Stunting, Poor Iron Status and Parasite Infection Are Significant Risk Factors for Lower Cognitive Performance in Cambodian School-Aged Children

Abstract

BackgroundNutrition is one of many factors affecting the cognitive development of children. In Cambodia, 55% of children <5 y were anemic and 40% stunted in 2010. Currently, no data exists on the nutritional status of Cambodian school-aged children, or on how malnutrition potentially affects their cognitive development.ObjectiveTo assess the anthropometric and micronutrient status (iron, vitamin A, zinc, iodine) of Cambodian schoolchildren and their associations with cognitive performance.MethodsSchool children aged 6–16 y (n = 2443) from 20 primary schools in Cambodia were recruited. Anthropometry, hemoglobin, serum ferritin, transferrin receptors, retinol-binding protein and zinc concentrations, inflammation status, urinary iodine concentration and parasite infection were measured. Socio-economic data were collected in a sub-group of children (n = 616). Cognitive performance was assessed using Raven’s Colored Progressive Matrices (RCPM) and block design and picture completion, two standardized tests from the Wechsler Intelligence Scale for Children (WISC-III).ResultsThe prevalence of anemia, iron, zinc, iodine and vitamin A deficiency were 15.7%; 51.2%, 92.8%, 17.3% and 0.7% respectively. The prevalence of stunting was 40.0%, including 10.9% of severe stunting. Stunted children scored significantly lower than non-stunted children on all tests. In RCPM test, boys with iron-deficiency anemia had lower scores than boys with normal iron status (−1.46, p<0.05). In picture completion test, children with normal iron status tended to score higher than iron-deficient children with anemia (−0.81; p = 0.067) or without anemia (−0.49; p = 0.064). Parasite infection was associated with an increase in risk of scoring below the median value in block design test (OR = 1.62; p<0.05), and with lower scores in other tests, for girls only (both p<0.05).ConclusionPoor cognitive performance of Cambodian school-children was multifactorial and significantly associated with long-term (stunting) and current nutritional status indicators (iron status), as well as parasite infection. A life-cycle approach with programs to improve nutrition in early life and at school-age could contribute to optimal cognitive performance.

Different Result of Cognitive Impairment Screening in Adolescent Aged 10-12 Years with Normal and Short Stature in Pangandaran District

“…[10] Based on a study by Perignon et al in Cambodia on stunted children aged 6-16 years old, low cognitive function appeared to be significantly linked, compared to normal children. [11] The same result was found in a study conducted by Picauly inKupang and East Sumba, East Nusa Tenggara. [12] Based on those backgrounds, the author is interested to conduct a study to find out thedifference of cognitive score in children aged 10-12 years from normal and stunted groups.…”

Zinc deficiency as risk factor for stunting among children aged 2-5 years

“…Children in developing countries who received zinc supplementation showed decreases in the incidence and duration of acute and chronic diarrhea. (28,29) A low level of food expenditure was not a risk factor for stunting. In the present study the mean income in the group of cases was Rp 2,023,267.00 and in the group of controls Rp 1,938,014.00.…”

“…(26) Children with disorders of the immune system are more susceptible to infectious disease, thus affecting nutritional status. (29) A limitation of this study was the use of a retrospective case control design, with the possibility of recall bias in data collection, particularly on the variables of food intakes. In this case the recall capacity of the respondents will considerably affect the study results.…”

Estado nutricional, parasitismo intestinal y sus factores de riesgo en una población vulnerable del municipio de Iza (Boyacá), Colombia año 2013

“…La carencia de hierro es la causa más común de anemia, pero pueden causarla otras carencias nutricionales (folato, vitamina B12 y vitamina A), la inflamación aguda, crónica, las parasitosis y las enfermedades hereditarias o adquiridas que afectan a la síntesis de hemoglobina y a la producción o la supervivencia de los eritrocitos. La suplementación con hierro es la estrategia más utilizada para disminuir la prevalencia de anemia (51,52).…”