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대한임상건강증진학회지제 4 권제 4 호 2004 Korean J Health Promot Dis Prev Vol. 4, No. 4, 2004 [ 원저 ] 유아의철분영양상태및철분결핍과관련된식이요인분석 이지윤, 이민숙, 김순기 1), 안홍석 성신여자대학교생활과학대학식품영양학과, 인하대학교의과대학소아과 1) - 요약 - 연구배경 유아기의철결핍성빈혈은가장흔한영양결핍이지만유아기섭식패턴과관련된연구는부족한실정으로본연구에서는학령전아동을대상으로철분영양상태를조사하고철분결핍과관련된식이요인을분석하여향후유아들의영양상태개선및영양교육의기초자료를마련하고자하였다. 방 법 인천일부지역유치원에다니는만 3~6세의유아 128명을대상으로신체계측과 24시간회상법으로식이섭취를조사하였고, 정맥 혈을채취하여헤모글로빈, 헤마토크리트치, 혈청페리틴과철및트랜스페린포화도를측정하여철분영양상태를평가하였다. 또한철분결핍과관련된식이요인을다중로지스틱회귀분석을이용하여교차비 (odds ratio) 와 95% 신뢰구간으로분석하였다. 결 과 대상자의철분영양지표는평균적으로는철분결핍기준보다높았으나혈청페리틴 (10 ng/ ml미만 ) 과트랜스페린포화도 (12% 미만 ) 를기준으로보았을때, 대상자중 18% 에해당하는 23명의유아는철분결핍이었다. 단변량분석시철분결핍은비타민 B 6 혹은비타민 C의섭취량이낮을수록, 과일류와채소류의섭취빈도가낮을수록발생률이높았으며연령, 설병, 수유방법을보정하여다변량분석을했을경우채소류의주 4회미만섭취에대한주 4회이상섭취시교차비가 0.267이었다. 결론철분결핍으로평가된유아들에게주 4 회이상채소류를섭취하도록한다면비타민 C 의섭취가증가되어철흡수가증진되고철결핍예방에도움이될것으로사료된다. ( 대한임상건강증진학회지 2004;4:233~240) 중심단어 철분영양, 철분결핍빈혈, 식이요인, 유아 7 서론 유아기는영아기와사춘기의급성장사이에서신체의성장발육이꾸준히진행되는시기로, 계속되는성장에비해소화흡수능력이미숙하며섭취해야할영양소의절대량은성인에비해적지만체중당열량, 단백질, 수분의필요량은성인에비해크다. 1) 또한이시기는식습관이형성되는중요한시기로이때에형성된식습관은성인이되어서의식습관에도영향을주게되며아동의정상적인성장발달과건강하고원만한성격형성에도큰영향을미치므로 2), 이시기에영양섭취의불균형은발육이나건강뿐만아니라장래의체력, 정 * 본연구는 2004 학년도성신여자대학교전기학술연구조성비에의해수행되었음. 교신저자 : 안홍석성신여자대학교식품영양학과 주소 : 서울성북구동선동 3가 249-14 전화 : 02-920-7519 E-mail : hsahn@sungshin.ac.kr 접수일 : 2004년 11월 29일 채택일 : 2004년 12월 10일 신적발달, 성격형성에도바로영향을미칠수있다. 3) 따라서학령전아동기에올바른영양관리는신체뿐만아니라정신의정상적인발육과질병예방을위해중요하다. 4) 세계보건기구의보고에의하면, 철분결핍은경제수준과상관없이어느연령층에서나발생할수있는영양문제로 5-7), 최근영양상태의개선, 모유영양기간의준수, 식품내의철분강화등으로철분결핍성빈혈의빈도가감소하기는하였으나 8-10) 아직도전세계적으로가장흔히볼수있는영양결핍이다. 미국의경우 1-5세의 8% 가철분결핍이라고보고하였다. 11) 우리나라의경우철분결핍의유병률을정확히파악하기는어렵지만, 아동복지시설의학령전아동을대상으로한조사에서철분결핍이 12.9~18.6% 라고보고한바있으며 12), 또 3-6세를대상으로한조사에서는헤모글로빈을기준으로할때 4.3% 의결핍을, 혈청페리틴을기준으로했을때는 17.7%, 트랜스페린포화도를기준으로했을때는 18.2% 의결핍을나타내고있었다. 13) 또 233

[ 유아의철분결핍과관련된식이요인분석 ] 한, 한대규모연구에서는헤모글로빈이 11 g/dl 미만인아동은남자 21.6%, 여자 18.9% 라고보고하였다. 14) 아동에서철분결핍시성장부진은물론식욕감퇴및까다로운섭식행동이야기되며철분을이용하는효소의활성저하로지적수행능력이떨어지고주의력감소가초래될초래될수있다. 15-17) 특히뇌가성숙되는시기에는철분결핍의치료가지체될경우비가역적인장애를초래할수있다. 15) 그러므로아동의철분결핍은조기에발견되고치료되어야한다. 더욱이철분결핍의주된원인은철분의섭취부족을들고있는데, 국민건강 영양조사에따르면학령전아동의철분섭취량은 7.0 mg/day 로영양권장량의 79.8% 로낮은섭취수준을보이고있었고 18), 다른철분영양상태조사에서도철분은부족되기쉬운영양소로보고되고있어 19-21), 학령전아동에서철분결핍은중요시되어야할문제이다. 그러나최근이들집단에서철분영양상태에대한연구는많이이루어졌으나, 철분결핍과관련된식이요인분석에대한연구는미흡한실정이다. 이에본연구에서는유아기에속하는학령전아동의철분영양상태를조사하고철분결핍과관련된식이요인을분석하고자하였으며, 이로부터이들집단에서의영양상태개선을위한바람직한식습관유도및영양교육의기초자료를마련하고자하였다. 1. 연구대상자 연구방법 인천지역 5개유치원에다니는만 3-6세의유아를대상으로하였으며이들에대한정보는가정통신문을통해본연구에대한취지를충분히인지시킨후부모가작성한설문지를통해얻을수있었다. 모집된유아 242명중설문이나혈액검사에응하지않았거나설문조사의응답이불성실한경우등을제외한 128명을최종대상자로하였다. Table 1. Distribution of subjects by age and sex Boys Girls Total No. % No. % No. % Age(yr) 3 11 16.4 12 19.7 23 18.0 4 22 32.9 20 32.8 42 32.8 5 26 38.8 23 37.7 49 38.3 6 8 11.9 6 9.8 14 10.9 Total 67 52.3 61 47.7 128 100.0 대상자들에대한성별연령별분포는표 1과같이, 남자 67명 (52.3%), 여자 61명 (47.7%) 이었으며, 연령별로는만 3세가 23명 (18.0%), 4세 42명 (32.8%), 5세 49명 (38.3%), 6세 14명 (10.9%) 이었다. 2. 연구내용및방법 1) 일반사항및신체계측출생후수유방법및기간, 영양제복용여부, 현병력등에대한문항으로구성된설문지를부모가작성하도록하였다. 신장과체중은최근정기신체검사의일부로시행된결과의기록을사용하였으며, 이로부터 Rohrer 지수를산출하였다. 2) 식이섭취조사영양소섭취는 24시간회상법을통해주말이아닌평일하루의식품섭취량을기록하도록하였다. 이때, 점심은유치원에서제공되므로유치원교사가각아동의섭취량을기록하도록하였다. 식이섭취조사결과는영양평가프로그램 (Can pro 전문가용 ) 을이용하여 1일영양소섭취량을계산한후한국인영양권장량에대한섭취비율을구하였다. 식품군별섭취빈도를조사하였는데, 이때섭취빈도는먹지않음, 월 1 회, 월 2-3회, 주 1-2회, 주 3-4회, 주 5-6회, 매일 1회, 매일 2 회, 매일 3회의 9단계로구성되었다. 3) 철분영양지표검사철분영양상태를평가하기위해정맥혈을채취하여헤모글로빈 (hemoglobin, Hb), 헤마코크릴 (hematocrit, Hct), 혈청페리틴 (ferritin), 혈청철을측정하였다. Hb, Hct는 Coulter counter 로, 혈청철분은 spectrophotometry로, 혈청페리틴 (ferritin) 은방사면역측정법 (radioimmunoassay) 로측정하였다. 트랜스페린 (transferrin) 포화도 (transtenin saturation, TS) 는 TIBC에대한혈청철분의 % 로계산하였다. 철분결핍빈혈의판정은 Gibson 등 22) 이제시한 Hb 11 g/dl 미만, Hct 33% 미만, 혈청철분 60 μg /dl 미만, 트랜스페린포화도 (transferin saturation) 14% 미만, 혈청페리틴 (ferritin) 농도 10 ng/ml 미만을기준으로비교하였다. 3. 통계분석수집된자료는 SAS 8.02를이용하여분석하였다. 철분결핍기준에따라분류한철분결핍군과정상군간의차이는 t-test와 chi-square test로, 철분결핍과관련된식이요인은다중로지스틱회귀분석을이용하여교차비와 95% 신뢰구간으로정량화하여분석하였다. 234

[Analysis of Dietary Factors Associated with Iron Deficiency in Preschool Children] 결과 1. 철분영양지표에따른철분영양상태평가 철분영상태의평가를위한 Hb, Hct, 혈청철분, 트랜스페린포화도및혈청페리틴등의측정결과는표 2와같다. Table 2. The level of hematological indices and distribution of subjects below the reference value Mean±S.D Percentage Criteria for No.. of subject deficiency Hemoglobin (g/dl) 12.5 ± 0.7 4 3.1 <11* Hematocrit (%) 36.9 ± 2.1 1 0.8 <33* Serum iron ( μg /dl) 75.4 ± 34.7 37 28.9 <60* Transferrin saturation (%) 28.1 ± 15.7 14 10.9 <12, <14 Serum ferritin (ng/ml) 21.7 ± 11.5 12 9.4 <10* * reference 24, reference 25 Hb과 Hct의농도는빈혈을판정하는비교적간단한측정방법으로, 본연구에서평균 Hb의농도는 12.5 ± 0.7 g/dl 였고, Hct는 36.9 ± 2.1% 였다. Hb 11 g/dl 미만을빈혈로판정할때 22) 본대상자중 3.1% 가빈혈이었으며, Hct 농도는 33% 미만 22) 을빈혈로판정하였을때 0.8% 만이빈혈로나타났다. 혈청철분은평균 75.4 ± 34.7 μg /dl이었고, 60 μg /dl 미만을철분결핍으로판정했을때 22) 본대상자중 28.9% 가이에해당하였다. 트랜스페린포화도는혈청철분과총철결합능 (Total iron binding capacity, TIBC) 의비율로, 철분결핍의초기에혈청철분이감소되고 TIBC가증가하여트랜스페린포화도가감소한다. 평균트랜스페린포화도는 28.1 ± 15.7% 으로, 연구자마다철분결핍의기준이다르기는하지만 3-4세의경우 12% 미만을, 5-6세의경우 14% 미만을기준으로했을때 23) 대상자의 10.9% 가철분결핍이었다. 혈청페리틴은철분의상태에가장민감한지표로, 평균혈청페리틴은 21.7 ± 11.5 ng/ml 이었다. 혈청페리틴의감소는철분결핍의초기에나타나는데 10 ng/ml 미만을철분결핍으로판정시 22) 대상자의 9.4% 가이에해당하였다. 2. 철분결핍과관련된식이요인의단변량분석 혈청페리틴농도가 10 ng/ml 미만이거나트랜스페린포화도가 3-4세의경우 12% 미만, 5-6세의경우 14% 미만을철분결핍으로정의하고이를철분결핍군 (Iron Deficiency) 으로, 그이상에해당하는아동을정상군 (Non Iron Deficiency) 으로하여두군간의비교를통해철분결핍과관련된요인에대한단변량분석을실시하였다. 1) 일반사항두군간의일반사항비교를표 3에제시하였다. Table 3. Baseline characteristics in iron deficiency and normal group ID* (n=23) NID (n=105) P value No. % No. % Age (yr) 3 1 4.3 22 21.0 0.019 4 6 26.1 36 34.3 5 12 52.2 37 35.2 6 4 17.4 10 9.5 Sex Boys 16 69.6 51 48.6 0.068 Girls 7 30.4 54 51.4 Type of feeding after birth Breast milk 1 4.4 25 24.0 0.041 Artificial milk 13 56.5 52 50.0 Mixing 9 39.1 27 26.0 Duration of breast feeding (month) 0 1 5.6 13 16.5 0.455 1-5 13 72.2 29 36.7 6 4 22.2 37 46.8 Nutritional supplement No 17 73.9 73 70.9 0.771 Yes 6 26.1 30 29.1 Current disease Gastrointestinal disease 0 0.0 4 3.8 0.342 Respiratory disease 2 8.7 6 5.7 0.593 Others 2 8.7 15 14.3 0.474 Height (cm) 108.7 ± 7.1 108.3 ± 8.2 0.866 Weight (kg) 19.1 ± 3.5 18.4 ± 3.3 0.401 Rohrer index 146.2 ± 15.2 143.8 ± 20.2 0.618 * ID (iron deficiency) NID (non iron deficiency) Mean ± S.D. 철분결핍은연령이증가할수록, 출생시모유보다는조제분유나혼합수유를시행한경우유의적으로많이발생하였다 (P<0.05). 반면, 철분결핍은성별이나출생후모유수유의기간, 보충제복용여부, 현병력, 신장및체중, Rohrer 지수등과는관련이없는것으로나타났다 (P>0.05). 2) 영양소섭취량각영양소섭취를권장량의 75% 미만, 75% 이상으로나누어, 235

[ 유아의철분결핍과관련된식이요인분석 ] 두군간에섭취수준을비교한결과를표 4 에제시하였다. 두군간에섭취빈도를비교한결과를표 5 에제시하였다. Table 4. Nutrients intake of % RDA in iron deficiency and normal group ID* (n=23) NID (n=105) No. % No. % P value Energy <75% of RDA 1 4.4 13 12.4 0.264 75% of RDA 22 95.6 92 87.6 Protein <75% of RDA 1 4.4 1 1.0 0.234 75% of RDA 22 95.6 104 99.0 Calcium <75% of RDA 5 21.7 36 34.3 0.243 75% of RDA 18 78.3 69 65.7 Phosphorus <75% of RDA 1 4.4 1 1.0 0.234 75% of RDA 22 95.6 104 99.0 Iron <75% of RDA 2 8.7 12 11.4 0.704 75% of RDA 21 91.3 93 88.6 Vitamin A <75% of RDA 10 43.5 45 42.9 0.957 75% of RDA 13 56.5 60 57.1 Vitamin B 1 <75% of RDA 1 4.4 3 2.9 0.710 75% of RDA 22 95.6 102 97.1 Vitamin B 2 <75% of RDA 1 4.4 12 11.4 0.309 75% of RDA 22 95.6 93 88.6 Vitamin B 6 <75% of RDA 2 8.7 1 1.0 0.026 75% of RDA 21 91.3 104 99.0 Niacin <75% of RDA 2 8.7 7 6.7 0.730 75% of RDA 21 91.3 98 93.3 Vitamin C <75% of RDA 8 34.8 16 15.2 0.030 75% of RDA 15 65.2 89 84.8 * ID (iron deficiency) NID (non iron deficiency) 철분결핍은비타민 B 6 와비타민 C의낮은섭취와유의하게관련이있는것으로나타났다 (P<0.05). 철분섭취는철분결핍과관련이없었고, 이외에도열량섭취를비롯한단백질, 칼슘, 인, 비타민 A, 비타민 B 1, 비타민 B 2, 나이아신등의섭취는철분결핍과관련이없었다 (P>0.05). 3) 식품군별섭취빈도식품군별섭취빈도를주 4회미만, 주 4회이상으로나누어, Table 5. Frequency by food groups in iron deficiency and normal group ID* (n=23) NID (n=105) No. % No. % P value Meats and fish <4 times/week 3 13.6 20 19.1 0.549 4 times/week 19 86.4 85 80.9 Eggs <4 times/week 14 60.9 74 71.8 0.300 4 times/week 9 39.1 29 28.2 Legumes <4 times/week 20 87.0 81 77.1 0.296 4 times/week 3 13.0 24 22.9 Cereals <4 times/week 8 36.4 32 30.5 0.589 4 times/week 14 63.6 73 69.5 Dairy products <4 times/week 4 17.4 22 21.0 0.701 4 times/week 19 82.6 83 79.0 Fruits <4 times/week 15 65.2 40 38.1 0.017 4 times/week 8 34.8 65 61.9 Vegetables <4 times/week 7 31.8 14 13.9 0.043 4 times/week 15 68.2 87 86.1 Oils <4 times/week 13 56.5 43 42.2 0.211 4 times/week 10 43.5 59 57.8 Snacks <4 times/week 12 52.2 50 48.1 0.722 4 times/week 11 47.8 54 51.9 * ID (iron deficiency) NID (non iron deficiency) 철분결핍은과일류와채소류의섭취빈도와유의하게관련이있었는데 (P<0.05), 과일류, 채소류의섭취빈도가주 4회미만으로낮을수록발생빈도가높았다. 그러나, 육류및생선류, 알류, 콩류, 곡류, 우유및유제품류, 유지류, 과자류등의섭취빈도는철분결핍과관련이없는것으로나타났다 (P>0.05). 3. 철분결핍과관련된식이요인의다변량분석 단변량분석에서유의한차이를보인비타민 B 6 와비타민 C 섭취량, 과일류와채소류의섭취빈도를연령, 성별, 출생시수유방법등의변수를보정하여다변량분석을시행하였으며그결과를표 6에제시하였다. 236

[Analysis of Dietary Factors Associated with Iron Deficiency in Preschool Children] Table 6. Multivariate analysis of dietary factors for iron deficiency 95% Odds ratio Adjusted P confidence interval Amount of vitamin B 6 intake <75% of RDA 1.000 75% of RDA >999.9 <0.001 - >999.9 0.956* Amount of vitamin C intake <75% of RDA 1.000 75% of RDA 2.586 0.808-8.272 0.109* Frequency of fruits <4 times/week 1.000 4 times/week 0.448 0.163-1.233 0.120 Frequency of vegetables <4 times/week 1.000 4 times/week 0.267 0.077-0.928 0.038 * Adjusted for age, sex, type of feeding after birth, and energy intake Adjusted for age, sex and type of feeding after birth 다변량분석결과, 비타민 B 6 섭취량의철분결핍발생에대한교차비는 999.9(95% 신뢰구간 <0.001->999.9) 였고, 비타민 C 섭취량의교차비는 2.586(95% 신뢰구간 0.808-8.272) 이었으며, 과일류의주 4회미만에대한주 4회이상섭취시철분결핍발생의교차비는 0.448(95% 신뢰구간 0.163-1.233) 이었다. 채소류의주 4회미만섭취에대한주 4회이상섭취시교차비는 0.267(95% 신뢰구간 0.077-0.928) 로채소류를주 4회이상섭취할경우철분결핍의발생을유의하게감소시키는것으로나타났다. 고찰 본연구에서는인천지역유치원에다니는만 3-6세의유아 128명을대상으로철분영양지표를측정하여철분영양상태를판정하고, 철분결핍과관련된식이요인을분석하고자하였다. 본연구에서사용한철분영양지표의농도는 Kim과 Chyun이보고한 24) Hb 12.2 g/dl, Hct 36.0% 나, Kim 등 25) 의 Hb 12.7 g/dl, Hct 38.0% 과비슷하였다. Hb 11 g/dl 미만을빈혈로판정할때 22) Kim과 Chyun 24) 의연구에서는빈혈아동의빈도가 3.4% 로나타났으며, 같은기준으로판정시저소득층의학령전아동을대상으로한 Son과 Park 등 13) 의 4.3% 보다는본연구대상자에서다소높게나타났다. 혈청철분은평균 75.4 ± 34.7 μg /dl 이었고, Kim과 Chyun 24) 의 101.1 μg /dl 보다는낮았으나 Lee 20) 의 53.5 μg /dl 보다는 높은결과였다. Son과 Park 13) 은철분결핍을 16% 미만으로했을때 18.2% 가이에해당하였는데, 본연구에서도 16% 미만을기준으로했을경우에는 18.2% 가철분결핍이었다. 철분의결핍상태는 3단계로진행되는데, 먼저혈청페리틴이감소하고, 다음으로혈청철분의감소, 총철결합능 (Total binding capacity, TIBC) 의상승, 트랜스페린포화도의감소단계로진행되며, 결국이는 Hb과 Hct가감소되는빈혈을초래하게된다. 22) Hb과 Hct 농도는간단한측정방법으로많이이용되기는하지만철분결핍상태의 3단계에해당되는증상으로민감도가큰지표라고할수없어상당수의철분결핍을놓칠수있으므로, 철분결핍을판정하기위해서는보다민감도가큰지표를사용하는것이좋으며한가지지표보다는여러지표를사용하는것이보다정확하게판정할수있다. 26) 따라서, 본연구에서는철분결핍의판정지표로혈청페리틴 (10 ng/ml 미만 ) 22) 과트랜스페린포화도 (3-4세 12% 미만, 5-6세 14% 미만 ) 23) 를사용하였으며, 대상자중 23명 (18.0%) 이철분결핍에해당되었다. 채소류는비타민 C의급원식품으로, 비타민 C는 nonheme 철분의흡수를증가시키는매우중요한요소로알려져있으며 27) 여러연구에서철분생체이용도증가효과를보여주고있다. Derman 등 28), Davidsson 등 29), Davidsson 등 30) 은식사에비타민 C를첨가했을때철분흡수가유의적으로증가했음을보고하였고, 이것은비타민 C가 phytate와 tannin 같은철분흡수의저해요인의영향을감소시킴으로써철분흡수를증가시키는것이라고하였다. 31) 또한, 이러한결과는혈청페리틴과비타민 C간에양의상관성을보고한 Koski 등 32) 의결과와, 철분흡수향상인자의섭취량이증가할수록혈청페리틴함량이증가한다고보고한 Ahn 등 33) 의결과와도일치하는것이다. 따라서, 비타민 C 섭취량자체는철분결핍의발생과상관성이없었으나, 채소류를주 4회이상섭취하여비타민 C 즉, 철분흡수향상인자의섭취를향상시킴으로써철분결핍을예방할수있을것으로본다. 기타다른영양소및식품의섭취는유아의철분영양상태와상관성이없는것으로나타났으나, 이에대한보다구체적인설명을위해서는향후보다많은연구대상자에대한분석연구가요구된다고하겠다. 본연구의제한점은첫째, 식이조사시부모가회상하여자가기록을하였기때문에섭취량이과소혹은과대평가되었을가능성을배제할수없으며, 둘째, 혈청페리틴은최근의감염, 염증성질환, 간질환등의상태일때는철분결핍이있는경우에도높은수치를보일수있는데 34), 본연구의채혈기간동안에는알려진감염성질환의유행은없었지만대상자중상기도감염등의가벼운감염이있는아동이포함 237

[ 유아의철분결핍과관련된식이요인분석 ] 되었을가능성을배제할수없어철분결핍의발생률이실제보다낮게평가되었을가능성이있다는것이다. 셋째, 본연구는인천일부지역의 5개유치원생을대상으로철분영양상태가조사된결과이므로이를유아의평균철분영양상태로평가하는데에는다소의무리가있을수있다. 이러한제한점에도불구하고본연구결과로부터채소류를주 4회이상섭취하여비타민 C의섭취를늘림으로써철분흡수를증가시켜철분결핍을예방할수있을것으로본다. 참고문헌 1. Pipes PL, Trahms CM. Nutrition in infancy and childhood. Mosby, St. Louis, 1993 pp.30-58. 2. Moon SJ, Lee MH. An effect of children's food altitude on nutritional status and personality. Korean J Nutr 1987;20(4): 258-271. 3. Krebs-Smith SM, Smicklas-Wright HS, Guthrie HA, Krebs-Smith J. The effect of variety in food choices on dietary quality. J Am Diet Assoc 1987;87:897-903. 4.Caliendo MA, Sanjur D, Wrght J, Cummings G. Nutritional status of preschool children. J Am Diet Assoc 1977;71:20-26 5. Dallman PR. Biochemical basis for the manifestations of iron deficiency. Ann Rev Nut 1986;6:13-40. 6. Chung HR, Moon HK, Song BH, Kim MK. Hemoglobin, hematocrit and serum ferritin as markers of iron status. Korean J Nutrition 1991;24(5):450-457. 7.Hereberg S, Galan P, Sourstre Y, Dop MC, Devanlaay M, Dupin H. Effects of iron supplementation on serum ferritin and other hematological indices of iron status in menstruating women. Ann Nut Metab 1985;2:232-238. 8. Dallman PR, Yip R. Changing characteristics of childhood anemia. J Pediatr 1989;114:161-164. 9. Yip R, Walsh KM, Goldfarb MG, Binkin NJ. Declining prevalence of anemia in childhood in a middle-class setting; a Pediatric success story? Pediatrics 1987;80:330-334. 10. Looker AC, Dallman PR, Carroll MD, Gunter EW. Johnson CL. Prevalence of iron deficiency in the United Status. JAMA 1997; 227:973-976. 11. Latham MC. Preventing specific micronutrient deficiencies. In: Human Nutrition in the Developing World. Rome, Italy. Food and Agriculture Organization of the United Nations. 1997;399-418. 12. Kye SH, Park KD. A survey on nutritional status and anthropometry of preschool children in orphanage. J Korean Soc Food Nutr 1993;22(5):552-558. 13. Son SM, Park SH. Nutritional status of iron, zinc and copper of preschool children residing in low-income area of Seoul. J Community Nutrition 1999;1(1):3-9. 14. Moon HK, Jung HJ, Park SY. Indicators of nutritional status on the basis of preschool children's anthropometry. Korean J Nutrition 1998;31(8):1283-1294. 15. Oski F, Honig A, Helu B, Howanitz P. Effect of iron therapy on behavior performance in nonanaemic, iron deficient infants. Pediatrics 1983;71:877-880. 16. Lozoff B. Behavioral alterations in iron deficiency. Adv Pediar 1988;35:331-359. 17. Pollitt E, Hathirat P, Kotchabhakdi NJ, Missell L. Valyasevi A. Iron deficiency and educational achievement in Thailand. Am J Clin Nutr 1989;50:687-697. 18. Korea health industry development institute. Report on 2001 national health and nutrition survey - Nutrition survey. 2002 19. Park SY, Paik HY, Moon HK. A study on the food habit and dietary intake of preschool children. Korean J Nutrition 1999;32(4):419-429. 20. Lee JS. Nutrition survey of children of a day care center in the low income area of Pusan - Ⅰ. A study on nutrient intake and nutritional status. J Korean Soc Food Nutr 1993;22(1):27-33. 21. Son SM, Park SH. Nutritional status of preschool children in low income urban area - Ⅰ. Anthropometry and dietary intake. Korean J Community Nutrition 1999;4(2):123-131. 22. Gibson RS. Principles of nutritional assessment. Oxford, 1990 23. Fidanza F. Nutritional status assessment. Chapman & Hall, 1991 24. Kim YK, Chyun JH. Nutrition intakes and relations to the obesity and the prevalance of anemia in preschool children living in metropolitan area of Korea. Korean J Dietary Culture 2001;16(5):451-462. 25. Kim KS, Lee SH, Chae KS, Lim HJ. Nutrition survey of children in a Kindergarden of a private elementary school in Pusan. - 1. A study on nutrient intake and nutritional status. J Korean Soc Food Nutr 1994;23(4):587-593. 26. Graiter PL, Galdsby JB, Nichaman MZ. Hemoglobins and hematocrit: Are they equally sensitive in detecting anemia? Am J Clin Nutr 1980;34:61-64. 27. Kim YJ. Nonheme iron absorption and dietary factors. J Korean Soc Food Nutr 1993;22(3):349-358. 28. Derman DP, Bothwell TH, Macphail AP, Torrance JD, Bezwoda WR, Chariton RW, Mayet FG. Importance of ascorbic acid in the absorption of iron from infant foods. Scandinavian J Haematology 1980;25(3):193-201. 29. Davidsson L, Walczyk T, Zavaleta N, Hurrell RF. Improving 238

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Korean J Health Promot Dis Prev Vol. 4, No. 4, 2004 [Abstract] Analysis of Dietary Factors Associated with Iron Deficiency in Preschool Children Ji Yun Lee, Min Sook Lee, Soon Ki Kim 1), Hong Seok Ahn Department of Food & Nutrition, Sungshin Women's University, Department of Pediatrics 1), College of Medicine, Inha University Background Methods Results Conclusions Key words Iron deficiency remains the most prevalent nutritional deficiency in the world. Especially, iron is very important in preschool children who need it for their growth. This study was performed to investigate the iron status and the dietary factors for iron deficiency in preschool children. One hundred twenty eight preschool children residing in In-chon were selected with age range of 3-6 years. The hematological indices, daily nutrient intakes and food frequency were measured. Three poirot one%, 0.8%, 28.9%, 10.9% and 9.4% of the children were less than 11g/in Hb, 33% in Hct, 60 μg /dl in serum iron, 12% for 3-4 years old children or 14% for 5-6 year old children in transferrin saturation and 10 ng/ml in serum ferritin, respectively. Twenty-three of the children (18.0%) showed iron deficiency which was defined by serum ferritin (<10 ng/ml) or transferrin saturation (<12% for 3-4 year old children, <14% for 5-6 year old children). In univariate analysis, iron deficiency was associated with low intake of vitamin B6 or C and low intake frequency of fruits or vegetables. In multivariate analysis, which was adjusted for age, sex and type of feeding method, the odds ratio of comparison of vegetables consumption more than 4 times a week with that less than 4 times a week was 0.267(95% confidence interval 0.077-0.928). It was recommended that preschool children should take vegetables over 4 times a week to reduce iron deficiency. (Korean J Health Promot Dis Prev 2004 ; 4 :233~240) iron deficiency, dietary factors, preschool children. 8 * This research was supported by grants from Sungshin Women's University in 2004. To whom correspondence should be addressed. Address for correspondence : Hong Seok Ahn Department of Food & nutrition, Sungshin Women's University, Seoul 136-742, Korea T e l : 02-920-7519 E-mail : hsahn@sungshin.ac.kr 240