Impaired Response of Serum IGF-I Levels to Puberty in Previously Malnourished Adolescents.

Serum levels of IGF-I were measured in Barbadian children, aged 9-15 years, half of whom had experienced protein-energy malnutrition limited to the first year of life. Despite current nutritional adequacy, menarche was delayed more than one year in the girls with a history of early malnutrition and their IGF-I levels failed to show the 60% postmenarchic increase seen in the controls. In addition, the IGF-I levels of boys and girls with prior malnutrition in infancy were not significantly correlated with current anthropometric measurements, whereas IGF-I values of control boys and girls were significantly correlated for almost every growth parameter. Infantile malnutrition may cause an alteration in hypothalamic function resulting both in delayed onset of hypothalamic pituitary functions needed for puberty, and in an impaired growth hormone-IGF-I response.

Infant feeding practices in Barbados predict later growth.

This longitudinal study was designed to examine reciprocal relationships between feeding practices and infant growth over the first 6 mo of life. The following three hypotheses were tested: 1) early feeding practices predict later infant growth; 2) early infant growth predicts later feeding practices; and 3) these relationships occur after controlling for related background variables. The sample included 226 healthy, well-nourished infants born at the Queen Elizabeth Hospital, Bridgetown, Barbados. Assessments were made at birth, 7 wk, and 3 and 6 mo of age. Factor analysis of a feeding practices questionnaire for those mothers who attended all three postnatal visits yielded five uncorrelated factors. Three of these factors, preference for breast-feeding, feeding intensity and feeding difficulty, declined with infant age. Two of these factors, father helps and relatives help, increased with infant age. Several background variables, including maternal age, anthropometry and reproductive history, and reliance on outside sources of information were correlated with infant growth. Multivariate analyses confirmed all three hypotheses. The group of feeding practices (particularly the preference for breast-feeding) at 7 wk predicted increases in infant lengths at subsequent ages. Conversely, infant weights at 3 and 6 mo predicted subsequent feeding practices, especially feeding intensity. These reciprocal relationships remained even after statistically controlling for the influence of the background variables. Implications for public policy include the need for comprehensive programs advocating breast-feeding and supporting the general health of mothers and infants.

The long-term effects of early kwashiorkor compared with marasmus. IV. Performance on the national high school entrance examination.

This is one of a series of studies on the long-term effects of early childhood malnutrition in Barbadian school children. This is the first report of the relationship between early malnutrition and later performance on a national examination administered to all 11-y-old children in Barbados to assign high school seats. We compared scores achieved on the 11-plus examination by 103 boys and girls with histories of marasmus or kwashiorkor with those obtained by 63 healthy comparison children and also with scores obtained by the total island population of children during the same years. We report that children with histories of either type of malnutrition confined to infancy had significantly lower scores on the national high school examination than healthy comparison children. Reduced 11-plus scores were closely associated with teacher reports of attention deficits in the classroom documented when the children were as young as 5 to 8 y of age and also with IQ and academic performance. Early malnutrition had independent effects on performance on the 11-plus examination even when home environmental conditions were controlled for. These findings have important implications for future opportunities available to children with histories of infantile malnutrition.

The influence of early malnutrition on subsequent behavioral development. VII. The effects on maternal depressive symptoms.

A self-rating scale was used to assess the presence or absence of depressive symptoms among mothers of 129 Barbadian school children, ages 5 to 11 years, who had experienced marasmus in the first year of life. They were matched with the same number of mothers of comparison children who had no documented histories of malnutrition. Depressive symptoms, especially feelings of hopelessness, occurred more often among the mothers of previously malnourished children than among mothers of comparison children. Depressive symptoms were also more common in association with disadvantaged socioeconomic and home conditions. Maternal depressive symptoms were significantly correlated with the behavioral and cognitive functioning of the child during the school years. When both nutritional history and environmental conditions were controlled, maternal hopelessness had significant effects on school attendance and grades in reading, but there was no association with IQ. This led us to hypothesize that maternal depressive feelings may be an independent factor contributing to long-term behavioral and cognitive deficits in children with histories of early malnutrition.

Long-term effects of early kwashiorkor compared with marasmus. II. Intellectual performance.

Intellectual performance including IQ (Wechsler Intelligence Scale for Children-Revised) and conservation was measured at ages 11-18 years in a follow-up study of Barbadian girls and boys who had histories of kwashiorkor (n = 53) or marasmus (n = 55) in their first year of life. They were compared with healthy neighborhood children matched by sex and age who had normal patterns of growth in early childhood (n = 58). On both IQ and conservation tests, children with previous kwashiorkor or marasmus had similar scores, which were significantly lower than scores of healthy comparison children. These findings were examined in relationship to current environmental conditions, which were similar in children with histories of kwashiorkor or marasmus and somewhat less advantaged than those of the comparison children. The effect of early malnutrition and related conditions at the time of episode still emerged as significant even when the current environmental factors were controlled for.

Long-term effects of early kwashiorkor compared with marasmus. I. Physical growth and sexual maturation.

Physical growth and sexual maturation were measured in a follow-up study of Barbadian girls and boys aged 11-18 years with histories of kwashiorkor (n = 54) or marasmus (n = 56) in their first year of life. They were compared with healthy neighborhood children matched by sex and age who had normal patterns of growth in early childhood (n = 59). Girls with histories of marasmus had significant delays in the onset of menarche compared with healthy comparison girls. However, their rate of growth during the previous 2 years was accelerated, and the differences in size were smaller than at the earlier testing, confirming catch-up. This pattern was not evident for girls with histories of kwashiorkor, who did not differ from the healthy comparison girls on either onset of menarche, Tanner ratings of sexual maturation, or measures of physical growth. In contrast, boys with histories of kwashiorkor or marasmus did not differ from healthy comparison boys in physical growth or Tanner ratings at these ages.

Long-term effects of early kwashiorkor compared with marasmus. III. Fine motor skills.

Children with histories of marasmus (n = 53) or kwashiorkor (n = 50) in the first year of life and healthy comparison children (n = 50) were tested for fine motor skills by the Purdue pegboard test at ages 11-18 years. The performance of children with histories of marasmus was impaired on two of the four test measures. However, the performance of children with a history of kwashiorkor was impaired on three measures. The presence of soft neurologic signs measured 6 years earlier in the same children was significantly correlated with current pegboard performance, implying that early malnutrition has effects on nervous system function that are evident at least through 18 years of age.