Associations of Learning Disability and Attention Deficit/Hyperactivity Disorder with High Serum Ferritin Concentrations among Children and Adolescents

Xueya Xiao; Buyun Liu; Yuhong Xiong; Zelong Wangchen; Wei Bao; Shuang Rong; Meiyuan Chen; Yang Du; Linda G. Snetselaar; Guifeng Xu

doi:10.1016/j.jand.2026.156328

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Associations of Learning Disability and Attention Deficit/Hyperactivity Disorder with High Serum Ferritin Concentrations among Children and Adolescents

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Associations of Learning Disability and Attention Deficit/Hyperactivity Disorder with High Serum Ferritin Concentrations among Children and Adolescents

Xueya Xiao, Buyun Liu, Yuhong Xiong, Zelong Wangchen, Wei Bao, Shuang Rong, Meiyuan Chen, Yang Du, Linda G. Snetselaar and Guifeng Xu

Journal of the Academy of Nutrition and Dietetics, 156328

03/12/2026

DOI: 10.1016/j.jand.2026.156328

PMID: 41831685

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Abstract

Background: Associations of iron deficit with learning disability (LD) and attention deficit/hyperactivity disorder (ADHD) have been fully investigated. However, the association of high body iron level with LD and ADHD in children and adolescents has seldom been investigated. Objective: This study aimed to examine the association of serum ferritin concentrations, a biomarker of body iron status, with LD and ADHD in a large population-based cross-sectional study. Design: This study utilized a cross-sectional study design. Participants/setting: This study used data from the 1999 to 2002 National Health and Nutrition Examination Survey, which is a nationwide, population-based, cross-sectional survey in the United States. Participants with missing data on serum ferritin concentration, or LD and ADHD diagnosis, as well as those with anemia were removed, and data of 4520 children and adolescents aged 4-15 years were included in the final analyses. Main outcome measures: Outcome variables were LD and ADHD diagnoses, which were reported by the children's parents. Statistical analyses performed: The characteristics of the participants according to quartile of serum ferritin concentrations were calculated. Analysis of variance and Rao-Scott chi-square tests were used to compare differences in continuous variables and categorical variables, respectively. Multivariable logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of LD and ADHD according to quartiles of serum ferritin concentration. Several covariates were adjusted for in the models, including age, sex, race/ethnicity, family income to poverty ratio, cotinine concentration (tobacco exposure marker), total energy intake, Body Mass Index, and serum C-reactive protein concentration. Results: Higher serum ferritin concentrations were associated with a higher odds of LD in U.S. children and adolescents. The adjusted odds ratio (ORs) (95% confidence interval [CI]) for LD across increasing quartiles of serum ferritin levels was 1.00 (reference), 1.61 (1.11-2.32), 1.47 (0.93-2.32), and 1.89 (1.13-3.13), respectively (P for trend < 0.05). Each 10 ng/ml increase of serum ferritin level was associated with a 13% higher odds of LD (adjusted OR 1.13, 95% CI 1.01-1.24). Additionally, no significant association between serum ferritin levels and ADHD prevalence was found, and the adjusted ORs (95% CI) for ADHD across increasing quartiles of serum ferritin levels were 1.00 (reference), 1.16 (0.66-2.01), 1.04 (0.64-1.70), and 1.63 (0.95-2.82), respectively (P for trend was 0.08). Stratified analyses found that significant associations between serum ferritin level and LD prevalence were only found in boys with the highest quartile of serum ferritin (adjusted OR= 2.21, 95% CI 1.05-4.67), and in children and adolescents whose race/ethnicity was non-Hispanic White with serum ferritin levels in quartile 2 (adjusted OR=1.73, 95% CI 1.05-2.85) and quartile 4 (adjusted OR=2.29, 95% CI 1.08-4.88). Additionally, the association between serum ferritin concentration and prevalence of ADHD was only significant for the highest quartile in boys , with an adjusted OR of 2.06 (95% CI 1.01-4.20). Conclusion: In a nationally representative, multiracial/ethnic population of the U.S. children and adolescents, high serum ferritin levels were found to be significantly associated with a higher odds of LD, and when the serum ferritin level was equal to or higher than 43 ng/ml, increased odds of LD and ADHD were both observed in boys.

Epidemiology

Attention Deficit/Hyperactivity Disorder

Increased risk

Learning Disability

Serum Ferritin

Details

Title: Subtitle: Associations of Learning Disability and Attention Deficit/Hyperactivity Disorder with High Serum Ferritin Concentrations among Children and Adolescents
Creators: Xueya Xiao - University of Science and Technology of China
Buyun Liu - University of Science and Technology of China
Yuhong Xiong - University of Science and Technology of China
Zelong Wangchen - Bengbu Medical College
Wei Bao - University of Science and Technology of China
Shuang Rong - University of Science and Technology of China
Meiyuan Chen - University of Science and Technology of China
Yang Du - University of Science and Technology of China
Linda G. Snetselaar - University of Iowa
Guifeng Xu - University of Science and Technology of China
Resource Type: Journal article
Publication Details: Journal of the Academy of Nutrition and Dietetics, 156328
DOI: 10.1016/j.jand.2026.156328
PMID: 41831685
NLM abbreviation: J Acad Nutr Diet
ISSN: 2212-2672
Publisher: Elsevier Inc
Language: English
Electronic publication date: 03/12/2026
Academic Unit: Epidemiology; Fraternal Order of Eagles Diabetes Research Center; Internal Medicine
Record Identifier: 9985147208002771

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