Abstract
Iron deficiency is the most common micronutrient deficiency in the world. Women of reproductive age and young children are particularly vulnerable. Iron deficiency in late prenatal and early postnatal periods can lead to long-term neurobehavioral deficits, despite iron treatment. This may occur because screening and treatment of iron deficiency in children is currently focused on detection of anemia and not neurodevelopment. Anemia is the end-stage state of iron deficiency. The brain becomes iron deficient before the onset of anemia due to prioritization of the available iron to the red blood cells (RBCs) over other organs. Brain iron deficiency, independent of anemia, is responsible for the adverse neurological effects. Early diagnosis and treatment of impending brain dysfunction in the pre-anemic stage is necessary to prevent neurological deficits. The currently available hematological indices are not sensitive biomarkers of brain iron deficiency and dysfunction. Studies in non-human primate models suggest that serum proteomic and metabolomic analyses may be superior for this purpose. Maternal iron supplementation, delayed clamping or milking of the umbilical cord, and early iron supplementation improve the iron status of at-risk infants. Whether these strategies prevent iron deficiency-induced brain dysfunction has yet to be determined. The potential for oxidant stress, altered gastrointestinal microbiome and other adverse effects associated with iron supplementation cautions against indiscriminate iron supplementation of children in malaria-endemic regions and iron-sufficient populations.
Highlights
Iron is essential for the normal development and function of all tissues in the body
We have previously reported that a cord blood ferritin < 35 μg/L predicts brain iron deficiency and dysfunction as indexed by impaired recognition memory at birth, and lower psychomotor development at 1 year of age in full-term infants with iron deficiency due to maternal gestational diabetes [20]
Given the difficulties with early detection of brain dysfunction and the ineffectiveness of iron treatment started after the onset of anemia in reversing the neurological deficits, strategies aimed at prevention of early-life iron deficiency are of the utmost importance and potentially should begin with ensuring adequate iron accretion by the fetus
Summary
Iron is essential for the normal development and function of all tissues in the body. Iron-containing heme proteins (Hemoglobin [Hgb] and cytochromes) participate in tissue oxygen delivery and energy metabolism. From a public health point of view, iron deficiency is the most common micronutrient deficiency in the world [2]. In addition to being the most common cause of anemia, iron deficiency during the late prenatal and early postnatal periods is a risk factor for long-term neurodevelopmental abnormalities [1,3,4]. Early detection and prompt treatment of iron deficiency is of public health significance. Nutrients 2018, 10, 227 causes and adverse neurological consequences of iron deficiency in infants and children, the current screening and treatment recommendations, and recent advances in diagnosis and treatment strategies for preventing iron-deficiency-induced adverse neurological effects
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