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Roger K, Vannasing P, Tremblay J, Bringas Vega ML, Bryce CP, Rabinowitz A, Valdes-Sosa PA, Galler JR, Gallagher A. Early childhood malnutrition impairs adult resting brain function using near-infrared spectroscopy. Front Hum Neurosci 2024; 17:1287488. [PMID: 38298205 PMCID: PMC10827877 DOI: 10.3389/fnhum.2023.1287488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/15/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Early childhood malnutrition affects 200+ million children under 5 years of age worldwide and is associated with persistent cognitive, behavioral and psychiatric impairments in adulthood. However, very few studies have investigated the long-term effects of childhood protein-energy malnutrition (PEM) on brain function using a functional hemodynamic brain imaging technique. Objective and methods This study aims to investigate functional brain network alterations using near infrared spectroscopy (NIRS) in adults, aged 45-51 years, from the Barbados Nutrition Study (BNS) who suffered from a single episode of malnutrition restricted to their first year of life (n = 26) and controls (n = 29). A total of 55 individuals from the BNS cohort underwent NIRS recording at rest. Results and discussion Using functional connectivity and permutation analysis, we found patterns of increased Pearson's correlation with a specific vulnerability of the frontal cortex in the PEM group (ps < 0.05). Using a graph theoretical approach, mixed ANCOVAs showed increased segregation (ps = 0.0303 and 0.0441) and decreased integration (p = 0.0498) in previously malnourished participants compared to healthy controls. These results can be interpreted as a compensatory mechanism to preserve cognitive functions, that could also be related to premature or pathological brain aging. To our knowledge, this study is the first NIRS neuroimaging study revealing brain function alterations in middle adulthood following early childhood malnutrition limited to the first year of life.
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Affiliation(s)
- Kassandra Roger
- LION Lab, Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Phetsamone Vannasing
- LION Lab, Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Julie Tremblay
- LION Lab, Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Maria L. Bringas Vega
- MOE Key Lab for Neuroinformation, The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China
| | | | - Arielle Rabinowitz
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Pedro Antonio Valdes-Sosa
- MOE Key Lab for Neuroinformation, The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China
| | - Janina R. Galler
- Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, United States
| | - Anne Gallagher
- LION Lab, Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
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Roger K, Vannasing P, Tremblay J, Bringas Vega ML, Bryce CP, Rabinowitz AG, Valdés-Sosa PA, Galler JR, Gallagher A. Impact of Early Childhood Malnutrition on Adult Brain Function: An Evoked-Related Potentials Study. Front Hum Neurosci 2022; 16:884251. [PMID: 35845242 PMCID: PMC9283562 DOI: 10.3389/fnhum.2022.884251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
More than 200 million children under the age of 5 years are affected by malnutrition worldwide according to the World Health Organization. The Barbados Nutrition Study (BNS) is a 55-year longitudinal study on a Barbadian cohort with histories of moderate to severe protein-energy malnutrition (PEM) limited to the first year of life and a healthy comparison group. Using quantitative electroencephalography (EEG), differences in brain function during childhood (lower alpha1 activity and higher theta, alpha2 and beta activity) have previously been highlighted between participants who suffered from early PEM and controls. In order to determine whether similar differences persisted into adulthood, our current study used recordings obtained during a Go-No-Go task in a subsample of the original BNS cohort [population size (N) = 53] at ages 45–51 years. We found that previously malnourished adults [sample size (n) = 24] had a higher rate of omission errors on the task relative to controls (n = 29). Evoked-Related Potentials (ERP) were significantly different in participants with histories of early PEM, who presented with lower N2 amplitudes. These findings are typically associated with impaired conflict monitoring and/or attention deficits and may therefore be linked to the attentional and executive function deficits that have been previously reported in this cohort in childhood and again in middle adulthood.
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Affiliation(s)
- Kassandra Roger
- LION Lab, Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Phetsamone Vannasing
- LION Lab, Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Julie Tremblay
- LION Lab, Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Maria L. Bringas Vega
- MOE Key Lab for Neuroinformation, The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China
| | | | | | - Pedro A. Valdés-Sosa
- MOE Key Lab for Neuroinformation, The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China
| | - Janina R. Galler
- Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, United States
| | - Anne Gallagher
- LION Lab, Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
- *Correspondence: Anne Gallagher,
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Hock RS, Rabinowitz AG, Bryce CP, Fitzmaurice GM, Jr PTC, Galler JR. Intergenerational effects of childhood maltreatment and malnutrition on personality maladaptivity in a Barbadian longitudinal cohort. Psychiatry Res 2020; 290:113016. [PMID: 32682171 PMCID: PMC9994185 DOI: 10.1016/j.psychres.2020.113016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/12/2020] [Accepted: 04/12/2020] [Indexed: 11/16/2022]
Abstract
Childhood adversities are linked with mental health problems throughout the life course, including personality pathology. Less is known about consequences in the next generation, particularly in non-Western populations. In the Barbados Nutrition Study, we assessed associations of two parental (G1) childhood adversities- (1) maltreatment history using the Childhood Trauma Questionnaire-Short Form (CTQ-SF), and (2) clinically ascertained infant malnutrition limited to the first year of life-on PD symptoms in their G2 offspring, using NEO FFM PD prototypes. In linear regression models clustered by family and adjusted for other G1 childhood adversities and family socioeconomic status, we found that G1 parental history of childhood maltreatment was significantly associated with increased G2 offspring Borderline, Histrionic, Narcissistic, and Dependent PD scores. When G1 childhood malnutrition was the exposure of interest, we found a significant association with Schizoid PD scores. When the sample was restricted to offspring of G1 mothers, even more extensive associations with G2 personality pathology were observed. This study supports a link between parental exposure to childhood adversities and increased personality maladaptivity in the next generation, with some specific patterns worthy of further exploration.
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Affiliation(s)
- Rebecca S Hock
- The Chester M. Pierce MD Division of Global Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Arielle G Rabinowitz
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Cyralene P Bryce
- Barbados Nutrition Study, Ladymeade Gardens No. 1, Bridgetown, Barbados
| | - Garrett M Fitzmaurice
- Department of Biostatistics, Harvard School of Public Health, Boston, MA. and McLean Hospital, Belmont, MA, USA
| | - Paul T Costa Jr
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Janina R Galler
- Division of Pediatric Gastroenterology and Nutrition, Mucosal Immunology and Biology Research Center, MassGeneral Hospital for Children, and Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Hock RS, Bryce CP, Fischer L, First MB, Fitzmaurice GM, Costa PT, Galler JR. Childhood malnutrition and maltreatment are linked with personality disorder symptoms in adulthood: Results from a Barbados lifespan cohort. Psychiatry Res 2018; 269:301-308. [PMID: 30172187 PMCID: PMC6267931 DOI: 10.1016/j.psychres.2018.05.085] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 05/05/2018] [Accepted: 05/29/2018] [Indexed: 10/28/2022]
Abstract
Both childhood malnutrition and maltreatment are associated with mental health problems that can persist into adulthood. Previously we reported that in Barbados, those with a history of infant malnutrition were more likely to report having experienced childhood maltreatment. Few studies, however, address the long-term outcomes of those who have been exposed to both. We assessed the unique and combined associations of a history of early malnutrition and childhood maltreatment with personality pathology in mid-adulthood in participants of the 47-year longitudinal Barbados Nutrition Study. We used the Structured Clinical Interview for DSM-IV-TR Axis II Personality Disorders Personality Questionnaire (SCID-II-PQ) and NEO Personality Inventory-Revised derived Five-Factor Model (NEO PI-R FFM) personality disorder (PD) scores to assess personality pathology, the Childhood Trauma Questionnaire-Short Form (CTQ-SF) to assess childhood maltreatment, and clinical documentation of malnutrition in infancy. We tested the associations of malnutrition and maltreatment with PD scores using linear regression models, unadjusted and adjusted for other childhood adversities. We found increased scores for paranoid, schizoid, avoidant, and dependent PDs among those who had been malnourished and increased scores for paranoid, schizoid, schizotypal, and avoidant PDs among those with higher childhood maltreatment scores. Overall, those exposed to both adversities had even greater PD scores.
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Affiliation(s)
- Rebecca S Hock
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Cyralene P Bryce
- Harvard Medical School, Boston, MA, USA; Barbados Nutrition Study, Bridgetown, Barbados
| | - Laura Fischer
- Children's National Medical Center, Washington, DC, USA
| | - Michael B First
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Garrett M Fitzmaurice
- McLean Hospital, Belmont, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Paul T Costa
- Behavioral Medicine Research Center, Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC, USA
| | - Janina R Galler
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Center on the Developing Child, Harvard University, Cambridge, MA, USA
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Waber DP, Bryce CP, Girard JM, Fischer LK, Fitzmaurice GM, Galler JR. Parental history of moderate to severe infantile malnutrition is associated with cognitive deficits in their adult offspring. Nutr Neurosci 2018; 21:195-201. [PMID: 27885962 PMCID: PMC6091515 DOI: 10.1080/1028415x.2016.1258379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We compared the IQ and academic achievement of the young adult offspring of parents malnourished in infancy and those of a healthy control group in order to test the hypothesis that the offspring of previously malnourished individuals would show IQ and academic deficits that could be related to reduced parental socioeconomic status. METHODS We conducted a group comparison study based on a community sample in Barbados (Barbados Nutrition Study). Participants were adult children ≥16 years of age whose parents had been malnourished during the first year of life (n = 64; Mean age 19.3 years; 42% male) or whose parents were healthy community controls (n = 50; Mean age 19.7 years; 48% male). The primary outcome was estimated IQ (Wechsler Abbreviated Scale of Intelligence); a secondary outcome was academic achievement (Wide Range Achievement Test - Third Edition). Data were analyzed using PROC MIXED with and without adjusting for parental socioeconomic status (Hollingshead Index of Social Position). RESULTS IQ was reduced in the offspring of previously malnourished parents relative to the offspring of controls (9.8 point deficit; P < 0.01), but this difference was not explained by parental socioeconomic status or parental IQ. The magnitude of the group difference was smaller for basic academic skills and did not meet criteria for statistical significance. DISCUSSION The deleterious impact of infant malnutrition on cognitive function may be transmitted to the next generation; however, this intergenerational effect does not appear to be explained by the reduced socioeconomic status or IQ of the parent generation.
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Affiliation(s)
- Deborah P Waber
- a Division of Psychology, Department of Psychiatry , Boston Children's Hospital and Harvard Medical School , Boston , MA , USA
| | | | - Jonathan M Girard
- c Department of Psychiatry , Boston Children's Hospital , Boston , MA , USA
| | - Laura K Fischer
- d Chester M Pierce MD Division of Global Psychiatry, Department of Psychiatry , Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA
| | - Garrett M Fitzmaurice
- e Laboratory for Psychiatric Biostatistics, McLean Hospital and Department of Biostatistics , Harvard T. H. Chan School of Public Health , Boston , MA , USA
| | - Janina R Galler
- d Chester M Pierce MD Division of Global Psychiatry, Department of Psychiatry , Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA
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Valdés-Sosa PA, Galler JR, Bryce CP, Rabinowitz AG, Bringas-Vega ML, Hernández-Mesa N, Taboada-Crispi A. Seeking Biomarkers of Early Childhood Malnutrition's Long-term Effects. MEDICC Rev 2018; 20:43-48. [PMID: 29773777 PMCID: PMC6310420 DOI: 10.37757/mr2018.v20.n2.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Protein-energy malnutrition affects one in nine people worldwide and is most prevalent among children aged less than five years in low-income countries. Early childhood malnutrition can have damaging neurodevelopmental effects, with significant increases in cognitive, neurological and mental health problems over the lifespan, outcomes which can also extend to the next generation. This article describes a research collaboration involving scientists from five centers in Barbados, China, Cuba and the USA. It builds on longer-term joint work between the Barbados Nutrition Study (which, over a 45-year span, has extensively documented nutritional, health, behavioral, social and economic outcomes of individuals who experienced protein-energy malnutrition in the first year of life and healthy controls from the same classrooms and neighborhoods) and the Cuban Neuroscience Center (which has developed low-cost brain imaging methods that can be readily used in low income settings to identify biomarkers for early detection and treatment of adverse consequences of childhood malnutrition). This collaboration, which involved Barbadian, Cuban and US scientists began in the 1970s, when quantitative EEG techniques were applied to EEG data collected in 1977-78, at which time study participants were aged 5-11 years. These EEG records were never fully analyzed but were stored in New York and made available to this project in 2016. These data have now been processed and analyzed, comparing EEG findings in previously malnourished and control children, and have led to the identification of early biomarkers of long-term effects of early childhood protein-energy malnutrition. The next stage of the project will involve extending earlier work by collecting EEG recordings in the same individuals at ages 45-51 years, 40 years later, and comparing findings to earlier data and to these individuals' behavioral and cognitive outcomes. Quantitative EEG biomarkers of the effects of protein-energy malnutrition may help identify children at greatest risk for early malnutrition's adverse neurodevelopmental effects and inform development of targeted interventions to mitigate the long-term adverse effects of protein-energy malnutrition in developing countries. KEYWORDS Protein-energy malnutrition, electroencephalography, EEG, biomarkers, neurosciences, Barbados, Cuba, USA.
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Hock RS, Bryce CP, Waber DP, McCuskee S, Fitzmaurice GM, Henderson DC, Galler JR. Relationship between infant malnutrition and childhood maltreatment in a Barbados lifespan cohort. Vulnerable Child Youth Stud 2017; 12:304-313. [PMID: 30034507 PMCID: PMC6051436 DOI: 10.1080/17450128.2017.1371817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Childhood malnutrition and maltreatment (abuse, neglect) are both prevalent, particularly in resource-limited settings. Despite their known negative impact on child development, there is surprisingly little research documenting their interrelationships. To address this gap, we administered the Childhood Trauma Questionnaire-Short Form (CTQ-SF), a retrospective structured self-report of childhood abuse and neglect, in a Barbadian cohort of 77 adult survivors of infant malnutrition, limited to the first year of life, and 62 healthy controls from the same classrooms and neighborhoods (mean age ± SD = 43.8±2.3 years). This cohort has been followed since birth. Using factor analysis and comparison with archival data addressing similar constructs, we found evidence for reliability and validity of the CTQ-SF in this population. Linear regression analyses, with and without adjusting for childhood household standard of living at three childhood ages, revealed that a history of infant malnutrition was significantly associated with increased levels of self-reported physical neglect in childhood, and, to a somewhat lesser degree, emotional neglect. This study highlights the co-occurrence of infant malnutrition and self-reported maltreatment in childhood in Barbados, with potential public health implications.
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Affiliation(s)
- Rebecca S. Hock
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Cyralene P. Bryce
- Harvard Medical School, Boston, MA, USA
- Barbados Nutrition Study, Bridgetown, Barbados
| | - Deborah P. Waber
- Harvard Medical School, Boston, MA, USA
- Children’s Hospital Boston, Boston, MA, USA
| | - Sarah McCuskee
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Garrett M. Fitzmaurice
- McLean Hospital, Belmont, MA, USA
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - David C. Henderson
- Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Janina R. Galler
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Center on the Developing Child, Harvard University, Cambridge, MA, USA
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Peter CJ, Fischer LK, Kundakovic M, Garg P, Jakovcevski M, Dincer A, Amaral AC, Ginns EI, Galdzicka M, Bryce CP, Ratner C, Waber DP, Mokler D, Medford G, Champagne FA, Rosene DL, McGaughy JA, Sharp AJ, Galler JR, Akbarian S. DNA Methylation Signatures of Early Childhood Malnutrition Associated With Impairments in Attention and Cognition. Biol Psychiatry 2016; 80:765-774. [PMID: 27184921 PMCID: PMC5036982 DOI: 10.1016/j.biopsych.2016.03.2100] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 03/10/2016] [Accepted: 03/12/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Early childhood malnutrition affects 113 million children worldwide, impacting health and increasing vulnerability for cognitive and behavioral disorders later in life. Molecular signatures after childhood malnutrition, including the potential for intergenerational transmission, remain unexplored. METHODS We surveyed blood DNA methylomes (~483,000 individual CpG sites) in 168 subjects across two generations, including 50 generation 1 individuals hospitalized during the first year of life for moderate to severe protein-energy malnutrition, then followed up to 48 years in the Barbados Nutrition Study. Attention deficits and cognitive performance were evaluated with the Connors Adult Attention Rating Scale and Wechsler Abbreviated Scale of Intelligence. Expression of nutrition-sensitive genes was explored by quantitative reverse transcriptase polymerase chain reaction in rat prefrontal cortex. RESULTS We identified 134 nutrition-sensitive, differentially methylated genomic regions, with most (87%) specific for generation 1. Multiple neuropsychiatric risk genes, including COMT, IFNG, MIR200B, SYNGAP1, and VIPR2 showed associations of specific methyl-CpGs with attention and IQ. IFNG expression was decreased in prefrontal cortex of rats showing attention deficits after developmental malnutrition. CONCLUSIONS Early childhood malnutrition entails long-lasting epigenetic signatures associated with liability for attention and cognition, and limited potential for intergenerational transmission.
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Affiliation(s)
- Cyril J. Peter
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Laura K. Fischer
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown MA 02129
| | - Marija Kundakovic
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Paras Garg
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Mira Jakovcevski
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029,Max-Planck Institute for Psychiatry, D-Munich 80804
| | - Aslihan Dincer
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Ana C. Amaral
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA 02129
| | - Edward I Ginns
- Departments of Psychiatry, Neurology, and Clinical Pathology, University of Massachusetts Medical School, Shrewsbury, MA 01545
| | - Marzena Galdzicka
- Department of Pathology, University of Massachusetts Medical School, Shrewsbury, MA 01545
| | | | - Chana Ratner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Deborah P Waber
- Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115
| | - David Mokler
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME
| | | | | | - Douglas L. Rosene
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston MA 02118
| | - Jill A. McGaughy
- Department of Psychology, University of New Hampshire, Durham, NH 03077
| | - Andrew J. Sharp
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Janina R. Galler
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown MA 02129
| | - Schahram Akbarian
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.
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Waber DP, Bryce CP, Fitzmaurice GM, Zichlin ML, McGaughy J, Girard JM, Galler JR. Neuropsychological outcomes at midlife following moderate to severe malnutrition in infancy. Neuropsychology 2014; 28:530-40. [PMID: 24635710 DOI: 10.1037/neu0000058] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To compare neuropsychological profiles of adults who had experienced an episode of moderate to severe protein-energy malnutrition confined to the first year of life with that of a healthy community comparison group. METHOD We assessed neuropsychological functioning in a cohort of Barbadian adults, all of whom had birth weight >2268 g. The previously malnourished group (N = 77, mean age = 38 years, 53% male) had been hospitalized during the first year of life for moderate to severe protein energy malnutrition and subsequently enrolled in a program providing nutrition education, home visits and subsidized foods to 12 years of age. They also had documented, adequate nutrition throughout childhood and complete catch-up in growth by the end of adolescence. The healthy comparison group (N = 59, mean age = 38 years, 54% male) were recruited as children from the same classrooms and neighborhoods. RESULTS Adjusted for effects of standard of living during childhood and adolescence and current intellectual ability level, there were nutrition group differences on measures of cognitive flexibility and concept formation, as well as initiation, verbal fluency, working memory, processing speed, and visuospatial integration. Behavioral and cognitive regulation were not affected. CONCLUSIONS Postnatal malnutrition confined to the first year of life is associated with neurocognitive compromise persisting into midlife. Early malnutrition may have a specific neuropsychological signature, affecting response initiation to a somewhat greater extent than response inhibition.
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Affiliation(s)
| | | | | | | | - Jill McGaughy
- Department of Psychology, University of New Hampshire
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Waber DP, Bryce CP, Girard JM, Zichlin M, Fitzmaurice GM, Galler JR. Impaired IQ and academic skills in adults who experienced moderate to severe infantile malnutrition: a 40-year study. Nutr Neurosci 2013; 17:58-64. [PMID: 23484464 DOI: 10.1179/1476830513y.0000000061] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES To evaluate IQ and academic skills in adults who experienced an episode of moderate-to-severe infantile malnutrition and a healthy control group, all followed since childhood in the Barbados Nutrition Study. METHODS IQ and academic skills were assessed in 77 previously malnourished adults (mean age = 38.4 years; 53% male) and 59 controls (mean age = 38.1 years; 54% male). Group comparisons were carried out by multiple regression and logistic regression, adjusted for childhood socioeconomic factors. RESULTS The previously malnourished group showed substantial deficits on all outcomes relative to healthy controls (P < 0.0001). IQ scores in the intellectual disability range (< 70) were nine times more prevalent in the previously malnourished group (odds ratio = 9.18; 95% confidence interval = 3.50-24.13). Group differences in IQ of approximately one standard deviation were stable from adolescence through mid-life. DISCUSSION Moderate-to-severe malnutrition during infancy is associated with a significantly elevated incidence of impaired IQ in adulthood, even when physical growth is completely rehabilitated. An episode of malnutrition during the first year of life carries risk for significant lifelong functional morbidity.
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Galler JR, Bryce CP, Zichlin ML, Waber DP, Exner N, Fitzmaurice GM, Costa PT. Malnutrition in the first year of life and personality at age 40. J Child Psychol Psychiatry 2013; 54:911-9. [PMID: 23488644 PMCID: PMC3686988 DOI: 10.1111/jcpp.12066] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Early childhood malnutrition is associated with cognitive and behavioral impairment during childhood and adolescence, but studies in adulthood are limited. METHODS Using the NEO-PI-R personality inventory, we compared personality profiles at 37-43 years of age (M 40.3 years, SD 1.9) of Barbadian adults who had experienced moderate-to-severe protein-energy malnutrition (PEM) in the first year of life (n = 77) with healthy controls, who were former classmates of the index cases and were matched for age, gender, and handedness in childhood (n = 57). The previously malnourished participants had been rehabilitated, with good health and nutrition documented up to 12 years of age, and study participants were followed longitudinally from childhood to 40 years. Group comparisons were adjusted for childhood and adolescent standard of living, with and without correcting for IQ. RESULTS At the broad domain or factor level, previously malnourished participants had higher scores on Neuroticism and lower scores on Extraversion, Openness, Agreeableness, and Conscientiousness than did the healthy controls. At the subdomain or facet level, previously malnourished participants reported more anxiety, vulnerability, shyness and lowered sociability, less intellectual curiosity, greater suspiciousness of others, a more egocentric than altruistic orientation, and a lowered sense of efficacy or competence. CONCLUSIONS Malnutrition limited to the first year of life with good health and nutrition documented up to 12 years of age is associated with a significant overrepresentation of adult personality trait scores outside of the average range. This outcome has important implications for a variety of important life and mental health outcomes.
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Affiliation(s)
- Janina R. Galler
- Judge Baker Children's Center, Harvard Medical School, Boston, MA,Barbados Nutrition Study, Ladymeade Gardens No. 1, Bridgetown, Barbados,Correspondence to: Janina R. Galler, M.D., Judge Baker Children’s Center, Harvard Medical School, 53 Parker Hill Avenue, Boston, MA 02120 USA. Phone: (617) 278-4148; Fax (617) 278-4156;
| | - Cyralene P. Bryce
- Barbados Nutrition Study, Ladymeade Gardens No. 1, Bridgetown, Barbados
| | | | | | - Natalie Exner
- Department of Biostatistics, Harvard School of Public Health, Boston, MA
| | | | - Paul T. Costa
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C
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Thomas JM, Zichlin ML, Bryce CP, Galler JR. Preliminary study on the intergerational effect of postnatal malnutrition on attention. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.618.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Julian M Thomas
- Judge Baker Children's CenterBostonMA
- Harvard Medical SchoolBostonMA
| | | | | | - Janina R Galler
- Judge Baker Children's CenterBostonMA
- Harvard Medical SchoolBostonMA
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Galler JR, Bryce CP, Waber DP, Zichlin ML, Fitzmaurice GM, Costa PT. MATERNAL DEPRESSIVE SYMPTOMS IN CHILDHOOD AND OPENNESS TO EXPERIENCE IN ADULTHOOD. Imagin Cogn Pers 2013; 33:151-163. [PMID: 25506118 PMCID: PMC4261157 DOI: 10.2190/ic.33.1-2.e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We examined the role of maternal depressive symptoms reported during childhood as a predictor of an important personality trait, Openness to Experience (O), in middle adulthood. Participants were 95 adults (38 previously malnourished, 57 control, mean age 42.1 years) who had been followed longitudinally since childhood by the Barbados Nutrition Study. Maternal depressive symptoms had been measured when the participants were 5-11 years of age by the General Adjustment and Morale Scale; O was measured in adulthood by the Revised NEO-Personality Inventory (NEO-PI-R). Multiple regression analyses, adjusted for childhood household standard of living, showed a significant main effect on O of maternal depressive symptoms (p < 0.01). Maternal depression also attenuated the significant effect of childhood malnutrition by 14%. Maternal depressive symptoms in childhood may therefore play a causal role in adult personality, in particular Openness to Experience, with implications for creativity.
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Affiliation(s)
- Janina R Galler
- Judge Baker Children's Center, Harvard Medical School, Boston, Massachusetts
| | | | - Deborah P Waber
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Miriam L Zichlin
- Judge Baker Children's Center, Harvard Medical School, Boston, Massachusetts
| | | | - Paul T Costa
- Duke University Medical Center, Durham, North Carolina
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Galler JR, Bryce CP, Waber DP, Hock RS, Harrison R, Eaglesfield GD, Fitzmaurice G. Infant malnutrition predicts conduct problems in adolescents. Nutr Neurosci 2012; 15:186-92. [PMID: 22584048 DOI: 10.1179/1476830512y.0000000012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The purpose of this study was to compare the prevalence of conduct problems in a well-documented sample of Barbadian adolescents malnourished as infants and a demographic comparison group and to determine the extent to which cognitive impairment and environmental factors account for this association. METHODS Behavioral symptoms were assessed using a 76-item self-report scale in 56 Barbadian youth (11-17 years of age) with histories of protein-energy malnutrition (PEM) limited to the first year of life and 60 healthy classmates. Group comparisons were carried out by longitudinal and cross-sectional multiple regression analyses at 3 time points in childhood and adolescence. RESULTS Self-reported conduct problems were more prevalent among previously malnourished youth (P < 0.01). Childhood IQ and home environmental circumstances partially mediated the association with malnutrition. Teacher-reported classroom behaviors at earlier ages were significantly correlated with youth conduct problems, confirming the continuity of conduct problems through childhood and adolescence. DISCUSSION Self-reported conduct problems are elevated in children and adolescents with histories of early childhood malnutrition. Later vulnerability to increased conduct problems appears to be mediated by the more proximal neurobehavioral effects of the malnutrition on cognitive function and by adverse conditions in the early home environment.
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Affiliation(s)
- Janina R Galler
- Judge Baker Children's Center, 53 Parker Hill Avenue, Boston, MA 02120, USA.
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Galler JR, Bryce CP, Zichlin ML, Fitzmaurice G, Eaglesfield GD, Waber DP. Infant malnutrition is associated with persisting attention deficits in middle adulthood. J Nutr 2012; 142:788-94. [PMID: 22378333 PMCID: PMC3301995 DOI: 10.3945/jn.111.145441] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Infantile malnutrition is known to be associated with cognitive and behavioral impairment during childhood and adolescence. Data pertaining to longer-term effects on behavioral outcomes in adulthood are limited. In this study, we report associations between infantile malnutrition and attention problems in adults at midlife. Attention problems were assessed by the Conners Adult ADHD Rating Scales (CAARS) and the Conners Continuous Performance Test (CPT) in 145 Barbadian adults (aged 37-43 y) who had been followed longitudinally since childhood. Previously malnourished participants (n = 80) had experienced moderate to severe protein-energy malnutrition in the first year of life and were successfully rehabilitated thereafter. They were compared with healthy adults (n = 65) who were former classmates of the index cases and who had been matched for age, sex, and handedness in childhood. Multiple regression analyses showed persisting effects of childhood malnutrition on both the CAARS and the CPT, independent of effects of household standard of living assessed in childhood. The malnutrition effect on the CAARS ratings was independent of IQ, whereas this effect was attenuated for the CPT after adjustment for IQ. Teacher-reported attention problems in childhood predicted attention problems in adulthood, indicating continuity over the life span. Infantile malnutrition may have long-term effects on attentional processes nearly 40 y after the episode, even with excellent long-term nutritional rehabilitation and independent of socioeconomic conditions in childhood and adolescence. This finding has major public health implications for populations exposed to early childhood malnutrition.
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Affiliation(s)
- Janina R. Galler
- Judge Baker Children's Center, Harvard Medical School, Boston, MA,Barbados Nutrition Study, Bridgetown, Barbados,To whom correspondence should be addressed. E-mail:
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Galler JR, Bryce CP, Waber DP, Medford G, Eaglesfield GD, Fitzmaurice G. Early malnutrition predicts parent reports of externalizing behaviors at ages 9-17. Nutr Neurosci 2012; 14:138-44. [PMID: 21902884 DOI: 10.1179/147683011x13009738172521] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To determine whether externalizing behaviors are more prevalent in youth who have experienced an episode of malnutrition in the first year of life than in healthy comparison youth. METHOD Parents of previously malnourished youth and a matched healthy comparison group completed a behavior rating scale when the youth were 9-15 years of age and again, 2 years later, when they were 11-17 years of age. Longitudinal multiple regression analysis was applied to evaluate group differences adjusted for baseline age, sex, household standard of living, and maternal depressive symptoms. RESULTS Early childhood malnutrition was associated with problems in executive functioning at both occasions. Malnutrition also predicted discernibly higher parent-reported levels of aggression toward peers at 9-15 years than at 11-17 years. These findings were independent of baseline age, sex, household standard of living, and maternal depressive symptoms. Problem behaviors in general decreased during follow-up. CONCLUSION Parents report persisting problems with executive functioning through adolescence in youth who suffered an episode of moderate-to-severe protein-energy malnutrition in the first year of life, while reports of aggression, although more common when this cohort were younger, did not persist at follow-up.
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Affiliation(s)
- Janina R Galler
- Judge Baker Children's Center, Harvard Medical School, Boston, MA 02120, USA.
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Galler JR, Bryce CP, Waber D, Hock R, Exner N, Eaglesfield D, Fitzmaurice G, Harrison R. Early childhood malnutrition predicts depressive symptoms at ages 11-17. J Child Psychol Psychiatry 2010; 51:789-98. [PMID: 20331492 PMCID: PMC2906663 DOI: 10.1111/j.1469-7610.2010.02208.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND We examined the prevalence of depressive symptoms in Barbadian youth with histories of infantile malnutrition and in a healthy comparison group and the extent to which the effect of malnutrition was mediated/moderated by maternal depression. METHODS Depressive symptoms were assessed using a 20-item scale administered to youths (11-17 years of age) who had experienced an episode of protein-energy malnutrition (marasmus or kwashiorkor) during the first year of life and in a comparison group of healthy youths without a history of malnutrition. Their mothers completed the same questionnaire on the same test on three occasions when their children were 5-17 years of age at 2-5-year intervals. RESULTS The prevalence of depressive symptoms was elevated among previously malnourished youth relative to healthy comparison children (p < .001). When youth depression scores were subjected to a longitudinal multiple regression analysis, adjusting for the effect of maternal depressive symptoms, significant effects due to the history of early childhood malnutrition remained and were not discernibly attenuated from an unadjusted analysis. We also found significant independent effects of maternal depressive symptoms on youth depressive symptoms. CONCLUSION Early childhood malnutrition contributed independently to depressive symptoms in youths who experienced a significant episode of malnutrition in the first year of life. This relationship was not mediated or moderated by the effects of maternal depression. Whether the later vulnerability to depression is a direct effect of the episode of malnutrition and related conditions early in life or whether it is mediated by the more proximal neurobehavioral effects of the malnutrition remains to be determined.
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Affiliation(s)
- JR Galler
- Judge Baker Children’s Center, Harvard Medical School, Boston MA
| | - CP Bryce
- Barbados Nutrition Study, Bridgetown, Barbados
| | - D Waber
- Children’s Hospital, Boston, MA
| | - R Hock
- Judge Baker Children’s Center, Harvard Medical School, Boston MA
| | - N Exner
- Judge Baker Children’s Center, Harvard Medical School, Boston MA
| | - D Eaglesfield
- Judge Baker Children’s Center, Harvard Medical School, Boston MA
| | - G Fitzmaurice
- Harvard School of Public Health, Boston, MA and McLean Hospital, Belmont, MA
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