Higher Body Mass Index Is Associated with Iron Deficiency in Children 1 to 3 Years of Age - 08/01/19

Doi : 10.1016/j.jpeds.2018.11.035

Emma E. Sypes, MSc Candidate ¹, Patricia C. Parkin, MD, FRCPC ^1,^2,^3,^4,^{*
Contributed equally.}, Catherine S. Birken, MD, MSc, FRCPC ^1,^2,^3,⁴, Sarah Carsley, PhD ^1,^2,³, Colin MacArthur, MBChB, PhD ^1,^2,^3,⁴, Jonathon L. Maguire, MD, MSc, FRCPC ^3,^4,^5,^6,⁷, Cornelia M. Borkhoff, PhD ^1,^2,^3,^*^{*
Contributed equally.}
on behalf of the
TARGet Kids! Collaboration^{^†}
List of additional contributors is available at www.jpeds.com (Appendix).
Mary Aglipay ⁸, Laura N. Anderson ⁸, David W.H. Dai ⁸, Charles Keown-Stoneman ⁸, Christine Kowal ⁸, Dalah Mason ⁸, Murtala Abdurrahman ⁹, Barbara Anderson ⁹, Kelly Anderson ⁹, Gordon Arbess ⁹, Jillian Baker ⁹, Tony Barozzino ⁹, Imaan Bayoumi ⁹, Sylvie Bergeron ⁹, Dimple Bhagat ⁹, Nicholas Blanchette ⁹, Gary Bloch ⁹, Joey Bonifacio ⁹, Ashna Bowry ⁹, Anne Brown ⁹, Jennifer Bugera ⁹, Caroline Calpin ⁹, Douglas Campbell ⁹, Sohail Cheema ⁹, Elaine Cheng ⁹, Brian Chisamore ⁹, Evelyn Constantin ⁹, Ellen Culbert ⁹, Karoon Danayan ⁹, Paul Das ⁹, Mary Beth Derocher ⁹, Anh Do ⁹, Michael Dorey ⁹, Kathleen Doukas ⁹, Anne Egger ⁹, Allison Farber ⁹, Amy Freedman ⁹, Sloane Freeman ⁹, Sharon Gazeley ⁹, Charlie Guiang ⁹, Dan Ha ⁹, Curtis Handford ⁹, Laura Hanson ⁹, Leah Harrington ⁹, Hailey Hatch ⁹, Teresa Hughes ⁹, Sheila Jacobson ⁹, Lukasz Jagiello ⁹, Gwen Jansz ⁹, Mona Jasuja ⁹, Paul Kadar ⁹, Tara Kiran ⁹, Holly Knowles ⁹, Bruce Kwok ⁹, Sheila Lakhoo ⁹, Margarita Lam-Antoniades ⁹, Eddy Lau ⁹, Denis Leduc ⁹, Fok-Han Leung ⁹, Alan Li ⁹, Patricia Li ⁹, Jennifer Loo ⁹, Joanne Louis ⁹, Sarah Mahmoud ⁹, Jessica Malach ⁹, Roy Male ⁹, Vashti Mascoll ⁹, Aleks Meret ⁹, Elise Mok ⁹, Rosemary Moodie ⁹, Julia Morinis ⁹, Maya Nader ⁹, Katherine Nash ⁹, Sharon Naymark ⁹, James Owen ⁹, Jane Parry ⁹, Michael Peer ⁹, Kifi Pena ⁹, Marty Perlmutar ⁹, Navindra Persaud ⁹, Andrew Pinto ⁹, Michelle Porepa ⁹, Vikky Qi ⁹, Nasreen Ramji ⁹, Noor Ramji ⁹, Jesleen Rana ⁹, Danyaal Raza ⁹, Alana Rosenthal ⁹, Katherine Rouleau ⁹, Janet Saunderson ⁹, Rahul Saxena ⁹, Vanna Schiralli ⁹, Michael Sgro ⁹, Hafiz Shuja ⁹, Susan Shepherd ⁹, Barbara Smiltnieks ⁹, Cinntha Srikanthan ⁹, Carolyn Taylor ⁹, Stephen Treherne ⁹, Suzanne Turner ⁹, Fatima Uddin ⁹, Meta van den Heuvel ⁹, Joanne Vaughan ⁹, Thea Weisdorf ⁹, Sheila Wijayasinghe ⁹, Peter Wong ⁹, Anne Wormsbecker ⁹, John Yaremko ⁹, Ethel Ying ⁹, Elizabeth Young ⁹, Michael Zajdman ⁹, Farnaz Bazeghi ¹⁰, Vincent Bouchard ¹⁰, Marivic Bustos ¹⁰, Charmaine Camacho ¹⁰, Dharma Dalwadi ¹⁰, Christine Koroshegyi ¹⁰, Tarandeep Malhi ¹⁰, Sharon Thadani ¹⁰, Julia Thompson ¹⁰, Laurie Thompson ¹⁰
⁸ Science Contributors, TARGet Kids! Collaboration
⁹ Site Investigators, TARGet Kids! Collaboration
¹⁰ Research Team, TARGet Kids! Collaboration

¹ Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada
² Sick Kids Research Institute, Toronto, Ontario, Canada
³ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
⁴ Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
⁵ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
⁶ Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
⁷ Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

^*Reprint requests: Cornelia M. Borkhoff, PhD, The Hospital for Sick Children, Research Institute, Peter Gilgan Center for Research and Learning, 686 Bay St, Toronto, ON M5G 0A4, Canada.The Hospital for Sick ChildrenResearch InstitutePeter Gilgan Center for Research and Learning686 Bay StTorontoONM5G 0A4Canada

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 08 January 2019

Abstract

Objectives

To examine the association between body mass index (BMI) and iron deficiency in early childhood, while considering the influence of low-grade systemic inflammation.

Study design

Healthy children ages 1-3 years were included in a cross-sectional analysis. Age- and sex-standardized World Health Organization BMI z score (zBMI) was calculated using height/length and weight measurements; iron status was assessed by serum ferritin; inflammation was assessed by C-reactive protein (CRP). Children with CRP ≥10 mg/L were excluded because this may indicate acute systemic inflammation. Adjusted multivariable regression analyses were used to investigate the association between zBMI and both serum ferritin (µg/L), and iron deficiency (serum ferritin <12 µg/L). We performed prespecified subgroup analyses according to CRP level (normal [≤1.0 mg/L] and low-grade inflammation [>1.0 mg/L to <10.0 mg/L]).

Results

Of 1607 children included, 20% were categorized as with zBMI >1, 13% had iron deficiency, and 18% had low-grade inflammation. Higher zBMI was associated with lower serum ferritin (−1.51 µg/L, 95% CI −2.23, −0.76, P < .0001) and increased odds of iron deficiency (OR 1.28, 95% CI 1.10, 1.50, P = .002). Though there was no interaction between zBMI and CRP for the adjusted linear regression model (P = .79) or logistic regression model (P = .43), children with low-grade inflammation had a higher serum ferritin (P < .0001).

Conclusions

Higher zBMI is associated with increased risk for iron deficiency in children between 1 and 3 years, and should be considered as a risk factor in targeted screening. Further research is needed to better understand the relationship between serum ferritin and CRP for children in all weight categories.