Risk factors for poor iron status in British toddlers: further analysis of data from the National Diet and Nutrition Survey of children aged 1.5±4.5 years CW Thane*, CM Walmsley, CJ Bates, A Prentice and TJ Cole MRC Human Nutrition Research, Downhams Lane, Milton Road, Cambridge CB4 1XJ, UK Submitted 24 February 1999: Accepted 23 May 2000 Abstract Objective: To examine risk factors for poor iron status in British toddlers. Design: National Diet and Nutrition Survey (NDNS) of children aged 1.5±4.5 years. Setting: Mainland Britain, 1992/93. Subjects: Of the 1859 children whose parents or guardians were interviewed, a weighed dietary intake was provided for 1675, and a blood sample obtained from 1003. Results: Mean haemoglobin (Hb) and ferritin levels were significantly lower in younger (1.5±2.5 years) than in older (3.5±4.5 years) children, with boys having significantly lower ferritin levels than girls. Poor iron status Hb , 110 g l 21 ; ferritin ,10 mgl 21 , or low values for both indices) was associated with lower socio- economic and employment status. Iron status was directly associated with meat and fruit consumption and inversely with that of milk and milk products, after adjustment for age and gender. The latter association remained significant after further adjustment for sociodemographic variables, energy intake and body weight. Children consuming .400 g day 21 of milk and cream were less likely to consume foods in other groups, with those also consuming little meat, fish, fruit and nuts at greatest risk of poor iron status. Few associations were observed between poor iron status and individual nutrient intakes, and iron status was not associated with either iron intake or with consumption of a vegetarian diet. Conclusions: Overdependence on milk, where it displaces iron-rich or iron- enhancing foods, may put toddlers at increased risk of poor iron status. However, this becomes non-significant when moderate-to-high amounts of foods known to enhance iron status (e.g. meat and/or fruit) are also consumed. Milk consumption in this age group should ideally be part of a mixed and balanced diet including all food groups, and particularly lean meat (or other iron-rich or fortified foods) and fruit. This is particularly relevant for households of lower socioeconomic and employment status. Keywords Toddlers Iron status Risk factors Milk consumption Iron deficiency (ID) is the most commonly reported nutritional disorder during early childhood in the UK 1 and other countries 2±4 . Young children are at increased risk due to their high physiological demands during this period of rapid growth and development. ID is associated with a number of manifestations, including anaemia, loss of appetite, pallor, general lassitude and apathy, increased susceptibility to infection, and delayed psychomotor and cognitive development 5±11 . Despite iron therapy, deficits in the latter symptoms in early childhood may result in long-lasting detriment 9,11,12 . Anaemia, 85% of which has been attributed to ID, has been estimated to occur in over a half of preschool children in developing countries (which contain 80% of the global population) compared with 10±11% in devel- oped countries 2,3,13 . The NDNS of British children aged 1.5±4.5 years 14 found that overall around one in 12 children, and among the youngest group (1.5±2.5 years) one in eight, had an Hb concentration below 110 g l 21 (the World Health Organization (WHO) level defining anaemia 15 ). A recent national study 16 found that up to one-third of toddlers from three different Asian groups living in the UK had Hb , 110 g l 21 : The prevalence of ID and iron deficiency anaemia (IDA) varies with age, socioeconomic status, ethnicity and according to criteria used for diagnosis 4,8,17 . Iron status 433 Public Health Nutrition: 3(4), 433±440 *Corresponding author: Email christopher.thane@mrc-hnr.cam.ac.uk q 2000 Nutrition Society