Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood

Undernutrition in infancy and early childhood is thought to adversely affec t cognitive development, although evidence of lasting effects is not well e stablished. With the use of data from the Cebu Longitudinal Health and Nutr ition Study, we assesshere the relationship between stunting in the first 2 y of life and later cognitive development, focusing on the significance of severity, timing and persistence of early stunting. The sample included > 2000 Filipino children administered a cognitive ability test at ages 8 and 11 y. Stunting status was determined on the basis of anthropometric data co llected prospectively between birth and age 2 y. Children stunted between b irth and age 2 y had significantly lower test scores than nonstunted childr en, especially when stunting was severe. The shortfall in test scores among children stunted in the first 2 y was strongly related to reduced schoolin g, which was the result of a substantial delay in initial enrollment as wel l as higher absenteeism and repetition of school years among stunted childr en. Interactions between stunting and schooling were not significant, indic ating that stunted and nonstunted children benefitted similarly from additi onal schooling. After multivariate adjustment, severe stunting at age 2 y r emained significantly associated with later deficits in cognitive ability, The timing of stunting was also related to test performance, largely becaus e children stunted very early also tended to be severely stunted (chi(2) P = 0.000). Deficits in children's scores were smaller at age 11 y than at ag e 8 y, suggesting that adverse effects may decline over time. Results empha size the need to prevent early stunting and to provide adequate schooling t o disadvantaged children.