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Functional Significance of the Covariance between Protein Energy Malnutrition and Iron Deficiency Anemia¹

Department of Pediatrics, School of Medicine, Program in International Nutrition, University of California, Davis, CA 95616

Most of the correlational and experimental studies that have tested the hypothesis that mild-to-moderate protein-energy malnutrition (PEM) has an adverse effect on cognitive development disregarded the potential confounder effect of micronutrients. This omission may have been a critical flaw in study design because it is now recognized that iron deficiency increases the probability of deviations in the trajectory of children's motor and mental development from a normal developmental path. This paper discusses two frequently cited studies on the effects of PEM on neurointegrative and cognitive development and proposes that neither study can discard the hypothesis that effects attributed to protein and energy deficiency are, instead, determined by iron deficiency.

KEY WORDS: • protein energy malnutrition • iron deficiency anemia • cognitive development

¹ Prepared for the International Dietary Energy Consultative Group (IDECG) Task Force workshop on malnutrition and behavior at the University of California, Davis, CA, December 6–10, 1993. This workshop was supported by IDECG, the Nestlé Foundation, Kraft Foods and the International Union for Nutritional Science. Guest editor for this supplement was Ernesto Pollitt, Department of Pediatrics, University of California, Davis, CA, 95616.

² To whom correspondence should be addressed: Department of Pediatrics, School of Medicine, Program in International Nutrition, University of California, Davis, CA 95616.