The Effect of Malnutrition and Micronutrient Deficiency on Children’s Mental Health

  • Sally Grantham-McGregor
  • Joanne SmithEmail author
Living reference work entry
Part of the Mental Health and Illness Worldwide book series (MHIW)


Malnutrition and micronutrient deficiencies are highly prevalent in low- and middle-income countries (LMICs) and micronutrient deficiencies also occur in high income countries. Ample research has examined the association of malnutrition to children’s cognitive, language, and motor development but mental health has generally been neglected. In this chapter, we selectively review the evidence linking malnutrition, iron, zinc, iodine, and vitamin D deficiencies to mental health and socioemotional behavior.


Malnutrition Micronutrient deficiency Children Mental health Socioemotional behavior Psychosocial interventions 


  1. Abel MH, Caspersen IH, Meltzer HM, Haugen M, Brandlistuen RE, Aase H, Alexander J, Torheim LE, Brantsaeter AL (2017a) Suboptimal maternal iodine intake is associated with impaired child neurodevelopment at 3 years of age in the Norwegian mother and child cohort study. J Nutr 147(7):1314–1324. Scholar
  2. Abel MH, Ystrom E, Caspersen IH, Meltzer HM, Aase H, Torheim LE, Askeland RB, Reichborn-Kjennerud T, Brantsaeter AL (2017b) Maternal iodine intake and offspring attention-deficit/hyperactivity disorder: results from a large prospective cohort study. Nutrients 9(11).
  3. Armony-Sivan R, Kaplan-Estrin M, Jacobson SW, Lozoff B (2010) Iron-deficiency anemia in infancy and mother-infant interaction during feeding. J Dev Behav Pediatr 31(4):326–332. Scholar
  4. Arnold LE, Disilvestro RA, Bozzolo D, Bozzolo H, Crowl L, Fernandez S, Ramadan Y, Thompson S, Mo X, Abdel-Rasoul M, Joseph E (2011) Zinc for attention-deficit/hyperactivity disorder: placebo-controlled double-blind pilot trial alone and combined with amphetamine. J Child Adolesc Psychopharmacol 21(1):1–19. Scholar
  5. Ashworth A, Morris SS, Lira PI, Grantham-McGregor SM (1998) Zinc supplementation, mental development and behaviour in low birth weight term infants in Northeast Brazil. Eur J Clin Nutr 52(3):223–227CrossRefGoogle Scholar
  6. Ataie-Jafari A, Qorbani M, Heshmat R, Ardalan G, Motlagh ME, Asayesh H, Arzaghi SM, Tajadini MH, Nejatinamini S, Poursafa P, Kelishadi R (2015) The association of vitamin D deficiency with psychiatric distress and violence behaviors in Iranian adolescents: the CASPIAN-III study. J Diabetes Metab Disord 14:62. Scholar
  7. Avan B, Richter LM, Ramchandani PG, Norris SA, Stein A (2010) Maternal postnatal depression and children’s growth and behaviour during the early years of life: exploring the interaction between physical and mental health. Arch Dis Child 95(9):690–695. Scholar
  8. Bailey RL, West KP Jr, Black RE (2015) The epidemiology of global micronutrient deficiencies. Ann Nutr Metab 66(Suppl 2):22–33. Scholar
  9. Baker-Henningham H, Hamadani JD, Huda SN, Grantham-McGregor SM (2009) Undernourished children have different temperaments than better-nourished children in rural Bangladesh. J Nutr 139(9):1765–1771. Scholar
  10. Bath SC, Steer CD, Golding J, Emmett P, Rayman MP (2013) Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Lancet 382(9889):331–337. Scholar
  11. Bener A, Kamal M, Bener H, Bhugra D (2014) Higher prevalence of iron deficiency as strong predictor of attention deficit hyperactivity disorder in children. Ann Med Health Sci Res 4(Suppl 3):S291–S297. Scholar
  12. Black MM, Baqui AH, Zaman K, Ake Persson L, El Arifeen S, Le K, McNary SW, Parveen M, Hamadani JD, Black RE (2004) Iron and zinc supplementation promote motor development and exploratory behavior among Bangladeshi infants. Am J Clin Nutr 80(4):903–910. Scholar
  13. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, Ezzati M, Grantham-McGregor S, Katz J, Martorell R, Uauy R, Maternal and Child Nutrition Study Group (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382(9890):427–451. Scholar
  14. Black MM, Walker SP, Fernald LCH, Andersen CT, DiGirolamo AM, Lu C, McCoy DC, Fink G, Shawar YR, Shiffman J, Devercelli AE, Wodon QT, Vargas-Baron E, Grantham-McGregor S, Lancet Early Childhood Development Series Steering Committee (2017) Early childhood development coming of age: science through the life course. Lancet 389(10064):77–90. Scholar
  15. Brito GN, Md Onis (2004) Growth status, behavior and neuropsychological performance: a study of Brazilian school age children. Arq Neuropsiquiatr 62(4):949–954. Scholar
  16. Brooks-Gunn J, Duncan GJ (1997) The effects of poverty on children. Future Child 7(2):55–71CrossRefGoogle Scholar
  17. Casale D, Desmond C, Richter L (2014) The association between stunting and psychosocial development among preschool children: a study using the South African Birth to Twenty cohort data. Child Care Health Dev 40(6):900–910. Scholar
  18. Chang SM, Walker SP, Grantham-McGregor S, Powell CA (2002) Early childhood stunting and later behaviour and school achievement. J Child Psychol Psychiatry 43(6):775–783CrossRefGoogle Scholar
  19. Chang S, Wang L, Wang Y, Brouwer ID, Kok FJ, Lozoff B, Chen C (2011) Iron-deficiency anemia in infancy and social emotional development in preschool-aged Chinese children. Pediatrics 127(4):e927–e933. Scholar
  20. Chen MH, Su TP, Chen YS, Hsu JW, Huang KL, Chang WH, Chen TJ, Bai YM (2013) Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study. BMC Psychiatry 13:161. Scholar
  21. Cheung YB, Ashorn P (2009) Linear growth in early life is associated with suicidal ideation in 18-year-old Filipinos. Paediatr Perinat Epidemiol 23(5):463–471. Scholar
  22. Corapci F, Radan AE, Lozoff B (2006) Iron deficiency in infancy and mother-child interaction at 5 years. J Dev Behav Pediatr 27(5):371–378CrossRefGoogle Scholar
  23. Corapci F, Calatroni A, Kaciroti N, Jimenez E, Lozoff B (2010) Longitudinal evaluation of externalizing and internalizing behavior problems following iron deficiency in infancy. J Pediatr Psychol 35(3):296–305. Scholar
  24. Daraki V, Roumeliotaki T, Koutra K, Chalkiadaki G, Katrinaki M, Kyriklaki A, Kampouri M, Margetaki K, Vafeiadi M, Papavasiliou S, Kogevinas M, Chatzi L (2018) High maternal vitamin D levels in early pregnancy may protect against behavioral difficulties at preschool age: the Rhea mother-child cohort, Crete, Greece. Eur Child Adolesc Psychiatry 27(1):79–88. Scholar
  25. DiGirolamo AM, Ramirez-Zea M, Wang M, Flores-Ayala R, Martorell R, Neufeld LM, Ramakrishnan U, Sellen D, Black MM, Stein AD (2010) Randomized trial of the effect of zinc supplementation on the mental health of school-age children in Guatemala. Am J Clin Nutr 92(5):1241–1250. Scholar
  26. Galler JR, Bryce CP, Waber D, Hock RS, Exner N, Eaglesfield D, Fitzmaurice G, Harrison R (2010) Early childhood malnutrition predicts depressive symptoms at ages 11–17. J Child Psychol Psychiatry 51(7):789–798. Scholar
  27. Galler JR, Bryce CP, Waber DP, Hock RS, Harrison R, Eaglesfield GD, Fitzmaurice G (2012) Infant malnutrition predicts conduct problems in adolescents. Nutr Neurosci 15(4):186–192. Scholar
  28. Gardner JM, Grantham-McGregor SM, Himes J, Chang S (1999) Behaviour and development of stunted and nonstunted Jamaican children. J Child Psychol Psychiatry 40(5):819–827CrossRefGoogle Scholar
  29. Grantham-McGregor S (1995) A review of studies of the effect of severe malnutrition on mental development. J Nutr 125(8 Suppl):2233S–2238S. Scholar
  30. Grantham-McGregor S, Ani C (2001) A review of studies on the effect of iron deficiency on cognitive development in children. J Nutr 131(2S-2):649S–666S; discussion 666S–668S. Scholar
  31. Grung B, Sandvik AM, Hjelle K, Dahl L, Froyland L, Nygard I, Hansen AL (2017) Linking vitamin D status, executive functioning and self-perceived mental health in adolescents through multivariate analysis: a randomized double-blind placebo control trial. Scand J Psychol 58(2):123–130. Scholar
  32. Hamadani JD, Fuchs GJ, Osendarp SJ, Huda SN, Grantham-McGregor SM (2002) Zinc supplementation during pregnancy and effects on mental development and behaviour of infants: a follow-up study. Lancet 360(9329):290–294. Scholar
  33. Hamadani JD, Huda SN, Khatun F, Grantham-McGregor SM (2006) Psychosocial stimulation improves the development of undernourished children in rural Bangladesh. J Nutr 136(10):2645–2652. Scholar
  34. Hamadani JD, Tofail F, Huda SN, Alam DS, Ridout DA, Attanasio O, Grantham-McGregor SM (2014) Cognitive deficit and poverty in the first 5 years of childhood in Bangladesh. Pediatrics 134(4):e1001–e1008. Scholar
  35. Hamadani JD, Mehrin SF, Tofail F, Hassan MJ, Huda SN, Baker-Henningham H, Ridout DA, Grantham-McGregor S (2019) Integrating an early childhood development programme into Bangladeshi primary health care services: an open-label, cluster randomised controlled trial. Lancet Glob Health 7:e366CrossRefGoogle Scholar
  36. Holick MF (2017) The vitamin D deficiency pandemic: approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord 18(2):153–165. Scholar
  37. Huang C, Martorell R, Ren A, Li Z (2013) Cognition and behavioural development in early childhood: the role of birth weight and postnatal growth. Int J Epidemiol 42(1):160–171. Scholar
  38. Husmann C, Frank M, Schmidt B, Jockel KH, Antel J, Reissner V, Libuda L, Hebebrand J, Focker M (2017) Low 25(OH)-vitamin D concentrations are associated with emotional and behavioral problems in German children and adolescents. PLoS One 12(8):e0183091. Scholar
  39. Johnson SB, Riis JL, Noble KG (2016) State of the art review: poverty and the developing brain. Pediatrics 137(4):e20153075. Scholar
  40. Khaled Saad, Ahmed A. Abdel‐Rahman, Yasser M. Elserogy, Abdulrahman A. Al‐Atram, Amira A. El‐Houfey, Hisham A. -K. Othman, Geir Bjørklund, Feiyong Jia, Mauricio A. Urbina, Mohamed Gamil M. Abo‐Elela, Faisal‐Alkhateeb Ahmad, Khaled A. Abd El‐Baseer, Ahmed E. Ahmed, Ahmad M. Abdel‐Salam, (2017) Retracted: Randomized controlled trial of vitamin D supplementation in children with autism spectrum disorder. Journal of Child Psychology and Psychiatry 59 (1):20-29Google Scholar
  41. Kieling C, Baker-Henningham H, Belfer M, Conti G, Ertem I, Omigbodun O, Rohde LA, Srinath S, Ulkuer N, Rahman A (2011) Child and adolescent mental health worldwide: evidence for action. Lancet 378(9801):1515–1525. Scholar
  42. Liu J, Raine A, Venables PH, Mednick SA (2004) Malnutrition at age 3 years and externalizing behavior problems at ages 8, 11, and 17 years. Am J Psychiatry 161(11):2005–2013. Scholar
  43. Lozoff B, Corapci F, Burden MJ, Kaciroti N, Angulo-Barroso R, Sazawal S, Black M (2007) Preschool-aged children with iron deficiency anemia show altered affect and behavior. J Nutr 137(3):683–689. Scholar
  44. Lozoff B, Castillo M, Clark KM, Smith JB, Sturza J (2014) Iron supplementation in infancy contributes to more adaptive behavior at 10 years of age. J Nutr 144(6):838–845. Scholar
  45. Mathur NB, Agarwal DK (2015) Zinc supplementation in preterm neonates and neurological development, a randomized controlled trial. Indian Pediatr 52(11):951–955CrossRefGoogle Scholar
  46. Melse-Boonstra A, Jaiswal N (2010) Iodine deficiency in pregnancy, infancy and childhood and its consequences for brain development. Best Pract Res Clin Endocrinol Metab 24(1):29–38. Scholar
  47. Metwally AM, Salah El-Din EM, Shehata MA, Shaalan A, El Etreby LA, Kandeel WA, Shaaban SY, Rabah TM (2016) Early life predictors of socio-emotional development in a sample of Egyptian infants. PLoS One 11(7):e0158086. Scholar
  48. Morales E, Julvez J, Torrent M, Ballester F, Rodriguez-Bernal CL, Andiarena A, Vegas O, Castilla AM, Rodriguez-Dehli C, Tardon A, Sunyer J (2015) Vitamin D in pregnancy and attention deficit hyperactivity disorder-like symptoms in childhood. Epidemiology 26(4):458–465. Scholar
  49. National Scientific Council (2008–2012) Establishing a level foundation for life: mental health begins in early childhood. Working paper 6 (ed: Center on the Developing Child). Harvard University, Cambridge, MAGoogle Scholar
  50. Nutrition International (formerly Micronutrient Initiative), Flour Fortification Initiative, Global Alliance for Improved Nutrition, USAID, The World Bank and UNICEF (2009) Investing in the future. A united call to action on vitamin and mineral deficiencies: Global Report (2009). Ontario, Canada.Google Scholar
  51. Nyaradi A, Li J, Hickling S, Foster J, Oddy WH (2013) The role of nutrition in children’s neurocognitive development, from pregnancy through childhood. Front Hum Neurosci 7:97. Scholar
  52. Pasricha SR, Hayes E, Kalumba K, Biggs BA (2013) Effect of daily iron supplementation on health in children aged 4–23 months: a systematic review and meta-analysis of randomised controlled trials. Lancet Glob Health 1(2):e77–e86. Scholar
  53. Prado EL, Abbeddou S, Adu-Afarwuah S, Arimond M, Ashorn P, Ashorn U, Brown KH, Hess SY, Lartey A, Maleta K, Ocansey E, Ouedraogo JB, Phuka J, Some JW, Vosti SA, Yakes Jimenez E, Dewey KG (2016) Linear growth and child development in Burkina Faso, Ghana, and Malawi. Pediatrics 138(2):e20154698. Scholar
  54. Richardson SA, Birch HG, Ragbeer C (1975) The behaviour of children at home who were severely malnourished in the first 2 years of life. J Biosoc Sci 7(3):255–267CrossRefGoogle Scholar
  55. Sudfeld CR, McCoy DC, Danaei G, Fink G, Ezzati M, Andrews KG, Fawzi WW (2015) Linear growth and child development in low-and middle-income countries: a meta-analysis. Pediatrics 135(5):e1266–e1275. Scholar
  56. Tamura T, Goldenberg RL, Ramey SL, Nelson KG, Chapman VR (2003) Effect of zinc supplementation of pregnant women on the mental and psychomotor development of their children at 5 y of age. Am J Clin Nutr 77(6):1512–1516. Scholar
  57. Tolppanen AM, Sayers A, Fraser WD, Lewis G, Zammit S, Lawlor DA (2012) The association of serum 25-hydroxyvitamin D3 and D2 with depressive symptoms in childhood – a prospective cohort study. J Child Psychol Psychiatry 53(7):757–766. Scholar
  58. Uckardes Y, Ozmert EN, Unal F, Yurdakok K (2009) Effects of zinc supplementation on parent and teacher behaviour rating scores in low socioeconomic level Turkish primary school children. Acta Paediatr 98(4):731–736. Scholar
  59. UNICEF, Sustainable elimination of Iodine Deficiency: Progress since the 1990 World Summit for Children, New York, UNICEF, 2008, p.5Google Scholar
  60. Vermiglio F, Lo Presti VP, Moleti M, Sidoti M, Tortorella G, Scaffidi G, Castagna MG, Mattina F, Violi MA, Crisa A, Artemisia A, Trimarchi F (2004) Attention deficit and hyperactivity disorders in the offspring of mothers exposed to mild-moderate iodine deficiency: a possible novel iodine deficiency disorder in developed countries. J Clin Endocrinol Metab 89(12):6054–6060. Scholar
  61. Wachs TD, Black M, Engle P (2009) Maternal depression: a global threat to children’s health, development and behavior and to human rights. Child Dev Perspect 3:51–59CrossRefGoogle Scholar
  62. Wachs TD, Posada G, Carbonell O, Creed-Kanashiro H, Gurkas P (2011) Infant nutrition and 12 and 18 months secure base behavior: an exploratory study. Infancy 16(1):91–111CrossRefGoogle Scholar
  63. Walker SP, Chang SM, Powell CA, Simonoff E, Grantham-McGregor SM (2006) Effects of psychosocial stimulation and dietary supplementation in early childhood on psychosocial functioning in late adolescence: follow-up of randomised controlled trial. BMJ 333(7566):472. Scholar
  64. Walker SP, Chang SM, Powell CA, Simonoff E, Grantham-McGregor SM (2007) Early childhood stunting is associated with poor psychological functioning in late adolescence and effects are reduced by psychosocial stimulation. J Nutr 137(11):2464–2469. Scholar
  65. Walker SP, Wachs TD, Grantham-McGregor S, Black MM, Nelson CA, Huffman SL, Baker-Henningham H, Chang SM, Hamadani JD, Lozoff B, Gardner JM, Powell CA, Rahman A, Richter L (2011) Inequality in early childhood: risk and protective factors for early child development. Lancet 378(9799):1325–1338. Scholar
  66. Wang T, Shan L, Du L, Feng J, Xu Z, Staal WG, Jia F (2016) Serum concentration of 25-hydroxyvitamin D in autism spectrum disorder: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 25(4):341–350. Scholar
  67. WHO (2006) WHO child growth standards: methods and development. World Health Organization, GenevaGoogle Scholar
  68. WHO (2018) WHO Global Health Observatory (GHO) data on child malnutrition. World Health Organization, GenevaGoogle Scholar
  69. Yang S, Tilling K, Martin R, Davies N, Ben-Shlomo Y, Kramer MS (2011) Pre-natal and post-natal growth trajectories and childhood cognitive ability and mental health. Int J Epidemiol 40(5):1215–1226. Scholar
  70. Yoshikawa H, Aber JL, Beardslee WR (2012) The effects of poverty on the mental, emotional, and behavioral health of children and youth: implications for prevention. Am Psychol 67(4):272–284. Scholar
  71. Zhang L, Kleiman-Weiner M, Luo R, Shi Y, Martorell R, Medina A, Rozelle S (2013) Multiple micronutrient supplementation reduces anemia and anxiety in rural China’s elementary school children. J Nutr 143(5):640–647. Scholar
  72. Zhou SJ, Skeaff SA, Ryan P, Doyle LW, Anderson PJ, Kornman L, McPhee AJ, Yelland LN, Makrides M (2015) The effect of iodine supplementation in pregnancy on early childhood neurodevelopment and clinical outcomes: results of an aborted randomised placebo-controlled trial. Trials 16:563. Scholar
  73. Zimmermann MB (2009) Iodine deficiency. Endocr Rev 30(4):376–408. Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.Emeritus Professor of International Child Health, Institute of Child HealthUniversity College LondonLondonUK
  2. 2.Epidemiology Research Unit, Caribbean Institute for Health ResearchThe University of the West IndiesKingstonJamaica

Section editors and affiliations

  • Eric Taylor
    • 1
  1. 1.Child and Adolescent Psychiatry Department, Institute of PsychiatryKing's College LondonLondonUK

Personalised recommendations