Iron-Fortified Foods Are Needed To Meet the Estimated Average Requirement for Iron in Australian Infants Aged 6 to 12 Months

Najma A Moumin; Jessica A Grieger; Merryn J Netting; Maria Makrides; Tim J Green

doi:10.1016/j.tjnut.2023.08.018

Iron-Fortified Foods Are Needed To Meet the Estimated Average Requirement for Iron in Australian Infants Aged 6 to 12 Months

J Nutr. 2023 Oct;153(10):3101-3109. doi: 10.1016/j.tjnut.2023.08.018. Epub 2023 Aug 19.

Authors

Najma A Moumin¹, Jessica A Grieger², Merryn J Netting³, Maria Makrides¹, Tim J Green⁴

Affiliations

¹ Women and Kids Theme, South Australia Health and Medical Research Institute, Adelaide South Australia, Australia; Discipline of Paediatrics, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide South Australia, Australia.
² Discipline of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia; Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia; Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
³ Women and Kids Theme, South Australia Health and Medical Research Institute, Adelaide South Australia, Australia; Discipline of Paediatrics, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide South Australia, Australia; Nutrition Department, Women's and Children's Health Network, Adelaide, South Australia, Australia.
⁴ Women and Kids Theme, South Australia Health and Medical Research Institute, Adelaide South Australia, Australia; College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia. Electronic address: tim.green@sahmri.com.

PMID: 37604385
DOI: 10.1016/j.tjnut.2023.08.018

Abstract

Background: Meeting iron intake recommendations is challenging for infants 6-12 mo, especially breastfed infants. Three-quarters of Australian infants 6-12 mo have iron intakes below the estimated average requirement (7 mg), placing them at risk of iron deficiency. After 6 mo, breastmilk is no longer sufficient to meet the increased demand for iron, and iron-rich complementary foods are recommended. Iron-fortified foods may be a means of improving iron intake in infants, particularly those that are breastfed.

Objectives: The aims of the study were as follows: 1) to examine the effect of milk-type and fortified foods on iron intake and the prevalence of inadequacy in infants 6-12 mo; 2) to model the effect of fixed amounts of iron-fortified infant cereal (IFIC) at 6 levels of iron fortification on total iron intake and the prevalence of inadequacy; and 3) to assess the effect IFIC on the intake of other nutrients in the diet.

Design: Secondary analysis of cross-sectional dietary intake data of infants 6-12 mo (n = 286) participating in the Australian Feeding Infants and Toddlers Study (OzFITS) 2021.

Results: Median (interquartile range) iron intake was 8.9 (7.5, 10.3); 6.3 (4.5, 8.2); and 2.7 (1.5, 4.4) mg/d in formula-fed, combination-fed, and breastfed infants, respectively. The corresponding prevalence of inadequacy was 19%, 67%, and 96%. Infants who consumed fortified foods had higher median iron intakes than those who did not, 6.2 compared with 1.9 mg/d. Dietary modeling showed that consuming 18 g (300 kJ) of IFIC, fortified at 35 mg/100 g dry weight, reduces the prevalence of inadequacy for iron from 75% to 5% for all infants.

Conclusions: Iron intakes are low in Australian infants, especially for breastfed infants in the second half of infancy. Modeling shows that 300 kJ of IFIC, the current manufacturer-recommended serving, fortified at 35 mg/100 g dry weight, added to infant diets would be an effective means to reduce the prevalence of inadequacy for iron.

Keywords: Australia; dietary modeling; infant feeding; iron; iron-fortified infant cereal.