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Peer-reviewedCC BY 4.0PLOS Global Public Health

Growth and cognition over eight years in three sites of the MAL-ED cohort study

  • Amber R. Huggins1
  • Rebecca J. Scharf2
  • Elizabeth T. Rogawski McQuade3
  • Erling Svensen4
  • Angelina Maphula5
  • Eliwaza Bayo6
  • Ladislaus Blacy7
  • Paula Pamplona E. de Souza8
  • Hilda Costa
  • Eric R. Houpt
  • Pascal O. Bessong
  • Estomih Mduma
3 more authors
  • Aldo A. M. Lima
  • Mark D. DeBoer
  • Richard L. Guerrant
8 affiliations
  1. 1Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
  2. 2Department of Pediatrics, University of Virginia, Charlottesville, Virginia, United States of America
  3. 3Department of Epidemiology, Emory University, Atlanta, Georgia, United States of America
  4. 4Haukeland University Hospital, Bergen, Norway
  5. 5University of Venda, Thohoyandou, South Africa
  6. 6Haydom Lutheran Hospital, Haydom, Tanzania
  7. 7Universidade Federal do Ceara, Fortaleza, Brazil
  8. 8Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, United States of America
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Abstract

The objective of this study was to examine if height at 2 years, 5 years, and 6–8 years of age was related to school-age cognitive development in low resource settings. Some studies report improved scores in those who catch up, while others found no improvement. We hypothesize that persistent stunting will be negatively associated with cognition and that children who experienced catch-up growth would show improved cognition.Follow-up anthropometry and cognitive assessments at 6–8 years were completed in the Brazil, South Africa, and Tanzania MAL-ED cohorts. Semantic and phonemic fluency and reasoning skills were assessed with the Developmental NEuroPSYchological test and Raven Coloured Matrices, respectively. Stunting at 2, 5, and 6–8 years was used to categorize growth into persistently stunted, early catch-up, late catch-up, and never stunted. Multivariable linear regression was used to estimate relationships between linear growth, stunting, and catch-up growth and 6–8-year-old cognition.Stunting prevalence decreased with each follow-up assessment from 40.1% at 2 years to 13.4% at 6–8 years. Height at each age was negatively associated with cognition (Semantic Fluency: 0.2 z-scores, 95% CI: 0.1, 0.3). Persistent stunting was associated with decreased cognitive scores at 6–8 years (Semantic Fluency: -0.4 z-scores, 95% CI: -0.8, -0.03). Children with catch-up growth, both early (Semantic Fluency: -0.4 z-scores, 95% CI: -0.6, -0.1) and late (Semantic Fluency: -0.4 z-scores, 95% CI: -0.8, -0.1), did not have improved scores compared to those persistently stuntedLinear growth at 2 years remains an important indicator of cognitive development in late childhood. Efforts to reduce early stunting may continue as catch-up growth is not always associated with improved cognitive functioning.

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Cite

BibTeXRIS
BibTeX
@article{huggins2026growth,
  title = {{Growth and cognition over eight years in three sites of the MAL-ED cohort study}},
  author = {Amber R. Huggins and Rebecca J. Scharf and Elizabeth T. Rogawski McQuade and Erling Svensen and Angelina Maphula and Eliwaza Bayo and Ladislaus Blacy and Paula Pamplona E. de Souza and Hilda Costa and Eric R. Houpt and Pascal O. Bessong and Estomih Mduma and Aldo A. M. Lima and Mark D. DeBoer and Richard L. Guerrant},
  journal = {PLOS Global Public Health},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pgph.0007217},
  url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007217},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Growth and cognition over eight years in three sites of the MAL-ED cohort study
AU  - Amber R. Huggins
AU  - Rebecca J. Scharf
AU  - Elizabeth T. Rogawski McQuade
AU  - Erling Svensen
AU  - Angelina Maphula
AU  - Eliwaza Bayo
AU  - Ladislaus Blacy
AU  - Paula Pamplona E. de Souza
AU  - Hilda Costa
AU  - Eric R. Houpt
AU  - Pascal O. Bessong
AU  - Estomih Mduma
AU  - Aldo A. M. Lima
AU  - Mark D. DeBoer
AU  - Richard L. Guerrant
PY  - 2026
DA  - 2026/09/11
JO  - PLOS Global Public Health
DO  - 10.1371/journal.pgph.0007217
UR  - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007217
AB  - The objective of this study was to examine if height at 2 years, 5 years, and 6–8 years of age was related to school-age cognitive development in low resource settings. Some studies report improved scores in those who catch up, while others found no improvement. We hypothesize that persistent stunting will be negatively associated with cognition and that children who experienced catch-up growth would show improved cognition.Follow-up anthropometry and cognitive assessments at 6–8 years were completed in the Brazil, South Africa, and Tanzania MAL-ED cohorts. Semantic and phonemic fluency and reasoning skills were assessed with the Developmental NEuroPSYchological test and Raven Coloured Matrices, respectively. Stunting at 2, 5, and 6–8 years was used to categorize growth into persistently stunted, early catch-up, late catch-up, and never stunted. Multivariable linear regression was used to estimate relationships between linear growth, stunting, and catch-up growth and 6–8-year-old cognition.Stunting prevalence decreased with each follow-up assessment from 40.1% at 2 years to 13.4% at 6–8 years. Height at each age was negatively associated with cognition (Semantic Fluency: 0.2 z-scores, 95% CI: 0.1, 0.3). Persistent stunting was associated with decreased cognitive scores at 6–8 years (Semantic Fluency: -0.4 z-scores, 95% CI: -0.8, -0.03). Children with catch-up growth, both early (Semantic Fluency: -0.4 z-scores, 95% CI: -0.6, -0.1) and late (Semantic Fluency: -0.4 z-scores, 95% CI: -0.8, -0.1), did not have improved scores compared to those persistently stuntedLinear growth at 2 years remains an important indicator of cognitive development in late childhood. Efforts to reduce early stunting may continue as catch-up growth is not always associated with improved cognitive functioning.
SN  - 2767-3375
ER  -