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Microcytosis is associated with low cognitive outcomes in healthy 2-year-olds in a high-resource setting
Elaine K McCarthy1, Mairead E Kiely1, Geraldine Hannon2
11Cork Centre for Vitamin D and Nutrition Research,University College Cork,Cork,Republic of Ireland.
Insights
Iron deficiency in healthy toddlers is linked to lower cognitive scores, even without anemia. Microcytosis, a sign of potential iron issues, indicates a need to re-evaluate diagnostic criteria for early childhood iron status.
Area of Science:
- Pediatric Nutrition
- Developmental Neuroscience
- Hematology
Background:
- Iron deficiency in early childhood has known long-term impacts on development.
- Research in healthy, low-risk populations is limited.
- Current diagnostic criteria for iron deficiency may not capture all at-risk children.
Purpose of the Study:
- To explore the association between iron status and neurodevelopmental outcomes in healthy 2-year-olds.
- To investigate if microcytosis (low mean corpuscular volume) is linked to cognitive function.
- To identify a predictive ferritin threshold for microcytosis.
Main Methods:
- Secondary analysis of a prospective birth cohort (Cork BASELINE Study).
- Measured serum ferritin, hemoglobin (Hb), and mean corpuscular volume (MCV) at 2 years.
- Assessed neurodevelopment using Bayley Scales of Infant and Toddler Development (n=87).
Main Results:
- Five children had iron deficiency (ferritin <12 µg/l); none had iron deficiency anemia.
- Children with microcytosis (MCV <74 fl) had significantly lower cognitive scores (88.5 vs 97.0, P=0.04).
- A ferritin threshold of 18.5 µg/l predicted microcytosis and was associated with lower cognitive scores.
Conclusions:
- Microcytosis, even in the absence of overt iron deficiency anemia, is associated with reduced cognitive outcomes in healthy toddlers.
- Current diagnostic criteria for iron deficiency may be insufficient for identifying all at-risk children.
- Further research with larger sample sizes is warranted to re-evaluate diagnostic criteria for iron deficiency in young children.
Abstract:
Fe deficiency in early childhood is associated with long-term consequences for cognitive, motor and behavioural development; however explorations in healthy children from low risk, high-resource settings have been limited. We aimed to explore associations between Fe status and neurodevelopmental outcomes in low risk, healthy 2-year-olds. This study was a secondary analysis of a nested case-control subgroup from the prospective, maternal-infant Cork Babies after Screening for Pregnancy Endpoints: Evaluating the Longitudinal Impact using Neurological and Nutritional Endpoints (BASELINE) Birth Cohort Study. At 2 years, serum ferritin, Hb and mean corpuscular volume (MCV) were measured and neurodevelopment was assessed using the Bayley Scales of Infant and Toddler Development (n 87). Five children had Fe deficiency (ferritin <12 µg/l) and no child had Fe deficiency anaemia (Hb<110 g/l+ferritin<12 µg/l). Children with microcytosis (MCV<74 fl, n 13) had significantly lower mean cognitive composite scores (88·5 (sd 13·3) v. 97·0 (sd 7·8), P=0·04, Cohen's d effect size=0·8) than those without microcytosis. The ferritin concentration which best predicted microcytosis was calculated as 18·4 µg/l (AUC=0·87 (95% CI 0·75, 0·98), P<0·0001, sensitivity 92 %, specificity 75 %). Using 18·5 µg/l as a threshold, children with concentrations <18·5 µg/l had significantly lower mean cognitive composite scores (92·3 (sd 10·5) v. 97·8 (sd 8·1), P=0·012, Cohen's d effect size=0·6) compared with those with ferritin ≥18·5 µg/l. All associations were robust after adjustment for potential confounding factors. Despite a low prevalence of Fe deficiency using current diagnostic criteria in this healthy cohort, microcytosis was associated with lower cognitive outcomes at 2 years. This exploratory study emphasises the need for re-evaluation of the diagnostic criteria for Fe deficiency in young children, with further research in adequately powered studies warranted.
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