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Jane M. Brotanek, MD, MPH; Jacqueline Gosz, MS; Michael Weitzman, MD; Glenn Flores, MD

Arch Pediatr Adolesc Med. 2008;162(4):374-381.

Objective  To examine secular trends in iron deficiency among US children 1 to 3 years old.

Design  Secular trend analyses of the National Health and Nutrition Examination Survey II-IV.

Setting  Large-scale national survey conducted by the National Center for Health Statistics from 1976 to 2002.

Participants  US children 1 to 3 years old.

Outcome Measure  Prevalence of iron deficiency.

Results  Between 1976 and 2002, there was no change in iron deficiency prevalence in US toddlers. Iron deficiency prevalence remained unchanged in Hispanic and white toddlers but decreased among black toddlers. Across all 3 survey waves, racial/ethnic disparities in iron deficiency persisted between Hispanic and white toddlers, with a disparity ratio of at least 2. Iron deficiency prevalence remained high (20%-24%) in overweight toddlers, significantly higher than in those at risk for overweight (11%) and in normal weight or underweight toddlers (8%). Iron deficiency prevalence decreased from 22% to 9% in toddlers in poor households but remained unchanged in toddlers in nonpoor households (7%). In multivariable analyses, Hispanic, younger, and overweight toddlers had higher odds of iron deficiency.

Conclusions  Despite the decline in iron deficiency prevalence among 1-year-old, black, and poor children, iron deficiency prevalence in US toddlers overall has not changed in the last 26 years and remains elevated in certain high-risk groups: Hispanic, younger, and overweight toddlers. Efforts to reduce the prevalence of iron deficiency in infancy and early childhood are urgently needed and should target high-risk groups.

Author Affiliations: Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, and Children's Medical Center, Dallas (Drs Brotanek and Flores); St Andrew's School, Boca Raton, Florida (Ms Gosz); and Department of Pediatrics, New York University School of Medicine, New York, New York (Dr Weitzman).