Title of Paper: Iron deficiency in international adoptees from Eastern Europe
Type of Paper: Original Article, Prospective Study
Purpose: To assess iron deficiency in children adopted from Eastern Europe.
- Physical growth: standard anthropometry [height, weight, head circumference (OFC)]. Z scores for height and weight were calculated using CDC 2000 as a reference
- Iron deficiency: Complete blood count (hemoglobin, mean corpuscular volume), transferrin saturation, and serum ferritin.
- Dietary intake of iron: three day food diaries in which parents reported everything their child ate for three days.
- Intestinal Parasites: stool examination for ova and parasites.
- Serum lead levels.
Participants: 37 children adopted from Eastern Europe who were under the age of 24 months at arrival. Age range at first assessment (soon after arrival) was 9 to 23 months (average age was 15. 7 months).
Methods: Physical growth, iron deficiency, and dietary intake were collected at baseline (within one month of arrival) and six months later.
- Physical growth:
- Average z scores were below the mean (i.e., z score of 0) at arrival. Average z scores were:
- Height for age (HAZ): -1. 24
- Weight for age (WAZ): -1. 73
- Weight for height (WHZ): -0. 63
- Head circumference for age (OFCZ): -0. 67
- There were significant improvements in all areas of physical growth during the six months. Average z scores at the six month follow-up were:
- HAZ: -0. 49
- WAZ: -0. 53
- WHZ: -0. 02
- OFCZ: 0. 11
- Iron deficiency (2 abnormal iron indices):
- 25% were iron deficient at baseline. The majority did not have anemia (low hemoglobin).
- The rate of iron deficiency did not improve significantly from baseline to follow-up. 16% were iron deficient at the six month follow-up. The majority did not have anemia (low hemoglobin).
- Risk for iron deficiency increased with:
- Greater post-adoption catch-up growth in height increased the risk for iron deficiency at the six month follow-up. The greater the increase in height over the six months, the more iron stores (serum ferritin) decreased.
- Parasitic infections (specifically Giardia lamblia ). There was a greater incidence of iron deficiency in those with Giardia lamblia.
- Average iron intake exceeded the national recommendations [Recommended Dietary Allowances (RDA)] and the U. S. average daily intake for children of this age range.
- There were no differences in dietary iron intake between those who were iron deficient and those who were iron sufficient.
Conclusions & Clinical Implications: Children adopted from Eastern Europe experience growth delays at arrival followed by post-adoption catch-up growth in height, weight, weight for height, and head circumference. Iron deficiency was common at arrival and did not improve significantly during the first six months post-adoption, despite the improvements in the nutritional and social environments. Some children even developed iron deficiency after arrival. Iron deficiency was more common in children with the intestinal parasite Giardia, which may interfere with iron absorption. Post-adoption catch-up growth also increased the risk for iron deficiency. This study emphasizes that the post-adoption catch-up growth increases the demands for iron and increases the risk for iron deficiency, even though the children on average were consuming the recommended intake of iron. Furthermore, this study found that adoptees are at risk for iron deficiency without anemia, and general pediatric practice has been to only screen for anemia. Under this practice, children with iron deficiency who do not have anemia will go undiagnosed.
Limitations of the Nutritional Results: This is the first study to investigate iron deficiency (not just anemia) in international adoptees, and it included only a small group. Investigation of iron deficiency, especially in children from other birth countries, is needed to determine the risk for international adoptees and children living in institutions.
Reference: Fuglestad AJ, Lehmann A, E. , Kroupina M, G. , et al. Iron deficiency in international adoptees from Eastern Europe. The Journal of Pediatrics. 2008; 153: 272-277. http://www.ncbi.nlm.nih.gov/pubmed/18534235