Iron Deficiency In Children Research Articles

Impact of Iron Status on Thyroid Function: A Community Based Cross-Sectional Study in Eastern Nepal

Background: Iron deficiency is the most common nutritional deficiency in the world. The relation between thyroid hormones and iron status is bidirectional. The aim of this study was to assess iron nutrition status and evaluate its relationship with thyroid hormone profile among children of Eastern Nepal.
 Methods: A community based cross-sectional study was conducted in eastern Nepal. A total of 200 school children aged 6-12 years were recruited after taking informed consent from their guardians. Blood samples were collected and assayed for free thyroid hormones (fT3 and fT4), thyroid stimulating hormone (TSH), serum iron, total iron binding capacity (TIBC) concentration and percentage transferrin saturation was calculated.
 Results: The mean serum iron and TIBC was 74.04 µg/dl and 389.38 µg/dl respectively. The median transferring saturation was 19.21%. The overall prevalence of iron deficiency (Transferrin saturation < 16%) was 34% (n=68). The mean concentration of fT3 and fT4 was 2.87 pg/ml and 1.21 ng/dl respectively, while the median TSH concentration was 3.03 mIU/L. Median TSH concentration in iron deficient group (3.11 µg/dl) and iron sufficient group (2.91 µg/dl) was not significantly different. Among iron deficient children 5.9% had subclinical hypothyroidism (n=4). Iron status indicators were not significantly correlated with thyroid profile parameters in the study population.
 Conclusions: The prevalence of iron deficiency is high and iron deficiency does not significantly alter the thyroid hormone profile in the study region.

Impact of iron deficiency in early life stages on children's motor development: a longitudinal follow-up

Objective: To clarify the impact of pre- and postnatal iron deficiency on children's motor development. Methods: This was a longitudinal follow-up study. A total of 114 infants (58 boys, 56 girls) born from April 2010 to December 2011 in Fuyang district of Hangzhou were enrolled. Based on cord blood and 9-month iron status, subjects were divided into prenatal iron deficiency (34 children), postnatal iron deficiency (37 children) and non-iron deficiency group (43 children). Peabody Developmental Motor Scale and BOT2-simplified version were used to evaluate the motor capacity in infants and preschoolers at 9 months, 18 months and 5 years, respectively. Hierarchical linear modeling (HLM) was used to investigate the trajectory of motor development with age, the influence of different timing of early iron deficiency on children's motor development, and the differences (adjusted for possible confounding factors) in motor development in children with pre- or postnatal iron deficiency or non-iron deficiency in different family educational environment. Results: At the age of 9 months, 18 months and 5 years, 107, 109, and 114 children were evaluated respectively. After controlling for a variety of confounding factors, it was found that children with prenatal iron deficiency had significantly lower scores of motor development compared with non-iron deficiency children (52.04 vs. 54.05 scores, β=-2.01, P=0.007), and that children with postnatal iron deficiency had similar scores of motor development compared with non-iron deficiency children, showing no significant difference (53.07 vs. 54.05 scores, β=-0.98, P=0.180). Regardless of the maternal education status, prenatal iron deficiency children always had lower motor scores than non-iron deficiency children (49.86 vs. 52.15 and 49.58 vs. 51.58 scores, β=-2.29, -2.00; P=0.031, 0.049). Among the non-iron deficiency children, those whose mothers had a higher education level had higher motor scores compared with those whose mothers had a lower education level (52.45 vs. 50.46 scores, β=1.99, P=0.035). Conclusions: The motor development of children with prenatal iron deficiency did not catch up with their counterparts without iron deficiency by 5 years of age. The results indicate the importance of preventing iron deficiency in the fetus.

A study of prevalence of iron deficiency anaemia in infants and toddlers (6-24 months) by measuring serum ferritin levels

Background: Nutritional anemia is a worldwide problem with the highest prevalence in the developing countries. One of the most vulnerable groups is 6-24 months of age. NFHS-3 survey shows that the incidence of anemia in children aged 6-35 months is 79.2% with 72.7% in urban areas and 81.2% in rural areas. First stage of iron deficiency is depletion of iron stores, which is reflected by decreased serum ferritin levels and increased total iron binding capacity (TIBC) levels. The objective of this study was to detect presence of iron deficiency in children even before clinical appearance of anemia by measuring serum ferritin levels.Methods: The study was conducted from March 2017 to November 2017 in the Department of Pediatrics of Sir Sayajirao Gaekwad General Hospital, a tertiary level hospital and government medical college, Vadodara. A cross sectional study was done in which a total of 111 asymptomatic infants and toddlers in age group of 6-24 months presenting to well-baby clinic were enrolled randomly. Haemoglobin, RBC indices and serum ferritin levels were estimated. The children were classified into mild, moderate and severe anaemia according to their haemoglobin levels. Correlation with their serum ferritin levels was carried out by using statistical analysis.Results: Prevalence of anaemia (Hb <11gm/dl) was 84.14% in 6-12 months age group, 81.25% in 13-18 months age group and 84.61% in case of 19-24 months age group. Overall 83.78% of infants and toddlers were found to be anemic among 6-24 months age group. 55 infants (49.54%) among 111 infants had mild anaemia, 29 infants (26.12%) had moderate anaemia, 9 infants (8.1%) had severe anaemia. Majority of children (87 of 111 infants) had microcytic and hypochromic RBCs in their peripheral smear examination. 78 infants (72.07%)) had low serum Ferritin levels while only 31 infants had normal ferritin levels which is statistically significant (p=0.0084). Out of these, 4 infants had normal hemoglobin level.Conclusions: Anaemia is highly prevalent in the age group of 6 to 24 months even in otherwise healthy infants. Serum ferritin level is a good indicator of iron deficiency in children.

Probiotics Did Not Enhance Iron Absorption in Iron-Deficient Children

Whether lactobacillus enhances therapy for iron deficiency in children is unknown. Investigators conducted a randomized, controlled trial comparing

Cadmium Health Risk Assessment and Anthropogenic Sources of Pollution in Mount-Lebanon Springs

Cadmium (Cd) is a highly toxic heavy metal with low permissible limits. This study aims at conducting a health risk assessment for Cd and examining potential sources of pollution in springs of the Mount-Lebanon Governorate, a semi-urbanized area in Lebanon. A total of 31 spring samples were collected during the wet and dry seasons and tested for water quality. Graphite furnace atomic absorption spectrometry was used to quantify Cd levels in water. Risk assessment was performed by means of a survey on water consumption and usage, and followed the USEPA Hazard Quotient (HQ) model. Correlations with different human activities were examined using different linear regression models and spatial analysis tools. Results highlight springs within El Metn and Keserwan Districts as posing a non-carcinogenic health risk in (1) Ain Saadeh both in adults (HQwet = 1.94) and iron-deficient children (HQwet = 1.29), and (2) Faraya both in healthy (HQwet = 1.33; HQdry = 1.19) and iron-deficient children (HQwet = 2.67; HQdry = 2.37), as well as in iron-deficient adults (HQwet = 1.57; HQdry = 1.39). In addition, Cd levels increased significantly with proximity to upstream open dumps (Pearson’s r = − 0.511; p = 0.003), agricultural land surface area, increased upstream industrial activity, mainly jewelry and fine stones industries in both bivariate (r = 0.33; p = 0.001) and multivariate analyses (r = 0.41; p = 0.002), plastic industries (Pearson’s r = 0.36; p = 0.05), and furniture manufacturing (Pearson’s r = 0.38; p = 0.038). Our findings constitute the first report assessing Cd health risk and identifying sources of pollution in Mount-Lebanon, and make a strong basis for a risk management strategy.

Iron metabolism and its association with dyslipidemia risk in children and adolescents: a cross-sectional study

BackgroundInformation on the association between iron metabolism and dyslipidaemia in children is limited. Thus, this study aims to evaluate the iron metabolic status of children with different body mass index (BMI) and to examine the association between iron metabolism and dyslipidaemia risk.MethodIn total, 1866 children and adolescents aged 7–18 were enrolled in this study, including 912 boys and 954 girls. In this cross-sectional study, parameters for anthropometry, lipids and iron metabolism including transferrin, soluble transferrin receptor (sTfR), ferritin and serum iron (SF) were evaluated. Data regarding demographic characteristics, diet, and physical activity were collected by self-reported questionnaires.ResultsThe prevalence of dyslipidaemia and iron deficiency in children and adolescents increased based on BMI categories (both P < 0.05) and were 58.3 and 8.9% in subjects with obesity, respectively. The lowest SF and the highest ferritin levels were observed in subjects who were obese (both P < 0.001). Subjects with dyslipidaemia had lower SF, transferrin and sTfR levels by different BMI categories, and those who were obese had higher ferritin levels (all P < 0.05). Most importantly, higher concentrations of transferrin and sTfR were related to lower dyslipidaemia risk (OR for transferrin: 0.49, 95% CI: 0.33–0.71; OR for sTfR: 0.68, 95% CI: 0.46–0.99).ConclusionsA downward trend in SF level by BMI categories and the highest ferritin level in subjects with obesity suggested that iron storage was associated with BMI in children and adolescents. Moreover, an inverse relationship was observed between transferrin and sTfR concentrations and dyslipidaemia risk in children with different BMI.

Use of a Probiotic to Enhance Iron Absorption in a Randomized Trial of Pediatric Patients Presenting with Iron Deficiency

To evaluate the efficacy of low dose ferrous sulfate for the treatment of iron deficiency and if the probiotic Lactobacillus plantarum 299v (LP299v) enhances treatment. This randomized, double-blinded, controlled trial of the treatment of iron deficiency in children compared the use of low-dose ferrous sulfate (1-3mg/kg/day), with or without probiotic (LP299v). Serum ferritin level increased in all children from a baseline of 23.7ng/mL to 45.4ng/mL after 6-8weeks of treatment. There was no significant difference in the increase in serum ferritin in children taking the probiotic LP299v compared with controls (23.2 vs 20.0ng/mL, respectively). Additionally, an increase in ferritin level was not significantly associated with probiotic use when controlling for other factors, including child weight and dosing. Overall, the treatments were well-tolerated, with mild side effects. Treatment with low-dose ferrous sulfate is well-tolerated and effective in correcting iron deficiency in children. However, the probiotic LP299v did not enhance treatment. Further attention should examine the dose-response effect in children, including an alternate day dosing schedule. ClinicalTrials.gov: NCT01617044.

Anemia and Iron Deficiency in Children with Chronic Kidney Disease (CKD): Data from the Know-Ped CKD Study.

Children with chronic kidney disease (CKD) are at high risk of anemia, an important risk factor for cardiovascular disease and poor quality of life. The present study used baseline data from the Korean cohort study for Outcome in patients With Pediatric Chronic Kidney Disease (KNOW-PedCKD). A Total of 437 patients was included in the analyses excluding missing data. The characteristics of patients with and without anemia and those of patients with and without iron deficiency were compared. Logistic regression analysis and Pearson correlation were conducted to evaluate associated risk factors and correlations in children with CKD. Anemia in children with CKD was associated with older age, low body weight and body mass index (BMI) z-score, birth age, preceding glomerulonephritis, decreased estimated glomerular filtration rate (eGFR), low levels of serum albumin and calcium, high levels of serum intact parathyroid hormone (iPTH), and serum phosphorus. Anemia was correlated positively with changes in the BMI z-score, body weight, and serum albumin and cholesterol levels, but correlated negatively with serum calcium, iPTH, ferritin levels, and transferrin saturation. Iron deficiency in children with CKD was associated with young age, low hemoglobin and serum ferritin levels, high BMI z-scores, and low levels of serum iPTH. This is the first nationwide cohort study of anemia in Korean children with CKD and the first prospective pediatric CKD cohort study in Asia. The study results demonstrated that anemia and iron deficiency are affected by various factors, including age, BMI, and levels of serum iPTH. To improve the retrospective outcome of affected children, it is important to understand the effect of each of these factors and to attempt an early intervention to prevent anemia and iron deficiency by regular measurement of these parameters in children at risk.

Nutrient patterns and their relation to anemia and iron status in 5- to 12-y-old children in South Africa.

The aim of this study was to assess nutrient patterns and their relation to anemia and iron status of school children using pooled data from three study populations in South Africa. Data from 5- to 12-y-old children (N = 578) from three independent studies conducted in two provinces in South Africa were pooled. Data used in the analysis were dietary intake, hemoglobin, and plasma ferritin concentrations. Nutrient patterns were determined using factor analysis. Logistic regression analysis was performed to determine relationships of nutrient patterns with anemia and iron deficiency. In the pooled group, 13.8% of the children were anemic and 27.7% were iron deficient (ID). More than half of children did not meet the Estimated Average Requirement for various nutrients, including vitamins A, C, B12, folate, and zinc, although only 17.7% of children had an iron intake below the requirements. Median intakes for vitamins A and C were lower for anemic than non-anemic children (P = 0.03 and 0.02, respectively) and for ID versus non-ID children (P = 0.03 and 0.046, respectively). Four nutrient patterns were identified: plant protein, carbohydrate, iron, and B vitamins; animal protein and saturated fat; vitamins A and B12; and calcium and fiber. The vitamin A and B12 nutrient pattern was associated with lower odds of being anemic (odds ratio, 0.63; 95% confidence interval, 0.49-0.91; P = 0.035). The present results highlighted the potential role of the combination of dietary vitamin A and B12 in the etiology of nutritional anemia in school-age children in South Africa. Nutrient pattern analysis may improve the understanding of the synergistic role of nutrients related to anemia and may assist in planning intervention strategies.

Higher Body Mass Index Is Associated with Iron Deficiency in Children 1 to 3 Years of Age

To examine the association between body mass index (BMI) and iron deficiency in early childhood, while considering the influence of low-grade systemic inflammation. Healthy children ages 1-3 years were included in a cross-sectional analysis. Age- and sex-standardized World Health Organization BMI z score (zBMI) was calculated using height/length and weight measurements; iron status was assessed by serum ferritin; inflammation was assessed by C-reactive protein (CRP). Children with CRP ≥10 mg/L were excluded because this may indicate acute systemic inflammation. Adjusted multivariable regression analyses were used to investigate the association between zBMI and both serum ferritin (µg/L), and iron deficiency (serum ferritin <12 µg/L). We performed prespecified subgroup analyses according to CRP level (normal [≤1.0 mg/L] and low-grade inflammation [>1.0 mg/L to <10.0 mg/L]). Of 1607 children included, 20% were categorized as with zBMI >1, 13% had iron deficiency, and 18% had low-grade inflammation. Higher zBMI was associated with lower serum ferritin (-1.51 µg/L, 95% CI -2.23, -0.76, P < .0001) and increased odds of iron deficiency (OR 1.28, 95% CI 1.10, 1.50, P = .002). Though there was no interaction between zBMI and CRP for the adjusted linear regression model (P = .79) or logistic regression model (P = .43), children with low-grade inflammation had a higher serum ferritin (P < .0001). Higher zBMI is associated with increased risk for iron deficiency in children between 1 and 3 years, and should be considered as a risk factor in targeted screening. Further research is needed to better understand the relationship between serum ferritin and CRP for children in all weight categories. ClinicalTrials.gov: NCT01869530.

Effects of Pubertal Status and Inflammation on the Use of Ferritin to Define Iron Deficiency in Children With Overweight or Obesity.

Background and aims:A worldwide increase in childhood overweight (OW) and obesity (OB) has been reported. OB is an inflammatory state which affects iron metabolism and the sensibility of the tests to detect iron deficiency (ID). Our aim was to evaluate the adequacy of current ferritin cut-offs to define ID in children with OW/OB.Methods:This cross-sectional study included 152 children (54% girls) aged (median [Q1-Q3]) 11 (8-13) years with OW/OB. Complete blood count and iron metabolism were evaluated. Low ferritin, transferrin saturation (TSat), and anemia were defined by age- and sex-specific cut-offs recommended by National Guidelines. Iron intake was assessed in a subgroup (n = 80) by a 24-hour dietary recall. Analyses were made according to pubertal development and ferritin tertiles.Results:The overall prevalence of low ferritin, TSat, and anemia was 2.6%, 23.8%, and 5.2%, respectively. Among pre-pubertal children (n = 87), the frequency of low TSat rose across ferritin tertiles (P < .05), whereas it decreased among pubertal children (n = 65; P < .005). Cases of anemia among pre-pubertal children were found in the highest ferritin tertile, whereas 4/6 anemia cases in pubertal children were found in the lowest ferritin tertile (<39 µg/L). Pubertal children within the lowest ferritin tertile + low TSat (n = 11) showed lower hemoglobin (–9%; P < .005) and hematocrit (–8%, P < .01) than those in the same tertile + normal TSat (n = 16). The overall prevalence of children with ferritin < 39 µg/L + low TSat was 9.2%.Conclusions:Higher ferritin cut-off values are required to define ID in children with OW/OB. Such cut-off remains to be validated in larger, multi-ethnic cohorts of children with OW/OB.

Fortification of maize flour with iron for controlling anaemia and iron deficiency in populations.

Fortification of maize flour with iron for controlling anaemia and iron deficiency in populations.

Is there an association between vitamin D level and iron deficiency in children?

Vitamin D (VitD) affects the erythropoiesis. The aim of this study was to evaluate the association between maternal/child 25-OH VitD (25-OHD) levels and iron deficiency (ID) and anemia (IDA) in children aged 6 months-5 years. Between September 2014 and January 2016 children who were admitted to outpatient clinic were included to study. We excluded the children with acute or chronic infection, malnutrition, chronic disease and preterm birth history. Complete blood count, serum iron, total iron binding capacity, ferritin, 25-OHD levels were examined from children and their mothers. Iron and VitD supplementation during infancy and pregnancy and breastfeeding history were questioned. The study included totally 117 children. There were 67 children with ID/IDA [Group 1, mean age (years):2.05±1.24 (0.5-5)] and 50 normal children [Group 2, mean age (years): 1.87±1.12 (0.58-5)]. There were more VitD deficient children and mothers in Group 1 than in Group 2 (respectively, children 49.3 % vs. 20 % p=0.002; mothers 94 % vs.64 %, p=<0.001). There was a positive correlation between hemoglobin levels of children and maternal/child 25-OHD.The independent risk factors for IDA in children were longer exclusively breastfeeding time (odds ratio [OR], 0.35; 95 % confidence interval [CI], 0.1550.789; p=0.011), shorter duration of regular iron supplementation during infancy and pregnancy (infancy: OR,1.69; 95 % CI 1.148-2.508; p=0.008. pregnancy: OR,1.39; 95 % 0,1.070-1.820; p=0.014) and lower maternal 25-OHD level (OR,1.16; 95 % 0,1.034-1.292; p=0.011). Maternal/child VitD deficiency is associated with ID/IDA in children aged 6 months-5 years.

Looking Behind the Iron Curtain.

One of medicine’s greatest strengths is its willingness to reexamine commonly accepted practices. This has been particularly true in the clinical application of screening tests. Frequently, the unsettling controversy that accompanies such reexamination helps shape the improvement that follows. In their article entitled “Screening for Iron Deficiency in Early Childhood by Using Serum Ferritin in the Primary Care Setting,” Oatley et al1 raise a fundamental and likely controversial question about the value of the current practice of measuring the hemoglobin level at 1 year of age. Are we screening for anemia, iron deficiency, or iron deficiency anemia? Only when that question is answered can we rationally choose the right test and the right timing. Current practice, as recommended by the American Academy of Pediatrics, is to test for anemia, either with a complete blood count test or a dedicated hemoglobin analyzer, with further testing before or after iron replacement if the hemoglobin level is <11.2 The problem, however, is that the … Address correspondence to Alan R. Cohen, MD, Children’s Hospital of Philadelphia, Abramson Research Center, Room 1416, 3615 Civic Center Blvd, Philadelphia, PA 19104. E-mail: cohen{at}email.chop.edu

Screening for Iron Deficiency in Early Childhood Using Serum Ferritin in the Primary Care Setting

The American Academy of Pediatrics recommends universal screening for anemia using hemoglobin at 12 months. However, hemoglobin lacks diagnostic accuracy for iron deficiency, and the optimal age for screening has not been determined. Our objective was to assess a screening strategy for iron deficiency using serum ferritin. We conducted a cross-sectional study of children 1 to 3 years old attending a health supervision visit. We examined the relationship between child age and serum ferritin, age and hemoglobin, hemoglobin and serum ferritin, and the prevalence of elevated C-reactive protein (CRP). Restricted cubic spline analysis (n = 1735) revealed a nonlinear relationship between age and serum ferritin (P < .0001). A linear spline model revealed that from 12 to 15 months, for each 1-month increase in age, serum ferritin levels decreased by 9% (95% confidence interval [CI]: 5 to 13). From 15 to 24 months, the rate of change was nonsignificant. From 24 to 38 months, for each month increase in age, serum ferritin increased by 2% (95% CI: 1 to 2). For hemoglobin, from 12 to 24 months, the rate of change was nonsignificant. From 24 to 38 months, for each 1-month increase in age, hemoglobin increased by 20% (95% CI: 9 to 32). Compared with the serum ferritin cutoff of <12 μg/L, the hemoglobin cutoff of <110 g/L had a sensitivity of 25% (95% CI: 19 to 32) and a specificity of 89% (95% CI: 87 to 91). Elevated CRP ≥10 mg/L occurred in 3.3% (95% CI: 2.5 to 4.2). Screening for iron deficiency using serum ferritin at 15 or 18 months may be a promising strategy. For children at low risk for acute inflammation, concurrent measurement of CRP may not be necessary.

Prevalence of Anemia and Iron Deficiency in Pediatric Patients on Ventricular Assist Devices.

The prevalence and characteristics of anemia and iron deficiency in children supported by a ventricular assist device (VAD) are unknown. Patients <21 years of age on durable VAD support for ≥7 days at Texas Children's Hospital from 2006 to 2015 were retrospectively reviewed. Red blood cell (RBC) and iron deficiency indices in pulsatile VAD (P-VAD) and continuous-flow VAD (CF-VAD) were evaluated. Anemia, iron deficiency, and iron therapy regimens were identified. Seventy-six VAD implants in 74 patients were included: 45 P-VAD and 31 CF-VAD. Overall, 48% (36/75) of patients were anemic at VAD implant, with 67% of CF-VAD and 34% of P-VAD affected. Iron deficiency was seen in 52% (39/75) of patients at implant (similar in both groups). At explant, 71% (53/75) had anemia (similar in both groups). No patients had microcytosis. Iron supplementation was given to 20 patients, with four receiving target replacement therapy (2-6 mg/kg/d × 90 days). Red blood cell transfusion volumes were higher for P-VAD versus CF-VAD. We concluded that anemia and iron deficiency are common in pediatric VAD patients. Pulsatile VAD patients tend to develop anemia over the course of VAD support. Lack of microcytosis, likely masked by high RBC transfusions, suggests that specific iron studies are necessary to identify iron deficiency.

How Eliminating Malaria May Also Prevent Iron Deficiency in African Children.

Malaria and iron deficiency are common among children living in sub-Saharan Africa. Several studies have linked a child’s iron status to their future risk of malaria infection; however, few have examined whether malaria might be a cause of iron deficiency. Approximately a quarter of African children at any one time are infected by malaria and malaria increases hepcidin and tumor necrosis factor-α concentrations leading to poor iron absorption and recycling. In support of a hypothetical link between malaria and iron deficiency, studies indicate that the prevalence of iron deficiency in children increases over a malaria season and decreases when malaria transmission is interrupted. The link between malaria and iron deficiency can be tested through the use of observational studies, randomized controlled trials and genetic epidemiology studies, each of which has its own strengths and limitations. Confirming the existence of a causal link between malaria infection and iron deficiency would readjust priorities for programs to prevent and treat iron deficiency and would demonstrate a further benefit of malaria control.

Traditional red cell indices are not suggestive of iron deficiency in children with chronic kidney disease

Background. Iron deficiency (ID) contributes significantly to the chronic anaemia seen in chronic kidney disease (CKD). The use of traditional red cell indices such as mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) and red cell distribution width (RCDW) in screening for ID has been recommended, because they are inexpensive and widely available, especially in low-income settings. Objectives. To determine the prevalence of anaemia and ID, and the role of traditional red cell indices in screening for ID in children with CKD. Methods. A sample of 130 children (aged 5 - 18 years) with various stages of CKD was recruited. Blood samples were taken and assessed for traditional red cell indices (MCV, MCH, MCHC and RCDW), serum haemoglobin, creatinine, C-reactive protein, iron, transferrin, transferrin saturation (TSAT) and ferritin. Results. The mean (standard deviation) age was 10.7 (3.6) years, with a male-to-female ratio of 1.8:1. There was a high prevalence (32%) of anaemia among the patients. The median TSAT and ferritin were 19 (range 13 - 26)% and 50 (28 - 102) ng/mL, respectively. The prevalence of ID and ID with anaemia (IDA) was 43% and 11%, respectively. The majority of the patients (110/130; 85%) were iron deplete, and serum ferritin and RCDW were found to be independent predictors for anaemia, ID and IDA. There was no significant difference in the traditional red cell indices in iron-deplete and iron-replete patients. Conclusion. The routine use of traditional red cell indices alone in screening for ID in children with CKD should be discouraged.

The usefulness of reticulocyte haemoglobin content, serum transferrin receptor and the sTfR-ferritin index to identify iron deficiency in healthy children aged 1-16years.

This cross-sectional study, conducted on a population-based representative sample, evaluates the usefulness of reticulocyte haemoglobin content (CHr), serum transferrin receptor (sTfR) and sTfR/log ferritin (sTfR-F index) to recognise iron deficiency (ID) without anaemia, provides specific cut-off points for age and gender, and proposes a new definition of ID. A total of 1239 healthy children and adolescents aged 1-16years were included. Complete blood count, iron biomarkers, erythropoietin, C-reactive protein, CHr, sTfR, and sTfR-F index were determined. ROC curves were obtained and sensitivity, specificity, predictive values, likelihood ratios, and accuracy for each specific cut-off points were calculated. Seventy-three had ID without anaemia. Area under the curve for sTfR-F index, sTfR and CHr were 0.97 (CI95% 0.95-0.99), 0.87 (CI95% 0.82-0.92) and 0.68 (CI95% 0.61-0.74), respectively. The following cut-off points defined ID: sTfR-F Index > 1.5 (1-5years and 12-16years boys) and > 1.4 (6-11years and 12-16years girls); sTfR (mg/L) > 1.9 (1-5years), > 1.8 (6-11years), > 1.75 (12-16years girls) and > 1.95 (12-16years boys); and CHr (pg) < 27 (1-5years) and < 28.5 (6-16years).Conclusions: CHr, sTfR and the sTfR-F indexare useful parameters to discriminate ID without anaemia in children and adolescents, and specific cut-off values have been established. The combination of these new markers offers an alternative definition of ID with suitable discriminatory power. What is Known: • In adults, reticulocyte haemoglobin content (CHr), serum transferrin receptor (sTfR) and sTfR/log ferritin index (sTfR-F index) have been evaluated and recognised as reliable indicators of iron deficiency (ID). • Clinical manifestations of ID may be present in stages prior to anaemia, and the diagnosis of ID without anaemia continues to pose problems. What is New: • CHr, sTfR and the sTfR-F index are useful parameters in diagnosis of ID in childhood and adolescence when anaemia is not present. • We propose a new strategy for the diagnosis of ID in childhood and adolescence, based on the combination of these measures, which offer greater discriminatory power than the classical parameters.

Iron deficiency in children and adolescents with attention deficit hyperactivity disorder: Does the relationship exist?

BackgroundIron is a cofactor in the production and breakdown of neurotransmitters like dopamine and is vital for normal brain function. Iron deficiency potentially contributes to the development of attention deficit hyperactivity disorder (ADHD) because dopamine imbalances can cause hyperactivity, restlessness and problems with concentration and attention. However, a direct association between iron deficiency and ADHD remains to be determined.ObjectivesThe aim of this study was to investigate the possible correlation between iron deficiency and ADHD in children and adolescents seen at the child psychiatry outpatient service at Tygerberg Hospital, South Africa.MethodsA retrospective chart review was conducted to gather data of all outpatient children and adolescents who had their serum ferritin and/or iron levels tested between February 2011 and January 2016. Relevant demographic and clinical information was extracted from 255 records, and statistical methods were used to test for correlations between ADHD and certain variables, including iron deficiency.ResultsOut of 255 patients, 88 (34.5%) had iron deficiency, 157 (61.6%) had ADHD and 54 (21.0%) had both iron deficiency and ADHD. Of those patients with ADHD, 11 (7.0%) had other psychiatric comorbidities, and more males (89.0%) had this dual diagnosis compared to females (11.0%). Variables found to be significantly associated with ADHD included gender, age, Ritalin treatment and psychiatric comorbidities, but there was no significant association between ADHD and iron deficiency (p = 0.150).ConclusionThere was no relationship between ADHD and iron deficiency in this cohort of children and adolescents. Further studies using a treatment-naïve sample are required.