Infant Malnutrition Is Associated with Persisting Attention Deficits in Middle Adulthood

Abstract

Infantile malnutrition is known to be associated with cognitive and behavioral impairment during childhood and adolescence. Data pertaining to longer-term effects on behavioral outcomes in adulthood are limited. In this study, we report associations between infantile malnutrition and attention problems in adults at midlife. Attention problems were assessed by the Conners Adult ADHD Rating Scales (CAARS) and the Conners Continuous Performance Test (CPT) in 145 Barbadian adults (aged 37-43 y) who had been followed longitudinally since childhood. Previously malnourished participants (n = 80) had experienced moderate to severe protein-energy malnutrition in the first year of life and were successfully rehabilitated thereafter. They were compared with healthy adults (n = 65) who were former classmates of the index cases and who had been matched for age, sex, and handedness in childhood. Multiple regression analyses showed persisting effects of childhood malnutrition on both the CAARS and the CPT, independent of effects of household standard of living assessed in childhood. The malnutrition effect on the CAARS ratings was independent of IQ, whereas this effect was attenuated for the CPT after adjustment for IQ. Teacher-reported attention problems in childhood predicted attention problems in adulthood, indicating continuity over the life span. Infantile malnutrition may have long-term effects on attentional processes nearly 40 y after the episode, even with excellent long-term nutritional rehabilitation and independent of socioeconomic conditions in childhood and adolescence. This finding has major public health implications for populations exposed to early childhood malnutrition.

Socioeconomic Outcomes in Adults Malnourished in the First Year of Life: A 40-Year Study

“…The adult follow-up also included measures of mental health, cognitive, and health outcomes that will be addressed elsewhere. 9 The BNS was explicitly designed to evaluate the impacts of a well-documented period of malnutrition during the first year of life. [10][11][12][13][14][15][16] Methodologic assets include the casecontrol design, detailed ecological data obtained throughout childhood and adolescence, and documentation of adequate nutrition after the malnutrition episode and of birth history.…”

Long-term nutritional and cognitive outcomes after liver transplantation in childhood

“…Difficulties with school and academic attainment during adolescence, and attention deficits and hyperactivity in adults have been reported in those who were malnourished in early childhood 97,131 . Other reported problems include deficits in analytic and reasoning skills, language, visual-spatial functions, working memory and even IQ; with the severity and duration of malnutrition being significant although deficits have been reported even in those with mild insults over an extended period 55 .…”

“…Malnutrition in childhood is recognised to affect long-term cognition despite recovery from the initial insult 55,97 . These long-term deficits may be subtle depending on the severity and duration of malnutrition, and gross testing using IQ, school grades, or need for special education assistance may fail to detect these problems 55,97 .…”

“…These long-term deficits may be subtle depending on the severity and duration of malnutrition, and gross testing using IQ, school grades, or need for special education assistance may fail to detect these problems 55,97 . Malnutrition is common in children with end-stage liver disease although resolution is expected once they have undergone successful transplantation.…”

Understanding stunting in Peruvian children: A multilevel analysis.

“…Even if children experience an excellent nutritional rehabilitation process, the child malnutrition observed before 60 months of life is associated with a persistent attention deficit in adulthood regardless o f socioeconomic conditions (Galler et al, 2012).…”