A cohort study of haemoglobin and zinc protoporphyrin levels in term Zambian infants: effects of iron stores at birth, complementary food and placental malaria.
OBJECTIVE
To examine zinc-protoporphyrin (ZPP) and haemoglobin levels, and to determine predictors of iron deficiency anaemia (IDA) in Zambian infants.


METHODS
Ninety-one women and their normal birth weight (NBW) infants were followed bi-monthly during the first 6 months of life, and iron status, food intake, malaria parasitaemia and growth were monitored. At 4 months, the infants were divided into two groups, and the data were analysed according to whether or not they were exclusively breastfed.


RESULTS
Almost two-third of infants were born with low iron stores as defined by ZPP levels, and this proportion increased with age. Over 50% had developed IDA by 6 months. Exclusive breastfeeding at 4 months could be a protective factor for IDA (odds ratio (OR): 0.2; 95% confidence interval (CI): 0.0-1.1). Exclusively breastfed infants had higher haemoglobin values at 4 and 6 months (mean difference 0.6; 95% CI: 0.1-1.2 g/dl and mean difference 0.9; 95% CI: 0.2-1.7 g/dl, respectively), compared with infants with early complementary feeding. In univariate analysis, past or chronic placental malaria appeared to be a predictor of IDA at 4 and 6 months, but the significance was lost in multivariate analysis.


CONCLUSIONS
Zambian NBW infants are born with low iron stores and have a high risk to develop IDA in the first 6 months of life. Continuation of exclusive breastfeeding after 4 months is associated with a reduction of anaemia. The effect of placental malaria infection on increased risk of infant IDA could not be proven.
Paediatric Gastroenterology, Department of Paediatrics, University Medical Centre, Groningen, The Netherlands. p.f.vanrheenen@gmail.com
P F
PF
van Rheenen
L T T
LT
de Moor
S
S
Eschbach
B J
BJ
Brabin
D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D000818:Animals; D001942:Breast Feeding / Q000453:epidemiology; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena / Q000502:physiology*; D007231:Infant, Newborn; D008288:Malaria / Q000150:complications / Q000453:epidemiology; D008297:Male; D009751:Nutritional Requirements; D016017:Odds Ratio; D010920:Placenta / Q000469:parasitology; D010922:Placenta Diseases / Q000097:blood / Q000453:epidemiology / Q000469:parasitology; D011237:Predictive Value of Tests; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000097:blood / Q000453:epidemiology*; D011524:Protoporphyrins / Q000032:analysis / Q000097:blood*; D012307:Risk Factors; D014886:Weaning; D015024:Zambia / Q000453:epidemiology
D006454:Hemoglobins; D011524:Protoporphyrins; C017803:zinc protoporphyrin