"Studies have shown that malnourished children in developing countries score lower on tests of cognitive function and fail to acquire fine motor skills at the normal rate. Do the effects of nourishment—good or bad—in early childhood linger into adolescence and adulthood, or do they fade away after a few years? This paper provides new evidence of the effects of early childhood nutritional interventions on adult outcomes, using longitudinal data and methods well suited to address the concerns that have been raised about earlier studies." from Textmalnutrition, Children, Education, Nutrition,

Behrman, Jere R.

Hoddinott, John

Maluccio, John A.

Martorell, Reynaldo

Quisumbing, Agnes R.

Stein, Aryeh D.

English

Research Papers in Economics

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tudies have shown that malnourished children in 
developing countries score lower on tests of cognitive 
function and fail to acquire fine motor skills at the normal 
rate. Do the effects of nourishment—good or bad—in early 
childhood linger into adolescence and adulthood, or do they 
fade away after a few years? This paper provides new 
evidence of the effects of early childhood nutritional 
interventions on adult outcomes, using longitudinal data and 
methods well suited to address the concerns that have been 
raised about earlier studies. 
The 1969-77 Intervention 
From 1969 to 1977, to test the hypothesis that improved 
preschool nutrition would accelerate mental development, 
the Institute of Nutrition of Central America and Panama 
(INCAP) made freely available a high-protein dietary 
supplement called atole to preschool-age children (under 7 
years of age) in two rural villages, Conacaste and San Juan, 
in Guatemala. Concerned that the social stimulation of the 
feeding process might positively affect children’s cognitive 
abilities, the researchers also made available a fruit-flavored 
drink called fresco, which contained no protein, to children 
in two other villages, Santo Domingo and Espíritu Santo. 
Assignment of the atole or fresco to villages was random. 
Data were collected on all children aged seven years or 
younger and all pregnant and breastfeeding women in the 
villages. Residents of all four villages also received free 
curative medical care and preventive health services. When 
the program ended in 1977, children 
ranged from 0 to 15 years of age. 
Children received 40 to 120 kilo-
calories of atole a day, depending on 
age. At three years, the children who 
received the atole supplement were 
found to be 2.5 centimeters taller than 
children who only received the fresco 
drink, reducing the prevalence of severe stunting by half. 
The 2002-04 Resurvey 
Subsets of the original sample of 2,393 children were re-
surveyed periodically over the years to measure the effects of 
the intervention on their health and nutritional status. 
Between 2002 and 2004 a multidisciplinary team of investi-
gators (including the authors of this paper) attempted to 
resurvey these same individuals—now young adults—to 
determine whether the feeding intervention had positive 
effects on their cognitive abilities and educational attain-
ments that could still be detected. The team went to great 
lengths to locate as many of the subjects as possible. They 
interviewed everyone currently in the four villages to de-
termine who of the original sample still lived in the villages, 
who had died, and who had migrated to other locations. Of 
the 2,393 persons in the 1969–77 sample, 77 percent were 
alive and living in Guatemala, 11 percent had died, and 8 
percent had migrated abroad. Nothing could be learned about 
the remaining 4 percent. This analysis uses data collected 
from 1,469 individuals (61 percent of the original sample) 
who answered the questionnaire pertaining to schooling, 
including information on the amount of schooling attained, 
their rates of progression through school, and measures of 
cognitive ability (using Raven’s Progressive Matrices) and 
reading comprehension skills (using a pre-literacy test and, 
for the literate, vocabulary and comprehension tests from the 
Inter-American Reading Series). 
Methodology 
Outcome variables are taken from the 2002–04 follow-up, 
while the right-side variables use individual and household 
data collected from 1969 to 1977, supplemented by com-
munity information collected 
during the earlier studies and 
retrospectively in 2002. In-
dividual characteristics include 
sex and age, while household 
characteristics include mother’s 
and father’s education, age, and 
dummy variables for the dis-
tance to the feeding center and an index of household wealth. 
Dummy variables for three of the four villages are included, 
reflecting differences in localities that influence education-
related outcomes. One village, Espíritu Santo, is close to a 
larger town with more educational opportunities. Commun-
S 
The Impact of an Experimental Nutritional Intervention in 
Childhood on Education among Guatemalan Adults 
 
John A. Maluccio, John Hoddinott, Jere R, Behrman, Reynaldo Martorell, 
Agnes R. Quisumbing, and Aryeh D. Stein 
A quarter century after the feeding 
intervention, participants scored 9 
percent higher on cognition tests and 
14 percent higher on reading 
comprehension tests. 
 
B R I E F 
Food Consumption and Nutrition Division 
Discussion Paper 207  
  2033 K STREET NW 
WASHINGTON, DC 20006-1002 USA 
 
  
  
  
 
 
 
 
FCND DP207 
ity-level covariates include the availability of a permanent 
structure for the primary school and the student-teacher ratio 
when the child was between 7 (starting school) and 13 years 
of age (finishing primary school). 
The Results 
Although most of the respondents started school at age 
seven, 8 percent dropped out during primary school and 30 
percent after completing grade six. About 20 percent at-
tended secondary school, and 3 percent went on to advanced 
studies. Reflecting Guatemalan society, men completed more 
schooling than women, and younger people completed more 
than older people. Children from households where parents 
had more education and more wealth tended to complete 
more grades. Individuals born in Espíritu Santo had 
significantly more education. While a permanent school 
structure was not significant, the student-teacher ratio was. 
The results indicate that the nutrition intervention had 
significantly positive and substantial effects. Women, in 
particular, were more likely to enter and complete primary 
school and some secondary school than their peers in the 
control group, and their progression through school was 
speedier. Both men and women scored higher on cognitive 
and educational achievement tests. For the full sample, there 
is no evidence that atole  affected the number of grades 
attained. When the results are examined by sex, however, 
women who received the supplement are found to have 
completed one full grade more than those who did not. 
Women who received atole were better able to negotiate 
the education system than those who received fresco. They 
were less likely to repeat a grade or to drop out and re-enter. 
When the number of grades passed was divided by the 
number of years attended school, they were found to have 
completed 0.11 grades per year more than their counterparts. 
The results of the Raven’s tests of cognition are signif-
icant for both men and women, representing a 9 percent 
improvement over the average score. Because these esti-
mates are the first to investigate the impact of a nutritional 
intervention on adult intellectual functioning more than 25 
years after the feeding, they are particularly important. 
The atole intervention increased reading comprehension 
scores by about 14 percent, on average, a quarter century 
later for both men and women. Although the number of 
grades completed by men was not affected by their exposure 
to the intervention, their reading ability apparently was. This 
may have been the result of later life experiences or it may 
be an indication of the improved cognition indicated by the 
Raven’s test. 
The results of this study provide strong evidence that 
nutrition of preschool-age children plays a crucial role in 
future educational attainments and underscores the value of 
including the preschool period in any approach to education. 
 
Keywords: early childhood nutrition, education, 
nutritional intervention, Guatemala 
 
 
 
 
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The impact of an experimental nutritional intervention in childhood on education among Guatemalan adults:

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