Greater reliance on breast-feeding and iron-fortified formula and decreased use of whole milk in diets of infants and young children has paid off in a marked decrease in anemia in youngsters, according to a government research team.
Public nutrition programs also responsible for gains in low-income youngsters, the researchers believe, but much of the credit goes to breast-feeding and other practices encouraged in the United States over the last 20 years.
A Signal of Success
The role of these practices is, to some degree, speculative, but it is clear the ongoing decline cuts across socioeconomic lines and affects poor and middle-class children, signaling a broad public health success story, researchers at the federal Centers for Disease Control in Atlanta agree.
The optimistic new conclusions are contained in a pair of new reports published in separate journals this week. Both studies have their origins in a single federal government research project that began as an attempt to validate the success of the Special Supplemental Food Program for Women, Infants and Children, better known as WIC.
When an analysis of children enrolled in WIC showed that they recorded at least some decline in anemia rates between 1975 and 1985, even before they were enrolled, the CDC researchers broadened their inquiry to include middle-class children treated by doctors in private practice. The government experts found the decline of anemia nearly identical for both groups.
It was the latter finding--reported in the journal Pediatrics--that led to confirmation of breast-feeding, fortified formula and less whole milk use as the apparent causes of the near disappearance of anemia.
In the second of the two articles, published today in the Journal of the American Medical Assn., the researchers even suggest the possible discontinuance of childhood anemia screening programs in the next few years because so much progress has been made against the disorder.
Anemia--or a deficiency of iron in the bloodstream--is a condition characterized by the reduction in the number of red blood cells. It can lead to a pale appearance, weakness, dizziness, fatigue, a generalized feeling of malaise, heart palpitations, chest pain and gastrointestinal disorders.
The question of childhood anemia's prevalence was studied by a CDC team led by Dr. Ronald Yip. In a telephone interview, Yip said the researchers started out to test a hypothesis that the WIC program was responsible for previously observed declines in anemia among the poor. The team studied data for nearly 500,000 children treated at public health centers in Arizona, Kentucky, Louisiana, Montana, Oregon and Tennessee between 1975 and 1985.
Anemia declined dramatically, the researchers reported, from 7.8% of poor children in 1975 to 2.9% a decade later. But, Yip said, team members were reluctant to attribute the improvement to the federal program alone--though they recognized it is greatly responsible for nutrition education and food supply efforts that probably caused the decline.
To investigate further, the CDC experts examined medical records for 2,400 middle-class children at a private group practice in Minneapolis, finding that a nearly identical reduction in anemia had occurred in them--5.8% to 2.7% in the same decade.
"It would have been an easy conclusion that public health nutrition programs (alone) seem to be contributing, but one thing (the drop in anemia rates before enrollment in WIC) intrigued us," Yip said. "And that led us to believe that maybe something was going on that is not unique to low-income children, but (applies) to all socioeconomic groups."
He said his conclusions about the responsibility of breast-feeding, iron-fortified formula and less whole milk consumption are, to some extent, speculative, but "I think it's a very safe speculation."
First urged by activist pediatricians and health workers in the 1960s, programs to increase breast-feeding and decreased reliance on whole milk have become unquestioned parts of the mainstream in the last 10 to 15 years.
"I believe this is the result of a very nice and concerted effort (begun) by a small group of pediatric health care workers in the '60s," Yip said. "Their recommendations were put forth in the 1970s and gradually worked their way into the educational process and translated into patient education and changing infant feeding patterns."
Dr. John Reynolds, a member of the nutrition committee of the American Academy of Pediatrics and professor of pediatrics at Oregon Health Sciences University in Portland, agreed.
Pregnant women, he noted, have been encouraged to consume iron-rich foods, especially during the final month before delivery. An infant born with a good body store of iron, Reynolds said, is likely to remain healthy--especially if breast milk is emphasized and fortified formula is used on those occasions when formula is appropriate.