Nutrients for cognitive development in school-aged children

Dietary patterns among children and adolescents in Germany consuming vegetarian, vegan or omnivore diets: results of the VeChi Youth Study

PURPOSE

To identify dietary patterns of vegetarian, vegan and omnivore children and adolescents in Germany and to examine associations with nutrient intake.

METHODS

First, three principal component analyses based on 17-22 food groups were used to identify dietary patterns among vegetarians (n = 145, 3-day weighed dietary records), vegans (n = 110) and omnivores (n = 135) from the cross-sectional Vegetarian and Vegan Children and Youth (VeChi Youth) Study (2017-2019, 6-18 years, 57% girls). Secondly, these patterns were correlated (Spearman correlations) with energy and nutrient intakes.

RESULTS

Among vegetarians, 3 dietary patterns were identified ("Animal foods", "Vegetables and fruits", "Meat alternatives and potatoes") accounting for 32.7% of the variance in food group intake. In the vegan group, 4 patterns were identified ("Vegetables and legumes", "Refined carbohydrates", "Meat alternatives and juices", "Fruits and convenience foods") accounting for 43.2% of the variance. Among omnivores, 5 ("Flexitarian", "Vegetables and fruits", "Dairy Products", "meat and convenience foods", "Refined grains and juices") patterns accounting for 43.0% of the variance could be identified. Regardless of diet group, both more favorable dietary patterns ("Vegetables and fruits", "Meat alternatives and potatoes", "Vegetables and legumes", "Fruits and convenience food", "Flexitarian") correlated with higher micronutrient density and less favorable dietary patterns ("Animal foods", "Refined carbohydrates", "Meat alternatives and juices", "Dairy products", "Meat and convenience food", "Refined grains and juices") with unfavorable nutrient profiles were found.

CONCLUSION

Various dietary patterns exist within omnivore, vegetarian, and vegan diets of children and adolescents, which differ in their contribution to nutrient intake. It is therefore necessary to distinguish between different dietary patterns, also within the vegetarian and vegan diet.

Is underweight associated with poorer diet, nutrient status, bone and cardiometabolic health, and school performance in Danish 8-11-year-olds?

PURPOSE

Underweight, i.e. low body mass index for age and sex, may indicate undernutrition, but despite high prevalence, this aspect is largely overlooked in children in high-income countries. We explored if dietary intake, nutrient status, body composition, bone mineralization, cardiometabolic markers and school performance differed in schoolchildren with underweight compared to normal- and overweight.

METHODS

We used cross-sectional data from 815 Danish 8-11-year-old children collected in 2011. Intake of foods, macronutrients and key micronutrients (vitamin D, vitamin B12, calcium, iron, zinc and selenium) was assessed by 7-day dietary records. Measurements included anthropometry, dual-energy X-ray absorptiometry and tests of attention and reading skills. Fasting blood samples were analyzed for biomarkers of iron, long-chain n-3 fatty acids and vitamin D status as well as blood lipids, insulin and growth markers.

RESULTS

Eighty-three (10.2%) children had underweight and were shown to have a lower intake of energy, red meat, protein and zinc and higher intake of added sugar than children with normal- and overweight. They also had higher fish intake relative to overweight, but blood biomarkers did not differ between groups. Children with underweight had lower fat percent and bone mineralization compared to peers with normalweight, but apart from lower insulin, they did not differ in overall cardiometabolic health or school performance.

CONCLUSION

Although we found some differences in diet, there were no considerable differences in nutrient status, cardiometabolic health or school performance between children with underweight and their normalweight peers. However, the lower bone mineralization is a concern and needs further investigation.

Cognitive Function and the Consumption of Probiotic Foods: A National Health and Nutrition Examination Survey Study

Background/Objectives: Impaired cognition is a key trait of the diseases of aging and is an important quality of life factor for older adults and their families. Over the past decade, there has been an increasing appreciation for the role of the microbiome in cognition, as well as emerging evidence that probiotics, such as those in yogurt and other dairy products, can have a positive impact on cognitive function. However, it is unclear to what extent the consumption of yogurt is associated with improved cognitive function in older adults. Methods: Therefore, we compared the scores for the Wechsler Adult Intelligence Scale, Digit-Symbol Substitution Test between respondents who self-reported daily yogurt/dairy consumption with those who claimed they did not in an NHANES. Results: We found that cognitive scores were significantly higher (40.03 ± 0.64 vs. 36.28 ± 1.26, p = 0.017) in respondents reporting daily yogurt/dairy consumption, though only a trend remained after adjusting for sociodemographic covariates (p = 0.074). Conclusions: Further studies are required to confirm that this is a cause-effect relationship and whether changing diets is a low-cost means of protecting aging populations from cognitive decline and improving their quality of life.

The Longitudinal Relationship Between Diet Quality and Executive Functioning Development of Hispanic Preschoolers in Houston, Texas

BACKGROUND

Diet quality has been found to be related to cognitive health in school-aged children. However, this relationship remains understudied among Hispanic preschool-aged children, who are vulnerable to poor dietary habits and low cognitive development due to socioeconomic, cultural, and structural disparities.

OBJECTIVE

This longitudinal study evaluated whether the diet quality of preschool-aged children would be associated with executive functions (EFs) in later childhood.

DESIGN

This is a secondary analysis of a longitudinal study of Hispanic preschool-aged children (age 4 and 5 years) at baseline (Time 1) and 18 months (Time 2).

PARTICIPANTS AND SETTING

This study included 185 mother-child dyads with complete data at Time 1, recruited through Head Start centers in Houston, TX, beginning in 2011.

MAIN OUTCOME MEASURES

Mothers reported on their child's dietary intake via 3 24-hour recalls, which was used to calculate Healthy Eating Index (HEI)-2010 component and total scores. Laboratory tasks assessed cold EFs (tapping and Flexible Item Selection Tasks) and hot EFs (delay of gratification and gift-wrapping tasks). Whereas higher scores on tapping, Flexible Item Selection Task, and delay of gratification tasks represent a high EF, higher scores in gift-wrapping task represent a low EF.

STATISTICAL ANALYSES PERFORMED

Hierarchical linear regression analyses assessed the relationship between diet quality, as measured by HEI-2010 total and component scores, at Time 1 (independent variables) and EF outcomes (dependent variables) at Time 2, controlling for child sex, age, body mass index z score, and EF at Time 1.

RESULTS

HEI-2010 component score for fatty acids (b = -.13; P = .04) and seafood and plant proteins (b = .09; P = .05), were respectively related to later cold and hot EFs of Hispanic preschool-aged children. Other HEI components or the overall score did not predict EFs.

CONCLUSIONS

This study shows that specific HEI components support cold and hot EFs development among Hispanic preschool-aged children, but total HEI-2010 score does not. Experimental research is needed to assess the influence of dietary interventions on cognitive development of Hispanic preschool-aged children.

Nutritional status, dietary habits, and their relation to cognitive functions: A cross-sectional study among the school aged (8-14 years) children of Bangladesh

BACKGROUND

Limited research addressed links between nutritional status, dietary habits, and cognitive functions in young children. This study assessed the status of cognitive functions and their association with nutritional status and dietary habits of school age children of Bangladesh.

METHODS

This cross-sectional multi-centre study was conducted on 776 participants in 11 conveniently selected educational institutions. A printed questionnaire with three sections (Section 1: background information, section 2: PedsQL™ Cognitive Functioning Scale, and section 3: semi-quantitative food-frequency questionnaire) was utilized for the data collection purpose. Sections 1 and 3 were self-reported by parents, and trained volunteers completed section 2 in-person along with the anthropometric measurements. Statistical analyses were done in Stata (v.16). Mean with standard deviation and frequencies with percentages were used to summarize quantitative and qualitative variables, respectively. Pearson's chi-square test and Spearman's rank correlation coefficient were used to explore bivariate relationships.

RESULTS

The mean age of the participants was 12.02±1.88 years, and the majority (67%) were females. The prevalence of poor cognitive function was 46.52%, and among them, 66.02% were females. In terms of body mass index (BMI), 22.44% possessed normal weight, 17.51% were overweight, and 5.19% were obese. This study found a statistically significant relationship between BMI and cognitive functions. Furthermore, different dietary components (e.g., protein, carbohydrate, fat, fiber, iron, magnesium) showed a significant (p<0.05 for all) weak positive correlation with cognitive function.

CONCLUSION

BMI and dietary habits were associated with the cognitive function of young children in Bangladesh. Although the cross-sectional design of the study precludes causal relationships from being determined, the study finding deserves further examination via longitudinal research.

Nutritional Quality Implications: Exploring the Impact of a Fatty Acid-Rich Diet on Central Nervous System Development

Given the comprehensive examination of the role of fatty acid-rich diets in central nervous system development in children, this study bridges significant gaps in the understanding of dietary effects on neurodevelopment. It delves into the essential functions of fatty acids in neurodevelopment, including their contributions to neuronal membrane formation, neuroinflammatory modulation, neurogenesis, and synaptic plasticity. Despite the acknowledged importance of these nutrients, this review reveals a lack of comprehensive synthesis in current research, particularly regarding the broader spectrum of fatty acids and their optimal levels throughout childhood. By consolidating the existing knowledge and highlighting critical research gaps, such as the effects of fatty acid metabolism on neurodevelopmental disorders and the need for age-specific dietary guidelines, this study sets a foundation for future studies. This underscores the potential of nutritional strategies to significantly influence neurodevelopmental trajectories, advocating an enriched academic and clinical understanding that can inform dietary recommendations and interventions aimed at optimizing neurological health from infancy.

Co-benefits from health and health systems to education

This review draws on over 70 studies spanning 2000 to 2023 to analyze the causal effect of health on educational outcomes. Health and health system interventions during the prenatal, infant, and childhood period impact longer-run educational attainment and performance. The magnitude of these effects is both statistically and economically significant, comparable in size to impacts on educational outcomes of interventions found in the literature. These impacts of health and health system interventions differ across gender and socioeconomic status, illustrating how health and health systems can exacerbate or mitigate educational inequalities. By showing the intertwined nature of health and education, this review highlights the importance of a comprehensive approach in policy-making that aligns with the Sustainable Development Goals.

Prevalence and Assessment of Factors Associated With Malnutrition in Children Residing in Slums of Mumbai: A Cross-Sectional Study

Background Malnutrition in children continues to be a serious public health problem in India. Therefore, this study aims to evaluate the prevalence of malnutrition and assess factors contributing to it in children of the marginalized slum population of India, masked in the metropolitan cities.  Methods A retrospective data analysis with a cross-sectional model was conducted by medical volunteers affiliated with the Rotaract Club of Medicrew who had organized a free pediatric health check-up camp in the Dharavi village of Mumbai, India for children under five. Children under five years of age group of either sex residing in the slums of Dharavi and whose parents consented are included in the study. Neonates, children older than five years of age, and children whose parents did not consent for them to be included in the study were excluded. A pretested, pre-validated questionnaire was administered, and statistical analysis was done with p-values <0.05 considered to be statistically significant. Results  A total of 126 children were included. Out of these children, 109 of them (86.50%) had a mid-arm circumference of more than 12.5 cm (normal), 11 (8.73%) were between 11.5 cm and 12.5 cm (moderate acute malnutrition), and five (4.77%) were less than 11.5 cm (severe acute malnutrition). Among the 126 kids, 86 kids were above the age of two and their BMI was assessed, 36 (44.19%) were found to be underweight (<5th percentile) while 14 (16.3%) were obese (>95th percentile), and four (4.65%) were overweight (85th-95th percentile). For 106 (84.13%) of these children, the caregivers were mothers while others were fathers (n=4; 3.18%), grandmothers (n=5; 3.97%), sisters (n=5; 3.97%), and aunts (n=6; 4.76%). Out of those who had commenced receiving formal education, only 39 (55.71%) were in an appropriate grade for their age. The mean expenditure on food as a proportion of the total household income was 36.40% (standard deviation (SD) 15.0%). On the single-item sleep quality scale, the sleep of only 36 kids (28.58%) was reported by their caregivers as excellent. A high proportion of other medical problems were reported in the children. Conclusion Our study reports a substantial burden of malnutrition among children residing in the slums of Dharavi. Rigorous strengthening and conceptualization of on-ground nutritional programs targeted toward slum children should be done by Indian healthcare policymakers.

Current evidence on the effectiveness of Ready-to-Use Supplementary Foods in children with moderate acute malnutrition: a systematic review and meta-analysis

Moderate acute malnutrition (MAM) is defined by a weight-for-height Z-score (WHZ) between -3 and -2 of the WHO reference or by a mid-upper arm circumference (MUAC) of ≥11⋅5 and <12⋅5 cm. This study aimed to synthesise the evidence for the effectiveness of Ready-to-Use Supplementary Food (RUSF) compared to other dietary interventions or no intervention on functioning at different levels of the International Classification of Functioning, Disability, and Health (ICF) among children with MAM between 2 and12 years old. Three databases (PubMed, Scopus, and Web of Science) were systematically searched (last update: 20 November 2022). Pooled estimates of effect were calculated using random-effects meta-analyses. The level of evidence was estimated with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method. Seven studies were included. RUSF had a significant small-sized better effect (pooled mean: 0⋅38; 95 % CI = [0⋅10, 0⋅67], P = 0⋅01, I² = 97 %) on different anthropometric measurements compared to other dietary interventions among MAM children (n 6476). Comparing RUSF with corn-soy blend Plus Plus (CSB++) showed that RUSF had a small-sized but significantly better effect on the children's anthropometric measures compared to children who received CSB++ (pooled mean: 0⋅16; 95 % CI = [0⋅05, 0⋅27], P = 0⋅01; I2 = 35 %). MAM children treated with RUSF had a better recovery rate compared to those treated with CSB++ (pooled risk difference: 0⋅11; 95 % CI = [0⋅06, 0⋅11], P < 0⋅001; I2 = 0 %). The RUSF intervention seems promising in improving MAM children's nutritional outcomes and recovery rate compared to other dietary interventions.

Dietary consumption of beef and red meat: a scoping review and evidence map on cognitive outcomes across the lifespan

OBJECTIVE

Mixed evidence exists on the impact of beef consumption on cognition. The goal was to create an evidence map capturing studies assessing beef consumption and cognition to reveal gaps and opportunities in the body of literature.

DESIGN

A scoping review was conducted to locate studies up to March 2022 using PubMed and backwards citation screening. Data were extracted by two independent reviewers with conflict resolution, and a database was created and made publicly available.

SETTING

Intervention and observational studies.

PARTICIPANTS

Humans of any age, sex and/or health status, without moderate to severe cognitive impairment and/or abnormalities.

RESULTS

Twenty-two studies were identified that quantified beef or red meat intake and assessed cognition. Six studies assessed beef intake, with the remaining studies describing intake of red meat that may or may not include beef. Nine articles described randomised controlled trials (RCT), mostly conducted in children. Thirteen described observational studies, primarily conducted on adults and seniors. The most common cognitive domains measured included intelligence and general cognition, and memory. The majority of controlled studies were rated with high risk of bias, with the majority of observational trials rated with serious or greater risk of bias.

CONCLUSIONS

Red meat and beef intake and cognition is largely understudied. There is a significant lack of replication across study designs, populations, exposures and outcomes measured. The quality of the research would be considerably enhanced by focused assessments of beef intake (and not red meat in general) and specific cognitive domains, along with improved adherence to reporting standards.

Health aspects of vegan diets among children and adolescents: a systematic review and meta-analyses

Health effects of vegan diets among children and adolescents are a controversial public health topic. Thus, the aim of the present systematic review is to evaluate a broad range of health outcomes among vegan children and adolescents aged 0 to 18 years. 18 studies met the inclusion criteria (17 cross-sectional, 1 RCT). Meta-analyses showed lower protein, calcium, vitamin B2, saturated fatty acid, and cholesterol intakes, and lower ferritin, HDL and LDL levels as well as height in vegan compared to omnivorous children/adolescents. Higher intakes of carbohydrates, polyunsaturated fatty acids, fiber, folate, vitamins C and E, magnesium, iron, and potassium were observed in vegans. Blood levels of vitamin B12 were higher among vegan children due to supplement use. Single study results suggested further differences between vegan and non-vegan children, such as lower bone mineral content or urinary iodine among vegan children. Risk of Bias was rated as high or very high in 7 out of 18 studies. The certainty of evidence for the meta-analyses was low (n = 2) or very low (n = 46). Overall, the available evidence points to both risks and benefits associated with a vegan diet among children, although more and better designed studies are needed.

Nutrient trajectories during infancy and their associations with childhood neurodevelopment

PURPOSE

To examine the associations between infants' dietary nutrient trajectories and subsequent neurodevelopment during childhood in the Growing Up in Singapore Towards healthy Outcomes study.

METHODS

One-day food records were collected at ages 6, 9 and 12 months, whilst Bayley Scales of Infant and Toddler Development-III and Kaufman Brief Intelligence Test-2 were conducted at ages 24 and 54 months respectively. Nutrient trajectories were constructed using multi-level mixed modelling and associations with neurodevelopment (24 months: n = 484; 54 months: n = 444) were examined using adjusted multivariable linear regression.

RESULTS

At age 24 months, higher protein intake (at 6 months) and increasing rate of intake (from 6 to 12 months) were associated with higher fine motor score [β = 0.17 SD (95% CI 0.03, 0.31) and 0.62 SD (0.10, 1.14) respectively]. Higher fat intake was associated with higher receptive language score [0.04 SD (0.003, 0.07)], but increasing rate of intake was associated with lower expressive language [- 0.20 SD (- 0.39, - 0.01)] and fine motor [- 0.29 SD (- 0.48, - 0.10)] scores. Higher carbohydrate intake was associated with lower gross motor score [- 0.07 SD (- 0.14, - 0.005)], but increasing rate of intake was associated with higher receptive language [0.44 SD (0.08, 0.81)] and fine motor [0.56 SD (0.18, 0.93)] scores. Increasing rate of dietary fibre intake was associated with higher fine motor scores [0.63 SD (0.16, 1.10)]. No significant associations were observed with neurodevelopment at 54 months.

CONCLUSION

Our findings provide greater understanding of how nutrition over time could have varying effects on child neurodevelopment.

Effect of School Feeding Program on School Absenteeism of Primary School Adolescents in Addis Ababa, Ethiopia: A Prospective Cohort Study

BACKGROUND

School feeding programs (SFP) in low-income countries are designed to provide food to vulnerable school children to create optimal educational and health conditions for learners. Ethiopia scaled up the implementation of SFP in Addis Ababa. Yet, the utility of this program in terms of school absenteeism has not been monitored thus far. Hence, we aimed at evaluating the effect of the SFP on school performance of primary school adolescents in Addis Ababa, Central Ethiopia.

METHODS

A prospective cohort study was carried out from 2020 to 2021 on SFP-beneficiary (n = 322) and non-SFP beneficiary (n = 322). Logistic regression models were done using SPSS version 24.

RESULTS

In logistic regression, unadjusted model (model 1), the school absenteeism of non-school-fed adolescents was higher by 1.84 (adjusted odds ratio [aOR] 0.36, 95% confidence interval [CI] 1.28-2.64) as compared to school-fed adolescents. The odds ratio remained positive after adjusting for age and sex (model 2: aOR 1.84, 95% CI 1.27-2.65), and sociodemographic (model 3: aOR 1.84, 95% CI 1.27-2.67). In the final model, adjusted model 4, health and lifestyle, there was a significant increase in absenteeism of non-school-fed adolescents (model 4: aOR 2.37, 95% CI 1.54-3.64). The likelihood of absenteeism in female increase by 2.03 (aOR 2.03, 95% CI 1.35-3.05), whereas being in a low tertile wealth index family decreases absenteeism by (aOR 0.51, 95% CI 0.32-0.82). School feeding was negatively associated with school absenteeism.

CONCLUSIONS

The findings imply the need for strengthening school feeding programs.

Macronutrient intake in stunted and non-stunted toddlers in Jember, Indonesia

Background

Stunting is a condition of toddlers who experience growth failure due to chronic nutrient deficiencies that must be addressed immediately, if children lack nutrients continuously, it can affect their nutritional status and will cause children to be shorter than their age. The purpose of this study was to determine the differences in macronutrient intake in stunted and non-stunted toddlers in Jember, Indonesia.

Design and methods

Type of analytical observational research with case control design, sampling technique using simple random sampling. The number of subjects needed in each group is 66 stunting toddlers and 66 non-stunting toddlers with total subjects used are 132 toddlers.

Results

There are differences in macronutrient intake: energy, protein, fat, and carbohydrates between stunted and non-stunted toddlers with a higher average value of food intake per day for non-stunted toddlers than for stunted toddlers.

Conclusions

There are differences in macronutrient intake between stunted and non-stunted toddlers in Jember, Indonesia with a p-value = 0.000 < 0.05.

School food programmes in the Pacific Islands: exploring opportunities and challenges for creating healthier school food environments

OBJECTIVE

The school setting can provide an environment that supports healthy behaviours, including the provision of food. School food activities, that is, school feeding, are commonplace globally, but not well understood in the Pacific Islands region. The aim of this research is to explore learnings associated within existing school food programmes (SFP), and adoption resistors in those Pacific Island Countries and Territories (PICT) without SFP, with the intent of improving current and future SFP interventions.

DESIGN

This observational cross-sectional study utilised four facilitated workshop sessions to explore SFP within an existing framework.

SETTING

Pacific Islands region.

PARTICIPANTS

Fourteen participants representing the education and health sectors from eleven PICT, and two participants representing regional organisations.

RESULTS

Most countries reported some form of related policy, but key critical constraints to the use of SFP included local food environments, strategic alignment to organisational priorities, advocacy and organisational leadership, and community and cultural connections and collaboration. There are opportunities for integration of SFP into existing frameworks (i.e. Health Promoting Schools), increased collaboration, greater professional development and awareness activities, improved monitoring and evaluation, improved awareness of SFP and promotion of healthy eating for the wider school community.

CONCLUSIONS

Given the current health, social and economic challenges faced by countries and territories in the Pacific Islands region, SFP should be considered as an opportunity for food provision and associated nutrition education for students and their wider community. Further research is needed to understand the critical constraints of SFP in this region and how to support stakeholders to advocate for, develop and sustain SFP that are contextually and culturally appropriate.

Dietary Intake Levels of Iron, Copper, Zinc, and Manganese in Relation to Cognitive Function: A Cross-Sectional Study

Background: Previous studies have related circulating levels of trace metal elements, of which dietary intake is the major source, to cognitive outcomes. However, there are still relatively few studies evaluating the associations of dietary intake levels of iron, copper, zinc, and manganese with cognitive function (CF). Methods: We leveraged the data of 6863 participants (mean [standard deviation] age = 66.7 [10.5] years) in the Health and Retirement Study (2013/2014). Dietary intake levels of iron, copper, zinc, and manganese were calculated from a semi-quantitative food frequency questionnaire. CF was assessed using the 27-point modified Telephone Interview for Cognitive Status (TICS). We used linear regression models to calculate the mean differences in global CF scores by quintiles of dietary intake levels of trace metal elements. Results: Among the study participants, the mean (SD) values of daily dietary intake were 13.3 (6.3) mg for iron, 1.4 (0.7) mg for copper, 10.7 (4.6) mg for zinc, and 3.3 (1.6) mg for manganese. Compared with the lowest quintile of dietary iron intake (<8.1 mg), the highest quintile (≥17.7 mg) was associated with a lower cognitive score (-0.50, -0.94 to -0.06, P-trend = 0.007). Higher dietary copper was significantly associated with poorer CF (P-trend = 0.002), and the mean difference in cognitive score between extreme quintiles (≥1.8 vs. <0.8 mg) was -0.52 (95% confidence interval: -0.94 to -0.10) points. We did not observe significant associations for dietary intake of zinc (P-trend = 0.785) and manganese (P-trend = 0.368). Conclusion: In this cross-sectional study, higher dietary intake of iron and copper was related to worse CF, but zinc and manganese intake levels were not significantly associated with CF.

Factors driving underweight, wasting, and stunting among urban school aged children: Evidence from Merawi town, Northwest Ethiopia

Prior research identified malnutrition as one of the most common causes of morbidity and mortality among children globally. Furthermore, research revealed that over two thirds of deaths associated with inappropriate feeding practices occurred during the early years of life. Improper feeding practices impact a child's health in many different ways. However, research on the possible factors driving underweight, wasting, and stunting among school aged children in developing countries is limited, hence warrant further attention. Against this backdrop, this research strives to identify and assess the determinants of underweight, wasting and stunting among school aged children of a developing country-Ethiopia. A community based cross-sectional study was conducted from April 1, 2018 to June 15, 2018 in Merawi town, Ethiopia. An interviewer-administered questionnaire was used to collect data from a sample of 422 children. Binary logistic regression technique was performed to examine the effect of each selected variable on the outcome measure. The prevalence of being underweight, wasting and stunting was found to be 5.7%, 9.8%, 10.4%, respectively. The age of the child [adjusted odds ratio (AOR) = 12.930 (2.350, 71.157)] and the number of children [AOR = 8.155 (1.312, 50.677)] were emerged as the key determinants for underweight, and the gender of the child was significantly associated with wasting [AOR = 0.455 (0.224, 0.927)]. Finally, the age of the child [AOR = 12.369 (2.522, 60.656)] was found to predict the risk of stunting. This study revealed the age, number of children and gender of the child to have a significant association with malnutrition. The findings of this research suggest that in improving the feeding practices of young school-aged children, special attention should be paid to female children and those coming from relatively large families.

Nutrient-Level Evaluation of Meals Provided on the Government-Funded School Lunch Program in New Zealand

Approximately 1 in 6 children in New Zealand are living in households facing poverty and 14% of the population is food insecure. The Ka Ora, Ka Ako|Healthy School Lunches program aims to reduce food insecurity by providing access to a nutritious lunch every school day. This study analyzed the nutritional content of Ka Ora, Ka Ako meals and compared them to national and international standards. Meals were selected at random from approved menus. The suppliers covered by the 302 meals analyzed provide 161,699 students with a lunch (74.9% of students on the program). The meals were analyzed using Foodworks 10 nutrient analysis software. The nutrient content was compared against the New Zealand/Australia Nutrient Reference Values (NRVs) and to nutrient-level standards for international school lunch programs. A total of 77.5% of nutrients analyzed exceeded 30% of the recommended daily intakes. Protein, vitamin A and folate met the NRV targets and a majority of the international standards (55/57). Energy, calcium, and iron were low compared to NRVs and international standards (meeting 2/76 standards). Carbohydrates were low compared to international standards. The findings have been used to inform the development of revised nutrition standards for the program, which will be released in 2022.

Nutritional Quality of School Breakfasts: An Experience Based on Improvements of the School Food Program in Buenos Aires

BACKGROUND

Since 2016, the School Food Program in the Buenos Aires Province, Argentina, implemented a nutritional regulatory framework (NRF) and varying administration systems (AS). Here, we examined the association between the interventions (only NRF and NRF + AS) and breakfast nutritional and food indicators between 2016 and 2019.

METHODS

Data collected from the Survey of the School Food Program, 2016-2019, were analyzed. The dependent variables were the energy, macro-and micronutrients, milk/yogurt, and fruit quantities in school breakfasts. The independent variables were the school's status: (a) control group, (b) Intervention 1 (only NRF), and (c) Intervention 2 (NRF + AS). We preformed crude and adjusted linear regressions with robust variances.

RESULTS

We evaluated 4,060 schools (control group: 24%; Intervention 1: 39%; Intervention 2: 37%). Only vitamin A levels increased after Intervention 1, and almost all indicators (80%) showed better values when applying Intervention 2.

SCHOOL HEALTH POLICY IMPLICATIONS

Nutritional and food indicator improvements were associated with the implementation of the NRF and AS, emphasizing the significance of design and management of school food public policies, along with the amount of investment/territorial coverage.

CONCLUSIONS

Our findings highlight the importance of school food and nutrition policies with a potential impact on improving the nutritional status of children.

Are Dietary Patterns Related to Cognitive Performance in 7-Year-Old Children? Evidence from a Birth Cohort in Friuli Venezia Giulia, Italy

Research from different sources supports a link between nutrition and neurodevelopment, but evidence is still sparse regarding the relationship between a posteriori dietary patterns (DPs) and cognitive performance in school-aged children. Within the Northern Adriatic Cohort II, Friuli Venezia Giulia, Italy, 379 7-year-old children were cross-sectionally evaluated. Dietary patterns were identified through a principal component factor analysis based on 37 nutrients from children’s 3-day dietary records. The Wechsler Intelligence Scale of Children (WISC-IV) test provided measures of cognitive performance, including the full-scale intelligence quotient (FSIQ) and single index scores. Each DP was related to FSIQ or single index scores through multiple robust linear regression models. We identified five DPs named “Dairy Products”, “Plant-based Foods”, “Fats”, “Meat and Potatoes”, and “Seafood” (63% of variance explained). After adjustment, no significant relationship was observed with the FSIQ score; positive associations were found between the “Seafood” DP and Verbal Comprehension Index or Perceptual Reasoning Index. The “Meat and Potatoes” and “Dairy Products” DPs were inversely associated with the Verbal Comprehension Index and Processing Speed Index scores, respectively. In the absence of a relation with the overall FSIQ score, single DPs might influence specific cognitive functions, including verbal and reasoning abilities, as targeted by single indexes, in the expected direction.

Nutritional needs of children with disabilities in the UAE: understanding predictors and mediators of nutritional knowledge and practices

Background

There is a high estimated prevalence of obesity and poor eating habits among children with disabilities. Unfortunately, the extent of parental and teachers’ awareness of the dietary needs and nutritional requirements of children with disabilities has been understudied. This study aims to explore the predictors and mediators of nutritional knowledge and practices among parents and teachers of children with disabilities in the United Arab Emirates (UAE) using Nutbeam’s hierarchical health literacy model as a framework to test three hypotheses.

Methods

A total of 149 parents and teachers were recruited from rehabilitation centres in two of the seven Emirates in the UAE. The revised Food and Nutritional Literacy Scale (FNLIT) was used for data collection. The revised scale was validated and its reliability was assessed using SPSS and AMOS version 28 to compute exploratory factor analysis and structural equation modelling (confirmatory factor analysis and path analysis), respectively.

Results

The results confirmed a four-factor structure for FNLIT, and all three hypotheses were supported by the study findings. We confirmed a relationship between understanding and practical nutritional skills (Hypothesis I), and found that two practical nutritional skills, functional and interactive, combined to predict the understanding of nutritional needs of children with disabilities (Hypothesis II). Hypothesis III was partially supported in that participant type mediated the relationship between functional, interactive, and understanding factors. The convergent and discriminant validities of the scale were confirmed, and path analysis showed the ability of practical skills to predict knowledge.

Conclusion

The study concludes on the need for public education on nutritional needs as well as developing the capacity of teachers and parents to implement appropriate eating programmes for children with disabilities.

Concurrent Assessment of Phthalates/HEXAMOLL® DINCH Exposure and Wechsler Intelligence Scale for Children Performance in Three European Cohorts of the HBM4EU Aligned Studies

Information about the effects of phthalates and non-phthalate substitute cyclohexane-1,2-dicarboxylic acid diisononyl ester (HEXAMOLL^® DINCH) on children's neurodevelopment is limited. The aim of the present research is to evaluate the association between phthalate/HEXAMOLL^® DINCH exposure and child neurodevelopment in three European cohorts involved in HBM4EU Aligned Studies. Participating subjects were school-aged children belonging to the Northern Adriatic cohort II (NAC-II), Italy, Odense Child Cohort (OCC), Denmark, and PCB cohort, Slovakia. In each cohort, children's neurodevelopment was assessed through the Full-Scale Intelligence Quotient score (FSIQ) of the Wechsler Intelligence Scale of Children test using three different editions. The children's urine samples, collected for one point in time concurrently with the neurodevelopmental evaluation, were analyzed for several phthalates/HEXAMOLL^® DINCH biomarkers. The relation between phthalates/HEXAMOLL^® DINCH and FSIQ was explored by applying separate multiple linear regressions in each cohort. The means and standard deviations of FSIQ were 109 ± 11 (NAC-II), 98 ± 12 (OCC), and 81 ± 15 (PCB cohort). In NAC-II, direct associations between FSIQ and DEHP's biomarkers were found: 5OH-MEHP+5oxo-MEHP (β = 2.56; 95% CI 0.58-4.55; N = 270), 5OH-MEHP+5cx-MEPP (β = 2.48; 95% CI 0.47-4.49; N = 270) and 5OH-MEHP (β = 2.58; 95% CI 0.65-4.51; N = 270). On the contrary, in the OCC the relation between DEHP's biomarkers and FSIQ tended to be inverse but imprecise (p-value ≥ 0.10). No associations were found in the PCB cohort. FSIQ was not associated with HEXAMOLL^® DINCH in any cohort. In conclusion, these results do not provide evidence of an association between concurrent phthalate/DINCHHEXAMOLLR DINCH exposure and IQ in children.

Adherence to a healthy and potentially sustainable Nordic diet is associated with child development in The Norwegian Mother, Father and Child Cohort Study (MoBa)

Background

The rapid neurodevelopment that occurs during the first years of life hinges on adequate nutrition throughout fetal life and early childhood. Therefore, adhering to a dietary pattern based on healthy foods during pregnancy and the first years of life may be beneficial for future development. The aim of this paper was to investigate the relationship between adherence to a healthy and potentially sustainable Nordic diet during pregnancy and in early childhood and child development.

Methods

This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa) and uses data from the Medical Birth Registry of Norway (MBRN). In 83,800 mother-child pairs, maternal pregnancy diet and child diet at 6 months, 18 months and 3 years were scored according to adherence to the New Nordic Diet (NND). NND scores were calculated both as a total score and categorized into low, medium, or high adherence. Child communication and motor development skills were reported by parents at 6 months, 18 months, 3 and 5 years, using short forms of the Ages and Stages Questionnaire and the Child Development Inventory. Associations of NND adherence with child development were estimated with linear and logistic regression in crude and adjusted models.

Results

When examining the NND and child developmental scores as percentages of the total scores, we found positive associations between the NND scores (both maternal pregnancy diet and child diet) and higher scoring on child development (adjusted \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\hat{\beta}$$\end{document}β^ s [95% confidence intervals] ranging from 0.007 [0.004, 0.009] to 0.045 [0.040, 0.050]). We further found that low and medium adherence to NND were associated with higher odds of later emerging developmental skills compared to high NND adherence at nearly all measured timepoints (odds ratios [95% CI] ranging from significant values 1.15 [1.03–1.29] to 1.79 [1.55, 2.06] in adjusted analyses).

Conclusions

Our findings support that adherence to a healthy and potentially sustainable diet early in life is important for child development every step of the way from pregnancy until age 5 years.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-022-00799-5.

Selenium Status in Paediatric Patients with Neurodevelopmental Diseases

Neurodevelopmental diseases are often associated with other comorbidities, especially inflammatory processes. The disease may affect the trace element (TE) status, which in turn may affect disease severity and progression. Selenium (Se) is an essential TE required for the biosynthesis of selenoproteins including the transporter selenoprotein P (SELENOP) and extracellular glutathione peroxidase (GPX3). SELENOP deficiency in transgenic mice resulted in a Se status-dependent phenotype characterized by impaired growth and disturbed neuronal development, with epileptic seizures on a Se-deficient diet. Therefore, we hypothesized that Se and SELENOP deficiencies may be prevalent in paediatric patients with a neurodevelopmental disease. In an exploratory cross-sectional study, serum samples from children with neurodevelopmental diseases (n = 147) were analysed for total serum Se, copper (Cu), and zinc (Zn) concentrations as well as for the TE biomarkers SELENOP, ceruloplasmin (CP), and GPX3 activity. Children with epilepsy displayed elevated Cu and Zn concentrations but no dysregulation of serum Se status. Significantly reduced SELENOP concentrations were found in association with intellectual disability (mean ± SD (standard deviation); 3.9 ± 0.9 mg/L vs. 4.4 ± 1.2 mg/L, p = 0.015). A particularly low GPX3 activity (mean ± SD; 172.4 ± 36.5 vs. 192.6 ± 46.8 U/L, p = 0.012) was observed in phacomatoses. Autoantibodies to SELENOP, known to impair Se transport, were not detected in any of the children. In conclusion, there was no general association between Se deficiency and epilepsy in this observational analysis, which does not exclude its relevance to individual cases. Sufficiently high SELENOP concentrations seem to be of relevance to the support of normal mental development. Decreased GPX3 activity in phacomatoses may be relevant to the characteristic skin lesions and merits further analysis. Longitudinal studies are needed to determine whether the observed differences are relevant to disease progression and whether correcting a diagnosed TE deficiency may confer health benefits to affected children.

The Effects of Nutritional Interventions on the Cognitive Development of Preschool-Age Children: A Systematic Review

The developing human brain requires all essential nutrients to form and to maintain its structure. Infant and child cognitive development is dependent on adequate nutrition. Children who do not receive sufficient nutrition are at high risk of exhibiting impaired cognitive skills. This systematic review aimed to examine the effects of nutritional interventions on cognitive outcomes of preschool-age children. PubMed, PsycInfo, Academic Search Complete, and Cochrane Library electronic databases were searched to identify Randomized Controlled Trials (RCTs) published after the year 2000. Studies assessing the effects of food-based, single, and multiple micronutrient interventions on the cognition of nourished and undernourished children aged 2-6 years were deemed eligible. A total of 12 trials were identified. Eight out of the twelve studies found significant positive effects on cognitive outcomes. Iron and multiple-micronutrients supplementation yield improvements in the cognitive abilities of undernourished preschool-age children. Increased fish consumption was found to have a beneficial effect in the cognitive outcomes of nourished children. On the other hand, B-vitamin, iodized salt, and guava powder interventions failed to display significant results. Findings of this review highlight the importance of adequate nutrition during preschool years, and the crucial role sufficient nutrition plays in cognitive development.

Adherence to Dietary Recommendations of 7-Year-Old Children from a Birth Cohort in Friuli Venezia Giulia, Italy

Few Italian and European studies have assessed adherence to dietary recommendations in primary school children using dietary records. No Italian studies have provided an index-based nutritional adequacy assessment. We provided a comprehensive overview of dietary intake in 381 7-year-old children from NAC-II cohort study, Friuli Venezia Giulia (Italy). Energy, macro-, and micronutrient intakes were derived from 3-day dietary records. Standard (median and percentage) and index-based (Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR)) approaches were used to evaluate adequacy to Italian dietary reference values at nutrient- and overall-diet-level. Percentage contribution of macronutrients to energy intake (%En) was unbalanced towards total fats and protein. In 25% of children, total fats intake exceeded the reference intake upper limit. In ~63% of children, protein intake was at least doubled in their child-specific population reference intake. Median intakes of sodium (1.7 g/day), saturated fatty acids (12.2 %En), and soluble carbohydrates (19.4 %En) exceeded the suggested dietary target in most (65–84%) children. Inadequacy was also observed for micronutrients, with median NARs ranging from 0.11 (vitamin D) to 0.90 (zinc). The median MAR was 0.75 (0.69–0.79), with 1 indicating optimal overall dietary intake. In conclusion, the enrolled children showed suboptimal intakes of several macro- and micronutrients, in line with Italian and European studies on primary school children. Based on the current findings, public health interventions may be targeted to specific nutrients or subpopulations.

Can Nutrients and Dietary Supplements Potentially Improve Cognitive Performance Also in Esports?

Factors influencing brain function and cognitive performance can be critical to athletic performance of esports athletes. This review aims to discuss the potential beneficial effects of micronutrients, i.e., vitamins, minerals and biologically active substances on cognitive functions of e-athletes. Minerals (iodine, zinc, iron, magnesium) and vitamins (B vitamins, vitamins E, D, and C) are significant factors that positively influence cognitive functions. Prevention of deficiencies of the listed ingredients and regular examinations can support cognitive processes. The beneficial effects of caffeine, creatine, and probiotics have been documented so far. There are many plant products, herbal extracts, or phytonutrients that have been shown to affect precognitive activity, but more research is needed. Beetroot juice and nootropics can also be essential nutrients for cognitive performance. For the sake of players’ eyesight, it would be useful to use lutein, which, in addition to improving vision and protecting against eye diseases, can also affect cognitive functions. In supporting the physical and mental abilities of e-athletes the base is a well-balanced diet with adequate hydration. There is a lack of sufficient evidence that has investigated the relationship between dietary effects and improved performance in esports. Therefore, there is a need for randomized controlled trials involving esports players.

Self-Recognition and Emotional Knowledge

Self-recognition emerges during the second year of life and represents the emergence of a reflective self, a metacognition which underlies self-conscious emotions such as embarrassment and shame, perspective taking, and emotional knowledge of others. In a longitudinal study of 171 children, two major questions were explored from an extant database: 1) Do early factors, including IQ, general environmental risk, mother-child attachment interaction, drug exposure, gender, and neonatal risk, relate to self-recognition?; 2) Does self-recognition, along with these earlier factors, predict the child's subsequent emotional knowledge? Consistent with previous data, 39% of children exhibited self-recognition by 18-months and few early factors explored were related to this ability. Moreover, path analysis revealed few effects of the earlier factors predicting self-recognition on children's emotional knowledge. Self-recognition did predict emotional knowledge at 4.5 years, such that children who showed early self-recognition showed greater emotional knowledge. Children from high risk environments also showed lower emotional knowledge. These findings indicate that self-recognition and environmental risk are related to children's later knowledge of emotions.

Efficacy of Omega-3 and Korean Red Ginseng in Children with Subthreshold ADHD: A Double-Blind, Randomized, Placebo-Controlled Trial

OBJECTIVE

The purpose of the present study was to investigate the efficacy of combined omega-3 and Korean red ginseng supplementation on ADHD symptoms and cognitive function in children with subthreshold ADHD.

METHOD

120 children from 6 to 12 years with subthreshold ADHD were enrolled in this 12-week, double-blind, randomized, placebocontrolled study. The primary outcome was measured by Attention-Deficit Hyperactivity Disorder Rating Scale (ADHD-RS). Children Behavior Check List (CBCL), and neuropsychological tests assessing attention, memory, and executive function were included as secondary primary outcome measures.

RESULTS

Significant effects on the scores of ADHDRS, as well as several subscales of CBCL including ADHD and attention problem subscales were revealed.

CONCLUSION

The combination of omega-3 and Korean red ginseng may have beneficial effects in children with subthreshold ADHD. Increased clinical awareness of ADHD symptoms even at a subthreshold level is needed.

Nutrients for executive function development and related brain connectivity in school-aged children

Executive functions refer to a set of higher-order cognitive processes involved in the control and organization of information to serve goal-directed behaviors. Skills in executive functioning are developed throughout childhood and adolescence and have been shown to be predictive of academic achievement. The coordination of these complex processes is critically dependent on brain maturation and connectivity, including key neurodevelopmental processes like myelination and synaptogenesis. Among other factors, research highlights the influential effect of nutrition and diet on these neurodevelopmental processes, which may impact executive function performance in healthy and deficient populations. This review considers the research to date on the role of key nutrients that have been identified for executive function development and their underlying neurophysiological processes in school-aged children.

Association of dietary diversity and cognition in preschoolers in rural China

OBJECTIVES

We sought to investigate the cognition of preschoolers in rural China and examine the relationship between dietary diversity and cognition.

METHODS

We performed a cross-sectional survey analysis. In 1334 preschoolers ages 3 to 5, from 26 preschools in two nationally designated poverty counties in Hunan Province in China, we calculated the dietary diversity score (DDS) using a 24-h recall method. To measure children's cognitive ability, we assessed the Working Memory Index and Verbal Comprehension Index on the Mandarin-language version of the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition. Multiple linear regression models were used to estimate the association between DDS and cognitive test scores.

RESULTS

A total of 22% of children had a Working Memory Index that was either extremely low or borderline, and 31% of children had a Verbal Comprehension Index that was either extremely low or borderline. The mean (± SD) DDS was 5.65 ± 1.30. Those preschoolers with medium DDS (5 or 6) or high DDS (7 to 9) scored higher on both Working Memory Index-respectively, mean difference (MD), 1.327; 95% confidence interval (CI), 0.246-3.901; and MD, 2.067, 95% CI, 0.261-4.641-and Verbal Comprehension Index-MD, 0.168; 95% CI, 0.072-2.135; and MD, 0.398; 95% CI, 0.032-2.137-than did those with low DDS (0 to 4).

CONCLUSIONS

Consuming a more diverse diet may contribute to better cognition in preschoolers. Future research is needed to better understand the possible causal effect of dietary diversity on cognitive development.

The Relationship between Family Meals and Mental Health Problems in Japanese Elementary School Children: A Cross-Sectional Study

The relative burden of mental health problems in children is increasing worldwide. Family meals have attracted attention as an effective modifiable factor for preventing children’s mental health problems. We examined the relationship between family meals and mental health problems in Japanese elementary schoolchildren. A cross-sectional, self-administered questionnaire survey was conducted with guardians of children aged 7 to 12 years in Gifu Prefecture, Japan. Frequency of family meals and with whom the child eats breakfast, lunch, and dinner were assessed separately for weekdays and weekends/holidays. Mental health was assessed using the Japanese version of the parent-reported Strengths and Difficulties Questionnaire. Multivariate adjusted odds ratios (ORs) for borderline/abnormal mental health status were calculated using logistic regression analysis. Of the 678 children, 24.9% had borderline/abnormal mental health status. Children eating breakfast with their family less than once a week (adjusted OR, 4.79; 95% confidence interval (CI), 1.51–15.25) and those eating weekend breakfast alone (adjusted OR, 3.61; 95% CI, 1.42–9.23) had a higher prevalence of borderline/abnormal mental health status compared to those eating breakfast seven times a week and weekend breakfast with their family, respectively. These results suggest that family meals, especially breakfast, might be positively associated with better mental health in children.

Association of Family Nutrition and Physical Activity with Preschooler's Working Memory: A Cross-Sectional Study among Mexican Children

Healthy eating and active lifestyles are associated with children’s healthy weight and cognitive development. This study examines whether family behaviors relevant for nutrition and activity levels are associated with children’s working memory, independent of their weight status. A convenience sample of child–caregiver dyads (n = 85 dyads) were recruited from a public preschool serving a low-income community in central Mexico. Caregivers reported the frequency of ten family behaviors using the Family Nutrition and Physical Activity screening tool. Children completed a test of their ability to recall four words after a 60-s distraction task, an assessment of working memory. Multiple linear regression models were used to test the association of children’s working memory with each family behavior, adjusting for children’s sex, age, mother’s age and education, and subjective social status and then also adjusting for children’s age- and sex-specific body mass index percentile (BMI-P) and covariates. Higher frequency of breakfast intake was significantly associated with working memory (β = 0.57, p = 0.013). This association was independent of children’s BMI-P. Other family behaviors (frequent family mealtimes, limiting screen time, and others) were not significantly associated with children’s working memory. Frequent breakfast intake could benefit young children’s working memory, regardless of their weight status. This association merits further investigation.

Identification of Genetic Loci and Candidate Genes Related to Grain Zinc and Iron Concentration Using a Zinc-Enriched Wheat 'Zinc-Shakti'

The development of nutritionally enhanced wheat (Triticum aestivum L.) with higher levels of grain iron (Fe) and zinc (Zn) offers a sustainable solution to micronutrient deficiency among resource-poor wheat consumers. One hundred and ninety recombinant inbred lines (RILs) from 'Kachu' × 'Zinc-Shakti' cross were phenotyped for grain Fe and Zn concentrations and phenological and agronomically important traits at Ciudad Obregon, Mexico in the 2017-2018, 2018-2019, and 2019-2020 growing seasons and Diversity Arrays Technology (DArT) molecular marker data were used to determine genomic regions controlling grain micronutrients and agronomic traits. We identified seven new pleiotropic quantitative trait loci (QTL) for grain Zn and Fe on chromosomes 1B, 1D, 2B, 6A, and 7D. The stable pleiotropic QTL identified have expanded the diversity of QTL that could be used in breeding for wheat biofortification. Nine RILs with the best combination of pleiotropic QTL for Zn and Fe have been identified to be used in future crossing programs and to be screened in elite yield trials before releasing as biofortified varieties. In silico analysis revealed several candidate genes underlying QTL, including those belonging to the families of the transporters and kinases known to transport small peptides and minerals (thus assisting mineral uptake) and catalyzing phosphorylation processes, respectively.

Preconception micronutrient supplementation positively affects child intellectual functioning at 6 y of age: A randomized controlled trial in Vietnam

BACKGROUND

Although there is growing evidence on the role of preconception nutrition for birth outcomes, very few studies have evaluated the long-term effects of nutrition interventions during the preconception period on offspring cognitive outcomes.

OBJECTIVE

We evaluate the impact of preconception weekly multiple micronutrients (MMs) or iron and folic acid (IFA) supplementation compared with folic acid (FA) alone on offspring intellectual functioning at age 6-7 y.

METHODS

We followed 1599 offspring born to women who participated in a double-blinded randomized controlled trial of preconception supplementation in Vietnam. Women received weekly supplements containing either 2800 μg FA only, 60 mg iron and 2800 μg FA, or MMs (15 micronutrients including IFA) from baseline until conception, followed by daily prenatal IFA supplements until delivery. We used the Wechsler Intelligence Scale for Children to measure full-scale IQ (FSIQ) and 4 related domains of intellectual functioning [Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI), and Processing Speed Index (PSI) scores] at 6-7 y. Group comparisons were done using ANOVA tests for all children and the subgroup born to women who consumed the supplements ≥26 wk before conception (per-protocol analyses).

RESULTS

The final sample with data at 6-7 y (n = 1321) was similar for baseline maternal and offspring birth characteristics and age at follow-up by treatment group. Compared with the offspring in the FA group, those in the MM group had higher FSIQ (β = 1.7; 95% CI: 0.1, 3.3), WMI (β = 1.7; 95% CI: 0.2, 3.2), and PSI (β = 2.5; 95% CI: 0.9, 4.1). Similar findings were observed in the per-protocol analyses. There were no significant differences by treatment group for VCI and PRI.

CONCLUSIONS

Preconception supplementation with MMs improved certain domains of intellectual functioning at age 6-7 y compared with FA. These findings suggest the potential for preconception micronutrient interventions to have long-term benefits for offspring cognition.

The association between dietary diversity and development among children under 24 months in rural Uganda: analysis of a cluster-randomised maternal education trial

OBJECTIVE

To assess the association between dietary diversity and development among children under 24 months in rural Uganda and to establish other factors that could be associated with development among these children.

DESIGN

A secondary data analysis of a cluster-randomised controlled maternal education trial (n 511) was conducted on a sub-sample of 385 children. We used adjusted ORs (AORs) to assess the associations of dietary diversity scores (DDS) and other baseline factors assessed at 6-8 months with child development domains (communication, fine motor, gross motor, personal-social and problem solving) at 20-24 months of age.

SETTING

Rural areas in Kabale and Kisoro districts of south-western Uganda.

PARTICIPANTS

Children under 24 months.

RESULTS

After multivariable analysis, DDS at 6-8 months were positively associated with normal fine motor skills development at 20-24 months (AOR = 1·18; 95 % CI 1·01, 1·37; P = 0·02). No significant association was found between DDS and other development domains. Children who were not ill at 6-8 months had higher odds of developing normal communication (AOR = 1·73; 95 % CI 1·08, 2·77) and gross motor (AOR = 1·91; 95 % CI 1·09, 3·36) skills than sick children. Girls had lower odds of developing normal gross motor skills compared with boys (AOR = 0·58; 95 % CI 0·33, 0·98). Maternal/caregiver nutritional education intervention was positively associated with development of gross motor, fine motor and problem-solving skills (P-values < 0·05).

CONCLUSIONS

We found an association between child DDS at 6-8 months and improvement in fine motor skills development at 20-24 months. Child illness status, maternal/caregiver nutritional education intervention and sex were other significant baseline predictors of child development at 20-24 months.

The Use of Lower or Higher Than Recommended Doses of Folic Acid Supplements during Pregnancy Is Associated with Child Attentional Dysfunction at 4-5 Years of Age in the INMA Project

We assessed the association between the use of lower- and higher-than-recommended doses of folic acid supplements (FAs) during pregnancy and attentional function in boys and girls at age of 4–5. We analyzed data from 1329 mother-child pairs from the mother-child cohort INfancia y Medio Ambiente Project (INMA) study. Information on FAs use during pregnancy was collected in personal interviews at weeks 12 and 30, and categorized in <400, 400–999 (recommended dose), and ≥1000 μg/day. Child attentional function was assessed by Conners’ Kiddie Continuous Performance Test. Multivariable regression analyses were used to estimate incidence rate ratios (IRR) and beta coefficients with 95% confidence intervals (CI). Compared to recommended FAs doses, the periconceptional use of <400 and ≥1000 μg/day was associated with higher risk of omission errors—IRR = 1.14 (95% CI: 1.01; 1.29) and IRR = 1.16 (95% CI: 1.02; 1.33), respectively. The use of FAs < 400 μg/day and ≥1000 μg/day was significantly associated with deficits of attentional function only in boys. FAs use < 400 μg/day was associated with higher omission errors with IRR = 1.22 and increased hit reaction time (HRT) β = 34.36, and FAs use ≥ 1000 μg/day was associated with increased HRT β = 33.18 and HRT standard error β = 3.31. The periconceptional use of FAs below or above the recommended doses is associated with deficits of attentional function in children at age of 4–5, particularly in boys.

The Impact of Micronutrient Fortified Foods on Cognitive Functioning among Low-Income Children: A Pilot and Feasibility Study

Brain development continues throughout childhood and requires micronutrients for optimal maturation, but studies have typically examined only a limited number of micronutrients and there has been inconsistent use of validated cognitive measures. This study evaluated the impact of providing low-income children with a daily fortified meal (570 kcal) in the form of a bar and shake containing >75% of the FDA Daily Values for all essential vitamins and minerals, as well as macronutrients (e.g., omega-3 and omega-6 fatty acids and protein), in an afterschool care setting (instead of the usual meal provided) on cognitive functioning. Students aged 8–12 were randomly assigned to intervention (n = 19) or control (n = 16) meals. Students completed the Stroop Color Word Task, Trail Making Test, and Conner’s Continuous Performance Task (CPT) at baseline and 3 months post-intervention. Differences in cognitive scores were examined using 2 × 2 mixed model ANOVAs (Stroop and CPT) and ANCOVAs (Trail Making Test). Significant main effects of time indicated improvements in both intervention and control groups, but there were no significant main effects of group or group*time interactions. When the amount of meal consumed was examined, most results became non-significant, suggesting that overall meal consumption significantly impacted the observed results. Overall, this pilot study suggests that there may be limited additional benefits to short-term consumption of micronutrient fortified meals among low-income children in an afterschool care setting, and potential benefits observed may be directly related to the amount of food consumed.

The Relationship Between Antioxidants and Inflammation in Children With Attention Deficit Hyperactivity Disorder

Introduction

Recent studies have identified Attention Deficit Hyperactivity Disorder (ADHD) as an inflammatory condition associated with immunological and oxidative responses. Therefore, it is necessary to examine these processes in these patients. The present study aimed at investigating the relationship between the dietary intake of antioxidants, Superoxide Dismutase (SOD) activity, and the serum levels of inflammatory factors in ADHD students.

Methods

This retrospective case-control study was conducted on 64 ADHD children aged 6 - 13 years. The demographic questionnaire, Food Frequency Questionnaire, and Baecke Physical Activity Questionnaire were used for data collection. SOD activity and the serum level of inflammatory factors (homocysteine, interleukin-6, and C-reactive Protein (CRP)) were measured in all patients. According to the CRP values, 32 patients were included in the case group (CRP≥1 mg/L) and 32 patients in the control group (0≤CRP<1 mg/L).

Results

There was no significant difference between the two groups in age, sex, weight, height, and body mass index. In the case group, the mean SOD activity (P=0.034), the physical activity (P=0.04), zinc intake (P=0.02), and homocysteine levels were higher than the control group (P=0.001). Of all studied variables, the best predictors were homocysteine (OR: 1.34, 95% CI: 1.082-1.670, P=0.029) and physical activity (OR: 0.85, 95% CI: 0.761-0.952, P=0.022) respectively, whereas other variables were not significant predictors.

Conclusion

The present study showed that the level of inflammatory factors in the case group was significantly higher than the control group. Homocysteine and physical activity can predict the inflammation status induced by CRP.

Consequences of early life exposure to the 1983-1985 Ethiopian Great Famine on cognitive function in adults: a historical cohort study

OBJECTIVES

To investigate the association between early life famine exposure and cognitive function in adults.

DESIGN

Historical cohort study SETTING: North Wollo Zone, Northeast Ethiopia.

PARTICIPANTS

We recruited 1047 adult men and women aged 30-38 years who had history of early life exposure to Ethiopian great famine. Based on self-reported age and birth date, participants were categorised into famine exposed in early life (prenatal/postnatal) and non-exposed groups.

OUTCOME MEASURES

The primary outcome measure of this study was cognitive function in adults after early life exposure to famine. Cognitive function was measured using Montreal Cognitive Assessment-basic. Associations between exposure and outcome variables were examined by linear regression analysis models.

RESULTS

Adjusted for covariates, early life exposure to famine showed 1.29 (β=-1.29; 95% CI -2.16 to -0.52) points lower cognitive function score compared with non-exposed. Based on subanalysis for timing of famine exposure, postnatal exposure to famine resulted in 2.26 (β=-2.26; 95% CI -3.12 to -1.36) points lower cognitive function score compared with non-exposed groups. Prenatal famine exposure had 1.26 (β=-1.26; 95% CI -2.35 to 0.94) points lower cognitive function score although not statistically significant.

CONCLUSIONS

Famine exposure in early life was associated with cognitive functions in adults. While the overall findings highlight the importance of optimal nutrition in early life for brain growth and development, the association observed between postnatal famine exposure and adult cognitive function may indicate the relative importance of learning and experience during early childhood for optimal brain development after birth. Further studies are needed to elucidate the potential mechanism behind this association.

Systematic review and meta-analysis of the effects of iodine supplementation on thyroid function and child neurodevelopment in mildly-to-moderately iodine-deficient pregnant women

BACKGROUND

Mild-to-moderate iodine deficiency, particularly in pregnancy, is prevalent; this is of concern because observational studies have shown negative associations with child neurodevelopment. Although neither the benefits nor the safety of iodine supplementation in pregnancy in areas of mild-to-moderate deficiency are well researched, such supplementation is increasingly being recommended by health authorities in a number of countries.

OBJECTIVES

By reviewing the most recent published data on the effects of iodine supplementation in mildly-to-moderately deficient pregnant women on maternal and infant thyroid function and child cognition, we aimed to determine whether the evidence was sufficient to support recommendations in these areas.

METHODS

A systematic review of randomized controlled trials (RCTs), non-RCT interventions, and observational studies was conducted. To identify relevant articles, we searched the PubMed and Embase databases. We defined mild-to-moderate iodine deficiency as a baseline median urinary iodine concentration (UIC) of 50-149 µg/L. Eligible studies were included in meta-analyses.

RESULTS

In total, 37 publications were included-10 RCTs, 4 non-RCT interventions, and 23 observational studies. Most studies showed no effect of iodine supplementation on maternal or infant thyroid-stimulating hormone and free thyroxine. Most RCTs found that supplementation reduced maternal thyroglobulin and in 3 RCTs, it prevented or diminished the increase in maternal thyroid volume during pregnancy. Three RCTs addressed child neurodevelopment; only 1 was adequately powered. Meta-analyses of 2 RCTs showed no effect on child cognitive [mean difference (MD): -0.18; 95% CI: -1.22, 0.87], language (MD: 1.28; 95% CI: -0.28, 2.83), or motor scores (MD: 0.28; 95% CI: -1.10, 1.66).

CONCLUSIONS

There is insufficient good-quality evidence to support current recommendations for iodine supplementation in pregnancy in areas of mild-to-moderate deficiency. Well-designed RCTs, with child cognitive outcomes, are needed in pregnant women who are moderately deficient (median UIC < 100 µg/L). Maternal intrathyroidal iodine stores should be considered in future trials by including appropriate measures of preconceptional iodine intake.This review was registered at www.crd.york.ac.uk/prospero as CRD42018100277.

Nutrition and growth in children

The well-balanced nourishment during "the first 1000 days," the period between conception (day 18) and the age of two years, is quite important for two main reasons. Firstly, the nutritive requirement is high due to the rapid physiological growth and functional development. Then, this period is characterized by extreme susceptibility to external stimuli such as inadequate maternal and infant nutritional status which they can interfere with the different stages of the development process leading to short and long-term consequences for health. Linear growth and brain development are particularly impaired from not sufficient nutrition. In consideration of the irreversible damage of malnutrition, especially on developing brain, an adequate nutrition during the first 1000 days of life is paramount. The aim of this review was to overview the latest scientific evidences on the relationship between nutrition and growth, focusing on nutritional requirements during the first 1000 days, and the impact of inadequate nutrition on brain development and linear growth.

Household food insecurity and educational outcomes in school-going adolescents in Ghana

OBJECTIVES

We examined the association of household food insecurity with educational outcomes and explored the moderating effect of gender and school lunch programme.

DESIGN

The study used a cross-sectional design. Data were collected in 2014 using interviewer-administered questionnaires and school administrative records. We measured household food insecurity using the Household Food Insecurity Access Scale. Educational outcomes referred to knowledge, attitudes and skills that students are expected to obtain while attending school. We obtained sixteen different measures of educational outcomes, ranging from academic grades to beliefs and attitudes towards school and education. Data were analysed using multilevel modelling with covariates at the student and school levels. We conducted moderation tests by adding a two-way interaction between food insecurity and gender, and between food insecurity and school lunch programme.

SETTING

The study was conducted in 100 schools located in fifty-four districts within Ghana's eight administrative regions in 2014.

PARTICIPANTS

Participants included 2201 school-going adolescents aged 15-19 years.

RESULTS

More than 60 % of adolescents were from food-insecure households. Household food insecurity was negatively associated with Math grade and school attendance. Food insecurity was also inversely associated with socio-emotional outcomes, including academic self-efficacy, commitment to school and academic aspirations and expectations. We did not find a moderating effect of gender and school lunch programme.

CONCLUSIONS

Food insecurity is negatively associated with wide-ranging educational outcomes related to both learning and socio-emotional abilities. Our study supports prior evidence suggesting the importance of food access on both cognitive and non-cognitive educational outcomes.

Effects of oily fish intake on cognitive and socioemotional function in healthy 8-9-year-old children: the FiSK Junior randomized trial

BACKGROUND

Long-chain n-3 PUFAs (n-3 LCPUFAs) accrete in the brain during childhood and affect brain development. Randomized trials in children show inconsistent effects of n-3 LCPUFAs on cognitive and socioemotional function, and few have investigated effects of fish per se.

OBJECTIVES

We aimed to investigate the effects of oily fish consumption on overall and domain-specific cognitive and socioemotional scores and explore sex differences.

METHODS

Healthy 8-9-y-old children (n = 199) were randomly allocated to receive ∼300 g/wk oily fish or poultry (control) for 12 ± 2 wk. At baseline and endpoint, we assessed attention, processing speed, executive functions, memory, emotions, and behavior with a large battery of tests and questionnaires and analyzed erythrocyte fatty acid composition.

RESULTS

One hundred and ninety-seven (99%) children completed the trial. Children in the fish group consumed 375 (25th-75th percentile: 325-426) g/wk oily fish resulting in 2.3 (95% CI: 1.9, 2.6) fatty acid percentage points higher erythrocyte n-3 LCPUFA than in the poultry group. The overall cognitive performance score tended to improve by 0.17 (95% CI: -0.01, 0.35) points in children who received fish compared with poultry, supported by n-3 LCPUFA dose dependency. This was driven mainly by fewer errors [-1.9 (95% CI: -3.4, -0.3)] in an attention task and improved cognitive flexibility measured as faster reaction time [-51 ms (95% CI: -94, -7 ms)] in a complex relative to a simple task ("mixing cost"). The fish intervention furthermore reduced parent-rated Strength and Difficulties Questionnaire total difficulties by -0.89 (95% CI: -1.60, -0.18) points mainly due to a -0.63 (95% CI: -1.11, -0.16) points reduction in internalizing problems that was reflected in tendency to a decrease in the overall socioemotional problems score of -0.13 (95% CI: -0.26, 0.01) points. The overall effects were similar in boys and girls.

CONCLUSIONS

Oily fish dose-dependently improved cognitive function, especially attention and cognitive flexibility, and reduced socioemotional problems. The results support the importance of n-3 LCPUFAs for optimal brain function and fish intake recommendations in children.The trial was registered at www.clinicaltrials.gov as NCT02809508.

Role of environmental factors and epigenetics in autism spectrum disorders

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder thought to be caused by predisposing high-risk genes that may be altered during the early development by environmental factors. The impact of maternal challenges during pregnancy on the prevalence of ASD has been widely studied in clinical and animal studies. Here, we review some clinical and pre-clinical evidence that links environmental factors (i.e., infection, air pollution, pesticides, valproic acid and folic acid) and the risk of ASD. Additionally, certain prenatal environmental challenges such as the valproate and folate prenatal exposures allow us to study mechanisms possibly linked to the etiology of ASD, for instance the epigenetic processes. These mechanistic pathways are also presented and discussed in this chapter.