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Lozoff et al1 demonstrated the persistent negative effects of iron deficiency in infancy on a cohort of children from Costa Rica that the researchers observed through age 19 years. In their recent study, they showed that cognitive scores remained lower in children who were iron deficient in infancy compared with those who were iron sufficient. This finding was more notable in children of lower socioeconomic status, hence the double burden on these children.
Another factor that should be considered in studying this problem is the effect of lead exposure on children's cognitive abilities. The authors point out that iron deficiency correlates with lower socioeconomic status; lead intoxication has a similar association.2 Iron deficiency often coexists with lead intoxication for a variety of reasons related to absorption of the 2 metals from the gastrointestinal tract.3 It has long been known that low-level lead exposure adversely affects test scores in children and that there is no threshold effect, ie, there is no lead level below which children are not affected.4 Although the authors may cite their data published in 1994,5 which showed no ill effects from lead in this same cohort of children, this association has been born out in several studies of socioeconomically similar populations from different parts of the world.2 ,4
From the well-done longitudinal studies by these authors, it is clear that iron deficiency and lower socioeconomic status are a double burden for children. I would suggest that lead poisoning creates a triple burden, which could be devastating. Primary prevention of lead poisoning can be accomplished by removing children from the lead source. However, the cost of doing so is often prohibitive. Secondary prevention should include preventing and/or treating iron deficiency. It has been found that supplementation with iron will reduce lead levels in children3 ; however, more research is needed to determine whether attainment on tests of cognitive abilities can be improved.
Correspondence: Dr Petrone, Family and Community Medicine, Jefferson Medical College, 2305 Fairmount Ave, Philadelphia, PA 19130 (lpetrone5@msn.com).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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