Iron Profile in Children with Behavioural Disorders: A Prospective Study in a Tertiary Care Hospital in North India

Abstract

Iron deficiency anemia is the most frequent micronutrient deficiency in the developing countries like India especially affecting pregnant women and young children. Iron is an essential element involved in myelin formation, neurotransmitter synthesis and neuro-metabolism. Several behavioural disturbances have been reported in iron deficient children. In the present study, we determined the prevalence of iron deficiency anemia in children with behavioural disorders and assessed the improvement in terms of symptoms (by child behaviour check list), haematological parameters and iron status after treatment with oral iron. In this prospective study, 44 children in the age group of 3-12 years who were diagnosed with behavioural disorders were evaluated. Complete blood counts using automated hematology analyzer and iron parameters (serum iron, total iron binding capacity, % transferrin saturation and serum ferritin) were measured in all the patients to assess the prevalence of iron deficiency in these children. Thirty age matched controls were also studied. Iron deficiency was found in 32 (73%) children, as assessed by transferrin saturation \16% and/or serum ferritin \16 lg/l. Following treatment with iron for 100 ± 10 days, there was a statistically (P B 0.05) significant improvement in the clinical features, haematological profile and iron status. The presence of iron deficiency in children with behavioural disorders and subsequent improvement in clinical features, haematological profile and iron status suggests a possible causal relationship between iron deficiency and behavioural disorders.

Soluble Transferrin Receptor and SFI Index - A new biomarker to identify Iron Deficiency in Drug Naïve Children with ADHD - A Case-Control Study

“…Out of 20 studies on conventional markers of iron, only nine studies have used serum iron. We found a lower value of serum iron in our study compared to other studies, including two studies done in India by Mahajan et al [16] & Islam et al [21]. In Mahajan et al [16] study in children with behavioural problems, the mean levels of serum iron were 64.6 ± 29.2 µg/dl in children with behavioural problems compared to controls (99.1 ±27.5µg/dl).…”

“…We found a lower value of serum iron in our study compared to other studies, including two studies done in India by Mahajan et al [16] & Islam et al [21]. In Mahajan et al [16] study in children with behavioural problems, the mean levels of serum iron were 64.6 ± 29.2 µg/dl in children with behavioural problems compared to controls (99.1 ±27.5µg/dl). Also, only 4 (12.5%) of their children with behavioural problems were in the latent period of iron deficiency.…”

“…Hence it is significantly associated with the serum iron. Very few studies have reported percentage transferrin saturation, a study by Mahajan et al [16] in India found significantly lower mean levels of percentage transferrin saturation in children with behavioural problems [12 (47.7%) of them were ADHD children] (17.9 ±7) compared to healthy controls (26.9 ±6.7) (p-value < 0.001). The mean values were even lower in our study, and these findings suggest that percentage transferrin saturation could also remain a potential marker to identify Iron deficiency in children with ADHD, if facilities to assess sTfR are unavailable.…”

“…They included standardized tests such as complete blood counts using automated hematology analyzer (SulpholyerHb, flow cytometry, Hydrodynamic focusing method, photometric measurement on XT 2000i Supra vital and westegren), C Reactive Protein (PETIA), Serum Iron (Photometric Ferene), Total Iron Binding Capacity (Photometric Ferene), Serum Ferritin (CLIA) and sTfR (Nephelometry). We have taken percentage Transferrin of ≤ 16%, Serum Ferritin of ≤ 16 µg/l, and normal Hb as latent iron deficiency [16] and Serum Iron ≤ 50 μg/dl [17]. We also repeated sTfR levels on a random basis in five ADHD and five Healthy Children to explore the reliability of the values.…”

<p>Prevalence of iron deficiency anemia in Iranian children under 6 years of age: a systematic review and meta-analysis</p>

“…These are higher than the prevalence rate we found among Iranian children. Iron deficiency anemia in children, especially in infants, can lead to changes in their development, especially in their nervous system that may be irreversible despite receiving appropriate treatments 29,30…”