Peer-reviewed article
Growth and cognition over eight years in three sites of the MAL-ED cohort study
Amber R. Huggins, Rebecca J. Scharf, Elizabeth T. Rogawski McQuade, Erling Svensen, Angelina Maphula et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5This study followed children in Brazil, South Africa, and Tanzania from age 2 to 6-8 years to see how stunted growth relates to later thinking skills. Stunting (being too short for age) became less common over time, dropping from about 40% at age 2 to 13% by age 6-8. Children who were short at age 2 tended to have lower cognitive test scores years later, even if their height later caught up to normal. This suggests that early childhood growth is a strong signal for later brain development, and catching up physically does not always mean catching up mentally.
Key points
- Stunting prevalence fell from 40.1% at age 2 to 13.4% at age 6-8 across the three sites.
- Height at each age was negatively associated with cognitive scores (Semantic Fluency: 0.2 z-scores, 95% CI 0.1-0.3).
- Persistent stunting was linked to lower cognition at 6-8 years (Semantic Fluency: -0.4 z-scores).
- Children who caught up in height, whether early or late, did not show improved cognitive scores compared to those who remained stunted.
- The authors conclude linear growth at age 2 remains an important marker of later cognitive development.
Limitations
The study is observational and covers only three specific cohort sites, so results may not generalize to all African settings; it does not test any intervention or program.
Abstract
The objective of this study was to examine if height at 2 years, 5 years, and 6-8 years of age was related to school-age cognitive development in low resource settings. Some studies report improved scores in those who catch up, while others found no improvement. We hypothesize that persistent stunting will be negatively associated with cognition and that children who experienced catch-up growth would show improved cognition.Follow-up anthropometry and cognitive assessments at 6-8 years were completed in the Brazil, South Africa, and Tanzania MAL-ED cohorts. Semantic and phonemic fluency and reasoning skills were assessed with the Developmental NEuroPSYchological test and Raven Coloured Matrices, respectively. Stunting at 2, 5, and 6-8 years was used to categorize growth into persistently stunted, early catch-up, late catch-up, and never stunted. Multivariable linear regression was used to estimate relationships between linear growth, stunting, and catch-up growth and 6-8-year-old cognition.Stunting prevalence decreased with each follow-up assessment from 40.1% at 2 years to 13.4% at 6-8 years. Height at each age was negatively associated with cognition (Semantic Fluency: 0.2 z-scores, 95% CI: 0.1, 0.3). Persistent stunting was associated with decreased cognitive scores at 6-8 years (Semantic Fluency: -0.4 z-scores, 95% CI: -0.8, -0.03). Children with catch-up growth, both early (Semantic Fluency: -0.4 z-scores, 95% CI: -0.6, -0.1) and late (Semantic Fluency: -0.4 z-scores, 95% CI: -0.8, -0.1), did not have improved scores compared to those persistently stuntedLinear growth at 2 years remains an important indicator of cognitive development in late childhood. Efforts to reduce early stunting may continue as catch-up growth is not always associated with improved cognitive functioning.