Iron deficiency and neural development: an update.

In Latin America, 10-30% of reproductive age females and upwards of 40-70% of pregnant women may be iron deficient. The true prevalence in young children and infants is often hard to determine because of problems in survey design, data collection, or sampling. There is little doubt, however, that iron deficiency anemia is a significant nutritional problem in many infants within the first 5 years of life. Numerous intervention studies have been performed across the world with varying success and it is clear that in nearly all situations it is a preventable disease with preventable consequences. One such consequence is the alteration in cognition that occurs in iron deficient individuals during the early parts of their life cycle and perhaps at later times as well. While iron deficiency was once presumed to exert most of its deleterious effects only if anemia was present, it is now clear that many organs show morphologic, physiologic, and biochemical changes before there is any drop in hemoglobin concentration. Iron deficiency is associated with alterations in many metabolic processes that may impact brain functioning; among them are mitochondria electron transport, neurotransmitter synthesis and degradation, protein synthesis, organogenesis, and others. It is necessary to separate the developmental aspects of iron deficiency and neural functioning from the aspects of iron deficiency that could occur at any time in life. A number of reviews have discussed the links between brain iron and neuropathology, brain iron, nutrition, and development, and iron status and cognition. New knowledge concerning the acquisition of iron by the brain in early life is being generated by numerous research groups. In the next decade a much clearer understanding of the role of brain iron on neural functioning will probably emerge.

Iron in the brain.

The location and function of iron in the central nervous system are reviewed with particular emphasis on human biology. Iron is distributed to different cell types in the brain in a heterogeneous fashion through the action of transferrin, transferrin receptors, and the metabolic needs of those cells. The function of this iron and its storage is documented in states of growth and development as well as during pathological states associated with aging. The information relating this biology to current observations of attention deficits in iron-deficient humans is also reviewed.

Iron deficiency anemia and steady-state work performance at high altitude.

Thirty-seven young adult male highland residents at 3,600-4,100 m in La Paz, Bolivia, performed short-duration cycle ergometry at 60, 80, and 100% of maximal voluntary O2 consumption (VO2max). Three groups of subjects representing the high-altitude population mean hemoglobin (Hb), the 10th percentile Hb, and below the 1st percentile were examined to test the hypothesis that the relationship of exercise performance to Hb concentration is similar to those relationships established at low altitude. Anemic individuals (n = 8) had 23% lower voluntary VO2max and 28% lower maximal work loads compared with controls (n = 17) or marginally anemic subjects (n = 12) although the relationship of VO2 to work load was similar. Anemic individuals maintained significantly higher arterial O2 partial pressures and Hb saturations during heavy exercise (90 +/- 0.5 vs. 85 +/- 0.6%) in conjunction with a greater heart rate up to maximal effort. A significantly decreased erythrocyte 2,3-diphosphoglycerate (2,3-DPG)-to-Hb molar ratio (0.70 +/- 0.04 vs. 1.12 +/- 0.06), suggestive of a left-shifted dissociation curve in anemics, is in contrast to the expected right-shifted curve. Moderate anemics were similar to controls. Anemic individuals did not differ in arterial lactate concentration from controls at absolute work loads; anemics had significantly lower arterial lactate concentrations at maximal effort than controls with no differences in the work load-to-lactate relationship. In conclusion, O2 transport during exercise at high altitude seems unaffected by the Hb concentrations as low as the 10th percentile of the population mean.(ABSTRACT TRUNCATED AT 250 WORDS)