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,3
*
Carolina Population Center,
Department of Epidemiology, and
**
Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516
3To whom correspondence should be addressed.
Undernutrition in infancy and early childhood is thought to adversely
affect cognitive development, although evidence of lasting effects is
not well established. With the use of data from the Cebu Longitudinal
Health and Nutrition Study, we assesshere the relationship between
stunting in the first 2 y of life and later cognitive development,
focusing on the significance of severity, timing and persistence of
early stunting. The sample included > 2000 Filipino children
administered a cognitive ability test at ages 8 and 11 y. Stunting
status was determined on the basis of anthropometric data collected
prospectively between birth and age 2 y. Children stunted between
birth and age 2 y had significantly lower test scores than
nonstunted children, especially when stunting was severe. The shortfall
in test scores among children stunted in the first 2 y was
strongly related to reduced schooling, which was the result of a
substantial delay in initial enrollment as well as higher absenteeism
and repetition of school years among stunted children. Interactions
between stunting and schooling were not significant, indicating that
stunted and nonstunted children benefitted similarly from additional
schooling. After multivariate adjustment, severe stunting at age 2 y remained significantly associated with later deficits in cognitive
ability. The timing of stunting was also related to test performance,
largely because children stunted very early also tended to be severely
stunted (
2 P = 0.000). Deficits in
children's scores were smaller at age 11 y than at age 8 y,
suggesting that adverse effects may decline over time. Results
emphasize the need to prevent early stunting and to provide adequate
schooling to disadvantaged children.
KEY WORDS: • developing countries • stunting • children • cognition • schooling
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