Associations between blood lead concentrations, body iron status and behavioural outcomes in children

Abstract Purpose This study aims to investigate the association between iron deficiency and blood lead level (BLL) in a cohort of Egyptian children, and to explore their association with children’s behaviour and school achievement. Methods This is a comparative cross-sectional study, involving 120 children (60 anemic and 60 non-anemic), aged 4–10 years, consecutively recruited from the Pediatric Hematology Outpatient Clinic. Anemia was defined as hemoglobin < 11 g/dl according to WHO criteria. Behavioural assessment was performed by Conners’ Parent Rating Scale-Revised, and blood tests for BLL, and iron indices were done. Results BLL was significantly higher in anemic children (4.3 ± 0.8 vs. 2.3 ± 0.6 µg/dL, p < 0.001), and children with iron deficiency (5.1 ± 1.1 vs. 2.1 ± 0.4 µg/dL, p < 0.001). Regression analysis revealed that low socioeconomic status, anemia, and low serum ferritin were independently associated with high BLL. Moreover, high BLL and low serum ferritin were independently associated with high Conners’ score. High BLL (OR1.5, 95%CI: 1.1–1.83) and high Conners’ score (OR1.2, 95%CI: 1.1–1.4) were independently associated with poor school achievement. Conclusion Elevated BLL was associated with iron deficiency and behavioural dysregulation, and both were associated with poorer academic performance. Screening for iron deficiency and BLL may be considered in vulnerable children; longitudinal studies are needed to confirm the benefit.