Development of Iron Status Measures during Youth: Associations with Sex, Neighborhood Socioeconomic Status, Cognitive Performance, and Brain Structure

BACKGROUND

Iron is essential to brain function, and iron deficiency during youth may adversely impact neurodevelopment. Understanding the developmental time course of iron status and its association with neurocognitive functioning is important for identifying windows for intervention.

OBJECTIVES

This study aimed to characterize developmental change in iron status and understand its association with cognitive performance and brain structure during adolescence using data from a large pediatric health network.

METHODS

This study included a cross-sectional sample of 4899 participants (2178 males; aged 8-22 y at the time of participation, M [SD] = 14.24 [3.7]) who were recruited from the Children's Hospital of Philadelphia network. Prospectively collected research data were enriched with electronic medical record data that included hematological measures related to iron status, including serum hemoglobin, ferritin, and transferrin (33,015 total samples). At the time of participation, cognitive performance was assessed using the Penn Computerized Neurocognitive Battery, and brain white matter integrity was assessed using diffusion-weighted MRI in a subset of individuals.

RESULTS

Developmental trajectories were characterized for all metrics and revealed that sex differences emerged after menarche such that females had reduced iron status relative to males [all R2partial > 0.008; all false discovery rates (FDRs) < 0.05]. Higher socioeconomic status was associated with higher hemoglobin concentrations throughout development (R2partial = 0.005; FDR < 0.001), and the association was greatest during adolescence. Higher hemoglobin concentrations were associated with better cognitive performance during adolescence (R2partial = 0.02; FDR < 0.001) and mediated the association between sex and cognition (mediation effect = -0.107; 95% CI: -0.191, -0.02). Higher hemoglobin concentration was also associated with greater brain white matter integrity in the neuroimaging subsample (R2partial = 0.06, FDR = 0.028).

CONCLUSIONS

Iron status evolves during youth and is lowest in females and individuals of low socioeconomic status during adolescence. Diminished iron status during adolescence has consequences for neurocognition, suggesting that this critical period of neurodevelopment may be an important window for intervention that has the potential to reduce health disparities in at-risk populations.

Changes in anemia and anthropometry during adolescence predict learning outcomes: findings from a 3-year longitudinal study in India

BACKGROUND

Anemia and poor physical growth during adolescence have far-ranging consequences, but limited longitudinal evidence exists on how changes in these factors relate to changes in learning skills as adolescents mature.

OBJECTIVES

We examined the association between changes in anemia and physical growth during adolescence and learning outcomes.

METHODS

We used longitudinal data from the Understanding the Lives of Adolescents and Young Adults (UDAYA) project, which surveyed adolescents aged 10-19 y in northern India in 2015-2016 and 2018-2019 (n = 5963). We used multilevel mixed-effects logistic regression models to examine associations between changes in anemia/thinness/stunting status (4 groups: never, improved, new, and persistent) and reading (ability to read a story) and math proficiency (ability to solve division problems) at follow-up.

RESULTS

Persistent anemia and stunting were higher among girls than among boys (46% compared with 8% and 37% compared with 14%, respectively), but persistent thinness was lower (7% compared with 16%). Improvement in anemia, thinness, and stunting was 1.4-1.7 times higher among boys than among girls. Boys who were anemic in both waves were 74% [adjusted odds ratio (AOR): 0.26; 95% CI: 0.12, 0.59] and 65% (AOR: 0.35; 95% CI: 0.16, 0.76) less likely to be able to read a story and solve division problems, respectively, than boys who were nonanemic in both waves. Persistent thinness in boys was negatively associated with both reading (AOR: 0.37; 95% CI: 0.21, 0.66) and math proficiency (AOR: 0.27; 95% CI: 0.16, 0.46). Persistent stunting contributed to lower reading and math proficiency in boys and girls (AORs: 0.29-0.46). Boys whose anemia or thinness status improved and girls whose stunting status improved had similar learning skills at follow-up as those who were never anemic/thin/stunted.

CONCLUSIONS

Persistent anemia, thinness, and short stature during adolescence were associated with poor learning. Programs targeted at adolescents should contribute to nurturing environments that foster healthy growth and learning.

Iron Status, Anemia, and Iron Interventions and Their Associations with Cognitive and Academic Performance in Adolescents: A Systematic Review

In adolescents, iron-deficiency anemia is the leading cause of disability-adjusted life years lost. The World Health Organization recommends delivering iron supplementation through school-based platforms, requiring partnerships with the education sector. This anemia-reduction intervention is valued for the perceived benefits of improved learning and school performance. This article aims to systematically review the available evidence on the relationship between iron status and anemia and impacts of iron interventions on cognitive and academic performance in adolescents. Fifty studies were included: n = 26 cross-sectional and n = 24 iron-containing interventions. Our review suggests that iron status and anemia may be associated with academic performance in some contexts and that iron supplementation during adolescence may improve school performance, attention, and concentration. However, nearly all supplementation trials were judged to have moderate or high risk of bias. We did not find evidence suggesting that iron status and anemia influenced or were associated with attention, intelligence, nor memory in adolescents. Further, iron supplementation did not improve memory and recall or intelligence. Overall, more high-quality research is needed to guide programmers and policy makers to understand the relationships between anemia and educational performance and the potential impacts of iron interventions, which effectively reduce anemia, on adolescents’ learning and school performance.

Trends and factors associated with the nutritional status of adolescent girls in Ghana: a secondary analysis of the 2003-2014 Ghana demographic and health survey (GDHS) data

OBJECTIVE

We examined the trends over time and the factors associated with malnutrition among adolescent girls in Ghana.

DESIGN

Cross-sectional analysis from 3 nationwide Ghana Demographic and Health Surveys conducted in 2003 (n 983), 2008 (n 955) and 2014 (n 857). We used Cox proportional hazard models with sample weighting to model the prevalence ratio (PR) of malnutrition.

SETTING

Countrywide, covering rural and urban areas in Ghana.

PARTICIPANTS

Non-pregnant adolescent girls aged 15-19 years.

RESULTS

Compared with 2003, thinness declined marginally (PR 0·88 (95 % CI 0·45, 1·73)) in 2008 and in 2014 (PR 0·71 (95 % CI 0·38, 1·56)). Stunting declined marginally by 19 % in 2008 (PR 0·81 (95 % CI 0·59, 1·12)), flattening out in 2014 (PR 0·81 (95 % CI 0·57, 1·17)). We found an increasing trend of overweight/obesity with the PR peaking in 2014 (PR 1·39 (95 % CI 1·02, 1·88)) compared to 2003. The anaemia prevalence remained severe without a clear trend. A low level of education of the adolescent girl was positively associated with stunting. Increasing age was positively associated with stunting but inversely associated with thinness and anaemia. Girls who ever bore a child were more likely to be anaemic compared to those who never did. A lower level of household wealth and a unit increase in household size was negatively associated with overweight/obesity. Urban dwelling girls were less likely to be stunted.

CONCLUSIONS

The stagnant burden of under-nutrition and rising over-nutrition emphasise the need for double-duty actions to tackle malnutrition in all its forms in Ghanaian adolescent girls.

Ten2Twenty-Ghana: Study Design and Methods for an Innovative Randomized Controlled Trial with Multiple-Micronutrient-Fortified Biscuits among Adolescent Girls in Northeastern Ghana

Investing in adolescent girls' nutrition is vital for health and for breaking the intergenerational cycle of malnutrition and deprivation, but limited knowledge on the type, timing, and efficacy of interventions delays progress. We describe the design of a 26-wk randomized placebo-controlled trial with multiple-micronutrient-fortified biscuits (MMBs) among adolescent girls in northeastern Ghana. Apparently healthy, premenarche (n = 312) and postmenarche (n = 309) girls (10-17 y) were randomly assigned to receive the following for 5 d/wk: 1) MMBs (fortified with 11 vitamins and 7 minerals) or 2) unfortified biscuits. Data included plasma micronutrient status, anthropometry, body composition, cognitive function, psychosocial health, fertility, dietary intake, and sociodemographic and socioeconomic covariates, complemented with in-depth interviews (n = 30) and 4 focus group discussions. We hypothesized an increase in plasma ferritin and retinol-binding protein with a resultant increase in hemoglobin, cognition, vertical height, and psychosocial health. Our study seeks to investigate the efficacy and optimal timing of a multiple-micronutrient food intervention program for adolescent girls. The RCT was registered prospectively with the Netherlands Clinical Trials Register (NL7487).

Anemia and Its Determinants among Male and Female Adolescents in Southern Ethiopia: A Comparative Cross-Sectional Study

Background

Adolescent anemia is a major public health problem worldwide. Adolescents (10–19 years) are at an increased risk of developing anemia due to increased iron demand during puberty, menstrual losses, limited dietary iron intake, and faulty dietary habits.

Objective

To assess the prevalence of anemia and associated factors among male and female adolescent students in Dilla Town, Gedeo Zone, Southern Ethiopia, May 2018.

Methods

A school-based comparative cross-sectional study was employed among 742 school adolescents. Basic characteristics, anthropometric measurements, haemoglobin measurement, and others were collected. Data were analyzed using SPSS version 20 software, and descriptive statistics were computed for all variables. Bivariate and multivariable logistic regression analyses using binary logistic regression were done, the results were interpreted by using AOR with their corresponding 95% CI, and statistically significant difference was declared at p < 0.05

Result

Out of the total 742 respondents, 377 (50.8%) were males and 365 (49.2%) were females. The overall prevalence of anemia was 21.1%, and the prevalence of anemia was 22.5% among male adolescents and 19.7% among females. Male adolescent students within the early adolescence age group (10–13 yrs) (AOR 0.27, 95% CI, 0.08–0.87), those consuming fibre-rich foods daily (AOR 0.11, 95% CI, 0.02–0.61), and those having no intestinal parasites (AOR 0.04, 95% CI, 0.02–0.09) were less likely to be anemic. Similarly, female adolescent students not having intestinal parasites (AOR 0.05, 95% CI, 0.01–0.11) were less likely to develop anemia while those from malaria endemic area (AOR 2.57, 95% CI, 1.13–5.83) were identified to be more anemic.

Conclusion

This study identified that anemia was a moderate public health significance in the study area, and the prevalence of anemia was slightly higher among male than female adolescents. Age category, frequency of eating fibre-rich foods, and positive intestinal parasite tests were factors contributing for anemia among male adolescents while presence of intestinal parasite and malaria endemicity were the determinants of anemia among female adolescents.

Iron Deficiency Anemia among In-School Adolescent Girls in Rural Area of Bahir Dar City Administration, North West Ethiopia

BACKGROUND

Anemia is a major public health problem worldwide. Adolescent girls are the most vulnerable group of population due to different reasons. The aim of this study was to assess the prevalence of anemia and associated factors among school adolescent girls in rural towns of Bahir Dar City Administration, North West Ethiopia.

METHODS

A cross-sectional study was conducted from March 5 to April 15, 2017, on 443 randomly selected school adolescent girls. Data were collected using pretested structured questionnaire and anthropometric measurements. Blood sample was also collected to assess the hemoglobin (Hgb) value of study participants. SPSS version 20 was used to analyze data. Descriptive statistics were used to describe data. Bivariate and multivariable logistic regression models were used to identify the associated factors with the outcome variable. Crude and adjusted odds ratios with 95% confidence interval (CI) were calculated to identify the variables significantly associated with the outcome variable.

RESULT

The prevalence of anemia was 11.1%. Household family size [AOR=3.2, 95%CI (1.29-7.89)], average household monthly income <500 ETB [AOR=10; 95%CI (2.49-41.26)], 501-1000 ETB [AOR=6, 95%CI (2.54-14.33)], history of intestinal parasitic infection [AOR=2.7; 95% CI (1.19-6.21)], duration of menstruation flow [AOR=2.4; 95%CI (1.08- 5.44)], and BMI for age [AOR-3.2; 95% CI (1.43-7.05)] were the predictors of anemia.

CONCLUSION AND RECOMMENDATION

Anemia was a mild public health problem among school adolescent girls in the study area. Household monthly income, family size, intestinal parasite infections, duration of menstruation, and BMI for age are predictors of anemia. Thus, intervention strategies should focus on prevention and early treatment of intestinal parasite, nutritional education, screening, and iron supplementation programs to prevent anemia among school adolescent girls.

Prevalence and associated factors of anemia among adolescent girls attending high schools in Dembia District, Northwest Ethiopia, 2017

Introduction

Anemia is a global public health problem affecting both developing and developed countries. In Ethiopia, Adolescent girls are more vulnerable to anemia because of gender norms can leave girls disproportionately impacted by food insecurity, increased iron requirements related to their rapid growth, and menstrual loss. However, evidence on the problem is scarce because it has not been given due attention in Ethiopia. Therefore, this study assessed the prevalence and associated factors of anemia among late adolescent girls attending high schools in Dembia District, northwest Ethiopia.

Methods

A school based cross-sectional study was conducted in Dembia District from March 1 to April 30/ 2017. Out of the randomly selected three high schools, 462 adolescents were included using the simple random sampling technique. A Standardized structured questionnaire was used to collect data. Capillary blood samples were drawn from adolescents using a portable Hb201+ instrument to measure hemoglobin. A bivariate and multivariable binary logistic regression analyses were employed to identify factors associated with anemia. Adjusted Odds Ratio (AOR) with a corresponding 95% Confidence Interval (CI) was computed to show the strength of associations.

Results

The overall prevalence of anaemia among adolescent girls was 25.5%, (95%CI, 21.4, and 29.2). Of the total anemic adolescents, 109(92.4%) had mild anaemia, while 7(5.9%) and 2(1.7%) were found with moderate and severe anaemia, respectively. Dietary diversity score ((AOR =4.2(95% CI;1.7, 10.5)), household food security status ((AOR = 4.1(95% CI; 1.3, 13.2)), living status of adolescents with either of the two parents((AOR = 2;(95%CI;1.14,3.6)) and guardians ((AOR = 2.4;(95% CI;1.02,5.6)) showed statistically significant association with anemia.

Conclusion

Anemia is a moderate public health problem in Dembia District. Dietary diversity score, household food security status, and living status of adolescents were the key determinants of anemia. Therefore, the government should focus on preventing food insecurity with increasing productivity to improve dietary diversification of the adolescent girls.

Trial registration

Retrospectively registered.