Iron Deficiency, Cognitive Functions, and Neurobehavioral Disorders in Children

Alterations in brain iron and myelination in children with ASD: A susceptibility source separation imaging study

Autism spectrum disorder (ASD) may have both brain iron and myelin changes, but traditional methods fail to differentiate them. This study utilized an advanced susceptibility source separation technique, APART-QSM (iterAtive magnetic suscePtibility sources sepARaTion), to investigate brain iron and myelination alterations in children with ASD and link neuroimaging findings to clinical symptom severity. Sixty-five school-aged children with ASD and Sixty age- and sex-matched typically developing children were included. By providing enhanced and broader detection capabilities compared to conventional QSM, APART-QSM uncovered reduced iron content across multiple deep gray matters and decreased myelin content in the globus pallidum in ASD. The iron and myelin contents in the globus pallidum and iron content in the substantia nigra were significantly negatively correlated with ASD symptom severity. Coexisting abnormal brain iron and myelin contents in ASD, particularly in the globus pallidus, offer innovative and promising insights into ASD pathology and potential biomarkers.

Assessment of Essential and Toxic Element Levels in the Toenails of Children with Autism Spectrum Disorder

Autism spectrum disorder (ASD) has become a global public health concern, impacting the quality of life. The question of gene-environment interaction in the emergence of ASD remains a subject of ongoing debate, and exploring its pathophysiology is thoroughly related to metals as a risk factor. Therefore, this study aims to assess the levels of toxic (Al, Cd, Hg, and Pb) and essential (Cr, Mn, Fe, Ni, Cu, Zn, and Se) elements in toenail samples collected in children with ASD and neurotypical children, by ICP-MS. Parallelly, we will discuss the use of toenails as an exposure indicator. The study involved 208 children aged 3 to 14 from Marrakech, Morocco. One hundred two were diagnosed with ASD and 106 were neurotypical children. Significant statistical differences in the concentration of Cr, Mn, and Fe were documented between the two groups. Higher levels of Pb in toenails compared to reference values have been reported. No association was established between concentrations of elements and age. Spearman correlation coefficients revealed a significantly different pattern of mutual dependence for toxic and essential elements between the two groups. The strongest positive correlations were found in the neurotypical group (Fe-Mn (ρ = 0.750), and Se-Zn (ρ = 0.800)). These results provide additional, although inconclusive, evidence on the probable role of element disturbance in the pathogenesis of ASD. Further studies should be performed to explore other nutritional, cultural, sociodemographic, environmental, and methodological factors that may impact the levels of these elements in the nails and their possible correlation with the incidence of ASD.

Prevalence and Hematological Changes in Urogenital Schistosomiasis: Infection Persistence in the Phase of Mass Drug Administration in Sempoa (Kwahu East, Ghana): A Cross-Sectional Study

Background

Schistosomiasis is a chronic neglected tropical disease and Ghana's second most prevalent helminth infection. The annual mass drug administration of praziquantel to school children is aimed at reducing disease morbidity as a public health problem.

Aim

The study aimed to assess the prevalence and hematological profile of urinary schistosomiasis in Sempoa after over a decade of consecutive Mass Drug Administration (MDA) of praziquantel.

Methods

A community-based cross-sectional study involving 126 participants was conducted. Schistosoma haematobium eggs were identified and quantified using the urine filtration-microscopy technique. The hematological profile was analyzed using a fully automated 5-part Sysmex XN-350 (Sysmex Co, Germany) analyzer.

Results

The study recorded a prevalence of 21.6% that was significantly related to water contact activities. Schistosomiasis was significantly associated with lower levels of Red Blood Cell (RBC) indices; MCV (p < 0.001), MCHC (p < 0.001), and MCH (p = 0.01) with higher platelet, lymphocytes, and basophil counts compared to the uninfected. Heavy infection was significantly associated with lower hemoglobin levels. The study further reported microhaematuria as a sensitive and specific proxy diagnostic tool for field surveillance in endemic communities.

Conclusion

Urinary schistosomiasis accompanied by an altered hematological profile persists in Sempoa under preventive praziquantel. Future control interventions must consider an integrated approach of marrying behavioral change, with preventive chemotherapy and vector control.

Whole Brain MRI Assessment of Age and Sex-Related R2* Changes in the Human Fetal Brain

Iron in the brain is essential to neurodevelopmental processes, as it supports neural functions, including processes of oxygen delivery, electron transport, and enzymatic activity. However, the development of brain iron before birth is scarcely understood. By estimating R2* (1/T2*) relaxometry from a sizable sample of fetal multiecho echo-planar imaging (EPI) scans, which is the standard sequence for functional magnetic resonance imaging (fMRI), across gestation, this study investigates age and sex-related changes in iron, across regions and tissue segments. Our findings reveal that brain R2* levels significantly increase throughout gestation spanning many different regions, except the frontal lobe. Furthermore, females exhibit a faster rate of R2* increase compared to males, in both gray matter and white matter. This sex effect is particularly notable within the left insula. This work represents the first MRI examination of iron accumulation and sex differences in developing fetal brains. This is also the first study to establish R2* estimation methodology in fetal multiecho functional MRI.

Neuroinflammation and iron metabolism after intracerebral hemorrhage: a glial cell perspective

Intracerebral hemorrhage (ICH) is the most common subtype of hemorrhagic stroke causing significant morbidity and mortality. Previously clinical treatments for ICH have largely been based on a single pathophysiological perspective, and there remains a lack of curative interventions. Following the rupture of cerebral blood vessels, blood metabolites activate resident immune cells such as microglia and astrocytes, and infiltrate peripheral immune cells, leading to the release of a series of inflammatory mediators. Degradation of hemoglobin produces large amounts of iron ions, leading to an imbalance of iron homeostasis and the production of large quantities of harmful hydroxyl radicals. Neuroinflammation and dysregulation of brain iron metabolism are both important pathophysiological changes in ICH, and both can exacerbate secondary brain injury. There is an inseparable relationship between brain iron metabolism disorder and activated glial cells after ICH. Glial cells participate in brain iron metabolism through various mechanisms; meanwhile, iron accumulation exacerbates neuroinflammation by activating inflammatory signaling pathways modulating the functions of inflammatory cells, and so on. This review aims to explore neuroinflammation from the perspective of iron metabolism, linking the complex pathophysiological changes, delving into the exploration of treatment approaches for ICH, and offering insights that could enhance clinical management strategies.

Feasibility of home-based urine collection in children under 5 years in the ORIGINS birth cohort study: mixed method protocol and sample completion results

BACKGROUND

Urine is an attractive biospecimen for nutritional status and population health surveys. It is an excellent non-invasive alternative to blood for appropriate biomarkers in young children and is suitable for home-based collection, enabling representative collections across a population. However, the bulk of literature in this population is restricted to collection in primary care settings. Feasibility of home-based collection at scale has not been tested. Here, we describe a mixed method approach to collect urine samples in a large cohort study with children under 5 years.

METHODS

The ORIGINS Project is an ongoing birth cohort investigating early life influences on child health outcomes in Perth, Australia. Recruitment began in 2017, with 3713 children consented by December 2022. Urine is collected longitudinally from children between 2 months and 5 years of age. Mixed methods for sample collection and return accommodates requirements across various ages and study timepoints. Uniquely, courier collection and postal kit deliveries were established in response to participant feedback regarding difficulty with in-person sample drop-offs with young children.

RESULTS

Over half of all eligible caregivers (1929/3713, 52%) returned a sample, 91% meeting quality standards. A third of all samples were returned by courier, with the highest uptake at 2-6 months of age, and increased uptake across all ages during COVID lockdowns. Caregivers cited being time-poor as the greatest barrier to sample completion and very few participants indicated difficulty with study methods.

CONCLUSION

Our data suggests that home-based urine collection using a mixed method approach is acceptable to caregivers at a large scale, supporting the use of urine for biomarker studies and population surveys with young children.

The Effects of Fisetin and Curcumin on Oxidative Damage Caused by Transition Metals in Neurodegenerative Diseases

Neurodegenerative diseases pose a significant health challenge for the elderly. The escalating presence of toxic metals and chemicals in the environment is a potential contributor to central nervous system dysfunction and the onset of neurodegenerative conditions. Transition metals play a crucial role in various pathophysiological mechanisms associated with prevalent neurodegenerative diseases such as Alzheimer's and Parkinson's. Given the ubiquitous exposure to metals from diverse sources in everyday life, the workplace, and the environment, most of the population faces regular contact with different forms of these metals. Disturbances in the levels and homeostasis of certain transition metals are closely linked to the manifestation of neurodegenerative disorders. Oxidative damage further exacerbates the progression of neurological consequences. Presently, there exists no curative therapy for individuals afflicted by neurodegenerative diseases, with treatment approaches primarily focusing on alleviating pathological symptoms. Within the realm of biologically active compounds derived from plants, flavonoids and curcuminoids stand out for their extensively documented antioxidant, antiplatelet, and neuroprotective properties. The utilization of these compounds holds the potential to formulate highly effective therapeutic strategies for managing neurodegenerative diseases. This review provides a comprehensive overview of the impact of abnormal metal levels, particularly copper, iron, and zinc, on the initiation and progression of neurodegenerative diseases. Additionally, it aims to elucidate the potential of fisetin and curcumin to inhibit or decelerate the neurodegenerative process.

Blood Lead Levels and Their Association with Iron Deficiency and Anemia in Children

Lead is a ubiquitous and neurotoxic heavy metal particularly harmful to children, who are more susceptible than adults to its toxic effects. The prevalence of lead poisoning and iron deficiency (ID) is high in socioeconomically vulnerable child populations, negatively affecting neurocognitive development in children. Although numerous studies have shown the association between blood lead levels (BLL) and ID, the issue remains controversial. Here, we aimed to identify the association between BLL and iron nutritional status in children. We conducted an analytical cross-sectional study of healthy children aged 1-6 y attending periodic health checks in primary healthcare units from La Plata and its surroundings, Buenos Aires, Argentina, between 2012 and 2017. We performed anthropometric evaluations and determined BLL, hemoglobin (Hb) and serum ferritin levels. Blood lead levels ≥ 5 µg/dL were defined as elevated BLL; ferritin levels < 12 ng/ml were considered ID; Hb levels < 11 g/dL (< 11.5 g/dL for children ≥ 5 y) were defined as anemia. Data were analysed using Mann Whitney test, Student´s t-test, chi-square test and logistic regression. The R package (v. 4.2.2.) was used for the statistical analysis of data. The sample included 392 children (mean age, 2.4 ± 1.4 y; 44.6% females). The prevalence of elevated BLL, ID and anemia was 8.7%, 26.3% and 31.8%, respectively. We found a significant association between elevated BLL and ID (odds ratio [OR], 95% confidence interval [CI]: 3.16 (1.50, 6.63)). The prevalence of elevated BLL was 16.2% and 5.8% in children with and without ID, respectively (p = 0.003). We also found association between elevated BLL and anemia (OR 95% CI: 3.03 (1.49, 6.29)). In conclusion, blood lead levels ≥ 5 µg/dL were significantly associated with ID and anemia in children aged 1-6 years.

Accuracy of noninvasive total haemoglobin measurement for detecting anaemia in infants: a cross-sectional study in a well-child care clinic, Khon Kaen, Thailand

OBJECTIVE

Infants are at a high risk of developing anaemia, which can arise from various causes, including inappropriate feeding practices. However, few infants attend anaemia screening programmes due to poor cooperation and being time-consuming. This study evaluated the accuracy of noninvasive total haemoglobin (Hb) spot-check monitoring as part of anaemia screening in healthy infants, compared with the conventional laboratory method.

DESIGN

A cross-sectional study was conducted using a consecutive sampling technique.

SETTING

The study was carried out at the Well-Child Clinic, Khon Kaen University, Thailand.

PARTICIPANTS

Healthy, full-term infants aged 6-12 months who were scheduled for vaccination. Spectrophotometric haemoglobin (SpHb) was measured using Masimo Rad-67 with Rainbow DCI-mini Sensor. These values were compared with conventional laboratory analysis (HbLab) performed on the same day.

PRIMARY AND SECONDARY OUTCOME

Differences between Hb values using the two methods were analysed using the Bland-Altman method. Sensitivity, specificity and positive and negative predictive values (PPV and NPV) for detecting anaemia were determined. Anaemia was defined as HbLab of <11.0 g/dL.

RESULTS

A total of 104 infants, with a median age of 9.6 (IQR 9.3, 10.9) months, were included. The prevalence of anaemia, defined by HbLab, was 38.46%. The mean SpHb was 12.20±1.10 g/dL, while the mean HbLab was 11.19±1.21 g/dL. A moderate positive correlation was observed (r=0.575, p<0.001). Bland-Altman analysis of SpHb vs HbLab showed an estimated bias of 1.007 g/dL with a 95% limit of agreement ranging from -1.091 to 3.104 g/dL. The mean bias was 1.635 g/dL (-0.617 to 3.887) in the anaemic group and 0.614 g/dL (-0.964 to 2.192) in the nonanaemic group. Using the SpHb cut-off point of <13.0 g/dL, the sensitivity and specificity of SpHb to detect anaemia were 95.0% and 35.9%, with PPV and NPV of 48.1% and 92.0%, respectively.

CONCLUSION

A noninvasive tool for measuring Hb, with moderate sensitivity and NPV, may provide utility for initial screening to reduce unnecessary venipuncture in infants. However, its limited specificity and PPV necessitate confirmatory testing through conventional laboratory methods for accurate diagnosis. Depending on the context and available resources, it has potential to complement existing diagnostic processes, particularly in settings where rapid and noninvasive screening is prioritised.

TRIAL REGISTRATION NUMBER

Thai Clinical Trials Registry (TCTR20210816002).

Lifestyle, biological, and genetic factors related to brain iron accumulation across adulthood

Iron is necessary for many neurobiological mechanisms, but its overaccumulation can be harmful. Factors triggering age-related brain iron accumulation remain largely unknown and longitudinal data are insufficient. We examined associations between brain iron load and accumulation and, blood markers of iron metabolism, cardiovascular health, lifestyle factors (smoking, alcohol use, physical activity, diet), and ApoE status using longitudinal data from the IronAge study (n = 208, age = 20-79, mean follow-up time = 2.75 years). Iron in cortex and basal ganglia was estimated with magnetic resonance imaging using quantitative susceptibility mapping (QSM). Our results showed that (1) higher peripheral iron levels (i.e., composite score of blood iron markers) were related to greater iron load in the basal ganglia; (2) healthier diet was related to higher iron levels in the cortex and basal ganglia, although for the latter the association was significant only in younger adults (age = 20-39); (3) worsening cardiovascular health was related to increased iron accumulation; (4) younger ApoE ε4 carriers accumulated more iron in basal ganglia than younger non-carriers. Our results demonstrate that modifiable factors, including lifestyle, cardiovascular, and physiological ones, are linked to age-related brain iron content and accumulation, contributing novel information on potential targets for interventions in preventing brain iron-overload.

Bridging the gap: Prenatal nutrition, myelination, and schizophrenia etiopathogenesis

Schizophrenia (SZ) is a complex mental illness characterized by disturbances in thinking, emotionality, and behavior, significantly impacting the quality of life for individuals affected and those around them. The etiology of SZ involves intricate interactions between genetic and environmental factors, although the precise mechanisms remain incompletely understood. Genetic predisposition, neurotransmitter dysregulation (particularly involving dopamine and serotonin), and structural brain abnormalities, including impaired prefrontal cortex function, have been implicated in SZ development. However, increasing evidence reveals the role of environmental factors, such as nutrition, during critical periods like pregnancy and lactation. Epidemiological studies suggest that early malnutrition significantly increases the risk of SZ symptoms manifesting in late adolescence, a crucial period coinciding with peak myelination and brain maturation. Prenatal undernutrition may disrupt myelin formation, rendering individuals more susceptible to SZ pathology. This review explores the potential relationship between prenatal undernutrition, myelin alterations, and susceptibility to SZ. By delineating the etiopathogenesis, examining genetic and environmental factors associated with SZ, and reviewing the relationship between SZ and myelination disorders, alongside the impact of malnutrition on myelination, we aim to examine how malnutrition might be linked to SZ by altering myelination processes, which contribute to increasing the understanding of SZ etiology and help identify targets for intervention and management.

Anti-anemic potential of Eruca sativa L. in iron-deficient rat model; network pharmacology profiling

Iron deficiency anemia is a global health concern, affecting around 2 billion people. Oral iron therapy often causes severe gastro-intestinal issues. Eruca sativa, member of the Brassicaceae family, is valued in traditional medicine and renowned for its rich iron and vitamin C content. This study aims to evaluate the anti-anemic properties of E. sativa extract in vivo and identify its compounds targeting anemia mechanisms using network pharmacology. Thirty-two Sprague-Dawley rats (200 ± 250 g) were split into two distinct groups, iron-deficient and iron-sufficient. Three different doses (200, 400, and 800 mg/kg) of aqueous extract of E. sativa were checked against anemia by studying hematological, oxidative stress, and histopathological parameters. GC-MS analysis of E. sativa revealed its phytochemical profile, followed by ADME screening. Network pharmacology explored targets related to iron deficiency anemia, with oral bioavailability and drug likeness assessment for compounds. The administration of extracts significantly improved various blood parameters, including osmotic fragility, Hb, RBCs, MCV, PCV, and alkaline phosphatase; catalase activity; and histopathological parameters such as liver in both iron-deficient and iron-sufficient rats (p < .001). Seventy-nine compounds were identified in E. sativa aqueous extract, with only six of them found to be bioavailable and drug-like against multiple targets. Gene ontology and pathway analysis revealed their diverse molecular, biological, and cellular functions. One gene EGFR was found to have functional association with ID anemia, suggesting potential for using E. sativa extracts. The study concludes that E. sativa extract has potential for iron deficiency anemia treatment, offering hope for future pharmaceutical interventions.

Physicochemical, nutraceutical, and sensory evaluation of a milk-type plant-based beverage of extruded common bean (Phaseolus vulgaris L.) added with iron

Milk-type beverages are popular vegan products requiring iron and calcium fortification to improve their nutritional value, as iron deficiency is the world's most prevalent nutritional problem. This research aimed to develop and characterize an extruded common bean (Phaseolus vulgaris L.)-based milk-type beverage added with bean protein isolate and iron. The formulations included flavors (non-flavored, vanilla, and nut) and two iron concentrations (2 and 3 mg FeSO4/100 mL). Extrusion increased the beverages' protein (+17.38 %) and starch digestibility, and reduced their antinutritional compounds (trypsin inhibitors, condensed tannins, and carbonates). Developed beverages' formulations differed from a commercial soybean beverage in their physicochemical properties but were more nutritious (protein: 3.33-3.44 %; fiber: 3.43-4.08 %). Iron-added beverages displayed a medium sensory acceptance (best overall likeness: 5.3-6.2). The developed beverage is a suitable, sensory-accepted, and nutritious bean-based beverage, suggesting novel research lines improving vegan beverage formulations to increase average daily iron intake.

Reference values for reticulocyte haemoglobin equivalent in healthy Chinese children under 5 years and its associations with various blood parameters

BACKGROUND

Reticulocyte haemoglobin equivalent (RET-He) is a useful tool for evaluating recent iron usage irrespective of inflammatory status. This study aims to establish a reference for RET-He among Hong Kong healthy children under the age of 5 years and to investigate the association between RET-He and various blood parameters.

METHODS

A total of 946 children aged 2-48 months from July 2019 to December 2022 were recruited in this cross-sectional study. The RET-He and other haematological parameters were measured by the haematology analyser from Sysmex XN-9100/XN-1500. The ferritin test was performed with the electrochemiluminescence immunoassay. Interval 2.5th percentile to 97.5th percentile represented the normal RET-He ranges. Linear multiple regression analysis was performed to examine the relation between RET-He and various blood parameters. Receiver-operating characteristic curve analysis revealed the sensitivity and specificity of RET-He in identifying iron deficiency.

RESULTS

The RET-He in the study population was approximately normally distributed. The age-specific lower limit of RET-He ranges from 25.81 pg (25-36 months) to 27.15 pg (13-24 months). RET-He was found to be lower in the age group 2-6 months (mean=29.47 pg) and 7-12 months (mean=29.41 pg). Changes in RET-He and haemoglobin in relation to age were observed in both sexes (both p<0.001). RET-He was influenced by age, some red blood cell parameters and reticulocyte concentrations (all p<0.05). A cut-off value of RET-He ≤27.8 pg was determined for identifying iron deficiency.

CONCLUSIONS

RET-He levels varied with age, with a relatively lower level in infants than in other age groups. The value below the age-specific lower limit of the reference range of RET-He can be used as a limit for preliminary iron-deficiency screening.

Impact of Iron Intake and Reserves on Cognitive Function in Young University Students

Iron is a key nutrient for cognitive function. During periods of high academic demand, brain and cognitive activity increase, potentially affecting iron intake and reserves. The present study aimed to investigate the impact of iron levels on cognitive function in a university sample, considering the influence of gender. A cross-sectional study was conducted with 132 university students (18-29 years) from the University of Castilla-La Mancha (Spain). A dietary record was formed through a questionnaire to analyze iron consumption, and blood and anthropometric parameters were measured. The Wechsler Adult Intelligence Scale-IV was used to determine the Intelligence Quotient (IQ), as well as the Verbal Comprehension Index (VCI), Working Memory Index (WMI), Processing Speed Index (PSI), and Perceptual Reasoning Index (PRI), to assess cognitive abilities. Among women, the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) was 21% and 4.2%, respectively. No ID or IDA was found in men. The impact of iron intake on IQ and cognitive abilities was mainly associated with the female population, where a positive association between iron intake, serum ferritin, and total IQ was revealed. In conclusion, low iron intake is related to poorer intellectual ability, suggesting that an iron-rich diet is necessary to maintain the academic level of university students.

Daily oral iron supplementation during pregnancy

BACKGROUND

Iron and folic acid supplementation have been recommended in pregnancy for anaemia prevention, and may improve other maternal, pregnancy, and infant outcomes.

OBJECTIVES

To examine the effects of daily oral iron supplementation during pregnancy, either alone or in combination with folic acid or with other vitamins and minerals, as an intervention in antenatal care.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Trials Registry on 18 January 2024 (including CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, WHO's International Clinical Trials Registry Platform, conference proceedings), and searched reference lists of retrieved studies.

SELECTION CRITERIA

Randomised or quasi-randomised trials that evaluated the effects of oral supplementation with daily iron, iron + folic acid, or iron + other vitamins and minerals during pregnancy were included.

DATA COLLECTION AND ANALYSIS

Review authors independently assessed trial eligibility, ascertained trustworthiness based on pre-defined criteria, assessed risk of bias, extracted data, and conducted checks for accuracy. We used the GRADE approach to assess the certainty of the evidence for primary outcomes. We anticipated high heterogeneity amongst trials; we pooled trial results using a random-effects model (average treatment effect).

MAIN RESULTS

We included 57 trials involving 48,971 women. A total of 40 trials compared the effects of daily oral supplements with iron to placebo or no iron; eight trials evaluated the effects of iron + folic acid compared to placebo or no iron + folic acid. Iron supplementation compared to placebo or no iron Maternal outcomes: Iron supplementation during pregnancy may reduce maternal anaemia (4.0% versus 7.4%; risk ratio (RR) 0.30, 95% confidence interval (CI) 0.20 to 0.47; 14 trials, 13,543 women; low-certainty evidence) and iron deficiency at term (44.0% versus 66.0%; RR 0.51, 95% CI 0.38 to 0.68; 8 trials, 2873 women; low-certainty evidence), and probably reduces maternal iron-deficiency anaemia at term (5.0% versus 18.4%; RR 0.41, 95% CI 0.26 to 0.63; 7 trials, 2704 women; moderate-certainty evidence), compared to placebo or no iron supplementation. There is probably little to no difference in maternal death (2 versus 4 events, RR 0.57, 95% CI 0.12 to 2.69; 3 trials, 14,060 women; moderate-certainty evidence). The evidence is very uncertain for adverse effects (21.6% versus 18.0%; RR 1.29, 95% CI 0.83 to 2.02; 12 trials, 2423 women; very low-certainty evidence) and severe anaemia (Hb < 70 g/L) in the second/third trimester (< 1% versus 3.6%; RR 0.22, 95% CI 0.01 to 3.20; 8 trials, 1398 women; very low-certainty evidence). No trials reported clinical malaria or infection during pregnancy. Infant outcomes: Women taking iron supplements are probably less likely to have infants with low birthweight (5.2% versus 6.1%; RR 0.84, 95% CI 0.72 to 0.99; 12 trials, 18,290 infants; moderate-certainty evidence), compared to placebo or no iron supplementation. However, the evidence is very uncertain for infant birthweight (MD 24.9 g, 95% CI -125.81 to 175.60; 16 trials, 18,554 infants; very low-certainty evidence). There is probably little to no difference in preterm birth (7.6% versus 8.2%; RR 0.93, 95% CI 0.84 to 1.02; 11 trials, 18,827 infants; moderate-certainty evidence) and there may be little to no difference in neonatal death (1.4% versus 1.5%, RR 0.98, 95% CI 0.77 to 1.24; 4 trials, 17,243 infants; low-certainty evidence) or congenital anomalies, including neural tube defects (41 versus 48 events; RR 0.88, 95% CI 0.58 to 1.33; 4 trials, 14,377 infants; low-certainty evidence). Iron + folic supplementation compared to placebo or no iron + folic acid Maternal outcomes: Daily oral supplementation with iron + folic acid probably reduces maternal anaemia at term (12.1% versus 25.5%; RR 0.44, 95% CI 0.30 to 0.64; 4 trials, 1962 women; moderate-certainty evidence), and may reduce maternal iron deficiency at term (3.6% versus 15%; RR 0.24, 95% CI 0.06 to 0.99; 1 trial, 131 women; low-certainty evidence), compared to placebo or no iron + folic acid. The evidence is very uncertain about the effects of iron + folic acid on maternal iron-deficiency anaemia (10.8% versus 25%; RR 0.43, 95% CI 0.17 to 1.09; 1 trial, 131 women; very low-certainty evidence), or maternal deaths (no events; 1 trial; very low-certainty evidence). The evidence is uncertain for adverse effects (21.0% versus 0.0%; RR 44.32, 95% CI 2.77 to 709.09; 1 trial, 456 women; low-certainty evidence), and the evidence is very uncertain for severe anaemia in the second or third trimester (< 1% versus 5.6%; RR 0.12, 95% CI 0.02 to 0.63; 4 trials, 506 women; very low-certainty evidence), compared to placebo or no iron + folic acid. Infant outcomes: There may be little to no difference in infant low birthweight (33.4% versus 40.2%; RR 1.07, 95% CI 0.31 to 3.74; 2 trials, 1311 infants; low-certainty evidence), comparing iron + folic acid supplementation to placebo or no iron + folic acid. Infants born to women who received iron + folic acid during pregnancy probably had higher birthweight (MD 57.73 g, 95% CI 7.66 to 107.79; 2 trials, 1365 infants; moderate-certainty evidence), compared to placebo or no iron + folic acid. There may be little to no difference in other infant outcomes, including preterm birth (19.4% versus 19.2%; RR 1.55, 95% CI 0.40 to 6.00; 3 trials, 1497 infants; low-certainty evidence), neonatal death (3.4% versus 4.2%; RR 0.81, 95% CI 0.51 to 1.30; 1 trial, 1793 infants; low-certainty evidence), or congenital anomalies (1.7% versus 2.4; RR 0.70, 95% CI 0.35 to 1.40; 1 trial, 1652 infants; low-certainty evidence), comparing iron + folic acid supplementation to placebo or no iron + folic acid. A total of 19 trials were conducted in malaria-endemic countries, or in settings with some malaria risk. No studies reported maternal clinical malaria; one study reported data on placental malaria.

AUTHORS' CONCLUSIONS

Daily oral iron supplementation during pregnancy may reduce maternal anaemia and iron deficiency at term. For other maternal and infant outcomes, there was little to no difference between groups or the evidence was uncertain. Future research is needed to examine the effects of iron supplementation on other maternal and infant health outcomes, including infant iron status, growth, and development.

Fluorescent MnO2@DEHP Nanoprobe for Rapid and Selective Detection of Fe(III) ions

Particle extraction via the liquid-liquid interface (PELLI) method has been utilized to produce Di-(2-ethylhexyl) phosphate (DEHP) coated MnO2 fluorescent nanoprobe denoted as MnO2@DEHP for the selective detection of Fe3+ ions. The synthesized MnO2@DEHP nanoprobe was characterized by various instrumental techniques such as FT-IR, PXRD, TEM, EDAX, HRTEM, DLS, and XPS. Since the high concentration of Fe3+ in waste water leads to water pollution, which in turn affects the ecosystem, and causes severe health hazards. Therefore, accurate detection of Fe3+ ions in the aqueous systems is essential as they are involved in various chemical and biological processes in living things. Here, the synthesized MnO2@DEHP nanoprobe selectively detects Fe3+ ions in the presence of various metal ions in an aqueous media by fluorescence quenching (turn-off) mechanism. The limit of detection (LOD) of MnO2@DEHP nanoprobe for Fe3+ was found to be 0.49 µM. The test-strip method and real water sample analysis were also used to demonstrate the viability of MnO2@DEHP as a fluorescent nanoprobe to detect Fe3+ ions visually and in environment monitoring applications.

Severe Unexplained Iron Deficiency Anemia in Children: High Yield of Upper Gastrointestinal Endoscopy Regardless of Gastrointestinal Symptoms

In this retrospective study spanning 2016 to 2022, we aimed to evaluate the diagnostic utility of upper gastrointestinal endoscopy (UGE) in children under 18 years presenting with severe unexplained iron deficiency anemia (IDA), defined as microcytic anemia of hemoglobin ≤7 g/dL with low ferritin levels. Of 106 children hospitalized for severe anemia, 29 had unexplained IDA (mean hemoglobin level of 6.2 [3.2 to 6.9] gr/dL), and 25 of them underwent UGE. The mean age was 10.7 ± 3.9 years, with 76% being female. Ten children (40%) had gastrointestinal (GI) symptoms at presentation. The cause of IDA was found in 18 (72%) of 25 children who underwent UGE, of whom 12 were without GI symptoms. Gastric nodularity, erosions, or polyps were observed in 68%, and gastritis was evident in 72% based on histopathology. Helicobacter pylori was found in 50% of those with gastritis. Follow-up showed normalized hemoglobin levels in 92% of cases, with only 2 children requiring repeat iron therapy. Our findings underscore the importance of incorporating UGE into the diagnostic investigation of severe unexplained IDA in children, irrespective of the presence of GI symptoms.

Microalbuminuria and Functional Iron Deficiency are Risk Factors for Hearing Loss in Adolescents

OBJECTIVES

Renal impairment and some systemic diseases are associated with hearing loss (HL) in adults. However, studies of these relationship in adolescents are rare. The objective of this study was to determine the association between HL and renal or systemic disease in adolescents.

METHODS

Subjects were extracted from the 5th Korea National Health and Nutrition Examination Survey from 2011 to 2012. We included adolescents aged 10-19 years old with normal tympanic membrane and those who underwent a physical and laboratory examination and pure tone audiometry. HL, high-frequency hearing loss (HFHL), albuminuria, impaired glomerular filtration rate, hypertension, diabetes, and obesity were evaluated based on the data.

RESULTS

Individuals with microalbuminruia (MIA) exhibited higher prevalence of HL (p = 0.003) and HFHL (p = 0.012) than those without MIA. The prevalence of HL and HFHL appeared to increase according to the severity of albuminuria. Additionally, individuals with HL or HFHL showed lower transferrin saturation (TSAT) than individuals without HL (p = 0.002) or HFHL (p = 0.001). And, HFHL was associated with lower ferritin levels (p = 0.017). HL and HFHL were related to MIA (p = 0.004 and p = 0.022, respectively) and TSAT (p = 0.005 and p = 0.011, respectively) after controlling other factors.

CONCLUSION

MIA and TSAT level were independently associated with the HL and HFHL. Since MIA can be easily detected by dipstick test and urine analysis, hearing evaluations for individuals with MIA might be helpful to identify hearing impairments earlier in adolescents.

LEVEL OF EVIDENCE

3 (individual cross-sectional study) Laryngoscope, 134:3329-3334, 2024.

Childhood undernutrition mediates the relationship between open defecation with anemia among Ethiopian children: a nationally representative cross-sectional study

BACKGROUND

Poor sanitation and/or open defecation are a significant public health problem in Ethiopia, where access to improved sanitation facilities is still limited. There is a growing body of literature about the effect of open defecation on children's linear growth failure. However, very few studies about the effects of open defecation on child anemia exist. In this study, we examine whether childhood undernutrition (i.e. stunting, wasting, and underweight) mediates the relationship between open defecation and childhood anemia in children aged 6-59 months in Ethiopia.

METHODS

We used pooled Ethiopia Demographic and Health Survey data (2005-2016) comprising 21,918 (weighted data) children aged 6-59 months. Anemia was defined as an altitude-adjusted hemoglobin (Hb) level of less than 11 g/deciliter (g/dl) for children under 5 years. Childhood undernutrition was assessed using height-for-age Z-scores (HAZ), weight-for-age Z-scores (WAZ), and weight-for-height Z-scores (WHZ) for stunting, wasting, and underweight respectively. Mediation effects were calculated using the bootstrap and the indirect effect was considered significant when the 95% bootstrap confidence intervals (95% CI) did not contain zero. Moreover, separate multilevel regression analyses were used to explore the statistical association between open defecation and child anemia, after adjusting for potential confounders.

RESULTS

Our analysis revealed that nearly half (49.6%) of children aged 6 to 59 months were anemic, 46.8% were stunted, 9.9% were wasted, and 29.5% were underweight. Additionally, 45.1% of children belonged to households that practiced open defecation (OD). Open defecation was associated with anemia (AOR: 1.28; 95% CI: 1.18-1.39) and it positively predicted anemia with direct effect of β = 0.233, p < 0.001. Childhood undernutrition showed a partial mediating role in the relationship between OD and anemia. Analyzing the indirect effects, results revealed that child undernutrition significantly mediated the relationship between open defecation and anemia (stunting (βindirect = 0.014, p < 0.001), wasting (βindirect = 0.009, p = 0.002), and underweight (βindirect = 0.012, p < 0.001)). When the mediating role of child undernutrition was accounted for, open defecation had a positive impact on anemia with a total effect of βtotal = 0.285, p < 0.001.

CONCLUSION

Open defecation showed a significant direct effect on anemia. Child undernutrition remarkably mediated the relationship between OD and anemia that further magnified the effect. This finding has an important programmatic implication calling for strengthened, accelerated and large-scale implementation of strategies to end open defecation and achieve universal access to sanitation in Ethiopia.

Causal relationship between iron deficiency anemia and asthma: a Mendelian randomization study

Background

Observational studies have suggested an association between iron deficiency anemia (IDA) and asthma, which may affect the occurrence of asthma. However, whether IDA is a new management goal for asthma remains to be determined.

Objective

We conducted a two-sample Mendelian randomization(MR)analysis to assess the association between IDA and asthma.

Methods

We performed a two-sample MR study to assess a causal relationship between IDA (ncase = 12,434, ncontrol = 59,827) and asthma (ncase = 20,629, ncontrol = 135,449). Inverse variance weighted (IVW) was used as the primary method for the analyses. Furthermore, we used weighted medians and MR-Egger to enhance robustness. Data linking genetic variation to IDA and asthma were combined to assess the impact of IDA on asthma risk.

Results

There are five single nucleotide polymorphisms (SNPs) were used as genetic tool variables for exposure factors. Genetically determined IDA was significantly associated with an increased risk of asthma (OR = 1.37, 95% CI: 1.09-1.72, p = 0.007). There was little heterogeneity in the MR studies and no evidence of level pleiotropy was found.

Conclusions

In our MR study, our findings emphasize that IDA may be associated with a high risk of asthma, indicating a potential role for IDA in the development of asthma. Future research needs to elucidate its potential mechanisms to pave the way for the prevention and treatment of asthma.

Brain iron concentration in childhood ADHD: A systematic review of neuroimaging studies

Iron deficiency may play a role in the pathophysiology of Attention Deficit/Hyperactivity Disorder (ADHD). Due to its preponderant function in monoamine catecholamine and myelin synthesis, brain iron concentration may be of primary interest in the investigation of iron dysregulation in ADHD. This study reviewed current evidence of brain iron abnormalities in children and adolescents with ADHD using magnetic resonance imaging methods, such as relaxometry and quantitative susceptibility mapping, to assess brain iron estimates. The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed for studies published between January 1, 2008 and July 7, 2023 in Medline, Scopus and Proquest. Regions of interest, brain iron index values and phenotypical information were extracted from the relevant studies. Risk of bias was assessed using a modified version of the National Heart, Lung, and Blood Institute quality assessment tool. Seven cross-sectional studies comparing brain iron estimates in children with ADHD with neurotypical children were included. Significantly reduced brain iron content in medication-naïve children with ADHD was a consistent finding. Two studies found psychostimulant use may increase and normalize brain iron concentration in children with ADHD. The findings were consistent across the studies despite differing methodologies and may lay the early foundation for the recognition of a potential biomarker in ADHD, although longitudinal prospective neuroimaging studies using larger sample sizes are required. Lastly, the effects of iron supplementation on brain iron concentration in children with ADHD need to be elucidated.

Iron imbalance in neurodegeneration

Iron is an essential element for the development and functionality of the brain, and anomalies in its distribution and concentration in brain tissue have been found to be associated with the most frequent neurodegenerative diseases. When magnetic resonance techniques allowed iron quantification in vivo, it was confirmed that the alteration of brain iron homeostasis is a common feature of many neurodegenerative diseases. However, whether iron is the main actor in the neurodegenerative process, or its alteration is a consequence of the degenerative process is still an open question. Because the different iron-related pathogenic mechanisms are specific for distinctive diseases, identifying the molecular mechanisms common to the various pathologies could represent a way to clarify this complex topic. Indeed, both iron overload and iron deficiency have profound consequences on cellular functioning, and both contribute to neuronal death processes in different manners, such as promoting oxidative damage, a loss of membrane integrity, a loss of proteostasis, and mitochondrial dysfunction. In this review, with the attempt to elucidate the consequences of iron dyshomeostasis for brain health, we summarize the main pathological molecular mechanisms that couple iron and neuronal death.

Determinants of iron-rich food deficiency among children under 5 years in sub-Saharan Africa: a comprehensive analysis of Demographic and Health Surveys

BACKGROUND

Iron deficiency is a major public health problem that affects the physical and cognitive development of children under 5 years of age (under-5 children) in sub-Saharan Africa (SSA). However, the factors associated with the limited consumption of iron-rich foods in the region are poorly understood.

OBJECTIVE

This study examined the prevalence and determinants of iron-rich food deficiency among under-5 children in 26 SSA countries.

DESIGN

This nationally representative quantitative study employed pooled data from Demographic and Health Surveys conducted between 2010 and 2019.

METHODS

Representative samples comprising 296 850 under-5 children from the various countries were used. Bivariate and multivariate logistic regression models were used to determine the associations between the lack of iron-rich food uptake and various sociodemographic factors.

RESULT

The overall prevalence of iron-rich food deficiency among the children in the entire sample was 56.75%. The prevalence of iron-rich food deficiency varied widely across the 26 countries, ranging from 42.76% in Congo Democratic Republic to 77.50% in Guinea. Maternal education, particularly primary education (OR 0.62, 95% CI 0.57 to 0.68) and higher education (OR 0.58, 95% CI 0.52 to 0.64), demonstrated a reduced likelihood of iron-rich food deficiency in the sample. Likewise, paternal education, with both primary education (OR 0.69, 95% CI 0.63 to 0.75) and higher education (OR 0.66, 95% CI 0.60 to 0.73) showed decreased odds of iron-rich food deficiency. Postnatal visits contributed significantly to reducing the odds of iron-rich food deficiency (OR 0.90, 95% CI 0.83 to 0.95), along with antenatal visits, which also had a positive impact (OR 0.84, 95% CI 0.74 to 0.95). Finally, residents in rural areas showed slightly higher odds of iron-rich food deficiency (OR 1.12, 95% CI 1.10 to 1.28).

CONCLUSION

Based on the findings, interventions targeting iron-food deficiency in the SSA region should take into strong consideration the key determinants highlighted in this study.

Prevalence and determinants of anaemia among women of reproductive age in Aspirational Districts of India: an analysis of NFHS 4 and NFHS 5 data

BACKGROUND

Over one-third of women worldwide suffer from anaemia. The prevalence of anaemia is particularly pronounced among women of reproductive age (WRA) in developing countries, such as India. No prior study has ever exclusively studied the prevalence of anaemia across the Aspirational Districts of India. Therefore, the purpose of this study was to examine the prevalence of anaemia across Aspirational Districts of India and to identify the determinants of anaemia among WRA in these districts.

METHODS

From the National Family Health Survey (NFHS)-4 (2015-16) and NFHS-5 (2019-21), data on 114,444 and 108,782 women aged 15-49 from Aspirational Districts were analyzed in our study, respectively. Bivariate statistics and multivariable binary logistic regression were used to identify the determinants of anaemia.

RESULTS

The national prevalence of anaemia among WRA has increased from 53% in NFHS-4 to 57% in NFHS-5 whereas anaemia among WRA in Aspirational Districts has increased from 58.7% in NFHS-4 to 61.1% in NFHS-5. Between 2015 and 2021, over 60% of Aspirational Districts experienced an increase in the prevalence of anaemia and one-fourth, specifically 29 out of 112, observed a rise by at least 10 percentage points (pp). Notably, there are significant variations in anaemia prevalence among districts, with Simdega and Udalgiri having the highest anaemia prevalence in NFHS-4 and NFHS-5 at 78.2% and 81.5%, respectively. During this period, Barpeta followed by Udalgiri of Assam have witnessed the maximum increase with 29.4% and 26.7% respectively. Moreover, pooled regression results show women with three to four children [AOR: 1.13, 95% CI: 1.08-1.17], women who breastfeed [AOR: 1.17, 95% CI: 1.13-1.20], Scheduled Tribe women [AOR: 1.39, 95% CI: 1.35-1.44], poorest women [AOR: 1.27, 95% CI: 1.22-1.33] and women those who consume fish occasionally [AOR: 1.14, 95% CI: 1.12-1.17] were more likely to be anaemic.

CONCLUSION

The significant increase in anaemia among WRA in Aspirational Districts of India is a matter of concern. Given the rise in anaemia among WRA, determinants-based and district-specific measures must be designed and implemented to reduce the prevalence of anaemia among Aspirational Districts of India.

The effect of iron supplementation on menstrual bleeding volume and hemoglobin level during menstrual bleeding : A randomized clinical trial

BACKGROUND

Many women around the world avoid taking iron supplements during their menstrual bleeding, thinking that menstrual bleeding will increase after taking these supplements. Due to the lack of relevant scientific evidence in this regard, this study was performed to determine the effect of iron supplementation on menstrual blood volume and hemoglobin level during menstrual bleeding.

MATERIALS AND METHODS

In this three-blind randomized clinical trial, 160 non-anemic female students of Rafsanjan University of Medical Sciences were selected through a public call and then they were randomly assigned to two intervention and control groups. The intervention group was given a ferrous sulfate tablet containsing 50 mg of elemental iron daily in the first four days of bleeding for three consecutive menstrual cycles, and the control group received a placebo simultaneously. Before and after the intervention, the level of hemoglobin was measured and the Higham chart was completed in each menstrual cycle by the participants of the two groups. The obtained data were analyzed using the SPSS software version 21 and Chi-square, independent t-test, paired t-test, analysis of variance with repeated measures, and nonparametric tests.

RESULTS

Before performing the intervention, the mean Higham score and hemoglobin level of the two groups were not statistically significant (P = 0.307, P = 0.670). The mean Higham score after each intervention was not statistically significant between the two groups over time or when considering the interaction of the time group (P = 0.77, P = 0.916). The hemoglobin level of these two groups did not change significantly after the intervention compared with that before the intervention (P = 0.444).

CONCLUSION

Compared with a placebo, taking iron supplements containing 50 mg of elemental iron during the first four days of menstrual bleeding in non-anemic women did not change the volume of menstrual bleeding and hemoglobin level.

Food sources of fiber and micronutrients of concern among infants and young children in Lebanon: a national cross-sectional study

BACKGROUND

Intakes of fiber, iron, zinc, calcium, vitamin D, vitamin A, and folate were shown to be low in a substantial proportion of infants and children in Lebanon. The study aims to identify the top food sources of fiber, iron, zinc, calcium, vitamin D, vitamin A, and folate amongst infants and young children in Lebanon and to evaluate the evolution of food sources of these nutrients from the beginning of the complementary feeding journey up until the age of 47.9 months.

METHODS

A national cross-sectional survey was conducted in 2012 as part of the "Early Life Nutrition and Health in Lebanon" project using stratified cluster sampling. Dietary intakes for infants and young children aged 6-47.9 months (n = 763) were assessed using 24- Hour Dietary Recall. Food items were categorized into food groups and the percent contribution of each food group to nutrient intakes was determined to identify the top food sources of fiber and selected micronutrients for three age groups: 6-11.9 m (infants), 12-23.9 m (toddlers), and 24-47.9 m (preschoolers).

RESULTS

The top food source of fiber was vegetables among children aged 6-47.9 months. Among infants and toddlers, infant/young child formula was the main contributor to iron, zinc, calcium, vitamin D, vitamin A, and folate intakes. Baby cereals also contributed to around 14% of iron intakes among infants. Among preschoolers, meat and fish contributed to 13% of iron intakes and 29% of zinc intakes, while cow's milk was the major contributor of calcium (41%), vitamin D (81%) and vitamin A (25%) intakes. Sweetened beverages and sweet bakery were also ranked among the major food sources contributing to substantial intakes of key nutrients, including fiber, iron, zinc, calcium, vitamin A, and folate among infants, toddlers, and preschoolers.

CONCLUSIONS

In addition to milk sources, vegetables, beans and legumes, breads, meats, and rice and pasta, sweet bakery and sweetened beverages have contributed to intakes of key nutrients from early ages. This calls for implementing initiatives and designing approaches to support nutrition education and improve nutrient intakes in infancy and early childhood.

A comparison between children and adolescents with autism spectrum disorders and healthy controls in biomedical factors, trace elements, and microbiota biomarkers: a meta-analysis

INTRODUCTION

Autism spectrum disorder (ASD) is a multifaceted developmental condition that commonly appears during early childhood. The etiology of ASD remains multifactorial and not yet fully understood. The identification of biomarkers may provide insights into the underlying mechanisms and pathophysiology of the disorder. The present study aimed to explore the causes of ASD by investigating the key biomedical markers, trace elements, and microbiota factors between children with autism spectrum disorder (ASD) and control subjects.

METHODS

Medline, PubMed, ProQuest, EMBASE, Cochrane Library, PsycINFO, Web of Science, and EMBSCO databases have been searched for publications from 2012 to 2023 with no language restrictions using the population, intervention, control, and outcome (PICO) approach. Keywords including "autism spectrum disorder," "oxytocin," "GABA," "Serotonin," "CRP," "IL-6," "Fe," "Zn," "Cu," and "gut microbiota" were used for the search. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to assess the article quality, and a random model was used to assess the mean difference and standardized difference between ASD and the control group in all biomedical markers, trace elements, and microbiota factors.

RESULTS

From 76,217 records, 43 studies met the inclusion and exclusion criteria and were included in this meta-analysis. The pooled analyses showed that children with ASD had significantly lower levels of oxytocin (mean differences, MD = -45.691, 95% confidence interval, CI: -61.667, -29.717), iron (MD = -3.203, 95% CI: -4.891, -1.514), and zinc (MD = -6.707, 95% CI: -12.691, -0.722), lower relative abundance of Bifidobacterium (MD = -1.321, 95% CI: -2.403, -0.238) and Parabacteroides (MD = -0.081, 95% CI: -0.148, -0.013), higher levels of c-reactive protein, CRP (MD = 0.401, 95% CI: 0.036, 0.772), and GABA (MD = 0.115, 95% CI: 0.045, 0.186), and higher relative abundance of Bacteroides (MD = 1.386, 95% CI: 0.717, 2.055) and Clostridium (MD = 0.281, 95% CI: 0.035, 0.526) when compared with controls. The results of the overall analyses were stable after performing the sensitivity analyses. Additionally, no substantial publication bias was observed among the studies.

INTERPRETATION

Children with ASD have significantly higher levels of CRP and GABA, lower levels of oxytocin, iron, and zinc, lower relative abundance of Bifidobacterium and Parabacteroides, and higher relative abundance of Faecalibacterium, Bacteroides, and Clostridium when compared with controls. These results suggest that these indicators may be a potential biomarker panel for the diagnosis or determining therapeutic targets of ASD. Furthermore, large, sample-based, and randomized controlled trials are needed to confirm these results.

Evolving trends and burden of iron deficiency among children, 1990-2019: a systematic analysis for the global burden of disease study 2019

Objectives

We aimed to provide a timely, comprehensive, and reliable assessment of the burden of iron deficiency (ID) in children between 1990 and 2019 at the global, regional, and national levels to inform policymakers in developing locally appropriate health policies.

Methods

Data related to ID among children younger than 15 years old were analyzed by sex, age, year, socio-demographic index (SDI), and location according to the Global Burden of Disease Study 2019 (GBD 2019). Age-standardized rates were used to compare the burden between different regions and countries. Furthermore, the Joinpoint regression model was used to assess temporal trends from 1990 to 2019.

Results

In 2019, the number of prevalent cases and disability-adjusted life years (DALYs) for ID in children were 391,491,699 and 13,620,231, respectively. The global age-standardized prevalence and DALY rates for childhood ID in 2019 were 20,146.35 (95% confidence interval: 19,407.85 to 20,888.54) and 698.90 (466.54 to 1015.31) per 100,000, respectively. Over the past 30 years, the global prevalence of ID among children has been highest in low-SDI regions, particularly in Western Sub-Saharan Africa, South Asia, and Eastern Sub-Saharan Africa. Since 1990, the prevalence and DALY of ID in children have been declining in most geographic regions. Nationally, Ecuador, China, and Chile have shown the most significant decreases in prevalence. The greatest decline in age-standardized DALY rate was observed in Ecuador, while Burkina Faso experienced the highest increase. Bhutan had the highest prevalence and DALY rates in 2019. On the age level, the prevalence was relatively higher among the <5 years age group. At the gender dimension, the prevalence of ID in children overall was more pronounced in girls than in boys, as was the case for DALY.

Conclusion

Although the burden of ID in children has been declining, this disease remains a major public health problem, especially in countries with low SDI. Children younger than 5 years of age are an important group for whom targeted measures are needed to reduce the burden of ID.

Management of Childhood Iron Deficiency Anemia in a Developed Country-A Multi-Center Experience from Croatia

Iron deficiency anemia (IDA) continues to be a global public health concern, mostly in the developing countries. However, precise epidemiological data on childhood IDA in Croatia are lacking. In order to establish its frequency, underlying etiologies, the rationale for tertiary care visits, diagnostic practices, and current treatment regimens of IDA, medical records of children referred to pediatric hematologists for iron deficiency in a five-year period at tertiary institutions (Zagreb, Rijeka, Split, Osijek) throughout Croatia were retrospectively analyzed. Eight hundred and sixty-four children, predominately of preschool age, were referred mainly by the primary care pediatricians, who, in general, performed basic diagnostics but failed to initiate oral iron therapy in half of the patients. Approximately one-third of patients were symptomatic, with inadequate nutrition prevailing as underlying etiology. Dextriferron was the preferred iron formulation among hematologists, with a median dose of 5 mg/kg, with acceptable compliance rates (63.5-93.2%). Hospital admission rates varied among the centers (9.4-35%), and so did transfusion policies (6.4-22.9%). The greatest difference was observed in the frequency of parenteral iron administration (0.3-21.5%). In conclusion, the burden of childhood IDA, even in a high-income country, remains substantial, necessitating consistent implementation of national guidelines and additional education of primary health care providers.

A Review of the Nutritional Approach and the Role of Dietary Components in Children with Autism Spectrum Disorders in Light of the Latest Scientific Research

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects several areas of mental development. The onset of ASD occurs in the first few years of life, usually before the age of 3 years. Proper nutrition is important to ensure that an individual's nutrient and energy requirements are met, and it can also have a moderating effect on the progression of the disorder. A systematic database search was conducted as a narrative review to determine whether nutrition and specific diets can potentially alter gastrointestinal symptoms and neurobehavioral disorders. Databases such as Science Direct, PubMed, Scopus, Web of Science (WoS), and Google Scholar were searched to find studies published between 2000 and September 2023 on the relationship between ASD, dietary approaches, and the role of dietary components. The review may indicate that despite extensive research into dietary interventions, there is a general lack of conclusive scientific data about the effect of therapeutic diets on ASD; therefore, no definitive recommendation can be made for any specific nutritional therapy as a standard treatment for ASD. An individualized dietary approach and the dietician's role in the therapeutic team are very important elements of every therapy. Parents and caregivers should work with nutrition specialists, such as registered dietitians or healthcare providers, to design meal plans for autistic individuals, especially those who would like to implement an elimination diet.

Association between Mineral Intake and Cognition Evaluated by Montreal Cognitive Assessment (MoCA): A Cross-Sectional Study

BACKGROUND

Mineral intake may protect against cognitive impairment (CI) and all-cause dementia, which affects a large number of adults worldwide. The aim of this study was to investigate the association between mineral intake and Montreal Cognitive Assessment (MoCA), which is a sensitive and specific test.

METHODS

In total, 201 adults were included in a cross-sectional study. They completed a three-day dietary record to estimate their average daily intake of minerals. Contributions to dietary reference intakes (DRIs) were also calculated. The participants were divided into tertiles according to their mineral intake. CI classifications were determined via the MoCA (score < 26). Apolipoprotein E (APOE) genotyping was carried out, and the patients' anthropometric measurements and physical activity, health and personal data were collected.

RESULTS

The prevalence of CI in this selective sample was 54.2% (34.3% females and 19.9% males). In women, being in the third tertiles of iron and manganese intake was associated with lower odds of having CI (OR [95% CI]: 0.32 [0.11 ± 0.93]; 0.33 [0.12 ± 0.93], p < 0.05). No significant differences were observed for any of the nutrients studied in men.

CONCLUSIONS

These findings suggest that a low mineral intake, especially low iron and manganese intake in women, is associated with a worse cognition as assessed by MoCA.

Anemia status of infants and young children aged six to thirty-six months in Ma'anshan City: A retrospective study

BACKGROUND

Anemia in infants and young children can have long-term effects on cognitive and physical development. In Ma'anshan City, China, there has been growing concern about the prevalence of anemia among children aged 6 to 36 mo. Understanding the factors influencing this condition is crucial for targeted interventions and improving overall child health in the region.

AIM

To analyze the anemia status and influencing factors of infants and young children aged 6 to 36 mo in Ma'anshan City, China. Providing scientific evidence for reducing the incidence of anemia and improving the health level of children in this age group.

METHODS

The study encompassed 37698 infants and young children, aged from 6 to 36 mo, who underwent health examinations at the Ma'anshan Maternal and Child Health Hospital from January 2018 to October 2022 were included in the study. Basic information, physical examination, and hemoglobin detection data were collected. Descriptive analysis was used to analyze the prevalence of anemia in children in the region, and univariate analysis was used to analyze the influencing factors of anemia.

RESULTS

The mean hemoglobin level of infants and young children aged 9 to 36 mo increased with age, and the anemia detection rate decreased with age. The anemia detection rate in rural infants aged 6, 9, and 12 mo was higher than that in urban infants. Although the anemia detection rate was higher in 6-mo-old boys than girls, it was higher in 24-mo-old girls than boys. There were statistically significant differences in the anemia detection rates among 9-mo-old and 12-mo-old infants with different nutritional statuses (emaciation, overweight, obese, and normal). Moreover, there were no statistically significant differences in anemia detection rates among infants and young children with different nutritional statuses at other ages. Besides, the anemia detection rates in obese infants aged 9 and 12 mo were higher than those in normal and overweight infants, with statistically significant differences. Finally, there were no statistically significant differences in the anemia detection rates between emaciation infants and those with other nutritional statuses.

CONCLUSION

The anemia situation among infants and young children aged 6 to 36 mo in Ma'anshan City, China, is relatively prominent and influenced by various factors. Our result shown that attention should be paid to the anemic infant and young child population, with strengthened education and targeted prevention and dietary guidance to help them establish good living habits, improve nutritional status, and reduce the occurrence of anemia to improve children's health levels.

Safety, pharmacokinetics, and pharmacodynamics of intravenous ferric carboxymaltose in children with iron deficiency anemia

BACKGROUND

Iron deficiency is the primary cause of anemia in children. Intravenous (IV) iron formulations circumvent malabsorption and rapidly restore hemoglobin.

METHODS

This Phase 2, non-randomized, multicenter study characterized the safety profile and determined appropriate dosing of ferric carboxymaltose (FCM) in children with iron deficiency anemia. Patients aged 1-17 years with hemoglobin <11 g/dL and transferrin saturation <20% received single IV doses of undiluted FCM 7.5 mg/kg (n = 16) or 15 mg/kg (n = 19).

RESULTS

The most common drug-related treatment-emergent adverse event was urticaria (in three recipients of FCM 15 mg/kg). Systemic exposure to iron increased in a dose-proportional manner with approximate doubling of mean baseline-corrected maximum serum iron concentration (157 µg/mL with FCM 7.5 mg/kg; and 310 µg/mL with FCM 15 mg/kg) and area under the serum concentration-time curve (1901 and 4851 h·µg/mL, respectively). Baseline hemoglobin was 9.2 and 9.5 g/dL in the FCM 7.5 and 15 mg/kg groups, respectively, with mean maximum changes in hemoglobin of 2.2 and 3.0 g/dL, respectively.

CONCLUSIONS

In conclusion, FCM was well tolerated by pediatric patients. Improvements in hemoglobin were greater with the higher dose, supporting use of the FCM 15 mg/kg dose in pediatric patients (Clinicaltrials.gov NCT02410213).

IMPACT

This study provided information on the pharmacokinetics and safety of intravenous ferric carboxymaltose for treatment of iron deficiency anemia in children and adolescents. In children aged 1-17 years with iron deficiency anemia, single intravenous doses of ferric carboxymaltose 7.5 or 15 mg/kg increased systemic exposure to iron in a dose-proportional manner, with clinically meaningful increases in hemoglobin. The most common drug-related treatment-emergent adverse event was urticaria. The findings suggest that iron deficiency anemia in children can be corrected with a single intravenous dose of ferric carboxymaltose and support use of a 15 mg/kg dose.

Urinary Glyphosate, 2,4-D and DEET Biomarkers in Relation to Neurobehavioral Performance in Ecuadorian Adolescents in the ESPINA Cohort

BACKGROUND

Herbicides are the most used class of pesticides worldwide, and insect repellents are widely used globally. Yet, there is a dearth of studies characterizing the associations between these chemical groups and human neurobehavior. Experimental studies suggest that glyphosate and 2,4-dichlorophenoxyacetic acid (2,4-D) herbicides can affect neurobehavior and the cholinergic and glutamatergic pathways in the brain. We aim to assess whether herbicides and insect repellents are associated with neurobehavioral performance in adolescents.

METHODS

We assessed 519 participants (11-17 years of age) living in agricultural communities in Ecuador. We quantified urinary concentrations of glyphosate, 2,4-D, and two N,N-diethyl-meta-toluamide (DEET) insect repellent metabolites [3-(diethylcarbamoyl)benzoic acid (DCBA) and 3-(ethylcarbamoyl)benzoic acid (ECBA)] using isotope-dilution mass spectrometry. We assessed neurobehavioral performance using 9 subtests across 5 domains (attention/inhibitory control, memory/learning, language, visuospatial processing, and social perception). We characterized the associations using generalized estimating equations and multiple imputation for metabolites below detection limits. Models were adjusted for demographic and anthropometric characteristics, urinary creatinine, and sexual maturation. Mediation by salivary cortisol, dehydroepiandrosterone, 17 β -estradiol , and testosterone was assessed using structural equation modeling.

RESULTS

The mean of each neurobehavioral domain score was between 7.0 and 8.7 [standard deviation (SD) range: 2.0-2.3]. Glyphosate was detected in 98.3% of participants, 2,4-D in 66.2%, DCBA in 63.3%, and ECBA in 33.4%. 2,4-D was negatively associated with all neurobehavioral domains, but statistically significant associations were observed with attention/inhibition [score difference per 50% higher metabolite concentration ( β ) = - 0.19 95% confidence interval (CI): - 0.31 , - 0.07 ], language [β = - 0.12 (95% CI: - 0.23 , - 0.01 )], and memory/learning [β = - 0.11 (95% CI: - 0.22 , 0.01)]. Glyphosate had a statistically significant negative association only with social perception [β = - 0.08 (95% CI: - 0.14 , - 0.01 )]. DEET metabolites were not associated with neurobehavioral performance. Mediation by gender and adrenal hormones was not observed.

CONCLUSION

This study describes worse neurobehavioral performance associated with herbicide exposures in adolescents, particularly with 2,4-D. Replication of these findings among other pediatric and adult populations is needed. https://doi.org/10.1289/EHP11383.

Early-life adversity is associated with poor iron status in infancy

Exposure to early-life adversity (ELA) and iron deficiency early in life are known risk factors for suboptimal brain and socioemotional development. Iron deficiency may arise from and co-occur with ELA, which could negatively affect development. In the present study, we investigated whether ELA is associated with iron deficiency in infants receiving no iron supplementation. This study is a secondary analysis of extant data collected in the 1990s; participants were healthy infants from working-class communities in Santiago, Chile (N = 534, 45.5% female). We measured stressful life events, maternal depression, and low home support for child development during infancy and assessed iron status when the infant was 12 months old. Slightly more than half of the infants were iron-deficient (51%), and 25.8% were iron-deficient anemic at 12 months. Results indicated that ELA was associated with lower iron levels and iron deficiency at 12 months. The findings are consistent with animal and human prenatal models of stress and iron status and provide evidence of the association between postnatal ELA and iron status in humans. The findings also highlight a nutritional pathway by which ELA may impact development and present a nutritionally-focused avenue for future research on ELA and psychopathology.

Iron-rich food consumption and associated factors among children aged 6-23 months in Sierra Leone: multi-level logistic regression analysis

BACKGROUND

Iron deficiency is the most common micronutrient deficiency worldwide. Also, iron deficiency is a significant public health problem in low- and middle-income countries. Thus, this study aimed to assess iron-rich food consumption and associated factors among children aged 6-23 months in Sierra Leone.

METHOD

This study is a cross-sectional study based on data from the Sierra Leone Demographic and Health Survey dataset with a total weighted sample of 2622 children aged 6-23 months. Data cleaning, coding, and labeling were done using STATA version 14 software. A multilevel logistic regression model was employed to identify associated factors.

RESULT

Almost half (53.38%) of children aged between 6-23 months consumed iron-rich foods. The odds of iron rich food consumption were high among children in the age group of 12-17 months (AOR = 4.81, 95% CI: 3.67, 6.31) and 18-23 months (AOR = 9.3, 95% CI: 6.55, 13.2), and who fed minimum acceptable diet (AOR = 22.5, 95% CI: 11.65, 43.46). Moreover, a child from a mother who had work (AOR = 1.49, 95% CI: 1.08, 2.06), and with a mother who had more than four ANC visits during her pregnancy of the most recent live birth (AOR = 1.87; 95%CI: 1.36-2.55) had higher odds of iron-rich food consumption compared to their counterparts. On the other hand, children who were breastfeeding (AOR = 0.72, 95% CI: 0.53, 0.97), and mothers aged 15-19 (AOR = 0.48, 95% CI: 0.27, 0.85) decreased the odds of iron rich food consumption.

CONCLUSION

Consumption of iron-rich food is low among children aged 6-23 months in Sierra Leone. Iron-rich food consumption among children was significantly associated with maternal occupation, child's age, child's breastfeeding status, taking drugs for intestinal parasites, minimum acceptable diet, frequency, and timing of ANC, and region. Thus, special emphasis should be given to those children aged between 6-11 months, currently breastfeeding, children who did not get the minimum acceptable diet, and children from women who did not have work.

Iron status, development, and behavior in young children in the Pennsylvania foster care system

BACKGROUND

Children in foster care are classified as a highly vulnerable population and struggle with both physical and mental health problems. Medical conditions, like poor nutritional status, remain understudied in children in foster care. To our knowledge, few studies in children in U.S. foster care have quantified the prevalence of anemia, and no studies have examined the association between anemia status and relevant developmental and behavioral outcomes.

OBJECTIVE/AIMS

(1) To determine the prevalence of anemia among children in or adopted from Pennsylvania foster care, between the ages of six months to ten years and (2) To examine if a child's anemia status is associated with greater odds of relevant developmental and behavioral diagnoses.

METHODS

We conducted a secondary data analysis utilizing the Medicaid Analytic eXtract database between 2010-2015. Children six months-ten years were included in the analysis if they were in or had been adopted from Pennsylvania foster care. Logistic regression was used to calculate adjusted odds ratios (AOR) with 95% confidence intervals for the association between iron status and health outcomes.

RESULTS

A total of 50,311 children were included in our sample, of which 1,365 children (2.7%) were diagnosed with anemia. Children diagnosed with anemia had greater odds of delayed milestones (AOR: 2.38 [1.64-3.45]), specific delays in development (AOR: 1.59 [1.23-2.07]), adjustment disorder (AOR: 1.59 [1.06-2.39]), and irritability (AOR: 10.57 [3.36-33.25]), than children not diagnosed with anemia.

CONCLUSION

The prevalence of anemia among children between six months-ten years in or adopted from the Pennsylvania foster care system is within the national rate of U.S. childhood anemia. Odds of several relevant developmental and behavioral diagnoses were greater among children diagnosed with anemia than children who were not.

Nutritional, health and socio-demographic determinants of anaemia in adolescent girls in Kumbungu District, Ghana

BACKGROUND

Anaemia is a serious health problem among adolescent girls in Ghana. The aims of this study were to measure the prevalence and identify the nutritional, health, and socio-demographic determinants of anaemia in adolescent girls in Kumbungu District, Northern Region, Ghana.

METHOD

An analytical cross-sectional study involving 370 adolescent girls residing in Kumbungu district, selected using multi-stage sampling procedure, was conducted. A semi-structured questionnaire, 24-hr dietary recall, food frequency questionnaire, Food Insecurity Experience scale, and anthropometry were used to gather information on socio-demographic characteristics, nutrition knowledge, dietary diversity score, food consumption score, food consumption frequency, household food insecurity, and waist and hip circumferences. Haemoglobin was measured using a portable HemoCue hg 301 + Analyzer. Anaemia in the adolescent girls was defined as haemoglobin concentration less than 12 g/dl. Chi-square test and binary logistic regression analysis were used to identify the determinants of anaemia.

RESULTS

The mean (± SD) age was 13.95 (± 2.94) years, and the majority of the girls were in school (79.5%) and lived in a rural area (81.1%). The mean (± SD) haemoglobin was 11.27 (± 1.19) g/dl, and 74.6% of the respondents had anaemia, with 1.6% having severe anaemia. The health determinant of anaemia was frequency of feeling nervous in the past 6 months [Adjusted Odds Ratio (AOR): 2.12: 95% Confidence Interval (CI): 1.17-3.89; p: 0.014], and the socio-demographic determinants were residential community status (AOR: 0.42; 95% CI: 0.24-0.75; p: 0.003), and fathers' educational qualification (AOR: 2.57, 95% CI: 1.17-5.65, p: 0.019). No nutritional determinants of anaemia were identified for this study population.

CONCLUSION

The prevalence of anaemia was very high and the frequency of feeling nervous in the past 6 months, residential community status, and fathers' educational qualification were associated with anaemia among adolescent girls in Kumbungu district, Ghana. The prevalence of anaemia measured highlights the need for intensification of anaemia prevention and management interventions in the district.

Hair Trace Elements and Mineral Content in Moroccan Children with Autism Spectrum Disorder: a Case-Control Study

The prevalence of autism spectrum disorder (ASD) around the world continues to increase while the pathophysiology remains insufficiently elucidated. Genetics, environment, and epigenetic changes are often implicated. Abnormal level in trace elements and minerals is among environmental factors assumed to be involved. The purpose of this article is to assess hair concentrations of toxic and essential elements in children with ASD and children with neurotypical development in the city of Marrakech. Two hundred and twenty-seven children (107 with ASD and 120 controls) aged 3 to 14 years old were recruited. The results of analysis by ICP-MS showed a significant decrease in hair levels of copper, zinc, iron, and selenium (25%, 13%, 17%, 11%) of children with ASD. The most significantly reduced concentrations in children with ASD are that of manganese by 34%. Hair aluminum level was significantly elevated by 29% in ASD compared to controls. Multiple linear regression analysis revealed that copper, selenium, and iron content in hair were significantly inversely associated with ASD, similarly, hair aluminum content was significantly associated with ASD. Adjusted model for demographic parameters increased the predictive ability of the model, father's age was a significant predictor. In addition, ASD and gender were significant predictors of hair levels of aluminum, selenium, and manganese.These results support the hypothesis of the disparity of trace elements and minerals levels in children with ASD and highlight the potential interest of micronutrient supplementation in the eventual improvement of ASD symptoms. Future research should explore the pathophysiology of these micronutrient deficiencies.

Nutritional Aspects of Iron in Health and Disease

Dietary iron assimilation is critical for health and essential to prevent iron-deficient states and related comorbidities, such as anemia. The bioavailability of iron is generally low, while its absorption and metabolism are tightly controlled to satisfy metabolic needs and prevent toxicity of excessive iron accumulation. Iron entry into the bloodstream is limited by hepcidin, the iron regulatory hormone. Hepcidin deficiency due to loss-of-function mutations in upstream gene regulators causes hereditary hemochromatosis, an endocrine disorder of iron overload characterized by chronic hyperabsorption of dietary iron, with deleterious clinical complications if untreated. The impact of high dietary iron intake and elevated body iron stores in the general population is not well understood. Herein, we summarize epidemiological data suggesting that a high intake of heme iron, which is abundant in meat products, poses a risk factor for metabolic syndrome pathologies, cardiovascular diseases, and some cancers. We discuss the clinical relevance and potential limitations of data from cohort studies, as well as the need to establish causality and elucidate molecular mechanisms.

Relationships of the gut microbiome with cognitive development among healthy school-age children

Background

The gut microbiome might play a role in neurodevelopment, however, evidence remains elusive. We aimed to examine the relationship between the intestinal microbiome and cognitive development of school-age children.

Methods

This cross-sectional study included healthy Israeli Arab children from different socioeconomic status (SES). The microbiome was characterized in fecal samples by implementing 16S rRNA gene sequencing. Cognitive function was measured using Stanford-Binet test, yielding full-scale Intelligence Quotient (FSIQ) score. Sociodemographics and anthropometric and hemoglobin measurements were obtained. Multivariate models were implemented to assess adjusted associations between the gut microbiome and FSIQ score, while controlling for age, sex, SES, physical growth, and hemoglobin levels.

Results

Overall, 165 children (41.2% females) aged 6-9 years were enrolled. SES score was strongly related to both FSIQ score and the gut microbiome. Measures of α-diversity were significantly associated with FSIQ score, demonstrating a more diverse, even, and rich microbiome with increased FSIQ score. Significant differences in fecal bacterial composition were found; FSIQ score explained the highest variance in bacterial β-diversity, followed by SES score. Several taxonomic differences were significantly associated with FSIQ score, including Prevotella, Dialister, Sutterella, Ruminococcus callidus, and Bacteroides uniformis.

Conclusions

We demonstrated significant independent associations between the gut microbiome and cognitive development in school-age children.

Mitochondria hormesis delays aging and associated diseases in Caenorhabditis elegans impacting on key ferroptosis players

Excessive iron accumulation or deficiency leads to a variety of pathologies in humans and developmental arrest in the nematode Caenorhabditis elegans. Instead, sub-lethal iron depletion extends C. elegans lifespan. Hypoxia preconditioning protects against severe hypoxia-induced neuromuscular damage across species but it has low feasible application. In this study, we assessed the potential beneficial effects of genetic and chemical interventions acting via mild iron instead of oxygen depletion. We show that limiting iron availability in C. elegans through frataxin silencing or the iron chelator bipyridine, similar to hypoxia preconditioning, protects against hypoxia-, age-, and proteotoxicity-induced neuromuscular deficits. Mechanistically, our data suggest that the beneficial effects elicited by frataxin silencing are in part mediated by counteracting ferroptosis, a form of non-apoptotic cell death mediated by iron-induced lipid peroxidation. This is achieved by impacting on different key ferroptosis players and likely via gpx-independent redox systems. We thus point to ferroptosis inhibition as a novel potential strategy to promote healthy aging.

Iron Deficiency in Attention-Deficit Hyperactivity Disorder, Autism Spectrum Disorder, Internalizing and Externalizing Disorders, and Movement Disorders

This article reviews the role of iron in brain development and function, with a focus on the association between iron deficiency (ID) and neuropsychiatric conditions. First, we describe how ID is defined and diagnosed. Second, the role of iron in brain development and function is summarized. Third, we review current findings implicating ID in a number of neuropsychiatric conditions in children and adolescents, including attention deficit hyperactivity disorder and other disruptive behavior disorders, depressive and anxiety disorders, autism spectrum disorder, movement disorders, and other situations relevant to mental health providers. Last, we discuss the impact of psychotropic medication on iron homeostasis.

Reducing the complexity of high-dimensional environmental data: An analytical framework using LASSO with considerations of confounding for statistical inference

PURPOSE

Frameworks for selecting exposures in high-dimensional environmental datasets, while considering confounding, are lacking. We present a two-step approach for exposure selection with subsequent confounder adjustment for statistical inference.

METHODS

We measured cognitive ability in 338 children using the Woodcock-Muñoz General Intellectual Ability (GIA) score, and potential associated features across several environmental domains. Initially, 111 variables theoretically associated with GIA score were introduced into a Least Absolute Shrinkage and Selection Operator (LASSO) in a 50% feature selection subsample. Effect estimates for selected features were subsequently modeled in linear regressions in a 50% inference (hold out) subsample, first adjusting for sex and age and later for covariates selected via directed acyclic graphs (DAGs). All models were adjusted for clustering by school.

RESULTS

Of the 15 LASSO selected variables, eleven were not associated with GIA score following our inference modeling approach. Four variables were associated with GIA scores, including: serum ferritin adjusted for inflammation (inversely), mother's IQ (positively), father's education (positively), and hours per day the child works on homework (positively). Serum ferritin was not in the expected direction.

CONCLUSIONS

Our two-step approach moves high-dimensional feature selection a step further by incorporating DAG-based confounder adjustment for statistical inference.

Prevalence and Risk Factors of Anaemia among Orang Asli Children in Malaysia: A Scoping Review

BACKGROUND

Anaemia continues to be a global public health burden affecting all age groups, particularly children. Indigenous people, including the Orang Asli (OA) population in Malaysia, are at risk of anaemia due to the vast disparities in social determinants of health in their population compared to the non-indigenous population.

OBJECTIVES

This review aimed to identify the prevalence and risk factors of anaemia among OA children in Malaysia and analyse the knowledge gaps.

METHODS

A systematic search was conducted in PubMed, Cochrane Library, Scopus and Google Scholar databases. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines.

RESULTS

This review identified six studies involving the participation of OA children from eight subtribes residing in Peninsular Malaysia. The overall prevalence of anaemia among OA children ranged from 21.6 to 80.0%, with iron deficiency anaemia prevalence at 34.0%. The risk factors of anaemia among OA children reported from one study in this review were being younger than ten years old children (AOR 2.11 (95% CI 1.23, 3.63)) and moderate to heavy Ascaris infections (AOR 2.05 (95% CI 1.12, 3.76)). There was no data from OA children from certain age groups and subtribes. Additionally, there is a paucity of data on risk factors for anaemia among OA children from the currently available evidence.

CONCLUSION

The prevalence of anaemia among OA children poses a moderate to severe public health concern. Therefore, more comprehensive studies in the future are needed to address the gaps identified in this review, primarily regarding anaemia risk factors. This data would encourage policymakers in devising effective national prevention strategies to improve morbidity and mortality among OA children in the future.

A Case-Control Study of the Factors Associated with Anemia in Chinese Children Aged 3-7 years Old

Background

Anemia in children is still an important public problem in China and can have a profound impact on the physical and mental health of children. The purpose of this study was to explore the risk factors for anemia among Chinese children aged 3-7 years old and to provide some basis for the prevention and control of anemia.

Methods

A matched case-control study was conducted and 1104 children (552 cases and 552 controls) were recruited in this study. Cases were children who were diagnosed with anemia by the doctor of physical examination and checked by one deputy chief physician of pediatrics, and controls were healthy children without anemia. Data were collected using a self-designed structured questionnaire. Univariable and multivariable analyses were used to identify independent determinants of anemia. P values less than 0.05 were used to declare statistical significance.

Results

In the multivariable analyses, maternal anemia before or during pregnancy and lactation (OR = 2.14, 95% CI: 1.10∼4.15; OR = 2.86, 95% CI: 1.66∼4.94; OR = 2.51, 95% CI: 1.13∼5.60), gestational weeks (OR = 0.72, 95% CI: 0.53∼0.96), having G6PD deficiency or thalassemia (OR = 8.12, 95% CI: 2.00∼33.04; OR = 36.25, 95% CI: 10.40∼126.43), having cold and cough in previous two weeks (OR = 1.56, 95% CI: 1.04∼2.34), family income (OR = 0.80, 95% CI: 0.65∼0.97), and being a picky eater (OR = 1.80, 95% CI: 1.20∼2.71) were determinants of anemia in children aged 3-7 years old.

Conclusions

Some of the identified factors are modifiable and could be targeted to reduce childhood anemia. More emphasis should be given by the concerned bodies to intervene in the anemia problem by improving the maternal health education, screening for disease-related anemia, requesting medical services in a timely manner, improving the economic status of households, promoting dietary habits, and improving sanitation and hygiene practices.

Factors Associated With Anemia Among Orang Asli Children Aged Two to Six Years in Negeri Sembilan, Malaysia

Background Anemia is a global public health problem that needs urgent attention, especially in early childhood. Young children living in remote indigenous communities are vulnerable to anemia. This study aimed to determine factors associated with anemia among children of the Orang Asli (OA) community, aged two to six years old. Methods A cross-sectional study was conducted among 269 OA children, together with their biological non-pregnant mothers. Their mothers were interviewed using a structured questionnaire to gather information on sociodemographic characteristics, sanitation facility and personal hygiene, food security, and dietary diversity. Anthropometric and biochemical assessments were measured using standard protocols. Results One in five of the OA children was anemic (21.2%) and had a low birth weight (20.4%). About 27.7% of the children were underweight, 35.2 % were stunted, 6.1% were wasted, and 5.7% were overweight. One-third of them (35.0%) had parasitic infections and almost all were food-insecure (96.3%). As for the mothers, more than one-third of them were anemic (39.0%), 58.9% had abdominal obesity, and 61.8% were overweight and obese. Parasitic infections (adjusted OR (AOR)=2.49, 95%CI=1.23-5.06), not wearing shoes outside the house (AOR=2.95, 95%CI=1.39-6.27), and mothers with anemia (AOR=2.62, 95%CI=1.30-5.28) were associated with increased risk of anemia among OA children. Conclusion Preventing maternal anemia and strengthening knowledge on sanitation and hygiene could be incorporated into nutrition intervention programs to address anemia issues among OA children.

Synaptic Activity Regulates Mitochondrial Iron Metabolism to Enhance Neuronal Bioenergetics

Synaptic activity is the main energy-consuming process in the central nervous system. We are beginning to understand how energy is supplied and used during synaptic activity by neurons. However, the long-term metabolic adaptations associated with a previous episode of synaptic activity are not well understood. Herein, we show that an episode of synaptic activity increases mitochondrial bioenergetics beyond the duration of the synaptic activity by transcriptionally inducing the expression of iron metabolism genes with the consequent enhancement of cellular and mitochondrial iron uptake. Iron is a necessary component of the electron transport chain complexes, and its chelation or knockdown of mitochondrial iron transporter Mfrn1 blocks the activity-mediated bioenergetics boost. We found that Mfrn1 expression is regulated by the well-known regulator of synaptic plasticity CREB, suggesting the coordinated expression of synaptic plasticity programs with those required to meet the associated increase in energetic demands.