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Malnourished Children:  Long-Term Effects of Early Malnutrition on 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 IIIB. Studies of the Long-Term Effects of Early Malnutrition on Intellectual Performance

Reference Test Results Type of malnutrition Age studied Study design
Winick et al. (1975), Lien et al. (1977 IQ (one of four group tests) Lower scores in severely malnourished children than in well-nourished children, although they scored in the average range for U.S. school-children. Unspecified School age United States
Korean girls adopted by U.S. families at 2 yr or at 2-5 yr (Study I and II, respectively) and subdivided into groups, based on growth deficit: severely undernourished (37 and 31 children), moderately nourished (38 and 62), and well-nourished (37 and 39) children.
Champakam et at. (1968) IQ (test designed for Indian children in this study) Markedly lower scores in index children, especially in younger ages. Kwashiorkor (18-26 mo) 8-11 Yr India
19 Malnourished children compared to 50 well-nourished controls (matched by religion, caste, family size, socioeconomic level).
Evans et al. (1971), Hansen et al. (1971) NSAIIS No difference between index children and siblings. Kwashiorkor (10-48 mo) 12 Yr South Africa
40 Children compared with 40 like-sexed siblings (within 2 years of age of index children).
Birch et al. (1971) WISC Lower scores (13 pts) in index children. Reduction greater for boys—IQ scores of control boys higher than of control girls, butsame for index boys and girls. Verbal and performance IQs equally depressed. Kwashiorkor (6-30 mo) 5-13 Yr Mexico
37 Children compared with 37 siblings (within 3 years of age of index children).
Pereira et al. (1979) Seguin Form Board and Passalong tests Lower scores in index children, who took longer to complete the task—similar at all ages for Seguin test, but most impaired in younger children for Passalong test. Not related to age at hospitalization. Kwashiorkor and marasmic-kwashiorkor (12-48 mo 6-12 Yr India
79 Children compared with 142 controls from nearby villages with comparable socioeconomic features.
Stoch and Smythe (1967, 1976) Individual Scale of National Bureau of Education Research IQ Test
NSAIIS (after 1967)
Lower scores in previously malnourished children at all ages. Results cannot be attributed to nutritional factors because of different social backgrounds. Reduction greater for boys—control boys had higher IQs than control girls, but similar for index boys and girls. Greatest reduction in verbal scores. Signs of MBD—impaired visual-motor perception. Marasmus (10-24 mo Tested three times at 5-yr intervals through 18 yr South Africa
20 Children (11 boys and 9 girls) compared with well-nourished controls from more-advantaged homes (who also attended nursery schools). At 10-24 mo, index children were below 2.5 percentile for weight of Cape colored children and controls were at or above 10th percentile. See also Stoche and Smythe (1963) in Table IIA.
Caller et al. (1983a WISC
(modified for Barbados)
Lower scores in previously malnourished children at all ages. Reduction greater for girls—control girls had higher IQs than control boys, but values similar for index boys and girls. Small differences in environmental features between index and control groups did not contribute to these differences. Marasmus (3-8 mo) 5-11 Yr Barbados
129 Children (77 boys and 52 girls) compared with 129 well-nourished classmates or neighborhood children (matched by age, sex, and handedness).
Liang et al. (1967)  WISC (modified for Indonesia) Lower scores in index children who also had vitamin A deficiency as compared with controls. Mixed PEM (up to 72 mo) 6-12 Yr Indonesia
31 Children (12 of whom also had signs of vitamin A deficiency) compared with 33 "healthy" controls (who were also reported to be small for their age).
Fisher et al. (1972) Koh's Blocks and
Matrix Design Test (both developed in Zambia)
Lower scores in
malnourished group. Boys performed better than girls.
Mixed PEM
(44 Kwashiorkor cases, 12 marasmus, 13 masmic-kwashiorkor and 3 unclassified at an average of 19 mo)
10-17 Yr Zambia
72 Children compared to 143 well-nourished controls (neighborhood children matched by family income and size). Both groups more prosperous than
those in South African studies.
Hoorweg and Stanfield (1972, 1976) WISC (Vocabulary
and Math) Porteus Mazes Knox Cubes
Raven Matrices Memory-for-Design
WAIS Block Design
No differences.

Lower scores in index children all attributed to "chronic PEM" and not "acute PEM." Results not associated with age at hospitalization.

Mixed PEM (8-27 mo) 11-17 Yr Uganda
60 Children (subdivided into three groups based on age at hospitalization)
compared with 20 well-nourished controls.
Hertzig et al. (1972), Richardson et at. (1978) WISC Lower scores in index than in siblings on verbal and full scale IQs; sibs had lower scores than classmates on performance IQ. Results also associated with amount of intellectual stimulation provided in the home. Results not associated with age at hospitalization. Mixed PEM (up to 24 mo) 6-10 Yr Jamaica
74 Boys compared with 38 male siblings and 71 male classmates.
Berglund and Rabo (1973) IQ test (administered to Swedish men at time of induction into military) No differences between groups. No unaffected control group studied. Undernutrition secondary to pyloric stenosis (treated medically only) About 18 Yr Sweden
180 Men (grouped into four groups on the basis of severity and duration of the undernutrition) selected from medical records between 1923 and 1943.
Lloyd-Still et al.
(1972, 1974)
Beardslee et al. (1982)

WAIS (depending
on age at testing)

No differences between groups [although index children had lower scores at 5 yr (see Section 2.3)] Undernutrition secondary to cystic fibrosis, ileal atresia, or severe diarrhea (up to 6 mo) 5-22 Yr United States
26 Children were compared with 29 siblings. See also Lloyd-Still et al. (1972, 1974) in Table IIA.
Ellis and Hill (1975 WISC Lower scores on Digit Span subtest in index children, but otherwise no differences. At time of study, 9 of the control children were at or below the 3rd percentile of growth and were also
Undernutrition secondary to cystic fibrosis (up to 12 mo) 7-10 Yr Canada
22 Children (13 boys and 9 girls) were compared with 16 "well-nourished" children, also diagnosed as having cystic fibrosis.
Klein et al. (1975) Raven Matrices Peabody
WISC Coding WISC Vocabulary
No differences.

Lower scores in severely malnourished group, suggesting deficits in attention and short-term memory.

Undernutrition secondary to pyloric stenosis (up to 2 mo) 5-14 Yr United States
50 Children (44 boys and 6 girls who were further subdivided by severity of undernutrition—13 had severe PEM) were compared with 44 siblings and 50 well-nourished controls.
(NSAIIS) New South African Individual Intelligence Scale; (WISC) Wechsler Intelligence Scale for Children; (WAIS) Wechsler Adult Intelligence Scale.

Beardslee, W. R., Wolff, A. H., Hurwitz, I., Parikh, B., and Shwashman, 1982, The effects of infantile malnutrition on behavioral development: A follow-up study. Am. J. Clin. Nutr. 35:1437-1441.

Berglund, G., and Rabo, E., 1973, A long-term follow-up investigation of patients with hypertrophic pyloric stenosis with special reference to the physical and mental development, Acta Paediatr. Scand. 62:125-129.

Birch, H. G., Pineiro, C., Alcalde, E., Toca, T., and Cravioto, J., 1971, Relation of kashiorkor in early childhood and intelligence at school age, Pediatr. Res. 5:579-585.

Caller, J. R., Ramsey, F., Solimano, G., Lowell, W. E., and Mason, E., 1983a, The influence of early malnutrition on subsequent behavioral development. I. Degree of impairment in intellectual performance, J. Child Psychiatry 22:8-15.

Champakam, S., Srikantia, S., and Gopalan, C., 1968, Kwashiorkor and mental development, Am. J. Clin. Nut.-. 21:844-852.

Ellis, C. E., and Hill, D. E., 1975, Growth, intelligence and school performance in children with cystic fibrosis who have had an episode of malnutrition during infancy, J. Pediatr. 87(4): 565-568.

Evans, D. E., Moodie, A. D., and Hansen, J. D. L., 1971, Kwashiorkor and intellectual development, S. Afr. Med. J. 45:1414-1426.

Fisher, M. M., Killeross, M. C., Simonsson, M., and Elgie, K. A., 1972, Malnutrition and reasoning ability in Zambian school children, Trans. R. Soc. Trop. Med. Hyg. 66:471-478.

Hansen, J. P. L., Freesman, C., Moodie, A. D., and Evans, D. E., 1971, What does nutritional growth retardation mean?, Pediatrics 47:299-313.

Hertzig, M. E., Birch, H. G., Richardson, S. A., and Tizard, J., 1972, Intellectual levels of school children severely malnourished during the first two years of life, Pediatrics 49(6):814-824.

Hoorweg, J., and Stanfield, J. P., 1976, The effect of protein energy malnutrition in early childhood on intellectual and motor abilities in later childhood and adolescence, Dev. Med. Child Neurol. 18:330-350.

Klein, P. S., Forbes, G. B., and Nadar, P. R., 1975, Effects of starvation in infancy (pyloric stenosis) on subsequent learning abilities, J. Pediatrics 87(1):8-15.

Liang, P. H., Hie, T. T., Jan, O. H., and Giok, L. T., 1967, Evaluation of mental development in relation to early malnutrition, Am. J. Clin. Nutr. 20(12):1290–1294.

Lien, N. M., Meyer, K. K., and Winick, M., 1977, Early malnutrition and "late" adoption: A study of their effects on the development of Korean orphans adopted into American families, Am. J. Clin. Nutr. 30:1734-1739.

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.

Lloyd-Still, J. 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.

Pereira, S. M., Sundararaj, R., and Begum, A., 1979, Physical growth and neurointegrative performance of survivors of protein–energy malnutrition, Br. J. Nutr. 42:165–171.

Richardson, S. A., Koller, H., Katz, M., and Albert, K., 1978, The contributions of differing degrees of acute and chronic malnutrition to the intellectual development of Jamaican boys, Early Hum. Dev. 2(2):163-170.

Stoch, M. B., and Smythe, P. M., 1967 The effect of undernutrition during infancy on subsequent growth and intellectual development, S. Afr. Med. ?. 41:1027.

Stoch, M. B., and Smythe, P. M., 1976, 15-Year developmental study on effects of severe undernutrition during infancy on subsequent physical growth and intellectual functioning, Arch. Pis. Child. 51:327-336.

Winick, M., and Rosso, P., 1975, Malnutrition and central nervous system development, in: Brain Function and Malnutrition (J. W. Prescott, M. S. Read, and D. B. Coursin, eds.), pp. 41-51, John Wiley and Sons, Inc., New York.