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Malnutrition at Age 3
Years and Lower Cognitive Ability at Age 11 Years
Independence From
Psychosocial Adversity
Jianghong Liu, PhD; Adrian
Raine, DPhil; Peter H. Venables, PhD, DSc;
Cyril Dalais, MA; Sarnoff A. Mednick,
PhD, DMed
Arch Pediatr Adolesc Med. 2003;157:593-600.
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.
From the School of Nursing, University of
California, Los Angeles (Dr Liu); the Department of
Psychology (Drs Raine, Venables, and Mednick) and the
Social Science Research Institute (Dr Mednick),
University of Southern California, Los Angeles; the
Department of Psychology, University of York, York,
England (Dr Venables); and the Child Health Project,
Quatre Bornes, Mauritius (Mr Dalais).
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Arch Pediatr Adolesc Med. 2003;157:507.
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