Five decades of trends in anemia in Israeli infants: implications for foodfortification policy

Objective: To describe the secular trends in the prevalence rates of iron-d eficiency anemia (IDA) in infants in Israel, identify population group diff erences and assess the effectiveness of the 1985 Public Health directives o n iron supplementation and avoidance of cow's milk in the first year of lif e. Design: A systematic analysis of published and unpublished cross-sectional studies. Methods: IDA rates in 1-y-old infants between 1946 and 1997 were assessed f rom published papers and reports. Rates for Arab infants were available fro m 1984. Data on routine hemoglobin tests on 1-y-old infants for Arabs and J ews separately were obtained from four health districts for the period 1987 to 1997. Analyses were done for the periods prior to and following the Pub lic Health directives. Results: The prevalence of IDA in Jewish infants declined from 68% in 1946 to 50% in 1985 at an average annual rate of - 1.43%. Following the iron sup plementation directives, the average annual rate of decline increased to -4 .0% and reached a prevalence of about 11% in 1996. IDA rates in Arab infant s declined by an annual average of -3.7%, and were consistently almost twic e as high as for Jewish infants. Conclusions: Despite the contribution of the iron supplementation program t o the reduction in IDA, the persistently high rates indicate inadequate iro n content in the diet. This emphasizes the important role of a national foo d fortification program, using staple foods commonly consumed.