Mixtures with a high iron content for babies. Complementary foods and the fight against iron deficiency

Artificial mixtures are available in three forms:

Dry mix with instructions on how much water to add;

Liquid concentrate, which is diluted with water in half;

Ready-to-use liquid mixture that can be immediately poured into a bottle.

Your choice of the form of the mixture depends mainly on time and funds. Dry mixes are the cheapest, but they take the most time to make milk; ready-to-use mixtures are the most expensive, but the easiest to use. Although more expensive, ready-to-drink formulas are best when you're traveling or when you're too busy to make powdered milk. Check the expiration date on the packaging co mixture; do not buy or use dented cans or leaking, damaged bags.

The nutrient content is approximately the same in dry and liquid mixtures. The difference lies in what type of oil is used as the fat source. Some formulas use corn oil in dry form and soybean oil in liquid form. A note on wet versus dry mixes. Because it is technically difficult to powder liquid oils and fats, some blends, as of this writing, do not contain linolenic acid, which some nutritionists consider an essential fatty acid. Talk to your doctor to make sure the formula you choose contains all of the recommended formulas. this moment nutrients.

Iron-fortified mixtures

Iron-fortified formulas are recommended, unless your doctor tells you otherwise. Formulas labeled "low iron" are deficient in iron; in my opinion there is no point in using them. Iron-fortified formulas contain the amount of iron recommended by the American Academy of Pediatrics and other organizations. Talk to your doctor about which iron-fortified formula to choose. Since the iron contained in artificial mixtures is not absorbed as well as iron from breast milk be prepared for your formula-fed baby's stool to be green (iron has green color). In this case, the green stool does not matter. Although some parents claim that iron-fortified formulas cause their child more distress than iron-free formulas, control studies comparing formulas with and without iron have shown no difference in their ability to cause gastrointestinal distress. .

"Hypoallergenic" soy blends

In truth, there is only one hypoallergenic formula - human milk. Soy formulas have been promoted for many years as being less allergenic than cow's milk formulas, but we have the following preconceptions against soy formulas:

Although soy formulas may be less likely to cause allergies than cow's milk formulas, 30-50% of babies who are allergic to cow's milk are also allergic to soy.

In families where there are many cases of allergies, parents are sometimes advised to start feeding their newborn soy formula in the hope of preventing allergies later. Research has not supported this practice. Initial feeding of a newborn with soy mixtures does not reduce the possibility of allergies in the future. Also, the use of soy formula does not reduce the risk of infantile colic (abdominal pain). For these reasons, the American Academy of Pediatrics Nutrition Committee does not recommend the use of soy protein formulas as a primary means of preventing colic or for children with potential allergies.

Soy is found in many foods, often as an additive hidden by the manufacturer. Giving soy to a child during infancy, when the intestines are more permeable to soy allergens, may cause the child to become allergic to soy in the future, even as an adult.

Most soy formulas are now labeled "lactose free." The value of using lactose-free artificial formulas is questionable. Lactose is a sugar found in human milk and in the milk of all other mammals. Why go against experimental nature? Lactose improves the absorption of calcium, helps reproduction in the intestines of the child beneficial bacteria, and is also a rich source of galactose, a valuable brain nutrient. (The lactose-replacing sugar in some soy formulas is corn syrup, which is itself an allergen.) Babies have an enzyme called lactase in their intestines to digest lactose. However, there is often temporary lack of lactase after an intestinal infection. Although it is sometimes recommended to use soy formulas to reduce the resulting diarrhea, the American Academy of Pediatrics Nutrition Committee does not recommend use lactose-free formulas for children recovering from diarrhea every day.

Most soy formulas are higher in salt, and the added iron and zinc bioavailability (activity) may be lower than other formulas.

IN currently the only definite indications for the use of lactose-free soy formulas are cases where the child has a lactase deficiency, a rare disease in which the body is not able to digest lactose, and some cases of allergy to cow's milk formulas. Always check with your pediatrician before switching to soy formula if you think your child is allergic to cow's milk.

Other "hypoallergenic" mixtures

When you see “hypoallergenic” or “hydrolyzed protein” on a formula label, these terms mean that the potentially allergenic protein has been pre-processed, that is, broken down into smaller proteins that are theoretically less allergenic. Children who are allergic to cow's milk formulas may be able to tolerate these formulas better, but at a cost. Formulas that have been proven to be hypoallergenic (Nutramigen, Pre-gestimil, Alimentum) are quite expensive (four to five times more expensive than regular formulas). Another disadvantage of some of these formulas is the lack of lactose as a source of carbohydrates and the replacement of it with corn syrup and modified corn starch. And the third problem is their unpleasant taste.

The bioavailability of iron is more important than the total amount of iron in the diet, and this should be taken into account when formulating recommendations on how to feed young children. Examples of iron content and bioavailability in infant foods are shown in Table 33. In the following section, foods are discussed in the context of the bioavailability of their iron content.

Table 33 Iron content and bioavailability in infant foods

Breast milk

The iron content is low (see table 33), but its bioavailability is about 50%, which is much higher than that of other foods. The reason for this high percentage of iron absorption from breast milk is not fully understood, but it may be due to the lower content of phosphate and protein in breast milk compared to cow's milk and the high concentration of the iron-binding protein lactoferrin (34). Due to iron stores present in the body at birth and the high bioavailability of iron in breast milk, term infants who are exclusively breastfeeding usually have satisfactory iron status until about 6 months of age (35, 36).

Baby formulas

If infants are not breastfeeding, they should receive commercially fortified iron. The level of enrichment is different; in Europe it is usually 6-7 mg/l, while in the USA it is 12 mg/l. Recent studies show that even lower amounts of iron (2-4 mg/l) can prevent the development of iron deficiency in infants under 6 months of age (37), but then higher levels are needed. The iron compound contained in the infant formula of industrial production - ferrous sulfate - is well absorbed (table 33).

Cow's milk and other dairy products

Unlike the iron in breast milk, iron in unmodified cow's milk is poorly absorbed (Table 33). The low bioavailability is likely due to the high protein and low vitamin C content compared to commercially available infant formula. In addition, early introduction of unmodified cow's milk and other dairy products can cause blood loss from the intestinal tract and thus have a negative effect on iron levels in the body. Many studies have confirmed that cow's milk has a negative effect on iron content, especially in the first 6 months of a child's life (16, 38, 39) and also during the second half of childhood (5, 16, 40). Over a 10-year period, when the percentage of breastfeeding at 5 months of age in Italy increased from 22% to 51%, and cow's milk consumption at 6 months of age decreased from 73% to 8%, there was a decrease in the percentage of Italian children with iron deficiency from 21 % to 10% (41). Similar changes were observed in the Russian Federation (O. Netrebenko, from personal correspondence, 1997).

This publication does not recommend giving cow's milk as a drink before 9 months of age. After that, if children are no longer breastfeeding, it can be introduced gradually. Infants who are not breastfed or fed commercially available iron-fortified infant formula should receive homemade cow's milk formula along with an iron supplement.

During the fermentation of milk, lactic acid and other organic acids are formed, which increase the absorption of iron. If fermented milk is consumed with meals, these acids are more likely to positively influence the absorption of iron from other foods.

Other drinks

If fruit juices are made from the pulp of fruits, they have a high content of vitamin C, and this has a positive effect on iron absorption when drinking juices with meals. However, in some countries fruit juice does not contain vitamin C, especially when made by mixing jam or fruit compotes with water. When processing jams and fruit compotes, all vitamin C is destroyed.

Low iron status is associated with tea consumption, which is very common in many parts of the Region, as tea has a negative effect on iron absorption.

Meat and fish

Due to the high bioavailability of heme iron in meat and fish, and due to their positive effect on the absorption of non-heme iron present in other foods at the same meal, meat and fish have a positive effect on the content in the body gland. Thus, the bioavailability of iron found in a vegetable dish can be greatly improved by adding some meat to it. One study of 7-month-old infants found a 50% increase in absorption of non-heme iron from vegetables after adding meat to the meal (42). Meat is not the most important component in complementary foods in most societies. In addition, early introduction of large amounts of meat will lead to a high level of protein intake, which can have negative consequences. However, only small amounts of meat are needed to improve iron status, and meat should be introduced gradually into the diet from about 6 months of age (see Chapter 8). In one intervention study of 8–10-month-old children, the group fed 27 g of meat per day had significantly higher hemoglobin levels after two months than children fed only 10 g of meat per day (43). Meat is expensive, but since only small amounts are needed to improve complementary foods, economic concerns should not be a significant limiting factor, especially if less expensive sources of iron (particularly liver) are recommended. If it is not economically feasible to give meat daily, eating it at least a few times or even once a week will be beneficial. For example, liver is both cheap and rich in nutrients such as zinc and vitamins A, B, and D, as well as iron. Mashed liver is thus a good complementary food after about 6 months. Fish contains heme iron and therefore has a positive effect on iron status. Fish is also believed to contain a "meat factor" that has a beneficial effect on the absorption of non-heme iron.

Grains, legumes and vegetables

Non-heme iron is the main form of dietary iron and is found in plant foods. The main sources are grains, legumes, beans, vegetables and fruits. Grains have a higher phytate content than legumes and therefore legumes are a better source of bioavailable iron. The iron present in sourdough bread (using yeast) has a better bioavailability than in safely prepared dough bread.

Iron-fortified baby food

Iron can be described as one of the “problem nutrients” for which there is a large discrepancy between dietary intake and the amount required for an infant (44). The iron content of complementary foods that are taken from homemade foods is often low and iron has low bioavailability. Changes in complementary feeding practices and methods recommended in this chapter and throughout this publication will increase the iron content of the diet and the bioavailability of iron in complementary foods and thereby improve the iron status of infants. However, in certain settings where there is evidence that the iron needs of infants cannot be met with complementary foods that come from home-cooked foods, iron fortification of these foods may help combat iron deficiency.

And young children is the most common form of targeted food fortification. There is good evidence (45-47) that iron supplemented in infant formulas and commercial formulas is well absorbed and that fortified complementary foods can help reduce the prevalence of iron deficiency in infants older than 6 months and young children (33 ).

Several different iron salts can be used for food fortification, but they differ in their value as sources of absorbable iron and in their shelf life. Although soluble iron fortifiers are readily absorbed, they usually cause undesirable changes in the texture, taste, and odor of food. Ferrous fumarate and succinate are recommended as iron fortifiers in infant cereals because they are well absorbed and do not usually cause these organoleptic effects. Milk-based products can be fortified with ferrous sulfate. NaFe salt of ethylenediaminetetraacetic acid (EDTA) has also proven to be a safe fortifier that can be used in populations with endemic iron deficiency. It is chemically stable, resistant to the most common non-heme iron absorption inhibitors, and improves absorption of dietary iron as well as zinc, but is expensive (11). In addition, fortification with Fe-EDTA salt should not be used in areas with high levels of lead contamination, as there is a risk of increasing lead absorption. Vitamin C can be added to counteract the inhibitory effect of phytate in cereal-based products with high flour yields.

A promising approach is the use of multi-nutrient formulations, especially when other nutrient deficiencies (eg, vitamin A) are present. There is no agreement yet on what the composition of such a supplement should be, but it has already been suggested that some kind of powder could be added to complementary foods and made at home.

Levchuk Victoria Alexandrovna©

The child eats adult food, and parents ask themselves the question “Does he have enough vitamins?”. Vitamin C contributes to the absorption of iron, which is why it is so necessary to include fruits and vegetables in the diet. It is important to know that children at risk of anemia fall into the following categories:

• Babies who were born prematurely; iron stores are deposited during the last few months of pregnancy.
• Babies who had a low birth weight, regardless of the gestational age.
• Babies whose mothers were malnourished during pregnancy or who have diabetes.

Our bodies require iron to carry the protein compound hemoglobin to carry oxygen throughout the body. Until 6 months of age, iron stores should not be replenished with both artificial and breastfeeding of healthy full-term infants. You should also keep in mind that the iron reserve in the baby's body will not suddenly start to decrease! Healthy and full-term children with artificial feeding are rarely prone to iron deficiency due to its large amount in milk mixtures. Healthy and full-term babies who are exclusively breastfed are also not susceptible to iron deficiency if the baby does not start eating adult foods before 6 months of age.
can actually change the level of iron in an infant's body. When breastfeeding, the baby receives required amount iron through mother's milk.
Most breastfeeding babies do not need any additional nutrition such as water, vitamins, iron for at least the first six months of their lives. Human milk provides the baby with all the necessary vitamins, fluids and nutrients to keep the baby healthy. At about the age of six months, it is necessary fortified with iron. Your pediatrician may prescribe vitamin D or iron supplements if needed.
it is necessary to supplement breast milk with iron-containing products at the age of the baby from 7 older. In the diet of infants up to a year with artificial feeding, a milk mixture with iron should be present.

Now let's see how much iron is in 1 tablespoon of the following common baby foods:

1.1 mg
Potato 1.7 mg
Beef 2.9 mg
Chicken meat 1.5 mg
Egg yolk 7.2 mg

Signs of iron deficiency

If your baby doesn't get enough iron, they may experience the following symptoms:

• slow weight gain
• no appetite
• pale skin
• low activity level but high irritability (moody and fussy)

What is the recommended daily dose of iron for a child?

Mother's milk contains vitamin C

As the infant grows, it is possible to increase iron absorption with natural foods, when meat foods are eaten with foods containing vitamin C at the same time. Consuming cereals with fruits that contain vitamin C will help absorb the iron found in the grain product.
Eating foods high in vitamin C in baby food will help the body absorb iron, which is present in most foods. Most of the iron received by the body is non-heme iron; This type of iron has less bioavailability and is absorbed in smaller amounts by the body. It turns out that vitamin C helps to make full use of iron.
Most pediatricians will recommend serving cereals along with fruit and vegetarian meals. As the child gets older, you can expand his menu and serve fruits, meat (for example, chicken), vegetables and yogurt - a balanced diet.

Foods fortified with vitamin C

• Citrus
• Berries
• Green vegetables (such as broccoli and cabbage)
• Peaches
• Tomatoes

Iron deficiency is rare in breastfeeding beyond 6 months of age. Iron is present in breast milk. Although human milk does not contain a large number of iron, but it is very well absorbed. Approximately 50 percent of the iron in mother's milk is absorbed by the baby's body, compared with 7-12 percent in formula. Because a full-term baby's iron stores begin to decline around six months of age, adult foods can help meet a baby's growing iron and protein needs at the same time.

Cow's milk has a rather low amount of iron, and babies are less able to absorb it. Feeding cow's milk to infants can lead to gastrointestinal upset. That is why they prefer not to give this milk to children until they have reached 1 year.
Sources of heme and non-heme iron in various foods are listed below:

Foods containing the maximum amount of iron:

• iron-fortified milk formulas
• dry beans
• potato
• broccoli
• mushrooms
• meat and poultry (beef, beef and chicken liver, pork, turkey, chicken)
• greens (spinach, cabbage, turnip)
• egg yolks
• dried fruits (figs, apricots, prunes, raisins)
• plum juice
• grain products (buckwheat, oatmeal, wheat germ, corn flour, millet, brown rice, semolina, bran, bread, iron fortified cereals)
• molasses (try adding some to porridge when baby is over 10 months old)
• Brewer's yeast
• crustaceans (clams, oysters, shrimp - 12 months + and please get pediatrician approval)
• tuna, sardines, canned salmon

Vitamin C aids in the absorption of iron, so you should include fruits and vegetables in your diet whenever possible.

« Desk book for parents. Feeding and nourishing a child from 0 to 5 years old with love and common sense. Ellen Satter.

Handbook for parents. Feeding and nourishing a child from 0 to 5 years old with love and common sense. Ellen Satter.

We are not afraid and add me to

Feeding children is one of the most important responsibilities of parents. Compared to the smorgasbord available to older adults, the options for what to eat as an infant are rather limited: the menu is either breast milk, formula, or a combination of both.

Unlike breast milk, whose composition has remained more or less the same for thousands of years, formula has come a long way since it was brewed in the kitchen from fresh cow's milk. And one of the important ingredients in the modern mixture recipe is iron.

In general, iron is a supplement designed to reduce the risk of iron deficiency anemia. But it's not so easy for him. Some nutrition experts say that formula manufacturers add more iron than is necessary, and that this excess iron may not be harmless. A provocative article published in October of this year suggests that excess iron in infancy can be very dangerous.

In the article, the scientists suggest that excess iron early in life can set off a chain of events that will leave the brain vulnerable to neurodegenerative diseases such as Parkinson's disease decades later. The idea, proposed in September by Nature Reviews Neurology, is controversial - there is no experimental evidence to support this claim. But just as iron deficiency is harmful, it's easy to see that excess iron is also dangerous, says co-author Dominic Hare, an analytical neurochemist at the University of Technology Sydney and Melbourne's Institute of Neurology and Mental Health. "I'm afraid this is quite possibly a case where the best is the enemy of the good," he says.

Before you eliminate iron for yourself and your child, please note one thing: iron is absolutely essential for a growing body. This element is not only critical for the maintenance of the body, iron is also necessary for the body to build. This is most evident in the developing brain. If children don't get enough iron, their brain cells form with defective connections and insulating sheaths. Severe iron deficiency in infancy can lead to lifelong mental and physical disabilities. "I've been researching the effects of iron deficiency on the brain and behavior all my life," says pediatrician Betsy Lozoff of the University of Michigan at Ann Arbor. “There are dozens of studies on this issue.”

Doctors in the US have been seeing these effects for decades. In the 1930s, anemia caused by iron deficiency was rampant among formula-fed babies. Thirty years later, health officials took action, and by the mid-1960s, several artificial formulas supplemented with iron were on the market. In 1969, the American Academy of Pediatrics published recommendations that formula should be fortified with iron. This intervention worked, and in many cases, the effect was good. In the 70s and 80s the rate of iron deficiency anemia began to fall. "Iron fortification of baby food is one of the great public health successes," says Lozoff.

However, this victory may have an unexpected effect, Hare and colleagues write. In young children, the blood-brain barrier is not yet fully formed. Excess iron in the body can slip through this leaky barrier and reach the brain, Hare and colleagues suggest. Animal studies have shown that excess iron in early age leads to higher levels of iron in the brain later.

And that could be a problem, Hare says: Some studies have shown a link between high levels of iron in the brain and certain brain diseases. Iron accumulates in nerve cells in the substantia nigra, an area of ​​the brain that is affected by Parkinson's disease. Alzheimer's plaques are made up of sticky amyloid, a beta protein, combined with iron. And the accumulation of iron in the brain is associated with outbreaks of multiple sclerosis. It's not yet clear whether excess iron itself causes these problems or merely serves as a marker for them, but the link is certainly worth exploring.

We do not yet know if an excess of iron early in life is a factor that can cause problems in old age. But there is a slight hint of the effect of excess iron in childhood in one of Lozoff's studies. She and her colleagues followed 473 Chilean infants who received either low iron formula (about 2.3 mg iron per liter) or normal US levels (about 12.7 milligrams per liter).

Ten years later, children who received the high-iron formula performed worse on tests of spatial memory and hand-eye coordination than children who received the low-iron formula. Lozoff and colleagues reported in 2012 that the lowest scores were in a small number of children who had the most high levels hemoglobin. So, for children who already get enough iron, its supplementation can harm. Since the results seem to concern only a handful of children—about 13 children in each group—the study provides only a preliminary look at the question. "This is data for more research, not for any change in nutritional policy, because that's just a few kids," says Lozoff.

What's more, the human body has developed a precise way of regulating iron stores. "If additional iron is supplied, iron absorption is reduced," says pediatric gastroenterologist Robert Baker of the University at Buffalo. Given this tight bodily control, it's not clear how much iron the brain actually gets.

However, the fact remains that standard iron levels in US blends are probably higher than necessary. European countries use formulas with about half that amount of iron (between 4 and 7 milligrams per liter) and have about the same rate of iron deficiency anemia, Hare says.

Recently, a panel of nutrition experts agreed that "current levels of iron fortification in US infant formula are not optimal and do not reflect the proven need for iron in this age group." Their new recommendations, published in October in a supplement to the Journal of Pediatrics, suggest lowering iron intake at birth and then gradually increasing it as the baby grows. In the first three months of life, children use up the iron accumulated during pregnancy and do not need it, the article says. After three months, babies should start taking formula, which has 2 to 4 mg of iron per liter, experts recommend today, and by 6 to 12 months, babies should get 4 to 8 mg of iron per liter. (Translator's note: we are talking only for formula-fed babies.)

Obviously, iron deficiency can be disastrous, especially for developing babies. And there is no doubt that decades of formula enrichment has reduced anemia. But Hare and colleagues raised an important point: Just because iron is healthy doesn't mean that more is better. Perhaps excess iron carries its own risks that have yet to be seen. The first generation of children who received iron-fortified formulas are still relatively young and will not reach their sixties before the 2030s.

So for now, Hare's idea of ​​the dangers of iron overload is just an idea. This is an idea that I find compelling, but experimental evidence does not yet exist. "We're working on it as quickly as we can," Hare says. But the hidden path from infant feeding to brain changes in older adults is not easy. And in the end, the trail may disappear.

It is difficult to remain in uncertainty, especially when this uncertainty relates to what to feed the child. The best we can do is keep asking questions - and encourage scientists, policy makers, and people who use blends to do the same.

Translation by Victoria Lebed

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Milk formulas	mg/l finished liquid product
Gallia-2 (Danone, France)
Frisolak (Friesland Nutrition, Holland)
Nutrilon 2 (Nutricia, Holland)
Bona 2R (Nestlé, Finland)
Similac with Iron (Abbott Laboratories, Denmark/USA)
Enfamil 2 (Mead Johnson, USA)
Semper Baby-2 (Semper, Sweden)
Mamex 2 (International Nutrition, Denmark)
NAS-2 (Nestlé, Switzerland)
Agusha-2 (Russia)
Nutrilak-2 (Nutritsia/Istra, Holland/Russia)
Lactofidus (Danone, France)
Nestozhen (Nestlé, Switzerland)

Both with natural and artificial feeding in the diet of a child suffering from anemia, juices and fruit purees are used at an earlier date - from 1.5-2 months, respectively. life. Also in more early dates(2-4 weeks earlier than healthy children) the yolk and all types of complementary foods are introduced. You need to start complementary foods with vegetable purees, giving preference to vegetables richer in iron and ascorbic acid (potatoes, carrots, spinach, beets, cabbage, etc.). IN vegetable puree you can add well-chopped garden greens (dill, parsley), which is a rich source of iron and vitamin C.

It is necessary to introduce early meat dishes into the child's diet as sources of heme iron. Minced meat can be given from 5 months, starting with 1/4 teaspoon, gradually increasing its amount to 30 g per day, by 8 months. - up to 60 g, by the year - up to 70 g.

At present, complementary foods enriched with iron are widely used in our country and abroad, which makes it possible to most fully correct the diets of children, especially in the winter-spring period, when vegetables and fruits are depleted in minerals and vitamins. These products include, first of all, industrially prepared cereals, specially enriched with vitamins and microelements. One serving of such porridge usually provides 25-30% of a child's daily iron requirement. From milk porridges of industrial production for infants, we can recommend cereals manufactured by Samper (Sweden), Nutricia (Poland, Holland), Nestle (Belgium, Switzerland), Heinz-Georgievsk (Russia / USA) , "Humana" (Germany). These porridges are prepared mainly on rice, corn, oatmeal, wheat, and in some cases contain fruit or vegetable additives.

Also, complementary foods enriched with vitamins and minerals include canned fruit juices, fruit and vegetable, vegetable, fruit and vegetable purees of domestic and foreign production.

Of canned meat and meat-vegetable based products, both domestic products (beef puree, beef with liver, "Petushok", "Kid", "Cornflower", "Chippolino", "Bogatyr", etc.) and imported (products of Heinz, Nestle, Nutricia, Danone, Samper, Gerber Products, etc.).