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Iron Iron is a component of a number of proteins including hemoglobin, which is essential for transporting oxygen to tissues throughout the body for use in metabolic processes. The most well-known consequence of iron deficiency is anemia. A full-term infant normally has a high hemoglobin concentration and a large amount of stored iron. Based on research evidence, this stored iron plus the iron provided in human milk is assumed to be adequate for solely breast-fed infants during the first 6 months after birth. Even though the amount of iron in

Life cycle stage —^ Infancy Childhood Adulthood Old age

Genetic susceptibility

Life style behaviors Diet


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Micronutrient Requirements

Micronutrient Requirements

Prevent deficiency Dietary sources can be sufficient Supplements sometimes needed (for example, calcium, B12, vitamin D iron, folic acid)

Prevent chronic disease?

Dietary sources likely not sufficient Supplementation generally beneficial (for example, calcium, folic acid)

Figure 1 Factors that influence micronutrient requirements.

human milk is low, its bioavailability is greater (>50%) than that of the iron in infant formula (<12%). The body stores of iron in infants decrease during the fourth through sixth months after birth. After 6 months of age, most of the infant's iron needs must be met from food intake. In Western countries, the primary food introduced after 6 months is infant cereal, usually fortified with iron that has low bioavailability. Evidence suggests that infants benefit from iron supplementation after 6 months, and that administration of iron drops between 6 and 9 months has a significant influence on iron status. The American Academy of Pediatrics (AAP) discourages using low-iron infant formulas. AAP recommends that infants who are not breastfed or who are only partially breast-fed should receive an iron-fortified formula from birth to 12 months of age.

Vitamin D Vitamin D enhances the efficiency of the small intestine to absorb calcium and phosphorus from the diet and thus helps to maintain normal serum levels of these minerals. Vitamin D deficiency in infants and children results in inadequate mineralization of the skeleton, causing rickets, which is characterized by various bone deformations. The major source of vitamin D is its formation in the skin as a result of exposure to sunlight. Dietary sources include fortified foods, such as milk and cereals, and certain fish. Infant formula is fortified with vitamin D in many countries. Because human milk contains only low amounts of vitamin D, breast-fed infants who do not receive either supplemental vitamin D or adequate exposure to sunlight are at risk for developing vitamin D deficiency. Subclinical vitamin D deficiency can be assessed by measuring serum 25-hydroxyl-vitamin D; deficiency occurs months before rickets is obvious on physical examination. Rickets in infants continues to be reported in the

United States as well as in other countries. Epide-miologic evidence indicates that African American infants and children are more likely to develop nutritional rickets than Caucasian infants and children. In the US, the AAP recommends that all breastfed infants receive a daily supplement of 200 IU vitamin D/day, beginning within the first two months of life, unless they are weaned to at least 500mL per day of vitamin D-fortified formula (<1 year old) or milk (>1 year old).

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