铁缺乏与儿童执行功能的研究进展

铁缺乏(iron deficiency,ID)和缺铁性贫血(iron deficiency anemia,IDA)是全球一种常见的单一营养缺乏症,尤其多见于孕妇及婴幼儿。早期缺铁通过影响大脑神经代谢、神经递质及髓鞘化而影响儿童的神经认知功能和行为,包括以工作记忆、抑制性控制、认知灵活度为主要成分的执行功能的发展。执行功能是高级认知功能,其发展在儿童出生后1~2年时达高峰,可能存在着铁依赖的发育关键期。了解儿童执行功能的发展,并弄清其铁依赖的发育关键期,对制定早期预防铁缺乏的公共卫生策略具有重要的意义。     

婴幼儿铁缺乏及缺铁性贫血预防策略

缺铁性贫血是影响全世界尤其是发展中国家的重要健康问题,婴幼儿是缺铁性贫血的高危人群。缺铁会造成婴幼儿智力和认知的永久损害,使成年后的劳动生产力低下。本文综述了国内外预防婴幼儿铁缺乏和缺铁性贫血的研究进展,提出了婴儿出生前、出生时及生后铁缺乏及缺铁性贫血的预防策略。     

母亲KAP模式干预对婴幼儿缺铁性贫血的影响研究

摘要:目的　了解母亲KAP（知识、态度、行为）对缺铁性贫血婴幼儿的影响,为防治婴幼儿缺铁性贫血提供理论依据。方法　对2013年3月-2014年8月武汉市儿保门诊首次进行规范化健康体检的1858例6月龄至36月龄婴幼儿抽取血红蛋白检测并对其母亲进行问卷调查,了解母亲KAP水平,予以教育指导及知识、态度、行为干预后再次进行KAP问卷调查。结果　婴幼儿缺铁性贫血发生率31.3％。母亲中普遍存在缺铁性贫血知识欠缺,对铁缺乏及其引起的疾病等知识贫乏,喂养行为不科学,尤其在母乳喂养、合理添加辅食、系统学习科学育儿知识等方面掌握明显不足,造成婴幼儿缺铁性贫血的发生。而对母亲进行喂养方式、食物提供及健康教育指导后,婴幼儿缺铁性贫血情况明显改善,婴幼儿缺铁性贫血发生率17.5％。结论　应开展多层面的婴幼儿缺铁性贫血知识专项宣传,提高母亲对贫血的认知水平,从饮食理念、饮食行为、饮食态度等方面改善母亲的喂养习惯,并要求其长期保持,以此逐步地养成其良好的饮食习惯,降低婴幼儿缺铁性贫血发生率。     

婴幼儿缺铁性贫血现状及影响因素

营养性缺铁性贫血是婴幼儿时期常见的营养性疾病,缺铁性贫血（iron—deficiency anemia,IDA）是由于体内铁缺乏导致血红蛋白减少所致,IDA是铁缺乏症的晚期表现。铁缺乏不仅影响造血机能,还影响儿童生长发育、运动和免疫等各种功能。本文对在我院儿保门诊系统管理的婴幼儿贫血状况及影响因素作一分析。     

铁缺乏症婴幼儿认知水平研究

目的 了解非贫血铁缺乏症和缺铁性贫血婴幼儿的认知水平, 为进一步治疗提供科学依据。方法 采用Gesell发育测试法评估非贫血铁缺乏症和缺铁性贫血婴幼儿适应性、大运动、精细动作、语言和个人社交5个能区发育水平。结果 患铁缺乏症的男婴较女婴更多(χ²=13.06, P=0.001), 非贫血铁缺乏症(non-anemia iron deficiency, NAID)组、缺铁性贫血(iron deficiency anemia, IDA)组较铁充足(iron sufficiency, IS)组婴幼儿的5个能区发育水平落后(F_适应性=13.64;F_大运动=6.24;F_精细动作=6.25;F_语言=4.89;F_个人社交=9.14, P值均<0.01), NAID和IDA婴幼儿之间差异无统计学意义;但男性婴幼儿在语言和个人社交发育商分数较女婴更低(F=9.299, P=0.003;F=4.250, P=0.042)。结论 铁缺乏症伴或不伴贫血对婴幼儿的认知水平都有影响, 提示在临床工作中应早期干预铁缺乏。     

浙江省宁海县城区6月龄婴儿缺铁性贫血分析

<正>缺铁和缺铁性贫血是目前全球四大营养缺乏性疾病之一。我国婴幼儿缺铁和缺铁性贫血总体患病率接近50.00%,严重危害儿童的生长发育与健康水平。有研究报道[1]贫血和铁缺乏严重影响婴幼儿的认知、学习能力和行为发育,给予补铁后,即使贫血和铁缺乏纠正后恢复正常,其对大脑及神经系统的危害仍会持续10年以上,甚至不可逆转。所以预防缺铁性贫血至关重要。有研究表明,儿童时期特别是6个     

回族地区婴幼儿缺铁性贫血影响因素研究

目的了解回族地区婴幼儿缺铁性贫血患病情况,分析其影响因素,探讨干预治疗措施。方法随机抽取吴忠市妇幼保健院儿童保健门诊检查的3 000例婴幼儿,并对相关内容进行问卷调查,分析婴幼儿缺铁性贫血的影响因素。结果回族地区婴幼儿贫血患病率为46.33%,影响因素依次为母亲孕期贫血、主要看护人/母亲文化程度、辅食转换时间及出生体重。结论贫血严重危害着儿童的健康,回族地区婴幼儿母亲孕期贫血情况、主要看护人、母亲文化程度、喂养方式及辅食转换时间是导致婴幼儿贫血的重要影响因素,如何加大健康教育宣传力度,预防婴幼儿贫血是儿童保健工作的重要任务。     

婴幼儿缺铁性贫血的现状及其影响因素分析

目的 了解婴幼儿缺铁性贫血的现状并探讨其主要影响因素。方法 随机抽取江苏丹阳6～24月的婴幼儿及其看护人作为调查对象, 对婴幼儿进行体格测量、血红蛋白和微量元素铁的测定, 通过对其监护人的现场问卷调查获得婴幼儿、母亲及父亲的基本情况、母亲孕期及哺乳期相关情况、家庭一般情况、婴幼儿喂养情况、家庭饮食习惯、接受健康教育情况等相关资料。应用多因素非条件二分类Logistic回归分析筛选婴幼儿缺铁性贫血的主要影响因素。结果 婴幼儿贫血患病率为23.32%。过早或过晚添加辅食、母亲孕晚期是否贫血、是否添加富含铁的食物、母亲哺乳期营养状况、家庭年人均收入、母亲文化程度、是否接受育儿指导等7个因素是婴幼儿缺铁性贫血的主要影响因素。结论 应重点针对当地经济条件较差、父母亲文化水平低的地区开展多种形式的健康教育, 提倡科学喂养, 合理地添加辅食, 多措并举才能降低婴幼儿缺铁性贫血患病率。     

中国居民2008年缺铁性贫血疾病负担分析

缺铁性贫血是指体内可用来制造血红蛋白的贮存铁已被用尽,红细胞生成受到障碍时所发生的贫血,对人群健康的危害较大〔1〕。中国第四次营养调查结果表明,中国居民缺铁性贫血患病率为20.1%,其中<2岁婴幼儿、>60岁老年人和15~50岁育龄妇女的缺铁性贫血患病率分别为31.1%、29.1%和19.9%〔2〕,缺铁性贫血已成为中国最常见的营养缺乏病之一。为了解中国2008年缺铁性贫血疾病负担情况,为采取缺铁性贫血防治干预措施提供参考依据,本研究对中国     

婴幼儿营养性缺铁性贫血影响因素分析

目的:了解婴幼儿营养性缺铁性贫血(NIDA)发生情况,分析其影响因素,探讨干预及治疗措施。方法:对湛江市霞山妇幼保健院儿科及儿保门诊检查的婴幼儿进行血常规检查,对体弱儿进行调查,分析缺铁性贫血婴幼儿的影响因素。结果:2 120名婴幼儿中,NIDA儿童580例,患病率为27.36%,0～6个月组占38.62%,6～12个月组占26.90%,1～2岁组占21.03%,2～3岁组占13.45%;影响因素:辅食添加不当占60.69%,需求量大占33.62%,先天储铁不足占3.45%,铁吸收障碍占2.24%。结论:营养性缺铁性贫血在婴幼儿0～6月龄时患病率偏高,辅食添加不合理是造成儿童NIDA的主要影响因素,应加强对婴幼儿科学正确的喂养指导,并定期进行健康检查。     

Iron deficiency and behavioral development in infants and preschool children

This paper selectively reviews the main findings of studies on the possible effects of iron deficiency on cognitive function among infants and preschool children published after 1976, and presents data from a study recently conducted in rural Guatemala. In comparison to infants without signs of sideropenia, infants with iron deficiency with and without anemia tend to score lower in the Bayley Scale of Mental Development; conversely, there is no evidence for an association between iron deficiency and delayed motor development. Iron repletion therapy implemented over a period of 7 to 10 days is likely to result in an improvement in mental development scale scores among infants with iron deficiency with or without anemia. In comparison with preschool children without sideropenia, preschool children with iron deficiency with or without anemia are less likely to pay attention to relevant cues in problem solving situations.     

铁与儿童精神运动发育、认知功能和神经行为关系的研究进展

铁是大脑新陈代谢的基本元素,缺铁可引起神经递质稳态的改变、减少髓鞘的产生、损害突触的形成、并使基底神经节功能下降,因此,缺铁性贫血会对精神运动发育、认知功能和神经行为产生不利影响,危害婴幼儿的健康发育。了解铁缺乏与精神运动发育、认知功能和神经行为的关系,弄清补充铁的疗效并在儿童保健时开展血清铁含量检验,对制定早期预防铁缺乏的公共卫生策略具有十分重要的意义。     

Iron Compounds for Food Fortification: Guidelines for Latin America and the Caribbean 2002

Iron deficiency is the most prevalent micronutrient deficiency in the world today. It affects millions of individuals throughout the life cycle, particularly infants and pregnant women, but also older children, adolescents, and women of reproductive age. Living organisms require iron for their cells to function normally. Iron is needed for the development of vital tissues - including the brain - and for transporting and storing oxygen in hemoglobin and muscle myoglobin. Iron deficiency anemia is the severe form of iron deficiency. It can result in low resistance to infection, impaired psychomotor development, and cognitive function in children, poor academic performance, as well as fatigue and poor physical/work endurance. In addition to the above, iron deficiency anemia in pregnancy can result in a low-birth-weight infant. Three intervention strategies are available to prevent iron deficiency and, therefore, iron deficiency anemia. These are supplementation, dietary diversification, and both targeted and untargeted food fortification. Nineteen countries in the Americas have a national food fortification program, in which iron and other micronutrients are added to at least one widely consumed food that is often wheat and/or corn flour. Table 1 shows the iron compounds added to the flours. Each iron compound has different properties and characteristics, which influence its bioavailability, as is discussed later. A number of countries also currently implement fortification programs targeted to specific groups of the population, primarily infants and young children age 6 to 24 months and school-age children.     

Iron and zinc supplementation improved iron and zinc status, but not physical growth, of apparently healthy, breast-fed infants in rural communities of northeast Thailand

Iron deficiency is prevalent in children and infants worldwide. Zinc deficiency may be prevalent, but data are lacking. Both iron and zinc deficiency negatively affect growth and psychomotor development. Combined iron and zinc supplementation might be beneficial, but the potential interactions need to be verified. In a randomized, placebo-controlled trial using 2 x 2 factorial design, 609 Thai infants aged 4-6 mo were supplemented daily with 10 mg of iron and/or 10 mg of zinc for 6 mo to investigate effects and interactions on micronutrient status and growth. Iron supplementation alone increased hemoglobin and ferritin concentrations more than iron and zinc combined. Anemia prevalence was significantly lower in infants receiving only iron than in infants receiving iron and zinc combined. Baseline iron deficiency was very low, and iron deficiency anemia was almost nil. After supplementation, prevalence of iron deficiency and iron deficiency anemia were significantly higher in infants receiving placebo and zinc than in those receiving iron or iron and zinc. Serum zinc was higher in infants receiving zinc (16.7 +/- 5.2 micromol/L), iron and zinc (12.1 +/- 3.8 micromol/L) or iron alone (11.5 +/- 2.5 micromol/L) than in the placebo group (9.8 +/- 1.9 micromol/L). Iron and zinc interacted to affect iron and zinc status, but not hemoglobin. Iron supplementation had a small but significant effect on ponderal growth, whereas zinc supplementation did not. To conclude, in Thai infants, iron supplementation improved hemoglobin, iron status, and ponderal growth, whereas zinc supplementation improved zinc status. Overall, for infants, combined iron and zinc supplementation is preferable to iron or zinc supplementation alone.     

Iron and Neurodevelopment in Preterm Infants: A Narrative Review

Iron is critical for brain development, playing key roles in synaptogenesis, myelination, energy metabolism and neurotransmitter production. NICU infants are at particular risk for iron deficiency due to high iron needs, preterm birth, disruptions in maternal or placental health and phlebotomy. If deficiency occurs during critical periods of brain development, this may lead to permanent alterations in brain structure and function which is not reversible despite later supplementation. Children with perinatal iron deficiency have been shown to have delayed nerve conduction speeds, disrupted sleep patterns, impaired recognition memory, motor deficits and lower global developmental scores which may be present as early as in the neonatal period and persist into adulthood. Based on this, ensuring brain iron sufficiency during the neonatal period is critical to optimizing neurodevelopmental outcomes and iron supplementation should be targeted to iron measures that correlate with improved outcomes.     

Iron and learning potential in childhood.

Cognitive function. There is reasonably good evidence that mental and motor developmental test scores are lower among infants with iron deficiency anemia. Although the research on cognitive function in iron deficient older children and adults is sparse and diverse, it suggests that there may be alterations in attentional processes associated with iron deficiency. Iron therapy has not yet been shown effective in completely correcting many of the observed disturbances. Although some aspects of cognitive function seem to change with iron therapy, lower developmental. I.Q., and achievement test scores have still been noted after treatment. The behavioral effects of iron-deficiency anemia may be due to changes in neurotransmission. However, the biochemical bases are not yet completely understood. Noncognitive disturbances. A variety of noncognitive alterations during infant developmental testing has also been observed, including failure to respond to test stimuli, short attention span, unhappiness, increased fearfulness, withdrawal from the examiner, and increased body tension. Exploratory analyses suggest that such behavioral abnormalities may account for poor developmental test performance in infants with iron deficiency anemia. These studies indicate the fruitfulness of examining noncognitive aspects of behavior such as affect, attention, and activity, in addition to specific cognitive processes. Activity and work capacity: There has been a steady accumulation of evidence that iron-deficiency anemia limits maximal physical performance, submaximal endurance, and spontaneous activity in the adult, resulting in diminished work productivity with attendant economic losses. The relative importance of central and peripheral mechanisms underlying these effects, the extent to which anemia or iron deficiency separate from anemia is responsible, and the counterpart in infants and children remain to be established. This essay has examined recent evidence from research on central nervous system biochemistry and from human studies that iron deficiency adversely affects behavior by impairing cognitive function, producing noncognitive disturbances, and limiting activity and work capacity. The body of research taken as a whole provides increasingly persuasive arguments for intensifying efforts to prevent and treat iron deficiency anemia.     

早期铁缺乏与婴幼儿情绪发展

缺铁是世界范围内最常见的单一营养缺乏性疾病,在孕妇与学龄前儿童中发病率最高.缺铁不仅能够引起贫血,而且早期铁缺乏通过影响大脑发育过程可影响感觉、运动、认知、社会情感功能等方面的发育.目前对精神运动功能发育方面的研究已经比较深入,但对社会情感或情绪方面的研究还相对较少,缺铁导致的多巴胺及其受体的变化被认为与情绪行为改变密切相关.该文就早期铁缺乏与婴幼儿情绪发展的关系作以综述.     

Effects of iron and zinc supplementation in Indonesian infants on micronutrient status and growth.

In this study the effects of supplementation of iron and zinc, alone or combined, on iron status, zinc status and growth in Indonesian infants is investigated. Micronutrient deficiencies are prevalent in infants in developing countries, and deficiencies often coexist; thus, combined supplementation is an attractive strategy. However, little is known about interactions between micronutrients. In a randomized, double-blind, placebo-controlled supplementation trial, 478 infants, 4 mo of age, were supplemented for 6 mo with iron (10 mg/d), zinc (10 mg/d), iron + zinc (10 mg of each/d) or placebo. Anthropometry was assessed monthly, and micronutrient status was assessed at the end of supplementation. Supplementation significantly reduced the prevalence of anemia, iron deficiency anemia and zinc deficiency. Iron supplementation did not negatively affect plasma zinc concentrations, and zinc supplementation did not increase the prevalence of anemia or iron deficiency anemia. However, iron supplementation combined with zinc was less effective than iron supplementation alone in reducing the prevalence of anemia (20% vs. 38% reduction) and in increasing hemoglobin and plasma ferritin concentrations. There were no differences among the groups in growth. The growth of all groups was insufficient to maintain the same Z-scores for height for age and weight for height. There is a high prevalence of deficiencies of iron and zinc in these infants, which can be overcome safely and effectively by supplementation of iron and zinc combined. However, overcoming these deficiencies is not sufficient to improve growth performance in these infants.     

Iron and its relation to immunity and infectious disease

The continuing unresolved debate over the interaction of iron and infection indicates a need for quantitative review of clinical morbidity outcomes. Iron deficiency is associated with reversible abnormalities of immune function, but it is difficult to demonstrate the severity and relevance of these in observational studies. Iron treatment has been associated with acute exacerbations of infection, in particular, malaria. Oral iron has been associated with increased rates of clinical malaria (5 of 9 studies) and increased morbidity from other infectious disease (4 of 8 studies). In most instances, therapeutic doses of oral iron were used. No studies in malarial regions showed benefits. Knowledge of local prevalence of causes of anemia including iron deficiency, seasonal malarial endemicity, protective hemoglobinopathies and age-specific immunity is essential in planning interventions. A balance must be struck in dose of oral iron and the timing of intervention with respect to age and malaria transmission. Antimalarial intervention is important. No studies of oral iron supplementation clearly show deleterious effects in nonmalarious areas. Milk fortification reduced morbidity due to respiratory disease in two very early studies in nonmalarious regions, but this was not confirmed in three later fortification studies, and better morbidity rates could be achieved by breast-feeding alone. One study in a nonmalarious area of Indonesia showed reduced infectious outcome after oral iron supplementation of anemic schoolchildren. No systematic studies report oral iron supplementation and infectious morbidity in breast-fed infants in nonmalarious regions.