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Derman RJ, Bellad RB, Bellad MB, Bradford-Rogers J, Georgieff MK, Aghai ZH, Thind S, Auerbach M, Boelig R, Leiby BE, Short V, Yogeshkumar S, Charantimath US, Somannavar MS, Mallapur AA, Pol R, Ramadurg U, Sangavi R, Peerapur BV, Banu N, Patil PS, Patil AP, Roy S, Vastrad P, Wallace D, Shah H, Goudar SS. RAPIDIRON Trial follow-up study - the RAPIDIRON-KIDS Study: protocol of a prospective observational follow-up study. Trials 2023; 24:818. [PMID: 38124098 PMCID: PMC10731903 DOI: 10.1186/s13063-023-07740-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/20/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Anemia is a worldwide problem with iron deficiency being the most common cause. When anemia occurs in pregnancy, it increases the risk of adverse maternal, fetal, and postnatal outcomes. It induces preterm births and low birth weight (LBW) deliveries, long-term neurodevelopmental sequelae, and an increased risk of earlier onset of postnatal iron deficiency. Anemia rates are among the highest in South Asia, and India's National Family Health Survey (NFHS-5) for 2019-2021 indicated that over half of pregnant women, and more than 65% of children, in the country are classified as anemic (Sciences IIfP, National Family Health Survey-5, 2019-21, India Fact Sheet). In 2021, the parent RAPIDIRON Trial (Derman et al., Trials 22:649, 2021) was initiated in two states in India, with the goal of assessing whether a dose of intravenous (IV) iron given to anemic women during early pregnancy results in a greater proportion of participants with normal hemoglobin concentrations in the third trimester and a lower proportion of participants with LBW deliveries compared to oral iron. As a follow-up to the RAPIDIRON Trial, the RAPIDIRON-KIDS Study will follow the offspring of previously randomized mothers to assess, neurobehavioral, hematological, and health outcomes. METHODS This prospective observational cohort study will follow a subset of participants previously randomized as part of the RAPIDIRON Trial and their newborns. Study visits occur at birth, 6 weeks, 4 months, 12 months, 24 months, and 36 months and include blood sample collection with both maternal and infant participants and specific neurobehavioral assessments conducted with the infants (depending on the study visit). The primary outcomes of interest are (1) infant iron status as indicated by both hemoglobin and ferritin (a) at birth and (b) at 4 months of age and (2) the developmental quotient (DQ) for the cognitive domain of the Bayley Scales of Infant Development Version IV (BSID-IV) at 24 months of age. DISCUSSION This RAPIDIRON-KIDS Study builds upon its parent RAPIDIRON Trial by following a subset of the previously randomized participants and their offspring through the first 3 years of life to assess neurodevelopmental and neurobehavioral (infants, children), hematological, and health outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT05504863 , Registered on 17 August 2022. Clinical Trials Registry - India CTRI/2022/05/042933 . Registered on 31 May 2022.
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Affiliation(s)
| | - Roopa B Bellad
- KLE Academy of Higher Education and Research (KAHER), Jawaharlal Nehru Medical College (JNMC), Belagavi, India
| | - Mrutyunjaya B Bellad
- KLE Academy of Higher Education and Research (KAHER), Jawaharlal Nehru Medical College (JNMC), Belagavi, India
| | | | | | | | - Simal Thind
- Thomas Jefferson University (TJU), Philadelphia, USA
| | | | - Rupsa Boelig
- Thomas Jefferson University (TJU), Philadelphia, USA
| | | | - Vanessa Short
- Thomas Jefferson University (TJU), Philadelphia, USA
| | - S Yogeshkumar
- KLE Academy of Higher Education and Research (KAHER), Jawaharlal Nehru Medical College (JNMC), Belagavi, India
| | - Umesh S Charantimath
- KLE Academy of Higher Education and Research (KAHER), Jawaharlal Nehru Medical College (JNMC), Belagavi, India
| | - Manjunath S Somannavar
- KLE Academy of Higher Education and Research (KAHER), Jawaharlal Nehru Medical College (JNMC), Belagavi, India
| | | | - Ramesh Pol
- S. Nijalingappa Medical College (SNMC), Bagalkot, India
| | | | - Radha Sangavi
- Raichur Institute of Medical Sciences (RIMS), Raichur, India
| | | | - Nasima Banu
- Raichur Institute of Medical Sciences (RIMS), Raichur, India
| | - Praveen S Patil
- Raichur Institute of Medical Sciences (RIMS), Raichur, India
| | - Amaresh P Patil
- KLE Academy of Higher Education and Research (KAHER), Jawaharlal Nehru Medical College (JNMC), Belagavi, India
| | - Subarna Roy
- Model Rural Health Research Unit (MRHRU), Sirwar, India
| | | | | | - Hemang Shah
- The Children's Investment Fund Foundation (CIFF), New Delhi, India
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research (KAHER), Jawaharlal Nehru Medical College (JNMC), Belagavi, India
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Arcot A, Xing X, Gao X, Font SA, Murray-Kolb LE. Iron status, development, and behavior in young children in the Pennsylvania foster care system. PLoS One 2023; 18:e0289951. [PMID: 37590213 PMCID: PMC10434919 DOI: 10.1371/journal.pone.0289951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 07/28/2023] [Indexed: 08/19/2023] Open
Abstract
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.
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Affiliation(s)
- Amrita Arcot
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States of America
| | - Xueyi Xing
- Evidence-to-Impact Collaborative, Social Science Research Institute, The Pennsylvania State University, University Park, PA, United States of America
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States of America
- Department of Nutrition and Food Hygiene, School of Public Health, Fudan University, Shanghai, China
| | - Sarah A. Font
- Department of Sociology and Criminology, The Pennsylvania State University, University Park, PA, United States of America
| | - Laura E. Murray-Kolb
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States of America
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Reid BM, Zhong D, Donzella B, Howland M, Moua B, Gunnar MR. Does rapid rebound height growth come at a neurocognitive cost for previously institutionalized youth? J Child Psychol Psychiatry 2022; 63:1434-1444. [PMID: 35253222 PMCID: PMC11114590 DOI: 10.1111/jcpp.13594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Height growth faltering is associated with less optimal behavioral outcomes and educational achievement. Although catch-up growth after growth delay may result in developmental gains, it may also present as a double-edged sword, with consequences for neurocognitive functioning such as symptoms of inattention and hyperactivity. As previously institutionalized (PI) children experience height delays at adoption and catch-up growth after adoption, they provide a cohort to test associations between catch-up growth and attention deficit hyperactivity disorder (ADHD) symptoms. METHODS This study used latent growth curve modeling to examine how catch-up in height-for-age growth is related to attention problems in a population of PI youth followed from adoption in infancy through kindergarten. Participants were assessed within three months of arrival into their families (age at entry: 18-36 months). Anthropometrics were measured four times, approximately 7 months apart. Two visits measured behavioral outcomes with parent and teacher reports of ADHD, internalizing, and externalizing symptoms at age 5 and kindergarten. RESULTS The slope of growth in height z-scores, but not the intercept, was positively associated with parent- and teacher-reported ADHD symptoms in children. A one standard deviation increase in the slope of height z-scores across four assessments was associated with a 0.252 standard deviation increase in ADHD symptoms after controlling for internalizing and externalizing problems, iron status, duration of institutional care, sex, and age. The slope of growth was also associated with internalizing but not externalizing symptoms. CONCLUSIONS This study demonstrates that PI children exhibit individual trajectories of height growth postadoption. Higher rates of change in height-for-age growth were associated with increased ADHD symptoms. These results suggest that catch-up growth comes 'at the cost' of poor attention regulation and hyperactive behavior.
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Affiliation(s)
- Brie M. Reid
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Danruo Zhong
- Institute of Child Development, University of Minnesota Twin-Cities, Minneapolis, MN, USA
| | - Bonny Donzella
- Institute of Child Development, University of Minnesota Twin-Cities, Minneapolis, MN, USA
| | - Mariann Howland
- Institute of Child Development, University of Minnesota Twin-Cities, Minneapolis, MN, USA
| | - Bao Moua
- Institute of Child Development, University of Minnesota Twin-Cities, Minneapolis, MN, USA
| | - Megan R. Gunnar
- Institute of Child Development, University of Minnesota Twin-Cities, Minneapolis, MN, USA
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Reid BM, Horne R, Donzella B, Szamosi JC, Coe CL, Foster JA, Gunnar MR. Microbiota-immune alterations in adolescents following early life adversity: A proof of concept study. Dev Psychobiol 2021; 63:851-863. [PMID: 33249563 DOI: 10.1002/dev.22061] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/17/2020] [Accepted: 10/23/2020] [Indexed: 12/21/2022]
Abstract
Early adverse care has long-term impacts on physical and mental health. The influence of rearing conditions on the infant's gut microbiota and its relationship with developmental health has become more evident. The microbiome is essential for normal growth and metabolism, and the signaling from the gut to the brain may underlie individual differences in resilience later in life. Microbial diversity and composition were determined using 16S rRNA gene amplicon sequencing in fecal samples from 17 adolescents adopted internationally from orphanages into the United States and 18 adolescents reared in birth families who had similar educational and income levels. Analyses focused on diversity of the microbial community structure and differences in the abundance of specific bacterial taxa. Blood samples were used to immunophenotype the numbers of several T-cell subsets and cytomegalovirus (CMV) seropositivity. Negative binomial regression analysis revealed several operational taxonomic units that were significantly different based on early rearing conditions and CMV seropositivity. There were significant associations between the relative abundance of certain taxa, the percentages of T-cell subsets in circulation, and CMV seropositivity. These findings demonstrate a possible link between the gut microbiota and associations with immune alterations initiated by early life adversity.
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Affiliation(s)
- Brie M Reid
- Institute of Child Development, University of Minnesota-Twin Cities, Minneapolis, MN, USA
| | - Rachael Horne
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, USA
| | - Bonny Donzella
- Institute of Child Development, University of Minnesota-Twin Cities, Minneapolis, MN, USA
| | - Jake C Szamosi
- Department of Medicine and Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, USA
| | | | - Jane A Foster
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, USA
| | - Megan R Gunnar
- Institute of Child Development, University of Minnesota-Twin Cities, Minneapolis, MN, USA
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East P, Doom JR, Blanco E, Burrows R, Lozoff B, Gahagan S. Iron deficiency in infancy and neurocognitive and educational outcomes in young adulthood. Dev Psychol 2021; 57:962-975. [PMID: 34424013 PMCID: PMC8386013 DOI: 10.1037/dev0001030] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This study examines the extent to which iron deficiency in infancy contributes to adverse neurocognitive and educational outcomes in young adulthood directly and indirectly, through its influence on verbal cognition and attention problems in childhood. Young adults (N = 1,000, M age = 21.3 years, 52% female; of Spanish or indigenous descent) from working-class families in Santiago, Chile, completed instruments assessing memory, processing speed, mental flexibility, and educational attainment. Iron status was assessed at ages 6, 12, and 18 months, and verbal intelligence, inattention, and sluggish cognitive tempo (SCT) symptoms were assessed at age 10. Results indicated that young adults who had iron-deficiency in infancy had poor executive control at age 21. Severity of iron deficiency during infancy was associated with lower verbal IQ and more frequent inattention and SCT symptoms in childhood, and with lower educational attainment in young adulthood through its effect on inattention. No additional indirect effects were found. Interventions directed toward improving cognitive and attention deficits linked to early-life iron deficiency appear warranted and could alter the course to adult functioning. Further research on the impact of such interventions would be helpful. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Patricia East
- Department of Pediatrics, University of California, San Diego
| | | | - Estela Blanco
- Department of Pediatrics, University of California, San Diego
| | - Raquel Burrows
- Institute of Nutrition and Food Technology, University of Chile
| | - Betsy Lozoff
- Department of Pediatrics, University of Michigan
| | - Sheila Gahagan
- Department of Pediatrics, University of California, San Diego
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Intestinal parasites may be associated with later behavioral problems in internationally adopted children. PLoS One 2021; 16:e0245786. [PMID: 33493225 PMCID: PMC7833226 DOI: 10.1371/journal.pone.0245786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 12/29/2020] [Indexed: 01/09/2023] Open
Abstract
Aim At arrival in new home country, internationally adopted children often have intestinal parasites. International adoptees also exhibit more behavioral problems than their biological peers. We examined whether intestinal parasite infections in international adoptees on arrival in Finland are associated with their later behavioral and emotional problems. Methods Data for this study were sourced from the Finnish Adoption Study (FinAdo) based on parental questionnaires for all internationally adopted children under 18 years (n = 1450) who arrived in Finland from 1985 to 2007. A total of 1293 families provided sufficient information on the adoptee’s background, parasitic status on arrival, and behavioral symptoms at the median time of 5 years after arrival (mean age = 7.8 years). Behavioral and emotional disorders were evaluated with the Child Behavior Checklist (CBCL). Statistical analyses were conducted using linear regression. Results Of the 1293 families, parents of 206 adoptive children reported intestinal parasites in their adopted children on arrival. Parasite-infected children had subsequently higher CBCL problem scores than the children without parasites (p < 0.001). The association between intestinal parasites and later behavioral problems was stronger than that between intestinal parasites and any other factors measured in this study, except disability. Limitations The control group was naturally provided by the adopted children without parasite infections, but we could not compare the adopted children to non-adopted children without a defined parasite infection. We were unable to specify the effects associated with a specific parasite type. It was not possible either to include multiple environmental factors that could have been associated with behavioral problems in the models, which indicated only modest explanatory values. Conclusions In this study, intestinal parasite infections in early childhood may be associated with children’s later psychological wellbeing, even in children who move to a country with a low prevalence of parasites. Our findings may support further developments pertaining to the gut-brain theory.
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Delayed iron does not alter cognition or behavior among children with severe malaria and iron deficiency. Pediatr Res 2020; 88:429-437. [PMID: 32403115 PMCID: PMC7483848 DOI: 10.1038/s41390-020-0957-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/03/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Malaria and iron deficiency (ID) in childhood are both associated with cognitive and behavioral dysfunction. The current standard of care for children with malaria and ID is concurrent antimalarial and iron therapy. Delaying iron therapy until inflammation subsides could increase iron absorption but also impair cognition. METHODS In this study, Ugandan children 18 months to 5 years old with cerebral malaria (CM, n = 79), severe malarial anemia (SMA, n = 77), or community children (CC, n = 83) were enrolled and tested for ID. Children with ID were randomized to immediate vs. 28-day delayed iron therapy. Cognitive and neurobehavioral outcomes were assessed at baseline and 6 and 12 months (primary endpoint) after enrollment. RESULTS All children with CM or SMA and 35 CC had ID (zinc protoporphyrin concentration ≥80 μmol/mol heme). No significant differences were seen at 12-month follow-up in overall cognitive ability, attention, associative memory, or behavioral outcomes between immediate and delayed iron treatment (mean difference (standard error of mean) ranged from -0.2 (0.39) to 0.98 (0.5), all P ≥ 0.06). CONCLUSIONS Children with CM or SMA and ID who received immediate vs. delayed iron therapy had similar cognitive and neurobehavioral outcomes at 12-month follow-up. IMPACT The optimal time to provide iron therapy in children with severe malaria is not known. The present study shows that delay of iron treatment to 28 days after the malaria episode, does not lead to worse cognitive or behavioral outcomes at 12-month follow-up. The study contributes new data to the ongoing discussion of how best to treat ID in children with severe malaria.
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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: 62] [Impact Index Per Article: 15.5] [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.
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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
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Bortone B, Totaro C, Putignano P, Sollai S, Galli L, de Martino M, Chiappini E. Auxo-endocrinological features in a cohort of internationally adopted children in Italy. World J Pediatr 2019; 15:297-305. [PMID: 30783950 DOI: 10.1007/s12519-019-00233-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Internationally adopted children (IAC) can present growth impairment at arrival, which usually recovers over time. Moreover, a major prevalence of precocious puberty has been reported in this group. METHODS All IAC referred to a tertiary level hospital in Italy from January 2016 to June 2017, underwent a standardized screening protocol and were prospectively enrolled in the study. The analyses of possible risk factors for growth impairment and precocious puberty were performed. RESULTS Overall, 422 children were included (males 59.5%), with median age of 6.5 years (IQR 9.4-3.9), 29.9% adopted from Europe, 26.8% from Asia, 23.9% from Africa and 19.4% from Latin America. Children were in Italy from a median of 75 days (IQR 137.0-38.7). Stunting was observed in 12.9% of children, wasting in 4.3%, underweight in 12.9%. Precocious puberty was diagnosed in 2.2% of children. 17.1% IAC had diagnosis of special needs. Fetal alcohol spectrum disorders represented the 41.7% of children with special needs and 48.1% of Russian children. Independent predictive factors for stunting were age < 5 years, a diagnosis of special need and having been living in Italy for < 60 days since the arrival. CONCLUSION Stunting among IAC is a frequent finding especially in children < 5 years and in those with special needs, independently from their geographical origin.
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Affiliation(s)
- Barbara Bortone
- Department of Health Sciences, University of Florence, Anne Meyer Children's University Hospital, Florence, Italy
| | - Camilla Totaro
- Department of Health Sciences, University of Florence, Anne Meyer Children's University Hospital, Florence, Italy
| | - Pasqua Putignano
- Department of Health Sciences, University of Florence, Anne Meyer Children's University Hospital, Florence, Italy
| | - Sara Sollai
- Department of Health Sciences, University of Florence, Anne Meyer Children's University Hospital, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Anne Meyer Children's University Hospital, Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, University of Florence, Anne Meyer Children's University Hospital, Florence, Italy
| | - Elena Chiappini
- Department of Health Sciences, University of Florence, Anne Meyer Children's University Hospital, Florence, Italy. .,Department of Pediatrics, Anne Meyer Children's University Hospital, Viale Pieraccini, 24, 50100, Florence, Italy.
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Rao R, Bora R. Timing of Umbilical Cord Clamping and Infant Brain Development. J Pediatr 2018; 203:8-10. [PMID: 30193752 DOI: 10.1016/j.jpeds.2018.07.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/24/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Raghavendra Rao
- Division of Neonatology Department of Pediatrics University of Minnesota Minneapolis, Minnesota.
| | - Reeta Bora
- Neonatal Unit Department of Pediatrics Assam Medical College Dibrugarh, Assam, India
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East P, Delker E, Lozoff B, Delva J, Castillo M, Gahagan S. Associations Among Infant Iron Deficiency, Childhood Emotion and Attention Regulation, and Adolescent Problem Behaviors. Child Dev 2018; 89:593-608. [PMID: 28233303 PMCID: PMC5569004 DOI: 10.1111/cdev.12765] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study examined whether iron deficiency (ID) in infancy contributes to problem behaviors in adolescence through its influence on poor regulatory abilities in childhood. Chilean infants (N = 1,116) were studied when there was no national program for iron fortification (1991-1996), resulting in high rates of ID (28%) and iron-deficiency anemia (IDA, 17%). Infants (54% male) were studied at childhood (Mage = 10 years) and adolescence (Mage = 14 years). IDA in infancy was related to excessive alcohol use and risky sexual behavior in adolescence through its effect on poor emotion regulation in childhood. Attentional control deficits at age 10 were also related to both infant IDA and heightened risk taking in adolescence. Findings elucidate how poor childhood regulatory abilities associated with infant IDA compromise adjustment in adolescence.
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Tseng PT, Cheng YS, Chen YW, Stubbs B, Whiteley P, Carvalho AF, Li DJ, Chen TY, Yang WC, Tang CH, Chu CS, Yang WC, Liang HY, Wu CK, Yen CF, Lin PY. Peripheral iron levels in children with autism spectrum disorders vs controls: a systematic review and meta-analysis. Nutr Res 2018. [DOI: 10.1016/j.nutres.2017.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Peripheral iron levels in children with attention-deficit hyperactivity disorder: a systematic review and meta-analysis. Sci Rep 2018; 8:788. [PMID: 29335588 PMCID: PMC5768671 DOI: 10.1038/s41598-017-19096-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/16/2017] [Indexed: 01/11/2023] Open
Abstract
There is growing recognition that the risk of attention-deficit hyperactivity disorder (ADHD) in children may be influenced by micronutrient deficiencies, including iron. We conducted this meta-analysis to examine the association between ADHD and iron levels/iron deficiency (ID). We searched for the databases of the PubMed, ScienceDirect, Cochrane CENTRAL, and ClinicalTrials.gov up to August 9th, 2017. Primary outcomes were differences in peripheral iron levels in children with ADHD versus healthy controls (HCs) and the severity of ADHD symptoms in children with/without ID (Hedges' g) and the pooled adjusted odds ratio (OR) of the association between ADHD and ID. Overall, seventeen articles met the inclusion criteria. Peripheral serum ferritin levels were significantly lower in ADHD children (children with ADHD = 1560, HCs = 4691, Hedges' g = -0.246, p = 0.013), but no significant difference in serum iron or transferrin levels. In addition, the severity of ADHD was significantly higher in the children with ID than those without ID (with ID = 79, without ID = 76, Hedges' g = 0.888, p = 0.002), and there was a significant association between ADHD and ID (OR = 1.636, p = 0.031). Our results suggest that ADHD is associated with lower serum ferritin levels and ID. Future longitudinal studies are required to confirm these associations and to elucidate potential mechanisms.
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Wang P, Wang ZY. Metal ions influx is a double edged sword for the pathogenesis of Alzheimer's disease. Ageing Res Rev 2017; 35:265-290. [PMID: 27829171 DOI: 10.1016/j.arr.2016.10.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 09/08/2016] [Accepted: 10/17/2016] [Indexed: 12/17/2022]
Abstract
Alzheimer's disease (AD) is a common form of dementia in aged people, which is defined by two pathological characteristics: β-amyloid protein (Aβ) deposition and tau hyperphosphorylation. Although the mechanisms of AD development are still being debated, a series of evidence supports the idea that metals, such as copper, iron, zinc, magnesium and aluminium, are involved in the pathogenesis of the disease. In particular, the processes of Aβ deposition in senile plaques (SP) and the inclusion of phosphorylated tau in neurofibrillary tangles (NFTs) are markedly influenced by alterations in the homeostasis of the aforementioned metal ions. Moreover, the mechanisms of oxidative stress, synaptic plasticity, neurotoxicity, autophagy and apoptosis mediate the effects of metal ions-induced the aggregation state of Aβ and phosphorylated tau on AD development. More importantly, imbalance of these mechanisms finally caused cognitive decline in different experiment models. Collectively, reconstructing the signaling network that regulates AD progression by metal ions may provide novel insights for developing chelators specific for metal ions to combat AD.
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Affiliation(s)
- Pu Wang
- College of Life and Health Sciences, Northeastern University, No. 3-11, Wenhua Road, Shenyang, 110819, PR China.
| | - Zhan-You Wang
- College of Life and Health Sciences, Northeastern University, No. 3-11, Wenhua Road, Shenyang, 110819, PR China.
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Tooley UA, Makhoul Z, Fisher PA. Nutritional status of foster children in the U.S.: Implications for cognitive and behavioral development. CHILDREN AND YOUTH SERVICES REVIEW 2016; 70:369-374. [PMID: 28626279 PMCID: PMC5472390 DOI: 10.1016/j.childyouth.2016.10.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Children in foster care are at greater risk for poor health, physical, cognitive, behavioral, and developmental outcomes than are children in the general population. Considerable research links early nutrition to later cognitive and behavioral outcomes. The aim of this narrative review is to examine the prevalence of poor nutrition and its relation to subsequent health and development in foster children. METHOD Relevant studies for inclusion were identified from numerous sources (e.g., PubMed, Google Scholar, and reference sections). Inclusion criteria were studies published between 1990 and 2016 of (i) the nutritional status of children in foster care or (ii) the nutritional status of children exposed to early adversity (e.g., low-income and internationally adopted children) or (iii) the developmental effects of poor nutrition and micronutrient deficiencies. RESULTS Two key findings that have adverse implications for cognitive development emerged: (i) the prevalence of anemia and iron-deficiency anemia is higher among foster children than among the general population of children in the U.S., and (ii) the developmental demands of catch-up growth post-placement may lead to micronutrient deficiencies even after children have begun sufficient dietary intake of these nutrients. Moreover, there is a paucity of recent studies on the nutritional status of children in foster care, despite the multiple factors that may place them at risk for malnutrition. CONCLUSION Attention to nutritional status among care providers and medical professionals may remove one of the possible negative influences on foster children's development and in turn significantly alter their trajectories and place them on a more positive path early in life. Recommendations for further research, policy, and practice are discussed.
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Affiliation(s)
- Ursula A. Tooley
- Department of Psychology, University of Oregon, UO Prevention Science Institute, 6217 University of Oregon, Eugene, OR 97403, USA
| | - Zeina Makhoul
- SPOON Foundation, 135 SE Main St, Suite 201, Portland, OR 97214, USA
| | - Philip A. Fisher
- Department of Psychology, University of Oregon, UO Prevention Science Institute, 6217 University of Oregon, Eugene, OR 97403, USA
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Su J, Cui N, Zhou G, Ai Y, Sun G, Zhao SR, Liu J. Hemoglobin Status and Externalizing Behavioral Problems in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13080758. [PMID: 27472352 PMCID: PMC4997444 DOI: 10.3390/ijerph13080758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/07/2016] [Accepted: 07/22/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Still considered one of the most prevalent nutritional problems in the world, anemia has been shown in many studies to have deleterious effects on neurobehavioral development. While most research efforts have focused on investigating the effects of anemia on social and emotional development of infants by using a cross-sectional design, research is still needed to investigate whether early childhood anemia, beyond infantile years, is linked with behavioral problems. OBJECTIVE This study assessed whether (1) hemoglobin (Hb) levels in early childhood are associated with externalizing behavior; and (2) this relationship is confounded by social adversity. METHODS Hemoglobin levels were taken from children (N = 98) of the China Jintan Cohort Study at age 4 years, and externalizing behaviors (attention and aggression) were assessed with the Child Behavior Checklist (ASEBA-CBCL) at age 6 years (mean age 5.77 ± 0.39 years old). RESULTS Compared with other children in the sample, children with relatively lower Hb levels at age 4 had more behavioral problems in both attention and aggression at age 6, independent of social adversity. For boys, this association was significant for attention problems, which did not interact with social adversity. For girls, the association was significant for aggression, which interacted with social adversity. While girls on average exhibited higher social adversity than boys, the main effect of Hb was only significant in girls with low social adversity. CONCLUSIONS These results indicate that there is an inverse association between hemoglobin levels and later behavioral problems. Findings of this study suggest that regular monitoring of children's hemoglobin levels and appropriate intervention may help with early identification of behavioral problems.
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Affiliation(s)
- Jianhua Su
- Department of Neurology, The Jintan Hospital Affiliated to Jiangsu University, 16 Nanmen Street, Jintan, Changzhou 213200, China.
| | - Naixue Cui
- Schools of Nursing and Medicine, University of Pennsylvania, 418 Curie Blvd., Room 426, Claire M. Fagin Hall, Philadelphia, PA 19104, USA.
| | - Guoping Zhou
- Department of Neurology, The Jintan Hospital Affiliated to Jiangsu University, 16 Nanmen Street, Jintan, Changzhou 213200, China.
| | - Yuexian Ai
- Department of Neurology, The Jintan Hospital Affiliated to Jiangsu University, 16 Nanmen Street, Jintan, Changzhou 213200, China.
| | - Guiju Sun
- Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Room #508, 87, DingJiaqiao, Nanjing 210096, China.
| | - Sophie R Zhao
- Schools of Nursing and Medicine, University of Pennsylvania, 418 Curie Blvd., Room 426, Claire M. Fagin Hall, Philadelphia, PA 19104, USA.
| | - Jianghong Liu
- Schools of Nursing and Medicine, University of Pennsylvania, 418 Curie Blvd., Room 426, Claire M. Fagin Hall, Philadelphia, PA 19104, USA.
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van Ginkel JR, Juffer F, Bakermans-Kranenburg MJ, van IJzendoorn MH. Do internationally adopted children in the Netherlands use more medication than their non-adopted peers? Eur J Pediatr 2016; 175:715-25. [PMID: 26847428 PMCID: PMC4839041 DOI: 10.1007/s00431-016-2697-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/19/2016] [Indexed: 11/12/2022]
Abstract
UNLABELLED Empirical evidence has shown that international adoptees present physical growth delays, precocious puberty, behavioral problems, and mental health referrals more often than non-adoptees. We hypothesized that the higher prevalence of (mental) health problems in adoptees is accompanied by elevated consumption of prescription drugs, including antidepressants, attention deficit hyperactivity disorder (ADHD) medication, and medication for growth inhibition/stimulation. In an archival, population-based Dutch cohort study, data on medication use were available from the Health Care Insurance Board by Statistics Netherlands from 2006 to 2011. The Dutch population born between 1994 and 2005 and alive during the period of measurement was included (2,360,450 including 10,602 international adoptees, of which 4447 from China). Their mean age was 6.5 years at start (range 1-12 years) and 11.5 years at the end of the measurement period (range 6-17 years). Chinese female adoptees used less medication for precocious puberty (as treatment for precocious puberty; odds ratio (OR) = 0.57, effect size Cohen's d = -0.31) and contraception (OR = 0.65, d = -0.24) than non-adoptees. For both males and females, non-Chinese adoptees used more medication for ADHD than non-adoptees (males: OR = 1.22, females: OR = 1.32), but the effect was small (males: d = 0.11, females: d = 0.15). CONCLUSIONS Adoptees in the Netherlands generally do not use more medication than their non-adopted peers. WHAT IS KNOWN • Meta-analytical evidence shows that international adoptees present physical growth delays and mental health referrals more often than non-adopted controls. • With the exception of one Swedish study on ADHD medication, there is no other systematic research on medication use of international adoptees. What is New: • All differences in medication use between international adoptees in the Netherlands and non-adopted controls were below the threshold of a small effect with the exception of medication for precocious puberty, but this effect was in the opposite direction with female adoptees using less medication for precocious puberty than non-adoptees. • International adoptees in the Netherlands do not use more medication despite experiences of preadoption adversity and higher rates of mental health referrals during childhood and adolescence.
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Affiliation(s)
- Joost R. van Ginkel
- Centre for Child and Family Studies, Leiden University, P.O. Box 9555, 2300 RB Leiden, The Netherlands
| | - Femmie Juffer
- Centre for Child and Family Studies, Leiden University, P.O. Box 9555, 2300 RB Leiden, The Netherlands
| | | | - Marinus H. van IJzendoorn
- Centre for Child and Family Studies, Leiden University, P.O. Box 9555, 2300 RB Leiden, The Netherlands
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18
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Predictors of developmental status in young children living in institutional care in Kazakhstan. Matern Child Health J 2016; 19:1408-16. [PMID: 25480471 DOI: 10.1007/s10995-014-1647-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The main objective of this study was to assess the developmental status of children living in the severely adverse environment of institutional care and the examination of risk factors with regard to developmental status, including degree of stunting and emotional-behavioral and anemia status. The Bayley Scales of Infant Development were used to assess development status in 103 children aged 14.9 months (SD = 6.8) in six Kazakh institutions. The Behavioral Rating Scales were used to assess emotional-behavioral regulation. Physical growth measures were converted to z scores using World Health Organization growth charts. Venous blood was collected for assessment of anemia. Our findings indicated that young children in institutions were developmentally compromised, with duration of institutional care correlated with the severity of delay. Negative predictors of developmental status included: Poor emotional-behavioral regulation, degree of stunting and age at assessment. A particularly large percentage of children were found to be anemic. Additionally, low birth weight was found to be a significant negative predictor of development. Our findings indicate that institutional care has a detrimental impact on the development and emotional regulation of young children. Time in institutional care is a negative predictor for cognitive status for children placed at birth. Moreover stunting was found to be a useful indicator of the degree of impact of early adversity on cognitive development. Particular attention is needed for special-needs children such as those with low birth weight, since their development was found to be more sensitive to early adversity than that of normal birth weight children.
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Fuglestad AJ, Kroupina MG, Johnson DE, Georgieff MK. Micronutrient status and neurodevelopment in internationally adopted children. Acta Paediatr 2016; 105:e67-76. [PMID: 26439893 DOI: 10.1111/apa.13234] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 09/22/2015] [Accepted: 09/29/2015] [Indexed: 11/27/2022]
Abstract
AIM To assess the status of nutrients relevant for brain development in internationally adoptees from disparate global regions and determine whether identified deficiencies are associated with neurodevelopment. METHODS Participants included children adopted from Post-Soviet States (n = 15), Ethiopia (n = 26) or China (n = 17), ages 8-18 months. A comprehensive nutritional battery and a neurodevelopmental assessment were completed at baseline (within one month of arrival) and follow-up (six months later). RESULTS At baseline, 35% were stunted, and 68% had at least one abnormal nutritional biochemical marker. The most common were low retinol-binding protein (33%), zinc deficiency (29%), vitamin D insufficiency/deficiency (21%), and iron deficiency (15%). There was significant catch-up growth in height and weight at follow-up, but little improvement in micronutrient deficiencies. Iron deficiency was associated with lower cognitive scores on the Bayley Scales of Infant Development-III, p = 0.027, and slower speed of processing, p = 0.012. Zinc deficiency was associated with compromised memory functioning, p = 0.001. CONCLUSION Nutrient deficiencies were common during the early adoption period in internationally adoptees from three global regions, and iron and zinc deficiencies were associated with poorer neurodevelopmental outcomes. Results emphasise the importance of monitoring micronutrient status at arrival and during the early adoption period, irrespective of country of origin.
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Affiliation(s)
- Anita J. Fuglestad
- Department of Psychology; University of North Florida; Jacksonville FL USA
| | - Maria G. Kroupina
- Department of Pediatrics; University of Minnesota; Minneapolis MN USA
| | - Dana E. Johnson
- Department of Pediatrics; University of Minnesota; Minneapolis MN USA
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20
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Hearst MO, Himes JH, Johnson DE, Kroupina M, Syzdykova A, Aidjanov M, Sharmonov T. Growth, nutritional, and developmental status of young children living in orphanages in Kazakhstan. Infant Ment Health J 2015; 35:94-101. [PMID: 25798515 DOI: 10.1002/imhj.21430] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article describes the nutritional and developmental status of young children living in Baby Houses (orphanages for children ages 0-3 years) in Kazakhstan. In 2009/2010, 308 children under age 3 years living in 10 Baby Houses were measured for height/length and weight. The Bayley Scales of Infant Development (N. Bayley, 2006) were used to assess mental and motor development. Blood was collected on a subsample to assess key nutritional factors. The World Health Organization growth charts were used to calculate Z-scores. Cut points for wasting (moderate to severe low weight for length/height growth), underweight (low weight for age), stunting (low length/height for age), development, and biomarkers used established guidelines. Most (n = 286) children had complete data on z-scores. Of these, 22.1% were experiencing wasting, 31.5% were underweight, and 36.7% had stunting. The nutritional status of the children, based on blood biomarkers, revealed that 37.1% of the children were anemic, 21.4% had low albumin, 38.1% had low vitamin D, 5.5% were iodine-deficient, and 2% had low serum zinc. One half had mild to significant mental and motor delays. Children living at these Baby Houses in Kazakhstan have substantial nutritional deficits and developmental delays. Focused attention is needed to provide a nutritionally enhanced diet and improved developmental opportunities to improve the long-term outcomes for these children.
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21
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Doom JR, Georgieff MK, Gunnar MR. Institutional care and iron deficiency increase ADHD symptomology and lower IQ 2.5-5 years post-adoption. Dev Sci 2015; 18:484-94. [PMID: 25070881 PMCID: PMC4309749 DOI: 10.1111/desc.12223] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 06/06/2014] [Indexed: 12/18/2022]
Abstract
Increased ADHD symptomology and lower IQ have been reported in internationally adopted (IA) children compared to non-adopted peers (Hostinar, Stellern, Schaefer, Carlson & Gunnar, 2012; Kreppner, O'Connor & Rutter, 2001). However, it is unclear whether these outcomes are due to institutional deprivation specifically or to co-occurring micronutrient deficiencies that disrupt brain development (Fuglestad, Rao & Georgieff, 2008b). In this study, IA children were compared to children raised in their biological families to examine differences in ADHD symptomology and IQ 2.5-5 years post-adoption and to assess the contributions of iron deficiency (ID) and duration of deprivation to these cognitive outcomes. ADHD symptoms (parent- and experimenter-reported) and IQ were evaluated in 88 IA (M = 62.1 months, SD = 2.4) and 35 non-adopted children (M = 61.4 months, SD = 1.6). IA children were assessed 29-64 months post-adoption (M = 41.9 months, SD = 10.2). ID was assessed during the initial post-adoption medical visit in 69 children, and children were classified into four groups by iron status, ranging from normal to ID anemia (most severe). IA children had greater ADHD symptomology, p < .01, and lower IQ, p = .001, than non-adopted children. Within the IA group, children with more severe ID at adoption had greater ADHD symptomology, r(69) = 0.40, p = .001, and lower IQ, r(68) = -0.28, p < .05. Duration of institutional care was positively correlated with ADHD symptoms, r(86) = .28, p < .01, but not IQ, r(85) = -.08, p = .52. Longitudinal results indicate improvement in IQ from 12 months post-adoption to age 5 for children with greater ID severity at adoption and longer duration of institutional care but no improvement in ADHD symptoms. These results signify continuing effects of early deprivation and ID on ADHD symptoms and IQ years after adoption. A video abstract of this article can be viewed at http://www.youtube.com/watch?v=vUFDAS3DD1c.
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Affiliation(s)
- Jenalee R Doom
- Institute of Child Development, University of Minnesota, USA; Center for Neurobehavioral Development, University of Minnesota, USA
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22
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Jeong KS, Park H, Ha E, Hong YC, Ha M, Park H, Kim BN, Lee SJ, Lee KY, Kim JH, Kim Y. Evidence that cognitive deficit in children is associated not only with iron deficiency, but also with blood lead concentration: a preliminary study. J Trace Elem Med Biol 2015; 29:336-41. [PMID: 25224739 DOI: 10.1016/j.jtemb.2014.08.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/11/2014] [Accepted: 08/25/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate whether blood lead concentrations are elevated in iron-deficient children, and to examine the association between iron deficiency and/or elevated blood lead concentration and cognitive deficits in children. METHOD The present study is a component of the Mothers' and Children's Environmental Health (MOCEH) study, a multi-center birth cohort project in Korea that began in 2006. The study cohort consisted of 194 children who underwent testing of blood lead and serum C-reactive proteins (CRPs) and ferritin concentrations, and the Korean version of the Wechsler Preschool and Primary Scale of Intelligence, revised edition (WPPSI-R), at 60 months of age. In addition, the mothers' blood lead concentrations during pregnancy were included in the analyses. Multivariate linear regression analysis was performed to analyze the correlation between high blood lead and low serum ferritin concentrations, after adjustment for covariates, in children, as well as to analyze the association of verbal IQ with serum ferritin and blood lead concentrations. RESULTS Lead and ferritin concentrations were inversely and significantly associated in children after adjustment for covariates. Moreover, both concentrations were associated with verbal IQ, after adjustment for covariates, and each was associated with cognitive deficits after adjustment for the other. Sobel test statistics showed that blood lead concentration was a significant partial mediator for the relationship between iron deficiency and verbal IQ. CONCLUSION Due to the results discussed in the present study, cognitive deficit in children seems to be associated not only with iron deficiency, but also with blood lead concentration.
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Affiliation(s)
- Kyoung Sook Jeong
- Department of Occupational and Environmental Medicine, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Hyewon Park
- Department of Child and Family Welfare, University of Ulsan, Ulsan, Republic of Korea
| | - Eunhee Ha
- Department of Preventive Medicine, Ewha Medical Research Center, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Yun-Chul Hong
- Institute of Environmental Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Mina Ha
- Department of Preventive Medicine, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Hyesook Park
- Department of Preventive Medicine, Ewha Medical Research Center, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Bung-Nyun Kim
- Department of Psychiatry, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Soo-Jeong Lee
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Kyung Yeon Lee
- Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Ja Hyeong Kim
- Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Yangho Kim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
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Striking while the iron is hot: Understanding the biological and neurodevelopmental effects of iron deficiency to optimize intervention in early childhood. CURRENT PEDIATRICS REPORTS 2014; 2:291-298. [PMID: 25512881 DOI: 10.1007/s40124-014-0058-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Prenatal and early postnatal iron deficiency (ID) is associated with long-term neurobiological alterations and disruptions in cognitive, social, and behavioral development. Early life ID is particularly detrimental as this is a period of rapid neurodevelopment. Even after iron supplementation, cognitive and social disruptions often persist in formerly iron deficient individuals. Observational studies of the acute and long-term effects of early life ID yield different results based on the timing of ID. Further, intervention studies demonstrate some improvement for certain domains but still show residual effects years later, which are dependent on the timing of ID and treatment. This review will cover the effects of ID during infancy and early childhood on brain structure and function, cognition, and behavior in relation to preclinical models of ID and sensitive periods of human brain development.
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Greminger AR, Lee DL, Shrager P, Mayer-Pröschel M. Gestational iron deficiency differentially alters the structure and function of white and gray matter brain regions of developing rats. J Nutr 2014; 144:1058-66. [PMID: 24744313 PMCID: PMC4056646 DOI: 10.3945/jn.113.187732] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Gestational iron deficiency (ID) has been associated with a wide variety of central nervous system (CNS) impairments in developing offspring. However, a focus on singular regions has impeded an understanding of the CNS-wide effects of this micronutrient deficiency. Because the developing brain requires iron during specific phases of growth in a region-specific manner, we hypothesized that maternal iron deprivation would lead to region-specific impairments in the CNS of offspring. Female rats were fed an iron control (Fe+) or iron-deficient (Fe-) diet containing 240 or 6 μg/g iron during gestation and lactation. The corpus callosum (CC), hippocampus, and cortex of the offspring were analyzed at postnatal day 21 (P21) and/or P40 using structural and functional measures. In the CC at P40, ID was associated with reduced peak amplitudes of compound action potentials specific to myelinated axons, in which diameters were reduced by ∼20% compared with Fe+ controls. In the hippocampus, ID was associated with a 25% reduction in basal dendritic length of pyramidal neurons at P21, whereas branching complexity was unaffected. We also identified a shift toward increased proximal branching of apical dendrites in ID without an effect on overall length compared with Fe+ controls. ID also affected cortical neurons, but unlike the hippocampus, both apical and basal dendrites displayed a uniform decrease in branching complexity, with no significant effect on overall length. These deficits culminated in significantly poorer performance of P40 Fe- offspring in the novel object recognition task. Collectively, these results demonstrate that non-anemic gestational ID has a significant and region-specific impact on neuronal development and may provide a framework for understanding and recognizing the presentation of clinical symptoms of ID.
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Affiliation(s)
| | - Dawn L. Lee
- Biomedical Genetics,Pathology and Laboratory Medicine, and
| | - Peter Shrager
- Neurobiology and Anatomy, University of Rochester, Rochester, NY
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Doom JR, Gunnar MR, Georgieff MK, Kroupina MG, Frenn K, Fuglestad AJ, Carlson SM. Beyond stimulus deprivation: iron deficiency and cognitive deficits in postinstitutionalized children. Child Dev 2014; 85:1805-12. [PMID: 24597672 DOI: 10.1111/cdev.12231] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Children adopted from institutions have been studied as models of the impact of stimulus deprivation on cognitive development (Nelson, Bos, Gunnar, & Sonuga-Barke, 2011), but these children may also suffer from micronutrient deficiencies (Fuglestad et al., 2008). The contributions of iron deficiency (ID) and duration of deprivation on cognitive functioning in children adopted from institutions between 17 and 36 months of age were examined. ID was assessed in 55 children soon after adoption, and cognitive functioning was evaluated 11-14.6 months postadoption when the children averaged 37.4 months old (SD = 4.9). ID at adoption and longer duration of institutional care independently predicted lower IQ scores and executive function (EF) performance. IQ did not mediate the association between ID and EF.
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Affiliation(s)
- Jenalee R Doom
- Institute of Child Development and Center for Neurobehavioral Development, University of Minnesota
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26
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Abstract
Micronutrient deficiencies, especially those related to iodine and iron, are linked to different cognitive impairments, as well as to potential long-term behavioral changes. Among the cognitive impairments caused by iron deficiency, those referring to attention span, intelligence, and sensory perception functions are mainly cited, as well as those associated with emotions and behavior, often directly related to the presence of iron deficiency anemia. In addition, iron deficiency without anemia may cause cognitive disturbances. At present, the prevalence of iron deficiency and iron deficiency anemia is 2%-6% among European children. Given the importance of iron deficiency relative to proper cognitive development and the alterations that can persist through adulthood as a result of this deficiency, the objective of this study was to review the current state of knowledge about this health problem. The relevance of iron deficiency and iron deficiency anemia, the distinction between the cognitive consequences of iron deficiency and those affecting specifically cognitive development, and the debate about the utility of iron supplements are the most relevant and controversial topics. Despite there being methodological differences among studies, there is some evidence that iron supplementation improves cognitive functions. Nevertheless, this must be confirmed by means of adequate follow-up studies among different groups.
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