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This paper attempts to highlight ongoing concerns in understanding the relations between malnutrition and cognition and the availability of knowledge to address such concerns. At the present time, there is insufficient information available to provide definitive answers to questions of processes, mechanisms and outcomes, but we are much closer to being able to design studies that will provide better answers to such questions. From the review presented here it can be argued that future research should:
1. Imbed within the design appropriate questions of processes and collect data that would illustrate links between malnutrition and behavior. For example, data from correlational studies should be specific enough to provide clues to actual behaviors that may mediate cognitive changes.2. Conceptualize potential interactions among variables that may be particularly relevant to the population under study. Researchers need not consider every possible interaction but rather target data collection efforts to test explicitly defined interactions.
3. Include studies of children beyond the ages typically considered sensitive. Available evidence, although limited, suggests that these children can respond to improved nutrition, and the implications for large numbers of children not currently targeted for interventions (i.e., school-age children) would be significant.
4. Include outcome measures that may be sensitive to nutritional manipulations. Cognitive change and school learning are mediated by affective and motivational variables that may be particularly sensitive to nutritional status.
A paper such as this would be remiss without a discussion of policy. In short, we can state that malnutrition has detrimental effects on infants, young children and school-age children that can be improved by better diets. At the same time, our understanding of the complex relations between poverty, malnutrition and child development is still incomplete, and many questions remain. It is certain that for children in developing countries to reach their potential, not only will their diets need to be improved but so will the conditions in which they live. Attention to diet, both quality and quantity, will be enhanced by attention to health, infection, education, socioeconomic status and other conditions of poverty.
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