Objectives Children from immigrant families may be at risk for iron deficiency (ID) due to differences in pre-migration and post-migration exposures. Our objectives were to determine whether there is an association between family immigrant status and iron stores and to evaluate whether known dietary, environmental or biological determinants of low iron status influence this relationship.
Design This was a cross-sectional study of healthy urban preschool children (12–72 months) recruited from seven primary care practices in Toronto. Laboratory assessment of serum ferritin and haemoglobin and standardised parent-completed surveys were completed between 2008 and 2013 during routine health maintenance visits. Multiple regression analyses were used to evaluate the association between family immigrant status and serum ferritin, ID (ferritin <14 μg/L) and iron deficiency anaemia (IDA) (ferritin <14 μg/L and haemoglobin ≤110 g/L).
Results Of 2614 children included in the analysis, 47.6% had immigrant family status. The median serum ferritin was 30 μg/L and 10.4% of all children had ID and 1.9% had IDA. After adjusting for maternal ethnicity and education, age, sex, income quintile, cow's milk intake, breastfeeding duration and bottle use, there were no significant associations between immigrant status and ferritin, ID or IDA. Significant predictors of low iron status included age, sex, cow's milk intake and breastfeeding duration.
Conclusions We found no association between family immigrant status and iron status after including clinically important covariates in the models. These data suggest immigrant children may not need enhanced screening for iron status or targeted interventions for iron supplementation.
- General Paediatrics
- Race and Health
- Evidence Based Medicine
- Paediatric Practice
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Collaborators TARGet Kids! Collaboration: Co-Leads: Patricia C. Parkin, Catherine S. Birken, Jonathon L. Maguire; Scientific Advisory: Colin Macarthur, Muhammad Mamdani; Scientific Committee: Kawsari Abdullah, Laura N. Anderson, Imaan Bayoumi, Cornelia M. Borkhoff, Sarah Carsley, Yang Chen, Mikael Katz-Lavigne, Kanthi Kavikondala, Christine Koroshegyi, Christine Kowal, Grace Jieun Lee, Dalah Mason, Jessica Omand, Navindra Persaud, Meta van den Heuvel, Weeda Zabih; Site Investigators: Jillian Baker, Tony Barozzino, Joey Bonifacio, Douglas Campbell, Sohail Cheema, Brian Chisamore, Karoon Danayan, Paul Das, Mary Beth Derocher, Anh Do, Michael Dorey, Sloane Freeman, Keewai Fung, Charlie Guiang, Curtis Handford, Hailey Hatch, Sheila Jacobson, Tara Kiran, Holly Knowles, Bruce Kwok, Sheila Lakhoo, Margarita Lam-Antoniades, Eddy Lau, Fok-Han Leung, Jennifer Loo, Sarah Mahmoud, Rosemary Moodie, Julia Morinis, Sharon Naymark, Patricia Neelands, James Owen, Michael Peer, Marty Perlmutar, Navindra Persaud, Andrew Pinto, Michelle Porepa, Nasreen Ramji, Noor Ramji, Alana Rosenthal, Janet Saunderson, Rahul Saxena, Michael Sgro, Susan Shepherd, Barbara Smiltnieks, Carolyn Taylor, Thea Weisdors, Sheila Wijayasinghe, Peter Wong, Ethel Ying and Elizabeth Young.
Contributors NRS conceptualised and designed the study, carried out the analysis, interpreted the results, drafted the initial manuscript, revised the manuscript and approved the final manuscript as submitted. PCP conceptualised and designed the study, interpreted the results, reviewed and revised the manuscript and approved the final manuscript as submitted. JLM and CSB conceptualised and designed the study, reviewed and revised the manuscript and approved the final manuscript as submitted. CMB conceptualised and designed the study, carried out the analysis, interpreted the results, reviewed and revised the manuscript and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Funding NRS was supported by a Restracomp Award through The Research Institute at The Hospital for Sick Children. The Pediatric Outcomes Research Team is supported by a grant from The Hospital for Sick Children Foundation. Support for the TARGet Kids! programme was provided by the Canadian Institute for Health Research (CIHR) Institute of Human Development, Child and Youth Health (IHDCYH), the CIHR Institute of Nutrition, Metabolism and Diabetes and the St. Michel's Hospital Foundation. Funding agencies had no role in the design, collection, analyses or interpretation of the results of this study.
Competing interests None declared.
Ethics approval Research Ethics Board at the Hospital for Sick Children.
Provenance and peer review Not commissioned; externally peer reviewed.