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Jane M. Brotanek, MD, MPH; Jill S. Halterman, MD, MPH; Peggy Auinger, MS; Glenn Flores, MD; Michael Weitzman, MD

Arch Pediatr Adolesc Med. 2005;159:1038-1042.

Background  Childhood iron deficiency is associated with behavioral and cognitive delays. Few studies have explored the relationship between prolonged bottle-feeding and iron-deficiency anemia among toddlers.

Objective  To examine the association between prolonged bottle-feeding and iron deficiency in a nationally representative sample of children ages 1 to 3 years.

Design and Methods  The National Health and Nutrition Examination Survey III provides data on the feeding practices of children 1 to 3 years old and contains measures of iron status including transferrin saturation, free erythrocyte protoporphyrin, and serum ferritin. The prevalence of iron deficiency and duration of bottle-feeding were determined for black, white, and Mexican American toddlers. Bivariate and multivariate analyses were performed to examine the association between bottle-feeding duration and iron deficiency.

Results  Among 2121 children ages 1 to 3 years, the prevalence of iron deficiency was 6% among whites, 8% among blacks, and 17% among Mexican Americans (P<.001). With increasing duration of bottle-feeding, the prevalence of iron deficiency among all children increased (3.8%, bottle-fed 12 months; 11.5%, bottle-fed 13-23 months; and 12.4%, bottle-fed 24-48 months [P<.001]). At 24 to 48 months of age, 36.8% of Mexican American children were still bottle-fed, compared with 16.9% of white and 13.8% of black children. In multivariate analyses, bottle-feeding for 24 to 48 months and Mexican ethnicity were associated with iron deficiency (odds ratio, 2.8; 95% confidence interval, 1.3-6.0; and odds ratio, 2.9; 95% confidence interval, 1.5-5.6, respectively).

Conclusions  Children with prolonged bottle-feeding and Mexican American children are at higher risk for iron deficiency. Screening practices and nutritional counseling should be targeted at these high-risk groups.

Author Affiliations: Center for the Advancement of Underserved Children, Department of Pediatrics, Medical College of Wisconsin and Children’s Research Institute (Drs Brotanek and Flores), and Department of Epidemiology, Health Policy Institute, Medical College of Wisconsin, Milwaukee (Dr Flores); University of Rochester School of Medicine and Dentistry (Drs Halterman, Weitzman, and Ms Auinger), and the American Academy of Pediatrics Center for Child Health Research, Rochester, NY (Drs Auinger and Weitzman).

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