Effects of diet on behaviour and cognition in children

Asymptomatic Plasmodium infection and cognition among primary schoolchildren in a high malaria transmission setting in Uganda

Asymptomatic parasitemia is common among schoolchildren living in areas of high malaria transmission, yet little is known about its effect on cognitive function in these settings. To investigate associations between asymptomatic parasitemia, anemia, and cognition among primary schoolchildren living in a high malaria transmission setting, we studied 740 children enrolled in a clinical trial in Tororo, Uganda. Parasitemia, measured by thick blood smears, was present in 30% of the children. Infected children had lower test scores for abstract reasoning (adjusted mean difference [AMD] -0.6, 95% confidence interval [CI] -1.01 to -0.21) and sustained attention (AMD -1.6 95% CI -2.40 to -0.81) compared with uninfected children. There was also evidence for a dose-response relationship between parasite density and scores for sustained attention. No associations were observed between anemia and either test of cognition. Schoolchildren in high transmission settings may experience cognitive benefits, from interventions aimed at reducing the prevalence of asymptomatic parasitemia.

Self-reported learning difficulties and dietary intake in Norwegian adolescents

Aim: The academic performance of children impacts future educational attainment which may increase socioeconomic status which again influences their health. One of several factors that might affect academic performance is the diet. The aim of this study was to investigate the cross sectional relation between diet and self-reported reading-, writing-, and mathematical difficulties in Norwegian adolescents. Methods: In total, 475 ninth- and tenth-grade students out of 625 eligible ones from four different secondary schools in three different municipalities in Vest-Agder County, Norway, participated, giving a participation rate of 77%. The students filled in a questionnaire with food frequency questions of selected healthy and unhealthy food items, questions of meal frequency and different learning difficulties. Results: Regular breakfast was significantly associated with decreased odds of both writing and reading difficulties (OR: 0.44 (0.2–0.8), p = 0.01) and mathematical difficulties (OR: 0.33 (0.2–0.6), p ≤ 0.001). In addition, having lunch, dinner and supper regularly were associated with decreased odds of mathematical difficulties. Further, a high intake of foods representing a poor diet (sugar-sweetened soft drinks, sweets, chocolate, savory snacks, pizza and hot dogs) was significantly associated with increased odds of mathematical difficulties. Conclusions: Having a less-frequent intake of unhealthy foods and not skipping meals are associated with decreased odds of self-reported learning difficulties in Norwegian adolescents in this study. The results of this study support the need for a larger study with a more representative sample.

The role of nutrition in children's neurocognitive development, from pregnancy through childhood

This review examines the current evidence for a possible connection between nutritional intake (including micronutrients and whole diet) and neurocognitive development in childhood. Earlier studies which have investigated the association between nutrition and cognitive development have focused on individual micronutrients, including omega-3 fatty acids, vitamin B12, folic acid, choline, iron, iodine, and zinc, and single aspects of diet. The research evidence from observational studies suggests that micronutrients may play an important role in the cognitive development of children. However, the results of intervention trials utilizing single micronutrients are inconclusive. More generally, there is evidence that malnutrition can impair cognitive development, whilst breastfeeding appears to be beneficial for cognition. Eating breakfast is also beneficial for cognition. In contrast, there is currently inconclusive evidence regarding the association between obesity and cognition. Since individuals consume combinations of foods, more recently researchers have become interested in the cognitive impact of diet as a composite measure. Only a few studies to date have investigated the associations between dietary patterns and cognitive development. In future research, more well designed intervention trials are needed, with special consideration given to the interactive effects of nutrients.

Effects of maternally exposed coloring food additives on receptor expressions related to learning and memory in rats

Exposure to artificial food colors and additives (AFCAs) has been implicated in the induction and severity of some childhood behavioral and learning disabilities. N-methyl-D-aspartate receptors (NMDARs) and nicotinic acetylcholine receptors (nACHRs) are thought to be effective in the learning and memory-generating process. In this study, we investigated the effects of intrauterine exposure to AFCAs on subunit concentrations of NMDARs and nAChRs isoforms in rats. We administered a mixture of AFCAs (Eritrosin, Ponceau 4R, Allura Red AC, Sunset Yellow FCF, Tartrazin, Amaranth, Brilliant Blue, Azorubin and Indigotin) to female rats before and during gestation. The concentration of NR2A and NR2B subunits and nAChR α7, α4β2 isoforms in their offspring's hippocampi were measured by Western Blotting. Expressions of NR2B and nAChR β2 were significantly increased (17% and 6.70%, respectively), whereas expression of nAChR α4 was significantly decreased (5.67%) in male experimental group compared to the male control group (p<0.05). In the female experimental group, AFCAs caused a 14% decrease in NR2B expression when compared to the female control group (p<0.05). Our results indicate that exposure to AFCAs during the fetal period may lead to alterations in expressions of NMDARs and nAChRs in adulthood. These alterations were different between male and female genders.

An Assessment of nutrition education in selected counties in New York State elementary schools (kindergarten through fifth grade)

OBJECTIVE

To assess the extent to which nutrition education is implemented in selected counties in New York State elementary schools (kindergarten through fifth grade) and explore how nutrition knowledge is presented in the classroom and what factors support it.

DESIGN

Cross-sectional, self-administered survey.

SETTING

New York State elementary schools in selected counties.

PARTICIPANTS

New York State elementary school teachers (n = 137).

MAIN OUTCOME MEASURES

Hours spent teaching nutrition; nutrition topics, methods of teaching, education resources, and aspects of the school environment that may influence nutrition education.

ANALYSIS

Crosstabs with a chi-square statistic and ANOVA.

RESULTS

Eighty-three percent of teachers taught some nutrition (9.0 ± 10.5 hours) during the academic year. Teachers taught lessons about finding and choosing healthy food (61%), relationship between diet and health (54%), and MyPyramid (52%) most often. Suburban teachers (12.4 ± 12.5 hours) taught significantly (P = .006) more hours of nutrition than rural teachers (4.2 ± 3.9 hours). Teachers at schools with fewer than 80% nonwhite students taught significantly (P = .02) more (10.4 ± 11.4 hours) compared to schools with greater than 80% nonwhite students (5.6 ± 6.4 hours).

CONCLUSIONS AND IMPLICATIONS

Teachers reported that nutrition education is important and that they are willing to teach nutrition. Efforts should be made that support integrated nutrition topics, methods of instruction, and availability of resources.

Association between dietary behaviors and attention-deficit/hyperactivity disorder and learning disabilities in school-aged children

We aimed to comprehensively investigate the associations between a wide range of measures of dietary behaviors and learning disabilities and attention-deficit/hyperactivity disorder (ADHD) in community-dwelling Korean children in order to generate hypotheses for future work. The present study included 986 children [507 boys, 479 girls; mean (S.D.) age=9.1 (0.7) years] recruited from five South Korean cities. Children's dietary behaviors were assessed by the mini-dietary assessment (MDA) for Koreans. It consists of ten items to assess the level of intake of dairy products, high-protein foods, vegetables, fried foods, fatty meats, salt, and sweetened desserts and whether the subject is eating three regular meals and has a balanced diet. Learning disability was assessed via the Learning Disability Evaluation Scale (LDES). ADHD was assessed via the Diagnostic Interview Schedule for Children version-IV and the ADHD rating scale, and ADHD-related behavioral problems were assessed via the Child Behavior Checklist. After adjusting for potential confounders, a high intake of sweetened desserts, fried food, and salt is associated with more learning, attention, and behavioral problems, whereas a balanced diet, regular meals, and a high intake of dairy products and vegetables is associated with less learning, attention, and behavioral problems. Our data suggest that existing encouraged dietary habits mostly have beneficial effects on learning, attention, and behavioral problems in Korean children. These findings are in general the same results in other studies on ADHD children in other countries. However, the cross-sectional study design prevents our ability to assess causal relationships.

Nutrition standards for away-from-home foods in the USA

Away-from-home foods are regulated with respect to the prevention of food-borne diseases and potential contaminants, but not for their contribution to dietary-related chronic diseases. Away-from-home foods have more calories, salt, sugar and fat, and include fewer fruits and vegetables than recommended by national nutrition guidelines. Thus, frequent consumption of away-from-home foods contributes to obesity, hypertension, diabetes, heart disease, and cancer. In light of this, many localities are already adopting regulations or sponsoring programs to improve the quality of away-from-home foods. We review the rationale for developing nutritional performance standards for away-from-home foods in light of limited human capacity to regulate intake or physiologically compensate for a poor diet. We offer a set of model performance standards to be considered as a new area of environmental regulation. Models for voluntary implementation of consumer standards exist in the environmental domain and may be useful templates for implementation. Implementing such standards, whether voluntarily or via regulations, will require addressing a number of practical and ideological challenges. Politically, regulatory standards contradict the belief that adults should be able to navigate dietary risks in away-from-home settings unaided.

Diet and behavioral problems at school in Norwegian adolescents

BACKGROUND

Discussion about dietary factors in relation to behavioral problems in children and adolescents has been going on for a long time.

OBJECTIVE

The aim of this study was to investigate the cross-sectional relation between diet and self-reported behavioral problems at school in adolescents in the southern part of Norway.

DESIGN

In total, 475 ninth- and tenth-grade students (236 boys and 239 girls) out of 625 eligible students from four different secondary schools in three different communities in Vest-Agder County, Norway, participated, giving a participation rate of 77%. The students filled in a questionnaire with food frequency questions of selected healthy (e.g. fruits, vegetables, and fish) and unhealthy (e.g. sweets, sugar-sweetened beverages, and crisps) food items, questions of meal frequency, and four questions regarding behavioral problems at school.

RESULTS

HAVING BREAKFAST REGULARLY WAS SIGNIFICANTLY ASSOCIATED WITH DECREASED ODDS OF BEHAVIORAL PROBLEMS (OR: 0.29 (0.15 - 0.55), p≤0.001). A high intake of unhealthy foods, such as sugar-sweetened soft drinks (OR: 2.8 (1.06 - 7.42), p=0.03) and sweets (OR: 2.63 (1.39 - 4.98), p=0.003), was significantly associated with increased odds of behavioral problems. At the same time, a high intake of fruits was associated with decreased odds of behavioral problems in Norwegian adolescents (OR: 0.30 (0.10 - 0.87), p=0.03). All ORs are adjusted for sex and BMI.

CONCLUSIONS

This study shows that having an optimal diet and not skipping meals are associated with decreased odds of behavioral problems at school in Norwegian adolescents. Hence, it is important to improve the dietary intake and meal pattern of Norwegian adolescents. The cross-sectional design of this study limits any causal interpretations of the results of the study.

Position of the Academy of Nutrition and Dietetics: use of nutritive and nonnutritive sweeteners

It is the position of the Academy of Nutrition and Dietetics that consumers can safely enjoy a range of nutritive sweeteners and nonnutritive sweeteners (NNS) when consumed within an eating plan that is guided by current federal nutrition recommendations, such as the Dietary Guidelines for Americans and the Dietary Reference Intakes, as well as individual health goals and personal preference. A preference for sweet taste is innate and sweeteners can increase the pleasure of eating. Nutritive sweeteners contain carbohydrate and provide energy. They occur naturally in foods or may be added in food processing or by consumers before consumption. Higher intake of added sugars is associated with higher energy intake and lower diet quality, which can increase the risk for obesity, prediabetes, type 2 diabetes, and cardiovascular disease. On average, adults in the United States consume 14.6% of energy from added sugars. Polyols (also referred to as sugar alcohols) add sweetness with less energy and may reduce risk for dental caries. Foods containing polyols and/or no added sugars can, within food labeling guidelines, be labeled as sugar-free. NNS are those that sweeten with minimal or no carbohydrate or energy. They are regulated by the Food and Drug Administration as food additives or generally recognized as safe. The Food and Drug Administration approval process includes determination of probable intake, cumulative effect from all uses, and toxicology studies in animals. Seven NNS are approved for use in the United States: acesulfame K, aspartame, luo han guo fruit extract, neotame, saccharin, stevia, and sucralose. They have different functional properties that may affect perceived taste or use in different food applications. All NNS approved for use in the United States are determined to be safe.

The role and requirements of digestible dietary carbohydrates in infants and toddlers

Digestible carbohydrates are one of the main sources of dietary energy in infancy and childhood and are essential for growth and development. The aim of this narrative review is to outline the intakes of digestible carbohydrates and their role in health and disease, including the development of food preferences, as well the consequences of excess carbohydrate. Key experts in these fields provided up-to-date reviews of the literature. A search of available information on dietary intakes of children below the age of 4 years was conducted from 1985 up to 2010. Articles and reports including information about sugars and/or starch intakes were selected. A number of factors limit the ability to obtain an overall picture of carbohydrate intakes and food sources in this age group. These include small numbers of intake studies, differing approaches to analysing carbohydrate, a variety of terms used to describe sugars intakes and a dearth of information about starch intakes. Data suggest that sweet taste is preferred in infancy and later food choices. There are few established adverse consequences of high intakes of digestible carbohydrate for young children. The greatest evidence is for dental caries, although this is influenced by high intake frequency and poor oral hygiene. Evidence for detrimental effects on nutrient dilution, obesity, diabetes or cognition is limited. In infants, minimum carbohydrate (mainly lactose) intake should be 40% of total energy, gradually increasing to 55% energy by the age of 2 years.

Effects of maternally exposed colouring food additives on cognitive performance in rats

Artificial food colourings and additives (AFCAs) have long been suggested to adversely affect the learning and behaviour in children. In this study, we aimed to provide additional data to clarify the possible side effects of colouring additives on behaviour and memory. We administered acceptable daily intake values of AFCAs as a mixture (Eritrosin, Ponceau 4R, Allura Red AC, Sunset Yellow FCF, Tartrazin, Amaranth, Brilliant Blue, Azorubin and Indigotin) to female rats before and during gestation and then tested their effects on behaviour and on spatial working memory in their offspring. Effects on spatial learning and memory were evaluated by Morris water maze, behavioural effects were evaluated by open-field test and forced swim test. Our results showed that commonly used artificial food colourings have no adverse effects on spatial working memory and did not create a depressive behaviour in offspring. But they showed a few significant effects on locomotor activity as AFCAs increased some parameters of locomotor activity.

Childhood diet and behavioural problems: results from the ALSPAC cohort

OBJECTIVE

To investigate whether a 'junk food' diet at 81 months of age is associated with the development of behavioural problems over the following 16 months.

SUBJECTS/METHODS

The study used data from the Avon Longitudinal Study of Parents and Children (ALSPAC) and 12,942 children were included. The main outcome measure was behavioural problems, measured using the Strengths and Difficulties Questionnaire (SDQ). SDQ scores were available at 81 and 97 months of age. Child-based dietary data were collected at 81 months by food frequency questionnaire; from this a 'junk food' score was derived, and mean weekly non-milk extrinsic sugar (NMES) intake estimated. Statistical analyses examined the associations between dietary exposures at 81 months and SDQ outcomes at 97 months. Children with SDQ scores suggesting behavioural problems at baseline were excluded in order to identify new cases. Adjustments were made for potential confounders such as socioeconomic status.

RESULTS

Unadjusted analyses suggested associations between the 'junk food' score at 81 months and both total difficulties and pro-social behaviour at 97 months. However, adjustment for baseline SDQ scores attenuated these associations, with confidence intervals including the null for both total difficulties (OR (95% CI): 1.05 (0.92, 1.21); P=0.45) and pro-social behaviour (1.13 (1.00, 1.26); P=0.04). Adjustment for other potential confounders further attenuated the effects. Adjustment for confounders similarly attenuated modest associations between NMES intake and behavioural problems.

CONCLUSIONS

There was no evidence to support an association between a 'junk food' diet at 81 months of age and behavioural problems after 16 months.

Healthy school meals and educational outcomes

This paper provides field evidence on the effects of diet on educational outcomes, exploiting a campaign lead in the UK in 2004, which introduced drastic changes in the meals offered in the schools of one borough - Greenwich - shifting from low-budget processed meals towards healthier options. We evaluate the effect of the campaign on educational outcomes in primary schools using a difference in differences approach; comparing educational outcomes in primary schools (Key Stage 2 outcomes more specifically) before and after the reform, using the neighbouring Local Education Authorities as a control group. We find evidence that educational outcomes did improve significantly in English and Science. We also find that authorized absences - which are most likely linked to illness and health - fell by 14%.

Diet and sleep in children with attention deficit hyperactivity disorder: preliminary data in Australian children

Sleep disturbances are common and consequential in children with attention deficit hyperactivity disorder (ADHD). Diet also influences ADHD symptoms. Interrelationships between diet, sleep and behaviour in children diagnosed with ADHD are little studied. We investigated, via parental report, the relationships between sleep and diet in 88 Australian children aged 6-13 years old (M = 8.94, SD = 1.78). This pilot data shows that 30 per cent of the children had sleep disturbance (≥ 2 standard deviations above the mean) with significant relationships between ADHD symptoms, sleep disturbance and diet. Parents who reported more sleep disturbance also reported a higher intake of carbohydrate, fats, and, most particularly, sugar which was also a significant predictor of night time sweating. These findings suggest an interrelationship between diet and sleep in children with ADHD. Given that both sleep and dietary intake are potentially modifiable behaviours within treatment regimes of children with ADHD, further investigation is needed.

Multivitamin/Mineral supplementation does not affect standardized assessment of academic performance in elementary school children

Limited research suggests that micronutrient supplementation may have a positive effect on the academic performance and behavior of school-aged children. To determine the effect of multivitamin/mineral supplementation on academic performance, students in grades three through six (approximate age range=8 to 12 years old) were recruited from 37 parochial schools in northern New Jersey to participate in a double-blind, placebo-controlled clinical trial conducted during the 2004-2005 academic school year. Participants were randomized to receive either a standard children's multivitamin/mineral supplement (MVM) or a placebo. MVM or placebo was administered in school only during lunch or snack period by a teacher or study personnel who were blinded to group assignment. The main outcome measured was change in scores on Terra Nova, a standardized achievement test administered by the State of New Jersey, at the beginning of March 2005 compared to March 2004. Compared with placebo, participants receiving MVM supplements showed no statistically significant improvement for Terra Nova National Percentile total scores by treatment assignment or for any of the subject area scores using repeated measures analysis of variance. No significant improvements were observed in secondary end points: number of days absent from school, tardiness, or grade point average. In conclusion, the in-school daily consumption of an MVM supplement by third- through sixth-grade inner-city children did not lead to improved school performance based upon standardized testing, grade point average, and absenteeism.

Essential role of vitamin C and zinc in child immunity and health

With the progressive elimination of dietary protein-energy deficits, deficiencies of micronutrients are emerging as the limiting factors in ensuring children's optimal health. Data from several countries in Asia and Latin America indicate that deficiencies of vitamin C and zinc continue to be at alarming levels. This article reviews the roles of vitamin C and zinc in supporting children's growth and development, with a particular focus on the complementary roles they play in supporting immune functions and combating infections. The contemporary relevance of vitamin C and zinc deficiency in the Asian and Latin American regions, both undergoing a rapid nutritional transition, are also discussed. Overall, there is increasing evidence that deficiency of vitamin C and zinc adversely affects the physical and mental growth of children and can impair their immune defences. Nutrition should be the main vehicle for providing these essential nutrients; however, supplementation can represent a valid support method, especially in developing regions.

Free healthy breakfasts in primary schools: a cluster randomised controlled trial of a policy intervention in Wales, UK

Objective

The present study evaluated the impact of a national school programme of universal free healthy breakfast provision in Wales, UK.

Design

A cluster randomised controlled trial with repeated cross-sectional design and a 12-month follow-up. Primary outcomes were breakfast skipping, breakfast diet and episodic memory. Secondary outcomes were frequency of eating breakfast at home and at school, breakfast attitudes, rest-of-day diet and class behaviour.

Setting

Primary schools in nine local education authority areas.

Subjects

A total of 4350 students (aged 9–11 years) at baseline and 4472 at follow-up in 111 schools.

Results

Students in intervention schools reported significantly higher numbers of healthy food items consumed at breakfast and more positive attitudes towards breakfast eating at 12 months. Parents in intervention schools reported significantly higher rates of consumption of breakfast at school and correspondingly lower rates of breakfast consumption at home. No other significant differences were found.

Conclusions

The intervention did not reduce breakfast skipping; rather, pupils substituted breakfast at home for breakfast at school. However, there were improvements in children’s nutritional intake at breakfast time, if not the rest of the day, and more positive attitudes to breakfast, which may have implications for life-course dietary behaviours. There was no impact on episodic memory or classroom behaviour, which may require targeting breakfast skippers.

Breakfast consumption among children and adolescents in the Netherlands

BACKGROUND

The Netherlands Nutrition Centre (NNC) recommends eating a daily breakfast preferably including products from five food groups. The aims of this study were to examine to what extent breakfast consumption among Dutch youngsters attending primary and secondary education (aged 10-19 years) is in accordance with these recommendations and whether breakfast habits differ among demographic subgroups.

METHODS

A cross-sectional study was conducted among 2404 youngsters at 71 schools in the Netherlands. All Dutch schools were stratified by educational level and province, and randomly ordered within the strata. Participants completed an online questionnaire at school including food frequency items and a 24-h recall.

RESULTS

The percentage of participants reporting to consume breakfast every day varied between 62.9 and 95.5 in different subgroups. Skipping breakfast was associated with being older, being a girl, attending vocational or senior general education and being of non-Dutch origin. Of the participants, <9% consumed products from five food groups as recommended. Participants especially ate products from the 'grain group', followed by the 'dairy group', the 'fats group', 'the liquids group' and the 'fruit/fruit juice group'. Bread, butter and milk were the most frequently consumed products and the majority chose healthy (i.e. low-fat) variants within food groups (i.e. wholemeal bread).

CONCLUSION

Health promotion efforts should aim to stimulate breakfast consumption, particularly among vocational school students and adolescents of non-Dutch origin. Special attention should be given to breakfast quality. Future research should investigate whether better adherence to the recommendations of the NNC results in enhanced nutrient intake at breakfast.

Snacking in children: the role of urban corner stores

OBJECTIVE

Childhood obesity is higher among ethnic minorities. One reason may be the limited access to affordable, healthy options. The disparate prevalence of urban corner stores in low-income and high-minority communities has been well documented. There are no data, however, on what children purchase in these environments before and after school. The purpose of this study was to document the nature of children's purchases in corner stores proximal to their schools.

METHODS

This was an observational study from January to June 2008. Participants were children in grades 4 through 6 from 10 urban K-8 schools with >or=50% of students eligible for free or reduced-price meals. A total of 833 intercept surveys of children's purchases were conducted outside 24 corner stores before and after school. The main outcomes were type and energy content of items purchased.

RESULTS

The most frequently purchased items were energy-dense, low-nutritive foods and beverages, such as chips, candy, and sugar-sweetened beverages. Students spent $1.07 +/- 0.93 on 2.1 +/- 1.3 items (1.6 +/- 1.1 food items and 0.5 +/- 0.6 beverage items) per purchase. The total number of calories purchased per trip was 1497.7 +/- 1219.3 kJ (356.6 +/- 290.3 kcal). More calories came from foods than from beverages.

CONCLUSIONS

Purchases made in corner stores contribute significantly to energy intake among urban school children. Obesity prevention efforts, as well as broader efforts to enhance dietary quality among children in urban settings, should include corner store environments proximal to schools.

Nutrition, mood and behaviour: a review

OBJECTIVE

To conduct a critical review of recent empirical research regarding mood, behaviour and nutrition factors including essential fatty acids, macronutrients, micronutrients and food additives.

METHOD

A literature search of databases Medline, PsycInfo, CINAHL and Embase up to October 2008. The search emphasised empirical research published in the last 10 years and also included older literature. Studies in both adults and children were addressed.

RESULTS

Research into omega-3 fatty acids has been substantial but evidence for their potential in treating mood and behaviour is modest. In comparison, there has been much less research into carbohydrate and protein intakes and little evidence for their ability to influence mood and behaviour. Recent trials with food additives suggest their removal from the diet may benefit susceptible children with hyperactivity disorders. Micronutrient supplementation appears to improve mood only in those who were initially deficient in micronutrients.

CONCLUSIONS

More stringent research designs such as longitudinal studies and the use of biologically inert placebos within randomised controlled trials are needed before supplemental use of omega-3 fatty acids to treat disorders of mood and behaviour can be recommended. Caution is advised regarding the indiscriminate use of diets free of artificial food additives in managing hyperactivity disorders, as they may place an undue burden on individuals and their families. Should omega-3 fatty acid supplementation or the elimination of certain food additives be established as effective, they may provide cost-effective, accessible and well-tolerated adjuncts to standard psychiatric treatments for mood and behavioural disturbances.

Facing malnutrition and poverty: evaluating the CONIN experience

The Undernutrition Prevention Center (UPC) of the Corporation for Childhood Nutrition (CONIN) assists children from 0-3 years of age who present with primary or secondary undernutrition. The aim of the retrospective study reported here was to complete a nutritional, cognitive, and social evaluation of UPC children in Mendoza, Argentina, from 1996 to 2005. During the study period, a total of 478 schoolchildren aged 5-17 years (186 in the CONIN group and 292 in the non-CONIN group) were evaluated. Although no differences in weight and height were found between the groups, the percentage of children below the cutoff level for the maturity test was significantly lower in the CONIN group (10.8% versus 17.6%; P = 0.043). CONIN provides important social support to families through work qualification programs and health education.

'Junk food' diet and childhood behavioural problems: results from the ALSPAC cohort

BACKGROUND/OBJECTIVES

To determine whether a 'junk food' diet at age 4(1/2) is associated with behavioural problems at age 7.

SUBJECTS/METHODS

Data on approximately 4000 children participating in the Avon Longitudinal Study of Parents and Children, a birth cohort recruited in Avon, UK in 1991/92 were used. Behavioural problems were measured at age 7 using the Strengths and Difficulties Questionnaire (SDQ; maternal completion). Total difficulties and scores for the five sub-scales (hyperactivity, conduct and peer problems, emotional symptoms and pro-social behaviour) were calculated. Principal components analysis of dietary data (frequency of consumption of 57 foods/drinks) collected at age 4(1/2) by maternal report was used to generate a 'junk food' factor. Data on confounders were available from questionnaires.

RESULTS

A one standard deviation increase in 'junk food' intake at age 4(1/2) years was associated with increased hyperactivity at age 7 (odds ratio: 1.19; 95% confidence interval: 1.10, 1.29). This persisted after adjustment for confounders including intelligence quotient score (odds ratio: 1.13; 95% confidence interval: 1.01, 1.15). There was little evidence to support an association between 'junk food' intake and overall behavioural difficulties or other sub-scales of the SDQ.

CONCLUSIONS

Children eating a diet high in 'junk food' in early childhood were more likely to be in the top 33% on the SDQ hyperactivity sub-scale at age 7. This may reflect a long-term nutritional imbalance, or differences in parenting style. This finding requires replication before it can provide an avenue for intervention.

Dietary Considerations for the Prevention and Treatment of Obesity in Youth

The global rise of obesity in children has raised serious concern for their current and future health and well-being. The prevention and treatment of childhood and adolescent obesity must encompass all aspects of a child's life, including home, school, and other settings. A multidisciplinary approach is critical, including physical activity, behavioral factors, and proper dietary habits. Age-appropriate nutrition education and role modeling from adults in children's lives can be important in promoting lifelong healthy eating. Foods to emphasize include vegetables, fruits, whole grains, legumes, low-fat dairy products, and lean sources of protein. Foods and beverages with low nutrient density and high energy density should be consumed in moderation, within a child's discretionary calorie allowance. The overall diet must support proper growth, health, development, academic achievement, and well-being without supplying excess energy beyond needs.

Benefits of Breakfast for Children and Adolescents: Update and Recommendations for Practitioners

A number of studies report health benefits for children and adolescents who consume breakfast. Breakfast skipping is fairly common in children and adolescents and increases as children age. Breakfast can enhance children's diets by positively contributing to daily nutrient intake, augmenting intake of key nutrients such as fiber and calcium, and provides an opportunity to help meet the recommendations of the Dietary Guidelines for Americans. Breakfast also is associated with more healthful food choices. Cross-sectional studies support that eating breakfast more often may help children and adolescents maintain a healthful weight. However, the results from longitudinal studies are inconclusive and suggest that more research is needed to clarify this relationship, including understanding the mediating effects of initial weight status, dieting behavior, and physical activity levels. Breakfast consumption may provide some benefit toward cognitive function and academic achievement, but more research is needed. Breakfast is one facet of a healthy lifestyle that may help contribute to the short- and long-term health and well-being of children and adolescents. Health practitioners can promote healthy breakfast consumption in children and adolescents by addressing barriers to eating breakfast and focusing on individuals who may be more likely to skip breakfast on a regular basis.

A good-quality breakfast is associated with better mental health in adolescence

OBJECTIVE

Breakfast consumption has been associated with better mental health in adulthood, but the relationship between breakfast and mental health in adolescence is less well known. The aims of the present study were to evaluate breakfast quality in a cohort of adolescents and to investigate associations with mental health.

DESIGN

Cross-sectional population-based study. Breakfast quality was assessed by intake of core food groups at breakfast, as determined from 3 d food diaries. Mental health was assessed using the Child Behaviour Checklist (CBCL), with higher scores representing poorer behaviour.

SETTING

The Western Australian Pregnancy Cohort (Raine) Study, Perth, Western Australia.

SUBJECTS

Eight hundred and thirty-six males and females aged between 13 and 15 years.

RESULTS

Mean mental health score as assessed by the CBCL was 45.24 (sd 11.29). A high-quality breakfast consisting of at least three food groups was consumed by 11 % of adolescents, while 7 % of adolescents did not consume any items from core food groups on average over the 3 d period. The two most common core food groups consumed at breakfast in this population were dairy products followed by breads and cereals. For every additional food group eaten at breakfast, the associated total mental health score decreased by 1.66 (95 % CI -2.74, -0.59) after adjustment for potential confounding factors, representing an improvement in mental health score.

CONCLUSION

These findings support the concept that breakfast quality is an important component in the complex interaction between lifestyle factors and mental health in early adolescence.

Back-to-School Nutrition

Back-to-school season can be an important time for enhancing dietary quality, which is vital to chil- dren's health and wellness. An abun- dance of scientific literature supports a critical role of proper nutrition in cognitive development, intellectual performance, and academic achieve- ment. Improvement of nutrient intakes for children with inadequa- cies enhances mental functioning. Iron deficiency, which is the most common nutrient deficiency in the United States, has been implicated in poor cognition, and supplementation for iron-deficient children improves most scholastically related outcomes. School breakfast and lunch pro- grams, which must adhere to the 2005 US Dietary Guidelines, offer a means to improve nutritional intake, particularly for children of low socio- economic status. However, competing food and beverage sources, as well as refusal to consume healthful items of these meals, may reduce dietary advantages. Breakfast consumption is associated with many benefits in schoolchildren, including academic performance. Wholesome lunches and snacks can also be significant contributors to nutritional value over the course of a school day. Parents, teachers, and caregivers should be role models and advocates for health- promoting eating behaviors not only throughout the academic year but for a lifetime

Impact of education on food behaviour, body composition and physical fitness in children

The increasing prevalence of obesity during growth and development is significantly related to the education of children, and also to that of parents who influence food intake and physical activity from the beginning of life. The effect of maternal level of education has been shown in regular anthropometric surveys in 10-year intervals since 1951. This concerns the mother's own nutrition and physical activity regimen as well as the child's nutrition since birth, including the duration of breast-feeding. Children of parents with overweight and obesity were shown more often to be obese, as was the case for children from families with the lowest level of education, or from smaller communities where the level of education is usually lower than in larger cities. The composition of the mother's diet during pregnancy had, for example, an effect on the blood lipids of newborns. During preschool age, less body fat, a higher level of HDL, and higher levels of cardiorespiratory fitness, skill and physical performance were found in active children. In school-age children, when obesity increases, a number of prevention programmes using diet, exercise and behavioural intervention have been developed for schools, communities, churches, and/or have been organized by special institutions and medical centres, which were most efficient in family groups. The greatest reduction of weight, BMI and fatness, and improvement of functional capacity, and hormonal and metabolic parameters were achieved in summer camps or spas, with consistent and monitored nutrition, exercise and behavioural treatment. Fluctuation of positive outcomes occurred due to the interruption of the educational process during the school year, and repeated long-lasting interventions have been always necessary for permanent desirable results.

Free breakfasts in schools: design and conduct of a cluster randomised controlled trial of the Primary School Free Breakfast Initiative in Wales [ISRCTN18336527]

Background

School-based breakfast provision is increasingly being seen as a means of improving educational performance and dietary behaviour amongst children. Furthermore, recognition is growing that breakfast provision offers potential as a means of addressing social inequalities in these outcomes. At present however, the evidence base on the effectiveness of breakfast provision in bringing about these improvements is limited.

Methods/Design

This paper describes the research design of a large scale evaluation of the effectiveness of the Welsh Assembly Government's Primary School Free Breakfast Initiative. A cluster randomised trial, with school as the unit of randomisation was used for the outcome evaluation, with a nested qualitative process evaluation. Quantitative outcome measures included dietary habits, attitudes, cognitive function, classroom behaviour, and school attendance. The study recruited 111 primary schools in Wales, of which 56 were randomly assigned to control condition and 55 to intervention. Participants were Year 5 and 6 students (aged 9–11 years) in these schools. Data were collected for all 111 schools at each of three time points: baseline, 4 month and 12 month follow-up. This was achieved through a repeated cross-sectional survey of approximately 4350 students on each of these occasions. Of those students in Year 5 at baseline, 1975 provided data at one or both of the follow-ups, forming a nested cohort. The evaluation also included a nested process evaluation, using questionnaires, semi-structured interviews and case studies with students, school staff, and local authority scheme coordinators as key informants.

Discussion

An overview of the methods used for the evaluation is presented, providing an example of the feasibility of conducting robust evaluations of policy initiatives using a randomised trial design with nested process evaluation. Details are provided of response rates and the flow of participants. Reflection is offered on methodological issues encountered at various stages through the course of the study, focusing upon issues associated with conducting a randomised trial of a government policy initiative, and with conducting research in school settings.

Trial registration

Current Controlled Trials ISRCTN18336527

Nutrition and performance in children

PURPOSE OF REVIEW

Malnutrition in late infancy and childhood remains a significant public health issue in developing nations as well as for those in transition to an industrialized economy. In addition, in these settings and particularly in developed nations, overweight is becoming a very serious threat to both the immediate and the long-term health of children. In this review, we present recent studies that have examined relationships between childhood undernutrition and three general areas of performance: physical activity, cognition and behavior.

RECENT FINDINGS

Malnourished children have been shown to have decreased physical activity and endurance, and poorer cognitive function and school performance. Multiple single micronutrient deficiencies, including vitamin B12, thiamin, niacin, zinc and iron, have been associated with poorer cognitive performance. Behavioral problems, including attention deficits, have also been associated with food insufficiency and malnutrition.

SUMMARY

The effects of impaired nutritional status during childhood may have long-standing consequences for the health and performance of children during their adult years.

Functional effects of food: what do we know in children?

The knowledge base underpinning the setting of nutrient requirements for children and adolescents is not very secure. The advent of the concepts of optimal nutrition and functional foods has encouraged the possible use of functional effects as criteria for adequate nutrition in this age group. Target functions have been identified for growth development and differentiation and for behavioural and cognitive development. However, ideal markers or effects for these are not generally available. Additionally, nutrition in young people should avoid predisposing them to diet-related disease in later life. It is suggested that functional effects should include markers of reduction of risks of disease (nutritional safety) as well of benefits for health and well-being. Such markers of functional effects should be expected to arise from fundamental studies of nutrient–gene interactions and post-genomic metabolism.

Comprehensive computerized assessment of cognitive sequelae of a complete 12-16 hour fast

Food deprivation has been shown to deleteriously affect human cognition, but findings are equivocal, and few studies have examined several cognitive domains. In this study, the authors used computerized testing to describe the profile of shifts in cognition attributable to short-term religious fasting. Multiple cognitive domains were evaluated at midday and late afternoon following complete abstention from eating and drinking beginning at midnight. Cross-domain, fasting-related deficits were found for tasks requiring perception of spatial relations. Fasting-related information processing deficits were found for response time but not accuracy for test levels of intermediate difficulty. Time-of-day effects often reflected poorer afternoon performance. These findings provide a detailed profile of cognitive consequences of food deprivation, affected by time of day, task demands, and type of outcome.

Design and descriptive results of the "Growth, Exercise and Nutrition Epidemiological Study In preSchoolers": the GENESIS study

BACKGROUND

The Growth, Exercise and Nutrition Epidemiological Study in preSchoolers (GENESIS) attempts to evaluate the food and nutrient intakes, as well as growth and development of a representative sample of Greek toddlers and preschool children. In the current work the study design, data collection procedures and some preliminary data of the GENESIS study are presented.

METHODS

From April 2003 to July 2004, 1218 males and 1156 females 1 to 5 years old, stratified by parental educational level (Census 1999), were examined from 105 nurseries in five counties. Approximately 300 demographic, lifestyle, physical activity, dietary, anthropometrical and DNA variables have been recorded from the study population (children and parents).

RESULTS

Regarding anthropometrical indices, boys were found to be taller than girls at all ages (P < 0.05) and heavier only for the age period from 1 to 3 years old (P < 0.05). No significant differences were found between genders regarding the prevalence of at risk of overweight (16.5% to 18.6% for boys and 18.5 to 20.6 % for girls) and overweight (14.0% to 18.9% for boys and 12.6% to 20.0% for girls). Additionally, boys older than 2 years of age were found to have a higher energy intake compared to girls (P < 0.05). A similar tendency was observed regarding the mean dietary intake of fat, saturated fat, carbohydrates and protein with boys exhibiting a higher intake than girls in most age groups (P < 0.05).

CONCLUSION

The prevalence of overweight in the current preschool population is considerably high. Future but more extensive analyses of the GENESIS data will be able to reveal the interactions of the parameters leading to this phenomenon.

Adverse reactions to food additives

OBJECTIVES

To summarize the literature related to the classification of food additives and their reported adverse reactions and to provide a practical approach for evaluation of patients suspected of having such reactions.

DATA SOURCES

Information was derived from selected reviews and original articles published in peer-reviewed journals and from authoritative textbook chapters, supplemented by the clinical experience of the authors.

STUDY SELECTION

Priority was given to studies that used blinded, placebo-controlled oral challenges to confirm adverse reactions to food additives. In addition, selected, appropriately evaluated case reports are included.

RESULTS

A large number of food additives are widely used in the food industry. Adverse reactions to additives seem to be rare but are likely underdiagnosed in part due to a low index of suspicion. Numerous symptoms have been attributed to food additive exposure, but the cause-and-effect relationship has not been well demonstrated in all.

CONCLUSIONS

Reactions to food additives should be suspected in patients who report symptoms to multiple unrelated foods or to a certain food when commercially prepared but not when homemade and the allergy evaluation rules out a role for food protein. It is also prudent to investigate food additives in patients considered to have idiopathic reactions. There is a minor role for skin testing or in vitro testing. Oral challenge testing with common additives, preferably preceded by a trial of an additive-free diet, is the definitive procedure for detecting the offending agent. Once the specific additive is identified, management is basically avoidance of all its forms.