Journal of Health Care for the Poor and Underserved

87 Presentation EDUCATION AND NUTRITION AARON SHIRLEY, M.D. Project Director Jackson-Hinds Comprehensive Health Center Post Office Box 3437 4433 Medgar Evers Road Jackson, Mississippi 39213 Before addressing specific implications of malnutrition and education, we would do well to examine the extent to which poverty and hunger with resulting malnutrition exist. There is really no precise way of knowing how many hungry people there are. But there are methods, fairly reliable I think, which can be used to estimate the dimensions of the problem. Based on these, there are probably 20 million Americans who suffer from hunger. The majority of these, about 15 million, are people who Uve below the poverty line but who receive no food stamps. The remainder are individualsand famines who receive food stamps but for whom the program is inadequate, and those who make up the near-poor who are unable to purchase food for nutritionaUy adequate diets. These figures are disturbing enough in themselves. But when we take into consideration the facts that hunger and malnutrition are directly related to poverty1, that 125 rmllion American children live in poverty, and that 7.3 mUlion of these are subjected to hunger on an ongoing basis, they take on added significance. Implications for education Considerable evidence shows that maternal malnutrition during the prenatal period, or infant malnutrition during the early postnatal stage, can produce lasting damage to the structure and function of the developing nervous system, resulting in deficits which become manifest by early childhood.1 Brain structure itself is uniquely vulnerable to damage during the intrauterine period. Beginning shortly after conception, and extending until about Journal of Health Care for the Poor and Underserved, Vol. 2, No. 1, Summer 1991 88 Education and Nutrition the age of two years, the brain experiences maximal growth to about two-thirds of adult size. During this period the brain has biosynthetic abilities that do not extend into later life.2 The absence of adequate nutrition during this critical period can produce permanent deficits in brain size—deficits which may notbe reversible later even with ample nutrition. Survivorsof severe childhood malnutrition show deficits in head circumference, which reflects brain size. Malnutrition during this period is associated with identifiable structural deficits in the brains of children, including a decreased number of neurons and glial cells as measured by DNA content. Such deficits extend into adult life. AU chUdren who suffer from growth retardation have at least one organically based medical disease: malnutrition. Malnutrition can induce many biological changes, including decreased intracellular energy metabolism and altered cellular chemistry. Correlates of nutritional deficiency in young children include decreased velocity of peripheral nerve conduction, persistent temporal-parietal hypoplasia, and a slowing of EEG frequencies. Protein and amino acid chemistry is altered as the pool of available amino acids is depleted. The malnourished condition leads to an alternation of the baseline metabolic state from anabolism (growth and increase in cell size, mass, and tissue) to catabolism (the autodigestion of tissue and muscle proteins). This is the body's way of trying to conserve energy for the most vital bodily function— organ preservation. These andrelated changes resultin altered hormonal levels and organ activity, and become manifest in reduced physical activity, decreased exploration of the environment, and ultimately deficits in cognition itself. Cognitive deficits associated with nutrition-based growth retardation range from moderate delays to mental retardation. The cumulative results of studies indicate that a high frequency (median of 50 percent) of children initially diagnosed as suffering from growth retardation have significant inteUectual deficits as older children. Moreover, most reports on preschool and school-aged children originally diagnosed as undernourished to the point of growth failure in infancy show high levels of chronic cognitive impairments compared to test norms.3 The sponsors of this conference have asked that my presentation focus on three major themes: research, particularly the identification of research needed to help at-risk children; policy, including policy recommendations for federal, state, or local officials; and practice, encompassing innovative programs addressing the needs of at-risk children. Perhaps a summary of a recent seminar on services for disadvantaged youth in which I participated will satisfy all three criteria. Aspen seminar From August 6 to...