Impact of health on intelligence
Health can affect intelligence in various ways. Conversely, intelligence can affect health. Health effects on intelligence have been described as being among the most important factors in the origins of human group differences in IQ test scores and other measures of cognitive ability. Several factors can lead to significant cognitive impairment, particularly if they occur during pregnancy and childhood when the brain is growing and the blood–brain barrier is less effective. Such impairment may sometimes be permanent, sometimes be partially or wholly compensated for by later growth.
Developed nations have implemented several health policies regarding nutrients and toxins known to influence cognitive function. These include laws requiring fortification of certain food products and laws establishing safe levels of pollutants (e.g. lead, mercury, and organochlorides). Comprehensive policy recommendations targeting reduction of cognitive impairment in children have been proposed.
Improvements in nutrition (often involving specific micronutrients) due to in public policy changes have been implicated in IQ increases in many nations (as part of the overall Flynn effect), such as efforts fighting iodine deficiency in the U.S.
- 1 Nutrition
- 2 Toxins
- 3 Healthcare during pregnancy and childbirth
- 4 Stress
- 5 Infectious diseases
- 6 Effects of other diseases
- 7 Other associations
- 8 See also
- 9 References
Malnutrition may occur during several periods of growth, such as pregnancy, during breastfeeding, infancy, or childhood. It may also happen due to deficiencies of different nutrients, such as micronutrients, protein or energy. This may cause different effects.
Some observers have argued that malnutrition during the first six months of life harms cognitive development much more than malnutrition later in life. However, a study from the Philippines argues that malnutrition in the second year of life may have a larger negative impact than malnutrition in the first year of life.
Intrauterine growth retardation
Undernutrition during pregnancy, and other factors, may cause intrauterine growth retardation (IUGR), which is one cause of low birth weight. However, it has been suggested that in IUGR the brain may be selectively spared. Brain growth is usually less affected than whole body weight or length. Several studies from developed nations have found that with the exception of extreme intrauterine growth retardation also affecting brain growth, and hypoxic injury, IUGR seems to have little or no measurable effect on mental performance and behavior in adolescence or adulthood. For example, acute undernutrition for a few months during the Dutch famine of 1944 caused a decrease in mean birthweight in certain areas. This was later associated with a change in performance on IQ tests for 18–19 years old Dutch males draftees from these areas compared to control areas. The subjects were exposed to famine prenatally but not after birth. During the famine, births decreased more among those with lower Socioeconomic status (SES), whereas after the famine, there was a compensatory increase in births among those with lower SES. Since SES correlates with IQ, this may have hidden an effect caused by the undernutrition.
Studies often find higher IQ in children and adults who were breastfed. It has also been proposed that the omega-3 fatty acids that are found in high doses in breast milk, and that are known to be essential constituents of brain tissues, could at least partially account for an increase in IQ.
Recently, however, the longstanding belief that breastfeeding causes an increase in the IQ of offspring was challenged in a 2006 paper published in the British Medical Journal. The results indicated that mother's IQ, not breastfeeding, explained the differences in the IQ scores of offspring measured between ages 5 and 14. The results of this study argued that prior studies had not controlled for the mother's IQ. Since mother's IQ was predictive of whether a child was breastfed, the study concluded that "breast feeding [itself] has little or no effect on intelligence in children." Instead, it was the mother's IQ that had a significant correlation with the IQ of her offspring, whether the offspring was breastfed or was not breastfed. Another study found that breastfeeding had a positive effect on cognitive development at 24 months of age even after controlling for parental IQ.
A potential resolution to these different interpretations was proposed in a study showing that breastfeeding was linked to raised IQ (as much as 7 points when not controlling for maternal IQ) if the infants had an SNP coding for a "C" rather than G base within the FADS2 gene. Those with the "G" version showed no IQ advantage, suggesting a biochemical interaction of child's genes on the effect of breast feeding. Other studies have failed to replicate any correlation between the FADS2 gene, breastfeeding and IQ, while others show a negative effect on IQ when combining bottledfeeding, and the "G" version of FADS2 .
Micronutrients and vitamin deficiencies
Micronutrient deficiencies (e.g. in iodine and iron) influence the development of intelligence and remain a problem in the developing world. For example, iodine deficiency causes a fall, in average, of 12 IQ points.
Policy recommendations to increase availability of micronutrient supplements have been made and justified in part by the potential to counteract intelligence-related developmental problems. For example, the Copenhagen consensus, states that lack of both iodine and iron has been implicated in impaired brain development, and this can affect enormous numbers of people: it is estimated that 2 billion people (one-third of the total global population) are affected by iodine deficiency, including 285 million 6- to 12-year-old children. In developing countries, it is estimated that 40% of children aged four and under suffer from anaemia because of insufficient iron in their diets.
Overall, studies investigating whether cognitive function in already iron-deficient children can be improved with iron supplements have produced mixed results, possibly because deficiency in critical growth periods may cause irreversible damage. However, several studies with better design have shown substantial benefits. One way to prevent iron deficiency is to give specific supplementation to children, for example as tablets. However, this is costly, distribution mechanisms are often ineffective, and compliance is low. Fortification of staple foods (cereals, flour, sugar, salt) to deliver micronutrients to children on a large scale is probably the most sustainable and affordable option, even though commitment from governments and the food industry is needed. Developed nations fortify several foods with various micronutrients.
Additional vitamin-mineral supplementation may have an effect also in the developed world. A study giving such supplementation to "working class," primarily Hispanic, 6–12-year-old children in the United States for 3 months found an average increase of 2 to 3 IQ points. Most of this can be explained by the very large increase of a subgroup of the children, presumably because these were not adequately nourished unlike the majority. The study suggests that parents of schoolchildren whose academic performance is substandard would be well advised to seek a nutritionally oriented physician for assessment of their children's nutritional status as a possible etiology.
More speculatively, other nutrients may prove important in the future. Fish oil supplement to pregnant and lactating mothers has been linked to increased cognitive ability in one study. Vitamin B12 and folate may be important for cognitive function in old age.
Another study found that pregnant women who consumed 340 grams of low-mercury containing fish with fatty acids per week have benefits that outweigh the risks for mercury poisoning. They were less likely to have children with low verbal IQ, motor coordination and behavioral problems. However, foods containing high amounts of mercury, such as shark, swordfish, king mackerel and tilefish, might cause mental retardation.
Protein and energy malnutrition
One study from a developing country, Guatemala, found that poor growth during infancy, rather than low birth weight, was negatively related to adolescent performance on cognitive and achievement tests. A later related very long term study looked at the effect of giving 6–24-month-old children in Guatemala a high protein-energy drink as a dietary supplement. A significantly positive and fairly substantial effects was found on increasing the probability of attending school and of passing the first grade, increasing the grade attained by age 13, increasing completed schooling attainment, and for adults aged 25–40 increasing IQ test scores.
31% of children under the age of 5 in the developing world are moderately (height-for-age is below minus 2 standard deviations) or severely stunted (below minus 3 standard deviations). The prevalence was even higher previously since the worldwide prevalence of stunting is declining by about half of a percentage point each year. A study on stunted children aged 9–24 months in Jamaica found that when aged 17–18 years they had significantly poorer scores than a non-stunted group on cognitive and educational tests and psychosocial functioning. Giving a nutritional supplementation (1 kg milk based formula each week) to these already stunted children had no significant effect on later scores, but psychosocial stimulation (weekly play sessions with mother and child) had a positive effect.
Popular sayings can reflect the notion that remolded memories produce new creative associations in the morning, and that performance often improves after a time-interval that includes sleep. Current studies demonstrate that a healthy sleep produces a significant learning-dependent performance boost. Healthy sleep must include the appropriate sequence and proportion of NREM and REM phases, which play different roles in the memory consolidation-optimization process. During a normal night of sleep, a person will alternate between periods of NREM and REM sleep. Each cycle is approximately 90 minutes long, containing a 20-30 minute bout of REM sleep.  NREM sleep consists of sleep stages 1–4, and is where movement can be observed. A person can still move their body when they are in NREM sleep. If you are observing someone sleeping and you see them turn, toss, or roll over, this indicates that they are in NREM sleep. REM sleep is characterized by the lack muscle activity. Physiological studies have shown that aside from the occasional twitch, a person actually becomes paralyzed during REM sleep.  In motor skill learning, an interval of sleep may be critical for the expression of performance gains; without sleep these gains will be delayed (Korman et al., 2003).
Procedural memories are a form of nondeclarative memory, so they would most benefit from slow-wave, or NREM sleep.  In a study, procedural memories have been shown to benefit from sleep (Walker et al., 2002, as cited in Walker, 2009). Subjects were tested using a tapping task, where they used their fingers to tap a specific sequence of numbers on a keyboard, and their performances were measured by accuracy and speed. This finger-tapping task was used to simulate learning a motor skill. The first group was tested, retested 12 hours later while awake, and finally tested another 12 hours later with sleep in between. The other group was tested, retested 12 hours later with sleep in between, and then retested 12 hours later while awake. The results showed that in both groups, there was only a slight improvement after a 12 hour wake session, but a significant increase in performance after each group slept. This study gives evidence that NREM sleep is a significant factor in consolidating motor skill procedural memories, therefore sleep deprivation can impair performance on a motor learning task. This memory decrement results specifically from the loss of stage 2, NREM sleep. 
Declarative memory has also been shown to benefit from sleep, but not in the same way as procedural memory. Declarative memories benefit from REM sleep.  A study was conducted where the subjects learned word pairs, and the results showed that sleep not only prevents the decay of memory, but also actively fixates declarative memories (Payne et al., 2006). Two of the groups learned word pairs, then either slept or stayed awake, and were tested again. The other two groups did the same thing, except they also learned interference pairs right before being retested to try to disrupt the previously learned word pairs. The results showed that sleep was of some help in retaining the word pair associations, while against the interference pair, sleep helped significantly.
After sleep, there is increased insight. This is because sleep helps people to reanalyze their memories. The same patterns of brain activity that occur during learning have been found to occur again during sleep, only faster. One way that sleep strengthens memories is by weeding out the less successful connections between neurons in the brain. This weeding out is essential to prevent overactivity. The brain compensates for strengthening some synapses (connections) between neurons, by weakening others. The weakening process occurs mostly during sleep. This weakening during sleep allows for strengthening of other connections while we are awake. Learning is the process of strengthening connections, therefore this process could be a major explanation for the benefits that sleep has on memory. 
Research has shown that taking an afternoon nap increases learning capacity. A study (Mednick et al. 2009) tested two groups of subjects on a nondeclarative memory task. One group engaged in REM sleep, and one group did not (meaning that they engaged in NREM sleep). The investigators found that the subjects who engaged only in NREM sleep did not show much improvement. The subjects who engaged in REM sleep performed significantly better, indicating that REM sleep facilitated the consolidation of nondeclarative memories. 
Certain toxins, such as lead, mercury, arsenic, toluene, and PCB are well-known causes of neuro-developmental disorders. Recognition of these risks has led to evidence-based programmes of prevention, such as elimination of lead additives in petrol. Although these prevention campaigns are highly successful, most were initiated only after substantial delays.
Policies to manage lead differ between nations, particularly between the developed and developing world. Use of leaded gasoline has been reduced or eliminated in most developed nations, and lead levels in US children have been substantially reduced by policies relating to lead reduction. Even slightly elevated lead levels around the age of 24 months are associated with intellectual and academic performance deficits at age 10 years.
A Lancet review identified 201 chemicals with the ability to cause clinical neurotoxic effects in human adults, as described in the peer-reviewed scientific literature. Most of them are commonly used. Many additional chemicals have been shown to be neurotoxic in laboratory models. The article notes that children are more vulnerable and argues that new, precautionary approaches that recognise the unique vulnerability of the developing brain are needed for testing and control of chemicals in order to avoid the previous substantial before starting restrictions on usage. An appendix listed further industrial chemicals considered to be neurotoxic.
Alcohol and drugs
Current cannabis use was found to be significantly correlated in a dose-dependent manner with a decline in IQ scores, during the effect of the use. However, no such decline was seen in subjects who had formerly been heavy cannabis users and had stopped taking the drug. The authors concluded that cannabis does not have a long-term effect on intelligence. However this is contradicted by the long term longitudinal study, carried out by Otago and Duke universities,which found that regular use of marijuana in teenage years affects IQ in adulthood even when the use stops. The drop in IQ was 8 points. Adults smoking marijuana had no lasting effect on IQ. Effects on fetal development are minimal when compared with the well-documented adverse effects of tobacco or alcohol use.
Maternal tobacco smoking during pregnancy is associated with increased activity, decreased attention, and diminished intellectual abilities. However, a recent study finds that maternal tobacco smoking has no direct causal effect on the child's IQ. Adjusting for maternal cognitive ability as measured by IQ and education eliminated the association between lower IQ and tobacco smoking. But another study instead looking at the relationship between environmental tobacco smoke exposure, measured with a blood biomarker, and cognitive abilities among U.S. children and adolescents 6–16 years of age, found an inverse association between exposure and cognitive ability among children even at extremely low levels of exposure. The study controlled for sex, race, region, poverty, parent education and marital status, ferritin, and blood lead concentration.
Healthcare during pregnancy and childbirth
Healthcare during pregnancy and childbirth, access to which is often governed by policy, also influences cognitive development. Preventable causes of low intelligence in children include infectious diseases such as meningitis, parasites, and cerebral malaria, prenatal drug and alcohol exposure, newborn asphyxia, low birth weight, head injuries, and endocrine disorders. A direct policy focus on determinants of childhood cognitive ability has been urged.
A recent theory suggests that early childhood stress may affect the developing brain and cause negative effects. Exposure to violence in childhood has been associated with lower school grades and lower IQ in children of all races. A group of largely African American urban first-grade children and their caregivers were evaluated using self-report, interview, and standardized tests, including IQ tests. The study reported that exposure to violence and trauma-related distress in young children were associated with substantial decrements in IQ and reading achievement. Exposure to Violence or Trauma lead to a 7.5-point (SD, 0.5) decrement in IQ and a 9.8-point (SD, 0.66) decrement in reading achievement.
Violence may have a negative impact on IQ, or IQ may be protective against violence. The causal mechanism and direction of causation is unknown. Neighborhood risk has been related to lower school grades for African-American adolescents in another study from 2006. Violence may also be more prevalent in the homes of parents with lower IQ's. These parents could have genetically produced children with lower IQ's.
A 2010 study by Eppig, Fincher and Thornhill found a close correlation between the infectious disease burden in a country and the average IQ of its population. The researchers found that when disease was controlled for, IQ showed no correlation with other variables such as educational and nutritional levels. Since brain development requires a very high proportion of all the body's energy in newborns and children, the researchers argue that fighting infection reduces children's IQ potential. The Eppig research may help to explain the Flynn effect, the rise in intelligence noted in rich countries. They also tested other hypotheses as well, including genetic explanations, concluding that infectious disease was "the best predictor". Christopher Hassall and Thomas Sherratt repeated the analysis, and concluded "that infectious disease may be the only really important predictor of average national IQ".
In order to mitigate the effects of education on IQ, Eppig, Fincher & Thornhill (2010) repeated their analysis across the United States where standardized and compulsory education exists. The correlation between infectious disease and average IQ was confirmed, and they concluded that the "evidence suggests that infectious disease is a primary cause of the global variation in human intelligence".
Tropical infectious diseases
Malaria affects 300–500 million persons each year, mostly children under age five in Africa, causing widespread anemia during a period of rapid brain development and also direct brain damage from cerebral malaria to which children are more vulnerable. A 2006 systematic review found that Plasmodium falciparum infection causes cognitive deficits in both the short- and long-term. Policies aimed at malaria reduction may have cognitive benefits. It has been suggested that the future economic and educational development of Africa critically depends on the eradication of malaria.
Roundworms infect hundreds of millions of people. There is evidence that high intensities of worms in the intestines can affect mental performance, but a systematic review in 2000 and a 2009 update found that there was insufficient evidence to show that deworming treatments improve cognitive performance or school performance in children.
Effects of other diseases
There are numerous diseases affecting the central nervous system which can cause cognitive impairment. Many of these are associated with aging. Some common examples include Alzheimer's disease and Multi-infarct dementia. Many diseases may be neurological or psychiatric and may primarily affect the brain. Others may affect many other organs, like HIV, Hashimoto's thyroiditis causing hypothyroidism, or cancer.
Major depression, affecting about 16% of the population on at least one occasion in their lives and the leading cause of disability in North America, may give symptoms similar to dementia. Patients treated for depression score higher on IQ tests than before treatment.
Myopia and hyperopia
A 2008 literature review writes that studies in several nations have found a relationship between myopia and higher IQ and between myopia and school achievement. Several, but not all, studies have found hyperopia to be associated with lower IQ and school achievements. A common explanation for myopia is near-work. Regarding the relationship to IQ, several explanations have been proposed. One is that the myopic child is better adapted at reading, and reads and studies more, which increases intelligence. The reverse explanation is that the intelligent and studious child reads more which causes myopia. Another is that the myopic child have an advantage at IQ testing which is near work because of less eye strain. Still another explanation is that pleiotropic gene(s) affect the size of both brain and eyes simultaneously. A study of Chinese schoolchildren found that after controlling for age, gender, school, parental myopia, father’s education, and books read per week, myopia was still associated with high nonverbal IQ. Nonverbal IQ was a more important explanation than books read per week.
Long working hours (55 vs. 40) was associated with increased scores on cognitive tests in a 5 year study on midlife British civil servants.
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