Essential Nutrients-Cognition:  Research Article

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Malnourrished Children: D
evelopment and Intellectual Performance

This table comes from Janina R. Galler (editor).  Nutrition and Behavior.  1984. Plenum Press New York. 
This book is out of print.

Table II A. Studies of Development and Intellectual Performance in Children Recently Recovered from Malnutrition

Reference Test Results Type of malnutrition Age studied Study design
Ashem and Janes (1978)  McCarthy Scale of Children's Abilities Lowest scores on abstract reasoning, logical and relational thinking in malnourished groups, intermediate scores in poor but well-nourished group, and highest in healthy group. Unspecified 24-72  Mo


73 Poor children (45 from rural areas and 28 urban) were subdivided by height/weight per age and compared with 45 wealthier children. Malnourished children were <10% of British standards.
Monckeberg (1968) Gesell Developmental Schedule

Stanford-Binet IQ Test

Lower scores, especially in
language development.

Lower scores.

(3-11 Mo) 
(protein-energy malnutrition)
36-72 Mo Chile
14 Children were assessed.
Stoch and Smythe (1963) Gesell Developmental Schedule
and Merrill-Palmer IQ
Test (depending on
age of child)
Lower scores in index group, which could not be fully attributed to lack of nursery experience. Socioeconomic factors were worse and mothers more negligent in index group. Marasmus (mean age of 9 Mo 
or 16 Mo)
Studied up to 72 Mo South Africa
21 Cape colored children (II girls and 10 boys) who were below the 2.5 percentile for weight were compared with 21 children at or above the 10th percentile (matched by sex and age). Controls were in a nursery creche. No children were hospitalized.
Brockman and Ricciuti (1971) Categorization behavior Lower scores in malnourished children (6-8 Mo delay relative to U.S. norms) even after 12 weeks of nutritional rehabilitation.  Marasmus 
(10-24 Mo)
12-44 Mo Peru
20 Children (subdivided by mean age of hospitalization: 9 Mo or 16 Mo) were compared with 19 age- and sex-matched controls and 7 stunted controls.
McLaren et al. (1973, 1975) Stanford-Binet IQ Test Lower scores in all three malnourished groups compared with siblings and controls. Two hospitalized groups had lower scores than outpatient group. No long-lasting effect of stimulation. No sex differences. Marasmus 
(2-16 Mo)
36-60 Mo Lebanon
29 Hospitalized children (14 not stimulated in hospital and 15 stimulated) and 15 moderately malnourished outpatients were
compared with 14, 15, and 15 siblings, respectively, and also with well-nourished controls.
Botha-Antoun et al. (1968) Stanford-Binet IQ Test (modified foi Lebanon) Lower scores for both verbal and performance items in index group at time of study. Groups, however, were similar before the onset of malnutrition with respect to weight and general functioning. Maternal age and IQ similar in both groups. Mixed PEM 
(up to 18 Mo)
54 Mo Lebanon
22 Children were compared with 22 well-nourished children (matched by age, sex, birth weight, and ethnic group). Sample derived from longitudinal study of 316 children. All children were healthy at birth, but most index children then fell below the 3rd percentile of the Stuart scale, whereas controls did not fall below the 25th percentile.
Chase and Martin (1970) Yale Revised Developmental Examination Lower scores in index children, especially in language. Children hospitalized at 4 Mo or older did worse than younger group. Mixed PEM 
(2-10 Mo)
23-82 Mo United States
19 Children were compared with 19 well-nourished children.
DeLicardie and Cravioto (1973) WPPSI IQ Test 
Behavioral styles of
children during
WPPSI testing.
Lower scores in index children. Behavioral patterns of index children and controls matched for lower IQ were similar, showing more passivity than controls not matched for IQ. Mixed PEM 
(4-38 Mo)
60 Mo See also Cravioto and DeLicardie (1972) in Tables IB or IC. 14 Children (of 22) who developed malnutrition over the course of a 5-year prospective study of 334 children were compared with well-nourished controls (matched by IQ at 60 Mo or by birth weight and Gesell score in infancy).
Barrera-Moncada (1963) Gesell Developmental Schedule Lower scores in children compared to expected values for this age group. Language slower to recover than motor skills.  Mixed PEM (16-72 Mo) 40–96 Mo Venezuela
60 Children were assessed after hospitalization and 2 years later.
Cravioto and Robles (1965) Gesell Developmental Schedule Lower scores, especially in language development. Children hospitalized prior to 6 Mo of age were slowest to recover.  Mixed PEM 
(3-42 Mo)
15–54 Mo See Table IB. Same children studied 1 year after discharge.
Grantham-McGregor et al. (1982) Griffiths Scale Lower scores in malnourished children continued. Weight/height index reaches that of hospitalized controls. Mixed PEM (16-24 Mo) 42–60 Mo See Table IB. Same children studied 3 years after discharge.
Lloyd-Still et al. (1972, 1974) Merrill–Palmer IQ Test Lower scores in index children (40 vs. 70% for siblings). Undernutrition secondary to cystic fibrosis, ileal atresia, or severe diarrhea (up to 6 Mo) 12–72 Mo United States
26 Children were compared with 29 siblings.

Ashem, B., and Janes, M. D., 1978, Deleterious effects of chronic undernutrition on cognitive abilities, J. Child Psycho/. Psychiat. 19:23-3I.

Barrera-Moncada, G., 1963, Estudios sobre Alteraciones del Crecimiento y del Desarrollo Psicologico del Sindrome Pluricarencial (Kwashiorkor), Editora Grafas, Caracas, Venezuela.

Botha-Antoun, E. Babayan, S., and Harfouche, J. K., 1968, Intellectual development related to nutritional status, J. Trop. Pediatr. 14:112-115.

Brockman, L., and Ricciuti, H., 1971, Severe protein–calorie malnutrition and cognitive development in infancy and early childhood, Der. Psycho/. 4:312-319.

Chase, H. P., and Martin, H. P., 1970, Undernutrition and child development, N. Engl. J. Med 282:933-939.

Cravioto, J., and Robles, B., 1965, Evolution of adaptive and motor behavior during rehabilitation from kwashiorkor, Am. J. Orthopsychiatry 35:449-464.

DeLicardie, E. R., and Cravioto, J., 1973, Behavioral responsiveness of survivors of clinically severe malnutrition to cognitive demands, in: Early Malnutrition and Mental Development (J. Cravioto, L. Hambreau, and B. Vahlquist, eds.) pp. 134-154, Almquist and Wiksell, Uppsala, Sweden.

Grantham-McGregor, S. M., Powell, C., Stewart, M. E., and Schofield, W. N., 1982, Longitudinal study of growth and development of young Jamaican children recovering from severe mal-nutrition, Dev. Med. Child Netted/. 24:321-331.

Lloyd-Still, b. D., Wolff, P. H., Hurwitz, I., and Shwachman, H., 1974, Studies on intellectual development after severe malnutrition in infancy in cystic fibrosis and other intestinal lesions, in: Proc. 9th Int. Congr. Nutr., Mexico, 1972, Vol. 2, pp. 357-364, S. Karger, Basel.

Lloyd-Still, J. D., Hurwitz, I., Wolff, P. H., and Shwachman, H., 1974, Intellectual development after severe malnutrition in infancy, Pediatrics 43(3):306-311.

McLaren, D. S., Yaktin, U. S., Kanawati, A. A., Sabbagh, S., and Kadi, Z., 1973, The subsequent mental and physical development of rehabilitated marasmic infants, J. Ment. Defic. Res. 17:273-281.

McLaren, D. S., Yaktin, U. S., Kanawati, A. A., Sabbagh, S., and Kadi, Z., 1975, The relationship of severe marasmic protein-energy malnutrition and rehabilitation in infancy to subsequent mental development, in: Protein-Calorie Malnutrition (R. E. Olson, ed.), pp. 107-112, Academic Press, New York.

Monckeberg, F., 1968, Effect of early marasmic malnutrition on subsequent physical and psycho-logical development, in: Malnutrition, Learning and Behavior (N. Scrimshaw and J. Gordon, eds.), pp. 269-277, MIT Press, Cambridge, Massachusetts.

Stoch, M. B., and Smythe, P. M., 1963, Does undernutrition during infancy inhibit brain growth and subsequent intellectual development?, Arch. Dis. Child. 38:546-552.