Iron status in early infancy is associated with trajectories of cognitive development up to pre-school age in rural Gambia.
Iron status in early infancy is associated with trajectories of cognitive development up to pre-school age in rural Gambia.
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DOI：
10.1371/journal.pgph.0002531
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发表时间：
2023
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缺铁是认知发育不良的主要危险因素之一。然而，针对缺铁的干预措施对认知结果的影响喜忧参半。这可能是由于以前的干预措施侧重于纠正婴儿后期和幼儿期的缺铁性贫血，此时可能已经建立了长期持久的神经影响。我们假设铁状态和认知发育之间的关系在出生后的头几个月就可以观察到，并且在5岁时不会恢复。使用来自冈比亚全球健康脑成像（BRIGHT）研究的数据（n = 179），我们进行了混合效应建模，以评估5个月龄时铁状况与5个月至5岁认知发育轨迹之间的关系，使用（i）认知发育的标准化测量（马伦早期学习量表）和（ii）注意力处理的眼动追踪评估（视觉脱离时间）。所有婴儿在1个月大时都有足够的铁。在5个月和12个月时，分别有30%和55%的婴儿缺铁。在完全校正的分析中，可溶性转铁蛋白受体（sTfR）最低三分位数（最佳铁状态）的婴儿比sTfR最高三分位数的婴儿平均高1.9分（p = 0.009，效应量= 0.48）。没有证据表明这种组间差异在5岁时恢复。在最低sTfR tercile的婴儿视觉脱离时间比最高tercile快57 ms（p = 0.001，效应量= 0.59）。然而，这种差异在幼儿期缩小（p = 0.024）。婴儿在婴儿早期有缺铁的风险。铁状况与认知发育之间的关系从5个月大起就很明显，并且在5岁时仍然可以观察到。婴儿早期铁的供应影响大脑发育的一个机制可能是通过影响早期注意力处理，这是快速发展，并在此期间有大量的营养需求。为了支持神经认知的发展，在产前和产后早期预防铁缺乏可能比纠正铁缺乏更有效。
Iron deficiency is among the leading risk factors for poor cognitive development. However, interventions targeting iron deficiency have had mixed results on cognitive outcomes. This may be due to previous interventions focusing on the correction of iron deficiency anaemia in late infancy and early childhood, at which point long lasting neural impacts may already be established. We hypothesise that the relationship between iron status and cognitive development will be observable in the first months of life and will not be recovered by 5 years of age. Using data from the Brain Imaging for Global Health (BRIGHT) Study in Gambia (n = 179), we conducted mixed effects modelling to assess the relationship between iron status at 5 months of age and trajectories of cognitive development from 5 months– 5 years using (i) a standardised measure of cognitive development (Mullen Scales of Early Learning) and (ii) an eye-tracking assessment of attention processing (visual disengagement time). All infants were iron sufficient at 1 month of age. At 5 and 12 months of age 30% and 55% of infants were iron deficient respectively. In fully adjusted analyses, infants in the lowest tercile of soluble transferrin receptor (sTfR) (best iron status) achieved MSEL Cognitive Scores on average 1.9 points higher than infants in the highest sTfR tercile (p = 0.009, effect size = 0.48). There was no evidence that this group difference was recovered by 5 years of age. Infants in the lowest sTfR tercile had visual disengagement time 57ms faster than the highest tercile (p = 0.001, effect size = 0.59). However, this difference diminished by early childhood (p = 0.024). Infants are at risk of iron deficiency in early infancy. A relationship between iron status and cognitive development is apparent from 5 months of age and remains observable at 5 years of age. One mechanism by which iron availability in early infancy impacts brain development may be through effects on early attentional processing, which is rapidly developing and has substantial nutritional requirements during this period. To support neurocognitive development, prevention of iron deficiency in pre- and early postnatal life may be more effective than correcting iron deficiency once already established.