for young infants based on the daily amount of iron secreted in human milk. The average iron concentration in human milk is 0.35 mg/L (Table 9-5). Therefore, the AI is set at 0.27 mg/day (0.78 L/ day × 0.35 mg/L).

Since there is strong reason to expect that iron intake and iron requirement are both related to achieved body size and growth rate (milk volume relating to energy demand), it is assumed that a correlation between intake and requirement exists. This allows the group mean intake to be lower than the ninety-seven and one-half percentile of requirements (Recommended Dietary Allowance). Therefore, there should be no expectation that an intake of 0.27 mg/day is adequate to meet the needs of almost all individual infants and therefore should be applied with extreme care.

The iron concentration in cow milk ranges between 0.2 and 0.3 mg/L (Lonnerdal et al., 1981). Although the iron content in human milk is lower, iron is significantly more bioavailable in human milk (45 to 100 percent) compared to infant formula (10 percent) (Fomon et al., 1993; Lonnerdal et al., 1981). Casein is the major iron-binding protein in cow milk (Hegenauer et al., 1979). Because of the poor absorption of iron, in the United States cow milk is not recommended for ingestion by infants until after 1 year of age; in Canada it is not recommended until after 9 months of age. In addition, the ingestion of cow milk by infants, especially in the first 6 months of life, has been associated with small amounts of blood loss in the stool. The cause of the blood loss is not well understood, but is assumed to be an allergic-type reaction between a protein in cow milk and the enterocytes of the gastrointestinal tract. Because the early, inappropriate ingestion of cow milk is associated with a higher risk of iron deficiency anemia, it would be prudent to monitor iron status of any infants ingesting cow milk. If anemia is detected, it should be treated with an appropriate dose of medicinal iron.

The American Academy of Pediatrics (AAP, 1999) and Canadian Paediatric Society (1991) reviewed the role of commercial formulas in infant feeding. Their conclusion was that infants who are not, or only partially, fed human milk should receive an iron-fortified formula.

Front Matter (R1-R24)

Summary (1-28)

1 Introduction to Dietary Reference Intakes (29-43)

2 Overview and Methods (44-59)

3 A Model for the Development of Tolerable Upper Intake Levels (60-81)

4 Vitamin A (82-161)

5 Vitamin K (162-196)

6 Chromium (197-223)

7 Copper (224-257)

8 Iodine (258-289)

9 Iron (290-393)

10 Manganese (394-419)

11 Molybdenum (420-441)

12 Zinc (442-501)

13 Arsenic, Boron, Nickel, Silicon, and Vanadium (502-553)

14 Uses of Dietary Reference Intakes (554-579)

15 A Research Agenda (580-586)

Appendix A Origin and Framework of the Development of Dietary Reference Intake (587-590)

Appendix B Acknowledgments (591-593)

Appendix C Dietary Intake Data from the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994 (594-643)

Appendix D Dietary Intake Data from the Continuing Survey of Food Intakes by Individuals (CSFII), 1994-1996 (644-653)

Appendix E Dietary Intake Data from the U.S. Food and Drug Administration Total Diet Study, 1991-1997 (654-673)

Appendix F Canadian Dietary Intake Data, 1990 (674-679)

Appendix G Biochemical Indicators for Iron, Vitamin A, and Iodine from the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994 (680-691)

Appendix H Comparison of Vitamin A and Iron Intake and Biochemical Indicators from the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994 (692-696)

Appendix I Iron Intakes and Estimated Percentile of the Distribution of Iron Requirements from the Continuing Survey of Food Intakes by Individuals (CSFII), 1994-1996 (697-703)

Appendix J Glossary and Acronyms (704-708)

Appendix K Conversion of Units (709-709)

Appendix L Options for Dealing with Uncertainties (710-714)

Appendix M Biographical Sketches of Panel and Subcommittee Members (715-728)

Index (729-769)

Summary Table, Dietary Reference Intakes: Recommended Intakes for Individuals, Vitamins (770-771)

Summary Table, Dietary Reference Intakes: Recommended Intakes for Individuals, Elements (772-773)