Dear Lactnet Friends:


*
**Iron-Fortified vs Low-Iron Infant Formula*

*Developmental Outcome at 10 Years*

Betsy Lozoff, MD; Marcela Castillo, PhD; Katy M. Clark, MA; Julia B. Smith,
EdD

*Arch Pediatr Adolesc Med.* Published online November 7, 2011.
doi:10.1001/archpediatrics.2011.197

*Objective * To assess long-term developmental outcome in children who
received iron-fortified or low-iron formula.

*Design * Follow-up at 10 years of a randomized controlled trial
(1991-1994) of 2 levels of formula iron. Examiners were masked to group
assignment.

*Setting * Urban areas around Santiago, Chile.

*Participants * The original study enrolled healthy, full-term infants in
community clinics; 835 completed the trial. At 10 years, 473 were assessed
(56.6%).

*Intervention * Iron-fortified (mean, 12.7 mg/L) or low-iron (mean, 2.3
mg/L) formula from 6 to 12 months.

*Main Outcome Measures * We measured IQ, spatial memory, arithmetic
achievement, visual-motor integration, visual perception, and motor
functioning. We used covaried regression to compare iron-fortified and
low-iron groups and considered hemoglobin level before randomization and
sensitivity analyses to identify 6-month hemoglobin levels at which groups
diverged in outcome.

*Results * Compared with the low-iron group, the iron-fortified group
scored lower on every 10-year outcome (significant for spatial memory and
visual-motor integration; suggestive for IQ, arithmetic achievement, visual
perception, and motor coordination; 1.4-4.6 points lower; effect sizes,
0.13-0.21). Children with high 6-month hemoglobin levels (>12.8 g/dL [to
convert to grams per liter, multiply by 10]) showed poorer outcome on these
measures if they received iron-fortified formula (10.7-19.3 points lower;
large effect sizes, 0.85-1.36); those with low hemoglobin levels (<10.5
g/dL) showed better outcome (2.6-4.5 points higher; small but significant
effects, 0.22-0.36). High hemoglobin levels represented 5.5% of the sample
(n = 26) and low hemoglobin levels represented 18.4% (n = 87).

*Conclusion * Long-term development may be adversely affected in infants
with high hemoglobin levels who receive 12.7 mg/L of iron-fortified
formula. Optimal amounts of iron in infant formula warrant further study.

*Trial Registration * clinicaltrials.gov Identifier:
NCT01166451<http://clinicaltrials.gov/show/NCT01166451>
warmly,

-- 
Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI, ANLC, CKC
craniosacral therapy practitioner
www.breastfeedingalwaysbest.com

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