Published online March 1, 2006
PEDIATRICS Vol. 117 No. 3 March 2006, pp. e518-e527 (doi:10.1542/peds.2005-1172)
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Efficacy of Iron and/or Zinc Supplementation on Cognitive Performance of Lead-Exposed Mexican Schoolchildren: A Randomized, Placebo-Controlled Trial

Javier Alatorre Rico, MSa, Katarzyna Kordas, PhDb, Patricia López, BSc, Jorge L. Rosado, PhDd, Gonzalo García Vargas, PhDe, Dolores Ronquillo, BSd and Rebecca J. Stoltzfus, PhDb

a Department of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
b DNS, Cornell University, Ithaca, New York
c Department of Nutritional Physiology, National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
d School of Natural Sciences, University of Querétaro, Querétaro, Mexico
e School of Medicine, University of Juárez, Gómez Palacio, Durango, Mexico

OBJECTIVE. Lead exposure in children has been associated with both global and specific cognitive deficits. Although chelation therapy is advised for children with blood lead concentrations of >44 µg/dL, treatment options for children with lower blood lead values are limited. Because lead absorption is related to children's nutritional status, micronutrient supplements may be 1 strategy for combating low-level, chronic lead exposure. This study was designed to test the efficacy of iron and zinc supplementation for lowering blood lead concentrations and improving cognitive performance in schoolchildren who live in a lead-contaminated city.

METHODS. This randomized, double-blind, placebo-controlled field trial was conducted in public elementary schools in Torreón, an industrialized city in northern Mexico. A metal foundry, located close to the city center and within 3.5 km of 9 schools, was the main source of lead exposure. A total of 602 children who were aged 6 to 8 years and regularly attending first grade in the study schools were enrolled. Children were given 30 mg of iron, 30 mg of zinc, both, or a placebo daily for 6 months. A total of 527 completed the treatment, and 515 were available for long-term follow-up, after another 6 months without supplementation. Eleven cognitive tests of memory, attention, visual-spatial abilities, and learning were administered at baseline and each follow-up.

RESULTS. There were no consistent or lasting differences in cognitive performance among treatment groups.

CONCLUSIONS. Daily supplementation with iron and/or zinc may be of limited usefulness for improving cognition in lead-exposed schoolchildren. However, these treatments may be effective in settings with higher prevalence of nutritional deficiencies or in younger children.

Key Words: child • cognitive function • lead toxicity • nutritional deficiency

Abbreviations: PbB—blood lead concentration • CDC—Centers for Disease Control and Prevention • ID—iron deficiency • SZn—serum zinc concentration • CI—confidence interval • TLC—Treatment of Lead-Exposed Children Trial Group

Accepted Aug 18, 2005.




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