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Malnutrition’s Side Effects

MED prof finds malnutrition can lead to ADD

About one-third of the world’s children, from sub-Saharan Africa to the Mississippi Delta, suffer from some type of malnutrition. And although the symptoms in the most severe cases — bloated bellies, brittle hair, wizened faces — are stark, even mild episodes of malnutrition early in life can lead to problems that persist long after a child has recovered.

In her decades-long study of the effects of malnutrition on children in Barbados, Janina Galler, a professor of psychiatry and public health at the School of Medicine, has found that many of these children develop attention deficit disorder and show signs of the condition even at 18 years of age and as adults.

“What we found in our population was that socioeconomic conditions and the home environments contributed only minimally to the attention deficit finding,” says Galler, director of the Center for Behavioral Development and Mental Retardation at Boston Medical Center. “We were able to conclude that the overall major contributor to the attention deficits was the early history of malnutrition.” She is following up on study participants, now in their 30s and 40s, to find out if they continue to struggle with the condition and what impact early malnutrition has had on their lives in general.


Janina Galler, a MED
professor of psychiatry
and public health. Photo
by Frank Curran

In 1973 Galler began studying 204 children, ages 5 to 11, who had normal birth weights but had experienced an episode of moderate to severe malnutrition during their first year, along with 129 healthy children. Galler and her team looked at IQ, behavior, neurologic function, physical growth and development, and home environment.

“When we first began this work, there were very few hypotheses, because there had not been too many children who had survived malnutrition,” Galler says. “The going theory at that time was that those children would be mentally retarded.” Her team found that an episode of malnutrition early in life had a minimal impact on IQ. But 60 percent of those children had symptoms of attention deficit disorder: short attention spans, poor memory, distractibility, restlessness, and inability to complete tasks.

“The most striking finding of that first phase of our study,” Galler says, “was the fourfold increase — completely unanticipated — in attention deficits in previously malnourished children as compared with the healthy comparison children, 15 percent of whom had attention deficits. We were so amazed we felt obligated to replicate, and we did so by looking at a number of different tests that teachers administered to the children.”

Further study showed that the children with a history of early malnutrition and who were subsequently diagnosed with attention deficits at ages five to seven did not perform as well on high school entrance exams as did those without that history. In Barbados, all 11-year-olds take these exams, which determine whether they will attend an academic high school or a trade school.

“Performance on this test is critically important to success in this island nation,” Galler says. “So we were intrigued to find not only that the history of early malnutrition is associated with reduced scores on the common entrance exam, but even more specifically, that whether or not you had an attention deficit disorder diagnosed at ages five to seven was the key determinant. It was not IQ, not environment.”

Galler and her team replicated the results when the children reached early adolescence and late adolescence. By age 18, she says, 50 percent of the previously malnourished children still showed signs of attention deficit disorder. The work debunked the conventional wisdom that children grow out of attention deficit disorder once they hit puberty, she says.

In the lab, Galler is studying the effects of malnutrition on brain development in animals. Among the theories she’s testing is that prenatal malnutrition delays the development of neurons. “When neuronal cells are delayed in reaching their final destination — they move during development — it may be that this delay does not allow the proper connections to be built,” she says.

Why is it that a country like Barbados — socioeconomically homogeneous, with a higher per capita income than most other developing nations — would struggle with early childhood malnutrition? In the population Galler studied in the 1970s, 80 percent of household income — derived mainly from the cultivation of sugar — went to food and housing.

“That doesn’t leave much for hard times,” she says. “When sugar cane markets were low globally, they had reduced income, and the appearance of malnutrition skyrocketed.” Barbados’ economy has expanded to include tourism, among other things, and its public health measures have improved, dramatically reducing the incidence of early childhood malnutrition. “Malnutrition has virtually vanished in Barbados,” she says.

Galler recently received funding from the National Institutes of Health to find out if the study participants, now adults, continue to struggle with attention deficit disorder and if they suffer from mental health problems, such as depression. She also is pursuing funding to look at the relationship between early malnutrition and hypertension and cardiovascular disease. About one-third of the adults in Barbados have high blood pressure, she says. In light of that statistic, her team reviewed its early data and found signs of hypertension in the children participating in the study. “We may have the opportunity to look at the relationship between early malnutrition, stress, and these conditions,” Galler says. Finally, she plans to evaluate the school-aged children of the original study participants to find out if they have attention deficit disorder. “We’re interested in the intergenerational consequences,” she says.

Her work has shown that the earlier intervention begins, the better. “It’s not as though it’s all over,” she says. “I have some very remarkable patients who have had severe attention deficit disorders but have done very well in their lives. So, early intervention, dealing with the whole child, including behavior, and dealing with environment and nutrition are really the three key points that are needed in public policy.”

This article was originally published in the winter 2006–2007 issue of Bostonia.

Cynthia K. Buccini can be reached at cbuccini@bu.edu.