Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Primary Care
Published in: BMC Primary Care 1/2018

Open Access 01-12-2018 | Research article

Iron deficiency among low income Canadian toddlers: a cross-sectional feasibility study in a Community Health Centre and non-Community Health Centre sites

Authors: Imaan Bayoumi, Patricia C. Parkin, Gerald Lebovic, Rupa Patel, Kendra Link, Catherine S. Birken, Jonathon L. Maguire, Cornelia M. Borkhoff

Published in: BMC Primary Care | Issue 1/2018

Login to get access

Abstract

Background

Iron deficiency in early childhood has been associated with poor developmental outcomes. Little is known about the nutritional health of young children receiving care at Canadian Community Health Centres (CHCs). Our objectives were to describe iron deficiency among toddlers at an Ontario CHC, to compare young children attending CHCs and non-CHCs, and assess the feasibility of conducting research on children in CHC settings.

Methods

One CHC, Kingston Community Health Centres (CHC) with two clinical sites and one community programming site was added to the nine non-CHC pediatric and primary care clinics in the existing TARGet Kids! research network. A cross-sectional feasibilitystudy was conducted.and. Healthy children, ages 12–36 months were Enrolled. iron deficiency without inflammation (ferritin< 14 μg/L and CRP < 10 mg/L) and serum ferritin were assessed. Adjusted multivariable regression analyses were used to evaluate an association between CHC enrolment and iron status.

Results

The CHC cohort (n = 31) was older, had lower household income, lower maternal education, higher nutrition risk scores, higher cow’s milk intake, shorter breastfeeding duration and higher prevalence of unhealthy weights compared with the non-CHC cohort (n = 875). There was no association between CHC status and serum ferritin (difference in median serum ferritin 4.78 μg/L, 95% confidence interval [CI] -2.5, 14.3, p = 0.22) or iron deficiency (OR 0.55, 95% CI 0.11, − 2.73, p = 0.46) using multivariable linear and logistic regression, respectively.

Conclusion

Despite differences in sociodemographic variables, we did not detect a difference in iron status between toddlers enrolled at CHCs compared to non-CHC settings. Further research is needed to understand the health effects of poverty generally, and iron deficiency specifically among children receiving care at CHCs.
Literature
1.
Grantham-McGregor S, Ani C. A review of studies on the effect of Iron deficiency on cognitive development in children. J Nutr. 2001;131:649S–68S.CrossRef
2.
Skalicky A, Meyers AF, Adams WG, Yang Z, Cook JT, Frank DA. Child food insecurity and iron deficiency anemia in low-income infants and toddlers in the United States. Matern Child Health J. 2006;10(2):177–85 PubMed PMID: 16328705.CrossRef
3.
Lozoff B, Jimenez E, Wolf A. Long-term developmental outcome of infants with iron deficiency. NEJM. 1991;325(10):687–94.CrossRef
4.
Walter T, de Andraca I, Chadud P, Perales CG. Iron deficiency Anemia: adverse effects on infant psychomotor development. Pediatrics. 1989;84(1):7–17.PubMed
5.
Hartfield D. Iron deficiency is a public health problem in Canadian infants and children. Pediatric Child Health. 2010;15:347–50.CrossRef
6.
Brotanek JM, Gosz J, Weitzman M, Flores G. Iron deficiency in early childhood in the United States: risk factors and racial/ethnic disparities. Pediatrics. 2007;120(3):568–75 PubMed PMID: 17766530.CrossRef
7.
Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL. Prevalence of iron deficiency in the United States. JAMA. 1997;277(12):973–6 PubMed PMID: 9091669.CrossRef
8.
9.
Saunders NR, Parkin PC, Birken CS, Maguire JL, Borkhoff CM. Iron status of young children from immigrant families. Arch Dis Child. 2016;101:1130–6.CrossRef
10.
11.
12.
Maguire J, Lebovic G, Kandasamy S, Khovratovich M, Mamdani M, Birken C, et al. The relationship between Cow's Milk and Stores of Vitamin D and Iron in early childhood. Pediatrics. 2013;131:e144–51.CrossRef
13.
Maguire JL, Salehi L, Birken C, Carsley S, Mamdani M, Thorpe KE, et al. The association between total duration of breastfeeding and iron deficiency. Pediatrics. 2013;131:e144–e51.CrossRef
14.
Cox KA, Parkin PC, Anderson LN, Chen Y, Birken CS, Maguire JL, et al. Association between meat and meat-alternative consumption and Iron Stores in Early Childhood. Acad Pediatr. 2016;16:783–91.CrossRef
15.
Abdullah K, Thorpe KE, Maguire JL, Birken CS, Fehlings D, Hanley AJ, et al. Risk factors, practice variation and hematological outcomes of children identified with non-anemic iron deficiency following screening in primary care setting. Paediatr Child Health. 2015;20(6):302–6 Epub 2015/10/06. PubMed PMID: 26435669; PubMed Central PMCID: PMCPMC4578469.CrossRef
16.
Glazier R, Rayner J, Kopp A. Examining Community Health Centres According to Geography and Priority Populations Served, 2011/12 to 2012/13. In: An ICES Chartbook. Toronto, ON: Institute for Clinical Evaluative Sciences; 2015.
17.
Glazier R, Hutchison B, Kopp A. Comparison of family health teams to other Ontario primary care models, 2004/05 to 2011/12. Toronto: Institute for Clinical Evaluative Sciences; 2015.
18.
Parpia R, Borkhoff CM, Muldoon L, Rayner J, Birken C, Parkin P, et al. Association of measures of marginalization and use of Ontario community health Centres for preventative and social determinants of health-related care in young children. Pediatric Academic Societies; Toronto 2018.
19.
20.
21.
22.
World Health Organization. C-reactive protein concentrations as a marker of inflammation or infection for interpreting biomarkers of micronutrient status 2014 [Aug. 29, 2018].
23.
24.
Randall Simpson J, Keller H, Rysdale L, Beyers J. Nutrition screening tool for every preschooler (NutriSTEP): validation and test–retest reliability of a parent-administered questionnaire assessing nutrition risk of preschoolers. Eur J Clin Nutr. 2008;62:770–80.CrossRef
25.
Randall Simpson J, Gumbley J, Whyte K, Lac J, Morra C, Rysdale L, et al. Development, reliability, and validity testing of toddler NutriSTEP: a nutrition risk screening questionnaire for children 18–35 months of age. Appl Physiol Nutr Metab. 2015;40:877–86.CrossRef
26.
National Health and Nutrition Examination Survey (NHANES) Anthropometry Procedures Manual. Centers for Disease Control, 2011.
27.
Cogswell ME, Looker AC, Pfeiffer CM, Cook JD, Lacher DA, Beard JL, et al. Assessment of iron deficiency in US preschool children and nonpregnant females of childbearing age: National Health and nutrition examination survey 2003–2006. Am J Clin Nutr. 2009;89:1334–42.CrossRef
28.
Sypes E, Parkin PC, Birken CS, Carsley S, Macarthur C, Maguire JL, Borkhoff CM. Association between increased weight and iron deficiency in early childhood. Pediatrics 2018;142(1 Meeting Abstract).
29.
Parkin PC, Maguire JL. Iron deficiency in early childhood. Can Med Assoc J. 2013;185:1237–8.CrossRef
30.
31.
Mickey RM, Greenland S. The impact of confounder selection criteria on effect estimation. Am J Epidemiol. 1989;129:125–37.CrossRef
32.
Little RJA, Rubin DB. Statistical analysis with missing data. New York, N.Y: Wiley; 2002.CrossRef
33.
Egeland GM, Williamson-Bathory L, Johnson-Down L, Sobol I. Traditional food and monetary access to market-food: correlates of food insecurity among Inuit preschoolers. Int J Circumpolar Health. 2011;70(4):373–83 PubMed PMID: 21878183.CrossRef
34.
35.
Christofides A, Schauer C, Zlotkin SH. Iron deficiency and anemia prevalence and associated etiologic risk factors in first nations and Inuit communities in northern Ontario and Nunavut. Can J Public Health. 2005;96(4):304–7 PubMed PMID: 16625803.PubMed
36.
Willows ND, Morel J, Gray-Donald K. Prevalence of anemia among James Bay Cree infants of northern Quebec. CMAJ. 2000;162(3):323–6 PubMed PMID: 10693587; PubMed Central PMCID: PMCPMC1231010.PubMedPubMedCentral
37.
Willows ND, Dewailly E, Gray-Donald K. Anemia and iron status in Inuit infants from northern Quebec. Can J Public Health. 2000;91(6):407–10 PubMed PMID: 11200728.PubMed
38.
Metallinos-Katsaras E, Colchamiro R, Edelstein S, Sui E. Household food security status is associated with Anemia risk at age 18 months among low-income infants in Massachusetts. J Acad Nutr Diet. 2016;116(11):1760–6.CrossRef
39.
Brotanek JM, Gosz J, Weitzman M, Flores G. Secular trends in the prevalence of iron deficiency among US toddlers, 1976-2002. Arch Pediatr Adolesc Med. 2008;162(4):374–81.CrossRef
40.
Verga ME, Widmeier-Pasche V, Beck-Popovic M, Pauchard JY, Gehri M. Iron deficiency in infancy: is an immigrant more at risk? Swiss Med Wkly. 2014;144:w14065.
41.
Ferrara M, Bertocco F, Ricciardi A, Ferrara D, Incarnato L, Capozzi L. Iron deficiency screening in the first three years of life: a three-decade-long retrospective case study. Hematology. 2014;19(4):239–43.CrossRef
42.
Brotanek JM, Halterman JS, Auinger P, Flores G, Weitzman M. Iron deficiency, prolonged bottle-feeding, and racial/ethnic disparities in young children. Arch Pediatr Adolesc Med. 2005;159(11):1038–42 PubMed PMID: 16275794.CrossRef
43.
Grant CC, Wall CR, Yates R, Crengle S. Nutrition and indigenous health in New Zealand. J Paediatr Child Health. 2010;46(9):479–82.CrossRef
44.
McCann J, Ames B. An overview of evidence for a causal relationship between iron deficiency during development and deficits in cognitive or behavioural function. Am J Clin Nutr. 2007;85(4):931–45.CrossRef
45.
Walker SP, Wachs TD, Meeks Gardner J, Lozoff B, Wasserman GA, Pollitt E, et al. Child development: risk factors for adverse outcomes in developing countries. Lancet. 2007;369:145–57.CrossRef
46.
Lozoff B, Smith JB, Kaciroti N, Clark KM, Guevara S, Jimenez E. Functional significance of early-life Iron deficiency: outcomes at 25 years. J Pediatr. 2013;163:1260–6.CrossRef
47.
Lozoff B, Jimenez E, Smith J. Double burden of iron deficiency in infancy and low socioeconomic status. A longitudinal analysis of cofnitive test scores to age 19 years. Arch Pediatr Adolesc Med. 2006;160:1108–13.CrossRef
48.
Baptist EC, Castillo SF. Cow's Milk-induced Iron deficiency Anemia as a cause of childhood stroke. Clin Pediatr. 2002;41:533–5.CrossRef
49.
Maguire JL, deVeber G, Parkin PC. Association between Iron-deficiency Anemia and stroke in young children. Pediatrics. 2007;120:1053–7.CrossRef
50.
Halfon N, Hochstein M. Life course health development : an integrated framework for developing health. Policy and Research The Milbank Quarterly. 2002;80(3):433–79.CrossRef
51.
Boivin M, Hertzman C, Barr RG, Boyce WT, Fleming A, MacMillan H, et al. Early childhood development: adverse experiences and developmental health. Ottawa, ON: Royal Society of Canada- Canadian Academy of Health Sciences Expert Panel; 2012.
52.
Shonkoff JP, Boyce WT, McEwen BS. Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention. JAMA 2009;301(21):2252–2259.CrossRef
53.
Shonkoff JP, Garner AS, Committee on Psychosocial Aspects of C, Family H, Committee on Early Childhood A, Dependent C, et al. The lifelong effects of early childhood adversity and toxic stress. Pediatrics. 2011;129(1):e232–46 PubMed PMID: 22201156.CrossRef
54.
Garner AS, Shonkoff JP, Committee on Psychosocial Aspects of C, Family H, Committee on Early Childhood A, Dependent C, et al. Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics. 2012;129(1):e224–31 PubMed PMID: 22201148.CrossRef
55.
Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. Am J Prev Med. 1998;14(4):245–58.CrossRef
56.
Metadata
Title
Iron deficiency among low income Canadian toddlers: a cross-sectional feasibility study in a Community Health Centre and non-Community Health Centre sites
Authors
Imaan Bayoumi
Patricia C. Parkin
Gerald Lebovic
Rupa Patel
Kendra Link
Catherine S. Birken
Jonathon L. Maguire
Cornelia M. Borkhoff
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2018
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-018-0848-9

Other articles of this Issue 1/2018

BMC Primary Care 1/2018 Go to the issue

Research article

The increasing importance of a continence nurse specialist to improve outcomes and save costs of urinary incontinence care: an analysis of future policy scenarios

Research article

Patient capacity for self-care in the medical record of patients with chronic conditions: a mixed-methods retrospective study

Research article

Impact of heart failure and other comorbidities on mortality in patients with chronic obstructive pulmonary disease: a register-based, prospective cohort study

Study protocol

Targeted prevention in primary care aimed at lifestyle-related diseases: a study protocol for a non-randomised pilot study

Research article

Coding of medically unexplained symptoms and somatoform disorders by general practitioners – an exploratory focus group study

Research article

GP/GPN partner* perspectives on clinical placements for student nurses in general practice: can a community of practice help to change the prevailing culture within general practice?