- In children with chronic iron deficiency, nutritional counseling and oral iron therapy improved ferritin levels but not cognitive function to levels seen in counterparts with adequate iron levels.
Why this matters
- Chronic iron deficiency in early life results in cognitive effects, that last at least into young adulthood, but the benefits of screening and treatment remain unclear.
Study design
- Canadian prospective cohort study with children aged 12–40 months from primary care whose hemoglobin and serum ferritin levels were screened (Study TARGet Kids! /a>)
- All parents received dietary recommendations, the children received oral iron based on iron status.
- According to 4 months:
- 41 Children suffered from chronic iron deficiency (baseline iron deficiency anemia or persistent non-anemia-related iron deficiency).
- 75 Children had adequate iron levels (to baseline or after non-anaemia-related iron deficiency subsided).
- Main result: cognitive function according to 4 and 12 months, assessed with the Early Learning Composite.
- Funding: Canadian Institutes of Health Research, other sponsors
- 41 Children suffered from chronic iron deficiency (baseline iron deficiency anemia or persistent non-anemia-related iron deficiency).
- 75 Children had adequate iron levels (to baseline or after non-anaemia-related iron deficiency subsided).
Key results
- Compared to their counterparts with adequate iron levels, children with chronic iron deficiency showed 4 months by 14.3 μg/l lower (p = 0.03), but after 12 3.6 μg/l lower serum ferritin levels (p = 0.21).
- However, in multivariable analyses, the chronic iron deficiency group had early learning composite scores that rose by 6.4 points lower (p = 0.04) and after 12 months by 7.4-_ points lower (p = 0.03).
- The group with chronic iron deficiency showed after 4 and 12 months also significantly worse scores for visual perception as well as after 4 months (but not after 12 months) significantly worse scores for a receptive speech disorder.
Expert comment
- In a Comment write Frank R.Greer, MD, and Robert D. Baker, MD, PhD: Physicians … remain unclear as to whether they should use a test that measures iron status to test for both iron deficiency anaemia (IDA) and non-anemia-related iron deficiency (NAID), and whether this should lead to treatment. … We would recommend all infants aged ~ 12 months at least on-_ Hb and for a value of iron status, such as serum ferritin. Both IDA and NAID should be treated with iron therapy, with appropriate follow-up required to include re-screening.
Restrictions
- The number of cases was small.
- The duration of chronic iron deficiency was not known.
- Long-term results are lacking.
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