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Major Study Finds 1 in 7 Kiwi Babies Iron Deficient

New Zealand's infants and toddlers have high levels of iron deficiency, with one in seven missing out on this vital micronutrient, a major new study has found. Researchers examined 405 children aged between six and 23 months from New Zealand's three largest ethnic groups and across all socioeconomic levels.

The dietary habits of these children were examined in detail by Deborah Brunt, a medical student at the University of Auckland. Her detailed work was performed under the guidance of Dr Clare Wall, Paediatric Nutritionist, and Associate Professor and Starship paediatrician Dr Cameron Grant. The study discovered that New Zealand's young children have a rate of iron deficiency twice that of American, Australian and European youngsters.

Dr Grant said the study identified four key dietary risk factors for iron deficiency:

• Drinking cow's milk daily and not breast feeding or using infant formula in children less than 12 months old;
• No infant formula;
• Having homemade rather than commercial solids as the first solid food;
• Having fruit as a snack rather than with a meal.

"Any one of these factors, as part of a baby's feeding habits, increases the risk of iron deficiency at least three times," Dr Grant said. "Once you have two or more factors present, the risk increases dramatically. For example, if a child aged six to 23 months is drinking cow's milk every day, and the first solid food is homemade, the likelihood of iron deficiency increases by a factor of eight."

"Very young children have high iron needs. In New Zealand, as in many developed countries, there is a nutritional paradox – we eat many foods that are high in energy but don't contain enough micronutrients."

Dr Grant said one of his team's main discoveries was that the feeding habits of many youngsters were not consistent with current recommendations. Less than one third of infants and toddlers consumed the currently recommended four servings of fruit and vegetables per day.

"We discovered that the timing of fruit consumption was important. Having fruit or fruit juice with meals protects against iron deficiency whereas having it as a snack does not. This helps to explain why iron deficiency is more frequent in Maori and Pacific children. Maori and Pacific children were more likely to be given fruit as a snack, while European babies tend to have it with meals."

"The research results stress the need to breastfeed infants, to give infants and toddlers fruit with meals and feed them infant formula instead of cow's milk. It also showed that homemade foods need to be iron-rich, and that commercial baby foods are useful for baby's first solids," Dr Grant said.

The study also found that for 39% of children, the introduction of meat into the diet was delayed beyond the recommended age of six to seven months. Meat is an excellent source of iron.

The study was funded through a grant from the Health Research Council of New Zealand. Mrs Brunt's work was made possible by a research scholarship created by the Starship Foundation and endowed by the baby-food producer Only Organic. Muir McCallum, director of Only Organic, said his company wanted to work with Starship to find out how they could meet parents' needs. "One of the biggest things we find when talking to parents is that they're often confused about the best ways to feed their kids, with all the conflicting messages about health and nutrition. The findings of this research make it very clear to parents that there are some key things they can do to keep their babies and toddlers healthy."

Mr McCallum believed many parents would be reassured by the study's evidence that giving children commercial baby food may assist in preventing iron deficiency. "The difficulty is even for the best home cooks, it can be tough to master the techniques for getting baby food to the right consistency without losing some of the micronutrients. On top of everything else you have to do to care for a baby, preparing the right food for them is a lot of work."

Iron deficiency is the world's most common micronutrient deficiency, with an estimated 3.5 billion people affected worldwide. Iron is essential for brain development, and many studies have linked a deficiency in iron to lower mental and motor function and altered social and emotional behaviour in infants. Behavioural effects can include clinginess, weariness and irritability, and the results of deficiency can last into childhood and adolescence.

The research team conducted interviews with 405 families about their toddlers' diets and eating habits, and compared this information with an analysis of their iron status, determined from a blood sample. The results showed the prevalence of iron deficiency varied across ethnic groups; overall, 13% were found to be iron deficient, compared with 20% of Maori children,16% of Pacific children and 7% of European children in the same age group. In a fourth, smaller category – defined as Other and including mostly southeast Asian, Chinese and Indian children – 27% of toddlers were iron deficient.

Starship Foundation Chief Executive Andrew Young was pleased parents could take away some helpful messages from the study. "It's reinforced the nutritional importance of fruits and vegetables, as we expected. However, we were surprised at how some simple dietary changes, like using formula instead of cow's milk, and the use of baby food from the supermarket, can prevent iron deficiency."

The study is to be published in the July-August 2007 issue of the Journal of Paediatrics and Child Health.

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About Starship Foundation

Starship Children's Health is part of Auckland District Health Board, New Zealand's largest public healthcare provider.

The Starship Foundation charity is set up to provide additional equipment, support and help to staff, patients and families, in addition to state funding.

About Only Organic

Proudly made in New Zealand, Only Organic is the only range of baby food made from pure organic meat, fruit and vegetables, with no thickening agents or artificial additives – ingredients you would find in your own kitchen.

Only product sourced from certified organic producers is used in Only Organic Baby food and Only Organic production is certified organic by AgriQuality New Zealand and under the supervision for the New Zealand Ministry of Agriculture and Forestry (MAF).

About the Research Team

Dr Cameron Grant is an Associate Professor at the University of Auckland and a paediatrician at Starship Children's Health. He received his paediatric training at the University of Auckland (where he also earned a PhD) and in the United States, at Duke University Medical Centre and the Johns Hopkins Hospital and University.

Dr. Grant's research into improving health in early childhood focuses largely on child nutrition. In 2006 he was awarded a University of Auckland Teaching Excellence Award.

Dr Clare Wall is a Senior Lecturer in Human Nutrition at the University of Auckland Medical School. After qualifying as a dietitian in the UK in 1984, she specialised in paediatric dietetics in the UK and Australia. She has an extensive research and clinical background, with many years of practical experience assisting parents and children with nutrition advice and support. Dr Wall is extensively published in scientific and professional journals on subjects related to infant and childhood nutrition.

Deborah Brunt is currently in her last year at the University of Auckland completing a medical degree. She completed this project as her Master of Health Science thesis. Her interest in this project was stimulated in part by her two young children. She hopes to be able to continue with this work and help New Zealand children become healthier.

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