Link Found Between Inflammation and Iron Deficiency in Pediatric Anemia

A recent cross-sectional study conducted in Brazil indicated that the interaction of inflammation and iron deficiency could be triggering a substantial amount of anemia cases in children.

Iron deficiency anemia has long been known to lead to eventual degradation of cognitive abilities. Attention span, intelligence, sensory perceptions, emotions, and behavior are heavily impacted by iron deficiency.2 Although recent reports from Brazil show a decline in cases, the team believes that preventative research is still necessary to stave off these negative effects.1

“Given the negative impacts of anemia and ID on children’s health in the short and long term and the importance of expanding and updating knowledge of their determinants to develop more effective prevention strategies, this study aimed to describe the prevalence of anemia and iron deficiency in children and verify possible associations with dietary practices, nutritional stats, and inflammatory markers,” wrote Luiz Felipe de Paiva Lourenção, Federal University of San Paulo, and colleagues.1

The study examined 112 children ages 6 months-3 years enrolled in one of the three public early childhood education system in the municipality of Paraguacu-MG. Children with chronic diseases, acute inflammatory diseases, or infections at time of blood collection were excluded.1

10 mL of blood was collected from each participant. Anemia was considered when hemoglobin <10.9 g/dL for children <24 months and hemoglobin <11.4 g/dL for children >24 months. Iron status was also calculated and categorized under one of the following groups:

• Normal iron status – normal hemoglobin and normal ferritin and Soluble Transferrin Receptor (sTfR) levels
• Iron deficiency without anemia – normal hemoglobin and ferritin <30.0 ng/mL (if High-sensitivity C-reactive protein [hsCRP] >5 mg/L) or ferritin <12.0 ng/mL (if hsCRP <5 mg/L) and/or high sTfR, >1.5 mg/L
• Anemia from iron deficiency – both low hemoglobin and iron deficiency
• Non-iron deficiency anemia – low hemoglobin without iron deficiency1

A correlation analysis was also carried out to indicate the association between biochemical marker results – this included the variables hemoglobin, RDW, ferritin, serum iron, TSI, sTfR, and the biomarkers of inflammation (hsCRP and Alpha-1-Acid Glycoprotein).1

Anemia and iron deficiency were observed in 58 (51.8%) of children >2 years and 89 (79.5%) of children <2 years (anemia: 18 <2 years and 40 >2 years, P =.431 and iron deficiency: 31<2 years and 58 >2 years, P =.600). Among the anemic children, 47 had iron deficiency. 29 children had high hsCRP values (>5.0 mg/L) and 80 had high Alpha-1 Acid Glycoprotein values (>1.0 g/L).1

Among the participants, 23 had normal iron status, 27 had iron deficiency without anemia, 38 had iron deficiency with anemia, and 24 had anemia without iron deficiency. Those with lower hemoglobin levels had higher hsCRP levels [2.39 mg/L (.68, 14.5) vs 1.25(.20, 3.41); P =.008), which correlated directly with RDW (r =.202; P =.033), ferritin (r =.425; P <.001), and sTfR (r =.446; P <.001) and inversely with serum iron (r = -.580; P <.001) and transferrin saturation index (r = -.528; P <.001).1

A Receiver Operating Characteristics (ROC) curve indicated that the RDW and sTfR values were most successful in discriminating between children with and without anemia. The team noted that RDW distinguishes iron deficiency from other causes, such as inflammation, while the sTfR is commonly used to assess iron status in the pediatric population. The sTfR is characterized as an essential biomarker for distinguishing iron deficiency anemia from inflammation anemia.1

The team indicated that these results indicate a higher presence of anemia than reported in the Brazilian National Survey on Child Nutrition (ENANI). They believe this is a result of the correlation between inflammatory markers and biomarkers of iron nutritional status.1

“[The correlation indicates] the importance of prior diagnosis of anemia in the child population, and the detection of the main risk factors that can increase its prevalence, including inflammation,” de Paiva Lourenção and colleagues wrote. “Public policies aimed at various interventions to improve children’s health and nutrition should be enhanced, creating a care network for the nutritional problems affecting this population and enabling strategies for early diagnosis, intervention and clinical, dietary and nutritional management."1

References

1. de Paiva Lourenção, L.F., Suano-Souza, F.I., Fonseca, F.L.A. et al. Impact of inflammation on anemia in children: a cross-sectional study. BMC Pediatr 25, 272 (2025). https://doi.org/10.1186/s12887-025-05639-z

2. Jáuregui-Lobera I. Iron deficiency and cognitive functions. Neuropsychiatr Dis Treat. 2014;10:2087-2095. Published 2014 Nov 10. doi:10.2147/NDT.S72491