1
|
Hua M, Shi D, Xu W, Zhu L, Hao X, Zhu B, Shu Q, Lozoff B, Geng F, Shao J. Differentiation between fetal and postnatal iron deficiency in altering brain substrates of cognitive control in pre-adolescence. BMC Med 2023; 21:167. [PMID: 37143078 PMCID: PMC10161450 DOI: 10.1186/s12916-023-02850-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Early iron deficiency (ID) is a common risk factor for poorer neurodevelopment, limiting children's potential and contributing to global burden. However, it is unclear how early ID alters the substrate of brain functions supporting high-order cognitive abilities and whether the timing of early ID matters in terms of long-term brain development. This study aimed to examine the effects of ID during fetal or early postnatal periods on brain activities supporting proactive and reactive cognitive control in pre-adolescent children. METHODS Participants were part of a longitudinal cohort enrolled at birth in southeastern China between December 2008 and November 2011. Between July 2019 and October 2021, 115 children aged 8-11 years were invited to participate in this neuroimaging study. Final analyses included 71 children: 20 with fetal ID, 24 with ID at 9 months (postnatal ID), and 27 iron-sufficient at birth and 9 months. Participants performed a computer-based behavioral task in a Magnetic Resonance Imaging scanner to measure proactive and reactive cognitive control. Outcome measures included accuracy, reaction times, and brain activity. Linear mixed modeling and the 3dlme command in Analysis of Functional NeuroImages (AFNI) were separately used to analyze behavioral performance and neuroimaging data. RESULTS Faster responses in proactive vs. reactive conditions indicated that all groups could use proactive or reactive cognitive control according to contextual demands. However, the fetal ID group was lower in general accuracy than the other 2 groups. Per the demands of cues and targets, the iron-sufficient group showed greater activation of wide brain regions in proactive vs. reactive conditions. In contrast, such condition differences were reversed in the postnatal ID group. Condition differences in brain activation, shown in postnatal ID and iron-sufficient groups, were not found in the fetal ID group. This group specifically showed greater activation of brain regions in the reward pathway in proactive vs. reactive conditions. CONCLUSIONS Early ID was associated with altered brain functions supporting proactive and reactive cognitive control in childhood. Alterations differed between fetal and postnatal ID groups. The findings imply that iron supplement alone is insufficient to prevent persisting brain alterations associated with early ID. Intervention strategies in addition to the iron supplement should consider ID timing.
Collapse
Affiliation(s)
- Mengdi Hua
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Donglin Shi
- Department of Curriculum and Learning Sciences, Zhejiang University, Hangzhou, China
| | - Wenwen Xu
- Department of Curriculum and Learning Sciences, Zhejiang University, Hangzhou, China
| | - Liuyan Zhu
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoxin Hao
- Department of Curriculum and Learning Sciences, Zhejiang University, Hangzhou, China
| | - Bingquan Zhu
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiang Shu
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- National Clinical Research Center for Child Health, Hangzhou, China
| | - Betsy Lozoff
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Fengji Geng
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- Department of Curriculum and Learning Sciences, Zhejiang University, Hangzhou, China.
- National Clinical Research Center for Child Health, Hangzhou, China.
| | - Jie Shao
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- National Clinical Research Center for Child Health, Hangzhou, China.
| |
Collapse
|
2
|
Geng F, Mai X, Zhan J, Xu L, Georgieff M, Shao J, Lozoff B. Timing of iron deficiency and recognition memory in infancy. Nutr Neurosci 2022; 25:1-10. [PMID: 31906824 PMCID: PMC7338245 DOI: 10.1080/1028415x.2019.1704991] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: To determine the relationship between iron deficiency (or iron-deficient, ID) and neural correlates of recognition memory depending on ID timing (gestation vs. infancy) and infant age at testing (9 vs. 18 months).Study design: Event-related potentials (ERP) were used in a visual recognition memory task (mother vs. stranger face) to compare healthy term infants according to iron status at birth and 9 months. Fetal-neonatal ID was defined as cord serum ferritin < 75 µg/l or zinc protoporphrin/heme ratio > 118 µmol/mol, postnatal ID as ≥ 2 abnormal iron measures at 9 months with normal cord-blood iron status, and iron-sufficient as not ID at birth or 9 months. Recognition of mother faces was measured by negative component (Nc) and late slow wave (LSW). These ERP components reflect attention and memory updating processes, respectively.Results: All groups showed differences in Nc amplitude elicited by mother and stranger faces at 9 months. At 18 months, only postnatal ID and iron-sufficient groups showed condition differences in Nc amplitude. However, the 2 groups were different in the involved brain regions. For LSW, only the 2 ID groups showed condition differences in amplitude at 9 months. At 18 months, condition differences were not observed in any group.Conclusions: This study indicates that the timing of ID in early life (fetal-neonatal vs. postnatal) modulates the impact of ID on recognition memory. Such impact also varies depending on the age of infants at testing (9 vs. 18 months).
Collapse
Affiliation(s)
- Fengji Geng
- Department of Curriculum and Learning Sciences, Zhejiang University, Hangzhou, People’s Republic of China
| | - Xiaoqin Mai
- Department of Psychology, Renmin University of China, Beijing, People’s Republic of China
| | - Jianying Zhan
- Children’s Hospital Zhejiang University School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Lin Xu
- Children’s Hospital Zhejiang University School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Michael Georgieff
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Jie Shao
- Children’s Hospital Zhejiang University School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Betsy Lozoff
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA,Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
3
|
McCarthy EK, Murray DM, Hourihane JOB, Kenny LC, Irvine AD, Kiely ME. Behavioral consequences at 5 y of neonatal iron deficiency in a low-risk maternal-infant cohort. Am J Clin Nutr 2021; 113:1032-1041. [PMID: 33515035 DOI: 10.1093/ajcn/nqaa367] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/12/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Iron is critical to the developing brain, but fetal iron accretion is compromised by several maternal and pregnancy-related factors. Little consideration has been given to the long-term neurologic consequences of neonatal iron deficiency, especially in generally healthy, low-risk populations. OBJECTIVE We aimed to investigate the association between neonatal iron deficiency and neurologic development at 2 and 5 y of age. DESIGN We measured umbilical cord serum ferritin concentrations in the prospective maternal-infant Cork BASELINE (Babies after SCOPE: Evaluating the Longitudinal Impact Using Neurological and Nutritional Endpoints) Birth Cohort. Lifestyle and clinical data were collected from 15 weeks of gestation to 5 y of age. Standardized neurologic assessments were performed at 2 y [Bayley Scales of Infant Development/Child Behavior Checklist (CBCL)] and 5 y (Kaufman Brief Intelligence Test/CBCL). RESULTS Among 697 maternal-infant pairs, median (IQR) cord ferritin concentrations were 200.9 (139.0, 265.8) µg/L; 8% had neonatal iron deficiency (ferritin <76 µg/L). Using fully adjusted models, there was no association between neonatal iron deficiency and cognitive or behavioral outcomes at 2 or 5 y. We conducted an a priori sensitivity analysis in 306 high-risk children, selected using known risk factors for neonatal iron deficiency (smoking/obesity/cesarean section delivery/small-for-gestational age birth). In this high-risk subgroup, children with iron deficiency at birth (12%) had similar cognitive outcomes, but the behavioral assessments showed higher internalizing [9.0 (5.3, 12.0) compared with 5.0 (3.0, 10.0), P = 0.006; adjusted estimate (95% CI): 2.8 (0.5, 5.1), P = 0.015] and total [24.5 (15.3, 40.8) compared with 16.0 (10.0, 30.0), P = 0.009; adjusted estimate (95% CI): 6.6 (0.1, 13.1), P = 0.047] problem behavior scores at 5 y compared with those born iron sufficient. CONCLUSIONS We have demonstrated lasting behavioral consequences of neonatal iron deficiency in high-risk children from our generally healthy, low-risk maternal-infant cohort. Although larger investigations are warranted, this study provides strong association data to suggest that interventions and strategies targeting the fetal and neonatal period should be prioritized for the prevention of iron deficiency and associated neurologic consequences.
Collapse
Affiliation(s)
- Elaine K McCarthy
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.,INFANT Research Centre, Cork, Ireland
| | - Deirdre M Murray
- INFANT Research Centre, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Jonathan O B Hourihane
- INFANT Research Centre, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.,Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Louise C Kenny
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Alan D Irvine
- INFANT Research Centre, Cork, Ireland.,Department of Clinical Medicine, Trinity College, Dublin, Ireland.,Department of Paediatric Dermatology, Children's Health Ireland at Crumlin, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - Mairead E Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.,INFANT Research Centre, Cork, Ireland
| |
Collapse
|
4
|
Bahr TM, Ward DM, Jia X, Ohls RK, German KR, Christensen RD. Is the erythropoietin-erythroferrone-hepcidin axis intact in human neonates? Blood Cells Mol Dis 2021; 88:102536. [PMID: 33450539 DOI: 10.1016/j.bcmd.2021.102536] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 02/09/2023]
Abstract
In a two-part process, we assessed elements of the principal hormonal pathway regulating iron homeostasis in human neonates. Part 1: Quantifying erythropoietin (Epo), erythroferrone (ERFE), hepcidin, and relevant serum and erythrocytic iron-related metrics in umbilical cord blood from term (n = 13) and preterm (n = 10) neonates, and from neonates born to mothers with diabetes and obesity (n = 13); Part 2: Quantifying serum Epo, ERFE, and hepcidin before and following darbepoetin administration. Part 1: We measured Epo, ERFE and hepcidin in all cord blood samples. Epo and ERFE levels did not differ between the three groups. Preterm neonates had the lowest hepcidin levels, while neonates born to diabetic women with a very high BMI had the lowest ferritin and RET-He levels. Part 2: Following darbepoetin dosing, ERFE levels generally increased (p < 0.05) and hepcidin levels generally fell (p < 0.05). Our observations suggest that the Epo/ERFE/hepcidin axis is intact in the newborn period.
Collapse
Affiliation(s)
- Timothy M Bahr
- Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA.
| | - Diane M Ward
- Department of Pathology, University of Utah Health, Salt Lake City, UT, USA; Center for Iron and Heme Disorders, University of Utah, Salt Lake City, UT, USA
| | - Xuan Jia
- Department of Pathology, University of Utah Health, Salt Lake City, UT, USA
| | - Robin K Ohls
- Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA
| | - Kendell R German
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Robert D Christensen
- Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA; Division of Hematology/Oncology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA; Center for Iron and Heme Disorders, University of Utah, Salt Lake City, UT, USA; Women and Newborns Research, Intermountain Healthcare, Murray, UT, USA
| |
Collapse
|
5
|
Juul SE, Vu PT, Comstock BA, Wadhawan R, Mayock DE, Courtney SE, Robinson T, Ahmad KA, Bendel-Stenzel E, Baserga M, LaGamma EF, Downey LC, O’Shea M, Rao R, Fahim N, Lampland A, Frantz ID, Khan J, Weiss M, Gilmore MM, Ohls R, Srinivasan N, Perez JE, McKay V, Heagerty PJ. Effect of High-Dose Erythropoietin on Blood Transfusions in Extremely Low Gestational Age Neonates: Post Hoc Analysis of a Randomized Clinical Trial. JAMA Pediatr 2020; 174:933-943. [PMID: 32804205 PMCID: PMC7432302 DOI: 10.1001/jamapediatrics.2020.2271] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Extremely preterm infants are among the populations receiving the highest levels of transfusions. Erythropoietin has not been recommended for premature infants because most studies have not demonstrated a decrease in donor exposure. OBJECTIVES To determine whether high-dose erythropoietin given within 24 hours of birth through postmenstrual age of 32 completed weeks will decrease the need for blood transfusions. DESIGN, SETTING, AND PARTICIPANTS The Preterm Erythropoietin Neuroprotection Trial (PENUT) is a randomized, double-masked clinical trial with participants enrolled at 19 sites consisting of 30 neonatal intensive care units across the United States. Participants were born at a gestational age of 24 weeks (0-6 days) to 27 weeks (6-7 days). Exclusion criteria included conditions known to affect neurodevelopmental outcomes. Of 3266 patients screened, 2325 were excluded, and 941 were enrolled and randomized to erythropoietin (n = 477) or placebo (n = 464). Data were collected from December 12, 2013, to February 25, 2019, and analyzed from March 1 to June 15, 2019. INTERVENTIONS In this post hoc analysis, erythropoietin, 1000 U/kg, or placebo was given every 48 hours for 6 doses, followed by 400 U/kg or sham injections 3 times a week through postmenstrual age of 32 weeks. MAIN OUTCOMES AND MEASURES Need for transfusion, transfusion numbers and volume, number of donor exposures, and lowest daily hematocrit level are presented herein. RESULTS A total of 936 patients (488 male [52.1%]) were included in the analysis, with a mean (SD) gestational age of 25.6 (1.2) weeks and mean (SD) birth weight of 799 (189) g. Erythropoietin treatment (vs placebo) decreased the number of transfusions (unadjusted mean [SD], 3.5 [4.0] vs 5.2 [4.4]), with a relative rate (RR) of 0.66 (95% CI, 0.59-0.75); the cumulative transfused volume (mean [SD], 47.6 [60.4] vs 76.3 [68.2] mL), with a mean difference of -25.7 (95% CI, 18.1-33.3) mL; and donor exposure (mean [SD], 1.6 [1.7] vs 2.4 [2.0]), with an RR of 0.67 (95% CI, 0.58-0.77). Despite fewer transfusions, erythropoietin-treated infants tended to have higher hematocrit levels than placebo-treated infants, most noticeable at gestational week 33 in infants with a gestational age of 27 weeks (mean [SD] hematocrit level in erythropoietin-treated vs placebo-treated cohorts, 36.9% [5.5%] vs 30.4% [4.6%] (P < .001). Of 936 infants, 160 (17.1%) remained transfusion free at the end of 12 postnatal weeks, including 43 in the placebo group and 117 in the erythropoietin group (P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that high-dose erythropoietin as used in the PENUT protocol was effective in reducing transfusion needs in this population of extremely preterm infants. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01378273.
Collapse
Affiliation(s)
- Sandra E. Juul
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle
| | - Phuong T. Vu
- Department of Biostatistics, University of Washington, Seattle,now with Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | | | - Rajan Wadhawan
- Department of Neonatal-Perinatal Medicine, AdventHealth, Orlando, Florida
| | - Dennis E. Mayock
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle
| | - Sherry E. Courtney
- Division of Neonatology, Department of Pediatrics, University of Arkansas, Little Rock
| | - Tonya Robinson
- Division of Neonatology, Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Kaashif A. Ahmad
- Department of Neonatal Medicine, Methodist Children’s Hospital, San Antonio, Texas
| | | | - Mariana Baserga
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City
| | - Edmund F. LaGamma
- Department of Neonatal Medicine, Maria Fareri Children’s Hospital at Westchester, Valhalla, New York
| | - L. Corbin Downey
- Division of Neonatology, Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael O’Shea
- Division of Neonatology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis
| | - Raghavendra Rao
- Division of Neonatology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis
| | - Nancy Fahim
- Division of Neonatology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis
| | | | - Ivan D. Frantz
- Division of Neonatology, Department of Pediatrics, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Janine Khan
- Division of Neonatology, Department of Pediatrics, Prentice Women’s Hospital, Chicago, Illinois
| | - Michael Weiss
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville
| | - Maureen M. Gilmore
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | - Robin Ohls
- Division of Neonatology, Department of Pediatrics, University of New Mexico, Albuquerque
| | - Nishant Srinivasan
- Department of Pediatrics, Children’s Hospital of the University of Illinois, Chicago
| | - Jorge E. Perez
- Department of Neonatology, South Miami Hospital, South Miami, Florida
| | - Victor McKay
- Department of Neonatology, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
| | | | | |
Collapse
|
6
|
Shao J, Richards B, Kaciroti N, Zhu B, Clark KM, Lozoff B. Contribution of iron status at birth to infant iron status at 9 months: data from a prospective maternal-infant birth cohort in China. Eur J Clin Nutr 2020; 75:364-372. [PMID: 32814856 PMCID: PMC7878278 DOI: 10.1038/s41430-020-00705-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/22/2020] [Accepted: 08/04/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND/OBJECTIVES The contribution of iron status at birth to iron status in infancy is not known. We used a physiologic framework to evaluate how iron status at birth related to iron status at 9 months, taking iron needs and sources into account. SUBJECTS/METHODS In a longitudinal birth cohort in China, iron status measures in cord blood and venous blood in infancy (9 months) and clinical data were prospectively collected in 545 healthy term maternal–infant dyads. We used structural equation modeling (SEM) to create a 9-month iron composite and to assess direct and indirect contributions of multiple influences on 9-month iron status. Logistic regression was used to calculate odds ratios (OR) for iron deficiency (ID), iron deficiency anemia (IDA), and anemia. RESULTS Approximately 15% (78/523) of infants were born with cord SF<75 μg/l, suggesting fetal-neonatal ID. At 9 months, 34.8% (186/535) and 19.6% (105/535) of infants had ID and IDA, respectively. The following factors were independently associated with poorer 9-month iron status: higher cord zinc protoporphyrin/heme (ZPP/H) (adjusted estimate −0.18, P< 0.001) and serum transferrin receptor (sTfR) (−0.11, P=0.004), lower cord hemoglobin (Hb) (0.13, P=0.004), lower birth weight (0.15, P< 0.001), male sex (0.10, P=0.013), older age at testing (−0.26, P<0.001), higher 9-month weight (−0.12, P=0.006) and breastfeeding (0.38, P<0.001). Breastfeeding at 9 months showed the strongest association, adjusting for all other factors. Compared to formula-fed infants, the odds of IDA were 19.1 (95%CI: 6.92, 52.49, P< 0.001) and 3.6 (95%CI: 1.04, 12.50, P=0.043) times higher in breastfed and mixed-fed infants, respectively. CONCLUSIONS Indicators of iron status at birth, postnatal iron needs, and iron sources independently related to iron status at 9 months. Sex was an additional factor. Public health policies to identify and protect infants at increased risk of ID should be prioritized.
Collapse
Affiliation(s)
- Jie Shao
- Children's Hospital Zhejiang University School of Medicine, Hangzhou, 310052, China. .,National Clinical Research Center for Child Health, Hangzhou, 310052, China.
| | - Blair Richards
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Niko Kaciroti
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Bingquan Zhu
- Children's Hospital Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Katy M Clark
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Betsy Lozoff
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA.,Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
7
|
McCann S, Perapoch Amadó M, Moore SE. The Role of Iron in Brain Development: A Systematic Review. Nutrients 2020; 12:E2001. [PMID: 32635675 PMCID: PMC7400887 DOI: 10.3390/nu12072001] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 01/12/2023] Open
Abstract
One-third of children falter in cognitive development by pre-school age. Iron plays an important role in many neurodevelopmental processes, and animal studies suggest that iron sufficiency in pregnancy and infancy is particularly important for neurodevelopment. However, it is not clear whether iron deficiency directly impacts developmental outcomes, and, if so, whether impact differs by timing of exposure or developmental domain. We searched four databases for studies on iron deficiency or iron supplementation in pregnancy, or at 0-6 months, 6-24 months, or 2-4 years of age. All studies included neurodevelopmental assessments in infants or children up to 4 years old. We then qualitatively synthesized the literature. There was no clear relationship between iron status and developmental outcomes across any of the time windows or domains included. We identified a large quantity of low-quality studies, significant heterogeneity in study design and a lack of research focused on pregnancy and early infancy. In summary, despite good mechanistic evidence for the role of iron in brain development, evidence for the impact of iron deficiency or iron supplementation on early development is inconsistent. Further high-quality research is needed, particularly within pregnancy and early infancy, which has previously been neglected.
Collapse
Affiliation(s)
- Samantha McCann
- Department of Women and Children’s Health, King’s College London, London SE1 7EH, UK;
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Marta Perapoch Amadó
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK;
| | - Sophie E. Moore
- Department of Women and Children’s Health, King’s College London, London SE1 7EH, UK;
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, P.O. Box 273, Banjul, The Gambia
| |
Collapse
|
8
|
McCarthy EK, Kiely ME. The neonatal period: A missed opportunity for the prevention of iron deficiency and its associated neurological consequences? NUTR BULL 2019. [DOI: 10.1111/nbu.12407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E. K. McCarthy
- Cork Centre for Vitamin D and Nutrition Research School of Food and Nutritional Sciences University College Cork and INFANT Research Centre Cork Ireland
| | - M. E. Kiely
- Cork Centre for Vitamin D and Nutrition Research School of Food and Nutritional Sciences University College Cork and INFANT Research Centre Cork Ireland
| |
Collapse
|
9
|
Markova V, Holm C, Pinborg AB, Thomsen LL, Moos T. Impairment of the Developing Human Brain in Iron Deficiency: Correlations to Findings in Experimental Animals and Prospects for Early Intervention Therapy. Pharmaceuticals (Basel) 2019; 12:ph12030120. [PMID: 31416268 PMCID: PMC6789712 DOI: 10.3390/ph12030120] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 02/06/2023] Open
Abstract
Due to the necessity of iron for a variety of cellular functions, the developing mammalian organism is vulnerable to iron deficiency, hence causing structural abnormalities and physiological malfunctioning in organs, which are particularly dependent on adequate iron stores, such as the brain. In early embryonic life, iron is already needed for proper development of the brain with the proliferation, migration, and differentiation of neuro-progenitor cells. This is underpinned by the widespread expression of transferrin receptors in the developing brain, which, in later life, is restricted to cells of the blood–brain and blood–cerebrospinal fluid barriers and neuronal cells, hence ensuring a sustained iron supply to the brain, even in the fully developed brain. In embryonic human life, iron deficiency is thought to result in a lower brain weight, with the impaired formation of myelin. Studies of fully developed infants that have experienced iron deficiency during development reveal the chronic and irreversible impairment of cognitive, memory, and motor skills, indicating widespread effects on the human brain. This review highlights the major findings of recent decades on the effects of gestational and lactational iron deficiency on the developing human brain. The findings are correlated to findings of experimental animals ranging from rodents to domestic pigs and non-human primates. The results point towards significant effects of iron deficiency on the developing brain. Evidence would be stronger with more studies addressing the human brain in real-time and the development of blood biomarkers of cerebral disturbance in iron deficiency. Cerebral iron deficiency is expected to be curable with iron substitution therapy, as the brain, privileged by the cerebral vascular transferrin receptor expression, is expected to facilitate iron extraction from the circulation and enable transport further into the brain.
Collapse
Affiliation(s)
- Veronika Markova
- Department of Obstetrics and Gynaecology, Hvidovre Hospital, Copenhagen University Hospital, 2650 Hvidovre, Denmark
- Pharmacosmos A/S, 4300 Holbæk, Denmark
- Laboratory of Neurobiology, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Charlotte Holm
- Laboratory of Neurobiology, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Anja Bisgaard Pinborg
- Fertility Clinic, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Lars Lykke Thomsen
- Pharmacosmos A/S, 4300 Holbæk, Denmark
- Laboratory of Neurobiology, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Torben Moos
- Laboratory of Neurobiology, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark.
| |
Collapse
|
10
|
Muleviciene A, D’Amico F, Turroni S, Candela M, Jankauskiene A. Iron deficiency anemia-related gut microbiota dysbiosis in infants and young children: A pilot study. Acta Microbiol Immunol Hung 2018; 65:551-564. [PMID: 30418043 DOI: 10.1556/030.65.2018.045] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Nutritional iron deficiency (ID) causes not only anemia but also malfunction of the entire human organism. Recently, a role of the gut microbiota has been hypothesized, but limited data are available especially in infants. Here, we performed a pilot study to explore the gut microbiota in 10 patients with iron deficiency anemia (IDA) and 10 healthy controls aged 6-34 months. Fresh stool samples were collected from diapers, and the fecal microbiota was profiled by next-generation sequencing of the V3-V4 hypervariable region of the 16S rRNA gene. Except for diet diversity, the breastfeeding status at the enrollment, the exclusive breastfeeding duration, and the introduction of complementary foods did not differ between groups. Distinct microbial signatures were found in IDA patients, with increased relative abundance of Enterobacteriaceae (mean relative abundance, patients vs. controls, 4.4% vs. 3.0%) and Veillonellaceae (13.7% vs. 3.6%), and reduced abundance of Coriobacteriaceae (3.5% vs. 8.8%) compared to healthy controls. A decreased Bifidobacteriaceae/Enterobacteriaceae ratio was observed in IDA patients. Notwithstanding the low sample size, our data highlight microbiota dysbalance in IDA worth for further investigations, aimed at unraveling the ID impact on the microbiome trajectory in early life, and the possible long-term consequences.
Collapse
Affiliation(s)
- Audrone Muleviciene
- 1 Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Federica D’Amico
- 2 Unit of Microbial Ecology of Health, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Silvia Turroni
- 2 Unit of Microbial Ecology of Health, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Marco Candela
- 2 Unit of Microbial Ecology of Health, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Augustina Jankauskiene
- 1 Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| |
Collapse
|
11
|
Clark KM, Li M, Zhu B, Liang F, Shao J, Zhang Y, Ji C, Zhao Z, Kaciroti N, Lozoff B. Breastfeeding, Mixed, or Formula Feeding at 9 Months of Age and the Prevalence of Iron Deficiency and Iron Deficiency Anemia in Two Cohorts of Infants in China. J Pediatr 2017; 181:56-61. [PMID: 27836288 PMCID: PMC5274569 DOI: 10.1016/j.jpeds.2016.10.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/25/2016] [Accepted: 10/12/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess associations between breastfeeding and iron status at 9 months of age in 2 samples of Chinese infants. STUDY DESIGN Associations between feeding at 9 months of age (breastfed as sole milk source, mixed fed, or formula fed) and iron deficiency anemia (IDA), iron deficiency, and iron sufficiency were determined in infants from Zhejiang (n = 142) and Hebei (n= 813) provinces. Iron deficiency was defined as body iron < 0 mg/kg, and IDA as iron deficiency + hemoglobin < 110 g/L. Multiple logistic regression assessed associations between feeding pattern and iron status. RESULTS Breastfeeding was associated with iron status (P < .001). In Zhejiang, 27.5% of breastfed infants had IDA compared with 0% of formula-fed infants. The odds of iron deficiency/IDA were increased in breastfed and mixed-fed infants compared with formula-fed infants: breastfed vs formula-fed OR, 28.8 (95% CI, 3.7-226.4) and mixed-fed vs formula-fed OR, 11.0 (95% CI, 1.2-103.2). In Hebei, 44.0% of breastfed infants had IDA compared with 2.8% of formula-fed infants. With covariable adjustment, odds of IDA were increased in breastfed and mixed-fed groups: breastfed vs formula-fed OR, 78.8 (95% CI, 27.2-228.1) and mixed-fed vs formula-fed OR, 21.0 (95% CI, 7.3-60.9). CONCLUSIONS In both cohorts, the odds of iron deficiency/IDA at 9 months of age were increased in breastfed and mixed-fed infants, and iron deficiency/IDA was common. Although the benefits of breastfeeding are indisputable, these findings add to the evidence that breastfeeding in later infancy identifies infants at risk for iron deficiency/IDA in many settings. Protocols for detecting and preventing iron deficiency/IDA in breastfed infants are needed. TRIAL REGISTRATION ClinicalTrials.gov: NCT00642863 and NCT00613717.
Collapse
Affiliation(s)
- Katy M. Clark
- Center for Human Growth and Development, University of Michigan, Ann Arbor, USA
| | - Ming Li
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Bingquan Zhu
- Department of Child Health Care, Zhejiang University Children’s Hospital, Hangzhou, China
| | - Furong Liang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jie Shao
- Department of Child Health Care, Zhejiang University Children’s Hospital, Hangzhou, China
| | - Yueyang Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Chai Ji
- Department of Child Health Care, Zhejiang University Children’s Hospital, Hangzhou, China
| | - Zhengyan Zhao
- Department of Child Health Care, Zhejiang University Children’s Hospital, Hangzhou, China
| | - Niko Kaciroti
- Center for Human Growth and Development, University of Michigan, Ann Arbor, USA
| | - Betsy Lozoff
- Center for Human Growth and Development, University of Michigan, Ann Arbor, USA,Department of Pediatrics and Communicable Diseases, CS Mott Children’s Hospital, University of Michigan, USA
| |
Collapse
|