Pattern of milk feeding and family size as risk factors for iron deficiency anemia among poor Egyptian infants 6 to 24 months old

Nutr Res. 2012 Feb;32(2):93-9. doi: 10.1016/j.nutres.2011.12.017.


Infants between 6 and 24 months of age are at the highest risk of development of iron deficiency anemia (IDA) in developing countries. Consuming unmodified cow's milk, delayed introduction of solid foods after 6 months, and high birth order could be predictors of the presence of IDA. Three hundred infants between the ages of 6 and 24 months (mean, 13.94 ± 6.17 months) from Ain Shams University Children's Hospital were enrolled in the study. Data collected included demographic information and dietary assessment including the type of milk feeding, introduction of solid foods, and daily iron intake. The infants were examined, and anthropometric measurements were recorded. Anemic infants (hemoglobin level <11 g/dL) were further evaluated by complete blood count, hemoglobin electrophoresis, and iron profile. Anemia was diagnosed among 198 infants (66%), of whom 129 (43%) had IDA. Red cell distribution width at a cutoff value of 15.8% was 86% sensitive and 74% specific in predicting IDA. The main risk factors for IDA included being between 6 and 18 months of age, of the male sex, birth order above the second order, consuming cow's milk, predominant breast-feeding beyond 6 months of age, and low daily iron intake. We conclude that IDA is the most common cause of anemia among Egyptian infants 6 to 24 months old of low socioeconomic standard. Independent clinical predictors were consuming cow's milk during the first 6 months, delayed introduction of solid foods after 6 months, and birth order beyond the second order.

MeSH terms

  • Age Factors
  • Anemia / epidemiology
  • Anemia, Iron-Deficiency / epidemiology
  • Anemia, Iron-Deficiency / etiology*
  • Animals
  • Birth Order*
  • Breast Feeding
  • Child, Preschool
  • Diet
  • Egypt / epidemiology
  • Erythrocytes
  • Feeding Behavior*
  • Female
  • Humans
  • Infant
  • Infant Nutritional Physiological Phenomena
  • Iron / administration & dosage
  • Iron / deficiency*
  • Iron, Dietary / administration & dosage*
  • Male
  • Milk*
  • Poverty*
  • Prevalence
  • Reference Values
  • Risk Factors
  • Sensitivity and Specificity
  • Sex Factors
  • Trace Elements / administration & dosage
  • Trace Elements / deficiency


  • Iron, Dietary
  • Trace Elements
  • Iron