title: Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States.
abstract: BACKGROUND
  Iron deficiency anemia in infants can cause developmental problems. However, the relationship between iron status and cognitive achievement in older children is less clear.
  
  
  OBJECTIVE
  To investigate the relationship between iron deficiency and cognitive test scores among a nationally representative sample of school-aged children and adolescents.
  
  
  METHODS
  The National Health and Nutrition Examination Survey III 1988-1994 provides cross-sectional data for children 6 to 16 years old and contains measures of iron status including transferrin saturation, free erythrocyte protoporphyrin, and serum ferritin. Children were considered iron-deficient if any 2 of these values were abnormal for age and gender, and standard hemoglobin values were used to detect anemia. Scores from standardized tests were compared for children with normal iron status, iron deficiency without anemia, and iron deficiency with anemia. Logistic regression was used to estimate the association of iron status and below average test scores, controlling for confounding factors.
  
  
  RESULTS
  Among the 5398 children in the sample, 3% were iron-deficient. The prevalence of iron deficiency was highest among adolescent girls (8.7%). Average math scores were lower for children with iron deficiency with and without anemia, compared with children with normal iron status (86.4 and 87.4 vs 93.7). By logistic regression, children with iron deficiency had greater than twice the risk of scoring below average in math than did children with normal iron status (odds ratio: 2.3; 95% confidence interval: 1.1-4.4). This elevated risk was present even for iron-deficient children without anemia (odds ratio: 2.4; 95% confidence interval: 1.1-5.2).
  
  
  CONCLUSIONS
  We demonstrated lower standardized math scores among iron-deficient school-aged children and adolescents, including those with iron deficiency without anemia. Screening for iron deficiency without anemia may be warranted for children at risk.
authors.affiliation: Department of Pediatrics, University of Rochester School of Medicine and Dentistry, NY, USA. jill_halterman@urmc.rochester.edu
authors.forename: J S
authors.initials: JS
authors.lastname: Halterman
authors.forename: J M
authors.initials: JM
authors.lastname: Kaczorowski
authors.forename: C A
authors.initials: CA
authors.lastname: Aligne
authors.forename: P
authors.initials: P
authors.lastname: Auinger
authors.forename: P G
authors.initials: PG
authors.lastname: Szilagyi
mesh_terms: D000124:Achievement; D000293:Adolescent; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D002648:Child; D003430:Cross-Sectional Studies; D003677:Deficiency Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005293:Ferritins / Q000097:blood; D006306:Health Surveys; D006801:Humans; D000090463:Iron Deficiencies; D008297:Male; D009749:Nutrition Surveys; D011581:Psychological Tests / Q000706:statistics & numerical data*; D012044:Regression Analysis; D013334:Students / Q000523:psychology / Q000706:statistics & numerical data*; D014168:Transferrin / Q000032:analysis; D014481:United States / Q000453:epidemiology
chemical_list: D014168:Transferrin; D005293:Ferritins