Agriculture Reference
In-Depth Information
the evidence linking undernutrition, defined in terms of linear growth retardation,
with child development, and then the role of insufficient breastfeeding and specific
micronutrients.
lIneAR gRowth RetARdAtIon (stuntIng)
s t u n t i n g a n D C o g n i t i v e D e v e L o P m e n t
Several studies have shown cross-sectional associations (height-for-age and devel-
opment measured at the same time) between linear growth retardation and poor
child development. These have been reviewed in detail (Grantham-McGregor et al.
2007) and are addressed briefly here. In young children, height-for-age is associated
with poor development, for example, as shown in studies in Guatemala (Lasky et al.
1981), Jamaica (Powell and Grantham-McGregor 1985), and Kenya (Sigman et al.
1989). Many cross-sectional studies in school-aged children have also shown that
being stunted is associated with poorer cognitive ability and lower school achieve-
ment levels (Grantham-McGregor et al. 2007).
longitudinal studies of stunting and cognitive development
Several prospective cohort studies of the association of stunting in early child-
hood (by age 2 or 3 years) with later cognitive functioning have been conducted
(in longitudinal studies, stunting or height-for-age was assessed in early childhood
and children remeasured after varying intervals). Details of the studies are given in
Table 11.1. After controlling for social background covariates, stunting was associ-
ated with deficits in IQ (Berkman et al. 2002, Walker et al. 2005), nonverbal intel-
ligence (Martorell et al. 1992, Mendez & Adair 1999), and other cognitive domains
(Walker et al. 2005). Follow-up in some cases continued to late adolescence (Walker
et al. 2005) and adulthood (Martorell et al. 1992). Stunting is also associated with
poor educational outcomes, such as fewer grades completed (Martorell et al. 1992)
and increased dropout (Daniels and Adair 2004, Walker et al. 2005). Deficits in
school achievement have also been found (Martorell et al. 1992, Chang et al. 2002,
Walker et al. 2005).
Two cohorts from South Africa and Brazil were included in a recent analysis
(Grantham-McGregor et al. 2007), and stunting was associated with reasoning abil-
ity at age 7 years (South Africa) and school grades attained at age 18 years (Brazil).
Deficits were thus consistently found in all longitudinal studies investigating the
effect of early childhood stunting. The magnitude of the difference between stunted
and nonstunted children varied, but effects were generally moderate to large.
s t u n t i n g a n D s of C i a L -e m o t i o n a L o u t C o m e s
In cross-sectional studies, underweight and stunted children were less happy and
more apathetic and fussy (Meeks Gardner et al. 1999), and they showed lower levels
of play and exploratory behavior (Graves 1976, 1978, Meeks Gardner et al. 1999)
and more anxious attachment (Graves 1976, 1978, Valenzuela 1990). At school age,
children malnourished during the first 2 years of life had attention deficits, more
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