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Abstract
Background Severe childhood malnutrition impairs growth and development short-term, but current understanding of long-term outcomes is limited. We aimed to identify studies assessing neurodevelopmental, cognitive, behavioural and mental health outcomes following childhood malnutrition.
Methods We systematically searched MEDLINE, EMBASE, Global Health and PsycINFO for studies assessing these outcomes in those exposed to childhood malnutrition in low-income and middle-income settings. We included studies assessing undernutrition measured by low mid-upper arm circumference, weight-for-height, weight-for-age or nutritional oedema. We used guidelines for synthesis of results without meta-analysis to analyse three outcome areas: neurodevelopment, cognition/academic achievement, behaviour/mental health.
Results We identified 30 studies, including some long-term cohorts reporting outcomes through to adulthood. There is strong evidence that malnutrition in childhood negatively impacts neurodevelopment based on high-quality studies using validated neurodevelopmental assessment tools. There is also strong evidence that malnutrition impairs academic achievement with agreement across seven studies investigating this outcome. Eight of 11 studies showed an association between childhood malnutrition and impaired cognition. This moderate evidence is limited by some studies failing to measure important confounders such as socioeconomic status. Five of 7 studies found a difference in behavioural assessment scores in those exposed to childhood malnutrition compared with controls but this moderate evidence is similarly limited by unmeasured confounders. Mental health impacts were difficult to ascertain due to few studies with mixed results.
Conclusions Childhood malnutrition is associated with impaired neurodevelopment, academic achievement, cognition and behavioural problems but evidence regarding possible mental health impacts is inconclusive. Future research should explore the interplay of childhood and later-life adversities on these outcomes. While evidence on improving nutritional and clinical therapies to reduce long-term risks is also needed, preventing and eliminating child malnutrition is likely to be the best way of preventing long-term neurocognitive harms.
PROSPERO registration number CRD42021260498.
- Nutrition
- Public Health
- Nutritional and metabolic disorders
- Systematic review
- Mental Health & Psychiatry
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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- Nutrition
- Public Health
- Nutritional and metabolic disorders
- Systematic review
- Mental Health & Psychiatry
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
MG and MK are joint senior authors.
Handling editor Seye Abimbola
Twitter @kirolos_amir, @mike_eliasz, @GlobalHealthNut
Contributors AK, MGo, MGl, MK conceived the study design. AK wrote the main draft of the paper and is the guarantor of the paper. AK, MGo, MKE, MC screened studies against selection criteria, extracted/checked data from studies and quality scored studies. AK, MGo analysed and synthesised data. All authors reviewed and contributed to the manuscript.
Funding AK is supported by a Wellcome Trust Clinical PhD Programme Fellowship (203919/Z/16/Z). MK gratefully acknowledges funding support from UKRI GCRF, (Medical Research Council Grant reference MR/V000802/1)
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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