Background Chronic malnutrition is a major global health challenge, particularly in low- and middle-income countries (LMICs). Malnutrition, in particularly stunting in early childhood, is associated with developmental delay, including cognitive deficits and poor academic performance, often leading to reduced work capacity in adulthood. Few studies have examined the long-term influence of chronic malnutrition in early life on subsequent cognitive outcome and how recovering from early stunting can benefit cognitive development in a cross-national context.
Methods Analysing data on 8062 children in Ethiopia (n=1,999), India (2,011), Peru (n=2,052) and Vietnam (n=2,000) from the Young Lives Study, a cross-national cohort study on child poverty and wellbeing in the developing world, we studied younger cohort, enrolled in 2002 at ages 6–17.9 months (round 1), followed in 2006 at 5 years old (round 2) and in 2009 at 8 years old (round 3) to explore whether duration of chronic malnutrition in early life matters for cognitive outcome and whether recovery from early stunting benefits for cognitive development.
The duration of stunting was defined as having a HAZ Height-for-Age Z scores (HAZ) < −2 based on WHO standards. Chronic malnutrition was determined as the number of stunting for three rounds, ranging from 0 to 3. Recovery from stunting was defined as having a HAZ >-2 in subsequent rounds after baseline. Cognitive outcome was assessed at age 8 using the Peabody Picture Vocabulary Test (PPVT) to evaluate vocabulary skills and listening comprehension.
Results Longer term of being stunted was associated with lower cognitive scores at age 8 for both girls (p<0.05) and boys (p<0.01). We found catch-up growth from early stunting significantly increases cognitive outcomes of girls who were stunted at baseline (coef=7.91, p<0.01). No significant associations were found for boys. Chronic malnutrition during childhood can be detrimental for children’s cognitive development in later life. Recovery from early stunting is possible, in particular for girls and this can lead to improvement in cognitive development.
Conclusion Policy makers and program planners should consider redoubling efforts to prevent stunting and promote catch-up growth over the first few years of life, especially for girls, as a way of improving children’s physical and intellectual development. Given the important role girls and women play in contributing to national and global economies, improving nutrition in early childhood of girls in developing countries is a long-term economic investment and driver of economic growth.
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