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Iron status in early infancy is associated with trajectories of cognitive development up to pre-school age in rural Gambia

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posted on 2023-11-06, 11:28 authored by Samantha McCann, Luke Mason, Bosiljka Milosavljevic, Ebrima Mbye, Ebou Touray, Alhassan Colley, Will JohnsonWill Johnson, Sarah Lloyd-Fox, Clare E. Elwell, Sophie E. Moore, BRIGHT Study Team


Iron deficiency is among the leading risk factors for poor cognitive development. However, interventions targeting iron deficiency have had mixed results on cognitive outcomes. This may be due to previous interventions focusing on the correction of iron deficiency anaemia in late infancy and early childhood, at which point long lasting neural impacts may already be established. We hypothesise that the relationship between iron status and cognitive development will be observable in the first months of life and will not be recovered by 5 years of age.


Using data from the Brain Imaging for Global Health (BRIGHT) Study in Gambia (n = 179), we conducted mixed effects modelling to assess the relationship between iron status at 5 months of age and trajectories of cognitive development from 5 months– 5 years using (i) a standardised measure of cognitive development (Mullen Scales of Early Learning) and (ii) an eye-tracking assessment of attention processing (visual disengagement time).


All infants were iron sufficient at 1 month of age. At 5 and 12 months of age 30% and 55% of infants were iron deficient respectively. In fully adjusted analyses, infants in the lowest tercile of soluble transferrin receptor (sTfR) (best iron status) achieved MSEL Cognitive Scores on average 1.9 points higher than infants in the highest sTfR tercile (p = 0.009, effect size = 0.48). There was no evidence that this group difference was recovered by 5 years of age. Infants in the lowest sTfR tercile had visual disengagement time 57ms faster than the highest tercile (p = 0.001, effect size = 0.59). However, this difference diminished by early childhood (p = 0.024).


Infants are at risk of iron deficiency in early infancy. A relationship between iron status and cognitive development is apparent from 5 months of age and remains observable at 5 years of age. One mechanism by which iron availability in early infancy impacts brain development may be through effects on early attentional processing, which is rapidly developing and has substantial nutritional requirements during this period. To support neurocognitive development, prevention of iron deficiency in pre- and early postnatal life may be more effective than correcting iron deficiency once already established.


To use a non-invasive optical brain imaging technology (near-infrared spectroscopy) to study cognitive function in malnourished infants and children.

Bill & Melinda Gates Foundation

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To chart the nature and pace of neurocognitive development from birth to 24 months of age in infants and children from the UK and sub-Saharan Africa

Bill & Melinda Gates Foundation

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MRC & the Department for International Development (DFID) under the MRC/DFID Concordat agreement (MRC Programme MC-A760-5QX00)

Micronutrient interventions to improve infant neurocognitive development and growth in early infancy

Wellcome Trust

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Body size trajectories and cardio-metabolic resilience to obesity in three United Kingdom birth cohorts

Medical Research Council

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National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, which is a partnership between University Hospitals of Leicester NHS Trust, Loughborough University, and the University of Leicester

Brain biomarkers and effective interventions to tackle global poverty from birth

UK Research and Innovation

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  • Sport, Exercise and Health Sciences

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PLOS Global Public Health






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© McCann et al.

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This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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The BRIGHT Study Team consists of: Andrew Prentice, Lena Acolatse, Saikou Drammeh, Buba Jobarteh, Mariama Saidykhan, Fabakary Njie, Tijan Fadera, Ousman Kambi, Ebrima Drammeh, Kassa Kora, Laura Steiner, Jasmine Siew.




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Dr Will Johnson. Deposit date: 3 November 2023

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