Medical

Communication

Biosci. Biotech. Res. Comm. 10(3): 592-596 (2017)

On the prevalence of iron de ciency in children and

adolescents with growth retardation

Arash Rahbar* and Arian Hajian

School of Medicine, Student Research Committee, Babol University of Medical Sciences, Babol, Iran

ABSTRACT

Iron is a fundamental micro-element in body. Iron de ciency is the most prevalent nutritional de ciency around world.

Iron de ciency can disarrange physical growth and neurocognitive development of children thorough different ways

such as decreasing oxygen transport capacity, decreasing energy production and decreasing the appetite. The aim of this

study was to evaluate iron de ciency prevalence in children between 6-18months old in Babol, Iran. This cross sectional

study was performed on 100 children and adolescents with growth retardation in Babol. Weight and height of children

was measured and comparing with the growth curve indices, Hb and mid MCV of children in percentile Height and

weight lesser than 3 was evaluated. In this study, prevalence of anemia in growth retarded children was 35.9% whereas

prevalence of microcytic anemia was 20% followed by iron de ciency prevalence of 1.6% and 25%. Average of ferritin

level decreased with increasing of severity of growth disorder in children. The results of this study suggest that treatment

of growth retarded children with iron supplements can improve their growth. Because data about prevalence of IDA in

Iranian children is limited, we suggest further studies to be performed to de ne an average range of iron concentrations

in accordance with other micro-elements such as zinc and copper in children of this area.

KEY WORDS: GROWTH RETARDATION, CHILDREN AND ADOLESCENTS, IRON DEFICIENCY ANEMIA

592

ARTICLE INFORMATION:

*Corresponding Author: arsah.rahbar@gmail.com

Received 20

July, 2017

Accepted after revision 29

Sep, 2017

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007 CODEN: USA BBRCBA

Thomson Reuters ISI ESC and Crossref Indexed Journal

NAAS Journal Score 2017: 4.31 Cosmos IF: 4.006

reserved.

Online Contents Available at: http//www.bbrc.in/

DOI: 10.21786/bbrc/10.3/38

INTRODUCTION

Iron de ciency is a worldwide problem during life, but

infants are especially susceptible to development and

complications of iron de ciency (Akramipour et al.,

2008). Iron de ciency during  rst two years of a child

life can cause irrecoverable de cits in cognitive devel-

opment, and also other potential adverse effects(Black

et al., 2013, Victora et al., 2008) 2013, Victora et al.,

2008. Iron requirements of infants under six months old,

are generally not well determined, since it is dif cult to

estimate the demands in infants which exclusively eat

breast milk (Bender, 2003) Assumed that most of new-

born infants are greatly protected from iron de ciency

Arash Rahbar and Arian Hajian

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS PREVALENCE OF IRON DEFICIENCY IN CHILDREN AND ADOLESCENTS WITH GROWTH RETARDATION 593

by the birth iron stores, usually iron de ciency is not

considered in infants below six months old. However,

iron de ciency (ID) and iron de ciency anemia (IDA) can

be observed, in the range of 0%–15% (ID) and 0%–4%

(IDA) in six-month-old infants around the world (Ziegler

et al., 2009, Nguyen et al., 2017b).

Older infants (up to 24 months old) are at higher risk

of ID and IDA than younger one. Infants are susceptible

to the effects of low iron levels, even before the  rst

moments of birth: low iron stores at birth have been

associated with iron de ciency and also elevated risk

of growth retardation and cognitive developmental dis-

orders later in infancy (Ziegler et al., 2009, MacQueen

et al., 2017).

Iron de ciency developing in infancy and leads to

IDA has similarly been associated with bad cognitive,

behavioral and growth problems; the consequences of

iron de ciency without IDA are not clear (Kazal Jr, 2002

Domellöf et al., 2014, Mamabolo and Alberts, 2014, Ritu

et al., 2017).

In Iran, there may be not an ordinary screening pro-

gram for anemia and ID in children and population-

based data on anemia, that includes ferritin concen-

tration in children, continue to be limited. The aim of

present study was to identify the prevalence of iron

de ciency and explores their associations with socio-

economic parameters and it’s complications in growth

failure in and adolescents of 1-18 years old in Babol,

Iran.

MATERIAL AND METHODS

In this cross-sectional study blood samples were col-

lected from 100 children and adolescents (56 boys and

44 girls). They aged 1 to 18 years with growth failure

including small height, low weight or both of them

whom referred to our Hospital during years 2015-2016

were investigated. The patients were divided to 3 cat-

egories according to the place of life (urban, suburb, and

rural). 70 individuals were urban patients (%70), 24 rural

patients (24%) and 6 suburb patients (6%).

The patient’s weight and height were measured and

compared according to growth curve indices (CDC) and

patients with growth retardation (percentile of weight

and height under 3%) were evaluated for iron de ciency

associated hematologic factors (blood hemoglobin level,

MCV, and serum ferritin level). Other factors such as

birth weight and the location of life were also evaluated

in the patients. The exclusion criteria were patients with

any associated disease such as heritable problems and

liver-heart or kidney diseases, and also patients under

treatment with iron were omitted from the study. Chil-

dren with growth disorder having serum ferritin levels

lower than normal (according to normal value associ-

ated with age and sex) regardless to presenting anemia

or not are considered as positive cases of the study.

STATISTICAL ANALYSIS

The Hb concentrations were symmetrically distributed.

The distribution of plasma ferritin was skewed regarding

higher values. The descriptive statistics included means,

medians, interquartile ranges, and 95% assurance inter-

vals as appropriate. Student t-test or Chi-square tests

were used to measure the dissimilarity between Hb and

ferritin with clinical or other baseline features. Data sta-

tistical analyses was performed via SPSS software ver-

sion 18.

RESULTS AND DISCUSSION

Anemia in little children lower than 2 years of age is of

ultimate concern since their fast growth needs a high

iron consumption which can be regularly not covered

by their food plan, (Kotecha, 2011, Nguyen et al., 2017a).

It was not possible to estimate the anemia prevalence in

this group separately due to the minimal records. How-

ever, considering that approximately half the world wide

population of preschool children are af icted by ane-

mia, with a prevalence as high as 64.6% in Africa and

47.7% in Asia, and that we know anemia prevalence is

higher in the group of children less than two years old,

we could possibly assume that anemia in this speci c

age group is an essential global public health problem,

mainly in low income countries(Mamabolo and Alberts,

2014, Ritu et al., 2017). According to previous studies in

Iran, the prevalence of anemia between children is 15%

in this area (Sayyari et al., 2006).

Blood Hb levels were evaluated in patients to deter-

mine anemia prevalence between children with growth

retardation. Ferritin levels among patients were meas-

ured to evaluate prevalence of iron de ciency between

children with growth failure. Mid cell volume (MCV) of

the patients was measured to evaluate the prevalence

rate of microcytic anemia in growth retarded chil-

dren and adolescents. Table 1 shows data about these

variables.

Also these variables were investigated according to

cut off points which is present in table 2.

Anemia prevalence was de ned between 4 different

age groups and the results were shown in table 3.

According to Gomez et al., (1955) and Waterlow

(1972) classi cation of undernutrition in children

is rearranged in table 4, the patients were divided in

3 categories (mild, intermediate and severe malnutri-

tion). There was signi cant relation between serum fer-

ritin levels and undernutrition. Serum levels of ferritin

decreases with increasing undernutrition.

Arash Rahbar and Arian Hajian

594 PREVALENCE OF IRON DEFICIENCY IN CHILDREN AND ADOLESCENTS WITH GROWTH RETARDATION BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Table 1. Blood Hb, ferritin and MCV maximum and minimum rates

Variable Maximum rate Minimum rate Average rate Standard deviation

Blood Hb 13.9gr/dl 9.2 gr/dl 11.8 gr/dl 1.25

Ferritin 180 μg/L 5 μg/L 43 μg/L 36.6

MCV 83fm 69fm 70fm

Table 2. Variables according to cut off point

Variable Cut off point Number of patients with

lower cut off point

percentage P value(between

two sexes)

Hb <11.3 g/dL 37 37% 0.028

ferritin <15 μg/L 25 25% 0.06

MCV <80 29 29% 0.08

Table 3. Anemia prevalence in 4 different age groups

Age group Number of

Patients

Percentage of patients

showed anemia based

on normal Hb

Average

μg/dL

Patients with ferritin

lower than normal value

6months- 2 years old 11 42.8% 38 -

2-6 years old 31 35% 29.5 -

6-12years old 39 20% 52.44 -

12-18years old 19 8.3% 49.2 2(10.5%)

Table 4. Gomez and Waterlow malnutrition classi cation in children

Grade of malnutrition Weight for age Height for weight Weight for height

0 Normal ›90 ›95 ›90

1 Mild 75-90 90-95 81-90

2 Moderate 60-74 85-89 70-80

3 Severe < 60 <85 <70

Anemia prevalence according to age associated nor-

mal Hb was 25% in boys and 41% in girls which was

signi cantly different.

In this study we resulted that the prevalence of ane-

mia in growth retarded children was 35.9%. In a similar

study, Anderson et al (Monchy et al., 2008) showed that

the prevalence of anemia in children with growth failure

in New Zealand was 71%. They also resulted that micro-

cytic anemia prevalence between the patients was 20 %

which matches with our results with 21% of prevalence.

Anderson et al also resulted that 6% of children with

growth retardation had lower ferritin levels than normal

value. In the present study the prevalence of low fer-

ritin levels was 1.6%. Socio-economic status, indicated

by place of life was an essential factor determining the

risk of anemia.

In our survey, anemia was detected in 41% of the girls

compared to 25% of the boys. Similarly, Kara et al and

Yavuz et al also noticed a higher prevalence of anemia

in girls compared with boys, (Kara et al., 2006, Yavuz et

al., 2004). The lower incidence of anemia among puber-

tal boys might possibly be explained by the physiologi-

cal surge in hemoglobin level triggered by sexual matu-

ration and consequently by lowering the requirements

after passing of the growth spurt. In girls, the phenom-

enon of menarche and menstrual irregularities reduce an

expected age related increasing amount of hemoglobin

concentration (Kara et al., 2006). The anemia found

in this study was microcytic, hypochromic anemia, as

showed by a low MCV. Anemia of this type has been

known to be connected with iron de ciency(Torabizadeh

et al., 2004).

The prevalence of anemia and iron de ciency in this

study is much less than previous reports about normal

kids from this age group in other regions of Iran as well

as the reports of other developing countries (Akramipour

et al., 2008, Hashizume et al., 2003), that indicates the

important role of iron de ciency in growth failure of

Arash Rahbar and Arian Hajian

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS PREVALENCE OF IRON DEFICIENCY IN CHILDREN AND ADOLESCENTS WITH GROWTH RETARDATION 595

children. In addition, we cannot  nd any considerable

correlation between hemoglobin level and serum ferri-

tin revealing that iron status was not likely an essential

determinant agent of anemia in the evaluated popula-

tion. These results are actually in opposition to Hashis-

mue et als study (Gomez et al., 1955). Brined et als study

in Bangladesh (Briend et al., 1990) evaluated growth

rate of 694 children from rural regions. They resulted

that children drinking water with iron values more than

1mg/lit, were signi cantly higher than children drinking

water containing less than 1mg/lit. They concluded that

iron de ciency causes growth retardation of children in

poor societies which in conformity with our study.

CONCLUSION

Since iron de ciency leads to growth failure in children

through different ways such as decreasing oxygen trans-

port capacity, decreasing energy production and decreas-

ing appetite, blood iron levels monitoring in children is

of great importance. The results of this study suggest that

treatment of growth retarded children with iron supple-

ments can improve their growth. Because data about prev-

alence of IDA in Iranian children is limited, we suggest

further studies to be performed to de ne an average range

of iron concentrations in accordance with other micro-

elements such as zinc and copper in children in this area.

AUTHORS’ CONTRIBUTION

Whole authors were in the same.

FINANCIAL DISCLOSURE

There is no con ict of interest.

FUNDING/SUPPORT

This study was  nancially supported by Student Research

Committee, Babol University of Medical Sciences, Babol,

IR Iran

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