Skip to main content
PMC home page
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 2000 Feb 8;162(3):323–326.

Prevalence of anemia among James Bay Cree infants of northern Quebec

N D Willows 1, J Morel 1, K Gray-Donald 1
PMCID: PMC1231010  PMID: 10693587

Abstract

BACKGROUND: Anemia is common among First Nation infants in Canada, often as a result of iron deficiency, which places them at risk for psychomotor impairment. Prevalence data are unavailable, and the risk factors are unknown. This study assessed the prevalence of anemia and associated risk factors among 9-month-old Cree infants in northern Quebec. METHODS: Between January 1995 and October 1998, 6 of 9 Cree villages in the James Bay region adopted a screening protocol for anemia in 9-month-old infants. Cross-sectional data were obtained from medical charts. The data for babies of very low birth weight and those with fever or infection were excluded. Among the 386 babies whose hemoglobin concentration was known, the type of milk consumed at the time of screening was known for 354. Associations between hemoglobin concentration and mean cell volume at 9 months, and milk type and weight gain since birth were analysed. RESULTS: The mean hemoglobin concentration of the 386 infants was 114.1 (standard deviation [SD] 10.6) g/L. The prevalence of anemia was 31.9% (95% confidence interval [CI] 27.2%-36.7%) with a hemoglobin cutoff value of 110 g/L, 17.6% 95% CI 13.9%-21.7%) with a cutoff value of 105 g/L, and 7.8% (95% CI 5.3%-10.9%) with a cutoff value of 100 g/L. Babies exclusively fed formula at 9 months had a higher mean hemoglobin concentration (118.5 [SD 9.9] g/L) than those exclusively fed breast milk (109.9 [SD 10.0] g/L), cow's milk (112.5 [SD 10.1] g/L) or more than one type of milk (112.0 [SD 10.8] g/L) (p < 0.05). Compared with formula, the odds ratio (OR) for anemia was 7.9 (95% CI 3.4-18.2) for breast milk, 5.0 (95% CI 2.0-12.7) for cow's milk and 5.2 (95% CI 1.9-14.6) for mixed milks. Infants fed formula and those fed cow's milk had significantly greater weight gains since birth, by 724 g and 624 g respectively, than breast-fed infants (p < 0.05). When milk type was controlled for, weight gain since birth was significantly associated with the presence of microcytic erythrocytes (OR comparing highest tertile of weight gain to lowest tertile 2.9, 95% CI 1.2-6.6). INTERPRETATION: Iron-deficiency anemia is highly prevalent among James Bay Cree infants. Measures to increase iron intake are required.

Full Text

The Full Text of this article is available as a PDF (203.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bernard L., Lavallée C., Gray-Donald K., Delisle H. Overweight in Cree schoolchildren and adolescents associated with diet, low physical activity, and high television viewing. J Am Diet Assoc. 1995 Jul;95(7):800–802. doi: 10.1016/S0002-8223(95)00221-9. [DOI] [PubMed] [Google Scholar]
  2. Dewey K. G., Cohen R. J., Rivera L. L., Brown K. H. Effects of age of introduction of complementary foods on iron status of breast-fed infants in Honduras. Am J Clin Nutr. 1998 May;67(5):878–884. doi: 10.1093/ajcn/67.5.878. [DOI] [PubMed] [Google Scholar]
  3. Dewey K. G., Heinig M. J., Nommsen-Rivers L. A. Differences in morbidity between breast-fed and formula-fed infants. J Pediatr. 1995 May;126(5 Pt 1):696–702. doi: 10.1016/s0022-3476(95)70395-0. [DOI] [PubMed] [Google Scholar]
  4. Dewey K. G., Peerson J. M., Brown K. H., Krebs N. F., Michaelsen K. F., Persson L. A., Salmenpera L., Whitehead R. G., Yeung D. L. Growth of breast-fed infants deviates from current reference data: a pooled analysis of US, Canadian, and European data sets. World Health Organization Working Group on Infant Growth. Pediatrics. 1995 Sep;96(3 Pt 1):495–503. [PubMed] [Google Scholar]
  5. Heinig M. J., Nommsen L. A., Peerson J. M., Lonnerdal B., Dewey K. G. Energy and protein intakes of breast-fed and formula-fed infants during the first year of life and their association with growth velocity: the DARLING Study. Am J Clin Nutr. 1993 Aug;58(2):152–161. doi: 10.1093/ajcn/58.2.152. [DOI] [PubMed] [Google Scholar]
  6. Hitchcock N. E., Gracey M., Gilmour A. I. The growth of breast fed and artificially fed infants from birth to twelve months. Acta Paediatr Scand. 1985 Mar;74(2):240–245. doi: 10.1111/j.1651-2227.1985.tb10957.x. [DOI] [PubMed] [Google Scholar]
  7. Kaplan K. M., Oski F. A. Anemia with Haemophilus influenzae meningitis. Pediatrics. 1980 Jun;65(6):1101–1104. [PubMed] [Google Scholar]
  8. Lavallée C. Anthropometric measurements and growth charts for Cree children of James Bay, from 0 to 5 years old. Arctic Med Res. 1988;47 (Suppl 1):204–208. [PubMed] [Google Scholar]
  9. Levitt C., Doyle-MacIsaac M., Grava-Gubins I., Ramsay G., Rosser W. Our strength for tomorrow: valuing our children. Part 8: Addressing the determinants of health. CFPC's task force on child health. Can Fam Physician. 1998 Mar;44:597–604. [PMC free article] [PubMed] [Google Scholar]
  10. López-Alarcón M., Villalpando S., Fajardo A. Breast-feeding lowers the frequency and duration of acute respiratory infection and diarrhea in infants under six months of age. J Nutr. 1997 Mar;127(3):436–443. doi: 10.1093/jn/127.3.436. [DOI] [PubMed] [Google Scholar]
  11. MacMillan H. L., MacMillan A. B., Offord D. R., Dingle J. L. Aboriginal health. CMAJ. 1996 Dec 1;155(11):1569–1578. [PMC free article] [PubMed] [Google Scholar]
  12. Michaelsen K. F., Milman N., Samuelson G. A longitudinal study of iron status in healthy Danish infants: effects of early iron status, growth velocity and dietary factors. Acta Paediatr. 1995 Sep;84(9):1035–1044. doi: 10.1111/j.1651-2227.1995.tb138212.x. [DOI] [PubMed] [Google Scholar]
  13. Mills A. F. Surveillance for anaemia: risk factors in patterns of milk intake. Arch Dis Child. 1990 Apr;65(4):428–431. doi: 10.1136/adc.65.4.428. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Moffatt M. E. Current status of nutritional deficiencies in Canadian aboriginal people. Can J Physiol Pharmacol. 1995 Jun;73(6):754–758. doi: 10.1139/y95-100. [DOI] [PubMed] [Google Scholar]
  15. Moffatt M. E., Longstaffe S., Besant J., Dureski C. Prevention of iron deficiency and psychomotor decline in high-risk infants through use of iron-fortified infant formula: a randomized clinical trial. J Pediatr. 1994 Oct;125(4):527–534. doi: 10.1016/s0022-3476(94)70003-6. [DOI] [PubMed] [Google Scholar]
  16. Morton R. E., Nysenbaum A., Price K. Iron status in the first year of life. J Pediatr Gastroenterol Nutr. 1988 Sep-Oct;7(5):707–712. doi: 10.1097/00005176-198809000-00015. [DOI] [PubMed] [Google Scholar]
  17. Olivares M., Walter T., Osorio M., Chadud P., Schlesinger L. Anemia of a mild viral infection: the measles vaccine as a model. Pediatrics. 1989 Nov;84(5):851–855. [PubMed] [Google Scholar]
  18. Pisacane A., De Vizia B., Valiante A., Vaccaro F., Russo M., Grillo G., Giustardi A. Iron status in breast-fed infants. J Pediatr. 1995 Sep;127(3):429–431. doi: 10.1016/s0022-3476(95)70076-5. [DOI] [PubMed] [Google Scholar]
  19. Pizarro F., Yip R., Dallman P. R., Olivares M., Hertrampf E., Walter T. Iron status with different infant feeding regimens: relevance to screening and prevention of iron deficiency. J Pediatr. 1991 May;118(5):687–692. doi: 10.1016/s0022-3476(05)80027-7. [DOI] [PubMed] [Google Scholar]
  20. Reeves J. D., Yip R., Kiley V. A., Dallman P. R. Iron deficiency in infants: the influence of mild antecedent infection. J Pediatr. 1984 Dec;105(6):874–879. doi: 10.1016/s0022-3476(84)80069-4. [DOI] [PubMed] [Google Scholar]
  21. Saarinen U. M., Siimes M. A. Iron absorption from breast milk, cow's milk, and iron-supplemented formula: an opportunistic use of changes in total body iron determined by hemoglobin, ferritin, and body weight in 132 infants. Pediatr Res. 1979 Mar;13(3):143–147. doi: 10.1203/00006450-197903000-00001. [DOI] [PubMed] [Google Scholar]
  22. Walter T., De Andraca I., Chadud P., Perales C. G. Iron deficiency anemia: adverse effects on infant psychomotor development. Pediatrics. 1989 Jul;84(1):7–17. [PubMed] [Google Scholar]
  23. Whalen E. A., Caulfield L. E., Harris S. B. Prevalence of anemia in First Nations children of northwestern Ontario. Can Fam Physician. 1997 Apr;43:659–664. [PMC free article] [PubMed] [Google Scholar]
  24. von Kries R., Koletzko B., Sauerwald T., von Mutius E., Barnert D., Grunert V., von Voss H. Breast feeding and obesity: cross sectional study. BMJ. 1999 Jul 17;319(7203):147–150. doi: 10.1136/bmj.319.7203.147. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES