The diagnostic criteria for iron deficiency in infants should be reevaluated

Magnus Domellöf, Kathryn G. Dewey, Bo Lönnerdal, Roberta J. Cohen, Olle Hernell

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188 Scopus citations


Diagnostic criteria for iron deficiency (ID) and iron deficiency anemia (IDA) in infants are poorly defined. Our aim was to establish appropriate cut-off values for hemoglobin (Hb), plasma ferritin, erythrocyte mean cell volume (MCV), zinc protoporphyrin (ZPP) and soluble transferrin receptors (TfR) in infancy. Exclusively breast-fed infants (n = 263) in Honduras and Sweden were randomly assigned to receive iron supplementation or placebo, and blood samples were obtained at 4, 6 and 9 mo of age. Reference ranges were determined using three different approaches for defining iron-replete infants. The usefulness of several variables for predicting the Hb response to iron was evaluated. We found the following 2 SD cut-off values in iron-replete infants: Hb <105 g/L at 4-6 mo and <100 g/L at 9 mo; ZPP >75 μmol/mol heme at 4-6 mo and β90 μ mol/mol heme at 9 mo; ferritin α20 μg/L at 4 mo, α9 μg/L at 6 mo and α5 μg/L at 9 mo; and TfR β11 mg/L at 4-9 mo. The Hb response to iron was not a useful definition of IDA at 4 mo of age. Hb, MCV and ZPP at 6 mo as well as growth variables predicted the Hb response at 6-9 mo, but ferritin and TfR at 6 mo did not. We conclude that there is need for a reevaluation of the definitions of ID and IDA in infants.

Original languageEnglish (US)
Pages (from-to)3680-3686
Number of pages7
JournalJournal of Nutrition
Issue number12
StatePublished - Dec 1 2002


  • Ferritin
  • Hemoglobin
  • Infants
  • Iron deficiency anemia
  • Reference values
  • Transferrin receptors

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Food Science


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