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The association between infantile microcytic anemia and attention deficit hyperactivity disorder, a case-control
Michal Yackobovitch-Gavan1,2, Daniel Ben-Hefer2, Ilan Feldhamer3
1The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Background:
Microcytic anemia due to iron deficiency is the most common type of anemia in children in Israel and many parts of the world, and has been shown to have negative consequences for the cognitive performance. We aimed to examine the association between microcytic anemia at age 9-18 months and ADHD during childhood.
Methods:
This case-control study included healthy children aged 6-18 years at data collection (April 2020), insured by Clalit-Health-Services, and aged 9-18 months between June 2004 and December 2013, when a blood-count was performed. The study group included children diagnosed with ADHD based on the medical documentation of at least two consecutive stimulant prescriptions. A control group without any stimulant prescriptions was matched in a ratio of 1-3:1, by year of birth, sex and cultural background. Any microcytic anemia was defined as Hb < 10.5 g/dl and MCV 60-75 fl. Moderate microcytic anemia as Hb 7-9.9 g/dl. We performed a conditional-logistic-regression analysis, adjusted by socioeconomic status (SES) and year of birth. Sensitivity analysis examined this association stratified by sex, cultural background, SES and age at data collection quintiles.
Results:
Any microcytic anemia prevalence was lower in the ADHD group (n = 19,467) as compared to the controls (n = 39,004) (3.4 % and 4.0 %, respectively), adjusted-OR = 0.86 (95%CI: 0.78, 0.98). The prevalence of moderate microcytic anemia was similar (0.9 % vs. 1.0 %). Lower any microcytic anemia prevalence in the ADHD group was found in boys, secular-traditional Jews, and in the 4th quintile of age (12.1-13.5 years).
Conclusions:
We found a small inverse association between microcytic anemia at 9-18-months and ADHD during childhood, thus rejecting our hypothesis that microcytic anemia at infancy is associated with a higher prevalence of ADHD. Further studies are warranted, to examine the effects of ID and brain iron concentration on the development of ADHD in childhood.
Insights
Microcytic anemia in infancy was inversely associated with ADHD, meaning lower prevalence in children with ADHD. This finding challenges the hypothesis that early anemia increases ADHD risk.
Area of Science:
- Pediatric Hematology
- Child Neurology
- Nutritional Epidemiology
Background:
- Microcytic anemia due to iron deficiency is common in children and linked to cognitive deficits.
- Investigating the link between early childhood anemia and Attention-Deficit/Hyperactivity Disorder (ADHD) is crucial for understanding developmental impacts.
Purpose of the Study:
- To examine the association between microcytic anemia in infancy (9-18 months) and the subsequent development of ADHD in childhood.
- To determine if early iron deficiency anemia is a risk factor for ADHD.
Main Methods:
- A case-control study involving healthy children aged 6-18 years, with ADHD cases identified by stimulant prescriptions.
- Controls were matched by birth year, sex, and cultural background. Microcytic anemia was defined by specific hemoglobin and MCV levels.
- Conditional logistic regression analysis adjusted for socioeconomic status and birth year was employed.
Main Results:
- The prevalence of any microcytic anemia was lower in the ADHD group (3.4%) compared to controls (4.0%), with an adjusted odds ratio of 0.86.
- Moderate microcytic anemia prevalence was similar between groups (0.9% vs. 1.0%).
- Lower anemia prevalence in the ADHD group was observed in boys, secular-traditional Jewish children, and older children in the study cohort.
Conclusions:
- The study found a small inverse association between microcytic anemia in infancy and ADHD, rejecting the initial hypothesis.
- Further research is needed to explore the complex relationship between iron deficiency, brain iron concentration, and ADHD development.
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