼儿 ID 和 IDA 的风险增加有关。FI 风险不是 ID 或 IDA 的危险因素。这些发现表明，与以食物获取为目标相比，以保障收入安全为目标可能更能有效减少铁缺乏症预防方面的健康不平等。
