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Community and International Nutrition

Daily Iron Alone but Not in Combination with Multimicronutrients Increases Plasma Ferritin Concentrations in Indonesian Infants with Inflammation^1,2

Sandhya Sankaranarayanan, Juliawati Untoro^*, Juergen Erhardt, Rainer Gross^** and Francisco J. Rosales³

Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA; ^* World Bank Office, Jakarta, Indonesia; University of Hohenheim, Stuttgart, Germany; and ^** UNICEF, New York, NY

³To whom correspondence should be addressed. E-mail: fxr5{at}psu.edu.

Iron deficiency is a public health problem in infancy. We assessed the efficacy of iron supplements in infants with inflammation on iron status and subsequent inflammation. This was a prospective, nested, case-control study of 6- to 12-mo-old infants participating in the International Research on Infant Supplementation study, Indonesia. Cases (n = 46) were selected on the basis of their inflammation status at baseline, C-reactive protein (>5 mg/L) or -1 acid glycoprotein (>1 g/L); there were 44 controls without inflammation. Infants received 10 mg/d of elemental iron alone or in combination with multimicronutrients, or placebo. Blood samples were collected at baseline and at 6 mo for determinations of plasma ferritin, zinc, copper, retinol, ß-carotene, -tocopherol, and inflammation status. Data on breast-feeding and acute respiratory infections (ARI) were collected daily. At baseline, 33% of infants had iron deficiency, and those with inflammation had lower retinol, ß-carotene, higher concentrations of copper and higher rates of ARI compared with controls. After 6 mo, compared with infants given placebo, ferritin concentration increased significantly in infants administered iron alone independently of inflammation status at baseline or at the end of the study. In those given multimicronutrients with iron, ferritin increased significantly in infants who did not have inflammation at baseline or at the end of the study compared with those given placebo. Consequently, iron alone resolved iron deficiency, whereas multimicronutrients reduced the deterioration of iron stores compared with placebo (², P < 0.05), without enhancing inflammation. Iron alone is recommended in populations in which iron deficiency is a public health problem despite the presence of inflammation in infants who are still breast-feeding.

KEY WORDS: • acute-phase proteins • breast-feeding • ferritin • copper • retinol

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