ANNUAL REVIEWS
Further
Quick links to online content
Ann. Rev. Psycho/. 1978. 29:157-77 Copyright © 1978 by Annual Reviews Inc. All rights reserved
Annu. Rev. Psychol. 1978.29:157-177. Downloaded from www.annualreviews.org Access provided by Technische Universiteit Eindhoven on 02/02/15. For personal use only.
NUTRITION, MALNUTRITION,
+285
AND BEHAVIOR Josef Brozek 1 Department of Psychology, Lehigh University, Bethlehem, Pennsylvania 1 8015
The etiology of chronic, subclinical, and of acute, clinical energy-protein malnutri tion is multifactorial, with poverty as the subsoil, the deficiency of specific nutrients as a frequent complicating factor, and infection and parasitism as added stresses. The effects of severe malnutrition are also mUltiple and appear in somatic growth, growth and development of the central nervous system, metabolism, and organ function as well as in behavior. The focus of the present review is on human behavior, with special reference to young children. We regret to have to leave out whole areas (brain development, behavioral animal research) and a large array of specific topics: factors controlling food intake, from physiological mechanisms to food habits; overnutrition leading to obesity; impaired utilization of nutrients due to inborn errors of metabolism, such as phenylketonuria; and in particular, effects of the deficits of specific nutrients such as iodine, iron, and vitamin A. The literature on generalized (energy-protein) malnutrition is unwieldy, with differences in terminology and also in the criteria used to characterize the severity of malnutrition. Finally, the frequent inconsistencies in the results do not make for a straightforward presentation. What can be offered is a "cumulative record," not a synthesis. Any attempt at a synthesis must be preceded by a series. of critical analyses dealing with specific issues, such as the comparability of measures of the severity of malnu trition across studies, importance of the child's age at time of hospitalization for clinical malnutrition, relative effects of subclinical and clinical malnutrition on specific mental functions (e.g. performance vs verbal I.Q.), and the etiology of behavioral impairment in malnourished children. IThe idea for this review evolved in the context of the activities of the U.S. Malnutrition Panel, a component of the U.S.-Japan Medical Cooperative Science Program. The acquisition of the literature
was
aided by a Nutrition Foundation grant.
Warm thanks are due to Lehigh University's Interlibrary Loan Service and to Ms. Christine L. Roysdon, reference librarian par excellence. 157
0066-4308/78/0201-0157$01.00
158
BROZEK
This review will first indicate some of the basic earlier literature and will then point out important newer sources of information-bibliographies, proceedings, and reviews. Thereafter we will consider effects of both subclinical and clinical general ized (energy-protein) malnutrition. Finally, we will take up bridges to the future needs and opportunities for research.
Annu. Rev. Psychol. 1978.29:157-177. Downloaded from www.annualreviews.org Access provided by Technische Universiteit Eindhoven on 02/02/15. For personal use only.
BRIDGES TO THE MORE DISTANT PAST The early literature was considered in the 1950 collaborative treatise on The Biology ofHuman Starvation (78). Twenty years ago, the topic was taken up in the Annual Review ofPsychology (17). More extensively, the output of the experimental studies of the 1940s and the 1950s was covered in an epilogue (16) to the proceedings of the 1957 Symposium on Nutrition and Behavior (15) and in several reviews (18, 23, 24), including a survey of the Russian work (19). Extensive experimental human investigations in young adult volunteers carried out in the Laboratory ofPhysiologi cal Hygiene, University of Minnesota, dealt primarily with vitamins (20) and with restriction of calories, varying in severity and duration (21). Valuable information on the literature of the 1950s and 1960s concerned with the effects of severe deficiency of calories and protein is contained in the reviews by Cravioto (36), in reference to research on children, and by Barnes (1), in reference to animal studies. The publication of Scrimshaw's review (154) covering both animal and human research almost coincided in time with the I:omprehensive 1967 MIT conference which he organized. The editors of the proce:edings (156), having been exposed to a veritable flood of information, stressed thl� need for careful additional studies, multidisciplinary in nature, carried out in a wide variety of cultural settings, and taking into account the influence of such confounding variables as infectious diseases and the sociopsychological influences on the young child. This was a challenge to the then "visible future." For the present purposes, the last 10 years constitute the "past" to which we shall address ourselves, with emphasis on the more recent publications.
NEWER SOURCES OF INFORMATION Bibliographies
While Rechcigl's general bibliography (140) contains several sections that are di rectly relevant, no comprehensive bibliography of the literature on malnutrition and behavior exists in print. Springer (160) compiled an annotated bibliography on nutrition and mental retardation. AFRICANA In a 1969 bibliography (71) one finds a short subsection on "Nutri tion" (p. 24). In addition, relevant references are contained in some of the other parts of the section on physiological psychology and in the section on developmental psychology. This applies also to a 1973 bibliography (74).
NUTRITION, MALNUTRITION, AND BEHAVIOR
159
Annu. Rev. Psychol. 1978.29:157-177. Downloaded from www.annualreviews.org Access provided by Technische Universiteit Eindhoven on 02/02/15. For personal use only.
Proceedings
In the area of research on malnutrition and behavior, the proceedings of symposia and conferences represent particularly important channels of publication. The mam moth 1967 MIT conference (156) was followed by a series of meetings and symposia held, in sequence, at Tysoland, Sweden (9), Lausanne, Switzerland (172), Bellagio, Italy (68), Norman, Oklahoma (112),Palo Alto, California (133), Mayaguez,Puerto Rico (76), Amsterdam, Holland (4), Miami, Florida (144), London, England (33), Mona, Jamaica (121), Chiang Mai, Thailand (117), Valencia, Spain (25), New York (157), Burg Wartenstein, Austria (152), and Saltsjobaden, Sweden (46, 184). The references to the relevant contributions were listed and classified in a separate communication (22). In addition to these "special" conferences and symposia there were other meet ings, held in the framework of various national [New York (116)] and international organizations [San Juan, Puerto Rico (134), Mexico City (28), New Delhi, India (11)]. Overviews
The statement of the Subcommittee (now Committee) on Nutrition, Brain Develop ment and Behavior (165) is a "position paper," not a review of literature. It stresses the complex interactions between diet, socioeconomic environment, and behavior, and the structural, biochemical, and neurophysiological roots of behavior. While human studies are considered essential, the importance of the behavioral studies using animal models is acknowledged. The overview closes with general consider ations of needed research. Among the specific topics on which inadequate informa tion is available at present, the overview singles out the effects of "hunger" on school performance (cf 137). A booklet published by the National Institute of Child Health and Human Development (139) provides a readable summary of findings on the effects of various forms of malnutrition on learning; a brief list of references is appended. Reviews
The reviews of the literature on malnutrition and behavior, as well as the primary literature, are widely scattered. Before we attempt to list and classify them, three volumes should be noted that survey, in separate chapters, various segments of the field. The magnum opus by Dodge, Prensky & Feigin (52) covers the morphological, biochemical, physiological, as well as the psychological aspects of normal cerebral maturation and the effects of protein-calorie malnutrition on somatic growth and on the growth of the nervous system in animals (pp. 252-304) and in man (pp. 305-65), including the behavioral aspects. Attention is given also to selected miner als (especially iodine), vitamins, and disorders of amino acid metabolism. Extensive lists of references are appended to individual chapters, with some 500 references cited in the chapter on "Influence of protein-calorie malnutrition on the human nervous system" alone.
Annu. Rev. Psychol. 1978.29:157-177. Downloaded from www.annualreviews.org Access provided by Technische Universiteit Eindhoven on 02/02/15. For personal use only.
160
BROZEK
Manocha's treatise (100) is action oriented,with several closing chapters devoted to the ways of combating malnutrition. In the first two-thirds of the book the author summarizes the available information on how malnutrition affects the human organ ism, with separate chapters (Chapter 3, pp. 92-131) devoted to "Malnutrition and mental development," and to food habits (Chapter 6, pp. 208-46). A volume of contributed articles dealing with various facets of malnutrition was edited by Lloyd-Still (96). The individual chapters deal with brain development (26), effects of prenatal nutrition (162), test proc:edures (73), clinical studies on the intellectual status of individuals who experi
Further
Quick links to online content
Ann. Rev. Psycho/. 1978. 29:157-77 Copyright © 1978 by Annual Reviews Inc. All rights reserved
Annu. Rev. Psychol. 1978.29:157-177. Downloaded from www.annualreviews.org Access provided by Technische Universiteit Eindhoven on 02/02/15. For personal use only.
NUTRITION, MALNUTRITION,
+285
AND BEHAVIOR Josef Brozek 1 Department of Psychology, Lehigh University, Bethlehem, Pennsylvania 1 8015
The etiology of chronic, subclinical, and of acute, clinical energy-protein malnutri tion is multifactorial, with poverty as the subsoil, the deficiency of specific nutrients as a frequent complicating factor, and infection and parasitism as added stresses. The effects of severe malnutrition are also mUltiple and appear in somatic growth, growth and development of the central nervous system, metabolism, and organ function as well as in behavior. The focus of the present review is on human behavior, with special reference to young children. We regret to have to leave out whole areas (brain development, behavioral animal research) and a large array of specific topics: factors controlling food intake, from physiological mechanisms to food habits; overnutrition leading to obesity; impaired utilization of nutrients due to inborn errors of metabolism, such as phenylketonuria; and in particular, effects of the deficits of specific nutrients such as iodine, iron, and vitamin A. The literature on generalized (energy-protein) malnutrition is unwieldy, with differences in terminology and also in the criteria used to characterize the severity of malnutrition. Finally, the frequent inconsistencies in the results do not make for a straightforward presentation. What can be offered is a "cumulative record," not a synthesis. Any attempt at a synthesis must be preceded by a series. of critical analyses dealing with specific issues, such as the comparability of measures of the severity of malnu trition across studies, importance of the child's age at time of hospitalization for clinical malnutrition, relative effects of subclinical and clinical malnutrition on specific mental functions (e.g. performance vs verbal I.Q.), and the etiology of behavioral impairment in malnourished children. IThe idea for this review evolved in the context of the activities of the U.S. Malnutrition Panel, a component of the U.S.-Japan Medical Cooperative Science Program. The acquisition of the literature
was
aided by a Nutrition Foundation grant.
Warm thanks are due to Lehigh University's Interlibrary Loan Service and to Ms. Christine L. Roysdon, reference librarian par excellence. 157
0066-4308/78/0201-0157$01.00
158
BROZEK
This review will first indicate some of the basic earlier literature and will then point out important newer sources of information-bibliographies, proceedings, and reviews. Thereafter we will consider effects of both subclinical and clinical general ized (energy-protein) malnutrition. Finally, we will take up bridges to the future needs and opportunities for research.
Annu. Rev. Psychol. 1978.29:157-177. Downloaded from www.annualreviews.org Access provided by Technische Universiteit Eindhoven on 02/02/15. For personal use only.
BRIDGES TO THE MORE DISTANT PAST The early literature was considered in the 1950 collaborative treatise on The Biology ofHuman Starvation (78). Twenty years ago, the topic was taken up in the Annual Review ofPsychology (17). More extensively, the output of the experimental studies of the 1940s and the 1950s was covered in an epilogue (16) to the proceedings of the 1957 Symposium on Nutrition and Behavior (15) and in several reviews (18, 23, 24), including a survey of the Russian work (19). Extensive experimental human investigations in young adult volunteers carried out in the Laboratory ofPhysiologi cal Hygiene, University of Minnesota, dealt primarily with vitamins (20) and with restriction of calories, varying in severity and duration (21). Valuable information on the literature of the 1950s and 1960s concerned with the effects of severe deficiency of calories and protein is contained in the reviews by Cravioto (36), in reference to research on children, and by Barnes (1), in reference to animal studies. The publication of Scrimshaw's review (154) covering both animal and human research almost coincided in time with the I:omprehensive 1967 MIT conference which he organized. The editors of the proce:edings (156), having been exposed to a veritable flood of information, stressed thl� need for careful additional studies, multidisciplinary in nature, carried out in a wide variety of cultural settings, and taking into account the influence of such confounding variables as infectious diseases and the sociopsychological influences on the young child. This was a challenge to the then "visible future." For the present purposes, the last 10 years constitute the "past" to which we shall address ourselves, with emphasis on the more recent publications.
NEWER SOURCES OF INFORMATION Bibliographies
While Rechcigl's general bibliography (140) contains several sections that are di rectly relevant, no comprehensive bibliography of the literature on malnutrition and behavior exists in print. Springer (160) compiled an annotated bibliography on nutrition and mental retardation. AFRICANA In a 1969 bibliography (71) one finds a short subsection on "Nutri tion" (p. 24). In addition, relevant references are contained in some of the other parts of the section on physiological psychology and in the section on developmental psychology. This applies also to a 1973 bibliography (74).
NUTRITION, MALNUTRITION, AND BEHAVIOR
159
Annu. Rev. Psychol. 1978.29:157-177. Downloaded from www.annualreviews.org Access provided by Technische Universiteit Eindhoven on 02/02/15. For personal use only.
Proceedings
In the area of research on malnutrition and behavior, the proceedings of symposia and conferences represent particularly important channels of publication. The mam moth 1967 MIT conference (156) was followed by a series of meetings and symposia held, in sequence, at Tysoland, Sweden (9), Lausanne, Switzerland (172), Bellagio, Italy (68), Norman, Oklahoma (112),Palo Alto, California (133), Mayaguez,Puerto Rico (76), Amsterdam, Holland (4), Miami, Florida (144), London, England (33), Mona, Jamaica (121), Chiang Mai, Thailand (117), Valencia, Spain (25), New York (157), Burg Wartenstein, Austria (152), and Saltsjobaden, Sweden (46, 184). The references to the relevant contributions were listed and classified in a separate communication (22). In addition to these "special" conferences and symposia there were other meet ings, held in the framework of various national [New York (116)] and international organizations [San Juan, Puerto Rico (134), Mexico City (28), New Delhi, India (11)]. Overviews
The statement of the Subcommittee (now Committee) on Nutrition, Brain Develop ment and Behavior (165) is a "position paper," not a review of literature. It stresses the complex interactions between diet, socioeconomic environment, and behavior, and the structural, biochemical, and neurophysiological roots of behavior. While human studies are considered essential, the importance of the behavioral studies using animal models is acknowledged. The overview closes with general consider ations of needed research. Among the specific topics on which inadequate informa tion is available at present, the overview singles out the effects of "hunger" on school performance (cf 137). A booklet published by the National Institute of Child Health and Human Development (139) provides a readable summary of findings on the effects of various forms of malnutrition on learning; a brief list of references is appended. Reviews
The reviews of the literature on malnutrition and behavior, as well as the primary literature, are widely scattered. Before we attempt to list and classify them, three volumes should be noted that survey, in separate chapters, various segments of the field. The magnum opus by Dodge, Prensky & Feigin (52) covers the morphological, biochemical, physiological, as well as the psychological aspects of normal cerebral maturation and the effects of protein-calorie malnutrition on somatic growth and on the growth of the nervous system in animals (pp. 252-304) and in man (pp. 305-65), including the behavioral aspects. Attention is given also to selected miner als (especially iodine), vitamins, and disorders of amino acid metabolism. Extensive lists of references are appended to individual chapters, with some 500 references cited in the chapter on "Influence of protein-calorie malnutrition on the human nervous system" alone.
Annu. Rev. Psychol. 1978.29:157-177. Downloaded from www.annualreviews.org Access provided by Technische Universiteit Eindhoven on 02/02/15. For personal use only.
160
BROZEK
Manocha's treatise (100) is action oriented,with several closing chapters devoted to the ways of combating malnutrition. In the first two-thirds of the book the author summarizes the available information on how malnutrition affects the human organ ism, with separate chapters (Chapter 3, pp. 92-131) devoted to "Malnutrition and mental development," and to food habits (Chapter 6, pp. 208-46). A volume of contributed articles dealing with various facets of malnutrition was edited by Lloyd-Still (96). The individual chapters deal with brain development (26), effects of prenatal nutrition (162), test proc:edures (73), clinical studies on the intellectual status of individuals who experi
