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TABLE 14-2 Situations in which the Iron Requirement May Vary

Special Consideration

Recommended Iron Intake

Infants who do not

The Adequate Intake (AI) of 0.27 mg/day does not receive human milk, apply. For infants who do not receive human milk, 0 through 6 months it is recommended that iron-containing formula (4–12 mg/L) be used from birth through 12 months.

Preterm infants

Even if they receive human milk, the AI is not adequate for preterm infants as their iron stores are low. Supplementation is recommended.

Menarche before (or after) age 14 in girls

The Estimated Average Requirement (EAR) and Recommended Dietary Allowance (RDA) for girls ages 9 to 13 years make no allowance for menstrual losses. Girls who reach menarche before age 14 years should consume an additional 2.5 mg/day. Conversely, the RDA for girls ages 14 to 18 years assumes that menstruation is occurring. It thus follows that girls 14 years and older who have not reached menarche would have a lower recommended intake of iron.

Teens/preteens in the growth spurt

Because the rate of growth during the adolescent growth spurt can be more than double the average rate for boys, and up to 50 percent higher for girls, it is recommended that boys’ intakes during the growth spurt increase by 2.9 mg/day and girls’ intakes by 1.1 mg/day.

Oral contraceptive users

Because blood losses are reduced by approximately 60 percent in women who habitually use oral contraceptive agents, the iron requirement and thus recommended intake for adolescent girls and women taking oral contraceptives would be lower.

Postmenopausal women using cyclic hormone replacement therapy (HRT)

Postmenopausal women who use HRT may be treated with use of either cyclic (a given number of days on active hormones followed by a week or so without hormones) or continuous protocols. Women using cyclic protocols frequently experience withdrawal bleeding in the week without hormones and thus would have higher iron requirements than women not using HRT or using continuous HRT. Few data are available on the magnitude and variability of HRT-associated blood loss, but it is probably between the losses experienced by premenopausal women who use oral contraceptives and those of postmenopausal women who do not bleed.

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