1. Presented by: Lindsey Sumpman
“Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study”
Presented by: Lindsey Sumpman
Chen, Mu-Hong, et al. "Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study." BMC Psychiatry. BioMed Central, 4 June Web. 14 May <

2. Introduction
Iron deficiency anemia is the most common nutritional deficiency worldwide
Iron deficiency: two or more abnormal measurements
Serum ferritin
transferrin saturation
erythrocyte protoporphyrin

3. Introduction
Anemia occurs when the deficiency is so extreme that is affects the ability of hemoglobin to transport oxygen
This team studied the association between iron deficiency anemia and psychiatric disorders

4. Review of Literature
1985: Iron deficiency is the most prevalent nutritional deficiency
DeMaeyer E, Adiels-Tegman M: The prevalence of anaemia in the world. World Health Stat Q , 38(3):302–316
1991: Iron plays a crucial role in the development of the central nervous system
Pollitt E: Effects of a diet deficient in iron on the growth and development of preschool and school-age children. Food Nutr Bull 1991, 13:110–118
2001: Abnormal measurements for iron deficiency are defined and it is difficult to self-detect this disorder
World Health Organization, Dept. of Nutrition for Health and Development: Iron deficiency anaemia: assessment, prevention and control: a guide for programme managers. Geneva: World Health Organization; 2001.
2003: Iron is key in the development and functioning of different neurotransmitters (dopamine, norepinephrine, serotonin)
Beard J: Iron deficiency alters brain development and functioning. J Nutr 2003, 133(5 Suppl 1):1468S–1472S.

5. Review of Literature
2008: Ferritin level is related to behavioral problems in children with ADHD
Oner O, Alkar OY, Oner P: Relation of ferritin levels with symptom ratings and cognitive performance in children with attention deficit hyperactivity disorder. Pediatr Int 2008, 50(1):40–44.
2011: People with lower serum ferritin concentration levels had a higher prevalence of depressive symptoms
Yi S, Nanri A, Poudel-Tandukar K, Nonaka D, Matsushita Y, Hori A, Mizoue T: Association between serum ferritin concentrations and depressive symptoms in Japanese municipal employees. Psychiatry Res 2011, 189(3):368–372.
2012: A high prevalence (30%) of IDA was observed in children with autism spectrum disorder
Herguner S, Kelesoglu FM, Tanidir C, Copur M: Ferritin and iron levels in children with autistic disorder. Eur J Pediatr 2012, 171(1):143–146.
2012: Infants with IDA showed significantly lower scores on language, environmental sound perception, and motor measures when compared with infants with normal iron status
Beltran-Navarro B, Matute E, Vasquez-Garibay E, Zarabozo D: Effect of chronic iron deficiency on neuropsychological domains in infants. J Child Neurol 2012, 27(3):297–303

6. Hypothesis SPECIFICALLY
-Clarify the association between IDA and various psychiatric disorders among children and adolescents
SPECIFICALLY
“We hypothesized that children and adolescents with ADHD exhibited higher risk of having psychiatric disorder.”

7. Methodology
1,000,000 randomly chosen subjects in Taiwan by National Health Insurance program
Children and adolescents (under age 18)
Found those diagnosed with iron deficiency anemia (IDA) between January 1996 and December 2008
Those found to have an overlap of IDA and psychiatric disorders became the subjects of the study

8. Methodology The following disorders were investigated: schizophrenia
unipolar depressive disorder
major depressive disorder
dysthymic depressive disorder
depressive disorder
obsessive-compulsive disorder
anxiety disorder
tic disorder
autistic spectrum disorder
attention-deficit hyperactivity disorder
delayed development
mental retardation

9. Methodology
Any subject who had a health condition affecting iron levels was not included
Control group- 4 control for every 1 patient
Had no health issues or condition
A two-tailed T-test was conducted
P-values less than .05

12. Discussion
Supported previous evidence that IDA is significantly associated with increased risk of
unipolar depressive disorder
bipolar disorder
autism spectrum disorder
ADHD
delayed development
mental retardation

13. Discussion
Increased risk of ADHD was noted among those with IDA in this study
disturbs norepinephrine and dopamine neurotransmitters
Increased risk of ASD with IDA
possible reciprocal effect
children with ASD are typically picky eaters which may lead to IDA

14. Discussion
Bipolar disorder associated with IDA was found to be more common in females
This information may be needed in future studies
Iron deficiency whether in childhood or adolescence has psychiatric effects
Iron depletion in childhood has immediate and chronic effects on brain development

15. Conclusion
Patients with IDA display a higher risk of psychiatric disorders
Iron supplementation should be prompted to prevent possible psychiatric disorders
Physicians should check the iron levels of patients displaying psychiatric disorders
Further studies are needed to determine the causality between IDA and psychiatric disorders