Wednesday, December 16, 2009

Zat Besi dalam ASI

Btw zat besi dalam ASI terbukti paling mudah dan paling tinggi % utk diserap oleh tubuh dari apapun loh.
termasuk susu formula. Jadi gak bener ah kalo tiap bayi ASI eksklusif selalu butuh suplemen zat besi.
Memang ada indikasi atau kondisi tertentu bayi yg butuh tambahan zat besi (spt bayi prematur, dsbnya).

http://www.kellymom .com/nutrition/ vitamins/ iron.html
Is Iron-Supplementatio n Necessary?
By Kelly Bonyata, IBCLC

Why is anemia uncommon in breastfed babies?
Which babies are more at risk for iron-deficiency anemia?
Why not use iron supplements as a protective measure for every baby?
What are some good iron sources?
What if my baby's iron levels have been checked and are TOO LOW?
In Conclusion
Additional Information
It's "common knowledge" that iron supplements are necessary after a baby reaches the magic age of six months. But is this an accurate statement?
Let's look at some of the current research.

Anemia is uncommon in breastfed babies for several reasons

Healthy, full-term babies have enough iron stores in their bodies to last for at least the first six months. The current research indicates that a
baby's iron stores should last between six and twelve months, depending upon the baby.

The iron in breastmilk is better absorbed than that from other sources. The vitamin C and high lactose levels in breastmilk aid in iron absorption.

Iron Source Percentage of Iron Absorbed
breastmilk ~50 - 70%
iron-fortified cow milk formula ~3 - 12%
iron-fortified soy formula less than 1% - 7%
iron-fortified cereals 4 - 10%
cow's milk ~10%
Note: The amount of iron absorbed from any food depends greatly upon the milk source of iron (eg, human vs cow), type of iron compound in the food,
the body's need for iron, and the other foods eaten at the same meal.

Breastfed babies don't lose iron through their bowels; cow's milk can irritate the intestinal lining (resulting in a tiny amount of bleeding and
the loss of iron). The original iron stores of a full-term healthy baby, combined with the better-absorbed iron in breastmilk, are usually enough
to keep baby's hemoglobin levels within the normal range well into the second six months.

Which babies are more at risk for iron-deficiency anemia?

Babies who were born prematurely, since babies get the majority of their iron stores from their mother during the last trimester of pregnancy.
In addition, there is evidence that babies whose birth weights are less than 3000 grams - about 6.5 pounds - (whether term or premature) tend to
have reduced iron stores at birth and appear to need additional iron earlier. Babies born to mothers with poorly controlled diabetes.
Theoretically, babies born to mothers who were anemic during pregnancy could have lower iron stores, however medical studies do not show this to
be a problem. Babies born to mothers who are anemic during pregnancy are no more likely to be iron deficient than those born to mothers who are not
anemic during pregnancy. Babies who are fed cow's milk (instead of breastmilk or iron-fortified formula) during the first year of life. Healthy, full-term infants who are breastfed exclusively for periods of 6-9 months have been shown to maintain normal hemoglobin values and normal iron stores. In one of these studies, done by Pisacane in 1995, the researchers concluded that babies who were exclusively breastfed for 7 months (and were not give iron supplements or iron-fortified cereals) had significantly higher hemoglobin levels at one year than breastfed babies who received solid foods earlier than seven months. The researchers found no cases of anemia within the first year in babies breastfed exclusively for seven months and concluded that breastfeeding exclusively for seven months reduces the risk of anemia.

The original recommendations for iron-fortified foods were based on a formula-fed baby's need for them and the fact that breastmilk contains
less iron than formula (doctors didn't know then that the iron in breastmilk is absorbed much better). Also, a few babies do have lower iron stores and will need extra iron at some point in addition to what they are getting from solids (though this can often be remedied by making sure that
solids are high in iron and vitamin C - see below).

If mom or doctor is concerned about a baby's iron levels, have the doctor to do a blood test for hemoglobin.

Some babies are exclusively breastfed for a year (and occasionally up to two years) with no problems at all. In addition, some doctors recommend
that babies with a high risk for allergies be exclusively breastfed for a year.

Why not use iron supplements as a protective measure for every baby?

The iron in breastmilk is bound to proteins which make it available to the baby only, thus preventing potentially harmful bacteria (like E.coli, Salmonella, Clostridium, Bacteroides, Escherichia, Staphylococcus) from using it. These two specialized proteins in breastmilk (lactoferrin and transferrin) pick up and bind iron from baby's intestinal tract. By binding this iron, they

stop harmful bacteria from multiplying by depriving them of the iron they need to live and grow, and ensure that baby (not the bacteria) gets the available iron. The introduction of iron supplements and iron-fortified foods, particularly during the first six months, reduces the efficiency of baby's
iron absorption. As long as your baby is exclusively breastfed (and receiving no iron supplements or iron-fortified foods), the specialized proteins in breastmilk ensure that baby gets the available iron (inst ead of "bad" bacteria and such). Iron supplements and iron in other foods is available on a first come, first served basis, and there is a regular "free-for-all" in the baby's gut over it. The "bad" bacteria thrive on the free iron in the gut. In addition, iron supplements can overwhelm the iron-binding abilities of the proteins in breastmilk, thus making some of the iron from breastmilk (which was previously available to baby only) available to bacteria, also. The result: baby tends to get a lower percentage of the available iron.

Supplemental iron (particularly when administered in solution or as a separate supplement rather than incorporated into a meal) can interfere with zinc absorption. In addition, iron supplements and iron-fortified foods can sometimes cause digestive upsets in babies.

A recent study (Dewey 2002) found that routine iron supplementation of breastfed babies with normal hemoglobin levels may present risks to the
infant, including slower growth (length and head circumference) and increased risk of diarrhea.

A recent review article on iron (Griffin and Abrams, 2001) indicates that if your baby is basically healthy, iron deficiency in the absence of
anemia should not have developmental consequences.

What are some good iron sources?

La Leche League recommends that babies be offered foods that are naturally rich in iron, rather than iron-fortified foods. Read more about when to
start solids here: Solid Foods and the Breastfed Baby

Foods that are high in iron include:
winter squash
sweet potatoes
prune juice
meat & poultry (beef, beef & chicken liver, turkey, chicken)
sea vegetables (arame, dulse), algaes (spirulina), kelp
greens (spinach, chard, dandelion, beet, nettle, parsley, watercress)
yellow dock root
grains (millet, brown rice, amaranth, quinoa, breads with these grains)
blackstrap molasses (try adding a little to cereal or rice)
brewer's yeast

High-iron foods to save until the end of the first year or later:

dried beans (lima, lentils, kidney)
chili con carne with beans
egg yolks
grains (cooked cracked wheat, cornmeal, grits, farina, bran, breads with
these grains)
dried fruit (figs, apricots, prunes, raisins)
meat (pork)
shellfish (clams, oysters, shrimp)
tuna, sardines
Warning: Some of the foods listed above are not suitable for babies. Dried fruits should not be given to babies under a year old, due to the choking
hazard. Also, pork, fish, shellfish, wheat, citrus fruits and eggs are highly allergenic and may not be suitable for babies under a year or who have a family history of allergies. See Suggested ages for introducing allergenic foods for more information.

Iron in the Vegan Diet by Reed Mangels, Ph.D., R.D. also has some great info on iron-rich foods.

See also Iron Content of Common Foods from Dial-A-Dietician

You may wish to give baby foods high in vitamin C along with iron-rich foods, since vitamin C increases iron absorption. Cooking in a cast iron
pan also increases iron content of foods. The absorption of iron is also increased by eating green leafy salads or citrus fruits, fruit juices and
potatoes (including instant potatoes at meals when consuming iron rich foods).

Here's a combination to try -- Cook brown rice (put in the blender if baby needs a smoother texture) and mix it with stewed iron-containing fruits
(apricots, prunes, etc). You can even add a touch of blackstrap molasses for extra flavor and extra iron. See this link for a few iron-rich recipes.

The caffeine/tannin in strong tea, coffee, chocolate and cola drinks interferes with the absorption of iron; avoid having these one hour before
and one hour after iron rich foods (this note is for adults and children - none of these things are recommended for babies).

What if my baby's iron levels have been checked and are TOO LOW?

For those babies who do need iron supplementation (hemoglobin levels have been checked and are too low), it's important to make sure that the solids
that baby eats are high in iron and vitamin C. In addition, the combination of yellow dock and dandelion root tinctures are said to be great (and non-constipating) for raising iron levels.

Note: Additional iron intake by the mother will not increase iron levels in breastmilk, even if the mother is anemic. Iron supplements taken by mom
may produce constipation in baby. Anemia in the nursing mother has been associated with poor milk supply, however. One nutritionist I know of has recommended that if this is the first time that you've gotten a reading "below normal" (if it is truly below normal - see below) then talk with your doctor about trying FIRST to correct it with diet, then after a few months have a re-test. If it's still low at that point, then iron supplements may be warranted.

Keep in mind that if your baby has been ill recently, his iron levels may be temporarily low due to the illness.

Another cause of anemia is lead poisoning - this should be ruled out if your child is anemic. Two of the most common sources of lead exposure in
children include (1) paint dust from chipped or peeling lead paint and/or home renovation (may be present in any home built prior to 1978) and (2)
lead contaminated drinking water from lead water pipes or lead solder.

Normal iron levels
Age Hemoglobin
(grams per deciliter) Hematocrit (Hct)
% [measures iron stores]
Serum Ferritin
(micrograms per liter)

newborn 13.5-24 42-68 -not available-
One week 10-20 31-67 -not available-
1-2 months 10-18 28-55 -not available-
2-6 months 9.5-14 28-42 -not available-
6-12 months 10.5-14
(12 average) 33-42
(37 average) 15 is minimum
(30 average)
1-2 years 11.0-13 32.9-41 (30 average)
2-5 years 11.1-13 34-40 -not available-

Centers for Disease Control and Prevention.
Recommendations to Prevent and Control Iron Deficiency in the United States. MMWR 1998;47(No. RR-3). Hemoglobin, Hematocrit from www.medicinenet. Com
Family Practice Hemoglobin.
Nelson Textbook of Pediatrics, 16th edition. Behrman, Kliegman and Arvin;
2000: p. 1462

A 2003 study by Domellof et al looked at the diagnostic criteria for iron
deficiency/iron deficiency anemia in infants, and (from studying 263
exclusively breastfed infants in Honduras and Sweden) determined the
following values to suggest the presence of iron deficiency in infants:

Iron Deficiency / Iron Deficiency Anemia in Infants
Age Hemoglobin
(grams per deciliter) Serum Ferritin
(micrograms per liter)
[measures iron stores]
4-6 months < 10.5 < 20
6 months - < 9
9 months < 10.0 < 5
Source: Domellof M, Dewey KG, Lonnerdal B, Cohen RJ, Hernell O. The
diagnostic criteria for iron deficiency in infants should be reevaluated.
J Nutr. 2002 Dec;132(12): 3680-6.

Read about how one mother successfully battled anemia in her baby without
using iron supplements: Anemia No More.

In Conclusion.. .

My interpretation of this information is that there is no problem with
(and lots of advantages to) continuing with exclusive breastfeeding until
your baby is truly ready for solids. At some point toward the end of the
first year, your baby will gradually begin to need more iron than that
provided by breastmilk alone, so offer your baby foods naturally rich in
iron and vitamin C as he begins to eat solids. If there is any question of
anemia, get a blood test - if baby's hemoglobin levels are OK then there
is no reason for additional iron in the diet.

Additional Information

Does My Baby Need Vitamins?

Solid Foods and the Breastfed Baby

Why Delay Solids?

The Truth About Iron: Do Breastfed Babies Need Supplements? by Gwen Morrison

Iron Fortified Cereal in Breastfed Infants by Jay Gordon, MD

Do babies get enough iron from breastfeeding? by Debbie Donovan, IBCLC

Is your breastfed babe getting enough iron? by Debbi Donovan, IBCLC

Does a nursing mom need to take iron? by Debbi Donovan, IBCLC

Breastfeeding and Other Foods: Iron by Dr. Jack Newman

What to Feed the Baby when the Mother is Working outside the Home by Dr.
Jack Newman (solids & iron needs are discussed here, too)

What can I do for my child's iron deficiency anemia? by Alan Greene, MD, FAAP

Anemia and children by Jay Gordon, MD

Routine Iron Supplementation during Pregnancy by John W. Feightner, from
The Canadian Guide to Clinical Preventive Health Care

Screening for Iron Deficiency Anemia -- Including Iron Prophylaxis from
the US Preventive Services Task Force's "Guide to Clinical Preventive

Prevention of Iron Deficiency Anemia in Infants by John W. Feightner,
from The Canadian Guide to Clinical Preventive Health Care

Anemia in Children by Joseph J. Irwin, M.D. and Jeffrey T. Kirchner, D.O.,
from Am Fam Physician 2001;64:1379- 86.


American Academy of Pediatrics. Committee on Nutrition. Iron fortification
of infant formulas. Pediatrics 1999 Jul;104(1 Pt 1):119-23.

Balmer SE, Wharton BA. Diet and faecal flora in the newborn: iron. Arch
Dis Child. 1991;66:1390- 1394.

Bullen JJ, Rogers HJ, Leigh L. Iron-binding proteins in milk and
resistance to Escherichia coli infection in infants. Br Med J.

Bullen JJ. Iron-binding proteins and other factors in milk responsible for
resistance to Escherichia coli.Ciba Found Symp 1976;(42):149- 69.

Butte NF, et al. Macro- and trace mineral intakes of exclusively
breast-fed infants, Am J Clin Nutr 45:42-47, 1987.

Centers for Disease Control and Prevention. Recommendations to Prevent
and Control Iron Deficiency in the United States. MMWR 1998;47(No. RR-3).

Dallman PR. Iron deficiency in the weanling: a nutritional problem on the
way to resolution. Acta Paediatr Scand Suppl 1986;323:59- 67.

Dewey KG, et al. Iron supplementation affects growth and morbidity of
breast-fed infants: results of a randomized trial in Sweden and Honduras.
J Nutr 2002 Nov;132(11): 3249-55.

Duncan B. et al.: Iron and the exclusively breastfed infant from birth to
six months. J Pediatr Gastroenterol Nutr 1985;4:421-25.

Griffin IJ, Abrams SA. Iron and breastfeeding. Pediatr Clin North Am
(United States), Apr 2001, 48(2) p401-13

Hamosh M, Dewey KG, Garza C, et al: Nutrition During Lactation. Institute
of Medicine, Washington, DC, National Academy Press, 1991. This book is
available free from the HRSA Information Center (look under Nutrition
publications) .

Krebs NF. Dietary zinc and iron sources, physical growth and cognitive
development of breastfed infants. J Nutr 2000 Feb;130(2S Suppl):358S- 360S.

Krebs NF. Overview of zinc absorption and excretion in the human
gastrointestinal tract [review]. J Nutr 2000 May;130(5S Suppl):1374S- 7S.

Lawrence R. Breastfeeding: A Guide for the Medical Profession, 4th ed. St.
Louis: Mosby, 1994.

McMillan JA , Landaw, SA, and Oski, FA. Iron sufficiency in breast-fed
infants and the availability of iron from human milk, Pediatrics
58:686-92, 1976.

McMillan JA, Oski FA, Lourie G, Tomarelli RM, Landaw SA. Iron absorption
from human milk, simulated human milk, and proprietary formulas.
Pediatrics 1977 Dec;60(6):896- 900.

Mevissen-Verhage EAE, et al. Effect of iron on neonatal gut flora during
the first three months of life, Eur J Clin Microbiol 4:273-78, 1985.

Mohrbacher N, Stock J. The Breastfeeding Answer Book, Third Revised
Edition. Schaumburg, Illinois: La Leche League International, 2003.

Murray MJ, Murray AB, Murray NJ, Murray MB. The effect of iron status of
Nigerien mothers on that of their infants at birth and 6 months, and on
the concentration of Fe in breast milk. Br J Nutr 1978 May;39(3):627- 30.

Newman J. How Breast Milk Protects Newborns.

Oski F and Landau F. Inhibition of iron absorption from human milk by baby
food. Am J Dis Child 1980; 134:459-60.

Pastel RA, Howanitz PJ, and Osk, FA. Iron sufficiency with prolonged
exclusive breast-feeding in Peruvian infants, Clin Pediatr 20:625-26,

Pisacane A, et al. Iron status in breast-fed infants. J Pediatr 1995
Sep;127(3):429- 31.

Riordan J and Auerbach K. Breastfeeding and Human Lactation, 2nd ed.
Boston and London: Jones and Bartlett, 1999.

Sears W. Pumping Up Your Iron by (also contains a list of iron-rich foods)

Siimes MA, Salmenpera L, Perheentupa J. Exclusive breast-feeding for 9
months: risk of iron deficiency. J Pediatr 1984 Feb;104(2):196- 9.

Stuart-Macadam P and Dettwyler K, ed. Breastfeeding: Biocultural
Perspectives, New York: Walter de Gruyter, Inc., 1995.

Woodruff CW, Latham C, and McDavid S. Iron nutrition in the breast-fed
infant, J Pediatr 90:36-38, 1977.

Wootan G. Breastfeeding: New Discoveries

Page last modified: 05/19/2006
Written: 05/22/1998

No comments:

Post a Comment