Prevalence and Predictors of Iron Deficiency in Bolivian Infants

Abstract

Iron deficiency (ID) in infancy can cause cognitive and developmental deficits that may be irreversible after the age of 2. The goals of this study were to quantify the prevalence of ID among 6‐month‐old infants in a high‐altitude population of Bolivia and identify modifiable risk factors of ID. Healthy infants were recruited from 2 hospitals in El Alto, Bolivia, and followed from 1 to 6 months of age. Blood taken at 6 months was analyzed for ferritin (Fer), C‐Reactive Protein (CRP), and alpha(1)‐acid‐glycoprotein (AGP). Fer values were adjusted for inflammation using internal correction factors (defined by elevated CRP and AGP), and ID was defined as corrected Fer < 12 µg/L. The following risk factors for Fer‐defined ID were initially considered: preterm birth (PTB; <37 weeks), sex, stunting (length‐for‐age Z < ‐ 2), recent diarrheal or respiratory infection, exclusive breastfeeding (EBF; defined as no complementary feeding or formula as of the 6‐month visit), maternal anemia, maternal age, maternal education, maternal employment, access to private toilet. The prevalence of ID at 6 months was 41% (67 of 163 infants assessed). Backwards elimination logistic regression identified only EBF as a significant (p < 0.05) predictor of ID at 6 months (OR: 4.7, 95% CI: 1.6 – 13.7). These results indicate that initiation of complementary feeding after 6 months (22% of this sample) increases risk of ID in this population, implying that infants may need iron supplementation prior to this time. Other interventions, such as prenatal iron supplementation and delayed cord clamping, need further exploration.