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Iron and attention deficit/hyperactivity disorder: What is the empirical evidence so far? A systematic review of the literature.

Abstract

The authors systematically reviewed evidence on iron status, as well as studies of iron supplementation, in individuals with attention deficit/hyperactivity disorder (ADHD). PubMed, Ovid, EMBASE and Web of Knowledge were searched on 4 July 2012. Quantitative appraisal of trials was performed using Jadad's score. Most (n = 20) of the retrieved studies assessed an index of peripheral iron status (i.e., serum ferritin), with overall mixed results - that is, both significant and nonsignificant association between ADHD symptoms and serum ferritin levels. One MRI study reported significantly lower indices of thalamic iron in ADHD versus comparison subjects. Two trials, an open-label and a pilot randomized placebo-controlled study with high Jaded score (4), showed improvement in some but not all measures of ADHD symptoms. Three studies showed that children with ADHD plus sleep disorders, in particular restless legs syndrome, are at risk of iron deficiency. Finally, two studies suggested that iron deficiency might decrease the effectiveness of psychostimulant treatment. The authors discussed how the field could move from initial research mainly focused on serum ferritin towards a more comprehensive and translational investigation of iron in ADHD, with the potential to inform clinical practice in terms of screening and treating iron deficiency in individuals with ADHD.

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  • Authors+Show Affiliations

    ,

    Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center of the NYU Langone Medical Center, New York, NY, USA. samuele.cortese@gmail.com

    , ,

    Source

    Expert review of neurotherapeutics 12:10 2012 Oct pg 1227-40

    MeSH

    Anemia, Iron-Deficiency
    Attention Deficit Disorder with Hyperactivity
    Central Nervous System Stimulants
    Dietary Supplements
    Drug Resistance
    Evidence-Based Medicine
    Ferritins
    Humans
    Iron, Dietary
    Nutritional Status
    Severity of Illness Index

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    23082739

    Citation

    Cortese, Samuele, et al. "Iron and Attention Deficit/hyperactivity Disorder: what Is the Empirical Evidence so Far? a Systematic Review of the Literature." Expert Review of Neurotherapeutics, vol. 12, no. 10, 2012, pp. 1227-40.
    Cortese S, Angriman M, Lecendreux M, et al. Iron and attention deficit/hyperactivity disorder: What is the empirical evidence so far? A systematic review of the literature. Expert Rev Neurother. 2012;12(10):1227-40.
    Cortese, S., Angriman, M., Lecendreux, M., & Konofal, E. (2012). Iron and attention deficit/hyperactivity disorder: What is the empirical evidence so far? A systematic review of the literature. Expert Review of Neurotherapeutics, 12(10), pp. 1227-40. doi:10.1586/ern.12.116.
    Cortese S, et al. Iron and Attention Deficit/hyperactivity Disorder: what Is the Empirical Evidence so Far? a Systematic Review of the Literature. Expert Rev Neurother. 2012;12(10):1227-40. PubMed PMID: 23082739.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Iron and attention deficit/hyperactivity disorder: What is the empirical evidence so far? A systematic review of the literature. AU - Cortese,Samuele, AU - Angriman,Marco, AU - Lecendreux,Michel, AU - Konofal,Eric, PY - 2012/10/23/entrez PY - 2012/10/23/pubmed PY - 2013/3/23/medline SP - 1227 EP - 40 JF - Expert review of neurotherapeutics JO - Expert Rev Neurother VL - 12 IS - 10 N2 - The authors systematically reviewed evidence on iron status, as well as studies of iron supplementation, in individuals with attention deficit/hyperactivity disorder (ADHD). PubMed, Ovid, EMBASE and Web of Knowledge were searched on 4 July 2012. Quantitative appraisal of trials was performed using Jadad's score. Most (n = 20) of the retrieved studies assessed an index of peripheral iron status (i.e., serum ferritin), with overall mixed results - that is, both significant and nonsignificant association between ADHD symptoms and serum ferritin levels. One MRI study reported significantly lower indices of thalamic iron in ADHD versus comparison subjects. Two trials, an open-label and a pilot randomized placebo-controlled study with high Jaded score (4), showed improvement in some but not all measures of ADHD symptoms. Three studies showed that children with ADHD plus sleep disorders, in particular restless legs syndrome, are at risk of iron deficiency. Finally, two studies suggested that iron deficiency might decrease the effectiveness of psychostimulant treatment. The authors discussed how the field could move from initial research mainly focused on serum ferritin towards a more comprehensive and translational investigation of iron in ADHD, with the potential to inform clinical practice in terms of screening and treating iron deficiency in individuals with ADHD. SN - 1744-8360 UR - https://www.unboundmedicine.com/medline/citation/23082739/full_citation L2 - http://www.tandfonline.com/doi/full/10.1586/ern.12.116 DB - PRIME DP - Unbound Medicine ER -