Americans (DHHS/USDA, 1991). Although there is no recommendation specific to iron, the first guideline, ''Eat a Variety of Foods,'' specifically discusses ways to increase dietary consumption of iron through the consumption of iron-rich foods. The use of the dietary guidelines has become a universal component of all nutrition education programs. However, changes in diet brought about by educational efforts alone are very difficult to evaluate and quantify. Program evaluations generally neglect to include an examination of dietary change (Dwyer, 1982). Also, most evaluations are related to a combination of nutrition education and the delivery of food or supplemental iron—nutrition education and supplemental food (food stamps, WIC, or school lunch) or nutrition education and iron supplements (WIC, prenatal intervention studies [CDC-Ohio intervention in progress]).

A study of the dietary intake of preschool-age children showed that those who were provided supplemental food and nutrition education through the WIC program had significantly higher intakes of energy, ascorbic acid, and iron than nonparticipants (Brown and Tieman, 1986). Data from the 1985 National WIC Evaluation showed that program participants had significantly higher intakes of thiamin, niacin, vitamin B6, ascorbic acid, and iron than nonparticipants (Rush et al., 1988). However, there was no residual long-term impact on dietary intake resulting from earlier enrollment in the program.

It appears that the use of nonfood supplemental iron is generally unnecessary for most infants and children. However, supplemental iron as ferrous sulfate drops is recommended for preterm infants who are fed breast milk. Iron-fortified infant formula supplies adequate iron for formula-fed preterm infants. Iron-fortified infant formula, iron-fortified infant cereal, and meat are good dietary sources of iron for infants and children (See also Appendix D).

It appears that supplemental iron for infants is safe at prescribed doses. However, all supplemental iron preparations should be kept out of the reach of children to avoid poisoning. (See Appendix B for additional information.)

Recommendations for the prescription of iron supplements have little prospect for success in preventing iron deficiency anemia unless they are accompanied by compliant behavior. Research shows that compliance is generally very inconsistent even for relatively simple drug regimens (Haynes et al., 1979). Although drug compliance is often poor even for individuals with life-threatening conditions such as diabetes, epilepsy, and organ transplantation, research shows that compliance is worse when the individual has no obvious illness, such as hypertension. The observed compliance with supplemental iron regi-

FRONT MATTER (R1-R12)

THE COMMITTEE (1-1)

MAJOR ISSUES (2-10)

RECOMMENDED GUIDELINES FOR PREVENTION, DETECTION, AND MANAGEMENT OF IRON DEFICIENCY ANEMIA (11-19)

RECOMMENDED GUIDELINES FOR PREVENTING AND TREATING IRON DEFICIENCY ANEMIA IN INFANTS AND CHILDREN (20-21)

RECOMMENDED GUIDELINES FOR PREVENTING AND TREATING IRON DEFICIENCY ANEMIA IN NONPREGNANT WOMEN OF CHILDBEARING AGE (22-23)

RECOMMENDED GUIDELINES FOR PREVENTING AND TREATING IRON DEFICIENCY ANEMIA IN PREGNANT WOMEN (24-25)

RECOMMENDATIONS FOR RESEARCH (26-31)

REFERENCES (32-36)

APPENDIXES (37-38)

A ACKNOWLEDGMENTS (39-40)

B IRON DEFICIENCY ANEMIA: A SYNTHESIS OF CURRENT SCIENTIFIC KNOWLEDGE AND U.S. RECOMMENDATIONS FOR PREVENTION AND TREATMENT (41-98)

C IRON-DEPENDENT PATHOLOGIES (99-112)

D DIETARY IRON: TRENDS IN THE IRON CONTENT OF FOODS, USE OF SUPPLEMENTAL IRON, AND THE FRAMEWORK FOR REGULATION OF IRON IN THE DIET (113-122)

E COMMITTEE AND STAFF BIOGRAPHIES (123-126)