Chmielewska Anna, Domellöf Magnus
Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
Curr Opin Clin Nutr Metab Care. 2025 May 1;28(3):284-288. doi: 10.1097/MCO.0000000000001120. Epub 2025 Mar 29.
Iron deficiency (ID) affects one in five children before they reach preschool age. Existing evidence on ID contributing to suboptimal development and neurodevelopmental disorders come mostly from mechanistic and observational studies. Recommendations for screening and treatment are diverging, emphasizing the knowledge gap. The purpose of this review is to summarize recent evidence on ID in infants and children, its possible role in developmental disorders, and effects of iron supplementation.
Recent well powered randomized controlled trials showed no effect of early iron supplementation on psychomotor development in infants, neither in populations at high nor low risk of ID. Treatment of nonanemic ID in children 1-3 years did not improve their cognitive scores. Evidence from observational and imaging studies suggests association of brain ID and attention deficit hyperactivity disorder in children (ADHD).
Universal prophylactic iron supplementation in infants is not supported by current evidence. Whether non anemic ID needs to be treated is uncertain and so is the legitimacy and timing of screening for ID and anemia. The role of ID and iron availability for the brain in pathogenesis of neurodevelopmental conditions such as ADHD requires further studies.
缺铁（ID）影响着五分之一的学龄前儿童。关于缺铁导致发育不良和神经发育障碍的现有证据大多来自机制研究和观察性研究。筛查和治疗的建议存在分歧，这凸显了知识差距。本综述的目的是总结关于婴幼儿缺铁的最新证据、其在发育障碍中的可能作用以及铁补充剂的效果。
近期有充足样本量的随机对照试验表明，早期补充铁剂对婴儿的精神运动发育没有影响，无论其缺铁风险是高还是低。1至3岁儿童的非贫血性缺铁治疗并未提高他们的认知分数。观察性研究和影像学研究的证据表明，儿童脑缺铁与注意力缺陷多动障碍（ADHD）有关。
目前的证据不支持对婴儿进行普遍预防性铁补充。非贫血性缺铁是否需要治疗尚不确定，缺铁和贫血筛查的合理性及时机也是如此。缺铁及大脑铁供应在ADHD等神经发育疾病发病机制中的作用需要进一步研究。
