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June 2003

Malnutrition at Age 3 Years and Lower Cognitive Ability at Age 11 Years: Independence From Psychosocial Adversity

Author Affiliations

From the School of Nursing, University of California, Los Angeles (Dr Liu); the Department of Psychology (Drs Raine, Venables, and Mednick) and the Social Science Research Institute (Dr Mednick), University of Southern California, Los Angeles; the Department of Psychology, University of York, York, England (Dr Venables); and the Child Health Project, Quatre Bornes, Mauritius (Mr Dalais).

Arch Pediatr Adolesc Med. 2003;157(6):593-600. doi:10.1001/archpedi.157.6.593

Background  Early malnutrition is linked to poor cognition, but long-term effects have not been extensively examined and psychosocial confounds have not always been controlled.

Objective  To test the hypothesis that malnutrition at age 3 years will be associated with poorer cognitive ability at age 11 years independent of psychosocial confounds.

Design  A prospective, longitudinal study of a birth cohort of 1559 children originally assessed at age 3 years for malnutrition (low hemoglobin level, angular stomatitis, kwashiorkor, and sparse, thin hair) and followed up to age 11 years.

Setting and Participants  A community sample of 1559 children (51.4% boys and 48.6% girls) born between September 1, 1969, and August 31, 1970, in 2 towns in the island of Mauritius, with 68.7% Indians and 25.7% Creoles (African origin).

Main Outcome Measures  Verbal and spatial ability measured at ages 3 and 11 years and reading, scholastic ability, and neuropsychologic performance measured at age 11 years.

Results  Malnourished children had poorer cognition at both ages. Deficits were stable across time, applied to all sex and ethnic groups, and remained after controlling for multiple measures of psychosocial adversity. Children with 3 indicators of malnutrition had a 15.3-point deficit in IQ at age 11 years.

Conclusions  Malnutrition at age 3 years is associated with poor cognition at age 11 years independent of psychosocial adversity. Promoting early childhood nutrition could enhance long-term cognitive development and school performance, especially in children with multiple nutritional deficits.