Maternal ethnicity and iron status in early childhood in Toronto, Canada: a cross-sectional study

Vinusha Gunaseelan, Patricia C Parkin, Gita Wahi, Catherine S Birken, Jonathon L Maguire, Colin Macarthur, Cornelia M Borkhoff, Members of the TARGet Kids! Collaboration, Catherine S Birken, Jonathon L Maguire, Ronald Cohn, Eddy Lau, Andreas Laupacis, Patricia C Parkin, Michael Salter, Peter Szatmari, Shannon Weir, Laura N Anderson, Cornelia M Borkhoff, Charles Keown-Stoneman, Christine Kowal, Dalah Mason, Murtala Abdurrahman, Kelly Anderson, Gordon Arbess, Jillian Baker, Tony Barozzino, Sylvie Bergeron, Dimple Bhagat, Gary Bloch, Joey Bonifacio, Ashna Bowry, Caroline Calpin, Douglas Campbell, Sohail Cheema, Elaine Cheng, Brian Chisamore, Evelyn Constantin, Karoon Danayan, Paul Das, Mary Beth Derocher, Anh Do, Kathleen Doukas, Anne Egger, Allison Farber, Amy Freedman, Sloane Freeman, Sharon Gazeley, Charlie Guiang, Dan Ha, Curtis Handford, Laura Hanson, Leah Harrington, Sheila Jacobson, Lukasz Jagiello, Gwen Jansz, Paul Kadar, Florence Kim, Tara Kiran, Holly Knowles, Bruce Kwok, Sheila Lakhoo, Margarita Lam-Antoniades, Eddy Lau, Denis Leuc, Fok-Han Leung, Alan Li, Patricia Li, Jessica Malach, Roy Male, Vashti Mascoll, Aleks Meret, Elise Mok, Rosemary Moodie, Maya Nader, Katherine Nash, Sharon Naymark, James Owen, Michael Peer, Kifi Pena, Marty Perlmutar, Navindra Persaud, Andrew Pinto, Michelle Porepa, Vikky Qi, Nasreen Ramji, Noor Ramji, Danyaal Raza, Alana Rosenthal, Katherine Rouleau, Caroline Ruderman, Janet Saunderson, Vanna Schiralli, Michael Sgro, Hafiz Shuja, Susan Shepherd, Barbara Smiltnieks, Cinntha Srikanthan, Carolyn Taylor, Stephen Treherne, Suzanne Turner, Fatima Uddin, Meta van den Heuvel, Joanne Vaughan, Thea Weisdorf, Sheila Wijayasinghe, Peter Wong, John Yaremko, Ethel Ying, Elizabeth Young, Michael Zajdman, Farnaz Bazeghi, Vincent Bouchard, Marivic Bustos, Charmaine Camacho, Dharma Dalwadi, Christine Koroshegyi, Tarandeep Malhi, Sharon Thadani, Julia Thompson, Laurie Thompson, Mary Aglipay, Imaan Bayoumi, Sarah Carsley, Katherine Cost, Karen Eny, Theresa Kim, Laura Kinlin, Jessica Omand, Shelley Vanderhout, Leigh Vanderloo, Christopher Allen, Bryan Boodhoo, Olivia Chan, David Wh Dai, Judith Hall, Peter Juni, Gerald Lebovic, Karen Pope, Kevin Thorpe, Rita Kandel, Michelle Rodrigues, Hilde Vandenberghe, Vinusha Gunaseelan, Patricia C Parkin, Gita Wahi, Catherine S Birken, Jonathon L Maguire, Colin Macarthur, Cornelia M Borkhoff, Members of the TARGet Kids! Collaboration, Catherine S Birken, Jonathon L Maguire, Ronald Cohn, Eddy Lau, Andreas Laupacis, Patricia C Parkin, Michael Salter, Peter Szatmari, Shannon Weir, Laura N Anderson, Cornelia M Borkhoff, Charles Keown-Stoneman, Christine Kowal, Dalah Mason, Murtala Abdurrahman, Kelly Anderson, Gordon Arbess, Jillian Baker, Tony Barozzino, Sylvie Bergeron, Dimple Bhagat, Gary Bloch, Joey Bonifacio, Ashna Bowry, Caroline Calpin, Douglas Campbell, Sohail Cheema, Elaine Cheng, Brian Chisamore, Evelyn Constantin, Karoon Danayan, Paul Das, Mary Beth Derocher, Anh Do, Kathleen Doukas, Anne Egger, Allison Farber, Amy Freedman, Sloane Freeman, Sharon Gazeley, Charlie Guiang, Dan Ha, Curtis Handford, Laura Hanson, Leah Harrington, Sheila Jacobson, Lukasz Jagiello, Gwen Jansz, Paul Kadar, Florence Kim, Tara Kiran, Holly Knowles, Bruce Kwok, Sheila Lakhoo, Margarita Lam-Antoniades, Eddy Lau, Denis Leuc, Fok-Han Leung, Alan Li, Patricia Li, Jessica Malach, Roy Male, Vashti Mascoll, Aleks Meret, Elise Mok, Rosemary Moodie, Maya Nader, Katherine Nash, Sharon Naymark, James Owen, Michael Peer, Kifi Pena, Marty Perlmutar, Navindra Persaud, Andrew Pinto, Michelle Porepa, Vikky Qi, Nasreen Ramji, Noor Ramji, Danyaal Raza, Alana Rosenthal, Katherine Rouleau, Caroline Ruderman, Janet Saunderson, Vanna Schiralli, Michael Sgro, Hafiz Shuja, Susan Shepherd, Barbara Smiltnieks, Cinntha Srikanthan, Carolyn Taylor, Stephen Treherne, Suzanne Turner, Fatima Uddin, Meta van den Heuvel, Joanne Vaughan, Thea Weisdorf, Sheila Wijayasinghe, Peter Wong, John Yaremko, Ethel Ying, Elizabeth Young, Michael Zajdman, Farnaz Bazeghi, Vincent Bouchard, Marivic Bustos, Charmaine Camacho, Dharma Dalwadi, Christine Koroshegyi, Tarandeep Malhi, Sharon Thadani, Julia Thompson, Laurie Thompson, Mary Aglipay, Imaan Bayoumi, Sarah Carsley, Katherine Cost, Karen Eny, Theresa Kim, Laura Kinlin, Jessica Omand, Shelley Vanderhout, Leigh Vanderloo, Christopher Allen, Bryan Boodhoo, Olivia Chan, David Wh Dai, Judith Hall, Peter Juni, Gerald Lebovic, Karen Pope, Kevin Thorpe, Rita Kandel, Michelle Rodrigues, Hilde Vandenberghe

Abstract

Objectives: This study aimed to evaluate the association between maternal ethnicity and iron deficiency (ID) in early childhood, and to evaluate whether infant feeding practices linked to ID differ between maternal ethnic groups.

Methods: This was a cross-sectional study of healthy children 1-3 years of age. Adjusted multivariable logistic regression analyses were used to evaluate the association between maternal ethnicity and ID (serum ferritin <12 µg/L) and the association between maternal ethnicity and five infant feeding practices (breastfeeding duration; bottle use beyond 15 months; current formula use; daily cow's milk intake >2 cups; meat consumption).

Results: Of 1851 children included, 12.2% had ID. Compared with the European referent group, we found higher odds of ID among children of South Asian and West Asian/North African maternal ethnicities, and lower odds of ID among children of East Asian maternal ethnicity. Statistically significant covariates associated with higher odds of ID included longer breastfeeding duration and daily cow's milk intake >2 cups. Current infant formula use was associated with lower odds of ID. Children of South Asian maternal ethnicity had higher odds of bottle use beyond 15 months of age and lower odds of meat consumption.

Conclusions: We found increased odds of ID among children of South Asian and West Asian/Northern African maternal ethnicities. We found a higher odds of feeding practices linked to ID in children of South Asian maternal ethnicity, but not in children of West Asian/North African maternal ethnicity. Culturally tailored approaches to providing guidance to parents on healthy infant feeding practices may be important to prevent ID in early childhood.

Trial registration number: NCT01869530.

Keywords: early childhood; ethnicity; infant feeding; iron deficiency; serum ferritin.

Conflict of interest statement

Competing interests: PCP reports receiving a grant from the Hospital for Sick Children Foundation during the conduct of the study. PCP reports receiving the following grants unrelated to this study: a grant from Canadian Institutes of Health Research (FRN # 115059) for an ongoing investigator-initiated trial of iron deficiency in young children, for which Mead Johnson Nutrition provides non-financial support (Fer-In-Sol liquid iron supplement) (2011–2017); and peer-reviewed grants for completed investigator-initiated studies from Danone Institute of Canada (2002–2004 and 2006–2009), Dairy Farmers of Ontario (2008–2010). CMB reports previously receiving a grant for a completed investigator-initiated study from the Sickkids Centre for Health Active Kids (CHAK) (2015–2016) involving the development and validation of a risk stratification tool to identify young asymptomatic children at risk for iron deficiency. JLM reports receiving an unrestricted research grant for a completed investigator-initiated study from the Dairy Farmers of Canada (2011–2012).

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. World Health Organization Iron deficiency anaemia: assessment, prevention and control: a guide for programme managers. World Health Organization, 2001.
    1. Baker RD, Greer FR, Committee on Nutrition American Academy of Pediatrics . Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics 2010;126:1040–50.10.1542/peds.2010-2576
    1. Akman M, Cebeci D, Okur V, et al. . The effects of iron deficiency on infants' developmental test performance. Acta Paediatr 2004;93:1391–6.10.1111/j.1651-2227.2004.tb02941.x
    1. Lozoff B, Jimenez E, Smith JB. Double burden of iron deficiency in infancy and low socioeconomic status: a longitudinal analysis of cognitive test scores to age 19 years. Arch Pediatr Adolesc Med 2006;160:1108–13.10.1001/archpedi.160.11.1108
    1. Sutcliffe TL, Khambalia A, Westergard S, et al. . Iron depletion is associated with daytime bottle-feeding in the second and third years of life. Arch Pediatr Adolesc Med 2006;160:1114–20.10.1001/archpedi.160.11.1114
    1. Maguire JL, Lebovic G, Kandasamy S, et al. . The relationship between cow's milk and stores of vitamin D and iron in early childhood. Pediatrics 2013;131:e144–51.10.1542/peds.2012-1793
    1. Maguire JL, Salehi L, Birken CS, et al. . Association between total duration of breastfeeding and iron deficiency. Pediatrics 2013;131:e1530–7.10.1542/peds.2012-2465
    1. Parkin PC, DeGroot J, Maguire JL, et al. . Severe iron-deficiency anaemia and feeding practices in young children. Public Health Nutr 2016;19:716–22.10.1017/S1368980015001639
    1. Cox KA, Parkin PC, Anderson LN, et al. . Association between meat and Meat-Alternative consumption and iron stores in early childhood. Acad Pediatr 2016;16:783–91.10.1016/j.acap.2016.01.003
    1. Chan-Yip A, Gray-Donald K. Prevalence of iron deficiency among Chinese children aged 6 to 36 months in Montreal. CMAJ 1987;136:373.
    1. D'Souza SW, Lakhani P, Waters HM, et al. . Iron deficiency in ethnic minorities: associations with dietary fibre and phytate. Early Hum Dev 1987;15:103–11.10.1016/0378-3782(87)90043-0
    1. Lawson MS, Thomas M, Hardiman A. Iron status of Asian children aged 2 years living in England. Arch Dis Child 1998;78:420–6.10.1136/adc.78.5.420
    1. Brotanek JM, Halterman JS, Auinger P, et al. . Iron deficiency, prolonged bottle-feeding, and racial/ethnic disparities in young children. Arch Pediatr Adolesc Med 2005;159:1038–42.10.1001/archpedi.159.11.1038
    1. Brotanek JM, Gosz J, Weitzman M, et al. . Iron deficiency in early childhood in the United States: risk factors and racial/ethnic disparities. Pediatrics 2007;120:568–75.10.1542/peds.2007-0572
    1. Brotanek JM, Schroer D, Valentyn L, et al. . Reasons for prolonged bottle-feeding and iron deficiency among Mexican-American toddlers: an ethnographic study. Acad Pediatr 2009;9:17–25.10.1016/j.acap.2008.10.005
    1. Brotanek JM, Gosz J, Weitzman M, et al. . Secular trends in the prevalence of iron deficiency among US toddlers, 1976-2002. Arch Pediatr Adolesc Med 2008;162:374–81.10.1001/archpedi.162.4.374
    1. Statistics Canada Immigration and ethnocultural diversity. Toronto City. Ottawa, Ontario: Statistics Canada, 2017.
    1. Carsley S, Borkhoff CM, Maguire JL, et al. . Cohort profile: the applied research group for kids (TARGet kids!). Int J Epidemiol 2015;44:776–88.10.1093/ije/dyu123
    1. Parkin PC, Hamid J, Borkhoff CM, et al. . Laboratory reference intervals in the assessment of iron status in young children. BMJ Paediatr Open 2017;1:e00007410.1136/bmjpo-2017-000074
    1. Bailey D, Colantonio D, Kyriakopoulou L, et al. . Marked biological variance in endocrine and biochemical markers in childhood: establishment of pediatric reference intervals using healthy community children from the CALIPER cohort. Clin Chem 2013;59:1393–405.10.1373/clinchem.2013.204222
    1. Statistics Canada Appendix C: comparison of ethnic origins disseminated in 2006, 2001 and 1996. Ottawa, Ontario: Statistics Canada, 2008.
    1. Omand JA, Carsley S, Darling PB, et al. . Evaluating the accuracy of a geographic closed-ended approach to ethnicity measurement, a practical alternative. Ann Epidemiol 2014;24:246–53.10.1016/j.annepidem.2013.12.015
    1. World Health Organization Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. World Health Organization, 2011.
    1. Saunders NR, Parkin PC, Birken CS, et al. . Iron status of young children from immigrant families. Arch Dis Child 2016;101:1130–6.10.1136/archdischild-2015-309398
    1. Sypes EE, Parkin PC, Birken CS, et al. . Higher body mass index is associated with iron deficiency in children 1 to 3 years of age. J Pediatr 2019;207:198–204.10.1016/j.jpeds.2018.11.035
    1. Li R, Scanlon KS, Serdula MK. The validity and reliability of maternal recall of breastfeeding practice. Nutr Rev 2005;63:103–10.10.1111/j.1753-4887.2005.tb00128.x
    1. Hosmer DW, Lemeshow S. Applied logistic regression. 2nd edition New York: Wiley, 2000.
    1. Oatley H, Borkhoff CM, Chen S, et al. . Screening for iron deficiency in early childhood using serum ferritin in the primary care setting. Pediatrics 2018;142:e2018209510.1542/peds.2018-2095
    1. Cooper M, Greene-Finestone L, Lowell H, et al. . Iron sufficiency of Canadians. Health Rep 2012;23:41–8.
    1. Christofides A, Schauer C, Zlotkin SH. Iron deficiency and anemia prevalence and associated etiologic risk factors in first nations and Inuit communities in Northern Ontario and Nunavut. Can J Public Health 2005;96:304–7.
    1. Willows ND, Dewailly E, Gray-Donald K. Anemia and iron status in Inuit infants from Northern Quebec. Can J Public Health 2000;91:407–10.10.1007/BF03404818
    1. Willows ND, Gray-Donald K. Blood lead concentrations and iron deficiency in Canadian aboriginal infants. Sci Total Environ 2002;289:255–60.10.1016/S0048-9697(01)01052-X
    1. Pirkle CM, Lucas M, Dallaire R, et al. . Food insecurity and nutritional biomarkers in relation to stature in Inuit children from Nunavik. Can J Public Health 2014;105:e233–8.10.17269/cjph.105.4520
    1. Hodgins S, Dewailly E, Chatwood S, et al. . Iron-deficiency anemia in Nunavik: pregnancy and infancy. Int J Circumpolar Health 1998;57:135–40.
    1. Hartfield D. Iron deficiency is a public health problem in Canadian infants and children. Paediatr Child Health 2010;15:347–50.10.1093/pch/15.6.347
    1. Lehmann F, Gray-Donald K, Mongeon M, et al. . Iron deficiency anemia in 1-year-old children of disadvantaged families in Montreal. CMAJ 1992;146:1571–7.
    1. Zlotkin SH, Ste-Marie M, Kopelman H, et al. . The prevalence of iron depletion and iron-deficiency anaemia in a randomly selected group of infants from four Canadian cities. Nutr Res 1996;16:729–33.10.1016/0271-5317(96)00063-2
    1. Innis SM, Nelson CM, Wadsworth LD, et al. . Incidence of iron-deficiency anaemia and depleted iron stores among nine-month-old infants in Vancouver, Canada. Can J Public Health 1997;88:80–4.10.1007/BF03403865
    1. Anand SS. Using ethnicity as a classification variable in health research: perpetuating the myth of biological determinism, serving socio-political agendas, or making valuable contributions to medical sciences? Ethn Health 1999;4:241–4.10.1080/13557859998029
    1. Steinman L, Doescher M, Keppel GA, et al. . Understanding infant feeding beliefs, practices and preferred nutrition education and health provider approaches: an exploratory study with Somali mothers in the USA. Matern Child Nutr 2010;6:67–88.10.1111/j.1740-8709.2009.00185.x

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