Skip to main content
×
Home

Effect of iron supplementation on mental and motor development in children: systematic review of randomised controlled trials

  • HPS Sachdev (a1), Tarun Gera (a2) and Penelope Nestel (a3)
Abstract
AbstractObjective

To evaluate the effect of iron supplementation on mental and motor development in children through a systematic review of randomised controlled trials (RCTs).

Data sources

Electronic databases, personal files, hand search of reviews, bibliographies of books, abstracts and proceedings of international conferences.

Review methods

RCTs with interventions that included oral or parenteral iron supplementation, fortified formula milk or cereals were evaluated. The outcomes studied were mental and motor development scores and various individual development tests employed, including Bayley mental and psychomotor development indices and intelligence quotient.

Results

The pooled estimate (random effects model) of mental development score standardised mean difference (SMD) was 0.30 (95% confidence interval (CI) 0.15 to 0.46, P < 0.001; P < 0.001 for heterogeneity). Initial anaemia and iron-deficiency anaemia were significant explanatory variables for heterogeneity. The pooled estimate of Bayley Mental Development Index (weighted mean difference) in younger children (<27 months old) was 0.95 (95% CI −0.56 to 2.46, P = 0.22; P = 0.016 for heterogeneity). For intelligence quotient scores (≥8 years age), the pooled SMD was 0.41 (95% CI 0.20 to 0.62, P < 0.001; P = 0.07 for heterogeneity). There was no effect of iron supplementation on motor development score (SMD 0.09, 95% CI -0.08 to 0.26, P = 0.28; P = 0.028 for heterogeneity).

Conclusions

Iron supplementation improves mental development score modestly. This effect is particularly apparent for intelligence tests above 7 years of age and in initially anaemic or iron-deficient anaemic subjects. There is no convincing evidence that iron treatment has an effect on mental development in children below 27 months of age or on motor development.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Effect of iron supplementation on mental and motor development in children: systematic review of randomised controlled trials
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Effect of iron supplementation on mental and motor development in children: systematic review of randomised controlled trials
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Effect of iron supplementation on mental and motor development in children: systematic review of randomised controlled trials
      Available formats
      ×
Copyright
Corresponding author
*Corresponding author: Email hpssachdev@hotmail.com
E-6/12 Vasant Vihar, New Delhi 110 057, India.
References
Hide All
1Yehuda S, Youdim MBH, Mostofsky DI. Brain iron deficiency causes reduced learning capacity in rats. Pharmacology, Biochemistry, and Behavior 1986; 25 141–4.
2Beard JL, Connor JR, Jones BC. Brain iron: location and function. Progress in Food & Nutrition Science 1993; 17: 183221
3Beard JL, Connor JR, Jones BC. Iron in the brain. Nutrition Reviews 1993; 51: 157–70.
4Connor JR, Menzies SL. Relationship of iron to oligodendrocytes and myelination. Glia 1996; 17: 8393.
5Lansdown R, Wharton BA. Iron and mental and motor behaviour in children. In: Iron, Nutrition and Physiological Significance: Report of the British Nutrition Task Force. London: Chapman and Hall, 1995; 6578.
6Grantham-McGregor S, Ani C. A review of studies on the effect of iron deficiency on cognitive development in children. Journal of Nutrition 2001; 131: 649S–68S.
7Logan S, Martins S, Gilbert R. Iron therapy for improving psychomotor development and cognitive function in children under the age of three with iron deficiency anaemia (Cochrane Review).In: The Cochrane Library, Issue 4. Oxford: Update Software, 2001.
8Juni P, Altman DG, Egger M. Assessing the quality of randomised controlled trials. In: Egger M, Smith GD, Altman DG, eds. Systematic Reviews in Health Care: Meta-analysis in Context. London: BMJ Publishing, 2001; 87108.
9Clarke M, Oxman AD, eds. Assessment of study quality. Cochrane Reviewers Handbook 4.1.1, updated December 2000. In: The Cochrane Library, Issue 1. Oxford: Update Software, 2001.
10Follmann D, Elliott P, Suh I, Cutler J. Variance imputation for overviews of clinical trials with continuous response. Journal of Clinical Epidemiology 1992; 45: 769–73.
11Sterne JAC, Egger M, Smith GD. Investigating and dealing with publication and other biases and other biases. In: Egger M, Smith GD, Altman DG, eds. Systematic Reviews in Health Care: Meta-analysis in Context. London: BMJ Publishing, 2001; 189208.
12Sterne JAC, Bradburn MJ, Egger M. Meta-analysis in STATATM. In: Egger M, Smith GD, Altman DG, eds. Systematic Reviews in Health Care: Meta-analysis in Context. London: BMJ Publishing, 2001; 347–69.
13Oski FA, Honig AS. The effects of therapy on the developmental scores of iron-deficient infants. Journal of Pediatrics 1978; 92: 21–5.
14Dienard AS, List A, Lindgren B, Hunt JV, Chang PN. Cognitive deficits in iron-deficient and iron deficient anemic children. Journal of Pediatrics 1986; 108: 681–9.
15Pollitt E, Hathirat P, Kotchabhakdi NJ, Missell L, Valyasevi A. Iron deficiency and educational achievement in Thailand. American Journal of Clinical Nutrition 1989; 50: 687–97.
16Cantwell RJ. The long-term neurological sequelae of anaemia in infancy. Pediatric Research 1974; 342: 68.
17Bruner AB, Joffe A, Duggan AK, Casella JF, Brandt J. Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls. Lancet 1996; 348: 992–6.
18Oski FA, Honig AS, Helu B, Howanitz P. Effect of iron therapy on behavior performance in nonanemic, iron-deficient infants. Pediatrics 1983; 71: 877–80.
19Pollitt E, Soemantri AG, Yunis F, Scrimshaw NS. Cognitive effects of iron deficiency anaemia. Lancet 1985; 1: 158.
20Lozoff B, Brittenham GM, Wolf AW, McClish DK, Kuhnert PM, Jimenez R, et al. Iron deficiency anemia and iron therapy effects on infant developmental test performance. Pediatrics 1987; 79: 981–95.
21Seshadri S, Gopaldas T. Impact of iron supplementation on cognitive functions in preschool and school-aged children: the Indian experience. American Journal of Clinical Nutrition 1989; 50(Suppl. 3): 675–84.
22Heywood A, Oppenheimer S, Heywood P, Jolley D. Behavioral effects of iron supplementation in infants in Madang, Papua New Guinea. American Journal of Clinical Nutrition 1989; 50(Suppl. 3): 630–7.
23Boivin MJ, Giordani B. Improvements in cognitive performance for school children in Zaire, Africa, following an iron supplement and treatment for intestinal parasites. Journal of Pediatric Psychology 1993; 18: 249–64.
24Lozoff B, Wolf AW, Jimenez E. Iron deficiency anemia and infant development: effects of extended oral iron therapy. Journal of Pediatrics 1996; 129: 382–9.
25Lynn R, Harland P. A positive effect of iron supplementation on the IQs of iron deficient children. Personality and Individual Differences 1998; 24: 883–5.
26Williams J, Wolff A, Daly A, Macdonald A, Aukett A, Booth AW. Iron supplemented formula milk related to reduction in psychomotor decline in infants from inner city areas: randomised study. British Medical Journal 1999; 318: 693–7.
27Walka H, Triana N, Jahari AB, Husaini AM, Pollitt E. Effects of an energy and micronutrient supplement on play behaviour in undernourished children in Indonesia. European Journal of Clinical Nutrition 2000; 54(Suppl. 2): S91106.
28Pollitt E, Jahari A, Walka H. A developmental view of the effects of an energy and micronutrient supplement in undernourished children in Indonesia. European Journal of Clinical Nutrition 2000; 54(Suppl. 2): S107–13.
29Lozoff B, De Andraca I, Castillo M, Smith JB, Walter T, Pino P. Behavioral and developmental effects of preventing iron deficiency anemia in healthy full-term infants. Pediatrics 2003; 112: 846–54.
30Lozoff B, Brittenham GM, Viteri FE, Wolf AW, Urrutia JJ. The effects of short-term oral iron therapy on developmental deficits in iron deficient anemic infants. Journal of Pediatrics 1982; 100: 351–7.
31Driva A, Kafatos A, Salman M. Iron deficiency and the cognitive and psychomotor development of children: a pilot study with institutionalised children. Early Child Development and Care 1985; 22: 7382.
32Soemantri AG, Pollitt E, Kim I. Iron deficiency anemia and educational achievement. American Journal of Clinical Nutrition 1985; 42: 1221–8.
33Aukett MA, Parks YA, Scott PH, Wharton BA. Treatment with iron increases weight gain and psychomotor development. Archives of Disease in Childhood 1986; 61: 849–57.
34Soewondo S, Husaini M, Pollitt E. Effects of iron deficiency on attention and learning processes in preschool children: Bandung, Indonesia. American Journal of Clinical Nutrition 1989; 50: 667–74.
35Walter T, De Andraca I, Chadud P, Perales CG. Iron deficiency anemia: adverse effects on infant psychomotor development. Pediatrics 1989; 84: 717.
36Soemantri AG. Preliminary findings on iron supplementation and learning achievement of rural Indonesian children. American Journal of Clinical Nutrition 1989; 50: 698702.
37Idjradinata P, Pollitt E. Reversal of developmental delays in iron deficient anaemic infants treated with iron. Lancet 1993; 341: 14.
38Moffatt MEK, Longstaffe S, Besant J, Dureski C. Prevention of iron deficiency and psychomotor decline in high risk infants through use of iron fortified infant formula: a randomised clinical trial. Journal of Pediatrics 1994; 125: 527–34.
39Morley R, Abbott R, Fairweather-Tait S, Macfayden U, Stephenson T, Lucas A. Iron fortified follow on formula from 9 to 18 months improves iron status but not development or growth: a randomised trial. Archives of Disease in Childhood 1999; 81: 247–52.
40Stoltzfus RJ, Kvalsvig JD, Chwaya HM, Montresor A, Albonico M, Tielsch JM, et al. Effects of iron supplementation and anthelminthic treatment on motor and language development of preschool children in Zanzibar: double blind, placebo controlled study. British Medical Journal 2001; 323: 18.
41Stoltzfus RJ, Dreyfuss ML. Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anemia. Washington, DC: ILSI Press, 1998.
42Nestel P, Davidsson L. Anemia, Iron Deficiency, and Iron Deficiency Anemia. Washington, DC: ILSI Press, 2002.
43Nokes C, van den Bosch C, Bundy DAP. The Effects of Iron Deficiency and Anaemia on Mental and Motor Performance, Educational Achievement, and Behaviour in Children: An Annotated Bibliography. Report of the International Nutritional Anemia Consultative Group (INACG). Washington, DC: INACG, 1998.
44Symes AL, Missala K, Sourkes TL. Iron and riboflavin dependent metabolism of a monoamine in the rat in vivo. Science 1971; 174: 153–5.
45Dallman PR, Siimes M, Manies EC. Brain iron: persistent deficiency following short-term iron deprivation in the young rat. British Journal of Haematology 1975; 31: 209–15.
46Findlay E, Reid RL, Ng KT, Armstrong SM. The effect of iron deficiency during development on passive avoidance learning in the adult rat. Physiology & Behavior 1981; 27: 1089–96.
47Weinberg J, Levin S, Dallman PR. Long term consequences of early iron deficiency in rat. Pharmacology, Biochemistry, and Behavior 1979; 11: 631–8.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 5
Total number of PDF views: 542 *
Loading metrics...

Abstract views

Total abstract views: 755 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 22nd November 2017. This data will be updated every 24 hours.