Children and adolescents with iron deficiency anemia (IDA) are at increased risk for psychiatric disorders, including depressive disorder, bipolar disorder, anxiety disorder, and autism, new research shows.
"When encountering those with IDA in clinical practice, prompt iron supplementation should be considered to prevent possible psychiatric sequelae, and vice versa, psychiatrists should check the iron level in those children and adolescents with psychiatric disorders," study author Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital and National Yang-Ming University, in Taiwan, told Medscape Medical News.
The study was published online June 4 in BMC Psychiatry.
Impact on Cognitive Development
IDA is prevalent in children, adolescents, and women in nonindustrialized countries, and iron deficiency is the most prevalent nutritional deficiency in industrialized countries, the investigators note.
Iron plays a key role in brain development, including myelination of white matter and the development and functioning of the different neurotransmitter systems, including the dopamine, norepinephrine, and serotonin systems.
"There is well-documented evidence in the literature that IDA has a significant influence on cognitive development, intelligence, and developmental delay. However, the association between IDA and childhood/adolescence-onset psychiatric disorders is rarely investigated," first author Mu-Hong Chen, MD, told Medscape Medical News.
Using the Taiwan National Health Insurance Database and a case-control method, the investigators set out to clarify the association between IDA and various psychiatric disorders. Participants included 2957 children and adolescents in the database with a diagnostic code of iron deficiency anemia and 11,828 healthy control individuals matched for age and sex.
In multiple logistic regression analysis adjusting for demographic data and risk factors related to IDA, children and adolescents with IDA had a higher risk for several psychiatric disorders.
Table. Association Between IDA and Psychiatric Disorders
|Disorder||Odds Ratio (95% CI)|
|Unipolar depressive disorder||2.34 (1.59 - 3.46)|
|Bipolar disorder||5.80 (2.24 - 15.05)|
|Anxiety disorder||2.17 (1.49 - 3.16)|
|Autism spectrum disorder||3.08 (1.79 - 5.28)|
|Attention-deficit/hyperactivity disorder||1.67 (1.29 - 2.17)|
|Tic disorder||1.70 (1.03 - 2.78)|
|Delayed development||2.45 (2.00 - 3.00)|
|Mental retardation||2.70 (2.00 - 3.65)|
CI, confidence interval
"This is an interesting and thought-provoking study," said Betsy Lozoff, MD, who studies the effects of iron deficiency in infants at the University of Michigan in Ann Arbor but who was not involved in the study.
"The researchers appropriately note that the observed associations cannot tell if iron deficiency contributed to the psychiatric problems or vice versa," she told Medscape Medical News. "For instance, eating patterns and problems often observed in children with psychiatric disturbances could contribute to nutritional deficiencies, such as iron deficiency. So it is important to avoid making causal inferences. Nonetheless, the findings of this important study warrant further investigation," Dr. Lozoff explained.
Dr. Bai agreed and noted that "further well-designed cohort studies are needed to elucidate the causality or comorbid effect between IDA and psychiatric disorders."
Hopefully, added Dr. Chen, the results will "inspire further studies to investigate the role of iron or IDA in brain development of cognitive function, intelligence, social cognition, and behavioral and emotional regulation."
The authors and Dr. Lozoff report no relevant financial relationships.
BMC Psychiatry. Published online June 4, 2013. Full article
Medscape Medical News © 2013 WebMD, LLC
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Cite this: Iron Deficiency Linked to Psychiatric Disorders in Kids - Medscape - Jun 24, 2013.