Elsevier

The Journal of Pediatrics

Volume 195, April 2018, Pages 199-205.e2
The Journal of Pediatrics

Original Articles
Infant Iron Deficiency and Iron Supplementation Predict Adolescent Internalizing, Externalizing, and Social Problems

https://doi.org/10.1016/j.jpeds.2017.12.008Get rights and content

Objective

To evaluate associations between iron supplementation and iron deficiency in infancy and internalizing, externalizing, and social problems in adolescence.

Study design

The study is a follow-up of infants as adolescents from working-class communities around Santiago, Chile who participated in a preventive trial of iron supplementation at 6 months of age. Inclusionary criteria included birth weight ≥3.0 kg, healthy singleton term birth, vaginal delivery, and a stable caregiver. Iron status was assessed at 12 and 18 months of age. At 11-17 years of age, internalizing, externalizing, and social problems were reported by 1018 adolescents with the Youth Self Report and by parents with the Child Behavior Checklist.

Results

Adolescents who received iron supplementation in infancy had greater self-reported attention-deficit/hyperactivity disorder but lower parent-reported conduct disorder symptoms than those who did not (Ps < .05). Iron deficiency with or without anemia at 12 or 18 months of age predicted greater adolescent behavior problems compared with iron sufficiency: more adolescent-reported anxiety and social problems, and parent-reported social, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, oppositional defiant, conduct, aggression, and rule breaking problems (Ps < .05). The threshold was iron deficiency with or without anemia for each of these outcomes.

Conclusions

Iron deficiency with or without anemia in infancy was associated with increased internalizing, externalizing, and social problems in adolescence.

Section snippets

Methods

This study was a follow-up of a project in Chile that included a clinical trial of preventing iron deficiency anemia in infancy. Infants were enrolled from 1991 to 1996 at clinics in 4 working-class communities outside of Santiago, Chile. Inclusion and exclusion criteria were chosen to enroll healthy infants without common risk factors for developmental or behavioral problems. Inclusion criteria include birth weight >3.0 kg, singleton term birth, vaginal delivery, stable caregiver, and

Results

In adolescence, 1018 participants (49.0% female) completed the YSR, and 893 parents completed the CBCL. Adolescents who completed this session did not differ from cohort participants who did not on infant iron status, sex, breastfeeding, family stress, Home Observation for Measurement of the Environment score, maternal age, weight or length at birth, gestational age, or growth in weight or length between 0 and 6 months of age, Ps > 0.05. However, adolescents who participated in this follow-up

Discussion

This study confirms in a much larger cohort what was found in the earlier Costa Rican study.3 Specifically, results indicate that iron deficiency in infancy is associated with increased behavior problems later on. In this Chilean cohort, participants with iron deficiency in infancy were reported to have greater social, anxiety, ADHD, PTSD, aggressive, conduct, oppositional defiant, and rule breaking problems in adolescence. These adverse effects are not driven solely by iron deficiency

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    Funded by NICHD (R01HD14122 [PI: B.L.], R01HD33487 [PI: B.L. and S.G.], F32HD088029 [PI: J.R.D.]), NHLBI (R01HL088530 [PI: S.G.]), NIDDK (T32DK071212 [to J.R.D.]), and NIDA (R01DA021181 [PI: J.D.]). The authors declare no conflicts of interest.

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