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Infant feeding in the second 6 months of life related to iron status: an observational study
  1. David Hopkins1,
  2. Pauline Emmett2,
  3. Colin Steer3,
  4. Imogen Rogers2,
  5. Sian Noble4,
  6. Alan Emond3
  1. 1
    Bristol Children’s Hospital, Bristol, UK
  2. 2
    ALSPAC, Department of Social Medicine, University of Bristol, Bristol, UK
  3. 3
    Department of Community-based Medicine, University of Bristol, Bristol, UK
  4. 4
    Department of Social Medicine, University of Bristol, Bristol, UK
  1. Dr Pauline Emmett, ALSPAC, Department of Social Medicine, University of Bristol, 24 Tyndall Avenue, Bristol BS8 1TQ, UK; p.m.emmett{at}


Objective: To investigate the relationship between iron status in infancy and type of milk and weaning solids consumed.

Design: An observational cohort study.

Setting: 928 term infants from the Avon Longitudinal Study of Parents and Children in 1993–94.

Methods: Haemoglobin and ferritin concentrations at 8 and 12 months were assessed in relation to type and quantity of milk intake at 8 months.

Results: By WHO criteria, 22.7% of the infants were anaemic at 8 months and 18.1% at 12 months. More breast- than formula-fed infants were anaemic at 8 and 12 months. Cows’ milk as the main drink was associated with increased anaemia at 12 months and low ferritin at 8 and 12 months. No association was found between any nutrients and haemoglobin concentrations. Protein and non-haem iron intakes were positively associated with ferritin concentrations and calcium intake negatively. This effect was more marked in infants being fed cows’ milk. More than 25% of infants in the breast milk and cows’ milk groups and 41% of infants having >6 breast feeds per day had iron intakes below the lower reference nutrient intake. Feeding cows’ milk or formula above 600 ml or >6 breast feeds per day was associated with lower intakes of solids.

Conclusions: Both breast and cows’ milk feeding were associated with higher levels of anaemia. Satisfactory iron intake from solids in later infancy is more likely if formula intake is <600 ml per day and breast feeds are limited to <6 feeds per day. Cows’ milk should be strongly discouraged as a main drink before 12 months.

  • cows’ milk
  • breast milk
  • formula
  • iron deficiency

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  • Funding: The UK Medical Research Council, the Wellcome Trust and the University of Bristol provide core support for ALSPAC. The analysis of this data was supported by an educational grant from SMA Nutrition. This publication is the work of the authors, and Pauline Emmett will serve as guarantor for the contents of this paper.

  • Competing interests: PE and DH have received speaker’s fees from SMA Nutrition in the past 5 years. SMA Nutrition supported the contribution of DH and CS to this paper.

  • Abbreviations:
    the Avon Longitudinal Study of Parents and Children
    breast milk group
    cows’ milk group
    formula milk group
    lower reference nutrient intake
    non-starch polysaccharide
    odds ratio

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