WHO GETS IRON DEFICIENCY ANEMIA (IDA) IN INFANCY

The purpose of the proposed study was to identify nutritional and social influences on IDA in infancy. A community project in Costa Rica on the behavioral effects of IDA provided an unusual opportunity to examine such influences, since the 191 12-to 23-month-old infants were all healthy, with birth weights ≥ 2.5kg, without previous iron therapy, and living in a country in which breast feeding was the norm and iron-fortified formula or cereal extraordinarily rare. Factors that were hypothesized to effect IDA (defined as a Hb ≤ 10.5 g/dl and a low ferritin and either a high FEP or low transferrin saturation) were grouped conceptually into five stages on the basis of their remote to immediate influence on IDA: family background, neonatal factors, age and sex, caregiving conditions, and current physiologic status of the child, using weight/length percentile and whole blood lead level. Structural modeling (LISREL) was used to develop and test a model of direct and indirect effects. Direct effects were that infants with IDA had lower birth weights (p=0.03), consumed greater amounts of cow's milk/day (p=0.01), were breast fed for shorter times (p=0.02), had poorer home environments (HOME scale) (p<0.01), and had their grandparents in the home (p=0.02). Indirect effects were that the lower the mother's IQ the poorer the quality of home and the more likely for grandparents to be living in the household; younger mothers were more likely to live with their parents. These results suggest that preventing and treating IDA requires not only appropriate doses of medicinal iron but also attention to feeding practices and disadvantaged conditions in the home environment.