Nutritional status, cognitive achievement, and educational attainment of children aged 8-11 in rural South India

Autoři: Yubraj Acharya aff001;  Nancy Luke aff002;  Marco Faytong Haro aff002;  Winsley Rose aff003;  Paul Swamidhas Sudhakar Russell aff004;  Anu Mary Oommen aff005;  Shantidani Minz aff005
Působiště autorů: Department of Health Policy and Administration, The Pennsylvania State University, Pennsylvania, United States of America aff001;  Department of Sociology and Criminology, The Pennsylvania State University, Pennsylvania, United States of America aff002;  Department of Pediatrics, Christian Medical College, Vellore, India aff003;  Department of Psychiatry, Christian Medical College, Vellore, India aff004;  Department of Community Health, Christian Medical College, Vellore, India aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article



Malnutrition among children is one of the most pressing health concerns middle- and low-income countries face today, particularly those in Sub-Saharan Africa and South Asia. Early-life malnutrition has been shown to affect long-term health and income. One hypothesized channel linking early-life malnutrition and long-term outcomes is cognitive development. However, there is limited empirical evidence on the relationship between nutritional status and cognitive achievement in middle childhood.

Study design

As part of the South India Community Health Study (SICHS), we collected educational attainment and anthropometric data from 1,194 children in rural Vellore district of Tamil Nadu, India, and assessed their math and reading skills. We analyzed the relationship between continuous and binary anthropometric measures of nutritional status and three measures of cognitive achievement (reading, math, and grade level), adjusting for potential confounders, using a regression framework.


Lower height-for-age and weight-for-age and their corresponding binary measures (stunting, underweight) were associated with lower reading scores, lower math scores, and lower grade level, with the exception of the association between weight-for-age and reading, which was marginally significant. A stunted child had one-third of a grade disadvantage compared to a non-stunted counterpart, whereas an underweight child had one-fourth of a grade disadvantage compared to a non-underweight counterpart. Lower BMI-for-age was associated with grade level and marginally associated with lower math scores, and its binary measure (thinness) was marginally associated with lower math scores.


Acute and chronic malnutrition in middle childhood were negatively associated with math scores, reading scores, and educational attainment. Our study provides new evidence that cognitive achievement during middle childhood could be an important mechanism underlying the association between early-life malnutrition and long-term wellbeing.

Klíčová slova:

Educational attainment – Children – India – Malnutrition – Mothers – Schools – Tamil people


1. United Nations. The Sustainable Development Goals Report 2017. 2017. doi: 10.18356/4d038e1e-en

2. Spears D, Lamba S. Effects of Early-Life Exposure to Sanitation on Childhood Cognitive Skills: Evidence from Indias Total Sanitation Campaign. J Hum Resour 2016;51:298–327. doi: 10.3368/jhr.51.2.0712-5051R1

3. Alderman H, Hoddinott J, Kinsey B. Long term consequences of early childhood malnutrition. Oxf Econ Pap 2006;58:450–74. doi: 10.1093/oep/gpl008

4. Dewey KG, Begum K. Long-term consequences of stunting in early life. Matern Child Nutr 2011;7:5–18. doi: 10.1111/j.1740-8709.2011.00349.x 21929633

5. Currie J, Vogl T. Early-Life Health and Adult Circumstance in Developing Countries 2013. doi: 10.1146/annurev-economics-081412-103704

6. Almond D, Currie J. Human capital development before age five. In: Ashenfelter O, Card D, editors. Handb Labor Econ, vol. 4b, Elsevier B.V.; 2011, p. 1315–486. doi: 10.1016/S0169-7218(11)02413-0

7. Mendez MA, Adair LS. Severity and Timing of Stunting in the First Two Years of Life Affect Performance on Cognitive Tests in Late Childhood. J Nutr 2018;129:1555–62. doi: 10.1093/jn/129.8.1555 10419990

8. Prentice AM, Ward KA, Goldberg GR, Jarjou LM, Moore SE, Fulford AJ, et al. Perspective Critical windows for nutritional interventions against stunting 1–3. Am J Clin Nutr 2013;97:911–8. doi: 10.3945/ajcn.112.052332 23553163

9. Crookston BT, Schott W, Cueto S, Dearden KA, Engle P, Georgiadis A, et al. Postinfancy growth, schooling, and cognitive achievement: Young lives 1–4. Am J Clin Nutr 2013;98:1555–63. doi: 10.3945/ajcn.113.067561 24067665

10. Walker SP, Grantham-McGregor SM, Powell CA, Chang SM. Effects of growth restriction in early childhood on growth, IQ, and cognition at age 11 to 12 years and the benefits of nutritional supplementation and psychosocial stimulation. J Pediatr 2000;137:36–41. doi: 10.1067/mpd.2000.106227 10891819

11. Crookston BT, Dearden KA, Alder SC, Porucznik CA, Stanford JB, Merrill RM, et al. Impact of early and concurrent stunting on cognition. Matern Child Nutr 2011;7:397–409. doi: 10.1111/j.1740-8709.2010.00255.x 21902807

12. Grantham-Mcgregor SM, Fernald LC, Sethuraman K. Effects of health and nutrition on cognitive and behavioural development in children in the first three years of life. Food Nutr Bull 1999;20:53–75.

13. Sigman M, McDonald MA, Neumann C, Bwibo N. Prediction of Cognitive Competence in Kenyan Children from Toddler Nutrition, Family Characteristics and Abilities. J Child Psychol Psychiatry 1991;32:307–20. doi: 10.1111/j.1469-7610.1991.tb00309.x 1903401

14. Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B. Developmental potential in the first 5 years for children in developing countries. Lancet 2007;369:60–70. doi: 10.1016/S0140-6736(07)60032-4 17208643

15. Doyle O, Harmon CP, Heckman JJ, Tremblay RE. Investing in early human development: Timing and economic efficiency. Econ Hum Biol 2009;7:1–6. doi: 10.1016/j.ehb.2009.01.002 19213617

16. Cusick SE, Georgieff MK. The Role of Nutrition in Brain Development: The Golden Opportunity of the “First 1000 Days.” J Pediatr 2016;175:16–21. doi: 10.1016/j.jpeds.2016.05.013 27266965

17. Pollitt E. Nutrition and educational attainment. Nutr Educ Ser 1984.

18. Perignon M, Fiorentino M, Kuong K, Burja K, Parker M, Sisokhom S, et al. Stunting, poor iron status and parasite infection are significant risk factors for lower cognitive performance in Cambodian school-aged children. PLoS One 2014;9. doi: 10.1371/journal.pone.0112605 25405764

19. Sandjaja S, Poh BK, Rojroonwasinkul N, Le Nyugen BK, Budiman B, Ng LO, et al. Relationship between anthropometric indicators and cognitive performance in Southeast Asian school-aged children. Br J Nutr 2013;110. doi: 10.1017/S0007114513002079 24016767

20. Case A, Paxson C. Causes and consequences of early-life health. Demography 2010;47–Supplem:S65–85.

21. Pratham. ASER Assessment and Survey Framework. n.d.

22. Kingdon G, Monk C. Health, Nutrition and Academic Achievement: New Evidence from India. CSEA Work Pap No 2010–14 n.d.

23. Spears D. Height and cognitive achievement among Indian children. Econ Hum Biol 2012;10:210–9. doi: 10.1016/j.ehb.2011.08.005 21907646

24. Cashin K, Oot L. Guide to Anthropometry: A Practical Tool for Program Planners, Managers, and Implementers. Food Nutr Tech Assist III Proj (FANTA)/ FHI 360 2018:93–115.

25. Macro International and International Institute for Population Sciences (IIPS). National Family Health Survey (NFHS-4), India, 2015–2016. 2017.

26. ASER Centre. Annual Status of Education Report (Rural) 2018 2019:1–335.

27. Borker G, Eeckhout J, Luke N, Minz S, Munshi K, Swaminathan S. Wealth, Marriage, and Sex Selection. 2018.

28. Vidmar SI, Cole TJ, Pan H. Standardizing anthropometric measures in children and adolescents with functions for egen: Update. Stata J 2013;13:366–78. doi: 10.2139/ssrn.2145803

29. World Health Organization. WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children: A Joint Statement by the World Health Organization and the United Nations Children’s Fund. 2006.

30. Scientific Advisory Committee on Nutrition; Royal College of Paediatrics and Child Health. Application of the WHO Growth Standards in the UK. Norwich: Stationery Office: 2007.

31. Jayachandran S, Kuziemko I. Why Do Mothers Breastfeed Girls Less than Boys? Evidence and Implications for Child Health in India. Q J Econ 2011;126:1485–538. doi: 10.1093/qje/qjr029 22148132

32. Borooah VK. Gender bias among children in India in their diet and immunisation against disease. Soc Sci Med 2004;58:1719–31. doi: 10.1016/S0277-9536(03)00342-3 14990373

33. Gupta M Das. Selective discrimination against female children in rural Punjab, India. Popul Dev Rev 1987:77–100.

34. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, De Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013;382:427–51. doi: 10.1016/S0140-6736(13)60937-X 23746772

35. Diamond-Smith N, Luke N, McGarvey S. “Too many girls, too much dowry”: Son preference and daughter aversion in rural Tamil Nadu, India. Cult Heal Sex 2008;10:697–708. doi: 10.1080/13691050802061665 18821352

36. Variyam JN, Blaylock J, Lin B-H, Ralston K, Smallwood D. Mother’s Nutrition Knowledge and Children’s Dietary Intakes. Am J Agric Econ 1999;81:373. doi: 10.2307/1244588

37. Vereecken CA, Keukelier E, Maes L. Influence of mother’s educational level on food parenting practices and food habits of young children. Appetite 2004;43:93–103. doi: 10.1016/j.appet.2004.04.002 15262022

38. Guldan GS, Zeitlin MF, Beiser AS, Super CM, Gershoff SN, Datta S. Maternal education and child feeding practices in rural Bangladesh. Soc Sci Med 1993;36:925–35. doi: 10.1016/0277-9536(93)90084-h 8480238

39. Sharma S. Caste-based crimes and economic status: Evidence from India. J Comp Econ 2015;43:204–26. doi: 10.1016/j.jce.2014.10.005

40. Luke N, Munshi K. Social Affiliation and the Demand for Health Services: Caste and Child Health in South India. J Dev Econ 2007;83:256–79. doi: 10.1016/j.jdeveco.2006.07.005 18046465

41. StataCorp. Stata Statistical Software: Release 15. 2017 2017. doi: 10.2307/2234838

42. Lelijveld N, Jalloh AA, Kampondeni SD, Seal A, Wells JC, Goyheneix M, et al. Brain MRI and cognitive function seven years after surviving an episode of severe acute malnutrition in a cohort of Malawian children. Public Health Nutr 2018;22:1406–14. doi: 10.1017/S1368980018003282 30501662

43. Heuvel M van den, Voskuijl W, Chidzalo K, Kerac M, Bandsma R, Gladstone M. Developmental and behavioural problems in children with severe acute malnutrition in Malawi: A cross–sectional study. J Glob Health 2017;7:1–10. doi: 10.7189/jogh.07.020416 29302321

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