title: Prevalence and risk factors of iron deficiency in healthy young children in the southwestern Netherlands.
abstract: OBJECTIVE
  Iron deficiency (ID) and iron deficiency anemia (IDA), during the first years of life, are associated with delayed motor and neurological development. Many studies evaluated iron status without an assessment of an acute-phase protein to identify infection. Because most indicators of iron status are influenced by infection, these data may underestimate the ID prevalence. A food consumption survey in the Netherlands showed that the mean iron intake of children ages 2 to 3 years was below the advised adequate intake of 7 mg/day. The aim of the study was to investigate iron status in a well-defined, healthy population of young children in the southwestern region of the Netherlands and to identify risk factors for ID.
  
  
  METHODS
  We conducted a multicenter, observational study in healthy children ages 0.5 to 3 years. We defined ID as ferritin <12 μg/L and IDA when, in addition, hemoglobin was <110 g/L. Children with elevated C-reactive protein levels (>5 mg/L) or underlying causes for anemia were excluded. Parents filled in a questionnaire to identify risk factors for ID.
  
  
  RESULTS
  We included 400 children in the study. ID and IDA were detected in 18.8% and 8.5% of the children, respectively. The present use of formula and the visit of preschool/day care were associated with a lower prevalence of ID, and a high intake of cow's milk was associated with a higher prevalence of ID, after adjustment for age.
  
  
  CONCLUSIONS
  ID is present in 18.8% of healthy children ages 0.5 to 3 years and living in the southwestern region of the Netherlands. The present visit of preschool/day care and the use of formula are associated with a reduced risk of ID, whereas a high intake of cow's milk is associated with an increased risk of ID.
authors.affiliation: *Department of Pediatrics, Juliana Children's Hospital †Haga Teaching Hospital ‡Department of Clinical Chemistry §Department of Anesthesiology, Juliana Children's Hospital, Haga Teaching Hospital, The Hague ||Department of Pediatrics ¶Department of Anesthesiology, Sophia Children's Hospital, Erasmus MC, Rotterdam #Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Lieke
authors.initials: L
authors.lastname: Uijterschout
authors.forename: Janneke
authors.initials: J
authors.lastname: Vloemans
authors.forename: Rimke
authors.initials: R
authors.lastname: Vos
authors.forename: Peter-Paul
authors.initials: PP
authors.lastname: Teunisse
authors.forename: Cisca
authors.initials: C
authors.lastname: Hudig
authors.forename: Sally
authors.initials: S
authors.lastname: Bubbers
authors.forename: Sascha
authors.initials: S
authors.lastname: Verbruggen
authors.forename: Margriet
authors.initials: M
authors.lastname: Veldhorst
authors.forename: Tom
authors.initials: T
authors.lastname: de Leeuw
authors.forename: Johannes B
authors.initials: JB
authors.lastname: van Goudoever
authors.forename: Frank
authors.initials: F
authors.lastname: Brus
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000453:epidemiology / Q000209:etiology; D000818:Animals; D002656:Child Day Care Centers; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003677:Deficiency Diseases / Q000453:epidemiology / Q000209:etiology; D004032:Diet; D004034:Diet Surveys; D005247:Feeding Behavior; D005260:Female; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D041943:Infant Formula; D007501:Iron / Q000008:administration & dosage; D000090463:Iron Deficiencies; D008297:Male; D008892:Milk; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012016:Reference Values; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D006454:Hemoglobins; D005293:Ferritins; D007501:Iron