[Changes in the hemogram and in the laboratory parameters indicative of iron metabolism in mild viral infections]. / Modificaciones del hemograma y de los parámetros de laboratorio indicadores del metabolismo de hierro en infecciones virales leves.

PURPOSE: To assess the duration and intensity of the changes appearing in laboratory values related to iron utilisation during viral infection. MATERIAL AND METHODS: With previous parental consent, 120 eutrophic infants received vaccination with attenuated measles virus or a combination of measles, mumps and rubella viruses as a model of mild viral infection. A number of laboratory tests were performed on day 0 and in two later occasions (4-21, 9-14 or 9-30); these included blood cell counts, ESR, serum iron, total iron binding capacity, transferrin saturation index, free erythrocytic protoporphyrin, serum ferritin, intra-erythrocytic ferritin, direct anti-human globulin test and C-reactive protein. The statistical analyses were done in accordance with ANOVA, Student's t test, Wilcoxon, Kruskall - Wallis, Mann-Whitney and Fisher methods. RESULTS: A significant haemoglobin drop was seen on days 9 and 14 post-vaccination. This descent was > 10 g/L in 8.2% of the cases, and > or = 6 g/L in 19.6%. Serum iron and transferrin saturation decreased significantly, whereas mean corpuscular volume, free erythrocyte protoporphyrin and serum ferritin were significantly increased. All these but protoporphyrin recovered by day 30. Subjects with normal iron metabolism figures on day 0 and those whose thermal variations were above 38 degrees C had greater changes in the figures related to iron metabolism. CONCLUSION: The evaluation of iron metabolism is not reliable if the patient has suffered from infection, although a mild viral one, in the three weeks prior to the study.

[Iron-deficiency anemia in the nursing infant: its elimination with iron-fortified milk]. / Anemia ferropriva en el lactante: erradicación con leche fortificada con hierro.

We evaluated the effect of iron-supplemented milk on 86 healthy infants who were followed from 3 to 12 months of age. Whole milk was supplemented with 15 mg elementary iron as ferrous sulphate and 100 mg ascorbic acid per 100 g powder. 104 infants received the same milk with no supplement and served as control. All iron nutritional parameters were higher in the supplemented group at 9 and 12 months of treatment (p < 0.01). Iron-deficiency anemia was shown in 34% of the control as compared to 0% of the treatment group. The product exhibited excellent tolerance and could therefore be used to eradicate iron-deficiency anemia of the infant.

Haemoglobin fortified cereal: a source of available iron to breast-fed infants.

We tested in the field an extruded rice flour, fortified with a bovine haemoglobin concentrate (Fe:14 mg/100 g of powder). This cereal has a high iron bioavailability, good protein quality and amino acid score. Healthy, term breast-fed infants were prospectively studied. One group (n = 92) received the fortified cereal (from 4 to 12 months of age). As control, 96 infants received regular solid foods (cooked vegetables and meat) from age 4 months. At the end of the field trial, a subsample of infants in both groups was supplemented with 45 mg Fe during 90 d. Iron nutrition status was determined at 9, 12 and 15 months. At 12 months, iron deficiency anaemia was present in 17 per cent of controls, in 10 per cent of fortified infants as a whole, but only in 6 per cent of the babies who consumed over 30 g of cereal/d. In addition, this latter group did not show any significant changes in iron nutrition status after the supplementation trial. Results demonstrate that the consumption of a haemoglobin fortified cereal is effective in markedly reducing the incidence of iron deficiency in breast-fed infants.

Hemoglobin-fortified biscuits: bioavailability and its effect on iron nutriture in school children.

School-age children in Chile received 30 g of wheat-flour biscuits daily through a National School Lunch Program. To improve iron nutrition, these biscuits were fortified with 6% of a bovine hemoglobin concentrate. Hemoglobin iron bioavailability, measured with a double isotope technique, showed that heme-iron absorption in fortified biscuits was high (19.7%). In a pilot field trial, a cohort of 215 school-children received fortified biscuits (30 g) daily during two school periods, and their iron nutrition status was compared with that of children who received non-fortified biscuits (n = 212). Acceptability of both types of biscuits was excellent. Initially, both groups had comparably good iron nutrition. The fortified children presented higher mean ferritin values at the end of the first and second school periods. Good iron stores (serum ferritin greater than or equal to 20 micrograms/lt) were present in 92% and 79% of the fortified and control subjects, respectively (P less than 0.004). The high-iron bioavailability, the good organoleptic characteristics and the biological effect on iron nutriture make this product an appealing alternative to combat iron deficiency.

Anemia of a mild viral infection: the measles vaccine as a model.

To define the hematologic changes during a mild viral infection, 93 infants were immunized with live attenuated measles virus and studied prospectively at 0, 4, 9, 14, 21, and 30 days. Hemoglobin concentration decreased significantly by days 9 and 14. The decrease was greater than 1.0 g/dL in 8.6% and greater than 0.6 in 24.3% of the infants. Of the nonanemic infants, 22% became anemic. Serum iron and percentage saturation of transferrin decreased, whereas serum ferritin increased significantly. Mean cell volume, iron-binding capacity, protoporphyrin, and haptoglobin did not show changes. Reticulocyte index and erythropoietin increased significantly at 30 days. Leukocyte counts, Zetacrit, and C-reactive protein did not help to predict the hemoglobin decrease. These results suggest that a mild viral infection in infants induces a significant decrease in hemoglobin that may persist for 14 to 30 days and may be difficult to distinguish from iron deficiency.

Iron deficiency anemia: adverse effects on infant psychomotor development.

In a double-blind, placebo-control prospective cohort study of 196 infants from birth to 15 months of age, assessment was made at 12 months of age of the relationship between iron status and psychomotor development, the effect of a short-term (10-day) trial of oral iron vs placebo, and the effect of long-term (3 months) oral iron therapy. Development was assessed with the mental and psychomotor indices and the infant behavior record of the Bayley Scales of Infant Development in 39 anemic, 30 control, and 127 nonanemic iron-deficient children. Anemic infants had significantly lower Mental and Psychomotor Developmental Index scores than control infants or nonanemic iron-deficient infants (one-way analysis of variance, P less than .0001). Control infants and nonanemic iron-deficient infants performed comparably. No difference was noted between the effect of oral administration of iron or placebo after 10 days or after 3 months of iron therapy. Among anemic infants a hemoglobin concentration less than 10.5 g/dL and duration of anemia of greater than 3 months were correlated with significantly lower motor and mental scores (P less than .05). Anemic infants failed specifically in language capabilities and body balance-coordination skills when compared with controls. These results, in a design in which intervening variables were closely controlled, suggest that when iron deficiency progresses to anemia, but not before, adverse influences in the performance of developmental tests appear and persist for at least 3 months despite correction of anemia with iron therapy. If these impairments prove to be long standing, prevention of iron deficiency anemia in early infancy becomes the only way to avoid them.

Prevention of iron deficiency by milk fortification. II. A field trial with a full-fat acidified milk.

In a longitudinal study from age 3 to 15 mo, 276 term, healthy, spontaneously weaned infants received a full-fat acidified milk fortified with 15 mg of elemental Fe as ferrous sulfate and 100 mg of ascorbic acid/100 g of powder and 278 control infants received milk without additives. At ages 9 and 15 mo significant differences were encountered in all measures of Fe nutriture in favor of the fortified group (p less than 0.001). Anemia (Hg less than 110 g/L) was present in 25.7% of unfortified infants compared with only 2.5% in those fortified at age 15 mo. Saturation of transferrin less than 9% was present in 33.8% and serum ferritin less than 10 micrograms/L in 39.1% of the nonfortified infants. The figures for the fortified group were 7 and 8.5% respectively. The efficiency of the fortified acidified milk in eradicating Fe deficiency in the infants while discouraging use by other family members make this milk a useful targeted product in programs of supplementary food distribution in the underdeveloped world.

[Prevention of iron deficiency in infants by fortified milk. Field study of a low-fat milk]. / Prevención de la carencia de hierro en lactantes, mediante la fortificación de la leche. I. Estudio sobre el terreno de una leche semidescremada.

Healthy term infants were given a low-fat powdered milk fortified with 15 mg/100g of iron, as ferrous sulphate, for one year, starting at three months of age. The control group received non-fortified milk. A total of 510 infants entered the study, and 314 could be studied at the age of 15 months. Consumption of the fortified formulas was monitored through iron determinations in stools. Groups had a comparable hemoglobin concentration at the age of three months. Hemoglobin was higher in the fortified group at nine months (11.7 +/- 1.0 vs 11.4 +/- 1.1 g/dl, p less than 0.02), and 15 months (12.0 +/- 1.1 vs 11.4 +/- 1.2, p less than 0.001). The percentage of subjects with anemia (Hb less than 11.0 g/dl) was lower in the fortified group: 14.8% vs 27.7% of the controls at nine months and 7.0% vs 35.3% at 15 months. Percentages of subjects with iron deficiency (Fe/TIBC less than 9%) were lower in the fortified group: 28.0% vs 49.1% of the controls at nine months, and 20.0% vs 41.8% at 15 months. Although the fortified milk markedly improved iron nutrition, deficiency of this mineral was still high in the group receiving it. This was probably due to the low bioavailability of iron when administered with non-modified milks.

Absorption of fortification iron from milk formulas in infants.

The bioavailability of iron added to different types of cows' milk formulas was studied using mono-isotopic and double-isotopic methods in 396 infants aged 5-18 mo. All the milk formulas were fortified with ferrous sulfate in concentrations varying between 10 and 19 mg elemental iron/liter. Iron absorption from low-fat milks and full-fat milks varied from 2.9 to 5.1%. A higher range of mean absorption, 5.9 to 11.3%, was observed in the same formulas with the addition of ascorbic acid at concentrations of 100 mg/l or higher (up to 800 mg/l), demonstrating its enhancing effect on iron absorption in fortified milks. The amount of milk fat, the addition of carbohydrates, or acidification did not seem to influence iron absorption.

Nutritional significance of interactions between iron and food components.

Most food iron in the gut enters into two "common pools" that behave quite differently in terms of absorption. Heme iron present in hemoglobin and myoglobin, is well absorbed and is relatively unaffected by diet composition. Non-heme iron, the form of iron present in vegetables and in man's staples, generally is poorly absorbed and is greatly affected by enhancing or inhibiting substances in the diet. In experiments employing intrinsically-labeled hemoglobin as a tracer, absorption of a dry hemoglobin concentrate added to milk, a rice cereal and wheat cookies, was uniformly good, relatively constant and quite independent from the type of food. In contrast, absorption of iron salts decreases markedly when given with food. The presence or absence of inhibiting or enhancing factors of non-heme iron absorption is determinant in the possibility of obtaining required iron for most people in the world whose diet contains little heme iron. Meat and ascorbic acid are the main enhancers of non-heme food iron absorption. Common inhibitors include carbonates, oxalates, phytate, bran, tea and egg yolk. The enhancing effect of ascorbic acid on the absorption of fortification iron in milk and the effect of tea, eggs or meat on the absorption of bread iron from common Chilean meals are discussed as examples of interactions of food components with non-heme iron.