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To address the hypothesis that increased infectious morbidity is associated with iron supplementation, 783 randomly selected infants were provided with a powdered full fat cow's milk (non-fortified group) and 872 with a powdered acidified full fat cow's milk fortified with 15 mg of iron as ferrous sulfate (fortified group). All infants were followed from birth to 15 months of age with a monthly home visit by a nurse who recorded morbidity occurring during the previous 30 days. At 9 months of age, 15% of infants in each cohort were receiving breast milk only; data for these infants were segregated to make the third group. Episodes (mean +/- SD) of diarrhea/infant/year were 1.06 +/- 1.29, 1.14 +/- 1.37, and 0.82 +/- 1.04 for the fortified, non-fortified and breast-fed groups, respectively; the fortified and non-fortified bottle-fed groups had a very similar incidence of respiratory illness; 2.66 +/- 2.07 and 2.74 +/- 2.24 episodes/infant/year, respectively. The incidence of respiratory illness for both bottle-fed groups was significantly higher than that for the breast-fed group (2.22 +/- 1.84 respiratory episodes/infant/year). We conclude that for the infants the tested form of iron fortified milk, which is sufficient to lower iron deficiency anemia, does not result in an increased incidence of diarrhea or respiratory illness.

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The Chilean School Lunch program, which serves one million children nationwide, was supplied with three 10-g cookies fortified with 6% bovine hemoglobin concentrate, designed to provide 1 mg bioavailable iron per day. A survey of 1000 children was performed after 3 y. Significant differences in hemoglobin concentrations were found in the children from the fortified vs the nonfortified province (P < 0.01). Low serum ferritin values were also significantly more prevalent in the nonfortified group. The effect was evident despite the very low prevalence of anemia in both the fortified and the unfortified school groups. Heme-iron-fortified cookies are a feasible and effective way to improve the iron status of school-age children. In regions of high prevalence of iron-deficiency anemia, the effect of a heme-fortified cookie program should be even more important.

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Extruded rice flour was fortified with 5 per cent bovine haemoglobin concentrate (BHC). The amino acid score of the product was 59 per cent. The protein efficiency ratio (PER) for the fortified cereal alone was 1.4; however, when given as a mixed diet of cereal and humanized milk (providing 41 and 59 per cent of the protein, respectively) PER was 2.6 (casein standard = 2.5). Iron absorption studies were performed with a double isotope technique, on 10 infants 8-10 months of age. Geometric mean absorption of the rice-BHC iron was 14.2 per cent, as measured with a tag of 55Fe-haemoglobin. The 59Fe-ferrous ascorbate reference dose had a mean absorption of 38.5 per cent. The use of a haem-iron fortified cereal as a weaning food seems feasible and advantageous, supplying an appropriate amount of absorbed iron, an adequate energy density, and a protein which could complement milk protein.

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A large proportion of the milk consumed by infants in Chile is distributed by a National Food Supplementary Program. Efforts to prevent iron deficiency by milk fortification started several years ago. Initially a field study involving the simple addition of ferrous sulfate to a low-fat powdered milk was only partially successful due to the relatively low iron absorption from this product. Following the observation that the enrichment of milk with ascorbic acid markedly improved iron bioavailability, a new fortified formula was developed and has been tested in the field since 1976. This is powdered full-fat milk, biologically acidified and fortified with 15 mg Fe, as ferrous sulfate, and 100 mg ascorbic acid per 100 g powder. In a pilot study, 276 infants spontaneously weaned before 3 months of age received the fortified milk, and 278 infants receiving unfortified milk served as controls. At the end of the study (15 months of age) anemia (Hb less than 11 g/dl) was present in 25.7% of unfortified infants compared with only 2.5% in those fortified. Saturation of Transferrin less than 9% was present in 33.8% and serum ferritin less than 10 micrograms/l in 39.1% of the nonfortified infants. The figures for the fortified group were 7% and 8.5% respectively. Acceptance of the fortified formula was good. Following these observations, and as a previous step to the use of the fortified milk in the national program, the formula was tested in 7 National Health Service inner city community clinics under regular milk distribution.(ABSTRACT TRUNCATED AT 250 WORDS)

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The relationship of natural and artificial feeding to serum and red cell folate levels, as a means of evaluating nutritional intake of this vitamin, was studied. First a cross-sectional study was undertaken in which a group of 112 infants still being breast-fed at 4, 6, and 9 months of age had significantly higher folate concentrations than another group of 102 infants who had been weaned before 2 months. At 6 months of age the prevalence of folic acid deficiency (red cell folate less than 160 micrograms/l of erythrocytes) was 0 per cent in the first group and 15.4 per cent in the second (P less than 0.02), and at 9 months the respective proportions were 3.6 and 28.9 per cent (P less than 0.01). In a second study, 50 nursing infants were followed longitudinally during their first 15 months of life, and up to 9 months of age a direct correlation was observed between the folate concentrations and the duration of breast-feeding. In order to prevent a deficiency of this vitamin, it is recommended that infants be exclusively breast-fed at least through the age of 6 months or, failing this, that they be fed infant formula enriched with folic acid (Au)

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The effects on pregnancy outcome and maternal iron status of powdered milk (PUR) and a milk-based fortified product (V-N) were compared in a group of underweight gravidas. These take-home products were distributed during regular prenatal visits. Women in the V-N group had greater weight gain (12.29 vs 11.31 kg, p less than 0.05) and mean birth weights (3178 vs 3105 g, p less than 0.05) than those in the PUR group. Values for various indicators of maternal Fe status were also higher in the V-N group. Compared with self-selected noncompliers, similar in all control variables to compliers, children of women who consumed powdered milk or the milk-based fortified product had mean birth weights that were higher by 258 and 335 g, respectively. Data indicate a beneficial effect of the fortified product on both maternal nutritional status and fetal growth.

PIP: The effects on maternal and infant weight gain and maternal iron status of powdered milk (PUR) and a milk-based fortified product (V-N) were compared in underweight women attending prenatal clinics in Santiago, Chile. All pregnant women attending 9 prenatal clinics of the Southeast Health Area, over 18 years old, parity 0-5, nonsmoking, nonalcohol-consuming and underweight (95% of standard) joined the study. They were given either the PUR, powdered milk with 26% milkfat, or V-N, (Vita-Nova Mother-food, Melkunie Holland, Woerden) which contained micronutrients and added vegetable fat, as mandated by law. Those who failed to consume supplements were relegated to the control group. The V-N group had greater weight gain (12.29 vs 11.31 kg, p0.05), mean birth weights (3178 vs 3105 g, p0.05) than the PUR group. Iron status, shown by significantly higher mean hematocrit, hemoglobin, mean corpuscular volume, transferrin saturation and plasma ferritin levels near term, was also better in the V-N group than in the PUR. Other significant differences in favor of the V-N supplement were number of intrauterine growth retarded infants and birth weights under 3001 g. The V-N group had greater fluid retention: the import of this is unknown. The infants of non-compliers had birthweights 258 and 335 g lower than the women consuming PUR and V-N, respectively. The babies of V-N mothers gained 74 g/kg maternal weight gain, higher than many previously reported increments, perhaps due to the micronutrients in the supplement.

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In a longitudinal study from age 3 to 15 mo, 276 term, healthy, spontaneously weaned infants received a full-fat acidified milk fortified with 15 mg of elemental Fe as ferrous sulfate and 100 mg of ascorbic acid/100 g of powder and 278 control infants received milk without additives. At ages 9 and 15 mo significant differences were encountered in all measures of Fe nutriture in favor of the fortified group (p less than 0.001). Anemia (Hg less than 110 g/L) was present in 25.7% of unfortified infants compared with only 2.5% in those fortified at age 15 mo. Saturation of transferrin less than 9% was present in 33.8% and serum ferritin less than 10 micrograms/L in 39.1% of the nonfortified infants. The figures for the fortified group were 7 and 8.5% respectively. The efficiency of the fortified acidified milk in eradicating Fe deficiency in the infants while discouraging use by other family members make this milk a useful targeted product in programs of supplementary food distribution in the underdeveloped world.

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Healthy term infants were given a low-fat powdered milk fortified with 15 mg/100g of iron, as ferrous sulphate, for one year, starting at three months of age. The control group received non-fortified milk. A total of 510 infants entered the study, and 314 could be studied at the age of 15 months. Consumption of the fortified formulas was monitored through iron determinations in stools. Groups had a comparable hemoglobin concentration at the age of three months. Hemoglobin was higher in the fortified group at nine months (11.7 +/- 1.0 vs 11.4 +/- 1.1 g/dl, p less than 0.02), and 15 months (12.0 +/- 1.1 vs 11.4 +/- 1.2, p less than 0.001). The percentage of subjects with anemia (Hb less than 11.0 g/dl) was lower in the fortified group: 14.8% vs 27.7% of the controls at nine months and 7.0% vs 35.3% at 15 months. Percentages of subjects with iron deficiency (Fe/TIBC less than 9%) were lower in the fortified group: 28.0% vs 49.1% of the controls at nine months, and 20.0% vs 41.8% at 15 months. Although the fortified milk markedly improved iron nutrition, deficiency of this mineral was still high in the group receiving it. This was probably due to the low bioavailability of iron when administered with non-modified milks.

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The bioavailability of iron added to different types of cows' milk formulas was studied using mono-isotopic and double-isotopic methods in 396 infants aged 5-18 mo. All the milk formulas were fortified with ferrous sulfate in concentrations varying between 10 and 19 mg elemental iron/liter. Iron absorption from low-fat milks and full-fat milks varied from 2.9 to 5.1%. A higher range of mean absorption, 5.9 to 11.3%, was observed in the same formulas with the addition of ascorbic acid at concentrations of 100 mg/l or higher (up to 800 mg/l), demonstrating its enhancing effect on iron absorption in fortified milks. The amount of milk fat, the addition of carbohydrates, or acidification did not seem to influence iron absorption.

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Utilizando una técnica dobleisotópica, con marcadores extrínsecos de hierro, se estableció el rol que tiene la acidificación en la biodisponibilidad del hierro de fortificación de la leche. El test de absorción se realizó en 11 mujeres, de 36 a 45 años de edad. Las fórmulas lácteas utilizadas contenían 26 g/l de materia grasa, 15 mg/l de Fe elemental como sulfato ferroso y 100 mg/l de ácido ascórbico. El primer día los sujetos recibieron una leche no acidificada marcada con 59Fe, día 2 una fórmula acidificada (acidez = 2.5 g/l ácido láctico) marcada con 55Fe. El día 15 recibieron una solución acuosa de ascorbato ferroso, como dosis de referencia, marcado con 55Fe. A los días 15 y 30 se les extrajo una muestra sanguínea para el cálculo de la absorción. Los promedios geométricos de absorción de las fórmulas lácteas fueron 14,84% para la leche no acidificada y 14,22% para la lecha acidificada. Se concluye que la acidificación no afecta la biodisponibilidad del hierro de fortificación de la leche

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To evaluate the effects of short-term iron therapy on developmental test scores of infants with varying stages of iron deficiency, 37 infants, all 15 months of age, were tested with the Bayley Scales of Infant Development before and 11 days after beginning a trial of orally administered iron therapy. They were separated into three groups according to iron status: 12 controls, with normal iron nutrition; 11 with mild anemia, i.e., hemoglobin less than 11.0 gm/dl but greater than 8.5 gm/dl; and 15 with iron deficiency without anemia, i.e., Hgb greater than or equal to 11.0 gm/dl but at least one abnormal biochemical measure of iron nutrition (transferrin saturation, free erythrocyte protoporphyrin, or serum ferritin). The Mental Development Index was significantly lower in the anemic infants before treatment, as compared with that of normal controls. Improvement with iron therapy was also significant in those with anemia and in nonanemic patients with two or more biochemical indicators of iron deficiency. The rise in Mental Development Index was associated with improvement in attention span and cooperativeness. These findings suggest that mild iron deficiency has an effect on infant behavior that is rapidly reversible with iron therapy.

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