From 1969-1977, the Institute of Nutrition of Central America and Panama (INCAP) carried out a longitudinal study of growth and development in four rural communities of Guatemala. The hypothesis under study, that malnutrition retards the mental development and physical growth of preschool-aged children, was tested by means; of direct interventions providing free food supplements on demand. The children who participated in the longitudinal study are now adolescents and young adults. An RO1 was obtained by a multidisciplinary team to return to the study villages to collect extensive cross-sectional data on current physical and psychosocial status. These recent data have been linked with the wealth of longitudinal records available for these same individuals allowing for investigations of the long-term effects of malnutrition on human development. The expected outcomes of improved nutrition in early childhood included large body size, greater work capacity, earlier maturation, and improved intellectual functioning and school achievement. Data collection took longer than expected and the analysis phase of the three year study (6/1/87-5/31/90) was reduced from 15 to 8 months. Later, a two-year competing renewal was obtained (12/1/90-11/30/92). The productivity of the research team has been high and dozens of papers have been published or submitted to journals. Preliminary results strongly support the hypothesis that improved nutrition in early childhood leads to enhanced functional capacity in the adult as measured by biological and behavioral outcomes. However, there is much important work that will not be completed by the end of the current funding period. Two more years of analyses are proposed. About a third of the research described in this application was included in our earlier proposal but will not be completed by November, 1992. This is due to drastic reductions in the work plan in response to administrative budget cuts of 33% by NIH. The majority of the analyses proposed are new ideas generated during the current funding period. In this revised two year application, continued analyses in several areas are proposed. Following recommendations by the study section, the work plan will be focused on three research areas, and all work will be carried out by INSP and Emory only. The issue of whether the nutritional intervention had a differential impact in subgroups of the population will continue to be explored. Analyses are proposed to fully understand the repercussions of growth failure in early childhood on later function in adolescence and adulthood. A major new area of emphasis include early childhood determinants of reproductive milestones. The research proposed provides a unique opportunity to test the general hypothesis that nutrition and health status in early life are related to the adult's potential to lead a healthy and productive life. These issues are critically important to governments and policy makers concerned with human welfare and economic development.
