Risk factors, practice variation and hematological outcomes of children identified with non-anemic iron deficiency following screening in primary care setting

OBJECTIVES: To determine the prevalence, risk factors, physician practice patterns and longitudinal hematological outcome of children following screening for non-anemic iron deficiency (NAID). METHODS: The present analysis was a longitudinal cohort study invovling healthy children one to five years of age. Descriptive statistics were used to describe the prevalence, risk factors, practice patterns and hematological outcome of children identified with NAID. The association between NAID and potential risk factors were examined using multivariate logistic regression analysis. RESULTS: Of 2276 children undergoing screening, 155 had NAID, corresponding to a prevalence of 7% (95% CI 5.95% to 8.05%). Risk factors significantly associated with NAID included: younger age (OR 1.08 [95% CI 1.06 to 1.11]), higher body mass index z-score (OR 1.22 [95% CI 1.01 to 1.48]), longer duration of breastfeeding (OR 1.05 [95% CI 1.01 to 1.08]) and increased volume of cow's milk intake (OR 1.13 [95% CI 1.01 to 1.26]). An assessment of practice patterns revealed that for 37% of children, an intervention for NAID was documented; and for 8.4% a physician-ordered follow-up laboratory test was completed to re-evaluate iron status. A total of 58 (37%) children underwent a follow-up laboratory test, of whom 38 (65.5%) had resolution of NAID, 15 (25.9%) had persistence of NAID and two (3.4%) had progression of NAID to anemia. CONCLUSION: NAID is common in early childhood and is associated with modifiable risk factors. Substantial practice variation exists in the management of NAID. Further research is necessary to understand the benefits of screening for NAID and evidence-informed practice guidelines may reduce practice variation in the management of NAID in early childhood.