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Iron Supplementation in Management of Neurodevelopmental Disorders: Systematic Review, Meta-Analysis, and Qualitative
Stephen D Elliott1, Mark L Vickers1, Gemma McKeon1
1Metro North Mental Health Service, Herston, Australia (Elliott, Vickers); Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom (Elliott); Faculty of Medicine (Vickers), Child Health Research Center (McKeon, Scott), and Herston Health Sciences Library (Eriksson), University of Queensland, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia (Vickers); West Moreton Health Psychology, Park Center for Mental Health, Brisbane, Australia (McKeon); Child and Youth Mental Health Group, Queensland Center for Mental Health Research, Brisbane, Australia (McKeon, Scott); Queensland Institute of Medical Research Berghofer Medical Research Institute, Brisbane, Australia (Malacova, Scott); Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia (Scott).
Insights
Iron supplementation shows no significant benefits for managing attention-deficit hyperactivity disorder (ADHD) symptoms in children. Further research is needed, and iron overdose poses serious risks.
Area of Science:
- Pediatric Neurology
- Nutritional Neuroscience
- Evidence-Based Medicine
Background:
- Neurodevelopmental disorders, including ADHD, autism spectrum disorder, and Tourette's syndrome, affect children and youths.
- Iron deficiency is a potential concern in pediatric populations, prompting investigation into supplementation's role.
- Understanding the efficacy of iron supplementation is crucial for evidence-based management strategies.
Approach:
- A systematic review and meta-analysis were conducted following PRISMA guidelines.
- Included studies focused on iron supplementation for neurodevelopmental disorders, with a focus on ADHD.
- Quality of evidence and recommendations were assessed using GRADE and Joanna Briggs Institute tools.
Key Points:
- Nine articles were reviewed, primarily focusing on attention-deficit hyperactivity disorder (ADHD).
- Meta-analysis of three randomized controlled trials on ADHD hyperactivity symptoms showed no significant differences between iron supplementation and placebo.
- Effect sizes for inattentive ADHD symptoms were large but not statistically significant for either group.
Conclusions:
- Current evidence for iron supplementation in managing ADHD and other neurodevelopmental disorders is of very low quality.
- Further research is required to definitively establish the role of iron supplementation.
- Iron supplementation carries risks, including potential toxicity and overdose, necessitating careful consideration.
Objective:
The authors sought to explore the role of iron supplementation in the management of neurodevelopmental disorders among children and youths.
Methods:
A systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken. A subset of results was suitable for meta-analysis. The quality of the evidence and strength of the clinical recommendations were assessed by using the Grading of Recommendations, Assessment, Development, and Evaluation method, and critical appraisal was conducted with the Joanna Briggs Institute critical appraisal tools.
Results:
Nine articles met inclusion criteria. These articles included studies of attention-deficit hyperactivity disorder (ADHD) (N=7), autism spectrum disorder (N=1), and Tourette's syndrome (N=1). Three randomized controlled trials evaluating iron supplementation for ADHD hyperactivity symptom severity (124 participants: placebo, N=56; supplement, N=68) met inclusion criteria for a meta-analysis. Effect sizes for the placebo and supplement groups were moderate (Cohen's d=0.76) and large (Cohen's d=1.70), respectively, although these differences were not significant. The impact of iron supplementation on inattentive ADHD symptom severity was examined in two trials (75 participants: placebo, N=31; supplement, N=44). Large, nonsignificant effect sizes were demonstrated for the placebo (Cohen's d=1.66) and supplementation (Cohen's d=3.19) groups. The quality of the evidence and strength of the clinical recommendations were considered very low.
Conclusions:
Further research is needed to examine the role of iron supplementation in the management of ADHD and neurodevelopmental disorders more generally. Additionally, iron supplementation comes with risks, including death in the case of overdose.
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