Patricia Chadud

21. ADVERSE EFFECT OF IRON DEFICIENCY ANEMIA ON INFANT PSYCOMOTOR DEVELOPMENT

In a prospective study of a cohort of 196 infants followed from birth to 15 months of age we studied the effect of iron status at 9 and 12 months on a) psychomotor development at 12 mo; b) short term iron therapy (10d) and c) long term iron treatment (3 months). Infants were classified as 39 anemic, 30 controls and 127 iron deficient without anemia. Anemic infants had mental and psychomotor development scores significantly lower (p < 0.0001) than both controls and iron deficient anemia. No differences were detected after 10 days or 3 months of iron therapy demonstrating a long term effect. A lower hemoglobin and longer duration of anemia were correlated to poorer scores. Specific areas of impairment were language aquisition and body balance leading to walking. These results, in a study where intervening variables were carefully controlled suggest that iron deficiency anemia has an adverse effect on infant development and that this effect is not reverted after treatment of anemia.

Folic acid nutrition in marasmic infants

Abstract To determine the prevalence of low folic acid levels in infants with marasmic malnutrition and to study its response to daily supplements of folic acid, a group of 80 malnourished infants 2 to 22 months of age were studied. In 12.5% of the group, serum folic acid levels were under 3ug/l and in 16.3%, red cell folic acid levels were under 140ug/l. In a sub group of 28 infants we determined the levels of folic acid on admission and discharge from a nutritional recovery center. During their hospital stay (median 117 days with a range of 94 to 130) infants received exclusively cows milk with a daily supplement of 100ug of folic acid. On discharge, a significant increase of serum folic levels to normal values was observed. A similar improvement, but not to the same extent, was appreciated in red cell folates. Inadequate quantity of supplementation or short time of observation could explain the lack of complete correction in the erythrocyte folic concentration.

Age-related changes in laboratory measures of iron nutrition in childhood

Abstract In the diagnosis of iron deficiency, age related variations of laboratory indices must be considered. With the purpose of analyzing these variations 154 children 6 to 9 years of age were studies. We determined hemoglobin, serum iron, total iron binding capacity, transferrin saturation, free erythrocyte protoporphyrin and serum ferritin. In order to exclude subjects possibly iron deficient, we analyzed only those children who complied with the following criteria: Hb≥11.9 and serum ferritin≥15 ug/1. For the estimation of the cut point of Fe/TIBC we required, in addition, FEP≤75 ug/dl RBC and for the calculation of FEP we required a transferrin saturation ≥15%. Results show a median and 95% confidence range for transferrin saturation of 26.7% (10.6–41.8) and for FEP of 64 ug/dl RBC (47–99).

Deficiencia de hierro y enriquecimiento de alimentos

La alta prevalencia de la carencia de hierro ha sido bien documentada en diferentes regiones haciendo de esta, tal vez, la deficiencia nutritional mas difundida en el mundo. En todos los paises, los lactantes entre los 6 y 18 meses de edad y las mujeres embarazadas aparecen como los grupos mas vulnerables (1). En estudios patrocinados por la OMS en diferentes partes del mundo, el porcentaje de mujeres embarazadas con anemia oscilo entre 21% y 80%, y el porcentaje con deficiencia de hierro fue m£s alto aun (40% a 99%) usando la saturation de la transferrina bajo 15% como criterio de deficiencia (2). En ninos, en estudios en Sudamerica el porcentaje con anemia ha variado entre un 15% y un 50% (1). En Chile, solo existen datos de prevalencia en lactantes que muestran un porcentaje de anemia que varia entre un 15% y un 40% de los casos y un porcentaje de hasta 83% con saturation de la transferrina bajo 15% (3, 4, 5). Si bien las consecuencias desfavorables de una anemia severa son evidentes, se ha debatido acerca de las desventajas que tendria una deficiencia de hierro mas larvada, llegando incluso a enumerarse posibles ventajas derivadas de esta condici6n (6). Ultimamente, sin embargo, han comenzado a documentarse efectos antes no reconocidos y posiblemente independientes de la anemia que van desde la disminucion en la capacidad de trabajo fisico y en el rendimiento intelectual (7, 8) hasta una alteration de la inmunidad celular (9) y una mayor frecuencia de infecciones (10). Resulta evidente que ante la magnitud que al-