Supplementation With Iron Syrup or Iron-Containing Multiple Micronutrient Powders Alters Resting Brain Activity in Bangladeshi Children

Leila M Larson; Daniel Feuerriegel; Mohammed Imrul Hasan; Sabine Braat; Jerry Jin; Sm Mulk Uddin Tipu; Shamima Shiraji; Fahmida Tofail; Beverley-Ann Biggs; Jena Hamadani; Katherine Johnson; Sant-Rayn Pasricha; Stefan Bode

doi:10.1016/j.tjnut.2022.12.026

Supplementation With Iron Syrup or Iron-Containing Multiple Micronutrient Powders Alters Resting Brain Activity in Bangladeshi Children

J Nutr. 2023 Jan;153(1):352-363. doi: 10.1016/j.tjnut.2022.12.026. Epub 2022 Dec 28.

Affiliations

¹ Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia; Department of Infectious Diseases at the Peter Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia. Electronic address: Larsonl@mailbox.sc.edu.
² Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
³ Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
⁴ Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia; Department of Infectious Diseases at the Peter Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia.
⁵ Department of Infectious Diseases at the Peter Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
⁶ Department of Infectious Diseases at the Peter Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia; The Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁷ Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia; Diagnostic Haematology, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Diagnostic Haematology and Clinical Haematology, The Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Parkville, Victoria, Australia.

PMID: 36913472
DOI: 10.1016/j.tjnut.2022.12.026

Abstract

Background: Anemia and iron deficiency have been associated with poor child cognitive development. A key rationale for the prevention of anemia using supplementation with iron has been the benefits to neurodevelopment. However, little causal evidence exists for these gains.

Objectives: We aimed to examine effects of supplementation with iron or multiple micronutrient powders (MNPs) on brain activity measures using resting electroencephalography (EEG).

Methods: Children included in this neurocognitive substudy were randomly selected from the Benefits and Risks of Iron Supplementation in Children study, a double-blind, double-dummy, individually randomized, parallel-group trial in Bangladesh, in which children, starting at 8 mo of age, received 3 mo of daily iron syrup, MNPs, or placebo. Resting brain activity was recorded using EEG immediately after intervention (month 3) and after a further 9-month follow-up (month 12). We derived EEG band power measures for delta, theta, alpha, and beta frequency bands. Linear regression models were used to compare the effect of each intervention with that of placebo on the outcomes.

Results: Data from 412 children at month 3 and 374 at month 12 were analyzed. At baseline, 43.9% were anemic and 26.7% were iron deficient. Immediately after intervention, iron syrup, but not MNPs, increased the mu alpha-band power, a measure that is associated with maturity and the production of motor actions (iron vs. placebo: mean difference = 0.30; 95% CI: 0.11, 0.50 μV²; P = 0.003; false discovery rate adjusted P = 0.015). Despite effects on hemoglobin and iron status, effects were not observed on the posterior alpha, beta, delta, and theta bands, nor were effects sustained at the 9-month follow-up.

Conclusions: The effect size for immediate effects on the mu alpha-band power is comparable in magnitude with psychosocial stimulation interventions and poverty reduction strategies. However, overall, we did not find evidence for long-lasting changes in resting EEG power spectra from iron interventions in young Bangladeshi children. This trial was registered at www.anzctr.org.au as ACTRN12617000660381.

Keywords: anemia; brain activity; child; electroencephalography; iron; multiple micronutrient powders; neurodevelopment; resting state.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Anemia* / drug therapy
Anemia, Iron-Deficiency* / drug therapy
Anemia, Iron-Deficiency* / prevention & control
Brain
Child
Dietary Supplements
Humans
Iron
Micronutrients
Powders

Substances

Iron
Powders
Micronutrients

Associated data

ANZCTR/ACTRN12617000660381