270903 High prevalence of iron deficiency in an urban low-income infant/toddler population

Monday, October 29, 2012 : 1:20 PM - 1:35 PM

Alan F. Meyers, MD, MPH , Department of Pediatrics, Boston Medical Center, Boston, MA
Hema Magge, MD , Pediatrics, Boston University School of Medicine, Boston, MA
Philippa Sprinz, MD , Pediatric Hematology, Boston University School of Medicine, Boston, MA
Bill Adams, MD , Pediatrics, Boston University School of Medicine, Boston, MA
Background: Both iron deficiency anemia (ID) and ID without anemia (IDA) in early life may have lasting neurodevelopmental consequences. Current NHANES data indicate a 9.2% prevalence of ID in U.S. children aged 12 - 35 months, with no poverty or Black/White race differential. Abnormal zinc protoporphyrin (ZPP) has been shown to be highly specific for ID in the absence of elevated lead (Pb). Objective: to determine the prevalence of abnormal ZPP in a large urban low-income infant/toddler population Methods: We reviewed initial routine screening data from all children age 8-18 months in primary care at Boston Medical Center between 1/1/02 and 12/31/10. Children with Pb >10mcg/dL and those with a sickle cell disease diagnosis were excluded. Results: Data from 4059 children were reviewed; 51% were female; 62% Black, 13% Latino, 7% White; 83% had public or no insurance. 48% had ZPP ≥35 mcg/dL. There was no association of abnormal ZPP with gender, Black/White race, or insurance type. Discussion: Nearly half the children in this study had an abnormal ZPP, a rate not statistically different from that reported by Lozoff et al in Detroit (Am J Hematol 2007;82:112), suggesting that the prevalence of ID in urban low-income children may be much higher than the 9.2% reported by NHANES. NHANES' ID definition, which requires that 2 of 3 iron status indicators be abnormal, may be too restrictive, given that some indicators (ZPP and ferritin) are highly specific for ID. Furthermore, given its low cost and high specificity, ZPP should be considered as a screening test for ID.

Learning Areas:
Basic medical science applied in public health
Clinical medicine applied in public health
Public health or related public policy

Learning Objectives:
Explain the public health importance of determining the prevalence of iron deficiency in infants and toddlers Describe the inconsistency in existing data which define the prevalence of iron deficiency Discuss the limitation of the current definition of iron deficiency, based on data from NHANES II

Keywords: Health Disparities, Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I designed the research question and participated in all aspects of the study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.