Child hemoglobin trajectories across the first 10 years of life and association with child cognition and academic achievement at 10-11 years

Young, Melissa F.; Tran, Lan Mai; Nguyen, Phuong Hong; Kalam, Md Abul; Khuong, Long Quynh; Martorell, Reynaldo; Ramakrishnan, Usha

Child hemoglobin trajectories across the first 10 years of life and association with child cognition and academic achievement at 10-11 years

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Editor

Elsevier

Descripción

Background Anemia is a global health concern, though the importance of changes in hemoglobin (Hb) and cognitive outcomes in childhood remains unclear. Objective We examined the association between child Hb trajectories and anemia with cognitive development and academic achievement at 10-11y. Methods We used prospective data from Vietnamese children (n=831) born to women who participated in a micronutrient supplementation trial (PRECONCEPT). Hb was measured at 3mo, 6mo, 1y, 2y and 10-11y. Multivariable linear regression models assessed the association between Hb trajectories and anemia with cognitive development (full-scale intelligence quotient- FSIQ), and academic achievement (mathematics and reading) at 10-11y, adjusting for maternal (intervention, education, age, mental health), child (age, sex), and household (home environment, socioeconomic status) characteristics. Results Three child Hb trajectories were identified (low-6.4%, middle-52.2% and high-41.4%). Compared to the middle and high trajectory groups, children in the low trajectory had the lowest Hb levels at 3 months (Hb: 9.7g/dL) and through age 10-11y (11.2g/dl). Children in the low-Hb trajectory had lower FSIQ (89.8 vs 93.2), math (12.1 vs 13.5) and reading (17.8 vs 19.0) scores compared to the high-Hb trajectory. These differences were attenuated in adjusted models. Children in the low and middle Hb trajectories had non-significantly lower FSIQ (-0.93; 95% CI: [-4.57, 2.71] and (-1.13 [-2.92, 0.66]), reading scores (-0.01 [-1.36,1.34]) and -0.46 [-1.13,0.21]) and math scores (-0.57 [-1.15,0.01] and -0.65 [-1.82, 0.51]). Anemia status at 10-11y was negatively associated with FSIQ (-3.82 [-6.68, -0.76]) and math scores (-1.04 [-2.03, -0.05]) in adjusted models. Conclusion Child Hb trajectories across the first 10 years of life were largely established early in life and had weak associations with cognition and academic achievement at 10-11y. Anemia among 10-year-old children was associated with lower IQ and math scores, which underscores the importance of continued investment in nutrition programs among school-age children.