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
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.
*Corresponding Author:
Received 20
July, 2017
Accepted after revision 29
Sep, 2017
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DOI: 10.21786/bbrc/10.3/38
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
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,
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.
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.
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
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
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
Percentage of patients
showed anemia based
on normal Hb
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
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.
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.
Whole authors were in the same.
There is no con ict of interest.
This study was  nancially supported by Student Research
Committee, Babol University of Medical Sciences, Babol,
IR Iran
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