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Recovery from stunting and cognitive outcomes in young children: evidence from the South African Birth to Twenty Cohort Study

Published online by Cambridge University Press:  24 September 2015

D. Casale*
Affiliation:
School of Economic and Business Sciences, University of the Witwatersrand, Johannesburg, South Africa
C. Desmond
Affiliation:
Human and Social Development, Human Sciences Research Council, Durban, South Africa Development Pathways to Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
*
*Address for correspondence: D. Casale, School of Economic and Business Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa. (Email [email protected])

Abstract

In this study we analyse the implications for cognitive function of recovery from stunting in early childhood. More specifically, we test whether children who met the definition for stunted at age 2, but not at age 5, perform better in cognitive tests than children who remain stunted over this period. The sample is drawn from the Birth to Twenty Cohort Study, a prospective data set of children born in 1990 in urban South Africa. The measure of cognitive function that we use is based on the Revised Denver Prescreening Developmental Questionnaire implemented when the children were age 5. We employ multivariate regression in the analysis to control for child-specific characteristics, socio-economic status, the home environment and caregiver inputs. We find that recovery from stunting is not uncommon among young children in our sample. However, children who recover from stunting by age 5 still perform significantly worse on cognitive tests than children who do not experience early malnutrition, and almost as poorly as children who remain stunted. These findings suggest that the timing of nutritional inputs in the early years is key in a child’s cognitive development, with implications for school readiness and achievement.

Type
Original Article
Copyright
© Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2015 

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References

1. de Onis, M, Blössner, M, Borghi, E. Prevalence and trends of stunting among pre-school children, 1990–2020. Public Health Nutr. 2012; 15, 142148.Google Scholar
2. Dewey, KG, Begum, K. Long-term consequences of stunting in early life. Matern Child Nutr. 2011; 7, 518.CrossRefGoogle ScholarPubMed
3. Walker, SP, Chang, SM, Powell, CA, Grantham-McGregor, SM. Effects of early childhood psychosocial stimulation and nutritional supplementation on cognition and education in growth-stunted Jamaican children: prospective cohort study. Lancet. 2005; 366, 18041807.Google Scholar
4. Victora, CG, Adair, L, Fall, C, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008; 371, 340357.CrossRefGoogle ScholarPubMed
5. Victora, CG, de Onis, M, Hallal, PC, Blossner, M, Shrimpton, R. Worldwide timing of growth faltering: revisiting implications for interventions. Pediatrics. 2010; 125, e473e480.Google Scholar
6. Cameron, N, Preece, MA, Cole, TJ. Catch-up growth or regression to the mean? Recovery from stunting revisited. Am J Hum Biol. 2005; 17, 412417.Google Scholar
7. Martorell, R, Horta, BL, Adair, LS, et al. Weight gain in the first two years of life is an important predictor of schooling outcomes in pooled analyses from five birth cohorts from low- and middle-income countries. J Nutr. 2010; 140, 348354.Google Scholar
8. Prentice, AM, Ward, KA, Goldberg, GR, et al. Critical windows for nutritional interventions against stunting. Am J Clin Nutr. 2013; 97, 911918.Google Scholar
9. Stein, AD, Wang, M, Martorell, R, et al. Growth patterns in early childhood and final attained stature: data from five birth cohorts from low- and middle-income countries. Am J Hum Biol. 2010; 22, 353359.Google Scholar
10. Golden, MH. Is complete catch-up possible for stunted malnourished children? Eur J Clin Nutr. 1994; 48(Suppl. 1), S58S71.Google Scholar
11. Nelson, CA, Thomas, KM, de Haan, M. Neuroscience of Cognitive Development: The Role of Experience and the Developing Brain. 2012. John Wiley & Sons: Hoboken, NJ.Google Scholar
12. Morgan, B, Gibson, KR. Nutritional and environmental interactions in brain development. In Brain Maturation and Cognitive Development (eds. Gibson KR, Peterson AC), 1991; pp. 91106. Aldine de Bruyter: New York, NY.Google Scholar
13. Shonkoff, JP, Garner, AS, Siegel, BS, et al. The lifelong effects of early childhood adversity and toxic stress. Pediatrics. 2012; 129, e232e246.Google Scholar
14. Glewwe, P, King, EM. The impact of early childhood nutritional status on cognitive development: does the timing of malnutrition matter? World Bank Econ Rev. 2001; 15, 81113.Google Scholar
15. Hoddinott, J, Maluccio, JA, Behrman, JR, Flores, R, Martorell, R. Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults. Lancet. 2008; 371, 411416.Google Scholar
16. Mendez, MA, Adair, LS. Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. J Nutr. 1999; 129, 15551562.Google Scholar
17. Crookston, BT, Schott, W, Cueto, S, et al. Postinfancy growth, schooling, and cognitive achievement: young lives. Am J Clin Nutr. 2013; 98, 15551563.Google Scholar
18. Crookston, BT, Penny, ME, Alder, SC, et al. Children who recover from early stunting and children who are not stunted demonstrate similar levels of cognition. J Nutr. 2010; 140, 19962001.Google Scholar
19. Crookston, BT, Dearden, KA, Alder, SC, et al. Impact of early and concurrent stunting on cognition. Matern Child Nutr. 2011; 7, 397409.Google Scholar
20. Casale, D, Desmond, C, Richter, L. The association between stunting and psychosocial development among preschool children: a study using the South African Birth to Twenty cohort data. Child Care Health Dev. 2014; 40, 900910.Google Scholar
21. Norris, SA, Richter, LM, Fleetwood, SA. Panel studies in developing countries: case analysis of sample attrition over the past 16 years within the Birth to Twenty cohort in Johannesburg, South Africa. J Int Dev. 2007; 19, 11431150.Google Scholar
22. Richter, L, Norris, S, Pettifor, J, Yach, D, Cameron, N. Cohort profile: Mandela’s children: the 1990 Birth to Twenty study in South Africa. Int J Epidemiol. 2007; 36, 504511.Google Scholar
23. Richter, LM, Yach, D, Cameron, N, Griesel, RD, Wet, T. Enrolment into Birth to Ten (BTT): population and sample characteristics. Paediatr Perinat Epidemiol. 1995; 9, 109120.Google Scholar
24. Frankenburg, WK, Fandal, AW, Thornton, SM. Revision of Denver Prescreening Developmental Questionnaire. J Pediatr. 1987; 110, 653657.Google Scholar
25. Hsiao, C, Richter, LM. Early mental development as a predictor of preschool cognitive and behavioral development in South Africa: the moderating role of maternal education in the Birth to Twenty Cohort. Infants Young Child. 2014; 27, 7487.Google Scholar
26. Luiz, DM, Foxcroft, CD, Tukulu, AN. The Denver II Scales and the Griffiths Scales of Mental Development: a correlational study. J Child Adolesc Ment Health. 2004; 16, 7781.Google Scholar
27. World Health Organization. WHO Child Growth Standards: Methods and Development: Head Circumference-for-Age, Arm Circumference-for-Age, Triceps Skinfold-for-Age and Subscapular Skinfold-for-Age. 2007. WHO: Geneva.Google Scholar
28. Shisana, O, Labadarios, D, Rehle, T, et al. South African National Health and Nutrition Examination Survey (SANHANES-1). 2013. HSRC Press: Cape Town.Google Scholar
29. World Health Organization. Global database on child growth and malnutrition, 2012. Retrieved 10 September 2015 from http://www.who.int/nutgrowthdb/database/countries/zaf/en/.Google Scholar
30. Adair, LS. Filipino children exhibit catch-up growth from age 2 to 12 years. J Nutr. 1999; 129, 11401148.Google Scholar
31. Berkman, DS, Lescano, AG, Gilman, RH, Lopez, SL, Black, MM. Effects of stunting, diarrhoeal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study. Lancet. 2002; 359, 564571.CrossRefGoogle ScholarPubMed
32. Adair, LS, Fall, CH, Osmond, C, et al. Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies. Lancet. 2013; 382, 525534.Google Scholar
33. Boersma, B, Wit, JM. Catch-up growth. Endocr Rev. 1997; 18, 646661.Google Scholar
34. Leroy, JL, Ruel, M, Habicht, JP. Critical windows for nutritional interventions against stunting. Am J Clin Nutr. 2013; 98, 854855.Google Scholar
35. Lundeen, EA, Stein, AD, Adair, LS, et al. Height-for-age z scores increase despite increasing height deficits among children in 5 developing countries. Am J Clin Nutr. 2014; 100, 821825.Google Scholar