ALTI AY- BEŞ YAŞ ARASI ÇOCUKLARDA DEMİR EKSİKLİĞİ VE BESLENME İLİŞKİSİ

Abstract

Amaç: Demir eksikliği (DE) ve demir eksikliği anemisi (DEA) en sık besinsel eksiklik olup, çocuklarda fiziksel ve kognitif gelişim üzerinde olumsuz etkiler doğurabilmektedir. Özellikle yaşamın ilk yıllarındaki beslenme DE/DEA ile doğrudan ilişkilidir. Bu çalışmadaki amacımız, 6 ay-5 yaş arasındaki sağlıklı çocuklarda beslenme ile DE/DEA arasındaki ilişkiyi araştırmaktır.

Gereç ve Yöntemler: Çalışmamız, Eylül 2014 - Eylül 2016 tarihlerinde Sivas Cumhuriyet Üniversitesi Tıp Fakültesi Hastanesi, Pediatri Polikliniğine başvuran 6 ay-5 yaştaki çocuklarda gerçekleştirilmiştir. Çocuklar tam kan sayımı, serum demir düzeyi, total demir bağlama kapasitesi, serum ferritin düzeyi ölçülerek iki gruba ayrılmıştır. Grup 1; DE/DEA olanlar, Grup 2; normal çocuklardan oluşmaktadır. Çocukların beslenme özellikleri annelerinden öğrenilmiştir.

Bulgular: Çalışmamızda toplam187 çocuk yer almıştır (Grup 1=88, Grup 2=99). Her iki grupta çocukların cinsiyet ve yaş ortalamaları benzerdir (sırasıyla 22,68±14,22 ve 21,77±13,27 ay, p>0,05). Grup 2’deki çocukların doğum ağırlığı daha fazla (sırasıyla 3091,07±487,78 ve 3268,68±509,28 gr, p<0,05) ve doğum haftası daha geçtir  (38,46±1,19 ve 38,82±1,24 hafta, p<0,05). Ağırlık ve boy persentili, ≥50 p olan çocuk sayısı Grup 2’de daha fazladır. Toplam anne sütü ile beslenme süresi benzer iken (sırasıyla 12,59±8,50 ve 13,50±7,06 ay, p>0,05), sadece anne sütü ile beslenme süresi Grup 1’de daha uzundur (sırasıyla 5,74±2,89 ve 4,36±2,15 ay, p<0,05). Grup 1’deki çocukların ek besine başlama zamanları daha geçtir. Çocukların demir durumu ile tüketilen beyaz peynir, kaşar, lor ve labne peyniri, yumurta, kırmızı et, tavuk ve balık, ev yoğurdu ve sebze yemekleri arasında pozitif korelasyon, yemek suyu, hazır çorba, hazır meyve suyu ve siyah çay tüketimi ile ise negatif korelasyon saptanmıştır.  

Sonuç: Çocuklarda DE/DEA ile beslenme arasında yakın bir ilişki vardır. Çocukların DE/DEA nden korunması için annelerin demir deposunun yeterli olması, anne sütüyle beslenme, doğru zamanda demir içeriği zengin ve biyoyararlanımı yüksek besinlerle tamamlayıcı beslenmeye geçiş ve düzenli takip önemlidir.

Keywords

• Çocukluk çağı,demir eksikliği,beslenme

THE RELATIONSHIP BETWEEN IRON DEFICIENCY AND NUTRITION IN CHILDREN AGED 6 MONTHS-5 YEARS

Abstract

Objective: Iron deficiency (ID)/iron deficiency anemia (IDA) are the most common nutritional deficiencies and may have negative effects on physical-cognitive development in children. Nutrition, especially in the first years of life, is directly related to ID/IDA. The aim of this study was to investigate the relationship between nutrition and ID/IDA in healthy children aged 6 months-5 years.

Material-Methods: Our study was carried out between September 2014-September 2016 in children aged 6 months-5 years who applied  Pediatric Outpatient Clinic of Sivas Cumhuriyet University Medical Faculty. Children were divided into two groups by measuring complete blood count, serum iron, ferritin levels and total iron binding capacity. Group1: patients with ID/IDA, Group2: normal children. Nutritional characteristics of children were learned from their mothers.

Results: The study included totally 187 children (Group1=88, Group2=99). The sex and mean age of the children were similar (respectively, 22.68±14.22 vs. 21.77±13.27 months, p>0.05). In Group2, mean birth weight was higher (respectively, 3091.07±487.78 vs. 3268.68±509.28 gr, p<0.05) and mean birth weeks were later (38.46±1.19 vs. 38.82±1.24 weeks, p<0.05). In Group2, the number of children with weight-height percentile ≥50 p were higher. While total duration of breastfeeding was similar (12.59±8.50 vs. 13.50±7.06 months, p>0.05), exclusively breastfeeding time was longer in Group1 (5.74±2.89 vs. 4.36±2.15 months, p<0.05). The time of starting complementary feeding was later in Group1. There was a positive correlation between the iron status of children and consumed white/cheddar/curd/labne cheese, eggs, red meat, chicken, fish, home yoghurt, vegetables and negative correlation with consumption of food juice, instant soup, instant fruit juice and black tea.

Conclusion: There is a close relationship between ID/IDA and nutrition in children. For the protection of children from ID/IDA, sufficient iron storage of mothers’, breastfeeding, transition to complementary feeding with iron rich content and bioavailability at the right time and regular follow-up are important.

Keywords

• Childhood,iron deficiency,nutrition

References

1. 1. FAO/WHO: Human vitamin and mineral requirements in human nutrition. Second edition. Geneva: World Health Organization and Food and Agriculture Organization of the United Nations, 2004.
2. 2. Soliman AT, De Sanctis V, Kalra S. Anemia and growth. Indian J Endocrinol Metab 2014; 18 (Suppl 1): 1–5.
3. 3. World Health Organization, 10 facts on nutrition. Erişim tarihi: 12 Haziran 2019. Available from; https://www.who.int/features/factfiles/nutrition/en/
4. 4. Aydın A, Gur E, Erener Ercan T, Can G, Arvas A. Comparison of different iron preparations in the prophylaxis of iron deficiency anemia. J Ped Hematol Oncol. 2017; 39(7):495-9.
5. 5. Dewey KG. The challenge of meeting nutrient needs of infants and young children during the period of complementary feeding: an evolutionary perspective. J Nutr. 2013;143(12): 2050-54.
6. 6. World Health Organization. Infant and young child nutrition. Global strategy on infant and young child feeding. Fifty-fifth World Health Assembly. A55/15. Geneva, World Health Organization; 2002.
7. 7. Özdemir N. Iron deficiency anemia from diagnosis to treatment in children. Türk Pediatri Arşivi 2015; 50: 11-9.
8. 8. Akman M, Cebeci D, Okur V, Angin H, Abali O, Akman AC. The effects of iron deficiency on infants’ developmental test performance. Acta Paediatr 2004; 93: 1391–96.

9. 9. WHO/UNICEF/UNU: Iron Deficiency Anaemia – Assessment, Prevention, and Control. A Guide for Programme Managers. Geneva, World Health Organization, 2001.
10. 10. Neyzi O, Günöz H, Furman A, Bundak R, Gökçay G, Darendeliler F, Baş F (2008). Türk çocuklarında vücut ağırlığı, boy uzunluğu, baş çevresi ve vücut kitle indeksi referans değerleri. Çocuk Sağlığı ve Hastalıkları Dergisi, 51: 1-14.
11. 11. Lanzkowsky P. Iron deficiency anemia. In Lanzkowsky P, Lipton J, Fish J (eds). Lanzkowsky´s Manual of Pediatric Hematology and Oncology. 6th ed. San Diego, CA: Elsevier; 2016: 69-83.
12. 12. Demir Gibi Türkiye Projesi 2004/21-TC Sağlık Bakanlığı. Erişim tarihi: 12 Haziran 2019. Available from; https://www.saglik.gov.tr/TR,11068/demir-gibi-turkiye-projesi--genelgesi-2004--21.html.
13. 13. World Health Organization, Worldwide Prevalence of Anaemia 1993-2005. WHO Global Database on Anaemia. Benoist B, McLean E, Egli I, Cogswell M (eds).
14. 14.Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2017;4:CD004905.
15. 15. Iqbal S, Ekmekcioglu C. Maternal and neonatal outcomes related to iron supplementation or iron status: a summary of meta-analyses. The Journal of Maternal-Fetal & Neonatal Medicine, 2019; 32:9, 1528-1540.
16. 16.Yurdakök K, İnce OT. Çocuklarda demir eksikliği anemisini önleme yaklaşımları. Çocuk Sağlığı ve Hastalıkları Dergisi 2009; 52: 224-231.
17. 17. Burke RM, Leon JS, Suchdev PS. Identification, Prevention and Treatment of Iron Deficiency during the First 1000 Days. Nutrients 2014, 6, 4093-4114.
18. 18. Monterrosa EC, Frongillo EA, Vasquez-Garibay EM, Romero-Velarde E, Casey LM, Willows ND. Predominant Breast-Feeding from Birth to Six Months Is Associated with Fewer Gastrointestinal Infections and Increased Risk for Iron Deficiency among Infants. J. Nutr. 2008;138: 1499–1504.
19. 19. Dube K, Schwartz J, Mueller, MJ, Kalhoff, H, Kersting M. Iron intake and iron status in breastfed infants during the first year of life. Clin. Nutr. 2010, 29, 773–778.
20. 20. Marques RFSV, Taddei JAAC, Lopez FA, Braga JAP. Breastfeeding exclusively and iron deficiency anemia during the first 6 months of age. Rev Assoc Med Bras 2014; 60(1):18-22.
21. 21. De-Regil LM, Suchdev PS, Vist GE, Walleser S, Peña-Rosas JP. Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age. Evid Based Child Health 2013; 8: 112–201.
22. 22. Jonsdottir OH, Thorsdottir I, Hibberd PL, Fewtrell MS, Wells JC, Palsson GI, et al. Timing of the introduction of complementary foods in infancy: a randomized controlled trial. Pediatrics 2012;130(6):1038–45.
23. 23.Obbagy JE, English LK, Psota TL, Wong YP, Butte NF, Dewey KG, et al. Complementary feeding and micronutrient status: a systematic review. Am J Clin Nutr 2019;109(Suppl):852–871.
24. 24. Dalili H, Baghersalimi A, Dalili S, Pakdaman F, Hassanzadeh Rad A, Abbasi Kakroodi M, et al. Is there any relation between Duration of breastfeeding and anemia? Iran J Ped Hematol Oncol. 2015;5:4, 218-226.
25. 25.Maguire JL, Salehi L, Birken CS, Carsley S, Mamdani M, Thorpe KE, et al. Association Between Total Duration of Breastfeeding and Iron Deficiency. Pediatrics. 2013, 131:5.
26. 26. Thorisdottir AV, Thorsdottir I, Palsson GI. Nutrition and Iron Status of 1-Year Olds following a Revision in Infant Dietary Recommendations Anemia. 2011;9 pages.
27. 27. Sultan AN, Zuberi RW. Late weaning: the most significant risk factor in the development of iron deficiency anaemia at 1–2 years of age. J Ayub Med Coll Abbottabad 2003; 15:3–7.
28. 28. Eussen S, Alles M, Uijterschout L, Brus F, Horst-Graat JVD. Iron Intake and Status of Children Aged 6–36 Months in Europe: A Systematic Review. Ann Nutr Metab 2015;66:80–92.
29. 29. Tympa-Psirropoulou E, Vagenas C, Psirropoulos D, Dafni O, Matala A, Skopouli F. Nutritional risk factors for iron-deficiency anaemia in children 12–24 months old in the area of Thessalia in Greece. Int J Food Sci Nutr 2005;56(1):1–12.
30. 30. Olaya GA, Lawson M, Fewtrell MS. Efficacy and safety of new complementary feeding guidelines with an emphasis on red meat consumption: a randomized trial in Bogota, Colombia. Am J Clin Nutr 2013;98(4):983–93.
31. 31. Urkin J, Adam D, Weitzman D, Gazala E, Chamni S, Kapelushnik J. Indices of iron deficiency and anaemia in Bedouin and Jewish toddlers in southern Israel. Acta Paediatr 2007;96(6):857–60.
32. 32. Male C, Persson LA, Freeman V, Guerra A, van’t Hof MA, Haschke F. Euro-Growth Iron Study Group. Prevalence of iron deficiency in 12-mo-old infants from 11 European areas and influence of dietary factors on iron status (Euro-Growth Study). Acta Paediatr 2001;90(5): 492-8.
33. 33. Michaelsen KF, Milman N, Samuelson G. A longitudinal study of iron status in healthy Danish infants: effects of early iron status, growth velocity and dietary factors. Acta Paediatr 1995;84(9): 1035–44.
34. 34. Thorsdottir I, Gunnarsson BS, Atladottir H, Michaelsen KF, Palsson G. Iron status at 12 months of age—effects of body size, growth and diet in a population with high birth weight. Eur J Clin Nutr 2003;57(4): 505–13.
35. 35. Makrides M, Hawkes JS, Neumann MA, Gibson RA. Nutritional effect of including egg yolk in the weaning diet of breast-fed and formula-fed infants: a randomized controlled trial.AmJ Clin Nutr 2002;75(6):1084–92.
36. 36. Engelmann MD, Sandstrom B, Michaelsen KF. Meat intake and iron status in late infancy: an intervention study. J Pediatr Gastroenterol Nutr 1998; 26(1): 26–33.
37. 37. Lawson MS, Thomas M, Hardiman A. Iron status of Asian children aged 2 years living in England. Arch. Dis. Child.1998; 78: 420-6.
38. 38. Wu AC, Lesperance L, Bernstein H.Screening for iron deficiency. Pediatrics in Review, 2002;23:5, 171-177.
39. 39.Thane CW, Walmsley CM, Bates CJ, Prentice A, Cole TJ. Risk factors for poor iron status in British toddlers: further analysis of data from the National Diet and Nutrition Survey of children aged 1.5-4.5 years. Public Health Nutrition.2000; 3(4), 433-440.
40. 40. Jackson LS, Lee K. The effect of dairy products on iron availability. Crit. Rev. Food Sci. Nutr. 1992; 31: 2559-70.