CENTER ON BEHAVIORAL MEDICINE
Essential Nutrients-Cognition: Research Article
Szilagyi, P.G., Halterman, J.S., et al. (2001) Iron Deficiency
and Cognitive Achievement Among
School-Aged Children and Adolescents in the
Context. Iron deficiency anemia
in infants can cause developmental problems. However, the relationship
between iron status and cognitive achievement in older children is less clear.
Objective. To investigate the relationship between iron deficiency and cognitive test scores among a nationally representative sample of school-aged children and adolescents.
Design. The National Health and
Nutrition Examination Survey III 1988–1994 provides cross-sectional
data for children 6 to 16 years old and contains measures of iron
status including transferrin saturation, free erythrocyte
protoporphyrin, and serum ferritin. Children were considered
iron-deficient if any 2 of these values were abnormal for age and gender, and standard hemoglobin values were used
to detect anemia. Scores from standardized tests were compared for
children with normal iron status, iron deficiency without anemia, and
iron deficiency with anemia. Logistic regression was used to estimate
the association of iron status and below average
Results. Among the 5398 children
in the sample, 3% were iron-deficient. The prevalence of iron
deficiency was highest among adolescent girls (8.7%). Average math
scores were lower for children with iron deficiency with and without
anemia, compared with children with normal iron status (86.4 and 87.4
vs 93.7). By logistic regression, children with iron deficiency had
greater than twice the risk of scoring below average in math than did
children with normal iron status (odds ratio: 2.3; 95% confidence
interval: 1.1– 4.4). This elevated risk was present even for
iron-deficient children without anemia (odds ratio: 2.4; 95% confidence
Conclusions. We demonstrated lower standardized math scores among iron-deficient school-aged children and adolescents, including those with iron deficiency without anemia. Screening for iron deficiency without anemia may be warranted for children at risk.
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