title: Functional significance of early-life iron deficiency: outcomes at 25 years.
abstract: OBJECTIVE
  To evaluate adulthood function following chronic iron deficiency in infancy.
  
  
  METHODS
  At 25 years, we compared 33 subjects with chronic iron deficiency in infancy to 89 who were iron-sufficient before and/or after iron therapy. Outcomes included education, employment, marital status, and physical and mental health.
  
  
  RESULTS
  Adjusting for sex and socioeconomic status, a higher proportion of the group with chronic iron deficiency did not complete secondary school (58.1% vs 19.8% in iron-sufficient group; Wald value = 8.74; P = .003), were not pursuing further education/training (76.1% vs 31.5%; Wald value = 3.01; P = .08; suggestive trend), and were single (83.9% vs 23.7%, Wald value = 4.49; P = .03). They reported poorer emotional health and more negative emotions and feelings of dissociation/detachment. Results were similar in secondary analyses comparing the chronic iron-deficient group with subjects in the iron-sufficient group who had been iron-deficient before treatment in infancy. Path analysis showed direct paths for chronic iron deficiency in infancy and being single and more detachment/dissociation at 25 years. There were indirect paths for chronic iron deficiency and not completing secondary school via poorer cognitive functioning in early adolescence and more negative emotions via behavior problems in adolescence, indicating a cascade of adverse outcomes.
  
  
  CONCLUSIONS
  The observational nature of this study limits our ability to draw causal inference, even when controlling for background factors. Nonetheless, our results indicate substantial loss of human potential. There may be broader societal implications, considering that many adults worldwide had chronic iron deficiency in infancy. Iron deficiency can be prevented or treated before it becomes chronic or severe.
authors.affiliation: Center for Human Growth and Development, University of Michigan, Ann Arbor, MI; Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI.
authors.forename: Betsy
authors.initials: B
authors.lastname: Lozoff
authors.forename: Julia B
authors.initials: JB
authors.lastname: Smith
authors.forename: Niko
authors.initials: N
authors.lastname: Kaciroti
authors.forename: Katy M
authors.initials: KM
authors.lastname: Clark
authors.forename: Silvia
authors.initials: S
authors.lastname: Guevara
authors.forename: Elias
authors.initials: E
authors.lastname: Jimenez
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000150:complications* / Q000175:diagnosis*; D003364:Costa Rica; D004522:Educational Status; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D000090463:Iron Deficiencies; D008297:Male; D017533:Marital Status; D008403:Mass Screening; D008603:Mental Health; D012923:Social Class; D011795:Surveys and Questionnaires
keywords: HB; Hemoglobin; SES; Socioeconomic status