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DOI 10.1007/s12098-010-0129-7
Received: 19 May 2010 / Accepted: 20 May 2010 / Published online: 3 September 2010
# Dr. K C Chaudhuri Foundation 2010
D. Yadav : J. Chandra
Department of Pediatrics, Kalawati Saran Childrens
Hospital and Lady Hardinge Medical College,
New Delhi, India
D. Yadav
e-mail: dineshmamc@gmail.com
J. Chandra (*)
Lady Hardinge Medical College,
Lecturer Flats, Flat no 5,
New Delhi 110001, India
e-mail: jchandra55@gmail.com
66
Pathogenesis
IDA is associated with increased red cell porphyrin, which
inhibits ferrochelatase enzyme, thus further inhibiting heme
synthesis. This eventually leads to decreased hemoglobin
synthesis and anemia of iron deficiency ensues. Besides
this, decreased activity of ribonucleotide reductase and
pyruvate dehydrogenase enzymes has also been demonstrated in iron deficient individuals, which explains decreased DNA synthesis and impaired cellular oxidation
respectively [5]. Perinatal iron deficiency in animal experimental models has been seen to be associated with
decreased cytochrome C activity in neonatal brain, which
is also required for cellular oxidation [6]. Iron is also
required for normal oligodendrocyte function and myelination; synthesis of neurotransmitters (Dopamine, NorEpinephrine and Epinephrine) by tryptophan hydroxylase
and tyrosine hydroxylase enzymes and for normal brain
energy metabolism.
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68
Preventive Trials
Preventive trials aim to determine whether the development
of iron deficiency anemia and developmental deficits can
be prevented in hematologically normal children if they are
supplemented with iron. Two recent trials reported beneficial effects of iron therapy in infancy. In first trial, Friel et al
studied a group of breastfed children supplemented with
iron or placebo from ages 1 to 6 month. At 1218 month of
age, higher visual acuity scores and improved performance
on the Bayley Psychomotor Development Index (but not on
the Mental Development Index) were observed [31]. In
second much larger trial by Lozoff et al, children were
examined at 1 year of age after 6 month of iron
supplementation. They observed differences in specific
behavioural and developmental outcomes but not on global
test scores. Infants who did not receive supplemental iron
processed information slower and were less likely to show
positive affect, interact socially, or check their caregivers
reactions. They crawled somewhat later and were more
likely to be tremulous [32].
Both above trials suggested developmental and behavioural benefits from iron supplementation in healthy full
term infants; however, larger field trials are required before
its incorporation in national health policies.
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70
Conclusions
Being most common nutritional disorder, it is imperative to
recognize effects and long term consequences of iron
deficiency. Though anemia is common, iron deficiency
state without anemia is largely under-recognized. Studies
have reported lower cognitive scores even in children with
iron deficiency without anemia. Irreversible cognitive
impairment has been reported in children who experienced
iron deficiency during period of critical brain growth
(<2 years of age). Iron deficiency anemia is highly
prevalent in India (reported 55.7% to 85.1% in different
states in NFHS-3) [78] and much larger population having
iron deficiency without anemia; hence, it is critical to
recognize the cognitive impairment and treat early.
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