Public Health Nutr. 2000 Dec; 3(4): 433-40.

Risk factors for poor iron status in British toddlers: further analysis of data from the National Diet and Nutrition Survey of children aged 1.5-4.5 years.

Thane CW, Walmsley CM, Bates CJ, Prentice A, Cole TJ.

MRC Human Nutrition Research, Cambridge, UK. thane@mrc-hnr.cam.ac.uk

OBJECTIVE:: To examine risk factors for poor iron status in British toddlers. DESIGN:: National Diet and Nutrition Survey (NDNS) of children aged 1.5-4.5 years. SETTING:: Mainland Britain, 1992/93. SUBJECTS:: Of the 1859 children whose parents or guardians were interviewed, a weighed dietary intake was provided for 1675, and a blood sample obtained from 1003. RESULTS:: Mean haemoglobin (Hb) and ferritin levels were significantly lower in younger (1.5-2.5 years) than in older (3.5-4.5 years) children, with boys having significantly lower ferritin levels than girls. Poor iron status ferritin <10 microg l-1, or low values for both indices) was associated with lower socioeconomic and employment status. Iron status was directly associated with meat and fruit consumption and inversely with that of milk and milk products, after adjustment for age and gender. The latter association remained significant after further adjustment for sociodemographic variables, energy intake and body weight. Children consuming >400 g day-1 of milk and cream were less likely to consume foods in other groups, with those also consuming little meat, fish, fruit and nuts at greatest risk of poor iron status. Few associations were observed between poor iron status and individual nutrient intakes, and iron status was not associated with either iron intake or with consumption of a vegetarian diet. CONCLUSIONS:: Overdependence on milk, where it displaces iron-rich or iron-enhancing foods, may put toddlers at increased risk of poor iron status. However, this becomes non-significant when moderate-to-high amounts of foods known to enhance iron status (e.g. meat and/or fruit) are also consumed. Milk consumption in this age group should ideally be part of a mixed and balanced diet including all food groups, and particularly lean meat (or other iron-rich or fortified foods) and fruit. This is particularly relevant for households of lower socioeconomic and employment status.