Many cases of iron deficiency in school-aged children could be diagnosed earlier, according to a new study published in\u00a0Blood Red Cells & Iron,\u00a0a journal of the American Society of Hematology (ASH). By applying a higher ferritin threshold than used in current guidelines, researchers found that\u00a0iron deficiency in U.S. children 5 to 14 years may be more common than previously thought and could be diagnosed earlier in many cases.\u00a0<\/p>\n
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Identifying the\u00a0ferritin\u00a0level\u00a0in blood\u00a0needed to support\u00a0a child’s\u00a0physical growth and learning is important\u00a0because low iron levels can lead to serious health issues\u00a0such as\u00a0difficulties with concentration\u202fand\u00a0learning,\u00a0fatigue,\u00a0and\u00a0reduced physical\u00a0performance.”<\/p>\n
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Yaw Addo, PhD,\u00a0lead author and\u00a0epidemiologist, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention (CDC)<\/p>\n
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Researchers\u00a0developed\u00a0a\u00a0new\u00a0method\u00a0to\u00a0identify\u00a0the ferritin cutoff\u00a0level\u00a0among U.S. school-age children.\u00a0This\u00a0new\u00a0method\u00a0detects\u00a0early stages\u00a0of iron deficiency\u00a0by\u00a0looking at\u00a0changes in red blood cells and\u00a0how the body makes them.\u00a0Using this\u00a0updated\u00a0approach,\u00a0about\u00a01 in 3 (30%)\u00a0children\u00a05 to 14\u00a0years\u00a0included in the study’s sample\u00a0were identified as\u00a0having\u00a0iron deficiency, a substantial increase from the 9%\u00a0identified\u00a0in the same sample\u00a0using\u00a0previous\u00a0methods.\u00a0<\/p>\n
Ferritin is a protein that stores iron in cells and releases it when needed. Iron is then used to make hemoglobin, the protein in red blood cells that carries oxygen to organs and tissues.\u00a0When a\u00a0child’s\u00a0ferritin is low, they develop iron\u00a0deficiency,\u00a0which\u00a0can\u00a0impair\u00a0brain development, learning,\u00a0and growth.\u00a0It is possible to have iron deficiency with\u00a0anemia (e.g.\u00a0low hemoglobin)\u00a0or without anemia.\u00a0<\/p>\n
The study included\u00a0data from\u00a03,765 otherwise healthy\u00a0children 5 to 14\u00a0years\u00a0(10.3 years\u00a0on average)\u00a0who\u00a0participated\u00a0in NHANES III, a 1988-1994 national survey\u00a0by CDC,\u00a0and\u00a0underwent\u00a0a physical exam and blood draws.\u00a0Children\u00a0were excluded from the analysis if they had evidence of infection, inflammation<\/a>,\u00a0or liver-related issues \u2013 all of which can affect ferritin \u2013 or if they were missing\u00a0data on\u00a0ferritin, hemoglobin,\u00a0or\u00a0zinc protoporphyrin (ZPP, a\u00a0red blood cell\u00a0compound that\u00a0increases\u00a0when tissue\u00a0iron needs increase\u00a0during\u00a0iron deficiency).\u00a0<\/p>\n Current guidelines\u00a0from CDC and\u00a0the\u00a0World Health Organization (WHO)\u00a0identify\u00a0iron deficiency at\u00a0a\u00a0ferritin threshold\u00a0around\u00a015\u00a0\u03bcg\/L. However, the\u00a0researchers’ findings\u00a0suggest iron levels may already be insufficient to sustain normal red blood cell production when\u00a0a child’s\u00a0ferritin\u00a0level\u00a0is\u00a0less than\u00a024\u00a0\u03bcg\/L.\u00a0This finding adds to growing evidence that current\u00a0CDC and\u00a0WHO thresholds\u00a0across the lifecycle\u00a0tend\u00a0to detect\u00a0iron deficiency\u00a0at\u00a0more advanced\u00a0stages,\u00a0when iron levels may already be\u00a0low and\u00a0depleted.\u00a0Iron deficiency\u00a0begins\u00a0at\u00a0a hemoglobin\u00a0level that\u00a0is\u00a0higher than the level used to diagnose anemia.\u00a0Because\u00a0screening\u00a0often\u00a0relies on\u00a0anemia,\u00a0it can\u00a0miss earlier, treatable\u00a0iron deficiency.\u00a0<\/p>\n “This study applied a new\u00a0methodology\u00a0to\u00a0identify\u00a0iron deficiency and found that iron can already be low and\u00a0possibly\u00a0start\u00a0to affect children’s health when ferritin is less than 24\u00a0\u03bcg\/L. The findings of this study might help\u00a0identify\u00a0earlier stages of iron deficiency than\u00a0the\u00a0previously\u00a0recommended\u00a0cutoff,” said\u00a0Maria Elena Jefferds, PhD,\u00a0coauthor and\u00a0team lead\u00a0in CDC’s Division of Nutrition, Physical Activity, and Obesity.\u00a0“CDC is continuing to examine how these thresholds can be used by healthcare providers to improve\u00a0detection\u00a0of\u00a0iron deficiency\u00a0in\u00a0children 5 to 14 years.”\u00a0<\/p>\n The\u00a0increased\u00a0demand and need for iron nutrition\u00a0during this life stage was\u00a0similar between boys and girls, all of whom are actively growing and need iron for\u00a0skeletal\u00a0growth\u00a0and development.\u00a0However, iron deficiency was higher\u00a0among\u00a0older\u00a0girls (12-14\u00a0years),\u00a0likely\u00a0due to blood loss from menstruation.\u00a0Still, the ferritin threshold\u00a0was\u00a0consistently higher than current cutoffs across ages and sexes.\u00a0<\/p>\n Because the study is based on 30-year-old NHANES\u00a0III\u00a0data, researchers performed supplemental analyses\u00a0using\u00a0more recent NHANES data (2017-2023)\u00a0that\u00a0included\u00a0soluble transferrin receptor instead of ZPP,\u00a0and the\u00a0ferritin\u00a0threshold\u00a0identified\u00a0was\u00a0consistent with\u00a0the\u00a0NHANES III\u00a0study, further\u00a0validating\u00a0the findings.\u00a0The researchers said one limitation of the study is that they were unable to account for puberty\u00a0for boys and girls\u00a0or the start of menstruation for girls.\u00a0<\/p>\n The researchers\u00a0hope\u00a0these\u00a0data\u00a0will\u00a0improve\u00a0detection of iron deficiency\u00a0in children 5\u00a0to\u00a014\u00a0years.\u00a0<\/p>\n Source:<\/p>\n American Society of Hematology<\/a><\/p>\n Journal reference:<\/p>\n