Malnutrition at age 3 years and lower cognitive ability at age 11 years: independence from psychosocial adversity

Arch Pediatr Adolesc Med. 2003 Jun;157(6):593-600. doi: 10.1001/archpedi.157.6.593.


Background: Early malnutrition is linked to poor cognition, but long-term effects have not been extensively examined and psychosocial confounds have not always been controlled.

Objective: To test the hypothesis that malnutrition at age 3 years will be associated with poorer cognitive ability at age 11 years independent of psychosocial confounds.

Design: A prospective, longitudinal study of a birth cohort of 1559 children originally assessed at age 3 years for malnutrition (low hemoglobin level, angular stomatitis, kwashiorkor, and sparse, thin hair) and followed up to age 11 years.

Setting and participants: A community sample of 1559 children (51.4% boys and 48.6% girls) born between September 1, 1969, and August 31, 1970, in 2 towns in the island of Mauritius, with 68.7% Indians and 25.7% Creoles (African origin).

Main outcome measures: Verbal and spatial ability measured at ages 3 and 11 years and reading, scholastic ability, and neuropsychologic performance measured at age 11 years.

Results: Malnourished children had poorer cognition at both ages. Deficits were stable across time, applied to all sex and ethnic groups, and remained after controlling for multiple measures of psychosocial adversity. Children with 3 indicators of malnutrition had a 15.3-point deficit in IQ at age 11 years.

Conclusions: Malnutrition at age 3 years is associated with poor cognition at age 11 years independent of psychosocial adversity. Promoting early childhood nutrition could enhance long-term cognitive development and school performance, especially in children with multiple nutritional deficits.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anemia / etiology
  • Child
  • Child, Preschool
  • Cognition*
  • Confounding Factors, Epidemiologic
  • Female
  • Hair Diseases / etiology
  • Humans
  • Intelligence Tests
  • Kwashiorkor / etiology
  • Male
  • Multivariate Analysis
  • Neuropsychological Tests
  • Nutrition Disorders / complications*
  • Prospective Studies
  • Stomatitis / etiology