• iron deficiency;
  • anemia;
  • infants;
  • African-American;
  • erythrocyte protoporphryrin;
  • body iron


The iron status of African-American infants continues to be subject to debate. We characterized the iron status of 198 9-month-old inner-city infants (94% fed iron-fortified formula) using a comprehensive panel of measures and assessing lead and inflammation markers. The proportion with iron deficiency was calculated based on three approaches (≥ 2 abnormal iron measures with or without anemia for MCV model—NHANES II, ferritin model—NHANES III, or Sweden/Honduras study) and a promising new measure—body iron, calculated from ferritin and transferrin receptor (TfR). There were no sex differences for any iron measure. Hb < 110 g/l was observed in 25%; Hb ≤ 105 g/l in 10.1%. Free erythrocyte protoporphyrin (FEP) values were elevated without elevated lead concentrations or an inflammatory response: mean FEP = 86.6 μg/dl red blood cells [75.5 μmol/mol heme]; 52.3% were > 80 μg/dl (1.42 μmol/l), almost half of which were accompanied by a second abnormal iron measure. The estimated prevalence of iron deficiency was 14.4, 5.3, and 2.5% for the MCV model, ferritin model, and Sweden/Honduras cutoffs, respectively, and 4.1% for body iron < 0 mg/kg. Regulation of iron storage is immature at < 1 year of age, making estimates of iron deficiency that depend on ferritin, including body iron, suspect in this age period. Thus, the “true” prevalence of iron deficiency could not be established with confidence due to major differences in the results, depending on the guidelines used. Functional indicators of poor iron status in young infants are urgently needed. Am. J. Hematol. 2006. © 2006 Wiley-Liss, Inc.