Written by:Sarah Nadiah Hanifah Rusdi, S.Gz, Nutritionist & HERProject Officer FMCH Indonesia
Anemia is not an uncommon disease in our life. The reality, anemia has still become a serious and widespread public health problem, including in Indonesia. Globally, anemia affects approximately one-third of the world’s population and over 800 million women and children. Based on Basic Health Research Indonesia 2018 show the prevalence of anemia in Indonesia still high, which is 23.7% where the proportion of anemia in children 0-59 months old still above national prevalent, which is 38.5%. The most common cause of anemia is iron deficiency, which is estimated to account for approximately 50% of all anemia cases.
One of the most vulnerable groups to anemia in infants and children under 2 years. That is because of the high iron requirements needed for their rapid growth and development, particularly during the first 2 years of life. Besides, typical complementary foods fed to children are frequently low in iron content (in quantity and bioavailability) and have high contents of inhibitors of iron absorption. Low birth weight and prematurity also negatively impact the iron stores present at birth.
Normal-birth-weight (> 2500 g), full-term (37 weeks’ gestation or more) infants are generally born with iron stores that are adequate for approximately the first 4 – 6 months of life. During this time, iron stores are the primary source of iron for the infant’s growth and development, and dietary iron needs are minimal. Breast milk is not high in iron, but the iron is thought to be relatively well absorbed: between 12% and 56% of breast-milk iron is estimated to be absorbed. Exclusive breastfeeding during the first 6 months of life is protective of iron status, as iron from other complementary foods or liquids will not be as well absorbed and can interfere with the absorption of breast-milk iron. Also, the early introduction of cow’s milk in young infants can cause intestinal blood loss, further compromising iron status.
Over the first six months, the iron stores will gradually be used up and the baby’s iron needs cannot be met only from breast milk alone so it needs to be filled with complementary foods. Iron needs for infants aged 6-12 months are 11 mg per day. Meanwhile, breast milk only fulfills 0.3 mg of iron per day, so approximately 97% of the iron requirement needs to come from complementary foods. If the child does not have enough iron, the child will become anemic, will be more likely to get infections, recover slowly from infection, cognitive impairment, and growth & development impairment. Therefore, it is very important to fill an infant’s iron requirement from complementary foods that are high in iron content.
Here are how to modify complementary foods to meet children’s iron need:
Consume food sources high in iron
Iron is present in foods in two forms, heme iron, which is derived from flesh foods (meats, poultry, and fish), and non-heme iron, which is the inorganic form present in plant foods such as cereals, pulses, legume, grains, nuts, and vegetable. The difference between the two types of iron is the bioavailability (the rate of absorption by the body). Heme iron is more well-absorbed by the body than non-heme iron. So, it is recommended to choose animal food source daily or as frequently as possible to meet the iron needs of infant and children
Consume foods that have been fortified with iron
It can be hard for children to meet their iron needs from foods unless meats are eaten regularly. Using fortified foods that high in iron can be an alternative to meet the iron needs in infants and children, as example flour.
Consume food that high in vitamin C
Food rich in vitamin C such as tomato, broccoli, guava, mango, pineapple, papaya, orange, lemon, and other citrus fruits can increase iron absorption. This is because vitamin C will make the stomach condition acidic so that the iron absorption becomes more optimal
Eliminate iron inhibitor
The content of tannin (in tea and coffee) and calcium can inhibit iron absorption. So, it is recommended not to consume tea, coffee, and milk at the same time as meals
The utilization of iron cooking utensil
Cooking in iron pots, particularly if the food is acidic can increase iron absorption. This happens because iron is more easily dissolved in acidic conditions
In a conclusion, Happy National Nutrition Day 2021! We wish it could be momentum for Indonesians about the awareness of how important the feeding process is with a balanced nutrition intake. We fight anemia causes together, reach balanced nutrition, children healthier, Indonesia become strong!
References:
- World Health Organization. 2017. Nutritional Anaemias: Tools for Effective Prevention and Control. Geneva: World Health Organization.
- Da Silva Lopes, Katharina; Takemoto, Yo; Garcia-Casal, Maria N; Ota, Erika. 2018. Nutrition-Specific Interventions for Preventing and Controlling Anaemia Throughout the Life Cycle: An Overview of Systematic Reviews. Cochrane Database of Systematic Reviews 2018, Issue 8. Art. No.: CD0139092. DOI: 10.1002/14651858.CD013092.
- Thompson, Brian. 2011. Food-Based Approaches for Combating Iron Defiency. Rome: Food and Agriculture Organization (FAO).
- World Health Organization. 2004. Complementary Feeding Counselling: Training Course. Geneva: World Health Organization.
- Kementerian Kesehatan RI. 2019. Laporan Nasional RISKESDAS 2018. Jakarta: Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan (LPB).
