title: The prevalence of anemia and iron deficiency is more common in breastfed infants than their mothers in Bhaktapur, Nepal.
abstract: OBJECTIVE
  Iron deficiency anemia is a widespread public health problem, particularly in low- and middle-income countries. Maternal iron status around and during pregnancy may influence infant iron status. We examined multiple biomarkers to determine the prevalence of iron deficiency and anemia among breastfed infants and explored its relationship with maternal and infant characteristics in Bhaktapur, Nepal.
  
  
  METHODS
  In a cross-sectional survey, we randomly selected 500 mother-infant pairs from Bhaktapur municipality. Blood was analyzed for hemoglobin, ferritin, total iron-binding capacity, transferrin receptors and C-reactive protein.
  
  
  RESULTS
  The altitude-adjusted prevalence of anemia was 49% among infants 2-6-month-old (hemaglobin (Hb) <10.8 g/dl) and 72% among infants 7-12-month-old (Hb <11.3 g/dl). Iron deficiency anemia, defined as anemia and serum ferritin <20 or <12 μg/l, affected 9 and 26% of infants of these same age groups. Twenty percent of mothers had anemia (Hb <12.3 g/dl), but only one-fifth was explained by depletion of iron stores. Significant predictors of infant iron status and anemia were infant age, sex and duration of exclusive breastfeeding and maternal ferritin concentrations.
  
  
  CONCLUSIONS
  Our findings suggest that iron supplementation in pregnancy is likely to have resulted in a low prevalence of postpartum anemia. The higher prevalence of anemia and iron deficiency among breastfed infants compared with their mothers suggests calls for intervention targeting newborns and infants.
authors.affiliation: Centre for International Health, University of Bergen, Bergen, Norway.|Department of Community Medicine, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal.
authors.forename: R K
authors.initials: RK
authors.lastname: Chandyo
authors.affiliation: Oslo and Akershus University College of Applied Science, Oslo, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Henjum
authors.affiliation: Department of Child Health, Institute of Medicine, Kathmandu, Nepal.
authors.forename: M
authors.initials: M
authors.lastname: Ulak
authors.affiliation: WorldFish, Malaysia, Bayan Lepas, Malaysia.|Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Thorne-Lyman
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway.|Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway.
authors.forename: R J
authors.initials: RJ
authors.lastname: Ulvik
authors.affiliation: Department of Child Health, Institute of Medicine, Kathmandu, Nepal.
authors.forename: P S
authors.initials: PS
authors.lastname: Shrestha
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Locks
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.|Department of Epidemiology and Global Health and Population, Harvard School of Public Health.
authors.forename: W
authors.initials: W
authors.lastname: Fawzi
authors.affiliation: Centre for International Health, University of Bergen, Bergen, Norway.|Innlandet Hospital Trust, Lillehammer, Norway.
authors.forename: T A
authors.initials: TA
authors.lastname: Strand
mesh_terms: D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology*; D015415:Biomarkers / Q000097:blood; D001942:Breast Feeding; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D005293:Ferritins / Q000097:blood; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D007501:Iron / Q000097:blood*; D000090463:Iron Deficiencies; D019266:Iron, Dietary / Q000008:administration & dosage; D016014:Linear Models; D008137:Longitudinal Studies; D009390:Nepal; D015995:Prevalence; D011990:Receptors, Transferrin / Q000097:blood; D018401:Sample Size; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D019266:Iron, Dietary; D011990:Receptors, Transferrin; D002097:C-Reactive Protein; D005293:Ferritins; D007501:Iron