Recent review paper on the impact of stunting and overweight on cognitive development in children 0-59 months

Key take out from the review
Parental education, general nutritional knowledge and improving diet quality with foods fortified with calcium, iron, zinc, vitamin B2 and high quality protein, including milk, are all associated with improvements in cognitive outcomes in undernourished children.

The review by Suryawan et al 2021 discusses the effect of both mild/moderate underweight and stunting as well as overweight/obesity on cognitive neurodevelopment in children aged 0 – 59 months. A total of 26 full text articles were included in this review. In other review papers underweight/stunting and overweight/obesity have been considered separately but in this review they are considered together as they can co-exist within the same population as seen in many countries around the world.

The findings presented in the paper show that underweight/stunting and overweight/obesity are both negatively associated with cognitive neurodevelopment. It appears likely that the period in which neurocognitive deficits can recover following appropriate nutritional interventions extends beyond the first 1000 days of life, up to 8 years of age, which is in agreement with prefrontal cortex development and ongoing synaptogenesis at that age.

Key points from the review

 1Evidence suggests that both underweight and stunting are negatively associated with various elements of cognitive functioning (attention span, mathematical and language abilities) in early life and socioeconomic status in later life.

Nutrition interventions for catch-up growth among undernourished children can potentially recover neurocognitive development up to the age of 8 years, particularly in those whose nutrition status have improved, the authors state. Furthermore, the importance of the first 1000 days of life as the most critical window of opportunity for the recovery of neurocognitive deficits was emphasized.

More studies should be conducted on the impact of nutritional/behavioural interventions in overweight/obese children on neurodevelopment and cognition, especially in low-income countries, as the currently retrieved literature all came from high-income countries. The impact of overweight/obesity seems to be limited to attention, gross motor skills and executive control.

Figure 1 from the review by Suryawan et al 2021, shows the impact of suboptimal growth in early childhood on various developmental aspects. Further research is required to better understand common factors between undernutrition/stunting and overweight/obesity on cognitive neurodevelopment.

Figure 1 Impact of suboptimal growth in early childhood on developmental-related aspects

Importance of Nutritional Interventions in Undernourished Children

The authors stated that parental education, nutritional knowledge, duration of breastfeeding and improvement of the dietary quality of complementary feeding with foods fortified in calcium, iron, zinc, vitamin B2 and high quality protein can modify the impact of undernutrition and improve cognitive outcomes in undernourished children. Access to affordable healthy foods for overweight/obese children, especially for children from families of a low socio-economic status, is important for cognitive development.

Conclusion from the review

The authors concluded that underweight, stunting and overweight/obesity have a significant impact on cognitive neurodevelopment. Parental education, general nutritional knowledge and improving diet quality with foods fortified with calcium, iron, zinc, vitamin B2 and high quality protein are all associated with improvements in cognitive outcomes in undernourished children. Access to affordable healthy foods is also important for those who are overweight/obese.

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Reference

Suryawan, A., Jalaludin, M., Poh, B., Sanusi, R., Tan, V., Geurts, J., & Muhardi, L. (2021). Malnutrition in early life and its neurodevelopmental and cognitive consequences: A scoping review. Nutrition Research Reviews, 1-14. doi:10.1017/S0954422421000159

Malnutrition in early life and its neurodevelopmental and cognitive consequences: a scoping review | Nutrition Research Reviews | Cambridge Core