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      Postinfancy growth, schooling, and cognitive achievement: Young Lives 1 2 3 4

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          Abstract

          Background: Early life growth failure and resulting cognitive deficits are often assumed to be very difficult to reverse after infancy.

          Objective: We used data from Young Lives, which is an observational cohort of 8062 children in Ethiopia, India, Peru, and Vietnam, to determine whether changes in growth after infancy are associated with schooling and cognitive achievement at age 8 y.

          Design: We represented the growth by height-for-age z score at 1 y [HAZ(1)] and height-for-age z score at 8 y that was not predicted by the HAZ(1). We also characterized growth as recovered (stunted at age 1 y and not at age 8 y), faltered (not stunted at age 1 y and stunted at age 8 y), persistently stunted (stunted at ages 1 and 8 y), or never stunted (not stunted at ages 1 and 8 y). Outcome measures were assessed at age 8 y.

          Results: The HAZ(1) was inversely associated with overage for grade and positively associated with mathematics achievement, reading comprehension, and receptive vocabulary. Unpredicted growth from 1 to 8 y of age was also inversely associated with overage for grade (OR range across countries: 0.80–0.84) and positively associated with mathematics achievement (effect-size range: 0.05–0.10), reading comprehension (0.02–0.10), and receptive vocabulary (0.04–0.08). Children who recovered in linear growth had better outcomes than did children who were persistently stunted but were not generally different from children who experienced growth faltering.

          Conclusions: Improvements in child growth after early faltering might have significant benefits on schooling and cognitive achievement. Hence, although early interventions remain critical, interventions to improve the nutrition of preprimary and early primary school–age children also merit consideration.

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          Most cited references26

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          Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood.

          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 (chi(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.
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            Effects of early childhood psychosocial stimulation and nutritional supplementation on cognition and education in growth-stunted Jamaican children: prospective cohort study.

            Growth retardation affects about a third of children younger than age 5 years in developing countries and is associated with poor development. Previously, we did a trial of nutritional supplementation and psychosocial stimulation in stunted children aged 9-24 months. Non-stunted children were also assessed. Both types of intervention improved development. We now present the effects of early interventions on cognition and education in 103 of the 129 stunted children and compare them with 64 of the 84 non-stunted children now aged 17-18 years. We recorded no significant effects of nutritional supplementation. Compared with no intervention, stimulation resulted in higher full scale IQ scores (coefficient 0.38, 95% CI 0.06-0.71, p=0.02) and higher scores on the verbal subscale (0.37, 0.07-0.68, p=0.02), Peabody picture vocabulary test (7.84, 0.73-14.95, p=0.03), verbal analogies (0.26, 0.03-0.49, p=0.03), and reading tests (4.73, 1.31-8.14, p=0.007, and 2.7, 1.12-4.37, p=0.001). Overall, stunted non-stimulated participants had significantly poorer scores than the non-stunted group on 11 of 12 cognitive and educational tests. Stunting in early childhood is associated with cognitive and educational deficits in late adolescence, which are reduced by stimulation at a young age.
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              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 Countries12

              Schooling predicts better reproductive outcomes, better long-term health, and increased lifetime earnings. We used data from 5 cohorts (Brazil, Guatemala, India, the Philippines, and South Africa) to explore the relative importance of birthweight and postnatal weight gain for schooling in pooled analyses (n = 7945) that used appropriate statistical methods [conditional weight (CW) gain measures that are uncorrelated with prior weights] and controlled for confounding. One SD increase in birthweight, ∼0.5 kg, was associated with 0.21 y more schooling and 8% decreased risk of grade failure. One SD increase in CW gain between 0 and 2 y, ∼0.7 kg, was associated with higher estimates, 0.43 y more schooling, and 12% decreased risk of failure. One SD increase of CW gain between 2 and 4 y, ∼0.9 kg, was associated with only 0.07 y more schooling but not with failure. Also, in children born in the lowest tertile of birthweight, 1 SD increase of CW between 0 and 2 y was associated with 0.52 y more schooling compared with 0.30 y in those in the upper tertile. Relationships with age at school entry were inconsistent. In conclusion, weight gain during the first 2 y of life had the strongest associations with schooling followed by birthweight; weight gain between 2 and 4 y had little relationship to schooling. Catch-up growth in smaller babies benefited schooling. Nutrition interventions aimed at women and children under 2 y are among the key strategies for achieving the millennium development goal of universal primary education by 2015.
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                Author and article information

                Journal
                Am J Clin Nutr
                Am. J. Clin. Nutr
                ajcn
                The American Journal of Clinical Nutrition
                American Society for Nutrition
                0002-9165
                1938-3207
                December 2013
                25 September 2013
                : 98
                : 6
                : 1555-1563
                Affiliations
                [1 ]From the Department of Health Science, Brigham Young University, Provo, UT (BTC); the Population Studies Center, University of Pennsylvania, Philadelphia, PA (WS); the Grupo de Analisis para el Desarrollo, Lima, Peru (SC); the Boston University Department of International Health and Center for Global Health and Development, Boston, MA (KAD); the Department of Psychology and Child Development, Cal Poly State University, San Luis Obispo, CA (PE); the Young Lives study, Department of International Development, University of Oxford, Oxford, United Kingdom (AG); the Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA (EAL); the Instituto de Investigación Nutricional, Lima, Peru (MEP); the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (ADS); and the Economics and Sociology Departments and Population Studies Center, University of Pennsylvania, Philadelphia, PA (JRB).
                Author notes
                [2]

                Findings and conclusions in this article are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation, the Eunice Kennedy Shriver National Institute of Child Health and Development, Grand Challenges Canada, the Young Lives, the Department for International Development, or other funders.

                [3]

                Supported by the Bill & Melinda Gates Foundation (global health grant OPP1032713), the Eunice Kennedy Shriver National Institute of Child Health and Development (grant R01 HD070993), and Grand Challenges Canada (grant 0072-03 to the grantee, the trustees of the University of Pennsylvania). This is a free access article, distributed under terms ( http://www.nutrition.org/publications/guidelines-and-policies/license/) that permit unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                [4 ]Address correspondence to BT Crookston, Department of Health Science, Brigham Young University, 229G Richards Building, Provo, UT 84602. E-mail: benjamin_crookston@ 123456byu.edu .
                Article
                067561
                10.3945/ajcn.113.067561
                3831540
                24067665
                56cdfaf5-bbde-441b-aeb1-aa3ffb1617fc
                © 2013 American Society for Nutrition

                This is a free access article, distributed under terms ( http://www.nutrition.org/publications/guidelines-and-policies/license/) that permit unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 3 June 2013
                : 30 August 2013
                Page count
                Pages: 9
                Categories
                International Nutrition

                Nutrition & Dietetics
                Nutrition & Dietetics

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