Longitudinal Evaluation of Externalizing and Internalizing Behavior Problems Following Iron Deficiency in Infancy

Center for Human Growth and Development, Department of Pediatrics and Communicable Diseases, University of Michigan, 300 N. Ingalls, Ann Arbor, MI 48109-0406, USA.
Journal of Pediatric Psychology (Impact Factor: 2.91). 10/2009; 35(3):296-305. DOI: 10.1093/jpepsy/jsp065
Source: PubMed


This study examined externalizing and internalizing behavior problem trajectories as a function of both iron status in infancy and infant characteristics.
A sample of 185 healthy Costa Rican children who either had chronic, severe iron deficiency or good iron status in infancy were followed for 19 years.
Mother ratings of externalizing and internalizing problems from age 5 to 11-14 years were higher for the chronic iron deficiency group compared with those with the good iron status. Iron deficiency in infancy predicted persisting externalizing problems over this time period, especially for those with low physical activity in infancy. Beyond adolescence, youth in the chronic iron deficiency group did not report more problems than those in the good iron group.
These findings underscore the importance of considering infant iron status along with early behavioral characteristics to better identify those children at greatest risk for persisting long-term behavior problems.

Download full-text


Available from: Niko Kaciroti
  • Source
    • "Infants and toddlers with iron deficiency anemia are reported to exhibit more shyness, less engagement, decreased positive affect, more difficulty in being soothed when upset, and less optimal interaction with their mothers (Armony-Sivan, KaplanEstrin, Jacobson, & Lozoff, 2010;Lozoff et al., 2008Lozoff et al., , 2010). ID in infancy is also associated with poorer longterm social–emotional outcomes in preschool age (Chang et al., 2011), school age (Lozoff, Castillo, Clark, Smith, & Sturza, 2014), adolescence (Corapci, Calatroni, Kaciroti, Jimenez, & Lozoff, 2010), and young adulthood (Lozoff et al., 2013). Iron status at birth was unknown in these studies. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study considered effects of timing and duration of iron deficiency (ID) on frontal EEG asymmetry in infancy. In healthy term Chinese infants, EEG was recorded at 9 months in three experimental conditions: baseline, peek-a-boo, and stranger approach. Eighty infants provided data for all conditions. Prenatal ID was defined as low cord ferritin or high ZPP/H. Postnatal ID was defined as ≥ two abnormal iron measures at 9 months. Study groups were pre- and postnatal ID, prenatal ID only, postnatal ID only, and not ID. GLM repeated measure analysis showed a main effect for iron group. The pre- and postnatal ID group had negative asymmetry scores, reflecting right frontal EEG asymmetry (mean ± SE: -.18 ± .07) versus prenatal ID only (.00 ± .04), postnatal ID only (.03 ± .04), and not ID (.02 ± .04). Thus, ID at both birth and 9 months was associated with right frontal EEG asymmetry, a neural correlate of behavioral withdrawal and negative emotions. © 2015 Wiley Periodicals, Inc. Dev Psychobiol 9999: 1-9, 2015.
    Full-text · Article · Dec 2015 · Developmental Psychobiology
  • Source
    • "Infants and young children from 6 to 24 months of age appear to be the most vulnerable to iron-deficiency and iron-deficient anemia [6], [19]. There is a significant amount of scientific literature suggests that iron deficiency and iron-deficient anemia may be associated with an impaired immune system [20] which could increase the morbidity and mortality, and with the delay in cognitive function development [21] or behavior problems [22]. The monitoring results from affected sites in our study showed that the anemia prevalence significantly increased in infants and young children from two months to two years of the earthquake, and this negative effect on girls was more significantly, for example, anemia percentage was respectively 76.2% for girls and 72.3% for boys after two years of earthquake. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To prospectively evaluate the efficiency of daily providing complementary food supplements decreasing malnutrition and anemia prevalence in elder infants and young children living in areas affected by Wenchuan Earthquake. Using promotional probability sampling method, 250 to 300 children from six-randomized townships (30 to 50 children in each township) in Kang County affected by the Earthquake were randomly chosen for follow up to evaluate intervention effectiveness using anthropometric measurement and hemoglobin level at six, twelve and eighteen months after start of intervention. All children from 6 to 18 months of age in Kang County (in North Western China) were daily provided with complementary food supplements containing multiple vitamins and minerals for up to 24 months of age. The intervention period lasted for one and half year. At beginning of intervention, malnutrition prevalence, including underweight, stunting and wasting were respectively 4.5%, 8.9% and 3.5%; anemia prevalence was 74.3%. After one and half year intervention, the growth and anemia status were significantly improved; the percentages of wasting, stunting underweight prevalence were decreased from 3.5%, 8.9% and 4.5% to 1.7%, 5.0% and 3.3% respectively, and the anemia rates were significantly decreased. Our results indicated that an intervention using complementary food supplements could improve nutritional status and elevate hemoglobin level in elder infants and young children, which would significantly decrease the prevalence of malnutrition and anemia.
    Preview · Article · Sep 2013 · PLoS ONE
  • Source
    • "IDA has long been associated with increased irritability and behavioral problems in children (Werkman et al. 1964; Orii et al. 2002). A well-controlled 20 year longitudinal study of Costa Rican children with a history of severe chronic IDA in infancy found that history of IDA was associated with lower cognitive scores and increased anxiety and depression, as well as increased behavioral problems (Lozoff et al. 2000; Corapci et al. 2010). In multiple studies, ID has been associated with various cognitive deficits and with psychiatric disorders (Lozoff et al. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Iron plays a key role in brain function, and a deficiency of iron has been implicated in various cognitive, motor, and psychiatric disorders. Because of recent evidence that iron deficiency may be related to attention-deficit/hyperactivity disorder (ADHD) and other psychiatric disorders, the goal of this study was to compare the iron status of children and youth seen in a community mental health clinic with a national sample of same-aged subjects. Methods: In this study, a consecutive series of 108 patients (79 males) referred to a community mental health clinic was compared with a National Health and Nutrition Examination Survey (NHANES) sample on measures of iron status. Wilcoxon sign rank and median tests were used to compare distributions of ferritin. Quantile regression was performed to compare the ferritin level in the two samples while adjusting for demographic differences. Chi squared (χ2) was used to compare rates of low hemoglobin in the two samples. Results: The iron status of the clinic sample, as measured by ferritin levels (median=23 μg/L), was significantly lower than that of the national sample (median=43 μg/L). After adjustment for age, gender, and race, the clinic sample was found to have 19.2 μg/L lower ferritin than the national sample (95% CI from 7.6 to 30.9, p value=0.001). There were also significantly more subjects in the clinic sample with low hemoglobin than in the national sample. There were no differences in ferritin levels between those patients in the clinic sample with and without an ADHD or other specific psychiatric diagnosis. Conclusions: The ferritin levels of children and youth in a mental health clinic sample were significantly lower than those of the same-aged subjects in a national sample. Therefore, compromised iron status may be an additional biological risk factor for cognitive, behavioral, and psychiatric problems in pediatric populations served by the community mental health clinic.
    Full-text · Article · Mar 2013 · Journal of child and adolescent psychopharmacology
Show more