Abstract
Millions of children worldwide especially in the Asian subcontinent are vulnerable to early childhood stunting. There are contradictory reports of the association between catch-up growth in childhood and school age cognition. A community-based birth cohort recruited between 2010 and 2012 from urban slums in Vellore, India was followed up until 9 years of age. From regular anthropometric measurements, stunting status for each individual child was calculated at 2, 5 and 9 years. Cognition was assessed at 9 years of age using the Malin's Intelligence Scale for Indian Children (MISIC). Children were divided into groups based on stunting at each time point as well as catch-up growth, and a regression model was utilised to evaluate their association with cognition at 9 years. Among 203 children included in this analysis, 94/203 (46.31%) children were stunted at 2 years of age, of whom 39.36% had a catch-up growth at 5 years of age, and 38.30% at 9 years. Around 10% of the cohort remained stunted at all time points. In the multivariable analysis, children who were stunted at 2, 5 and 9 years had a significantly lower verbal and total intelligence quotient (IQ) scores by 4.6 points compared to those who were never stunted. Children with catch up growth following stunting at 2 years had higher cognition scores than those who were persistently stunted throughout the childhood. This study showed persistent stunting in childhood was associated with lowering of 4-5 IQ points in childhood cognition at 9 years of age. Recovery from early life stunting in children with catch up growth prevented further lowering of cognition scores in these children compared to persistently stunted children. Nutritional supplementation during late infancy and early toddlerhood in addition to continuing nutritional supplementation programmes for preschool and school children can improve childhood stunting and cognitive abilities in vulnerable populations.
Highlights
The sustainable development goal (SDG) 4 of achieving quality education by 2030 [1] is vulnerable to ongoing early childhood risks
Among 203 children included in this analysis, 94/203 (46.31%) children were stunted at 2 years of age, of whom 39.36% had a catch-up growth at 5 years of age, and 38.30% at 9 years
Around 10% of the cohort remained stunted at all time points
Summary
The sustainable development goal (SDG) 4 of achieving quality education by 2030 [1] is vulnerable to ongoing early childhood risks. Twin risks of early childhood stunting, and absolute poverty have caused over 200 million young children worldwide, majority of them in the lowand middle-income countries (LMIC), to have suboptimal developmental potential [2–4]. Children globally have similar growth potential in life, as evidenced by comparable growth performance of affluent Indian children to that in developed countries [8]; but those growing up in vulnerable environments are exposed to early childhood risks affecting not just their linear growth, and developmental potential. Children exposed to early childhood risk factors have not just stunting, and developmental, cognitive and learning difficulties. Meta analyses have shown consistent relationship between early childhood stunting with child cognitive and motor development [11] and later adult height, but an inconclusive association with adult educational potential and achievement [12]. There are contradictory reports of the association between catch-up growth in childhood and school age cognition
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