Iron deficiency and blood lead levels

Abstract

To the Editor: I read with interest the report by Wright et al1.Wright R.O. Tsaih S.-W. Schwartz J. Wright R.J. Hu H. Association between iron deficiency and blood lead level in a longitudinal analysis of children followed in an urban primary care clinic.J Pediatr. 2003; 142: 9-14Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar and the accompanying editorial2.McGeehin M.A. Getting the lead out: can iron help?.J Pediatr. 2003; 142: 3-4Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar describing the association of lead poisoning with iron deficiency. Because I assumed that this relationship had been well documented, it was surprising to see that no prospective studies existed. What is missing from both articles, however, is reference to what is likely a major mechanism for this association—the frequent occurrence of pica in iron deficiency.3.Buchanan G.R. The tragedy of iron deficiency during infancy and early childhood.J Pediatr. 1999; 135: 413-415Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar The authors indicate that iron deficiency enhances lead absorption, but to complete the cycle, susceptible children must also have a “diet” that includes increased environmental lead. The iron deficiency likely encourages them to partake in a non-nutritious diet with excessive lead that is absorbed at an increased rate. It is clear that prevention of iron deficiency with reduction in the complication of pica would further reduce the devastating sequelae of acute or chronic lead intoxication. To the Editor: I read with interest the report by Wright et al1.Wright R.O. Tsaih S.-W. Schwartz J. Wright R.J. Hu H. Association between iron deficiency and blood lead level in a longitudinal analysis of children followed in an urban primary care clinic.J Pediatr. 2003; 142: 9-14Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar and the accompanying editorial2.McGeehin M.A. Getting the lead out: can iron help?.J Pediatr. 2003; 142: 3-4Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar describing the association of lead poisoning with iron deficiency. Because I assumed that this relationship had been well documented, it was surprising to see that no prospective studies existed. What is missing from both articles, however, is reference to what is likely a major mechanism for this association—the frequent occurrence of pica in iron deficiency.3.Buchanan G.R. The tragedy of iron deficiency during infancy and early childhood.J Pediatr. 1999; 135: 413-415Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar The authors indicate that iron deficiency enhances lead absorption, but to complete the cycle, susceptible children must also have a “diet” that includes increased environmental lead. The iron deficiency likely encourages them to partake in a non-nutritious diet with excessive lead that is absorbed at an increased rate. It is clear that prevention of iron deficiency with reduction in the complication of pica would further reduce the devastating sequelae of acute or chronic lead intoxication.