Peer-reviewed article

Impact of Chronic Malnutrition on Neurodevelopmental Outcomes in Early Childhood: A Prospective Cohort Study in Rural Hispanic Populations.

María de Los Ángeles Álvarez Falcón, Kleber Mosquera Rodríguez, Xavier Grandes Andrade, Nicole Al Alam Rabie · 2 Jul 2026

Abstract

BACKGROUND: Chronic child malnutrition is highly prevalent in low- and middle-income countries and has been associated with impairments across multiple neurodevelopmental domains. The objective of this study is to evaluate the impact of chronic malnutrition and intercurrent morbidity on early neurodevelopmental changes in children in a rural setting. METHODS: A prospective cohort study was conducted in children aged 6-60 months with baseline (T0) and 3-month follow-up (T1) assessments. Neurodevelopment was evaluated using the Denver II test, and nutritional status using height-for-age Z-scores. Longitudinal analyses were performed using generalized estimating equations. RESULTS: One hundred fifty-six children were included (median age: 19 months; 55.1% male), of whom 49.4% had chronic malnutrition. At baseline, children with malnutrition had a higher prevalence of positive screening findings for neurodevelopmental risk (82.3% vs 49.4%; P < 0.001), with language as the most affected domain. During follow-up, malnourished children experienced higher burden of intercurrent morbidity, including severe respiratory infections and hospitalizations (P < 0.05). No significant differences were observed in overall neurodevelopmental classification. However, positive screening results for fine motor delay were more frequent among malnourished children (11.69% vs 1.27%; P = 0.035). In multivariable analysis, age was independently associated with fine motor developmental risk (adjusted odds ratio = 1.19; 95% confidence interval: 1.13-1.24), particularly after 24 months, while chronic malnutrition showed a directionally increased, although not statistically significant association (adjusted odds ratio = 2.52; 95% confidence interval: 0.36-17.27). CONCLUSIONS: Chronic malnutrition was associated with early neurodevelopmental risk, particularly in language and fine motor domains. Age-related effects suggest critical windows for the clinical detection of deficits, underscoring the importance of early neurodevelopmental screening in high-risk rural populations.