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Cited by 154Iron Metabolism and DisordersChild Nutrition and Water AccessPublic Health and Nutrition

Effects of daily iron supplementation in primary-school–aged children: systematic review and meta-analysis of randomized controlled trials

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Low, Michael, Farrell, Ann, Biggs, Beverley-Ann, Pasricha, Sant-Rayn·2013·Canadian Medical Association Journal
DOI 10.1503/cmaj.130628PMC PMC3832580
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Abstract

BACKGROUND: Anemia is an important public health and clinical problem. Observational studies have linked iron deficiency and anemia in children with many poor outcomes, including impaired cognitive development; however, iron supplementation, a widely used preventive and therapeutic strategy, is associated with adverse effects. Primary-school-aged children are at a critical stage in intellectual development, and optimization of their cognitive performance could have long-lasting individual and population benefits. In this study, we summarize the evidence for the benefits and safety of daily iron supplementation in primary-school-aged children. METHODS: We searched electronic databases (including MEDLINE and Embase) and other sources (July 2013) for randomized and quasi-randomized controlled trials involving daily iron supplementation in children aged 5-12 years. We combined the data using random effects meta-analysis. RESULTS: We identified 16 501 studies; of these, we evaluated 76 full-text papers and included 32 studies including 7089 children. Of the included studies, 31 were conducted in low- or middle-income settings. Iron supplementation improved global cognitive scores (standardized mean difference 0.50, 95% confidence interval [CI] 0.11 to 0.90, p = 0.01), intelligence quotient among anemic children (mean difference 4.55, 95% CI 0.16 to 8.94, p = 0.04) and measures of attention and concentration. Iron supplementation also improved age-adjusted height among all children and age-adjusted weight among anemic children. Iron supplementation reduced the risk of anemia by 50% and the risk of iron deficiency by 79%. Adherence in the trial settings was generally high. Safety data were limited. INTERPRETATION: Our analysis suggests that iron supplementation safely improves hematologic and nonhematologic outcomes among primary-school-aged children in low- or middle-income settings and is well-tolerated.

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  • Iron intake is associated with improved cognitive performance.

    “iron intake was associated with improved cognitive performance.45”

    From Critical connections: health and academics (2015) · cites this paper as [45]

  • In a meta-analysis of 32 studies including 7089 children aged 5-12 years, iron supplementation in anemic children significantly improved measures of attention and concentration, global cognitive scores and intelligence quotient.

    “a meta-analysis of 32 studies that included 7089 children aged 5–12 years. Iron supplementation in anemic children significantly improved measures of attention and concentration, global cognitive scores and intelligence quotient [205].”

    From Vitamins and Minerals for Energy, Fatigue and Cognition: A Narrative Review of the Biochemical and Clinical Evidence (2020) · cites this paper as [205]

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Research works printed but not linked: 4

  1. Goswami U, Bryant P. Children's cognitive development and learning: primary review research survey 2/1a. Cambridge (UK): University of Cambridge, Faculty of Education; 2007.
  2. Borenstein M, Hedges L, Rothstein H. Chichester (UK): John Wiley & Sons; 2007.
  3. Gebreselassie H. Iron supplementation and malaria infection: results of a randomized controlled field trial [dissertation]. Montreal (QC): McGill University, 1996.
  4. Taubman P, Wales T. Mental ability and higher education attain- ment in the 20th century. New York (NY): McGraw-Hill; 1972.

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Authors
Low, M., Farrell, A., Biggs, B.-A., & Pasricha, S.-R.
Affiliations
The Royal Melbourne Hospital (AU)
ORCID
Venue
Canadian Medical Association Journal
Publisher
CMA Joule Inc.
Published
2013-10-15
Volume
185
Issue
17
Pages
E791-E802
ISSN
  • 0820-3946 (ISSN-L)
  • 1488-2329
DOI
10.1503/cmaj.130628
PMC
PMC3832580
OpenAlex
W2011497294
Cited by
154
References
69
Citations by year
2026: 6 · 2025: 10 · 2024: 11 · 2023: 17 · 2022: 11 · 2021: 18 · 2020: 19 · 2019: 8 · 2018: 14 · 2017: 14 · 2016: 8 · 2015: 10 · 2014: 6 · 2013: 1 · 2012: 1
FWCI
1.27
Type
journal article
Language
en
Open access
Locations
  • Canadian Medical Association Journal (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc-nd)
Funders
Vifor Pharma
Topics
  • Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Public Health and Nutrition
Keywords
iron supplementation, childhood anemia, iron deficiency, primary school-aged children, cognitive development, intelligence quotient, attention and concentration, height and weight, anemia prevention, low- and middle-income settings, supplement safety
MeSH terms
Child, Child Development, Drug Administration Schedule, Humans, Iron, Schools, Anemia, Iron-Deficiency, Dietary Supplements

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