PEDIATRICS Vol. 114 No. 1 July 2004, pp. 329
Iron Deficiency and Blood Lead Levels
Alvin N. Eden, MD
Department of Pediatrics
Wyckoff Heights Medical Center
Brooklyn, NY 11237
To the Editor. —
I read with interest the article "Prevalence of Blood Lead Levels 
5 µg/dL Among US Children 1 to 5 Years of Age and Socioeconomic and Demographic Factors Associated With Blood of Lead Levels 5 to 10 µg/dL, Third National Health and Nutrition Examination Survey, 1988–1994" by Bernard and McGeehin.1 Of particular significance to me was the finding that 32% of the 1- to 2-year-olds tested had blood lead levels >5 µg/dL, because recent studies2,3 have demonstrated that lead-associated cognitive deficits occur at blood lead levels <10 µg/dL, levels previously thought to be harmless. Furthermore, both studies determined that the IQ deficits observed with each 1 µg/dL increase in blood lead concentration was greater at blood lead levels <10 µg/dL than at higher blood lead levels. What this indicates is that one third of all the 1- to 2-year-olds tested were at risk for loss of IQ points.
In light of the studies by Bradman et al4 and Wright et al,5 demonstrating the association of iron deficiency with increased lead absorption, the case for the prevention of iron deficiency during the second year of life becomes even more compelling. Three recent studies6–8 reported a l0% prevalence of iron deficiency anemia and a 30% prevalence of iron deficiency in 1- to 2-year-olds, which are unacceptably high rates. In my opinion, the current Academy of Pediatrics9 "screen and treat" recommendations have not been successful enough. I and others6 continue to advocate for the primary prevention of iron deficiency and iron deficiency anemia during the second year of life with daily iron supplements. I believe that the case for routine iron supplementation during the second year of life has been greatly strengthened by the Bernard and McGeewin1 data.
REFERENCES
- Bernard SM, McGeehin MA. Prevalence of blood lead levels 5 µg/dL among US children 1 to 5 years of age and socioeconomic and demographic factors associated with blood of lead levels 5 to 10 µg/dL, Third National Health and Nutrition Examination Survey l988–1994.
Pediatrics. 2004;112
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–1313
- Lanphear BP, Dietrich K, Auinger P, Cox C. Cognitive deficits associated with blood lead concentrations <10 mcg/dL in US children and adolescents.
Public Health Rep. 2000;115
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- Canfield RL, Henderson CR Jr, Cory-Slechta DA, Cox C, Jusko TA, Lanphear BP. Intellectual impairment in children with blood lead concentrations below 10 µg per deciliter.
N Engl J Med. 2003;348
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- Bradman A, Eskenazi B, Sutton P, Athanasoulis M, Goldman LR. Iron deficiency associated with higher blood lead in children living in contaminated environments.
Environ Health Perspect. 2001;109
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- Wright RO, Shannon MW, Wright RJ, Hu H. Association between iron deficiency and low-level lead poisoning in an urban primary care clinic.
Am J Public Health. 1999;89
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- Eden AN, Mir MA. Iron deficiency in 1- to 3-year-old children. A pediatric failure?
Arch Pediatr Adolesc Med. 1997;151
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–988[Abstract]
- Brugnara C, Zurakowski D, DiCanzio J, Boyd T, Platt O. Reticulocyte hemoglobin content to diagnose iron deficiency anemia in children.
JAMA. 1999;281
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- Bogen DL, Duggan AK, Dover GJ, Wilson MH. Screening for iron deficiency anemia by dietary history in a high-risk population.
Pediatrics. 2000;105
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–1259[Abstract/Free Full Text]
- American Academy of Pediatrics.
Pediatric Nutrition Handbook. 5th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003–2004:307–308
PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics
