Infant nutrition and later achievement

Early-life risk factors for Alzheimer disease

Research findings obtained over the past 20 years suggest that Alzheimer disease (AD) may have its origins in early life. In this review, we consider the evidence for early-life risk factors for this illness. We propose that risk factors that predict neuropathology are largely distinct from those related to the clinical expression of Alzheimer disease. Early-life risk factors for pathology include genes, chromosomal abnormalities, head injury, insulin resistance, and inflammation. With regard to risk factors for clinical expression of Alzheimer disease, six general groups of childhood exposures are reviewed: (1) perinatal conditions, (2) early-life brain development, (3) early-life body growth, (4) early-life socioeconomic conditions, (5) environmental enrichment, and (6) cognitive reserve. The literature reviewed suggests that risk of Alzheimer disease is probably not determined in any single time period but results from the complex interplay between genetic and environmental exposures throughout the life course. Enhancement or preservation of brain or cognitive reserve could delay the onset of Alzheimer disease and in some cases prevent the disease from occurring altogether.

Neurodevelopmental outcome of young children with extrahepatic biliary atresia 1 year after liver transplantation

STUDY DESIGN

Forty children < 2 years of age receiving extrahepatic liver transplantation were tested with the Bayley Scales of Infant Development before transplantation and again at 3 and 12 months after transplantation. Neurodevelopmental status 1 year after transplantation was organized by a descriptive statistic of normal, suspect, or delayed. Disease and transplantation variables were investigated for association with delayed neurodevelopmental outcome.

RESULTS

Before transplantation mental development was in the low-average range (92 +/- 13.2) with psychomotor development 1 SD below the norm (82.5 +/- 13). Three months after transplantation both mental (80.1 +/- 12.6) and psychomotor (69 +/- 16.1) scores dropped 1 SD, but 1 year after transplantation mental and psychomotor scores recovered to the pretransplantation level of functioning. One year after transplantation 35% of the study group was diagnosed as developmentally delayed. Delayed development was associated with decreased weight (p < 0.04), low albumin (p < 0.02), length of hospital stay (p < 0.04), and age at transplantation (p < 0.05).

CONCLUSION

Young children undergoing liver transplantation are at risk for developmental delay. Aggressive nutritional support before transplantation and timing of transplantation before malnutrition develops may reduce developmental delays.

[Long-term consequences of fetal nutrition]

A large number of animal experimental data indicate that pre- or early postnatal malnutrition can have long-term negative consequences on weight and height, with smaller weight and height in adulthood than predicted on genetics basis. Furthermore, according to the Barker's hypothesis, based on data available from British cohort studies, in utero malnutrition could also result in an increased risk of cardiovascular, endocrine and metabolic diseases in adulthood. There are however discordant data in the literature which invite to be cautious about on this hypothesis, mainly because the role of the socio-economic factors during childhood and adulthood have not been taken into account.

The computed axial tomography of the brain in protein energy malnutrition

Forty consecutive new cases of protein energy malnutrition were evaluated clinically and biochemically; in addition, the brain morphology was assessed by computed tomography within 24 hours of admission. Cerebral shrinkage was shown in six of 14 (42.9%) cases of marasmus, ten of 14 (71.4%) cases of kwashiorkor, and 11 of 12 (91.7%) cases of marasmic-kwashiorkor. Ventricular dilatation was demonstrated in 57.1% of marasmus cases, 71.4% of kwashiorkor cases and 91.7% of patients suffering from marasmic-kwashiorkor. However, none of the subjects studied showed any changes in the brain stem or cerebellum. Only ten returned 2 months after nutritional rehabilitation for repeat tomograms. None of these repeat tomograms showed any residual morphological changes. The study demonstrated that the brain is affected in all types of malnutrition, albeit in different proportions, but these changes are completely reversible.

Neurological follow-up of small-for-gestational age newborn infants. A study of risk factors related to prognosis at one year of age

To examine the relative importance of some risk factors and neurological prognosis in the first year of life, 37 small-for-gestational age newborns were followed prospectively to 1 year of conceptional age. An abnormal neurological examination was found in 51.3% of the newborns and, at 12 months, 32.5% were still considered abnormal. Only 8.1% of the group had severe neurological sequelae at 1 year of corrected age. The developmental tests showed little changes during the first year, with abnormality rates varying from 16.1 to 25%. The following risk factors were analyzed concerning their relation to neurological and developmental abnormalities: high-risk pregnancy, maternal hypertension, social class, pre-term birth, neonatal asphyxia and weight and height less than 2.5 percentile at the age of 1 year. The statistical analysis showed a high correlation between subnormal weight gain and neurological (p = 0.0001) and developmental (p = 0.001) abnormalities at 1 year. None of the other risk factors were statistically related to neurological prognosis at 1 year.

A Comparative-Developmental Approach to Behaviour

The comparative study of behaviour may well be a necessary requirement for our understanding of human individual differences. The theme is illustrated with reference to two areas of research, the effect of undernourishing animals early in life and the part played by pheromones in modifying behaviour. The research raises questions about the relationship between psychology and other sciences and particularly its position within the neurosciences. The spectacular achievements in biological sciences over the last 50 years are regarded as providing psychology with a strong base from which it can draw and yet be differentiated from biology where interest focuses on species rather than the study of individual differences. Ethology has broadened our awareness of the complexity of behaviour in a wide range of species and directed attention to the constraints needed in the traditional explanations of behaviour proffered by psychologists. Sociobiology has also provided a quantitative element to the study of interactions between animals that we had hitherto lacked. Genetic and social factors act throughout development. Research on undernutrition and on pheromones emphasizes that there are sensitive periods during which the underlying neural, hormonal and metabolic states differ as between groups and individuals. These need to be examined in relation to both short- and long-term behavioural changes.

Failure to thrive

Malnutrition is the primary biologic insult in most cases of failure to thrive. A transactional model of infant development provides a framework for understanding the psychosocial context in which such malnutrition occurs. Each child who fails to thrive should receive a multidisciplinary evaluation to address the diagnostic and therapeutic implications of nutritional, medical, psychosocial, and developmental factors contributing to growth failure.

Computed tomography in severe protein energy malnutrition

Computed tomography of the brain was performed on eight children aged 1 to 4 years with severe protein energy malnutrition. Clinical features typical of kwashiorkor were present in all the children studied. Severe cerebral atrophy or brain shrinkage according to standard radiological criteria was present in every case. The findings of this study suggest considerable cerebral insult associated with severe protein energy malnutrition.