The Influence of Early Malnutrition on Subsequent Behavioral Development III. Learning Disabilities as a Sequel to Malnutrition

Abstract

SummaryThe academic performance of 129 Barbadian children (77 boys and 52 girls), who were 5-11-yrsld and suffered moderate to severe protein-energy malnutrition in the first year of life, was compared with the performance of matched comparisons, children who had no history of malnutrition. Children with a history of malnutrition were found to have lower performance on eight out of nine academic subject areas, namely, language arts, mathematics, general science, social science, reading, health, religion, and artslcrafts. Socioeconomic factors in the backgrounds of the children were also examined. A model is presented clarifying the interrelationships of malnutrition, socioeconomic status and school performance. Reduced school performance in the previously malnourished children can be largely accounted for by deficits in classroom behavior, and, to a lesser extent by a reduction in I.Q. Current socioeconomic status is not directly involved in altering academic performance whereas the early history of malnutrition and its accompanying conditions at the time of the illness are leading contributors to altered behavioral outcome and school performance. This report is one of a series of studies comparing 129 boys and girls who were 5-1 1-yr-old and had moderate to severe PEM in the first year of life, with 129 matched control children who had no history of malnutrition. The objective of these studies was to provide a comprehensive description of the long-term consequences of malnutrition occumng early in life in a welldocumented population of school-aged children in Barbados. In the earlier papers we described the presence of deficits in I.Q. and classroom behavior in the children with previous malnutrition (4,5). The purpose of this paper is to examine the consequences of early, severe malnutrition in the child's academic performance, as measured by grades achieved in school. We report a reduction in the grades of children with histories of malnutrition and correlate academic performance to I.Q., classroom behavior, and socioeconomic background. This allows us to develop a model of the behavioral effects of early malnutrition as seen when the child is between 5-1 1 yr of age. MATERIALS A N D METHODSSite of study. The current study was conducted at the National Nutrition Centre, Bridgetown, Barbados. This Centre was established in 1967 to follow the development of all children in Barbados diagnosed as being malnourished. Since its inception, the Nutrition Centre at the Queen Elizabeth Hospital has treated and provided follow-up care for approximately 2100 children. Extensive records of diagnosis, treatment, and follow-up to 12 yr of age are available for each child. The availability of these records has allowed us to select a well-documented population of children who had marasmus during the first year of life. Several features of this island population were especially favorable to our investigation. First, health care delivery is good. Almost all children are born in the Queen Elizabeth Hospital or allied facilities,...

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

“…For IQ, the Wechsler Intelligence Scale for Children 28 was administered at T1, 10 and the Wechsler Intelligence Scale for Children-Revised at T2 29 and T3, 12 …”

“…17,20,21 Participants Participants were born between 1967 and 1972. 10,13,22 All children admitted to the Queen Elizabeth Hospital in their first year of life (mean age of admission: 6.9 6 3.1 months) with grade II or III PEM (marasmus or kwashiorkor) based on the Gomez Scale, which classifies degree of malnutrition on the basis of expected weight for age, 23 were eligible if they met the following inclusion criteria: normal birth weight (.2500 g), absence of pre-or postnatal complications, Apgar scores $8, no encephalopathic events during childhood, and no malnutrition after the first year of life. These children were subsequently enrolled in a government-supported intervention program that provided health care, growth monitoring, nutrition education, subsidized foods, and regular home visits and followed to age 12 years.…”

“…17 These children were matched on the basis of gender, age, and handedness with a healthy comparison group recruited from the same classrooms. Despite their nutritional rehabilitation and complete catchup in physical growth, 13 the previously malnourished children displayed persisting deficits in attention, IQ, 12 and academic achievement 18 through adolescence, as well as an increased level of conduct problems and depressive symptoms. 15,19 The primary aim of the current study was to compare these 2 groups at midlife on basic metrics of social outcome, including occupation, educational attainment, standard of living, and household income.…”

“…We also investigated the extent to which childhood cognitive impairment accounted for any group differences. We hypothesized that malnutrition-related effects on socioeconomic outcomes would be mediated by cognitive impairment, which was more prevalent in the previously malnourished group 10,12 . Finally, we assessed household income across the life span, hypothesizing that the trajectory of change in household income would differ in the 2 nutrition groups.…”

“…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.…”