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Iron Deficiency in Infancy: Impact on Cognitive Development and Performance

Iron Deficiency in Infancy: Impact on Cognitive Development and Performance. Betsy Lozoff, M.D. Working Group Ottawa, Canada September 2002. Iron and the Brain. Neuro- anatomy. Neuro- chemistry. Neuro- metabolism. Preventive Trial in Chile. Full-term no health problems, BW  3.0 kg

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Iron Deficiency in Infancy: Impact on Cognitive Development and Performance

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  1. Iron Deficiency in Infancy:Impact on Cognitive Development and Performance Betsy Lozoff, M.D. Working Group Ottawa, Canada September 2002

  2. Iron and the Brain Neuro-anatomy Neuro-chemistry Neuro- metabolism

  3. Preventive Trial in Chile • Full-term no health problems, BW  3.0 kg • Screened for anemia at 6 months • Randomly assigned to high or low; high or no-added-iron • Specific, sensitive measures • 1657 healthy infants completed trial

  4. Initial Analyses • No difference in growth • No behavior/development differences between high- and low-iron groups • Combined to form iron-supplemented group • No differences between iron and no-iron groups on global test scores • Effects in every other domain

  5. Source: This IS the original slide linked to the datasheet. Do NOT delink (duplicate first). Data came from “Behavioral and Developmental Benefits of Iron Supplementation in Healthy Full-Term Infants”, table 3 (Significant Items). Created by M. Perez. Iron-Supplemented(n=1082) No-Added-Iron (n=531) Behavior Rating Scale1 * * *** ** * Percent (%) * 1 Controlling for a comprehensive set of background factors *p<0.05, **p<0.01, ***p<0.001

  6. Role of Dopamine • Extraneous motor movements – Tremor • Behavioral activation/inhibition; inherent reward – Affective changes – Social referencing – Adaptability

  7. Source: H:\USERS\BLRSRCH\PPT\sitevisit\March31final\ Slide show A. This slide was originally created by Rosa. Design/color pattern altered by M. Perez. Total Motor Activity Around a Daytime Nap in the Laboratory Control (n’s=4-9) Anemic (n’s=7-11) 100 80 * * 60 Frequency (m.u./min) 40 20 0 6 12 18 Age (months) *p<0.05 Source: Angulo-Kinzler, et al. (2002). Spontaneous motor activity in human infants with iron-deficiency anemia. Early Human Development, 66: 67-79.

  8. Long-Term Effects on Nerve Conduction • 3- to 4-year-olds with or without IDA in infancy • Auditory brainstem responses (ABRs) in former IDA children (n=29) and controls (n=35) • Visual evoked potentials (VEPs) in former IDA children (n=40) and controls (n=40)

  9. Source: H:\USERS\BLRSRCH\PPT\effect size abrvep ORIGIN.ppt Evoked Potential Latencies at 3 - 4 Years: Differences between Former IDA Children and Control 1.0 0.5 Effect Size (in SD units) 0.0 -0.5 - - - - - - - - - - - - - - - - - - - - - - - - - - -1.0 -1.5 Wave I Wave III Wave V I-III III-V I-V P100 Interval Interval Interval ABR VEP

  10. Inferences Regarding Myelination • Differences in latency but not amplitude suggests altered myelination • Long-lasting differences in at least 2 sensory systems • Other intracerebral effects seem likely • Impaired myelination could underlie other poorer outcomes

  11. Source: This IS the original slide linked to the datasheet. Do NOT delink (duplicate first). Data came from “Behavioral and Developmental Benefits of Iron Supplementation in Healthy Full-Term Infants”, table 3. Created by M. Perez. Iron-Supplemented (n=1082) No-Added-Iron (n=531) Specific Developmental Outcomes at 12 Months1 ** * Seconds Days Fagan Test 1 Controlling for a comprehensive set of background factors *p<0.05, **p<0.01

  12. Overall Impact • Delayed or mistimed sensory input • Less seeking/receiving stimulation • Reduced input from physical/social environment Consequences • Secondary effects on brain structure and function

  13. Disadvantaged Environment Quality of Parent-Child Transactions CNS Development and Function Behavioral/Developmental Outcome Iron Deficiency Level of Child Involvement with the Environment Functional Isolation

  14. Brain and Behavior in Early Iron DeficiencyUnresolved Issues • Specific CNS alterations • Iron deficiency without anemia • Reversibility with iron therapy • Timing and duration • Causal connections • Underlying mechanisms

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