Iron Deficiency and Physical Growth Predict Attainment of Walking but Not Crawling in Poorly Nourished Zanzibari Infants

Abstract

Locomotion allows infants to explore their environment, promoting development in other domains. Motor progression involves biological systems and experiential factors. Nutritional deficiencies could interfere with systems involved in locomotion. This study examined the associations between height-for-age (HAZ), weight-for-height (WHZ) Z-scores and anemia-iron status on locomotion in 646 Zanzibari infants. Motor milestones were assessed by trained observers using a 14-item scale. Two mutually exclusive samples were created. The crawling sample (n = 167, 6-18 mo old) included infants that crawled only or did not crawl; the walking sample (n = 479, 9-18 mo old) included children that walked alone or did not walk alone. Of the crawling and walking samples, 82.6 and 83.9% respectively, were iron deficient and/or anemic (hemoglobin < 100 g/L; zinc protoporphyrin > or = 90 micromol/mol heme). Stunting (HAZ less than -2) occurred in 30.5% of the crawling sample and 38.4% of the walking sample. Logistic regression models estimated the influence of factors on crawling vs. not crawling or walking vs. not walking. Two models were tested: 1) included sex, age, SES, HAZ and WHZ; 2) added anemia-iron status category to Model 1. HAZ improved the odds of crawling by 30%, but was not significant in either model. Model 2 fit the walking sample data best (P < 0.0001); an increase in HAZ doubled the odds of walking and nonanemic, noniron deficient children were 66% more likely to walk than those with anemia and/or iron deficiency. In this sample of poorly nourished infants, growth and anemia-iron status are significant predictors of walking, but not crawling.

Dietary Patterns in Pregnancy and Effects on Nutrient Intake in the Mid-South: The Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) Study

“…These results are similar to what had been earlier reported from Indonesia where nutritional influences mediated the relationship between poverty-related variables (e.g., SES) and child outcomes (Pollitt et al, 1994). As far as our literature search has revealed, the majority of studies exploring the relationship between undernutrition, co-occurring risk factors and other aspects of impaired child outcome has largely concentrated on children under the age of 5 years (Kariger et al, 2005;Abubakar et al, 2008;Olney et al, 2009Olney et al, , 2007McDonald et al, 2013). We would like to build up on earlier work and extend the lines of research by focussing on school-age children.…”

Behavioral consequences of developmental iron deficiency in infant rhesus monkeys

“…Growth retardation is not a common finding unless IDA is severe; retarded growth linked to altered metabolism has been demonstrated in rodent models [38,3] and stunting is found in connection with anemia in generally malnourished populations [34]. A smaller head width was detected in the prenatally deprived group, but head circumferences did not differ, suggesting a conformational rather than growth related source of the head width difference.…”

Iron Supplementation in Pregnancy or Infancy and Motor Development: A Randomized Controlled Trial

“…[42][43][44] Similarly, an association between better iron status in infancy and earlier onset of walking was reported in 2 observational studies. 45,46 These locomotor-related benefits of iron supplementation may enhance infant development in other domains (eg, cognitive, socialemotional). 2,3,40,47 Our results may not be directly comparable to previous RCTs of iron supplementation due to differences in several respects: we used a different motor assessment (PDMS-2 vs Bayley or motor milestones in other studies), our population was growing well and mainly breastfed, and the prevalence of ID was higher than in some other studies.…”