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Hindawi Publishing CorporationAnemiaVolume , Article ID ,pageshttp://dx.doi.org/.//

Research ArticleEffects of Iron Deficiency on Cognitive Function in School Going

Adolescent Females in Rural Area of Central India

Sarika More,1 V. B. Shivkumar,2 Nitin Gangane,2 and Sumeet Shende3

Department of Pathology, Sri Lakshmi Narayana Institute of Medical Sciences, Osudu, Kudapakkam Post, Villanur Communie,Pondicherry , India

Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India Department of Forensic Medicine, Sri Lakshmi Narayana Institute of Medical Sciences, Pondicherry , India

Correspondence should be addressed to Sarika More; [email protected]

Received August ; Revised October ; Accepted October

Academic Editor: Eitan Fibach

Copyright Sarika More et al. Tis is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Iron deciency anemia is most common nutritional deciency disorder in India and remains a ormidable health challenge. Girlsin the period o later school age and early adolescence are prone to develop iron deciency. Iron deciency leads to many non-hematological disturbances which include growth and development, depressed immune unction in inants; reduces physical workcapacity; decreases the cognitive unction in both inants and adolescents. Present study was done to know the prevalence o irondeciency in both the anemic and non anemic school going adolescent girls, to assess the effect o iron deciency on cognitive

unctions in anemic iron decient and non-anemic iron decient school girls in a village school situated in central India.Methods.A secondary school having girl students in the age group o years studying in sixth to ninth standard was selected. Serumerritin concentration was estimated by ELISA. For assessing the cognitive unction mathematics score, one multi-component testor memory,attentionand verbal learning and IntelligentQuotientscoreso the studentswere used.Results. ScholasticPerormance,IQ and Scores o Mental balance, Attention & Concentration, Verbal Memory and Recognition were decreased in iron decientgirls, both anemic and non anemic as compared to the non iron decient girls.

1. Introduction

Iron deciency is the third greatest global health risk aferobesity and unsae sex []. Anemia resulting rom iron de-ciency affects approximately billion people or % o the

world population []. Iron deciency anemia most severestage o iron deciency (dened as a low hemoglobin con-centration with iron deciency) was ound in % o theadolescent emales in the United State o America [].

Iron deciency has both physiologic and pathologiccauses. Physiologic causes relate to the greater iron demandsduring periods o growth and development whereas patho-logic causes reer to iron losses secondary to a chronicmedical condition. In general, iron deciency results wheniron demands by the body are not met by iron absorption.Tus, iron deciency can result rom inadequate intake,impaired absorption, increased requirements, and chronicblood loss.

More than hal o the worlds undernourished populationlives in India [] and hal o Indian children and womenare malnourished []. Apart rom overall poverty and lowerliteracy rate the health status o women in India reectsgender discrimination rom birth []. Intraamilial ood

distribution, where the males are privileged with high qualitynutritious ood and the emales are deprived o it, is seen inIndia. Moreover, early and requent reproductive cycling andpresence o reproductive tract inections in adolescent girlslead to iron deciency anemia []. Among emales, menstrualblood loss becomes an issue and heavy loss (> mL/month)is a signicant risk actor. Menstrual blood loss averagesabout mg o iron per month and in some individualsbe as high as mg []. In spite o increased iron needsmany adolescent girls have iron intake o only - mg/day,resulting in approximately mg o absorption o iron. Aboutthree ourth o adolescent emales do not meet the dietaryrequirements [].
http://dx.doi.org/10.1155/2013/819136http://dx.doi.org/10.1155/2013/819136


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Iron deciency is a systemic condition which has manynon ematological consequences, which occurs in relationto its severity, like decreased physical work capacity [],decreased athletic perormance [], lowered indurations[], depressed immune unction [], decreased scholasticperormance, compromised growth and development, and

increased risk o pregnancy complication including prema-turity and total growth retardation and impaired cognitiveunction [].

In present study, effort has been made to assess theeffect o iron deciency on cognitive unctions in anemiciron decient and in nonanemic iron decient school goingadolescent girls in a village school.

2. Materials and Methods

Te present study was carried out in the Department oPathology, MGIMS, Sevagram, India rom July toSeptember . Approval was obtained rom the Institu-tional Ethics Committee or the study.

.. Selection of Subjects. A secondary school in the neigh-borhood, having girl students in the age group o yearsstudying in sixth to ninth standard was selected. Necessarypermission was taken rom the school authority and girlswere explained in detail about the study in the schoolassembly. Participation in the screening programme was

voluntary. An explanatory letter and consent orm was givento all the girls. Written consent was obtained rom parents orguardian or participation in the screening as all participantswere minor. Participants completed a questionnaire askingor signicant amily, medical and menstrual history, parenteducation, and their dietary habits.

.. Method of Screening. Screening or anemia and irondeciency was done by () complete blood count: doneby automatic cell counter, that is, Coulter or hemoglobinconcentration. () estimation o serum erritin concentrationwas done by ELISA. For this recommended protocol by thekit used was ollowed. Established age adjusted values orhemoglobin and serum erritin were used.

Te participants afer screening were divided into threegroups.

()Group Iparticipants who were anemic (Hb < gm%) and iron decient (serum erritin less than g/L).

()Group IIparticipants who were nonanemic (Hb gm%) and iron decient (serum erritin less than g/L).

()Group IIIparticipants who were nonanemic (Hb gm%) and noniron decient (serum erritin levelso g/L or more).

.. Method of Assessing the Cognitive Function. Afer divid-ing the participants into three groups, that is, anemic irondecient (group I), nonanemic iron decient (group II), andnonanemic noniron decient (group III), or assessing thecognitive unction mathematics score, one multicomponent

test ormemory, attention andverbal learning, andintelligentquotient (IQ) scores o the students was used.

... Scholastic Assessment (Mathematics Score). For assess-ment o scholastic perormance, the mathematics scoreobtained in the nal term examination was noted rom the

report card. Te score obtained were rom total marks.

... Multicomponent est (MC) for Verbal Learning, Mem-ory, and Attention. Multicomponent test o the three groupswas assessed afer randomization by using PGI test(Dr.N. N. Wig & Dr. Dwarka Prasad) or testing memoryattention and verbal learning [] Both participants and theinvestigators were unaware o the group assignment.

PGI test(Dr. N. N. Wig & Dr. Dwarka Prasad), consistedo the ollowing ten subtests: (I) remote memory, (II) recentmemory, (III) mental balance, (IV) attention and concentra-tion, (V) delayed recall, (VI) immediate memory, and (VII)

verbal retention or similar pairs, (VIII) verbal retention withdissimilar pairs, (IX) visual retention, and (X) recognition.

... For Intelligent Quotient (IQ) Assessment. For assessingthe intelligent quotient o the girl students, Bhatia batteryperormance test(Dr. C. M. Bhatia) or intelligent quotient(I.Q) was used, which includes two subtest Kohls blockdesign and Pass along test [].

All these tests were selected because these have Indiannorms and are constructed and standardized in India. Sta-tistical analysis: the data was analyzed with SPSS (version )statistical sofware. One-way ANOVAs test(able ) and testo signicance or comparison o two sample means (ables

and ) wereapplied;value and mean and standard deviationwere calculated.

.. Results. Out o total girl students in the age groupo years, consent was obtained rom students toparticipate in the study. Subsequently studentswere testedor hemoglobin concentration, serum erritin, and cognitiveunction. ( students reused to give blood or test.)

o girl students had hemoglobin levels less than gm% and had hemoglobin levels above gm%. Tus,prevalence o anemia in school going adolescent girls was%. Te overall mean hemoglobin in the study was 11.66 1.27 g/dL.

Out o the girl students who had anemia, girls(%)had Hb values between and gm%, girls (%) had Hb

values between and gm%, and rest o the girls (%) hadHb values below gm%. Tus, mild anemia (Hb gm%)was present in % o the study subjects, moderate anemia(Hb gm%) in %, and severe anemia (Hb


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: Number o students in different groups, mean serum erritin, and hemoglobin levels.

Groups Number o students Mean serum erritin (g/L) Mean hemoglobin levels (gm%)

Anemic iron decient (group I) . .

Nonanemic iron decient (group II) . .

Nonanemic noniron decient (group III) . .

: Te meanmathematicsscore o the girl students in differentgroups.

Groups Mean mathematics scoreSD

Anemic iron decient (group I)( = 50)

47.76 8.26

Nonanemic iron decient (groupII) ( = 17)

52.64 9.88

Nonanemic noniron decient(group III) ( = 20)

62.15 5.93

SD: Standard deviation.

thus, the prevalence o iron deciency anemia was % andrest o the girls who were anemic, the cause o anemiawas other than iron deciency (see able ). o know theprobable cause o anemia in these girls who were anemicbut were not iron decient, urther investigation in theorm o peripheral smear examination, reticulocyte count,and electrophoresis was done. Sickle cell trait was oundin out o the students, was sickle cell disease, wasthalassemia minor, and were macrocytic anemia probablydue to vitamin B and olic acid deciency; hence, they wereexcluded rom the study.

For assessing the cognitive unction, mathematics score,one multicomponent test or verbal learning, attention andmemory, and IQ scores was used. For assessing the scholasticperormance, the mathematics scores obtained in the nalterm examination was noted rom the report card. Te scoresobtained were rom a total o marks. Mean mathematicscore calculated or three groups.

Te difference in mathematics score was highly sig-nicant ( value < .) between nonanemic nonirondecient (group III) and anemic iron decient (group I), itwas signicant (value .) between nonanemic nonirondecient (group III) and nonanemic iron decient (group II).

Multicomponent test(MC)o verbal learning, attention,memory and IQ scores o all the three groups was assessedafer randomization. ests were administered under the

guidance o trained research assistant o the Department oPsychological Medicine. Te person who was assessing thetests was unaware o the group assignment.

Te difference in scores o mental balance between thenonanemic noniron decient (group III) and anemic irondecient (group I) was signicant (value


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: Te mean multicomponent test (MC) scores in the three different groups.

estAnemic iron decient

(group I) = 50(MeanSD)

Nonanemic iron decient(group II) = 17

(MeanSD)

Nonanemic noniron decient(group III) = 20

(MeanSD)

Recent memory 4.98 0.14 5 0 4.95 0.22

Remote memory 5.82 0.52 5.88 0.48 5.6 0.75

Mental balance 1.66 0.55 2.05 0.74 2.7 0.47

Attention and concentration 11.28 3.83 13.76 3.41 16.2 2.06

Delayed recall 8.28 1.48 8.48 1.85 8.9 1.07

Immediate recall 1.78 0.73 1.82 0.72 1.9 0.78

Verbal retention or similar pairs 4.1 0.64 4.23 0.83 4.9 0.30

Verbal retention or dissimilar pairs 4.3 0.67 4.35 0.49 4.8 0.41

Visual retention 2.36 1.13 2.41 1.46 2.85 1.34

Recognition 7.7 1.84 7.87 1.66 8.95 2.39

otal test scores 52.26 5.73 55.82 6.12 61.75 4.92


: Te mean scores in Kohls block design, pass along test, and mean IQ score.

Groups Kohls block design Pass along test est quotient (Q) Mean intelligent

quotient (SD)

Anemic iron decient(group I)

. . . . (.)

Nonanemic iron decient(group II)

. . . . (.)

Nonanemic nonirondecient (group III)

. . . . (.)


anemic and non anemic had lower mathematics score com-

pared with adolescent with normal iron status. SimilarlySungthong et al. [] observed that the school perormanceincluding Tai language and mathematics score were less iniron decient children than in non iron decient children ina study done on school children in Tailand.

.. Multicomponent est for Verbal Learning, Memory, andAttention. Multicomponent test o verbal learning, attention,and memory o all the three groups was assessed afer ran-domization. Te overall total score was less in iron decientboth anemic and nonanemic groups than noniron decientnonanemic group.

Similar ndings were also seen in scores o mentalbalance and verbal retention or similar and dissimilar pairs.Tere was no difference in score o recent and remotememory, delayed and immediate recall, and visual retentionsubsets between iron decient (group I and II) and nonirondecient (group III).

Te ndings suggest that iron deciency, even in theabsence o anemia causes decrease in at least some aspect ocognitive unctioning.

Te present ndings are in accordance with the ndingsoa randomized trialdone by Bruner etal. [] on nonanemiciron decient adolescent girls in our Baltimore high schoolsin USA, where baseline cognitive unction was assessed.

Te investigators then randomly assigned these girls to either

placebo or oral errous sulphate treatment or weeks. Tegirls treated with errous sulphate had improved scores in

verbal learning and memory compared to the scores ogirls who were given placebo. Similar observation was alsoseen in the study done by Seshadri et al. [] in India whoshowed benecial effect o iron therapy on cognitive unctiono anemic children o various age. In anemic adolescentgirls o years o age group on iron therapy therewas improvement in the scores o attention, memory, andconcentration than those girls who were given placebo. Astudy done in Vadodara, India by Sen, and Kanani presentevidence rom a controlled intervention trial that iron andolic acid supplementation in children aged between and years leads to modest (. to units on a scale o ) butsignicant improvement in the various cognitive tests[].

.. Intelligent Quotient Assessment. Te difference o meanIQ scoresbetween iron decient both anemic and nonanemicgroups (I and II) and nonanemic noniron decient wasstatistically signicant.

Pollitt et al. [], Soemantri et al. [], and Sunthonget al. [] also reported low IQ scores in iron decientsubjects compared to the noniron decient subjects. Tis isin accordance with present study ndings.


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4. Conclusion

Te ndings o the present study are iron decient schoolgoing adolescent emales both anemic and nonanemic hadlow scholastic perormance in the orm o low mathematicsscore and low scores in verbal learning, attention, mentalbalance, and recognition component o multicomponenttest along with low IQ scores than their noniron decientcomparers. Iron deciency independently leads to decreasedcognitive scores. Iron deciency without anemia is the initialstage and as the iron deciency increases anemia maniests.Te cognitive scores were lowest in the iron decient anemic(group I). In iron decient without anemia it was slightlymore than group I but much less than group III, that is,nonanemic noniron decient subjects. Prevalence o anemiawas % while prevalence o iron deciency anemia inpresent study was %.

Tere is need to initiate programme or supplementationo iron and olic acid to school going adolescent girlsor the prevention o hematological and nonhematological

consequences o iron deciency with government andprivateorganizational efforts.

Consent

Consent was obtained rom Institutional Ethical committeeo Mahatma Gandhi Institute o Medical Sciences, Sevagram,India.

Conflict of Interests

Te authors declare there is no conict o interests.

References

[] A. M. Rosenthal, WHO names top health risks,Environ-mental Health Perspectives, vol. , no. , article A, .

[] J. R. Boccio and I. Ventkatesh, Iron deciency causes, conse-quences and straticationto overcomethe nutritional problem,Biological race Element Research, vol. , no. , pp. , .

[] Centre or disease control and prevention, Recommendationsto prevent and control iron deciency in the United States,Morbidity & Mortality Weekly Report, vol. , no. RR-, pp. , .

[] . Ganz, Hepcidin, a key regulator o iron metabolism andmediator o anemia o inammation,Blood, vol. , no. , pp.

, .[] K. Krishnaswami, Counrty prole: India. Nutritional dis-

ordersold and changing,Te Lancet, vol. , pp. ,.

[] S. Kumar, India health survey nds too many women andchildren in poor health,Te Lancet, vol. , no. , p. ,.

[] S. Kishor, Gender differentials in child mortality: a review othe evidence, inWomens Health in India: Risk and Vulnerabil-ity, M. Das Gupta, L. C. Chen, and . N. Krishnan, Eds., pp., Bombay Oxord University Press.

[] J. L. Beard, Iron biology in immune unction, musclemetabolism and neuronal unctioning, Journal of Nutrition,vol. , no. , pp. SS, .

[] A. Sen and S. J. Kanani, Deleterious unctional impact oanemia on young adolescent school girls, Indian Pediatrics, vol., no. , pp. , .

[] . W. Rowland, M. B. Deisroth, G. M. Green, and J. F. Kelleher,Te effect o iron therapy on the exercise capacity o nonane-mic iron-decient adolescent runners, American Journal ofDiseases of Children, vol. , no. , pp. , .

[] S. S. Basta, S. Soekirman, D. Karyadi, and N. S. Scrimshaw,Iron deciency anemia and the productivity o adult males inIndonesia,American Journal of Clinical Nutrition, vol. , no., pp. , .

[] P. R. Dallman, Iron deciency & immune response, TeAmerican Journal of Clinical Nutrition, vol. , pp. ,.

[] J. Beard, W. Green, L. Miller, and C. Finch, Effect o iron-deciency anemia on hormone levels and thermoregulationduring cold exposure,Te American Journal of Physiology, vol., no. , part , pp. RR, .

[] M. J. Murray, A. B. Murray, M. B. Murray, and C. J. Murray,Te adverse effect o iron repletion on the course o certain

inections, British MedicalJournal, vol. , no. ,pp. ,.

[] E. Pollittand R. L. Leibel, Iron deciency andbehavior,Journalof Pediatrics, vol. , no. , pp. , .

[] C. M. Bhatia, Performance est of Intelligence under IndianConditions, London Oxord University Press, .

[] J. S. Halterman, J. M. Kaczorowski, C. A. Aligne, P. Auinger,and P. G. Szilagyi, Iron deciency and cognitive achievementamong school-aged children and adolescents in the UnitedStates,Pediatrics, vol. , no. , pp. , .

[] D. M. Prestonjee, Tird Handbook of Psychological and SocialInstrument, .

[] R. Sungthong, L. Mo-suwan, and V. Chongsuvivatwong,Effects o haemoglobin and serum erritin on cognitiveunction in school children, Asia Pacic Journal of ClinicalNutrition, vol. , no. , pp. , .

[] A. B. Bruner, A. Joffe, A. K. Duggan, J. F. Casella, and J. Brandt,Randomised study o cognitive effects o iron supplementationin non-anaemic iron-decient adolescent girls, Te Lancet, vol., no. , pp. , .

[] S. Seshadri, . Gopaldas,. Walter, andA. Heywood, Impactoiron supplementation on cognitive unctions in preschool andschool-aged children: the Indian experience,American Journalof Clinical Nutrition, vol. , no. , pp. , .

[] A. Sen and S. J. Kanani, Impact o iron-olic acid supplemen-tation on cognitive abilities o school girls in Vadodara, IndianPediatrics, vol. , no. , pp. , .

[] E. Pollitt, P. Hathirat, N. J. Kotchabhakdi et al., Iron deciencyand educational achievement in Tailand,American Journal ofClinical Nutrition, vol. , no. , pp. , .

[] A. G. Soemantri, E. Pollitt, and I. Kim, Iron deciency anemiaand educational achievement, American Journal of ClinicalNutrition, vol. , no. , pp. , .

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