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Am J Clin Nutr. 2013 Dec;98(6):1555-63. doi: 10.3945/ajcn.113.067561. Epub 2013 Sep 25.

Postinfancy growth, schooling, and cognitive achievement: Young Lives.

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Department of Health Science, Brigham Young University, Provo, UT (BTC); the Population Studies Center, University of Pennsylvania, Philadelphia, PA (WS); the Grupo de Analisis para el Desarrollo, Lima, Peru (SC); the Boston University Department of International Health and Center for Global Health and Development, Boston, MA (KAD); the Department of Psychology and Child Development, Cal Poly State University, San Luis Obispo, CA (PE); the Young Lives study, Department of International Development, University of Oxford, Oxford, United Kingdom (AG); the Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA (EAL); the Instituto de Investigación Nutricional, Lima, Peru (MEP); the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (ADS); and the Economics and Sociology Departments and Population Studies Center, University of Pennsylvania, Philadelphia, PA (JRB).



Early life growth failure and resulting cognitive deficits are often assumed to be very difficult to reverse after infancy.


We used data from Young Lives, which is an observational cohort of 8062 children in Ethiopia, India, Peru, and Vietnam, to determine whether changes in growth after infancy are associated with schooling and cognitive achievement at age 8 y.


We represented the growth by height-for-age z score at 1 y [HAZ(1)] and height-for-age z score at 8 y that was not predicted by the HAZ(1). We also characterized growth as recovered (stunted at age 1 y and not at age 8 y), faltered (not stunted at age 1 y and stunted at age 8 y), persistently stunted (stunted at ages 1 and 8 y), or never stunted (not stunted at ages 1 and 8 y). Outcome measures were assessed at age 8 y.


The HAZ(1) was inversely associated with overage for grade and positively associated with mathematics achievement, reading comprehension, and receptive vocabulary. Unpredicted growth from 1 to 8 y of age was also inversely associated with overage for grade (OR range across countries: 0.80-0.84) and positively associated with mathematics achievement (effect-size range: 0.05-0.10), reading comprehension (0.02-0.10), and receptive vocabulary (0.04-0.08). Children who recovered in linear growth had better outcomes than did children who were persistently stunted but were not generally different from children who experienced growth faltering.


Improvements in child growth after early faltering might have significant benefits on schooling and cognitive achievement. Hence, although early interventions remain critical, interventions to improve the nutrition of preprimary and early primary school-age children also merit consideration.

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