According to the World Bank, undernourishment has declined globally from 19 percent to 11 percent in the past quarter century, while child stunting fell from 40 percent to 23 percent. But as populations and in turn food demand continues to grow, particularly in Asia and Africa, more rapid downward trends are needed. Food poverty is about not only the quantity of food available, but the quality: in other words, the vitamins and minerals that give us nutrition. This is particularly important for children. In China, for example, it has been proven that children who are deficient in iron or other nutrients do worse in school than their peers.
The statistics, however lower they are compared to 25 years ago, are cause for concern. According to the World Health Organisation, 50 million children are affected by life-threatening acute malnutrition. A further 156 million under the age of 5 have stunted growth because they are chronically undernourished. Research into combatting childhood hunger is increasingly looking at the earliest stages of development – from birth to three years old – and the long-term impacts of malnutrition during these years. The data found so far paints a chilling picture.
A collection of studies published in the Lancet showed that malnutrition in the first two years of life could be irreversible. The researchers also found that at least a third of all child deaths (numbered 3.5 million yearly in 2008) was attributed to malnutrition. Another such study, undertaken from a socio-economic point of view, found that children under 3 who were already stunted went on to do worse in school, earn less as adults, as well as being generally less healthy later in life – and by one measure, caused an 8% drop in productivity in affected countries. These studies have helped make donors and institutions like the World Bank think of early childhood health as not only an important humanitarian concern, but as a long-term investment.
Led by Shahria Hafiz Kakon, a recent feature in Nature took a similarly long-term perspective as researchers looked at brain development in young children and babies in Bangladesh. They used non-intrusive techniques such as MRI (Magnetic Resonance Imaging) and fNIRS (functional Near-Infrared Spectroscopy), which is easier to use for young children as it does not require the use of a large machine. While fNIRS measures blood flow in the brain to give a rough map of neuronal activity, MRI uses the magnetic properties of our brain cells to create a contrast map of the different areas of our brains. The research, funded by the Bill & Melinda Gates Foundation, looks at differences between MRI (in 12 children, aged 2 to 3 months) and fNIRS scans (in 130 children, aged 36 months) of children whose growth is deemed stunted, with children of similar age but healthy growth.
One early result was a significant reduction in grey matter detected by MRI – which is particularly worrying when observed as early as in 2 months old babies. In previous studies, a decreased amount of grey matter has led to a slower take-up of language and diminished visual memory. The fNIRS test points to differences in how healthy and stunted children respond to stimuli – healthy children seem to respond more to social stimuli, as opposed to non-social stimuli for stunted children – although what the implications of this are will only become clear when the children get follow-ups as they grow older. A last method to study the brain – EEG, Electroencephalography – pointed to the fact that brainwaves associated with problem solving were stronger in stunted children than in their healthy counterparts. The going hypothesis is that this is explained by the difficult life these children face.
One clear caveat from the Bangladesh study is that it does not seem to control for external variables which could very well affect brain development, such as sanitation or physical and mental health of the mother. Indeed, even the most successful nutritional programmes typically don’t manage to alleviate all growth stunting, indicating either that the nutritional programme leaves to be desired, or that there are other factors causing stunting.
But this research has yet to run its course. Another collection of socio-economic studies in Guatemala had to collect data over 35 years to assess the impacts of its nutritional programme. One stated aim of Dr Kakon’s research, however, is to create benchmarks for future programmes – should it be possible to detect brain patterns that can predict better future outcomes, this would be a formidable shortcut to measure the success of nutritional or developmental programmes in poorer countries (or indeed in richer ones). Now that the children are 5 years old, the latest step is to take new measurements (including IQ tests) to then be correlated back to the older data.
Regardless, it’s already clear that stunted growth is but one outer physical sign of hunger. The challenge therefore becomes not only about helping people cope with chronic lack of food, but avoiding losing an entire generation to stunted development.