Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Weaning food practice in children with iron deficiency anemia

철결핍빈혈 영유아의 식이력 조사 및 이유지식의 평가

  • Chang, Joo Hee (Department of Pediatrics, College of Medicine, Inha University) ;
  • Cheong, Woo Sik (Department of Pediatrics, College of Medicine, Inha University) ;
  • Jun, Yong Hoon (Department of Pediatrics, College of Medicine, Inha University) ;
  • Kim, Soon Ki (Department of Pediatrics, College of Medicine, Inha University) ;
  • Kim, Hung Sik (Department of Pediatrics, College of Medicine, Keimyong Univeristy) ;
  • Park, Sang Kyu (Department of Pediatrics, College of Medicine Ulsan University) ;
  • Ryu, Kyung Ha (Department of Pediatrics, College of Medicine Ewha University) ;
  • Yoo, Eun Sun (Department of Pediatrics, College of Medicine Ewha University) ;
  • Lyu, Chuhl Joo (Department of Pediatrics, College of Medicine Yonsei University) ;
  • Lee, Kun soo (Department of Pediatrics, College of Medicine Kyungpook University) ;
  • Lee, Kwang Chul (Department of Pediatrics, College of Medicine Korea University) ;
  • Lim, Jae Young (Department of Pediatrics, College of Medicine Gyeongsang University) ;
  • Choi, Du Young (Department of Pediatrics, College of Medicine Wonkwang University) ;
  • Choe, Byung Kyu (Department of Pediatrics, College of Medicine Keimyong Univeristy) ;
  • Choi, Eun Jin (Department of Pediatrics, College of Medicine Daegu Catholic University) ;
  • Choi, Bong Soon (Department of Nutrition, Daegu Catholic University)
  • 장주희 (인하대학교 의과대학 소아과학교실) ;
  • 정우식 (인하대학교 의과대학 소아과학교실) ;
  • 전용훈 (인하대학교 의과대학 소아과학교실) ;
  • 김순기 (인하대학교 의과대학 소아과학교실) ;
  • 김흥식 (계명대학교 의과대학 소아과학교실) ;
  • 박상규 (울산대학교 의과대학 소아과학교실) ;
  • 유경하 (이화여자대학교 의과대학 소아과학교실) ;
  • 유은선 (이화여자대학교 의과대학 소아과학교실) ;
  • 유철주 (연세대학교 원주의과대학 소아과학교실) ;
  • 이건수 (경북대학교 의과대학 소아과학교실) ;
  • 이광철 (고려대학교 의과대학 소아과학교실) ;
  • 임재영 (경상대학교 의과대학 소아과학교실) ;
  • 최두영 (원광대학교 의과대학 소아과학교실) ;
  • 최병규 (계명대학교 의과대학 소아과학교실) ;
  • 최은진 (대구가톨릭대학교 의과대학 소아과학교실) ;
  • 최봉순 (대구가톨릭대학교 영양학과)
  • Received : 2008.07.29
  • Accepted : 2008.09.05
  • Published : 2009.02.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : Iron deficiency anemia (IDA) is one of the most common nutritional deficiencies in children on a weaning diet. We investigated weaning practices in infants and children, as well as their mothers' knowledge about weaning. Methods : We investigated 129 children with IDA and 166 without IDA (aged 6-36 months) who had visited 10 university hospitals between March 2006 and July 2007. We investigated the hematologic values of both groups. A questionnaire on weaning was answered by the mothers of these children. Results : The hematologic values in the IDA group showed a significant difference from those in the comparison group (P<0.05). Children who were solely breastfed until 6 months of age were 85%, 34% (P<0.05), and weaning was started by 6.3, 6.4 months, respectively (P>0.05). Rice gruel, boiled rice, and fruit juice accounted for approximately 80% of the starting foods in both groups (P>0.05). Only 40% of the children in the IDA group had a balanced diet within a month, versus 38% in the comparison group. In response to questions about the necessity of iron-fortified foods for breast-fed infants, less than 50% of mothers in both groups answered correctly. In the IDA group, 42% showed serum ferritin less than 10 ng/mL, while 92% showed serum MCV less than 72 fL. Conclusion : In conclusion, collection of information on history should be thorough for feeding and selective examinations for IDA in high-risk groups. Considering the adaptation period, we suggest beginning children on a weaning diet at 45 months. In addition, we need to educate mothers on weaning practice, especially on the necessity of iron-fortified foods for breast-fed infants.

목 적 : IDA는 이유기 영유아에게서 흔한 영양장애이다. 본 연구는 이유기 영유아의 이유식 진행 상황 및 이유지식 등에 관해 알아보았다. 방 법 : 2006년 3월부터 2007년 7월까지 10개 대학병원에 내원한 6-36개월의 영유아 가운데, IDA로 진단된 129명 및 IDA가 없는 166명을 비교군으로 하여 분석하였다. 대상아의 부모에게서 이유식 진행 상황 및 이유지식을 묻는 문제가 포함된 설문지를 작성하도록 하였다. 결 과 : IDA군의 혈역학적 지표는 IDA가 없는 비교군과 유의한 차이를 보였다(P<0.05). 생후 6개월까지 모유만 먹인 경우는 각각 85%, 34%로 유의한 차이가 있었다(P<0.05). 이유식 시작시기는 각각 6.3개월, 6.4개월로 유의한 차이가 없었다(P>0.05). 처음으로 시작한 음식은 두 군 모두 미음, 죽, 과즙이 80% 이상을 차지하였고, 두 군 간에 차이는 없었다(P>0.05). IDA군에서 첫 1개월 내에 여러 가지 이유식을 골고루 잘 먹게 된 경우는 40 %였고, 비교군에서는 38%였다. 두 군 모두 모유 영양아에서 철분강화 음식의 필요성을 묻는 문제의 정답률이 가장 낮았다. IDA로 진단된 환아에서 ferritin이 10 ng/mL 미만인 경우는 42%였고, mean corpuscular volume (MCV)이 72 fL 미만인 경우는 92%이었다. 결 론 : IDA를 조기에 발견하고 예방하기 위해 이유기 영유아에 있어 철저한 식이력 조사와, 고위험군에 대한 선별 검사가 필요하다. 또 철분이 함유된 이유식을 골고루 섭취하기까지의 적응 기간을 고려하여, 4-5개월에 이유식을 시작하는 것이 보다 안전한 방법으로 생각된다. 마지막으로, 현재의 이유식 지도에 있어 모유 영양아에서 철분 강화 식이의 필요성에 대하여 보호자에게 인식시킬 필요가 있다.

Keywords

References

  1. Yip R, Binkin NJ, Fleshood L, Trowbridge L. Declining prevalence of anemia among low-income children in the United States. JAMA 1987;258:1619-23 https://doi.org/10.1001/jama.258.12.1619
  2. Bogen DL, Duggan AK, Dover GJ, Wilson MH. Screening for iron deficiency anemia by dietary history in a high-risk population. Pediatrics 2000;105:1254-9 https://doi.org/10.1542/peds.105.6.1254
  3. Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL. Prevalence of iron deficiency in the United States. JAMA 1997;277:973-6 https://doi.org/10.1001/jama.277.12.973
  4. Wu AC, Lesperance L, Bernstein H. Screening for iron deficiency. Pediatr Rev 2002;23:171-7 https://doi.org/10.1542/pir.23-5-171
  5. 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;120:568-75 https://doi.org/10.1542/peds.2007-0572
  6. Yang YJ, Kim SK, Hong YJ, Kim GK, Hyon IY, Hong KS, et al. The prevalence of iron deficiency in preschool children. Korean J Pediatr Hematol Oncol 1998;5:14-20
  7. Brotanek JM, Halterman J, Auinger P, Flores G, Weitzman M. Iron deficiency, prolonged bottle feeding, and racial/ethnic disparities in young children. Arch Pediatr Adolesc Med 2005;159:1038-42 https://doi.org/10.1001/archpedi.159.11.1038
  8. Bonuck KA, Kahn R. Prolonged bottle use and its association with iron deficiency anemia and overweight: a preliminary study. Clin Pediatr 2002;41:603-7 https://doi.org/10.1177/000992280204100808
  9. Sutcliffe TL, Khambalia A, Westergard S, Jacobson S, Peer M, Parkin PC. Iron depletion is associated with daytime bottle-feeding in the second and third years of life. Arch Pediatr Adolesc Med 2006;160:1114-20 https://doi.org/10.1001/archpedi.160.11.1114
  10. Dallman PR, Simmes MA, Stekel A. Iron deficiency in infancy and chilhood. Am J Clin Nutr 1980;33:86-118
  11. Chung WJ, Kim KS, Kim MK, Kim SN. Iron deficiency anemia in infants. J Korean Pediatr Soc 1995;38:1253-61
  12. Kim SJ, Kim DH, Chang JH, Jun YH, Hong YJ, Son BK, et al. A study of mothers knowledge of weaning of infants with iron-deficiency anemia. Korean J Pediatr 2008;51:468-73 https://doi.org/10.3345/kjp.2008.51.5.468
  13. Dallman PR, Siimes MA. Percentile curves for hemoglobin and red cell volume in infancy and childhood. J Pediatr 1979;94:26-31 https://doi.org/10.1016/S0022-3476(79)80344-3
  14. Pollitt E, Leibel RL. Iron deficiency and behavior. J Pediatr 1976;88:372-81 https://doi.org/10.1016/S0022-3476(76)80250-8
  15. Oski FA, Honig AS, Helu B, Howanitz P. Effect of iron therapy on behavior performance in nonanemic iron-deficiency infants. Pediatrics 1983;71:877-80
  16. Boutry M, Needlman R. Use of diet history in the screening of iron deficiency. Pediatrics 1996;98:1138-42
  17. Gartner LM, Greer FR. Section on breastfeeding and committee on nutrition. Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake. Pediatrics 2003; 111:908-10 https://doi.org/10.1542/peds.111.4.908
  18. Park SY, Park SW, Kang SK, Jun YH, Kim SK, Son BK, et al. Subclinical rickets in breastfed infants. Korean J Pediatr 2007;50:1188-93 https://doi.org/10.3345/kjp.2007.50.12.1188
  19. Oski FA. Iron-fortified formulas and gastrointestinal symptoms in infants: a controlled study, with the cooperation of the Syracuse consortium for pediatric clinical studies. Pediatrics 1980;66:168-70
  20. Pizarro F, Yip R, Dallman PR, Olivares M, Hertrampf E, Walter T. Iron status with different infant feeding regimens: relevance to screening and prevention of iron deficiency. J Pediatr 1991;118:687-92 https://doi.org/10.1016/S0022-3476(05)80027-7
  21. Infant and nutrition. In: Kretchmer N, Zimmermann M, editors. Developmental nutrition. 1st ed. Seoul: Kyomunsa Publishing Co, 2000:348-49
  22. American Academy of Pediatrics. Committee on nutrition: iron fortification of infant formulars. Pediatrics 1999;104: 119-23 https://doi.org/10.1542/peds.104.1.119
  23. Lee YS, Kim KS, Yoo Y, Lee SJ, Kim SN, Kim SK. Red blood cell indices and iron status in infants and young children with iron deficiency anemia. Korean J Pediatr Hematol Oncol 2001;8:173-80
  24. Kahn JL, Binns HJ, Chen T, Tanz RR, Listernick R. Persistence and emergence of anemia in children during participation in the special supplemental nutrition program for women, infants, and children. Arch Pediatr Adolesc Med 2002;156:1028-32
  25. Preventive pediatrics. In : An HS, Editor. Pediatrics. 9th ed. Seoul : Daehan Printing & Publishing Co, 2007:106

Cited by

  1. 철 결핍 빈혈 영.유아의 수유 형태 및 이유 지식 평가 vol.12, pp.2, 2009, https://doi.org/10.5223/kjpgn.2009.12.2.215
  2. 모유수유아에서의 철결핍 빈혈과 비타민 D 결핍 vol.13, pp.2, 2009, https://doi.org/10.5223/kjpgn.2010.13.2.164
  3. Iron deficiency, its epidemiological features and feeding practices among infants aged 12 months in Qatar: a cross-sectional study vol.8, pp.5, 2009, https://doi.org/10.1136/bmjopen-2017-020271