title: Infant malnutrition is associated with persisting attention deficits in middle adulthood.
abstract: Infantile malnutrition is known to be associated with cognitive and behavioral impairment during childhood and adolescence. Data pertaining to longer-term effects on behavioral outcomes in adulthood are limited. In this study, we report associations between infantile malnutrition and attention problems in adults at midlife. Attention problems were assessed by the Conners Adult ADHD Rating Scales (CAARS) and the Conners Continuous Performance Test (CPT) in 145 Barbadian adults (aged 37-43 y) who had been followed longitudinally since childhood. Previously malnourished participants (n = 80) had experienced moderate to severe protein-energy malnutrition in the first year of life and were successfully rehabilitated thereafter. They were compared with healthy adults (n = 65) who were former classmates of the index cases and who had been matched for age, sex, and handedness in childhood. Multiple regression analyses showed persisting effects of childhood malnutrition on both the CAARS and the CPT, independent of effects of household standard of living assessed in childhood. The malnutrition effect on the CAARS ratings was independent of IQ, whereas this effect was attenuated for the CPT after adjustment for IQ. Teacher-reported attention problems in childhood predicted attention problems in adulthood, indicating continuity over the life span. Infantile malnutrition may have long-term effects on attentional processes nearly 40 y after the episode, even with excellent long-term nutritional rehabilitation and independent of socioeconomic conditions in childhood and adolescence. This finding has major public health implications for populations exposed to early childhood malnutrition.
authors.affiliation: Judge Baker Children's Center, Harvard Medical School, Boston, MA, USA. jgaller@jbcc.harvard.edu
authors.forename: Janina R
authors.initials: JR
authors.lastname: Galler
authors.forename: Cyralene P
authors.initials: CP
authors.lastname: Bryce
authors.forename: Miriam L
authors.initials: ML
authors.lastname: Zichlin
authors.forename: Garrett
authors.initials: G
authors.lastname: Fitzmaurice
authors.forename: G David
authors.initials: GD
authors.lastname: Eaglesfield
authors.forename: Deborah P
authors.initials: DP
authors.lastname: Waber
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000209:etiology*; D001460:Barbados; D003072:Cognition Disorders / Q000150:complications / Q000209:etiology; D015331:Cohort Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000178:diet therapy / Q000503:physiopathology* / Q000523:psychology / Q000534:rehabilitation; D008137:Longitudinal Studies; D008297:Male; D011502:Protein-Energy Malnutrition / Q000178:diet therapy / Q000503:physiopathology* / Q000523:psychology / Q000534:rehabilitation; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D057566:Self Report; D012720:Severity of Illness Index