Peer-reviewed article
The association between serum trace elements and iron deficiency anemia in children and adolescents: a systematic review and meta-analysis.
Maryam Mobasheri-Shiri, Sepehr Ramezanipour, Zahra Azizi, Faezeh Mobasheri-Shiri, Zeinab Karimi-Moghadam et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review and meta-analysis examined the relationship between trace elements (iron, zinc, copper, and magnesium) and iron deficiency anemia in children and adolescents. The analysis of eight studies with over 1,100 participants found that children with iron deficiency anemia had significantly lower levels of iron, zinc, and magnesium but higher copper levels compared to healthy controls. The findings suggest that multiple trace elements are dysregulated in pediatric iron deficiency anemia, which could inform more comprehensive nutritional approaches to treatment.
Key points
- Children with iron deficiency anemia had significantly lower serum iron (-13.07 μmol/L), zinc (-4.33 μmol/L), and magnesium (-18.17 μmol/L) compared to controls
- Serum copper was significantly higher in children with iron deficiency anemia (+4.33 μmol/L)
- Trends were consistent across subgroups stratified by age, gender, and geography
- High heterogeneity was found across studies examining iron, zinc, and copper levels
- Multiple trace elements appear dysregulated in pediatric iron deficiency anemia, suggesting potential for comprehensive nutritional management strategies
Limitations
This is a synthesis of observational studies, which cannot establish causality or determine whether trace element dysregulation contributes to anemia development or results from it. The high heterogeneity across studies limits the strength of conclusions, and the review does not evaluate any intervention or treatment approach.
Abstract
OBJECTIVES: Iron deficiency anemia (IDA) remains the most prevalent form of anemia in children and adolescents globally. In addition to iron (Fe), other trace elements, such as zinc (Zn), copper (Cu), and magnesium (Mg), may influence hematopoiesis, yet the extent of their dysregulation in IDA remains unclear. METHODS: We conducted a systematic review and meta-analysis of observational studies assessing the serum levels of Fe, Zn, Cu, and Mg in pediatric IDA populations. The literature was searched in PubMed, Scopus, Embase, and Web of Science up to January 2025. The data were standardized to consistent units (μmol/L), and pooled weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated. Subgroup, sensitivity, and publication bias analyses were performed. The study protocol was registered online (PROSPERO number: CRD42024578704). RESULTS: Eight articles encompassing twelve datasets and 1105 participants were included. Compared to controls, IDA patients had significantly lower levels of Fe (WMD: -13.07 μmol/L, 95% CI: -16.09 to -10.05), Zn (WMD: -4.33 μmol/L, 95% CI: -5.30 to -3.35), and Mg (WMD: -18.17 μmol/L, 95% CI: -21.00 to -15.33) but higher levels of Cu (WMD: 4.33 μmol/L, 95% CI: 2.21-6.46). High heterogeneity (I² > 95%) was noted for Fe, Zn, and Cu. Subgroup analyses confirmed consistent trends across age, gender, and geography. CONCLUSION: Pediatric IDA is associated with broad alterations in trace elements, highlighting potential roles for Fe, Zn, Cu, and Mg in the pathophysiology of anemia. These findings may inform comprehensive nutritional strategies in managing IDA.