Effects of diet on behaviour and cognition in children

Impact of hydration and nutrition on personal performance in the clinical workplace

As clinicians we sometimes fail to look after ourselves at work. We often do not drink enough during the day or miss lunch breaks while caring for patients, and this can be particularly evident during an all-day operating list when procedures are long and complex. Some operating theatre staff do not even eat breakfast regularly. Inadequate intake of fluids or nutrition can impair performance, lead to tiredness and headaches, and may compromise both our own health and the care we provide to patients. Other high-risk organisations, including aviation, have recognised that employees must look after themselves if they are to optimise their performance. In this review, we discuss the importance of adequate hydration and nutrition at work to raise awareness that this is essential if we are to provide the best care for our patients.

Life History theory hypotheses on child growth: Potential implications for short and long-term child growth, development and health

Life history theory integrates ecological, physiological, and molecular layers within an evolutionary framework to understand organisms' strategies to optimize survival and reproduction. Two life history hypotheses and their implications for child growth, development, and health (illustrated in the South African context) are reviewed here. One hypothesis suggests that there is an energy trade-off between linear growth and brain growth. Undernutrition in infancy and childhood may trigger adaptive physiological mechanisms prioritizing the brain at the expense of body growth. Another hypothesis is that the period from conception to infancy is a critical window of developmental plasticity of linear growth, the duration of which may vary between and within populations. The transition from infancy to childhood may mark the end of a critical window of opportunity for improving child growth. Both hypotheses emphasize the developmental plasticity of linear growth and the potential determinants of growth variability (including the role of parent-offspring conflict in maternal resources allocation). Implications of these hypotheses in populations with high burdens of undernutrition and infections are discussed. In South Africa, HIV/AIDS during pregnancy (associated with adverse birth outcomes, short duration of breastfeeding, and social consequences) may lead to a shortened window of developmental plasticity of growth. Furthermore, undernutrition and infectious diseases in children living in South Africa, a country undergoing a rapid nutrition transition, may have adverse consequences on individuals' cognitive abilities and risks of cardio-metabolic diseases. Studies are needed to identify physiological mechanisms underlying energy allocation between biological functions and their potential impacts on health.

Elimination diets' efficacy and mechanisms in attention deficit hyperactivity disorder and autism spectrum disorder

Nutrition plays an important role in neurodevelopment. This insight has led to increasing research into the efficacy of nutrition-related interventions for treating neurodevelopmental disorders. This review discusses an elimination diet as a treatment for attention deficit hyperactivity disorder and autism spectrum disorder, with a focus on the efficacy of the food additives exclusion diet, gluten-free/casein-free diet and oligoantigenic diet. Furthermore, we discuss the potential mechanisms of elimination diets' effects in these neurodevelopmental disorders. The main candidate mechanism is the microbiome-gut-brain axis possibly involving complex interactions between multiple systems, including the metabolic, immune, endocrine, and neural system. We conclude with practical implications and future directions into the investigation of an elimination diet's efficacy in the treatment of attention deficit hyperactivity disorder and autism spectrum disorder.

A comparative study of the prevalence and correlates of psychiatric disorders in Almajiris and public primary school pupils in Zaria, Northwest Nigeria

BACKGROUND

'Almajiris' are children and adolescents sent far away from their homes to study in Islamic schools under the care of Muslim scholars. Over the years, there has been a decline in the capacity of the scholars to cater to these pupils. Consequently, Almajiris spend significant periods of time on the streets begging and carrying out menial jobs to earn a living thereby increasing their risk for physical and mental disorders. The aim of this study was to compare the prevalence of psychiatric disorders among Almajiris and public primary school pupils in Zaria.

METHODS

A comparative cross-sectional design was utilized to compare 213 Almajiris and 200 public primary school children and adolescents aged between 5 and 19 years. All participants were administered a Socio-demographic questionnaire and the Schedule for Affective Disorders and Schizophrenia for School-aged Children Present and Lifetime Version (K-SADS-PL). Data were analyzed using Chi square tests and logistic regression.

RESULTS

The current prevalence of psychiatric disorders among Almajiris and public school pupils was 57.7 and 37.0% respectively. After adjusting for age and family characteristics, Almajiris were significantly more likely to have any psychiatric diagnosis, depression, enuresis, substance use, and post traumatic stress disorder but less likely to have separation anxiety disorder than the public school pupils.

CONCLUSION

Psychiatric disorders are more prevalent among Almajiris and public primary school pupils in Northwest Nigeria than found in other prevalence studies with a significantly higher rate among the Almajiris. Joint efforts need to be made by the Government and Civil Society organizations including religious groups towards reforming the Almajiri education system and the provision of programmes aimed at reducing the prevalence of psychiatric disorders in both Almajiris and the school pupils.

Eating Habits and Food Additive Intakes Are Associated with Emotional States Based on EEG and HRV in Healthy Korean Children and Adolescents

PURPOSE

Recent study suggests that psychological issues and eating habits are closely related. In this study, we aimed to find the association between eating habits and intakes of artificial sweeteners with emotional states of schoolchildren using quantitatively analyzing objective biosignals.

METHODS

The study was conducted at the National Standard Reference Data Center for Korean EEG as a cross-sectional study. Three hundred eighteen healthy children who have not been diagnosed with neurologic or psychiatric disorders were evaluated (168 girls and 150 boys; mean age of 11.8 ± 3.6 years). Analysis indicators were a dietary intake checklist for children's nutrition-related behavior score (NBS), consisting of 19 items; food frequency questionnaires (FFQs), consisting of 76 items; the Child Depression Inventory (CDI); State-Trait Anxiety Inventory-State (STAI-S); State-Trait Anxiety Inventory-Trait (STAI-T); electroencephalograph (EEG); and heart rate variability (HRV).

RESULTS

Higher scores on the CDI, STAI-S, and STAI-T indicate negative emotions, and these scores were significantly decreased from the first to the fourth quartiles. The HRV results showed that the standard deviation of all normal-to-normal (SDNN) intervals was significantly higher in the first quartile than in the fourth quartile (p < 0.05). The intakes of artificial sweeteners and processed foods such as hamburgers correlate with higher theta/beta ratios, and intakes of natural foods such as legumes and fruits correlate with lower theta/beta ratios (p < 0.05).

CONCLUSIONS AND IMPLICATIONS

From this result we confirmed a link between overall nutritional behavior, food additive intakes, and emotion in apparently healthy children and adolescents.

Prevalence of Thinness in Adolescent Girls in Low- and Middle-Income Countries and Associations With Wealth, Food Security, and Inequality

PURPOSE

Adequate nutrition during adolescence is important for optimal physical and cognitive development and for pregnancy either during adolescence or later life. Thinness among adolescent girls in low- and middle-income countries has been little studied.

METHODS

We used body mass index data from 40 countries from the Global School Health Survey to estimate the prevalence of moderate and severe thinness in 12- to 18-year-olds using the World Health Organization 2007 growth reference. Self-report data on going to bed hungry were used as a proxy for household food insecurity. We used multilevel models to assess whether national wealth (gross domestic product), income inequality (Gini index), national gender inequality (Gender Inequality Index), and food security (Global Food Security Index) were associated with undernutrition.

RESULTS

Prevalence rates of moderate and severe thinness across 61,603 girls from 40 countries were 6.30% (95% confidence interval [CI]: 5.71-6.95) and 1.34% (1.12-1.59), respectively, with higher rates in Asia. Combined moderate/severe thinness was more common among early (12-14 years) than later adolescents (15-18 years). Going to bed hungry sometimes was associated with increased risk of moderate/severe thinness (odds ratio [OR]: 1.102; 95% CI: 1.007-1.206). A significant inverse relationship was found between thinness and gross domestic product (OR: .94; 95% CI: .88-.99) and Global Food Security Index (OR: .96; 95% CI: .93-.99) but not Gini or Gender Inequality Index.

CONCLUSION

Thinness remains prevalent in adolescent schoolgirls in low- and middle-income countries and poses a significant threat to their health and that of the next generation. Further research is needed to assess potential interventions for this group.

Impact of Nutritional Status on Cognition in Institutionalized Orphans: A Pilot Study

INTRODUCTION

Proper nutrition is critical for maximizing brain function and enhancing learning. There is accumulating evidence that early malnutrition, marked by stunting, is associated with long-term deficits in cognitive and academic performance, even when social and psychological differences are controlled. All over the world, children living without permanent parental care are at a heightened risk for under-nutrition, putting their health and development in great jeopardy.

AIM

To assess the nutritional and cognitive status in institutionalized orphans which might help to formulate effective interventions for improving the nutritional status of vulnerable children in future.

MATERIALS AND METHODS

This cross-sectional, study included 70 children (35 orphans and 35 non-orphans). Their anthropometric measurements (height, weight, and BMI) were measured and cognition was assessed using subsets of Wechsler Intelligence Scale for Children-Revised (WISC-R): Block design and Digit span. The data obtained was subjected to descriptive statistical analysis.

RESULTS

18.57% (13) of children had stunting, 15.71% (11) had wasting, 22.86% (16) were underweight, and 17.14% (12) showed thinness. Mean±SD of Block design in non-orphans was significantly higher compared to orphans (p-value 0·05). Mean±SD of Digit span in non-orphans was significantly higher compared to orphans (p-value 0·000). For Block design, there was moderate positive correlation with nutritional status based on Z-scores (p-value <0·05). Digit span also showed moderate positive correlation (p-value <0·05).

CONCLUSION

The results of our study indicate that children in orphanages have high rates of both malnutrition and cognitive delay compared to the non-orphans and there was a direct correlation between both the variables. If orphanages are here to stay as a last resort for children deprived of a family there is an urgent need to improve the institutional environment in order to foster the development of millions of children in orphanages around the world.

Relationships between Dietary Intake and Cognitive Function in Healthy Korean Children and Adolescents

Background

It has long been theorized that a relatively robust dietary intake impacts cognitive function. The aim of the study was to explore dietary intake and cognitive function in healthy Korean children and adolescents.

Methods

Three hundred and seventeen healthy children with no previous diagnosis of neurologic or psychiatric disorders were evaluated (167 girls and 150 boys with a mean age of 11.8 ± 3.3 years). Analysis indicators including food frequency questionnaires (FFQs) consisting of 76 items and neurocognitive tests including symbol digit modalities (SDMT), verbal memory, visual memory, shift attention, reasoning, and digit span (forward and backward) tests were observed and recorded.

Results

The standard deviation in reaction time was significantly shorter in girls than in boys (p < 0.05). Verbal memory and SDMT percentile results were significantly higher in girls than in boys (p < 0.05). Vitamin C and potassium intake showed positive correlation with SDMT results (p < 0.05). Vitamin B1 intake showed positive correlation with the results of digit span forward tasks and SDMT (p < 0.01). Vitamin B6 intake showed positive correlation with the results of digit span forward tasks (p < 0.01). The consumption of noodles showed negative correlation with verbal memory, SDMT, shift attention, and reasoning test results (p < 0.05). The consumption of fast food showed negative correlation with SDMT and reasoning test results (p < 0.05). The consumption of Coca-Cola showed negative correlation with the results of verbal memory tests (p < 0.05). The consumption of mushrooms showed positive correlation with visual memory and reasoning test results (p < 0.05). The consumption of nuts showed positive correlation with SDMT results (p < 0.01). Omission errors were negatively correlated with the intake of protein, vitamin B1, vitamin B2, niacin, and vitamin B6 (p < 0.05), as well as with vitamin D and zinc intake (p < 0.01). Reaction time showed positive correlation with caffeine intake (p < 0.05). Omission errors were positively correlated with the consumption of rice and ramyeon (p < 0.01). Reaction time showed positive correlation with the consumption of snacks (p < 0.05). Standard deviations in reaction times showed positive correlation with the consumption of rice (p < 0.01), snacks, and chocolate (p < 0.05). Omission errors were negatively correlated with the consumption of rice with mixed grains (p < 0.01) and eggs (p < 0.05).

Conclusion

The relationship between dietary intake and cognitive function is generally better observed in girls than in boys. The consumption of healthy foods is correlated with good cognitive function. These results suggest that diet is closely related to cognitive function, even in healthy children and adolescents.

Effect of Sugar versus Mixed Breakfast on Metabolic and Neurofunctional Responses in Healthy Individuals

We investigated the effects of glucose and diverse breakfasts on glucose increment and ghrelin suppression and cognitive processing of sensory information assessed by frontal P300 evoked potentials. In a randomized crossover design, 12 healthy individuals (6M/6F; BMI 22.2 ± 0.4 kg/m²; 27 ± 1.3 years, mean ± SEM) underwent 50 g OGTT (A) and 3 breakfasts (B1: milk and cereals; B2: milk, apple, and chocolate cream-filled sponge cake; B3: milk, apple, bread, and hazelnut chocolate cream) to assess plasma glucose-, insulin-, and ghrelin excursions. An electroencephalography was performed before and 100 min after consumption of each load to measure the latency of frontal P300 evoked potentials as index of cognitive performance. Breakfasts B1 and B2 exhibited significantly lower glycemic and insulinemic responses as compared to A. Breakfast B3 exhibited significantly lower glycemic, but not insulinemic response, as compared to A. Final plasma ghrelin inhibition was more pronounced, albeit not significantly, in all breakfasts with respect to A. P300 latency tended to decrease following each of the three breakfasts, but B3 was the only breakfast capable to elicit a statistically significant reduction in P300 latency with respect to A (p < 0.01), suggesting ameliorated cognitive performance. Such amelioration was correlated with the 2-hour final inhibition of plasma ghrelin concentration (r = 0.61, p = 0.01).

Importance of mental performance in parental choice of food for children aged 4-10 years: a study in four European countries

OBJECTIVE

Typically, attention focuses on how nutrition affects physical health. The present study investigated the importance that parents attach to the impact of diet on mental performance when choosing food for their child.

DESIGN

Questionnaire.

SETTING

Four European countries.

SUBJECTS

Parents of children aged 4-10 years (n 1574): England (n 397), Germany (n 389), Hungary (n 398) and Spain (n 390).

RESULTS

Most parents (80-85 %) considered the effect of food on four elements of mental performance (child's ability to learn, attention, behaviour, mood) to be moderately, very, extremely (v. slightly, not at all) important in food choices; over 90 % considered healthiness of food and making food appealing to their child important; 79·8 % cost; 76·8 % convenience. Belief that food affects mental performance was 57·4 % (ability to learn), 60·5 % (attention); less than 40 % of parents agreed they were aware which foods had an effect. Parents with lower general interest in healthy eating were less likely to consider the effect of food on mental performance elements as important. Respondents from Germany were more likely to rate mental performance as important (except behaviour); those in Hungary less likely. The most important influence on parents' decisions about feeding their child was their own experience, except Spain, where family/friends/health professionals were more important.

CONCLUSIONS

Nutrition affects brain development and cognitive functioning. Low prioritisation of the effect of food on mental performance indicates potential for educating parents.

Association between energy drink intake, sleep, stress, and suicidality in Korean adolescents: energy drink use in isolation or in combination with junk food consumption

BACKGROUND

A considerable amount of research suggests that the frequent use of caffeinated energy drinks may be associated with undesirable effects, particularly so in children and adolescents. This study aimed to investigate the associations between energy drink intake and mental health problems, in isolation or in combination with junk food consumption, in a nationally representative sample of Korean adolescents.

METHODS

Data from the 2015 Korean Youth Risk Behavior Web-Based Survey, collected from 68,043 adolescents aged 12-18 years (mean age 15.09 ± 1.72 years), were analyzed. Questionnaires were administered to collect information related to dietary behavior including energy drink intake and junk food consumption. Single item measures of sleep dissatisfaction, stress, depression, suicidal ideation, suicide plan, and suicide attempt were also administered. Associations between energy drink intake and sleep dissatisfaction, perceived severe stress, persistent depressive mood, and suicidality were investigated, and a multivariate approach was taken so that additional variance from demographic and lifestyle factors could be controlled for statistically.

RESULTS

Energy drink intake was significantly associated with sleep dissatisfaction (adjusted odd ratios [AORs] = 1.64 and 1.25), severe stress (AORs = 2.23 and 1.38), depressive mood (AOR = 2.59 and 1.51), suicidal ideation (AORs = 3.14 and 1.43), suicide plan (AORs = 4.65 and 1.78), and suicide attempt (AORs = 6.79 and 1.91), with a higher risk for more frequent use of energy drinks (≥5 times/wk) than for less frequent use (1-4 times/wk). The detrimental effect of energy drinks on mental health was particularly prominent in frequent junk food consumers.

CONCLUSIONS

Our data suggest that energy drink intake had detrimental effects related to stress, sleep dissatisfaction, mood, and suicidality, in isolation or in combination with junk food consumption, in Korean adolescents. However, the cross-sectional study design prevents our ability to assess causal relationships.

Lunch at school and children's cognitive functioning in the early afternoon: results from the Cognition Intervention Study Dortmund Continued (CoCo)

Studies about effects of school lunch on children's cognition are rare; two previous studies (CogniDo, CogniDo PLUS) generally found no negative effects of lunch on children's cognitive performance at the end of lunch break (i.e. 45 min after finishing lunch), but suggested potential beneficial effects for single parameters. Therefore, the present study investigated the hypothesis of potential positive effects of school lunch on cognitive performance at early afternoon (90 min after finishing lunch). A randomised, cross-over intervention trial was conducted at a comprehensive school with fifth and sixth grade students. Participants were randomised into two groups: On day 1, group 1 did not eat lunch, whereas group 2 received lunch ad libitum. On day 2 (1 week later), group 2 did not eat lunch and group 1 received lunch ad libitum. The cognitive parameters task switching, working memory updating and alertness were tested using a computerised test battery 90 min after finishing the meal. Of the 204 recruited children, fifty were excluded because of deviations from the study protocol or absence on one of the 2 test days, which resulted in 154 participants. Data showed no significant effects of lunch on task switching, working memory updating and alertness (P values between 0·07 and 0·79). The present study suggests that school lunch does not seem to have beneficial effects on children's cognitive functions regarding the conducted tests at early afternoon. Together with our previous studies, we conclude that school lunch in general has no negative effects on cognitive performance in children. However, beneficial effects seem to be restricted to a relatively short time period after eating lunch.

Participation in the special supplemental nutrition program for women, infants, and children is not associated with early childhood socioemotional development: Results from a longitudinal cohort study

Socioemotional development in early childhood has long-term impacts on health status and social outcomes, and racial and socioeconomic disparities in socioemotional skills emerge early in life. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an early childhood nutrition intervention with the potential to ameliorate these disparities. Our objective was to assess the impact of WIC on early socioemotional development in a longitudinal study. We examined the association between WIC participation and scores on the Brief Infant Toddler Social Emotional Assessment (BITSEA) in 327 predominantly African American mother–child dyads who were participants in the longitudinal Conditions Affecting Neurocognitive Development in Early Life (CANDLE) Study (Memphis, TN). To account for selection bias, we used within-child fixed effects to model the variability in each child's BITSEA scores over two measurement occasions (ages 12 and 24 months). Final models were adjusted for time-varying characteristics including child age, maternal stress, mental health, child abuse potential, marital status, and food stamp participation. In fully adjusted models, we found no statistically significant effect of WIC on change in socioemotional development (β = 0.22 [SD = 0.39] and β = − 0.58 [SD = 0.79] for BITSEA Competence and Problem subdomains, respectively). Using rigorous methods and a longitudinal study design, we found no significant association between WIC and socioemotional development in a high needs population. This finding suggests that early childhood interventions that more specifically target socioemotional development are necessary if we are to reduce racial disparities in socioemotional skills and prevent poor social and health outcomes across the life course.

•

The effect of WIC on early childhood socioemotional development is largely unknown.

•

We study this association in a well-characterized, longitudinal cohort of mother–child dyads.

•

We adjust for stable characteristics with fixed effects and add covariates.

•

We find no association between WIC and childhood socioemotional development.

Breakfast consumption has no effect on neuropsychological functioning in children: a repeated-measures clinical trial

BACKGROUND

Although many studies have investigated the relation between breakfast consumption and various domains of cognitive functioning within children, some of the reported findings are inconsistent.

OBJECTIVE

We sought to determine the short-term effects of a breakfast meal on the neuropsychological functioning of healthy school-aged children after an overnight fast.

DESIGN

The study was conducted in a clinical research center with the use of a counterbalanced repeated-measures design among children who either consumed breakfast or were fasting. The administered neuropsychological tests included measures of attention, impulsivity, short-term memory, cognitive processing speed, and verbal learning. The sample consisted of children aged 8-10 y (n = 128), of whom 52% were female, 38% were African American, 31% were Hispanic, 28% were white, and 3% were of another race/ethnicity.

RESULTS

There were no significant (P ≥ 0.004) differences between breakfast meal consumption and fasting for any of the neuropsychological measures administered.

CONCLUSION

Breakfast consumption had no short-term effect on neuropsychological functioning in healthy school-aged children. This trial was registered at clinicaltrials.gov as NCT01943604.

Sugar-Sweetened Beverage Consumption Is Adversely Associated with Childhood Attention Deficit/Hyperactivity Disorder

Attention deficit/hyperactivity disorder (ADHD) is one of the most common childhood neurobehavioral conditions. Evidence of the negative effects of sugar-sweetened beverages (SSBs) on mental health has not been convincing, although a few studies have found an association between high SSB levels and attention problems in children. This study aimed to test the hypothesis that SSB consumption is associated with ADHD among children. Doctor-diagnosed ADHD cases (n = 173) and non-ADHD controls (n = 159) between age 4 to 15 were recruited. SSB consumption, socio-demographic and lifestyle characteristics of the children, as well as of their mothers' characteristics during pregnancy, were collected using a questionnaire. Blood lead levels and polymorphisms of two commonly verified dopaminergic-related genes (the D4 dopamine receptor gene DRD4 and the dopamine transporter gene DAT1) were also analyzed. There was a dose-response relationship between SSB consumption and ADHD. After covariates were adjusted, children who consumed SSBs at moderate levels and high levels had 1.36 and 3.69 odds, respectively, of having ADHD, compared with those who did not consume SSBs (p for trend < 0.05). Similar results were obtained when females were excluded. Our findings highlighted the adverse correlation between SSB consumption and ADHD and indicated a dose-response effect even after covariates were adjusted.

Body mass loss correlates with cognitive performance in primates under acute caloric restriction conditions

Brain functions are known to consume high levels of energy, thus, the integrity of cognitive performance can be drastically impacted by acute caloric restriction. In this study, we tested the impact of a 40% caloric restriction on the cognitive abilities of the grey mouse lemur (Microcebus murinus). Twenty-three male mouse lemurs were divided into two groups: 13 control animals (CTL) that were fed with 105kJ/day and 10calorie restricted (CR) animals that received 40% less food (63kJ/day) than the CTL animals. The animals were fed according to their group for 19days. Before treatment, we assessed baseline associative learning capacities, resting metabolic rates and locomotor performance of both animal groups. After treatment, we tested the same functions as well as long-term memory. Our results showed that CR animals had lower learning performance following caloric restriction. The effects of caloric restriction on memory recall varied and depended on the metabolism of the individual animal. Body mass loss was linked to memory test performance in the CR group, and lower performance was observed in individuals losing the most weight. While CR was observed to negatively impact learning, locomotor capacities were preserved in CR animals, and there were higher resting metabolic rates in the CR group. Our data reinforce the strong link between energy allocation and brain function, and suggest that in the context of food shortage, learning capacities could be a limiting parameter in the adaptation to a changing environment.

Do thin, overweight and obese children have poorer development than their healthy-weight peers at the start of school? Findings from a South Australian data linkage study

Little is known about the holistic development of children who are not healthy-weight when they start school, despite one fifth of preschool-aged children in high income countries being overweight or obese. Further to this, there is a paucity of research examining low body mass index (BMI) in contemporary high-income populations, although evidence from the developing world demonstrates a range of negative consequences in childhood and beyond. We investigated the development of 4-6 year old children who were thin, healthy-weight, overweight, or obese (as defined by BMI z-scores) across the five domains of the Australian Early Development Census (AEDC): Physical Health and Wellbeing, Social Competence, Emotional Maturity, Language and Cognitive Skills, and Communication Skills and General Knowledge. We used a linked dataset of South Australian routinely collected data, which included the AEDC, school enrollment data, and perinatal records (n = 7533). We found that the risk of developmental vulnerability among children who were thin did not differ from healthy-weight children, after adjusting for a range of perinatal and socio-economic characteristics. On the whole, overweight children also had similar outcomes as their healthy-weight peers, though they may have better Language and Cognitive skills (adjusted Risk Ratio [aRR] = 0.73 [95% CI 0.50-1.05]). Obese children were more likely to be vulnerable on the Physical Health and Wellbeing (2.20 [1.69, 2.87]) and Social Competence (1.31 [0.94, 1.83]) domains, and to be vulnerable on one or more domains (1.45 [1.18, 1.78]). We conclude that children who are obese in the first year of school may already be exhibiting some developmental vulnerabilities (relative to their healthy-weight peers), lending further support for strategies to promote healthy development of preschoolers.

Relationships between milk consumption and academic performance, learning motivation and strategy, and personality in Korean adolescents

BACKGROUND/OBJECTIVES

A healthy diet has been reported to be associated with physical development, cognition and academic performance, and personality during adolescence. This study was performed to investigate the relationships among milk consumption and academic performance, learning motivation and strategies, and personality among Korean adolescents.

SUBJECTS/METHODS

The study was divided into two parts. The first part was a survey on the relationship between milk consumption and academic performance, in which intakes of milk and milk products and academic scores were examined in percentiles among 630 middle and high school students residing in small and medium-sized cities in 2009. The second part was a survey on the relationships between milk consumption and learning motivation and strategy as well as personality, in which milk consumption habits were collected and Learning Motivation and Strategy Test (L-MOST) for adolescents and Total Personality Inventory for Adolescents (TPI-A) were conducted in 262 high school students in 2011.

RESULTS

In the 2009 survey, milk and milk product intakes of subjects were divided into a low intake group (LM: ≤ 60.2 g/day), medium intake group (MM: 60.3-150.9 g/day), and high intake group (HM: ≥ 151.0 g/day). Academic performance of each group was expressed as a percentile, and performance in Korean, social science, and mathematics was significantly higher in the HM group (P < 0.05). In the 2011 survey, the group with a higher frequency of everyday milk consumption showed significantly higher "learning strategy total," "testing technique," and "resources management technique" scores (P < 0.05) in all subjects. However, when subjects were divided by gender, milk intake frequency, learning strategy total, class participation technique, and testing technique showed significantly positive correlations (P < 0.05) in boys, whereas no correlation was observed in girls. Correlations between milk intake frequency and each item of the personality test were only detected in boys, and milk intake frequency showed positive correlations with "total agreeability", "organization", "responsibility", "conscientiousness", and "intellectual curiosity" (P < 0.05).

CONCLUSION

Intakes of milk and milk products were correlated with academic performance (Korean, social science, and mathematics) in Korean adolescents. In male high school students, particularly, higher milk intake frequency was positively correlated with learning motivation and strategy as well as some items of the personality inventory.

Health Behaviors and Academic Performance Among Korean Adolescents

PURPOSE

This study aimed to examine the most prominent health-related behaviors impacting the academic performance of Korean adolescents.

METHODS

The 2012 Korea Youth Risk Behavior Web-Based Survey data were analyzed using an ordinal regression analysis after adjusting for general and other health behaviors.

RESULTS

Before adjustment, all health behaviors were significantly associated with academic performance. After adjustment for other health behaviors and confounding factors, only smoking [odds ratio (OR) = 2.07, 95% confidence interval (CI) (1.98, 2.16), p < .001], alcohol consumption [OR = 1.22, 95% CI (1.18, 1.27), p < .001], and physical activity [OR = 1.09, 95% CI (1.06, 1.13), p < .001] were associated with lower academic performance, and engaging in a regular diet [OR = 0.65, 95% CI (0.65, 0.62), p < .001] was associated with higher academic performance.

CONCLUSIONS

Regular diet, reducing smoking and alcohol drinking, and physical activity should be the target when designing health interventions for improving academic performance in Korean adolescents.

The effect of diet on the physical and mental development of children: views of parents and teachers in four European countries

Although the impact of diet on physical health is an important public health issue, less attention has been devoted to the relationship between nutrition and children's mental development. The views of parents and teachers about the extent to which diet affects physical and mental development of children were compared in four European countries. An online questionnaire (developed in English and translated) was circulated through a market research agency. Participants were parents or teachers of children aged 4-10 years without learning or behavioural issues. Questionnaires were returned by 1606 parents (401 in England, Germany and Hungary; 403 in Spain) and 403 teachers (100 in each country, except for 103 in Hungary). Teachers were older than parents (35·3 % v. 18·3 % over 45 years; P<0·001) and less likely to smoke (15·9 % v. 26·3 %, P<0·001). There was no difference between the proportions of parents and teachers who felt that a child's physical development depended very much/extremely (v. moderately/slightly/not at all) on diet (overall 79·8 %). Lower proportions of both groups thought that mental development was very much/extremely influenced by diet (67·4 %). In the regression modelling, believing that physical and mental performance was greatly influenced by diet was significantly and positively associated with living in Hungary, scoring higher on a measure of General Health Interest and (parents only) level of education attained. Differences existed among countries in most views. Lower levels of awareness of the importance of diet for brain development and cognition (compared with physical health outcomes) indicate the potential for educating consumers, especially parents with lower educational attainment.

Conceptual framework of a simplified multi-dimensional model presenting the environmental and personal determinants of cardiometabolic risk behaviors in childhood

Clinical manifestations of cardiometabolic risk (CMR) may be set early in childhood due to unfavorable behaviors or lifestyle patterns related to diet and physical activity. Several factors may determine the adoption of such lifestyle-related behaviors, which researchers have tried to cluster under certain frameworks or models. In this context, the framework developed and proposed by this review gathers all the present knowledge regarding these determining factors to date and groups them into three main categories related to personal characteristics and the social and physical environment. Based on the proposed framework, a large variety of personal, social and physical environmental factors can positively or negatively influence CMR-related behaviors (either directly or indirectly via their interrelations), thus leading to decreased or increased risk, respectively. This framework could be of great value to public health policy makers and legislators for designing and implementing interventional programs tailored to the needs of susceptible population groups who are most in need for such initiatives. Targeting the correlates as potential determinants of CMR-related behaviors, and not just on the behaviors themselves, has been shown previously to be the most effective approach for tackling health issues related to CMR starting from early life stages.

Nutrition and Cognitive Achievement: An Evaluation of the School Breakfast Program

This paper investigates the impact of the School Breakfast Program (SBP) on cognitive achievement. The SBP is a federal entitlement program that offers breakfast to any student, including free breakfast for any low-income student, who attends a school that participates in the program. To increase the availability of the SBP, many states mandate that schools participate in the program if the percent of free or reduced-price eligible students in a school exceeds a specific threshold. Using the details of these mandates as a source of identifying variation, I find that the availability of the program increases student achievement.

School nutrition guidelines: overview of the implementation and evaluation

Objective

To holistically evaluate the extent of implementation of dietary guidelines in schools and present various monitoring systems.

Design

The study comprises three methods: (i) a cross-sectional survey (process evaluation); (ii) an indicator-based evaluation (menu quality); and (iii) a 5 d weighed food record of school lunches (output evaluation).

Setting

Slovenian primary schools.

Subjects

A total 234 food-service managers from 488 schools completed a self-administrated questionnaire for process evaluation; 177 out of 194 randomly selected schools provided menus for menu quality evaluation; and 120 school lunches from twenty-four schools were measured and nutritionally analysed for output evaluation.

Results

The survey among food-service managers revealed high levels of implementation at almost all process evaluation areas of the guidelines. An even more successful implementation of these guidelines was found in relation to organization cultural issues as compared with technical issues. Differences found in some process evaluation areas were related to location, size and socio-economic characteristics of schools. Evaluation of school menu quality demonstrated that score values followed a normal distribution. Higher (better) nutrition scores were found in larger-sized schools and corresponding municipalities with higher socio-economic status. School lunches did not meet minimum recommendations for energy, carbohydrates or dietary fibre intake, nor for six vitamins and three (macro, micro and trace) elements.

Conclusions

The implementation of the guidelines was achieved differently at distinct levels. The presented multilevel evaluation suggests that different success in implementation might be attributed to different characteristics of individual schools. System changes might also be needed to support and improve implementation of the guidelines.

Dietary fat and carbohydrate have different effects on body weight, energy expenditure, glucose homeostasis and behaviour in adult cats fed to energy requirement

The effects of dietary carbohydrate and fat on feline health are not well understood. The effects of feeding diets moderately high in fat (HF; n 10; 30 % fat, 26 % carbohydrate as fed) or carbohydrate (HC; n 10; 11 % fat, 47 % carbohydrate), for 84 d, were investigated in healthy, adult cats (3·5 (sd 0·5) years). Data on indirect calorimetry, blood biomarkers, activity, play and cognition were collected at baseline, and at intervals throughout the study. Body composition was measured by dual-energy X-ray absorptiometry at baseline and on day 85. There were no significant main effects of diet on body weight and composition. When data were analysed over study day within diet, cats fed HF diets experienced a significant increase in body fat (P = 0·001) and body weight (P = 0·043) in contrast to cats consuming the HC diet that experienced no change in body fat or body weight (P = 0·762) throughout the study. Overall, energy expenditure was similar between diets (P = 0·356 (fasted), P = 0·086 (postprandial)) and respiratory quotient declined with exposure to the HF diet and increased with exposure to the HC diet (P < 0·001; fasted and postprandial). There was no difference in insulin sensitivity as an overall effect of diet (P = 0·266). Activity declined from baseline with exposure to both diets (HC: P = 0·002; HF: P = 0·01) but was not different between diets (P = 0·247). There was no effect of diet on play (P = 0·387) and cats consuming either the HF or HC diet did not successfully learn the cognitive test. Overall, cats adapt to dietary macronutrient content, and the implications of feeding HC and HF diets on risk for adiposity as driven by metabolic and behavioural mechanisms are discussed.

Dietary patterns and weight status associated with behavioural problems in young children

OBJECTIVE

To investigate the associations of behavioural problems with dietary patterns and weight status in young children.

DESIGN

We assessed poor social skills and behavioural problems with a seventy-six-item Preschool and Kindergarten Behavior Scale (PKBS) and found three dietary patterns ('Korean healthy', 'animal foods' and 'sweets') in food/food group intake data assessed by an FFQ and analysed using factor analysis. Multiple logistic regression analyses were used to assess the association of diet and weight status with behaviour.

SETTING

Pre-schools in the metropolitan areas of Korea.

SUBJECTS

A total of 1458 children (mean age 5·2 (sd 0·9) years) from the Practical Approach for Better Maternal and Child Nutrition and Health Study conducted from 2001 to 2005.

RESULTS

The 'Korean healthy' pattern showed a significant inverse association with poor social skills in the second highest quartile group (OR = 0·42; 95 % CI 0·21, 0·82) compared with the lowest quartile group for boys. For girls, the 'sweets' pattern was associated with a greater risk of poor social skills (OR = 3·41; 95 % CI 1·29, 9·01 at Q4 v. Q1) and problem behaviours (OR = 2·80; 95 % CI 1·05, 7·43 at Q4 v. Q1). Regarding weight status, both underweight and overweight boys had a higher risk of poor social skills than normal-weight boys.

CONCLUSIONS

Dietary patterns and weight status are important indicators for the behaviour of young children. Healthy and unhealthy dietary patterns, underweight and overweight status, and gender differences should thus be considered for further studies.

Pediatric trainees' engagement in the online nutrition curriculum: preliminary results

BACKGROUND

The Pediatric Nutrition Series (PNS) consists of ten online, interactive modules and supplementary educational materials that have utilized web-based multimedia technologies to offer nutrition education for pediatric trainees and practicing physicians. The purpose of the study was to evaluate pediatric trainees' engagement, knowledge acquisition, and satisfaction with nutrition modules delivered online in interactive and non-interactive formats.

METHODS

From December 2010 through August 2011, pediatric trainees from seventy-three (73) different U.S. programs completed online nutrition modules designed to develop residents' knowledge of counseling around and management of nutritional issues in children. Data were analyzed using SPSS version 19. Both descriptive and inferential statistics were used in comparing interactive versus non-interactive modules. Pretest/posttest and module evaluations measured knowledge acquisition and satisfaction.

RESULTS

Three hundred and twenty-two (322) pediatric trainees completed one or more of six modules for a total of four hundred and forty-two (442) accessions. All trainees who completed at least one module were included in the study. Two-way analyses of variance (ANOVA) with repeated measures (pre/posttest by interactive/non-interactive format) indicated significant knowledge gains from pretest to posttest (p < 0.002 for all six modules). Comparisons between interactive and non-interactive formats for Module 1 (N = 85 interactive, N = 95 non-interactive) and Module 5 (N = 5 interactive, N = 16 non-interactive) indicated a parallel improvement from the pretest to posttest, with the interactive format significantly higher than the non-interactive modules (p < .05). Both qualitative and quantitative data from module evaluations demonstrated that satisfaction with modules was high. However, there were lower ratings for whether learning objectives were met with Module 6 (p < 0.03) and lecturer rating (p < 0.004) compared to Module 1. Qualitative data also showed that completion of the interactive modules resulted in higher resident satisfaction.

CONCLUSIONS

This initial assessment of the PNS modules shows that technology-mediated delivery of a nutrition curriculum in residency programs has great potential for providing rich learning environments for trainees while maintaining a high level of participant satisfaction.

Intelligence is in the eye of the beholder: investigating repeated IQ measurements in forensic psychiatry

BACKGROUND

A stable assessment of cognition is of paramount importance for forensic psychiatric patients (FPP). The purpose of this study was to compare repeated measures of IQ scores in FPPs with and without intellectual disability.

METHODS

Repeated measurements of IQ scores in FPPs (n = 176) were collected. Differences between tests were computed, and each IQ score was categorized. Additionally, t-tests and regression analyses were performed.

RESULTS

Differences of 10 points or more were found in 66% of the cases comparing WAIS-III with RAVEN scores. Fisher's exact test revealed differences between two WAIS-III scores and the WAIS categories. The WAIS-III did not predict other IQs (WAIS or RAVEN) in participants with intellectual disability.

DISCUSSION

This study showed that stability or interchangeability of scores is lacking, especially in individuals with intellectual disability. Caution in interpreting IQ scores is therefore recommended, and the use of the unitary concept of IQ should be discouraged.

Cross-sectional survey of daily junk food consumption, irregular eating, mental and physical health and parenting style of British secondary school children

BACKGROUND

Previous research has established that poor diets and eating patterns are associated with numerous adverse health outcomes. This study explored the relationships between two specific eating behaviours (daily junk food consumption and irregular eating) and self-reported physical and mental health of secondary school children, and their association with perceived parenting and child health.

METHODS

10 645 participants aged between 12 and 16 completed measures of junk food consumption, irregular eating, parental style, and mental and physical health through the use of an online survey implemented within 30 schools in a large British city.

RESULTS

2.9% of the sample reported never eating regularly and while 17.2% reported daily consumption of junk food. Young people who reported eating irregularly and consuming junk food daily were at a significantly greater risk of poorer mental (OR 5.41, 95% confidence interval 4.03-7.25 and 2.75, 95% confidence interval 1.99-3.78) and physical health (OR 4.56, 95% confidence interval 3.56-5.85 and 2.00, 95% confidence interval 1.63-2.47). Authoritative parenting was associated with healthier eating behaviours, and better mental and physical health in comparison to other parenting styles.

DISCUSSION

A worrying proportion of secondary school children report unhealthy eating behaviours, particularly daily consumption of junk food, which may be associated with poorer mental and physical health. Parenting style may influence dietary habits. Interventions to improve diet may be more beneficial if also they address parenting strategies and issues related to mental and physical health.

Cognitive and behavioural effects of sugar consumption in rodents. A review

The pronounced global rise in sugar consumption in recent years has been driven largely by increased consumption of sugar-sweetened beverages. Although high sugar intakes are recognised to increase the risk of obesity and related metabolic disturbances, less is known about how sugar might also impair cognition and learned behaviour. This review considers the effects of sugar in rodents on measures of learning and memory, reward processing, anxiety and mood. The parallels between sugar consumption and addictive behaviours are also discussed. The available evidence clearly indicates that sugar consumption can induce cognitive dysfunction. Deficits have been found most consistently on tasks measuring spatial learning and memory. Younger animals appear to be particularly sensitive to the effects of sugar on reward processing, yet results vary according to what reward-related behaviour is assessed. Sugar does not appear to produce long-term effects on anxiety or mood. Importantly, cognitive impairments have been found when intake approximates levels of sugar consumption in people and without changes to weight gain. There remain several caveats when extrapolating from animal models to putative effects of sugar on cognitive function in people. These issues are discussed in conjunction with potential underlying neural mechanisms and directions for future research.

A systematic review of the effects of experimental fasting on cognition

Numerous investigations have been conducted on the impact of short-term fasting on cognition in healthy individuals. Some studies have suggested that fasting is associated with executive function deficits; however, findings have been inconsistent. The lack of consensus regarding the impact of short-term fasting in healthy controls has impeded investigation of the impact of starvation or malnutrition in clinical groups, such as anorexia nervosa (AN). One method of disentangling these effects is to examine acute episodes of starvation experimentally. The present review systematically investigated the impact of short-term fasting on cognition. Studies investigating attentional bias to food-related stimuli were excluded so as to focus on general cognition. Ten articles were included in the review. The combined results are equivocal: several studies report no observable differences as a result of fasting and others show specific deficits on tasks designed to test psychomotor speed, executive function, and mental rotation. This inconsistent profile of fasting in healthy individuals demonstrates the complexity of the role of short-term fasting in cognition; the variety of tasks used, composition of the sample, and type and duration of fasting across studies may also have contributed to the inconsistent profile. Additional focused studies on neuropsychological profiles of healthy individuals are warranted in order to better develop an understanding of the role of hunger in cognition.

Caloric and nutrient intake in children with attention deficit hyperactivity disorder treated with extended-release methylphenidate: analysis of a cross-sectional nutrition survey

Objectives

To study calorie and nutrients intake in a group of patients diagnosed with attention deficit hyperactivity disorder (ADHD) under treatment with extended-release methylphenidate (MPH-ER), and to analyse the need to design nutrition intervention strategies.

Design

Observational (case-control).

Setting

Navarra Hospital Complex, Pamplona, Spain.

Participants

A total of 100 patients diagnosed with ADHD under treatment with MPH-ER and 100 healthy children (control group).

Main outcome measures

A nutrition survey was carried out (food intake registration of 3 consecutive school days). Calorie and nutrient intake, as well as nutrition status, were evaluated and compared in both groups.

Results

Nutritional status in ADHD group was significantly lower (p < 0.05) than in control group. Calorie intake in mid-morning snack, lunch and afternoon snack was significantly higher (p < 0.05) in the control group. Calorie intake in supper was significantly higher (p < 0.05) in the ADHD group. There were no significant differences in breakfast. Total calorie intake, as well as protein, carbohydrates, fat, fibre, calcium, iron, magnesium, zinc, selenium and phosphorous, thiamine, niacin, vitamin B6 and folate intake, in control group was significantly higher than in ADHD group.

Conclusions

The daily calorie and nutrients intake in patients under treatment with MPH-ER is, generally, lower than in healthy population of similar age. The need to impart programmes of nutrition education simultaneously with multimodal treatment in order to avoid the nutrition consequences of treatment with MPH should be considered.

[Evaluation of diet and nutrient intake in children under three years old. ALSALMA pilot study]

OBJECTIVE

The present study evaluates energy and nutrient intake in Spanish children under three years of age, and compares the results with the current recommendations in order to identify possible inadequate nutrient intake.

PATIENTS AND METHODS

A cross-sectional pilot study. The mothers completed a diet diary for four non-consecutive days, recording the products and amounts consumed by their children. Nutrient intake was calculated, and the results were compared with the dietary reference intakes (DRI) for each age group.

RESULTS

A total of 188 children (93 boys and 95 girls) aged 0-6 (n=41), 7-12 (n=24), 13-24 (n=57), and 25-36 months (n=66) were included. Statistically significant differences in DRI were observed for most of the nutrients analyzed. Protein intake, in particular was 376% of DRI in children between 1-3 years of age. By age groups, 96% of the children aged 7-12 months, 88% of the children aged 13-24 months, and 97% of the children aged 25-36 months showed protein intakes more than two-fold DRI.

CONCLUSIONS

Nutrient intake differed from the DRI, particularly as regards proteins. A new study is required to determine whether the observed study deviations could be representative of the national population of this age group, as well as the possible effects on child health.

Eating patterns and mental health problems in early adolescence--a cross-sectional study of 12-13-year-old Norwegian schoolchildren

OBJECTIVE

To investigate the association between eating patterns and mental health problems in young Norwegian adolescents (12-13 years of age).

DESIGN

Cross-sectional study. Dietary information was reported by parents using a retrospective FFQ. Eating patterns were identified using principal component analysis. The Strengths and Difficulties Questionnaire was used to measure mental health problems. The association between eating patterns and mental health problems was examined using multiple logistic regression analysis.

SETTING

Primary schools, Telemark County, Norway.

SUBJECTS

Children (n 1095) aged 12-13 years and their parents.

RESULTS

Children with high scores on a 'varied Norwegian' eating pattern were less likely to have indications of any psychiatric disorders (adjusted OR = 0·5; 95 % CI 0·3, 1·0) and hyperactivity-inattention disorders (adjusted OR = 0·4; 95 % CI 0·2, 0·8) than children with low scores on this pattern. Children with high scores on a 'junk/convenient' eating pattern were more likely to have indications of hyperactivity-inattention disorders (adjusted OR = 3·4; 95 % CI 1·3, 8·6) than children with low scores on this pattern. Children with high scores on a 'snacking' eating pattern were more likely to have indications of conduct/oppositional disorders (adjusted OR = 3·8; 95 % CI 1·2, 11·5) than those with low scores on this eating pattern.

CONCLUSIONS

We identified a significant association between eating patterns and mental health problems in young adolescents, independently of physical activity, sedentary activity and background variables. A diverse diet rich in unrefined plant foods, fish and regular meals was associated with better mental health, while energy-dense, nutrient-poor diets and irregular meals were associated with poorer mental health.

Nutrition and neurodevelopment in children: focus on NUTRIMENTHE project

There is growing evidence that early nutrition affects later cognitive performance. The idea that the diet of mothers, infants, and children could affect later mental performance has major implications for public health practice and policy development and for our understanding of human biology as well as for food product development, economic progress, and future wealth creation. To date, however, much of the evidence is from animal, retrospective studies and short-term nutritional intervention studies in humans. The positive effect of micronutrients on health, especially of pregnant women eating well to maximise their child's cognitive and behavioural outcomes, is commonly acknowledged. The current evidence of an association between gestational nutrition and brain development in healthy children is more credible for folate, n-3 fatty acids, and iron. Recent findings highlight the fact that single-nutrient supplementation is less adequate than supplementation with more complex formulae. However, the optimal content of micronutrient supplementation and whether there is a long-term impact on child's neurodevelopment needs to be investigated further. Moreover, it is also evident that future studies should take into account genetic heterogeneity when evaluating nutritional effects and also nutritional recommendations. The objective of the present review is to provide a background and update on the current knowledge linking nutrition to cognition and behaviour in children, and to show how the large collaborative European Project NUTRIMENTHE is working towards this aim.

Effects of a multi-micronutrient-fortified beverage, with and without sugar, on growth and cognition in South African schoolchildren: a randomised, double-blind, controlled intervention

Little is known about the effects of combined micronutrient and sugar consumption on growth and cognition. In the present study, we investigated the effects of micronutrients and sugar, alone and in combination, in a beverage on growth and cognition in schoolchildren. In a 2 × 2 factorial design, children (n 414, 6-11 years) were randomly allocated to consume beverages containing (1) micronutrients with sugar, (2) micronutrients with a non-nutritive sweetener, (3) no micronutrients with sugar or (4) no micronutrients with a non-nutritive sweetener for 8.5 months. Growth was assessed and cognition was tested using the Kaufman Assessment Battery for Children version II (KABC-II) subtests and the Hopkins Verbal Learning Test (HVLT). Micronutrients decreased the OR for Fe deficiency at the endpoint (OR 0.19; 95% CI 0.07, 0.53). Micronutrients increased KABC Atlantis (intervention effect: 0.76; 95% CI 0.10, 1.42) and HVLT Discrimination Index (1.00; 95% CI 0.01, 2.00) scores. Sugar increased KABC Atlantis (0.71; 95% CI 0.05, 1.37) and Rover (0.72; 95% CI 0.08, 1.35) scores and HVLT Recall 3 (0.94; 95% CI 0.15, 1.72). Significant micronutrient × sugar interaction effects on the Atlantis, Number recall, Rover and Discrimination Index scores indicated that micronutrients and sugar in combination attenuated the beneficial effects of micronutrients or sugar alone. Micronutrients or sugar alone had a lowering effect on weight-for-age z-scores relative to controls (micronutrients - 0.08; 95% CI - 0.15, - 0.01; sugar - 0.07; 95% CI - 0.14, - 0.002), but in combination, this effect was attenuated. The beverages with micronutrients or added sugar alone had a beneficial effect on cognition, which was attenuated when provided in combination.

[Dietary patterns in patients with attention deficit hyperactivity disorder]

OBJECTIVE

To evaluate the dietary patterns in a group of patients diagnosed with attention deficit hyperactivity disorder (ADHD) and under treatment with extended-release methylphenidate (MPH-ER).

MATERIAL AND METHODS

A nutrition survey (food intake recall for three consecutive days) was carried out on 100 patients diagnosed with ADHD and under treatment with MPH-ER, and in 150 healthy children (control group). Calorie and nutrient intake, as well as nutrition status, were evaluated and compared in both groups.

RESULTS

The mean MPH-ER dose was 1.02 mg/kg/day. Nutritional status in the ADHD group was significantly lower (P < .05) than in control group. The consumption of cereals, meat, pulses and fruits in the control group was significantly higher (P < .05) than in ADHD group. Calorie intake in the mid-morning snack, lunch and afternoon snack was significantly higher (P < .05) in the control group. Calorie intake at supper was significantly higher (P < .05) in the ADHD group. Total calorie intake, as well as protein, carbohydrates, fat, fibre, calcium, iron, magnesium, zinc, selenium and phosphorous, thiamine, niacin, vitamin B6 and folate intake in the control group was significantly higher than in ADHD group.

CONCLUSIONS

Treatment with MPH-ER substantially modifies the percentage distribution of calorie intake of the different meals. The daily calorie and nutrients intake in patients under treatment with MPH-ER is, generally, lower than in the healthy population of a similar age. Nutrition education should be provided, along with multimodal treatment, to the patients and/or their families.

Mental health and food consumption among California children 5-11 years of age

OBJECTIVE

The purpose of this research was to determine if poor mental health is associated with the intake of specific foods among California children.

DESIGN

Secondary data analysis of the 2007 and 2009 California Health Interview Survey (CHIS) was conducted. Mental health was measured using a shortened version of the Strengths and Difficulties Questionnaire (SDQ). Dietary measures were self-reported servings of fruit, vegetables, 100% fruit juice, high sugar foods, soda/sweetened drinks, and French fries/fried potatoes consumed the previous day, as well as frequency of fast food consumed during the past week.

SETTING

Phone interviews were conducted via the CHIS on households in California.

SUBJECTS

Data belonging to children (n = 11,190) ages 5-11 years whose parents completed the CHIS 2007 and 2009 random-dial telephone surveys was investigated.

RESULTS

Of an estimated annual population of 3.7 million children, 180,000 (4.9%) had poor mental health. Children with poor mental health consumed more soda/sweetened drinks (0.60 vs 0.45 servings per day, p = 0.024), French fries/fried potatoes (0.27 vs 0.14 servings per day, p = 0.003), and fast food (2.02 vs 1.38 servings per week, p = 0.009) compared to children with good mental health. Mental health was not associated with other dietary measures. Adjusting for relevant socio-demographic characteristics, logistic regression found poor mental health to be significantly associated with any consumption of French fries/fried potatoes (odds ratio (OR) = 2.0, p = 0.001) or vegetables (OR 0.6, p = 0.005) on the previous day, and fast food two or more times in the past week (OR 1.7, p < 0.001). Interaction analysis revealed that an estimated 33% of girls with poor mental health consumed French fries, compared to 12% of girls with good mental health (OR 2.91, p = 0.006).

CONCLUSIONS

Children with poor mental health are more likely to consume calorie-dense but nutrient-poor foods compared to their counterparts. Intake of such foods may contribute to worse physical health as these children mature.