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

J Pediatr. 2018 Apr;195:199-205.e2. doi: 10.1016/j.jpeds.2017.12.008. Epub 2018 Feb 1.

Abstract

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.

Keywords: Chile; adolescence; behavior problems; iron deficiency anemia.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Anemia, Iron-Deficiency / prevention & control*
  • Anemia, Iron-Deficiency / psychology
  • Anxiety / diagnosis
  • Anxiety / etiology*
  • Anxiety / prevention & control
  • Attention Deficit Disorder with Hyperactivity / diagnosis
  • Attention Deficit Disorder with Hyperactivity / etiology*
  • Attention Deficit Disorder with Hyperactivity / prevention & control
  • Child
  • Conduct Disorder / diagnosis
  • Conduct Disorder / etiology*
  • Conduct Disorder / prevention & control
  • Dietary Supplements*
  • Double-Blind Method
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Iron / therapeutic use*
  • Male
  • Parents
  • Risk Factors
  • Self Report
  • Trace Elements / therapeutic use*
  • Treatment Outcome

Substances

  • Trace Elements
  • Iron