Abstract
Early childhood factors can have persisting effects on development and cognition in children. We propose to explore the trends of Fe deficiency and Pb toxicity in early childhood and their association with child development at 2 years of age and cognition at 5 years. Longitudinal birth cohort study. Urban slum, Vellore, India. Children enrolled at birth were followed up regularly in the first 2 years with developmental and cognitive assessments at 2 and 5 years of age, respectively. The birth cohort enrolled 251 children with 228 children followed up at 2 years and 212 at 5 years of age. Fe deficiency (ID) was highest at 15 months of age and improved subsequently at 24 months. Blood Pb levels (BLL) remained high at all age groups with an increasing trend with age; 97 % at 36 months having high BLL. Persistent high mean BLL at 15 and 24 months had negative association with both cognition and expressive language raw scores of 24 months, while high mean BLL at 15, 24 and 36 months had no significant association with any of the domains of cognition at 5 years of age. Early childhood cumulative body Fe status at 7, 15 and 24 months did not show any association with child development at 2 years, but was associated with verbal, performance and processing speed components of cognition at 5 years. Optimising body Fe status and limiting Pb exposure in early childhood can augment child development and school entry cognition.
Highlights
Other factors associated with the 5 year cognition in the multivariate analysis were the maternal intelligence affecting verbal, performance and processing speed components and socio-economic status (SES) the performance domain. This prospective birth cohort follow-up study from urban Vellore provided the trends of Hb, Fe and Pb levels during the early childhood
The current study showed a negative association of ID with verbal, performance and processing domains of cognition
ID anaemia became the commonest cause of anaemia at 15 months of age and remained so at 24 months, despite a drop in overall prevalence of anaemia and improvement in Fe stores in the later age group
Summary
The multivariate models built for each domain of the child development measured at 2 years of age (Table 5) were statistically significant (P < 0·01) and had an adjusted R2 value ranging between 5 and 7 % (adjusted R2 values of cognition, expressive language and receptive language domains were 4·6, 7·2 and 4·7 %, respectively). High mean BLL of 15 and 24 months was associated with lower cognition and expressive language raw scores at 2 years of age, which remained significant in the multivariate analysis with sex, mean body Fe (of 7, 15 and 24 months), maternal intelligence and SES (Table 5).
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