La carence en fer durant l’enfance: causes et conséquences pour le développement de l’enfant

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Abstract

Les principales causes de la carence en fer (CF) sont brièvement discutées, puis un examen des études s’intéressant à la CF et classées en fonction de leur méthodologie et design, a été réalisé, à la recherche de liens de causalité entre la CF et le comportement et le développement cognitif et moteur de l’enfant. L’anémie ferriprive (AF) est associée à de nombreux problèmes psychosociaux et économiques qui peuvent affecter le développement de l’enfant et pourraient expliquer la relation, souvent observée, entre AF et troubles du développement et du comportement. De nombreuses données indiquent des modifications du fonctionnement cérébral chez les nourrissons présentant une AF. Cependant, de nombreux essais visant à traiter la CF manquent de puissance statistique en raison d’un faible effectif, de l’inclusion d’enfants non carencés, ou d’un traitement induisant peu ou pas de différence sur le statut ferrique entre le groupe placebo et le(s) groupe(s) traité(s). Chez les enfants de moins de 3 ans présentant une AF, les essais randomisés indiquent qu’une complémentation en fer est généralement bénéfique pour le développement moteur, mais pas nécessairement pour le développement mental. Une complémentation en fer a également des effets bénéfiques sur la fonction cognitive chez les enfants en âge scolaire présentant une AF. Il ne semble pas exister de seuil au-delà duquel une CF affecterait le développement de l’enfant, mais ceux dont la CF est suffisemment importante pour provoquer une AF devraient bénéficier en priorité d’une complémentation en fer. Cependant, les effets délétères d’une complémentation martiale sur la croissance et la morbidité chez des enfants non carencés doivent être pris en considération lors de l’élaboration de tels programmes interventionnels ou de politiques de santé publique.

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Most cited references 39

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Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States.

J Halterman, J M Kaczorowski, C Aligne … (2001)

Iron deficiency anemia in infants can cause developmental problems. However, the relationship between iron status and cognitive achievement in older children is less clear. To investigate the relationship between iron deficiency and cognitive test scores among a nationally representative sample of school-aged children and adolescents. The National Health and Nutrition Examination Survey III 1988-1994 provides cross-sectional data for children 6 to 16 years old and contains measures of iron status including transferrin saturation, free erythrocyte protoporphyrin, and serum ferritin. Children were considered iron-deficient if any 2 of these values were abnormal for age and gender, and standard hemoglobin values were used to detect anemia. Scores from standardized tests were compared for children with normal iron status, iron deficiency without anemia, and iron deficiency with anemia. Logistic regression was used to estimate the association of iron status and below average test scores, controlling for confounding factors. Among the 5398 children in the sample, 3% were iron-deficient. The prevalence of iron deficiency was highest among adolescent girls (8.7%). Average math scores were lower for children with iron deficiency with and without anemia, compared with children with normal iron status (86.4 and 87.4 vs 93.7). By logistic regression, children with iron deficiency had greater than twice the risk of scoring below average in math than did children with normal iron status (odds ratio: 2.3; 95% confidence interval: 1.1-4.4). This elevated risk was present even for iron-deficient children without anemia (odds ratio: 2.4; 95% confidence interval: 1.1-5.2). We demonstrated lower standardized math scores among iron-deficient school-aged children and adolescents, including those with iron deficiency without anemia. Screening for iron deficiency without anemia may be warranted for children at risk.

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Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls.

Katherine Duggan, Samuel Casella, Karim Brandt … (1996)

Up to 25% of adolescent girls in the USA are iron deficient. This double-blind, placebo-controlled clinical trial assessed the effects of iron supplementation on cognitive function in adolescent girls with non-anaemic iron deficiency. 716 girls who enrolled at four Baltimore high schools were screened for non-anaemic iron deficiency (serum ferritin < or = 12 micrograms/L with normal haemoglobin). 98 (13.7%) girls had non-anaemic iron deficiency of whom 81 were enrolled in the trial. Participants were randomly assigned oral ferrous sulphate (650 mg twice daily) or placebo for 8 weeks. The effect of iron treatment was assessed by questionnaires and haematological and cognitive tests, which were done before treatment started and repeated after the intervention. We used four tests of attention and memory to measure cognitive functioning. Intention-to-treat and per-protocol analyses were done. Of the 81 enrolled girls with non-anaemic iron deficiency, 78 (96%) completed the study (39 in each group). Five girls (three control, two treatment) developed anaemia during the intervention and were excluded from the analyses. Thus, 73 girls were included in the per-protocol analysis. Ethnic distribution, mean age, serum ferritin concentrations, haemoglobin concentrations, and cognitive test scores of the groups did not differ significantly at baseline. Postintervention haematological measures of iron status were significantly improved in the treatment group (serum ferritin 27.3 vs 12.1 micrograms/L, p < 0.001). Regression analysis showed that girls who received iron performed better on a test of verbal learning and memory than girls in the control group (p < 0.02). In this urban population of non-anaemic iron-deficient adolescent girls, iron supplementation improved verbal learning and memory.

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

P Nestel, Tarun Gera, HPS Sachdev (2005)

To evaluate the effect of iron supplementation on mental and motor development in children through a systematic review of randomised controlled trials (RCTs). Electronic databases, personal files, hand search of reviews, bibliographies of books, abstracts and proceedings of international conferences. 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. 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 or =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). 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.

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Author and article information

Journal

Journal ID (publisher-id): ANF

Journal ID (doi): 10.1159/issn.0250-9644

Title: Annales Nestlé (Ed. française)

Publisher: S. Karger AG

ISBN:

ISBN: 978-3-8055-9823-1

ISSN (Print): 0250-9644

ISSN (Electronic): 1661-3732

Publication date Subscription-year: 2010

Publication date (Print): July 2011

Publication date (Electronic): 12 July 2011

Volume: 68

Issue: 3

Pages: 108-123

Affiliations

Epidemiology Research Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Jamaïque

Author notes

*Sally Grantham-McGregor, Epidemiology Research Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston 7 (Jamaica), Tel. +1 876 927 2471, Fax +1 876 927 2984, E-Mail sallymcgregor@yahoo.com

Article

Publisher ID: 328758 Other ID: Ann Nestlé [Fr] 2010;68:108–123

DOI: 10.1159/000328758

SO-VID: 3c24e1a7-5dff-4209-9ab7-67becf5db8d2

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

La carence en fer durant l’enfance: causes et conséquences pour le développement de l’enfant

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Most cited references 39

Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States.

Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls.

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

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