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PEDIATRICS Vol. 112 No. 5 November 2003, pp. 1156-1162

Effects of Early Childhood Supplementation on the Educational Achievement of Women

Haojie Li, MD, PhD*, Huiman X. Barnhart, PhD{ddagger}, Aryeh D. Stein, MPH, PhD*,§ and Reynaldo Martorell, PhD*,§

* Division of Biological and Biomedical Sciences, Nutrition and Health Sciences Program
{ddagger} Department of Biostatistics
§ Department of International Health, Rollins School of Public Health, Emory University, Atlanta, Georgia

Objective. Malnutrition during early childhood has been suggested to cause functional disadvantages in adults, including reduced intelligence and lower educational achievement (EA). We assessed the effects of improved nutrition in early life on the EA of women in 4 rural Guatemalan villages.

Methods. The study sample comprised 130 female singletons exposed to either Atole (53%, 91 kcal and 6.4 g protein/100 mL) or Fresco (47%, 33 kcal/100 mL, no protein) during the prenatal period and the first 2 years of life. EA was assessed at the ages of 22 to 29 years by knowledge, numeracy, and several reading tests. A summary measure of EA was computed based on 5 tests, and outcome variables were categorized into quintiles. Analysis was based on a proportional odds model. Generalized estimating equations were used to account for sibling clustering.

Results. Overall, 36.2% of women completed primary school. Women exposed to Atole had better EA than those exposed to Fresco (odds ratio [OR]: 2.8; 95% confidence interval [CI], 1.4, 5.4), with a significant treatment-by-schooling interaction. Atole was not associated with EA (OR: 1.5; 95% CI: 0.7, 3.2) among women who did not complete primary school, whereas among those who completed primary school, Atole was associated with improved EA (OR: 13.7; 95% CI: 3.7, 50.8).

Conclusions. We conclude that better nutrition during early childhood improved adult EA, but only among children who completed primary school.

Key Words: early childhood nutrition • supplementation • schooling • adulthood • educational achievement • longitudinal study • Guatemala

Abbreviations: EA, educational achievement • INCAP, Institute of Nutrition of Central America and Panama • SES, socioeconomic status • TRT, treatment • GRADE, schooling • CI, confidence interval • OR, odds ratio • GA, gestational age

Received for publication Aug 26, 2002; Accepted Feb 18, 2003.


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