The Legacy of Childhood Malnutrition in Barbados: 35 Years Later

Janina R. Galler, of Boston University, U.S.A.presented the long-term Barbados Nutrition Study, which took place in the Barbados Nutrition Study Centre, St. Michael, Barbados (Figure 3.1). The co-investigator of this study was Cyralene Bryce.

 

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The study focussed on children who had protein energy malnutrition (PEM) in the first year of life, but not thereafter.

 

Dr. Galler pointed out that the immediate and long term effects of PEM were dependent on several factors (Figure 3.2), as well as the age of the affected child (Figure 3.3).

 

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The Barbados study included a group of children affected during the first year along with matched controls (Figure 3.4). The research involved follow-up at specific points during childhood and again at 35-40 years. Evaluation of the children of the study subjects was also conducted (Figure 3.5).

 

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The results of evaluation during childhood showed reduced IQ for PED-affected children (Figures 3.6 and 3.7). The same group exhibited poor performance on the “11-Plus” academic examination and in school behaviour (Figures 3.8, 3.9, 3.10).

 

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The results were not affected by socioeconomic and home environment differences between the study and control groups (Figures 3.11 and 3.12).

 

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Figure 3.13 provides a summary of the long-term effects (through 18 years) of PEM which is experienced during the first year of life.

       
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Dr. Galler also described her findings from the long-term (through 35 years) follow-up of this cohort.; Figures 3.14, 3.15, 3.16, 3.17, 3.18, 3.19, 3.20 show the results of the Conners’ Adult ADHD Rating Scales (CAARS ADHD) and the associated analysis. Clearly PEM in the first year of life affects behaviour in adult life. The results were not affected by gender, parental household income or IQ.

     
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The results of the 35-year follow-up of affected children are summarized in Figure 3.21. The policy implications of these findings are summarized in Figure 3.22.

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References:

 

Galler, J.R., Ramsey, F., Forde, V., Salt, P. and Archer, E. (1987) Long-term effects of early kwashiorkor compared with marasmus.  II) Intellectual performance.  J. Ped. Gastro. Nutr. 6:847-854

 

Galler JR, Ramsey FC, Morley DS, Archer E, Salt P.The long-term effects of early kwashiorkor compared with marasmus. IV. Performance on the national high school entrance examination. Pediatr Res. 1990 Sep;28(3):235-9

 

Galler JR, Ramsey F, Solimano G, Lowell WE, Mason E. The influence of early malnutrition on subsequent behavioral development. I. Degree of impairment in intellectual performance. J Am Acad Child Psychiatry. 1983 Jan;22(1):8-15

 

Galler, J.R. and Ramsey, F. (1985) The influence of early malnutrition on subsequent behavioral development. VI) The role of the microenvironment of the household. Nutr. Behav. 2:161-173