Evaluation of Iron Status Biomarkers and Cognitive Performance Among Pediatric Patients with Iron Deficiency Anemia

Abstract

Background: Iron deficiency anemia (IDA) is the most common nutritional deficiency among children worldwide and is associated with impaired neurocognitive development. Iron plays a crucial role in neurotransmitter synthesis, myelination, and energy metabolism in the developing brain. Early identification of cognitive impairment associated with iron deficiency may facilitate timely intervention and improve developmental outcomes.
Objectives: To evaluate iron status biomarkers among pediatric patients with iron deficiency anemia and assess their association with cognitive performance.
Materials and Methods: A hospital-based cross-sectional study was conducted among 100 children aged 6–12 years attending the pediatric outpatient department of a tertiary care teaching hospital. Fifty children diagnosed with iron deficiency anemia constituted the study group, while fifty age- and sex-matched healthy children served as controls. Hemoglobin concentration, serum ferritin, serum iron, total iron-binding capacity (TIBC), and transferrin saturation were measured using standard laboratory methods. Cognitive performance was assessed using age-appropriate standardized cognitive assessment tools evaluating memory, attention, processing speed, and executive functions. Statistical analysis was performed using SPSS version 25.0. Independent t-test and Pearson correlation analysis were used to determine differences and associations. A p-value <0.05 was considered statistically significant.
Results: Children with iron deficiency anemia (IDA) had significantly lower hemoglobin (9.2 ± 1.1 vs. 12.8 ± 0.9 g/dL), serum ferritin (11.4 ± 4.2 vs. 42.8 ± 8.5 ng/mL), serum iron (38.7 ± 9.3 vs. 86.5 ± 12.1 μg/dL), and transferrin saturation (8.7 ± 2.1 vs. 27.4 ± 4.5%) compared to controls, while TIBC was significantly higher (445 ± 35 vs. 325 ± 28 μg/dL) (p<0.001). Cognitive performance scores, including attention, memory, processing speed, and executive function, were significantly lower in the IDA group (p<0.001). Overall cognitive performance showed positive correlations with hemoglobin (r=0.52, p<0.001) and serum ferritin (r=0.48, p<0.001), whereas TIBC demonstrated a negative correlation (r=-0.41, p=0.004). Cognitive scores declined progressively with increasing severity of anemia.
Conclusion: Pediatric patients with iron deficiency anemia exhibited significantly altered hematological and iron status biomarkers along with impaired cognitive performance compared to healthy controls. Lower hemoglobin and ferritin levels were significantly associated with poorer cognitive outcomes. These findings highlight the importance of early screening, diagnosis, and treatment of iron deficiency anemia to improve cognitive development and academic performance among children.