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Published on: January 19, 2024
Relatively high prevalence of subclinical iron deficiency in Japanese children: evidence from a preoperative
Yamato Hanawa1,2, Yuji Baba3, Wataru Murasaki4,5
1Department of Pediatrics, Jikei University Kashiwa Hospital, Chiba, Japan. kazuyama2496@gmail.com.
Insights
Subclinical iron deficiency (ID) is common in asymptomatic children, even without anemia. Early identification through dietary and clinical risk assessment is crucial for pediatric care.
Area of Science:
- Pediatric Health
- Nutritional Science
- Micronutrient Deficiencies
Background:
- Iron deficiency (ID) is a prevalent childhood micronutrient deficiency, critical during infancy and early childhood due to rapid brain development.
- Iron is vital for myelination, neurotransmitter synthesis, and neuronal energy metabolism, with early-life ID potentially linked to later attention and executive function deficits.
- The full extent and reversibility of early-life iron deficiency's impact on cognitive development remain under investigation.
Purpose of the Study:
- To determine the prevalence of iron deficiency (ID) in asymptomatic pediatric patients undergoing elective surgery.
- To identify characteristics of children with ID, including those without anemia.
- To inform strategies for early identification of iron deficiency in pediatric populations.
Main Methods:
- Retrospective review of pediatric patients (January 2021-June 2024) undergoing elective surgery.
- Exclusion criteria included hematologic disorders, severe chronic disease, active inflammation, or elevated C-reactive protein (CRP).
- ID defined by age-specific low serum ferritin and/or transferrin saturation (TSAT) <16%; anemia by WHO 2024 criteria.
Main Results:
- Of 129 eligible patients (6 months-4 years), 20.2% had ID (26/129), with 23 cases of ID without anemia and 3 with iron deficiency anemia (IDA).
- All identified cases of ID were asymptomatic.
- The ID group exhibited lower hemoglobin, MCV, MCH, serum iron, and ferritin, alongside higher RDW-CV, platelet count, and UIBC compared to the non-ID group.
Conclusions:
- Subclinical iron deficiency is prevalent in asymptomatic Japanese children undergoing elective surgery.
- Clinically silent iron deficiency can exist even in seemingly healthy children.
- Routine pediatric care should emphasize dietary and clinical risk assessment for early ID identification, rather than relying solely on surgery-based screening.
Background:
Iron deficiency (ID), even in the absence of anemia, is one of the most common micronutrient deficiencies in childhood and remains particularly relevant during infancy and early childhood, when brain development is rapid. Iron plays an essential role in myelination, neurotransmitter synthesis, mitochondrial function, and neuronal energy metabolism. Contemporary longitudinal and mechanistic studies suggest that early-life iron deficiency may be associated with later deficits in attention, executive function, and educational performance, although the magnitude and reversibility of these effects remain incompletely defined.
Methods:
We retrospectively reviewed pediatric patients who underwent elective surgery between January 2021 and June 2024. Patients with hematologic disorders, severe chronic disease, ongoing iron therapy, clinically active inflammatory conditions, or preoperative C-reactive protein (CRP) > 1.0 mg/dL were excluded. ID was defined as age-specific low serum ferritin and/or transferrin saturation (TSAT) < 16%. Anemia was defined using the 2024 World Health Organization hemoglobin cutoffs. Cases with discordant ferritin and TSAT results were classified as ID if either criterion was abnormal.
Results:
Of 199 eligible patients, 129 were included (76 males, 53 females). The majority were aged 6 months to 4 years. ID was identified in 26 children (20.2%), including 23 with ID without anemia and 3 with IDA (2.3%); all were asymptomatic. The ID group showed lower hemoglobin, MCV, MCH, serum iron, and ferritin, and higher RDW-CV, platelet count, and UIBC than the non-ID group.
Conclusions:
Subclinical ID was common among asymptomatic Japanese children undergoing elective surgery, indicating that clinically silent iron deficiency may be present even in children who appear otherwise well. Rather than supporting surgery-based screening as a stand-alone strategy, these findings underscore the importance of careful dietary and clinical risk assessment during routine pediatric care and the need for context-sensitive approaches to early identification of children at risk for iron deficiency.
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