Neuropsychological outcomes at midlife following moderate to severe malnutrition in infancy.

Abstract

Objective To compare neuropsychological profiles of adults who had experienced an episode of moderate to severe protein-energy malnutrition confined to the first year of life with that of a healthy community comparison group. Method We assessed neuropsychological functioning in a cohort of Barbadian adults, all of whom had birth weight >2500g. The previously malnourished group (N=77, Mean age = 38 years, 53% male) had been hospitalized during the first year of life for moderate to severe protein energy malnutrition and subsequently enrolled in a program providing nutrition education, home visits, and subsidized foods to 12 years of age. They also had documented, adequate nutrition throughout childhood and complete catch-up in growth by the end of adolescence. The healthy comparison group (N=59, Mean age = 38 years, 54% male) were recruited as children from the same classrooms and neighborhoods. Results Adjusted for effects of standard of living during childhood and adolescence and current intellectual ability level, there were nutrition group differences on measures of cognitive flexibility and concept formation, as well as initiation, verbal fluency, working memory, processing speed, and visuospatial integration. Behavioral and cognitive regulation were not affected. Conclusions Postnatal malnutrition confined to the first year of life is associated with neurocognitive compromise persisting into mid-life. Early malnutrition may have a specific neuropsychological signature, affecting response initiation to a somewhat greater extent than response inhibition.

Prenatal Malnutrition Leads to Deficits in Attentional Set Shifting and Decreases Metabolic Activity in Prefrontal Subregions that Control Executive Function

“…Despite complete catch-up in growth by the end of adolescence [55], attention deficits persisted up to 40 years of age and were not attributable to continuing malnutrition, low IQ or home environmental factors [6]. In adulthood, the BRIEF and WCST [7] were used to document set shifting in this same cohort and confirmed malnutrition-related deficits on measures of cognitive flexibility and concept formation. The malnutrition-associated deficits in performance on the WCST were of particular interest, not only because of striking parallels to the current findings but because functional neuroimaging studies have confirmed a significant role of the PFC on this task.…”

“…Effects have been documented longitudinally up to 40 years after the childhood malnutrition episode [4,5,6]. In this cohort, parent, teacher and self-report behavior questionnaires of attentional impairments [6], including cognitive rigidity, have been confirmed by impaired performance on tests of attentional set shifting [7], with the Wisconsin Card Sorting Task (WCST). In both human and animal models, executive function has also been shown to be sensitive to other nutritional insults such as iron deficiency [8], which affects the integrity of the prefrontal cortices (PFC) [9], the region reported as most closely associated with executive function in humans [10,11,12] and animals [13,14,15].…”

Nutrition Delivery and Growth Outcomes in Infants With Gastroschisis

“…Although it may be reassuring to see that catch‐up growth does occur, we cannot overlook the potential long‐term negative impact of acute deterioration of nutrition status. Growth velocity in the NICU has been shown to correlate with neurodevelopmental outcomes at 18–22 months corrected age; in addition, even acute episodes of childhood malnutrition can be associated with impaired neurocognitive outcomes that persist into adulthood …”

“…Growth velocity in the NICU has been shown to correlate with neurodevelopmental outcomes at 18-22 months corrected age; in addition, even acute episodes of childhood malnutrition can be associated with impaired neurocognitive outcomes that persist into adulthood. 32,33 Due to the retrospective nature of the study and practice variability within our institution, the reasoning behind clinical management decisions cannot always be ascertained. Other confounding variables may be impacting EN advancement and weaning of PN that we have been unable to capture.…”

The Intergenerational Effects of Early Adversity

“…In addition, approximately 25% of previously malnourished participants had IQs in the range of intellectual disability, and this prevalence rate was nine times higher than in the control group. Behavioral and neuropsychological tests conducted at this time also showed increased prevalence of maladaptive personality traits [49] and cognitive rigidity, slow processing and impaired cognitive control [51]. The long-lasting differences identified between the two study groups underscored outright the lack of brain plasticity and the irreversible nature of the nutritional insult despite comprehensive intervention.…”