Running head: MALNUTRITION AND BRAIN DEVELOPMENT

Malnutrition and Brain Development

Stephanie Griffiths
Amanda Medland
November 18, 2013

Running head: MALNUTRITION AND BRAIN DEVELOPMENT

Malnutrition and Brain Development

One can describe malnutrition as a diet that contains inadequate portions or a lack
of one or more essential nutrients required for typical growth (Santos de Souza,
Fernandes, & Carmo, 2011). Malnutrition can occur within our society for a variety of
reasons, whether due to lack of resources, environmental disasters such as famine, a lack
of nutritional understanding from parents, or purposely as a form of neglect. To date, a
substantial portion of the literature addressing malnutrition has been completed using
animal studies, particularly rats. While looking at studies with animals allows researchers
to control for more variables such as particular nutrients, looking into circumstances of
humans who experience malnutrition gives us a more accurate depiction of what is faced
in a sense of global malnutrition. Malnutrition inevitably has negative effects on living
organisms, as we need caloric intake to sustain life, regardless of age. An area of much
interest lies in determining which stages of life experiencing malnutrition poses the most
harmful and long-term effects to the subject, in regards to brain development and
cognition.
Intrauterine Malnutrition
Malnutrition while in utero is a common area of research in regards to brain
development. Intrauterine malnutrition or prenatal or gestational malnutrition results
when a mother does not consume adequate nutrition while a fetus is developing before
birth. This form of malnutrition is more common in developing countries than is postnatal
malnutrition (Morgane, Austin-LaFrance, Bronzino, Tonkiss, Diaz-Cintra, Cintra,
Kemper, & Galler, 1993) while impoverished countries may experience both pre- and

Running head: MALNUTRITION AND BRAIN DEVELOPMENT

post-natal malnutrition. As the child develops it is crucial that the fetus receives
nourishment in order to develop, but to what extent does malnutrition affect the fetal
development? Cognitive development progresses through critical periods both in utero
and in early childhood that, if missed, will have lifelong impacts on the individuals
cognitive abilities. These developments must be fueled by an adequate intake of proteins
and micronutrients if development is to be continued as intended (Ampaabeng, & Tan,
2013). If nutritional proteins are in low supply when in utero, the child runs the risk of
underdeveloped brain growth that has potential to result in life long deficits, not only
within the brain but also within the entire central nervous system (Santos de Souza,
Fernandes, & Carmo, 2011). As a result of malnutrition, neuron production may be
limited, which has the potential to result in an inability to create or reorganize neural
connections. As well, cell migration may occur at inopportune times, leading to a gamut
of learning and behaviour struggles (Morgane et al., 1993). Many of these prenatal
processes occur during critical periods or time sensitive events, which if missed may
result in an inability to compensate for such losses (Morgane, et al., 1993). As the brain
progresses through a period of rapid growth starting around the third trimester until
postnatal 48 months, the fetus requires large amounts of energy and nutrition (MalseBoonstra & Jaiswal, 2010). Malnutrition during a period of rapid growth has been shown
to result in more severe deficits than in periods of slower developments (Santos de Souza,
Fernandes, & Carmo, 2011). As is consistent throughout all times of malnourishment, the
ability for brain development or recovery after a period of malnutrition depends not only
on the timing, but also on the duration and the intensity of the malnutrition (Santos de
Souza, Fernandes, &Carmo, 2011).

Running head: MALNUTRITION AND BRAIN DEVELOPMENT

The particular nutritional deficit also may affect the course of brain development
as is documented in several studies. Iodine deficiencies of mothers and fetus have been
indicated as increasing the risk of stillbirths, impacting brain development and may result
in underdeveloped height as well as thyroid irregularities (Melse-Boonstra & Jaiswal,
2010). In addition, if a mother experiences thyroid hormone deficits during pregnancy,
the child runs the risk of developing visual processing and fine motor deficits as they
progress into childhood (Melse-Boonstra & Jaiswal, 2010). Other nutrients that have
been deemed important during prenatal development include protein, iron, vitamin A,
zinc and fatty acids (Santos de Souza, Fernandes, & Carmo, 2011). It is understood that
nutritional supplements, even in mothers who are only mildly deficient, can be of benefit
for the childs development (Melse-Boonstra & Jaiswal, 2010). These nutritional deficits
can result not only in cognitive and learning deficits, but have the potential to influence
an individuals metabolism, blood pressure, diabetes and result in an increased risk for
other chronic diseases as an adult (Santos de Souza, Fernandes, & Carmo, 2011). When
looking at human studies addressing prenatal malnutrition, school achievement for
children who were in utero during the Great Chinese Famine ranked significantly lower
academically than children who were not impacted by this shock (Ampaabeng & Tan,
2013).
Interpretation of studies addressing pre-natal nutrition of humans must be taken
with caution because despite the recorded intrauterine malnourishment, there is
frequently little documentation of whether post-natal development was then met with
adequate nutrition or continued malnutrition. Animal studies give us more precise
information on malnutrition. Rat studies have shown that if malnutrition occurs as the

Running head: MALNUTRITION AND BRAIN DEVELOPMENT

brain develops that it can alter the neurochemistry and formation of the hippocampus,
which can have large impacts on memory and spatial learning (Santos de Souza,
Fernandez, & Carmo, 2011). It was also found that babies displayed less harmful effects
when the mothers were malnourished only while pregnant, as opposed to experiencing
malnourishment one-month prior in combination with pregnancy (Morgane et al., 1993).
It is believed that if a mother has higher nutrient reserves when a pregnancy begins, the
risk of atypical development is less than if she had depleted her reserves prior to
conception. When rats are deprived of alpha-linolenic acid in their diet, while in utero (as
well as after), the babies developed lower cognitive abilities, which was seen as these rats
required longer lengths of time to complete human developed mazes (Santos de Souza,
Fernandes, & Carmo 2011). When pregnant rats were given a diet that consisted of low
levels of protein, vitamins, lipids, and minerals, their babies displayed low body and
brain weight (Santos de Souza, Fernandez, & Carmo, 2011). The basic formation and
regulation of body weight is determined starting in the gestational period, so malnutrition
during this time will influence the pathway for adulthood growth (Valares, Fukuda,
Francolin-Silva, Hernandez, & Almeida, 2010). As a result of this malnutrition, the rats
developed asymmetrical brains, and altered cortical responses (Santos de Souza,
Fernandes, & Carmo, 2011).
Prenatal malnourishment has been shown to result in atypical brain development
resulting in learning disabilities and cognitive deficits. Although this is true, a large
portion of an individuals rapid brain growth occurs after birth (Morgane et al., 1993) so
there is reason to believe that if only exposed to malnutrition prenatally, the brains
plasticity would be able to compensate for some of these insults during prenatal

Running head: MALNUTRITION AND BRAIN DEVELOPMENT

development. A childs brain begins to form in utero, while the foundations for
intelligence and cognition continues to develop into childhood, setting the stage of early
childhood as the next consideration when addressing child malnutrition.
Malnutrition in Early Childhood (0-2 years).
Once a child is born, the reliance on nutrition to foster development continues.
Within a developing brain, cell development and brain growth is the most prominent in
the first two years of a childs life (Ampaabeng & Tan, 2013), so it is easily understood
why lack of nutrition could affect this development. As mentioned earlier, many human
studies address global malnutrition as a result of environmental conditions as opposed to
particular nutritional factors that affect development. Proteins are required for brain
development, particularly in infants, so shortages of these essential molecules have the
potential to result in deficits in development and intelligence (Ivanovick, Leiva, Perez,
Almagia, Toro, Urrutia, 2002). This can be seen within numerous studies throughout the
literature as a result of malnutrition. The country of Ghana experienced a famine within
the years of 1983-1984 and during this time many adults and children were left without
proper nutrition. Children who were zero to two years old at this time experienced large
deficits in cognitive development as a result of inadequate nutrition, with the average IQ
falling by 6% for these individuals (Ampaabeng & Tan, 2013). Children who lived in the
Philippines who were identified as being malnourished at age two were cognitively
assessed at age eight. These children were identified as scoring lower on IQ tests than
those who received adequate sustenance (Glewwe & King, 2001). During the 1941-1942
famine experienced in Greece, children who were under one year of age show the
greatest effects, with lower literacy rates as well as higher school drop out rates than

Running head: MALNUTRITION AND BRAIN DEVELOPMENT

those who were older during the famine (Neelsen & Stratmann, 2011). Malnourished
children have shown impulsivity, difficulty with attention as well as deficits in executive
functioning, which appear to be the most vulnerable to early malnutrition (Strupp &
Levitsky, 1995). It has also been noted that children who have experienced malnutrition
in early childhood also show deficits in socio-emotional, social language and sensory
integration skills when compared with typically developing peers (Brockman & Ricciuti,
1971). When comparing children who experienced famine in Zimbabwe, Alderman et al.
(2006) indicated that children aged six months to six years who received adequate
nutrition tend to achieve greater height. Paired with this, they found an association
between increased height and higher school grades completed, while malnourished
children tended to start school later and leave school earlier to work (Alderman et al.,
2006). An inference can be made that these children who have failed to grow in height
and appear to reject educational growth at an earlier age, may possess lower cognitive
abilities. It is also noted that growth deficits as a result of malnourishment show
increased risks of disease and death, lower academic achievements, and delayed
psychological and motor development (Santos de Souza, Fernandes, & Carmo, 2011).
Several studies have also recorded malnourished children as developing smaller head
circumference when compared with typical aged peers, which also correlates with
intelligence (Brockman & Ricciuti, 1971). The reduced head circumference provides
evidence of reduced brain weight as well as a reduction in protein content; the degree of
which mirrors the severity of malnutrition the child experienced within the first year of
life (Winick & Rosso, 1969; Brockman & Ricciuti, 1971). If a child develops
malnutrition within the first few years, despite receiving the best nutritional intake

Running head: MALNUTRITION AND BRAIN DEVELOPMENT

afterwards, a reduction in head circumference will still be maintained (Santos de Souza,

Fernandes, & Carmo, 2011). Lastly, if a child were to experience a deficit in the thyroid
hormone, there has been evidence of attention deficits and memory problems as well as
language delays (Melse-Boonstra & Jaiswal, 2010). Despite the evidence of malnutrition
in young children whether looking at global malnutrition or in comparison to particular
elements, the theme remains consistent; malnutrition results in deficits, many of which
are irreversible even after nutritional restoration.
Interventions were attempted with children ages 11 to 44 months who were
admitted to the hospital in Lima, Peru with extreme malnutrition resulting in less than
50% of expected bodily growth in weight. Researchers found that if the children
experienced malnutrition before the age of 6 months, there was minimal mental recovery
even if the children were later met with nutritional needs (Brockman & Ricciuti, 1971).
These children were given sorting tasks both as malnourished children and after 12 weeks
of nutritional treatment. When tested when malnourished, the results showed delays in
cognitive ability and little to no improvement was made after continued nourishment
(Brock & Ricciuti, 1971). This is evidence that there are periods of critical development
that if missed, can create lifelong impacts on development, despite all attempts to
compensate for such loses. As these periods of learning exist throughout early childhood,
malnutrition can result not only in developmental delays but can create difficulties on
further learning as the foundations to learning have been misses or are lacking (Strupp &
Levitsky, 1995). When looking at the effects of supplementation for at risk children,
results continue to support the concept that a childs brain needs nutrients to develop
typically. Children and pregnant mothers were given supplements over extended periods

Running head: MALNUTRITION AND BRAIN DEVELOPMENT

of time, and these children recipients showed average cognitive development as a result
(Gorman, 1995). Looking at children who received food aid after their countries famine
times, these children grew taller than the older children who went through early
childhood during the famine period without aid (Ampaabeng, & Tan, 2013).
In regards to animal studies, researchers have the ability to control many variables
such as particular nutrients, timing, and length of malnutrition. Providing rats with a diet
that was high in saturated fats and carbohydrates showed higher strengths in memory
than those who were not provided with a diet consisting of high concentrations of both
(Santos de Souza, Fernandes, & Carmo, 2011). Valares et al. (2010) looked at male albino
rats that were submitted to protein malnutrition from 21 to 50 days after birth and then
from 50 to 70 days experienced nutritional recovery. After which, the rats who
experienced protein malnutrition spent less time exploring items presented to them,
experienced greater impulsivity, took longer periods of time to locate platforms within a
maze, showed increased anxiety and aggression, as well as difficulties with cognitive
flexibility (Valares et al., 2010). Typically when an individual or an animal presents with
cognitive inflexibility, this is associated with frontal lobe damage or malformation,
providing evidence that malnutrition can result in physical malformation of the brain
structure (Strupp & Levitsky, 1995). Looking into the research, it appears evident that not
only does malnutrition have an affect on reduced cognitive and learning abilities in
children who were malnourished during early childhood; these cognitive deficits tend to
persist into adulthood, even after nutritional recovery.
Malnutrition in Older Children

Running head: MALNUTRITION AND BRAIN DEVELOPMENT

10

Although many research studies focus their attention on pre- and post-natal development,
interesting discoveries have been found when looking at nutritional effects on older
childhood development. In a study comparing malnourished and adequately nourished
children aged five to ten, researchers found that malnourished children showed deficits in
learning and attention (Kar, Rao, & Chandramouli, 2008). When looking at the Ghana
Famine discussed above, studies found that although children zero to two years showed
cognitive defects as a result of malnutrition, older children ages three to eight did not
appear to develop direct irreversible effects as a result of the famine (Ampaabeng & Tan,
2013).
Malnutrition over the age of five also shows impact on the development of higher
cognitive processes such as difficulties with working memory as the child ages. (Kar,
Rao, & Chandramouli, 2008). Studies conducted in Southeast Asia of school aged
children who showed deficiencies in iodine showed a cognitive delay averaging 13.5
points lower and deficits in short term memory than those who received adequate iodine
in their diets (Melse-Boonstra & Jaiswal, 2010). When these children were provided with
nutritional supplements addressing the iodine deficiency for 12 months, an improvement
in short tem memory was seen and it appears that cognitive performance can be reversed
if the deficiency was experienced after the brains development within the first years of
life (Melse-Boonstra & Jaiswal, 2010). As children develop, it is believed that IQ levels
tend to remain stable at approximately age 10 (Ampaabeng & Tan, 2013). Malnutrition
after this age may not show the potential to alter cognitive capacity, although other side
effects such as difficulty concentrating, delayed recall of information as well as mental
health concerns such as depression may occur. It appears that if malnutrition is

Running head: MALNUTRITION AND BRAIN DEVELOPMENT

11

experienced only in older childhood, the impact may be less severe than if experienced
while the fetal brain is developing or within the first few years of life in which the brain
is rapidly developing.
In conclusion, it appears evident that malnutrition experienced throughout
development has the potential to impose long term cognitive, learning, biological and
physical deficits in living beings, whether they are humans or rats. Despite the fact that
malnutrition throughout any part of life can influence cognition, malnutrition during
certain developmental time periods seem to result in more severe or persistent
disabilities. Research shows that the most crucial period of time for development exists in
utero and proceeds until approximately two years of age. Within this time, the brain
requires much time and energy to create the neural pathways and develop each of the
intricate structures which contributes to creating a functioning individual. It appears that
if the brain does not receive adequate nutrition, regardless of the form, the development
of brain structures is compromised and has the potential to result in cognitive delays,
executive functioning deficits as well as many other brain alterations. Many research
studies look into children impacted by famines, but the possibility still exists for
malnutrition in countries who are not experiencing famine. Special attention must be paid
to ensure maternal nutrition as well as providing proper nutrition for the child as they
continue to age. Without this, the potential for damage and delays are certain as a result
of the nutritional deficit. Malnutrition experienced in older children continues to have an
affect, although the impact seems to be less severe and has the potential to be reversible
as the basis for cognition and brain development has already been formulated. Although
all forms of malnutrition appear to have impact on an individual, the timing, duration,

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12

and severity play a crucial role in determining how the brain is affected as well as if the
affects are reversible.

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13

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