Behavioral problems in preadolescence: Does nutritional status have a role?

Malnutrition in children and adolescents is a global issue, particularly
in low- and middle-income countries, while behavioral problems are
becoming a growing public health concern in the area of child and
adolescent mental health, with very few studies examining their
association in preadolescence. This study aimed to assess the
epidemiological relationship between malnutrition and behavioral problems
in preadolescence. A school-based, cross-sectional survey was
conducted in Pakistan. A total of 660, 11-12-year-old preadolescents were
selected from a middle-class, co-educational school chain.
Socio-demographic questionnaires and an officially adapted version of the
Youth Self Report Form (YSR), which is the child and adolescent reported
version of the Child Behavior Checklist (CBCL), were used to collect data,
along with anthropometric assessments following the WHO protocol. Thin and
stunted preadolescents had significantly higher odds of internalizing
problems (AOR= 2.05, P= 0.003 and AOR= 2.09, P= 0.039, respectively) than
normal ones. Over-nutrition was not associated with any behavioral issues.
According to the composite index of anthropometric failure, 40% of
preadolescents had at least one type of malnutrition, and among them,
about 3% had co-occurring malnutrition (stunted and thin or overweight).
They had a higher risk of being associated with internalizing problems
(AOR 2.92, P = 0.027). The effect was considerably higher than
that associated with stunted or thin only, highlighting the cumulative
impact of the co-occurring malnutrition on the internalizing problems. Our
study concludes that over- and under-nutrition are prevalent in
preadolescents, with a significant association of under-nutrition with
internalizing problems. Moreover, our study is the first that report that
the co-occurrence of malnutrition is significantly associated with
increased risk of internalizing problems. This study highlights the
importance of the link between physical and mental health and emphasizes
the need for holistic interventions and programs for addressing
preadolescents' issues.