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Preventing early, prolonged vitamin E deficiency: an opportunity for better cognitive outcomes via early diagnosis
Rebecca L Koscik1, HuiChuan J Lai, Anita Laxova
1Department of Biostatistics/Medical Informatics, Nutritional Sciences, and Pediatrics, University of Wisconsin, Madison, WI 53792, USA. koscik@biostat.wisc.edu
Insights
Early diagnosis of cystic fibrosis (CF) via newborn screening (NBS) and adequate vitamin E levels are linked to better cognitive function in children. Prolonged vitamin E deficiency in infancy may negatively impact cognitive development.
Area of Science:
- Pediatric Health
- Neuroscience
- Nutritional Science
Background:
- Cystic Fibrosis (CF) affects multiple organs, including potential impacts on neurodevelopment.
- Vitamin E (alpha-tocopherol) is crucial for neurological health, and deficiency is common in CF.
- Newborn screening (NBS) allows for early CF diagnosis and intervention.
Purpose of the Study:
- To investigate the association between early CF diagnosis through NBS and early vitamin E status with cognitive function in children.
- To determine if vitamin E deficiency in infancy impacts later cognitive performance in children with CF.
- To explore the role of NBS in potentially mitigating cognitive deficits in CF.
Main Methods:
- Cognitive function was assessed using the Test of Cognitive Skills, 2nd edition in 71 children (ages 7.3-16.9) from the Wisconsin CF Neonatal Screening Project.
- Children were categorized into screened (S) or control (C) groups, and by vitamin E status (alpha-tocopherol <300 microg/dL or >300 microg/dL) at diagnosis.
- Analysis of covariance was used to evaluate cognitive skills index (CSI) scores across the four groups, adjusting for covariates.
Main Results:
- Children in the control group with vitamin E deficiency (<300E) showed significantly lower CSI scores compared to all other groups (control without deficiency, screened with deficiency, screened without deficiency).
- The highest proportion of low cognitive scores (CSI >84) was observed in the control group with vitamin E deficiency (41%).
- This group also exhibited the lowest mean head circumference z-scores at diagnosis, suggesting potential early developmental impacts.
Conclusions:
- Prolonged vitamin E deficiency during infancy is associated with reduced cognitive performance in children.
- Early diagnosis of CF through NBS may support better cognitive development, especially for children at risk of vitamin E deficiency.
- Optimizing vitamin E status in infancy is critical for the neurocognitive outcomes of children with CF diagnosed via NBS.
Objective:
To evaluate whether early diagnosis of cystic fibrosis (CF) through newborn screening (NBS) and early vitamin E status are associated with cognitive function.
Study Design:
We assessed cognitive function for 71 children without meconium ileus (ages 7.3-16.9 years) enrolled in the screened (S) or control (C) group of the Wisconsin CF Neonatal Screening Project. The Test of Cognitive Skills, 2nd edition generated the cognitive skills index (CSI; mean = 100, SD = 16). Vitamin E deficiency at diagnosis was defined as plasma alpha-tocopherol (alpha-T) below 300 microg/dL (<300E). Primary analyses evaluated CSI scores across the 4 levels of group (S or C) by using alpha-T status (<300E or >300E) with analysis of covariance.
Results:
After adjusting for covariates, CSI in the C<300E group was significantly lower than each of the other groups (C>300E, S<300E, and S>300E; P < .05). The highest proportion of CSI scores >84 occurred in the C<300E group (41%). Patients in this group also had the lowest mean head circumference z-scores at diagnosis.
Conclusions:
Our results show that prolonged alpha-T deficiency in infancy is associated with lower subsequent cognitive performance. Thus, diagnosis via NBS may benefit the cognitive development of children with CF, particularly in those prone to vitamin E deficiency during infancy.
