Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults

doi:10.1016/S0140-6736(08)60205-6

The Lancet

Volume 371, Issue 9610, 2–8 February 2008, Pages 411-416

https://doi.org/10.1016/S0140-6736(08)60205-6 Get rights and content

Summary

Background

Substantial, but indirect, evidence suggests that improving nutrition in early childhood in developing countries is a long-term economic investment. We investigated the direct effect of a nutrition intervention in early childhood on adult economic productivity.

Methods

We obtained economic data from 1424 Guatemalan individuals (aged 25–42 years) between 2002 and 2004. They accounted for 60% of the 2392 children (aged 0–7 years) who had been enrolled in a nutrition intervention study during 1969–77. In this initial study, two villages were randomly assigned a nutritious supplement (atole) for all children and two villages a less nutritious one (fresco). We estimated annual income, hours worked, and average hourly wages from all economic activities. We used linear regression models, adjusting for potentially confounding factors, to assess the relation between economic variables and exposure to atole or fresco at specific ages between birth and 7 years.

Findings

Exposure to atole before, but not after, age 3 years was associated with higher hourly wages, but only for men. For exposure to atole from 0 to 2 years, the increase was US$0·67 per hour (95% CI 0·16–1·17), which meant a 46% increase in average wages. There was a non-significant tendency for hours worked to be reduced and for annual incomes to be greater for those exposed to atole from 0 to 2 years.

Interpretation

Improving nutrition in early childhood led to substantial increases in wage rates for men, which suggests that investments in early childhood nutrition can be long-term drivers of economic growth.

Introduction

The World Bank's 2006 report Repositioning Nutrition as Central to Development: a Strategy for Large Scale Action argued for urgent and effective national programmes to prevent child malnutrition by targeting pregnancy and the first 2 years of life. This period of a child's life is thought to be the time when nutrition has the greatest effect on child health, growth, and development.¹ One argument for increasing investment in such programmes is that they drive long-term economic growth by leading to healthier and more productive adults. Several reports support this “productivity” hypothesis. In a review of five cohort studies, including the Guatemalan one in this report, Victora and colleagues² concluded there was evidence to link small size at birth and childhood stunting with short adult stature, reduced lean body mass, less schooling, diminished intellectual functioning, and reduced earnings.

About 200 million children in developing countries do not reach their developmental potential and are likely to do poorly in school;³ documented risk factors for loss of potential include stunting, iodine deficiency, iron-deficiency anaemia, and inadequate cognitive stimulation.⁴ Measures of human capital, such as adult stature and schooling, have been shown to be positively related to income and wealth.5, 6 Results from Guatemala show that improved nutrition in early childhood leads to better adult human capital including larger body size,⁷ improved physical work capacity,⁸ more schooling, and better cognitive skills.9, 10

We are unaware of any study that has assessed the direct effects of nutrition interventions in early childhood on incomes in adulthood. Thus, we aimed to address this gap by analysis of data from Guatemala to estimate the effect of exposure to nutritional supplements in early childhood on incomes more than 25 years later.

Section snippets

Study participants and procedures

Between 1969 and 1977, the Institute of Nutrition of Central America and Panama (INCAP) undertook a study of the effect of improved protein intakes on physical and mental development of children from four villages of mixed Spanish-Amerindian ethnic origin in Guatemala.¹¹ 300 rural communities of appropriate size were screened to identify villages of appropriate compactness, ethnicity and language, diet, access to health-care facilities, demographic characteristics, nutritional status, and

Results

In table 1, we show selected individual and family characteristics and measures of income-generating capacity for men according to the exposure of nutritional supplementation at 0–24 months of age. Parents from fresco-supplemented villages had more grades of schooling than those from atole villages; some of these differences were significant, underscoring the importance of controlling for such factors. The mean annual earned income and wage rates of men exposed to either supplement during 0–24

Discussion

In our study, exposure to the atole supplement during 0–36 months of age, but not during 36–72 months, significantly increased hourly wage rates in men, though not in women. For atole supplementation during 0–24 months, the corresponding increase in the hourly wage rate was US$0·67 per h, representing an increase of 46% over average wages in the sample. However, atole supplementation in early childhood did not consistently affect the number of hours men worked, although these men tended to work

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ArticlesEffect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults

Summary

Background

Methods

Findings

Interpretation

Introduction

Section snippets

Study participants and procedures

Results

Discussion

Lancet

Lancet

J Health Econ

Repositioning nutrition as central to development: a strategy for large-scale action

Maternal and child undernutrition: consequences for adult health and human capital

Lancet

Wages, schooling and background: investments in men and women in urban Brazil

Returns to investment in education: a further update

Edu Econ

Nutritional supplementation during the preschool years influences body size and composition of Guatemalan adolescents

J Nutr

Nutritional supplementation during the preschool years and physical work capacity in adolescent and young adult Guatemalans

J Nutr

Effects of early childhood supplementation on the educational achievement of women

Pediatrics

The impact of nutrition during early childhood on education among Guatemalan adults. Middlebury College Economics Discussion paper no 06–14

History and design of the INCAP longitudinal study (1969–77) and its follow up (1988–89)

J Nutr

Patterns and predictors of participation and consumption of supplement in an intervention study in rural Guatemala

Food Nutr Bull

Articles
Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults