Height gain after two‐years‐of‐age is associated with better cognitive capacity, measured with Raven's coloured matrices at 15‐years‐of‐age in Malawi

Abstract

Stunting is a measure of chronic undernutrition, and it affects approximately 160 million children worldwide. Cognitive development of stunted children is compromised, but evidence about the association between height gain in late childhood and adolescent cognitive capacity is scarce. We aimed to determine the association between height gains at different ages, including late childhood, and cognitive capacity at 15-years-of-age. We conducted a prospective cohort study in a rural African setting in Southern Malawi. The study cohort was enrolled between June 1995 and August 1996. It originally comprised mothers of 813 fetuses, and the number of children born live was 767. These children were followed up until the age of 15 years. The anthropometrics were measured at one and 24-months-of-age and 15-years-of-age, and cognitive capacity of participants was assessed at 15-years-of-age with Raven's Coloured Matrices score, mathematic test score, median reaction time (RT) (milliseconds) and RT lapses. The associations between growth and the outcome measures were assessed with linear regression. Raven's Coloured Matrices score was predicted by height gain between 24 months and 15-years-of-age (coefficient 0.85, P = 0.03) and (coefficient 0.69, P = 0.06), but not by earlier growth, when possible confounders were included in the model. The association weakened when school education was further added in the model (coefficient = 0.69, P = 0,060). In conclusion, in rural Malawi, better growth in late childhood is likely to lead to better cognitive capacity in adolescence, partly through more school education. In light of these results, growth promotion should not only be limited to early childhood.

Impact of early-onset persistent stunting on cognitive development at 5 years of age: Results from a multi-country cohort study

“…A recent meta-analysis of 29 LMICs has established a positive association between linear growth and cognitive development in the first 2 years of life [16], but the meta-analysis could not integrate environmental, educational, and follow-up data to describe the relationship between stunting and cognitive impairment. Previous longitudinal studies have considered the relationship between linear growth and cognitive development [17][18][19][20][21][22][23][24]; however, the MAL-ED study collected an unprecedented range of data on the demographics and exposures of children over time and will be able to explore this question while controlling for potential confounding factors. We investigated whether the timing and persistence of stunting plays a role in long-term cognitive development using data from the MAL-ED study.…”

The association of early linear growth and haemoglobin concentration with later cognitive, motor, and social–emotional development at preschool age in Ghana

“…Together with these studies, our results suggest that during the period from gestation up to age 2 years, exposure to biological and environmental risk factors, as reflected by poor linear growth, is likely to constrain cognitive development with longterm consequences. In contrast, findings from three other studies indicate that linear growth during later childhood as compared with early childhood is more strongly associated with cognitive development (Fink & Rockers, 2014;Gandhi et al, 2011;Teivaanmäki et al, 2017). This suggests that exposure to biological and environmental risks after age 2 years can have long-term consequences for cognition and school achievement in certain settings.…”

“…Nine of these studies found stronger and more consistent associations of early linear growth (before age 1 or 2 years) as compared with linear growth during later childhood with later cognitive and school outcomes Cheung & Ashorn, 2010;Crookston et al, 2013;Glewwe, Jacoby, & King, 2001;Hamadani et al, 2014;Kowalski et al, 2018;Kuklina, Ramakrishnan, Stein, Barnhart, & Martorell, 2006;Li, Digirolamo, Barnhart, Stein, & Martorell, 2004;Pongcharoen et al, 2012). The other three studies found the opposite pattern (Fink & Rockers, 2014;Gandhi et al, 2011;Teivaanmäki et al, 2017). These studies have focused on cognitive scores or educational achievement, with only one assessing motor (Kuklina et al, 2006) and none assessing social-emotional development.…”

The role of nutrition in integrated early child development in the 21st century: contribution from the Maternal and Child Nutrition journal

“…This finding indicates that it is important to address stunting throughout the first 5 years and not just during the first 1000 days of life. Teivaanmäki et al () found in their cohort study conducted in Malawi that improved height gain between two and 15 years of age, but not between birth and two years of age, was independently associated with cognitive development. Consistent with Crookston et al (), this study strongly suggests that promoting linear growth post‐1,000 days is very important for long‐term cognitive development and policy.…”