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

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Infant malnutrition is known to be associated with behavioral and cognitive impairment throughout childhood, adolescence, and young adulthood. However, controlled studies addressing adult outcomes in middle life, including earning potential, educational attainment, and standard of living, are limited. WHAT THIS STUDY ADDS:A discrete episode of moderate to severe malnutrition in infancy, with good rehabilitation thereafter, is associated with lower adult social status and a widening income gap relative to healthy controls, partially attributable to cognitive impairment in the previously malnourished. abstract OBJECTIVE: Lifelong functional, adaptive, and economic outcomes of moderate to severe infantile malnutrition are not well known. We assessed social status and income at midlife in a cohort of Barbadian adults, hospitalized for protein-energy malnutrition (PEM) during the first year of life, with good nutrition and health thereafter, in the context of a 40-year longitudinal case-control study. We also examined to what extent childhood IQ mediated any group differences.METHODS: Educational achievement, occupational status, and standard of living were assessed by the Hollingshead scales and a sitespecific Ecology Questionnaire in Barbadian adults (aged 37-43 years) with a history of malnutrition (n = 80) and a matched healthy control group (n = 63), classmates of the index cases. Malnutrition effects, adjusted for childhood standard of living, were estimated by longitudinal multiple regression analyses, with and without childhood IQ, in the models.RESULTS: PEM predicted poorer socioeconomic outcomes with medium to large effect sizes (0.50-0.94), but childhood IQ substantially attenuated the magnitude of these effects (adjusted effect sizes: 0.17-0.34). The gap in weekly household income between the PEM and control groups increased substantially over the life span (P , .001).CONCLUSIONS: Moderate to severe PEM during the first year of life with adequate nutrition and health care thereafter is associated with significant depression of socioeconomic outcomes in adulthood, mediated in part by cognitive compromise in affected individuals. This finding underscores the potential long-term economic burden of infant malnutrition, which is of major concern given the continued high prevalence of malnutrition worldwide. Pediatrics 2012;130:e1-e7 AUTHORS:

Relationship between infant malnutrition and childhood maltreatment in a Barbados lifespan cohort

“…These problems can involve conduct (Galler et al, 2012) and attention (Galler & Ramsey, 1989) problems, as well as depressive symptoms (Galler et al, 2010). The child’s psychological and/or behavioral difficulties may then influence the parent-child relationship (Larsson et al, 2008).…”

“…The subset of the original cohort in the present study included 77 malnourished and 62 controls, born between 1967 and 1972. We compared this subset with the non-participants and found no differences in age, gender, childhood socioeconomic status, or IQ (Galler et al, 2012). All study participants provided written informed consent and were compensated for their time and travel expenses (IRB Protocol 2015P000329/MGH).…”

Neurocriminology: implications for the punishment, prediction and prevention of criminal behaviour

“…Malnutrition in infancy is associated with conduct problems in adolescence, a relationship that is partly mediated by low IQ 28 . Similarly, children with signs of malnutrition at age 3 have higher rates of aggressive and antisocial behavior at ages 8, 11, and 17 years 29 over and above any contribution from social risk factors.…”

Neurodevelopment: The Impact of Nutrition and Inflammation During Adolescence in Low-Resource Settings

“…29 Intervention programs in adolescents that address specific nutrient deficiencies appear to have better results when adolescents are enrolled for at least 3 months; attention deficits and learning disabilities appear to benefit the most from this intervention. 30 In summary, the brain, behavioral, and cognitive sequelae of childhood and adolescent malnutrition may significantly limit the educational and occupational opportunities of impacted individuals, 31 and the potential cost to society is great. 32 Therefore, there is an urgent need to identify research gaps related to our understanding of the relationships between early childhood malnutrition and neurocognitive, behavioral, and social development of adolescents and to develop the basis for designing and implementing effective interventions to mitigate these outcomes ( Table 1).…”