Effects of early childhood supplementation with and without stimulation on later development in stunted Jamaican children

It is not known whether nutritional supplementation in early childhood has long-term benefits on stunted children's mental development. We followed up 127 7-8-y old children who had been stunted in early childhood and received supplementation, stimulation, or both. At 9-24 mo of age, the children had been randomly assigned to four treatment groups: nutritional supplementation, stimulation, both treatments, and control. After 2 y, supplementation and stimulation had independent benefits on the children's development and the effects were additive. The group receiving both treatments caught up to a matched group of 32 nonstunted children. Four years after the end of the 2-y intervention 97 percent of the children were given a battery of cognitive function, school achievement, and fine motor tests. An additional 52 nonstunted children were included. Factor analyses of the test scores produced three factors: general cognitive, perceptual-motor, and memory. One, the perceptual-motor factor, showed a significant benefit from stimulation, and supplementation benefited only those children whose mothers had higher verbal intelligence quotients. However, each intervention group had higher scores than the control subjects on more test than would be expected by chance (supplemented and both groups on 14 of 15 tests, P = 0.002; stimulated group in 13 of 15 tests, P = 0.01), suggesting a very small global benefit. There was no longer an additive effect of combined treatments at the end of the intervention. The stunted control group had significantly lower scores than the nonstunted children on most tests. Stunted children's heights and head circumferences on enrollment significantly predicted intelligence quotient at follow-up.(AU)

Stunting and mental development in children

Stunting is the nutritional indicator most consistenly correlated with children's mental development. In Third World countries stunting is usually associated with poor development in older children. Moreover, stunting in young children predicts poor later development. Generally, when social background is controlled for, the association between stunting and poor development remains. In a recent Jamaican study, nutritional supplementation given to stunted children for 2 years produced an improvement in psychosocial development. Supplementation and linear growth had shared and independent effects on change in development. There was also a significant relationship between change in developemnt and growth over the 2 year period. It is therefore probably that at least part of the poor development found in stunted children is due to poor nutrition. (AU)

Factors associated with lowered intelligence in homozygous sickle cell disease

The intelligence quotient (IQ) of 60 patients with homozygous sickle cell (SS) disease and 60 age and sex matched controls with a normal haemoglobin (AA) genotype aged 15-18 years, followed up in a cohort study from birth, was assessed by the Wechsler intelligence scales for children and adults. IQ appeared to be normally distributed in both genotypes but mean values in SS disease were 5.6 points (95 percent confidence interval (CI) 1.0 to 10.2) lower than in AA controls (p=0.016). THe difference occurred in both verbal (5.5 points, p=0.017) and performance (5.0 points, p=0.044) subscales of the IQ defect in SS disease was associated with a significantly lower attention factor score (p=0.005) but not with other factor scores. The genotype difference in IQ was not accounted for by differences in parental occupational level, school absenteeism, or school drop out, or reported activity level. In SS disease, IQ was not related to mean steady state haemoglobin, or mean cell haemoglobin concentration, or clinical severity as judged by the frequency of painful crises, hospital admission, or sick visits. IQ, at age 15-18 years, correlated with the patients' height at all ages from 1 to 10 years (partial correlations increasing from 0.14 (p=0.15) at age 1 to 0.27 (p=0.004) at age 10). Adjusting for height reduced the mean genotype difference in IQ to 5.5 (95 percent CI 0.6 to 10.3) points at age 1 and 10 2.6 points (95 percent CI 0.6 to 10.3) points at age 10. Prepubertal height therefore accounted for much of the genotype difference in IQ. It is speculated that early factors, possibly nutritional, contribute to both impaired growth and mental development in sickle cell disease(AU)

Intelligence in adolescents with homozygous sickle cell (SS) disease

Strokes occur in approximately 8 percent of children with SS disease most commonly below age 15 years. The cause is generally cerebral infraction secondary to occlusion of major cerebral vessels. Less extensive cerebral lesions might also occur producing subtle defects of cerebral function. This hypothesis has been tested using the Wechsler Intelligence Scales-Revised (WISC-R) adjusted to Jamaican conditions in SS children and controls followed from birth in the Jamaican cohort study. The first 125 children with SS disease were each matched with 2 children of the same sex and age but with a normal haemoglobin (AA) genotype. IQ scores in 60 age/sex matched pairs (1SS; 1AA) of cohort children aged 15-18 years were normally distributed in both genotypes but average IQ was significantly lower in SS disease (p<0.01). The possible mechanism of this defect are being explored. (AU)

Intellectual impairment in adolescents with sickle-cell disease - abstract

Sickle-cell disease is known to lead to increased incidence of the major neurological complication, stroke. The findings of several studies suggest that it can also give rise to less obvious neurological sequelae that manifest in more subtle clinical signs and deficits in neuropsychological functioning, particularly intellectual functioning. It is known, however, that chronic illnesses such as sickle-cell disease are associated with psychosocial factors such as school absenteeism and decreased activity that could also contribute to intellectual impairment. This study examined intellectual status and activity scale scores in 60 adolescents with homozygous (SS) sickle-cell disease and no history of stroke, compared to 60 normal (AA) controls matched for age, sex and socioeconomic background. All subjects were taken from a cohort group followed from birth at the sickle-cell clinic, MRC Laboratories Kingston, Jamaica. School attendance was examined in those subjects still attending school. Sickle-cell disease was found to be related to significant lowering of intelligence test scores (IQ) by 5.6 points on average, suggesting intellectual impairment. There was no relationship between school absenteeism, activity level and genotype or IQ, suggesting psychosoical factors did not contribute to lowered IQ in this group. Patterns of IQ scores in subjects with the disease suggested the likelihood of organicity, of a diffuse or generalized nature. Results suggest that IQ levels in sickle-cell disease are generally lower than in normal children and that this is likely to be the result of subtle neurological complications, even in the absence of stroke. Pathogenesis and onset are not at present known but merit further investigation (AU)

The long-term effects of early kwashiorkor compared with marasmus. IV. Performance on the national high school entrance examination

This one of a series of studies on the long-term effects of early childhood malnutrition in Barbadian school children. This is the first report of the relationship between early malnutrition and later performance on a national examination administered to all 11-y-old children in Barbados to assign high school seats. We compared scores achieved on 11-plus examination by 103 boys and girls with histories of marasmus or kwashiorkor with those obtained by 63 healthy comparison children and also with scores obtained by the total island population of children during the same years. We report that children with histories of either type of malnutrition confined to infancy had significantly lower scores on the national high school examination than health comparison children. Reduced 11-plus scores were closely associated with teacher reports of attention deficits in the classroom documented when the children were as young as 5 to 8 y of age and also with IQ and academic performance. Early malnutrition had independent effects on performance on the 11-plus examination even when home environmental conditions were controlled for. These findings have important implications for future opportunities available to children with histories of infantile malnutrition. (AU)

Effects of missing breakfast on the cognitive functions of school children of differing nutritional status

We examined the effects of omitting breakfast on the cognitive functions of three groups of children: stunted, nonstunted controls, and previously severely malnourished. They were admitted to a metabolic ward twice. After an overnight fast half the children received breakfast on their first visit and a cup of tea the second time. The treatment order was reversed for the other half. When breakfast was omitted, both the stunted and previously malnourished groups responded similarly. The malnourished groups had lower scores in influency and coding whereas the control group had higher scores in arithmetic. The children were divided into wasted and nonwasted groups. Wasted children were adversely affected in digit span backwards test and wasted members of the malnourished groups were adversely affected on efficiency of problem solving and those control group in digit span forwards. These results indicate that cognitive functions are more vulnerable to missing breakfast in poorly nourished children (AU)

Patterns of mental development among young, middle-class Jamaican children

This study looked at the performance on the Griffiths Mental Development Scales of middle-class children, aged 6-60 months, from three suburban neighborhoods in Kingston, Jamaica. Their mean DQs were higher than the English standardisation sample. The high scores below 2 years were similar to those reported from black children elsewhere. After 2 years the scores fell into the general range reported for middle-class children from other countries. The children had relatively high hearing and speech scores and low performance scores. Girls scored higher than boys, but birth order and maternal age were not associated with DQs (AU)

The contributions of differing degrees of acute and chronic malnutrition to the intellectual development of Jamaican boys

The purpose of this paper is to determine whether differing degrees and types of malnutrition cause differing degrees of mental impairment. Subjects were 59 Jamaican boys hospitalized for malnutrition in infancy and whose intelligence was assessed at school age. The measure used for degree of chronic malnutrition was height for age and for acute malnutrition weight for height. The measure of intelligence was the I.Q. (WISC). Because the social environment in which a child lives influences his intellectual development, a measure of social background was used as an independent variable in addition to the nutrition measures. Social background showed a significant effect on I.Q. but neither measure of nutrition was significant. A further analysis using comparisons who had not been hospitalized for malnutrition suggests that malnutrition may contribute to mental impairment, through a threshold effect rather than acting as a continous variable where increasing degrees of malnutrition cause increasing degrees of mental impairment.(Summary)

Growth, behaviour, and educational achievement of Jamaican children with sickle cell trait

A longitudinal study of the mental and physical development of 200 children with normal haemoglobin and 21 with the sickle-cell trait was carried out in a small rural community in Jamaica. At about 2 and 10 years of age heights and weights showed no significant differences. At about 10 years of age classroom behaviour, sociability, and educational achievement were similar. The results suggest that the sickle-cell trait does not affect growth and mental development.(Summary)

Intellectual levels of school children severely malnourished during the first two years of life

Intellectual functioning at school age was studied in boys who had been severely malnourished during the first 2 years of life (index cases). IQ in these index cases was compared with that of male siblings closest in age and unrelated class mates or neighbors matched for sex and age (comparisons). Full scale, verbal and performance IQs were lowest for the index cases. All IQ measures were significantly lower in the index cases than in the comparisons. full scale and verbal IQ were significantly lower in the index cases than in the siblings. Siblings differed from comparison children only in performance IQ. No association was found between the intellectual level of index cases and the ages at which they had been hospitalized for the treatment of severe malnutrition during the first 2 years of life. (AU)

Psychiatric disorder in the children of West Indian immigrants

The clinical characteristics of fifty-five children, born of West Indian parents, who had been referred to a Child Guidance Clinic over a period of three years, are described. The children are compared with fifty-five other children matched for age and sex. Roughly equal numbers of West Indian boys and girls were referred, although there is a considerable preponderance of boys in the rest of the clinic population. The two groups did not differ in social class or family size, nor was there a high rate of current separation amongst the parents of West Indian children. However, the West Indian children had suffered more separations from parent figures in their early years. West Indian boys showed less neurotic disorder and West Indian girls more antisocial disorder than the controls. All groups showed a severe degree of reading retardation. Caution is expressed about generalizing these findings to the population from which the children are drawn, but there is felt to be a clear cause for concern in the frequent and sometimes traumatic separations that the current migration imposes on West Indian family life (Summary)