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Iron status of young children from immigrant families
  1. Natasha Ruth Saunders1,2,3,
  2. Patricia C Parkin1,2,3,4,
  3. Catherine S Birken1,2,3,4,
  4. Jonathon L Maguire1,2,3,4,5,6,
  5. Cornelia M Borkhoff2,3,4,7
  6. on behalf of the TARGet Kids! Collaboration
    1. 1Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    2. 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    3. 3Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada
    4. 4Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
    5. 5Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
    6. 6Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
    7. 7Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
    1. Correspondence to Dr Cornelia Borkhoff, Peter Gilgan Centre for Research and Learning, Room 109832, 10th Floor, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4; Cory.borkhoff{at}


    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
    • Nutrition
    • Paediatric Practice

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