Nutrition, Learning and Behavior in Children:

The objective was to determine if a relationship exists between participation in a school breakfast program and measures of psychosocial and academic functioning in school aged children. Information on participation in a school breakfast program, school record data, and in depth interviews with parents and children were collected in 1 public school in Philadelphia, PA, and 2 public schools in Baltimore, MD, prior to the implementation of a universally free (UF) breakfast program and again after the program had been in place for 4 months. One hundred thirty three low income students had complete data before and after the UF breakfast program on school breakfast participation and school recorded measures, and 85 of these students had complete psychosocial interview data before and after the UF breakfast program. Teacher ratings of behavior before and after the UF breakfast program were available for 76 of these students. Schoolwide data showed that prior to the UF breakfast program, 240 (15%) of the 1627 students in the 3 schools were eating a school supplied breakfast each day. Of the 133 students in the interview sample, 24 (18%) of the students ate a school supplied breakfast often, 26 (20%) ate a school supplied breakfast sometimes, and 83 (62%) ate a school supplied breakfast rarely or never. Prior to the UF breakfast program, students who ate a school supplied breakfast often or sometimes had significantly higher math scores and significantly lower scores on child , parent , and teacher reported symptom questionnaires than children who ate a school supplied breakfast rarely or never. At the end of the school term 4 months after the implementation of the UF breakfast program, school supplied breakfast participation had nearly doubled and 429 (27%) of the 1612 children in the 3 schools were participating in the school breakfast program each day. In the interview sample, almost half of the children had increased their participation. Students who increased their participation in the school breakfast program had significantly greater increases in their math grades and significantly greater decreases in the rates of school absence and tardiness than children whose participation remained the same or decreased. Child and teacher ratings of psychosocial problems also decreased to a significantly greater degree for children with increased participation in the school breakfast program. Both cross sectional and longitudinal data from this study provide strong evidence that higher rates of participation in school breakfast programs are associated in the short term with improved student functioning on a broad range of psychosocial and academic measures. U.S. Department of Agriculture School Breakfast Program. E. Kennedy and C. Davis. American Journal of Clinical Nutrition, 67(4): 798S 803S. 1998. NAL Call Number: 389.8 J824 Description: This article reviews the history of the US Department of Agriculture School Breakfast Program (SBP) and provides a synthesis of factors influencing participation rates. Certain children are more likely to participate than others, such as those in lower grades and those from low income households, and African American, Hispanic, and male students. A few studies in the past 25 y have examined the effectiveness of the SBP in improving the diets and nutritional status of children. The overall pattern that emerges from these studies is that the SBP contributes to improved nutrient intake in program participants. Less attention has been devoted to assessing the effects of SBP on cognitive development. Some of the evidence reviewed here suggests that the SBP significantly improves school performance and reduces absenteeism and tardiness. Future directions for research and operation of the SBP are discussed in light of the changing dietary profile of American children. file:////CSCSRVLNH5DSS1/Shared_Data/Share/Content Co....05cb/Nutrition, Learning and Behavior in Children.htm (21 of 35)10/11/2005 3:21:27 PM Nutrition, Learning and Behavior in Children: IV. General Nutrition, Hunger, Learning and Behavior in Developing Nations A. Articles dated 2000-present An association between chronic undernutrition and educational test scores in Vietnamese children. A. Hall, et al. European Journal of Clinical Nutrition, 55(9): 801-4. 2001. NAL Call Number: QP141.A1J68 Abstract: Using cross-sectional data collected during the baseline survey of a randomized trial, this study examined the association between results of educational tests and the anthropometric status of schoolchildren. The data originated from eighty-one primary schools in three districts of northern Vietnam and involved a total of 3055 schoolchildren enrolled in class 3 and born in 1990. After controlling for age, sex, district and school the results of test scores in both mathematics and Vietnamese were significantly negatively correlated with Z-scores of height-for-age (P<0.001) and weight-for-age (P<0.001), but not with weight-for-height (P=0.75). A cross-sectional negative association was observed in Vietnamese primary school children between indicators of chronic undernutrition and tests of educational achievement. Comparative school performance through better health and nutrition in Nsukka, Enugu, Nigeria. R.O. Abidoye, D.I. Eze. Nutrition Research, 20(5): 609 620. 2000. NAL Call Number: QP141.A1N88 Abstract: School academic performance was compared among primary school pupils of different nutritional and health status in Nsukka, Enugu State of Nigeria after a simple random sampling selection of participant pupils and retrospective assessment of their health and nutritional history dating back to their gestation periods. Mothers and guardians of the pupils supplied information on their health and nutritional history through a well structured self administered questionnaire. Two hundred and eighty five (73.1%) of the pupils selected, participated in the final studies. There was predominance of malnutrition among the pupils. Only 28.9% of the pupils were of normal weight for height (using Z scores on Nutritional Center for Health Statistics Values). 47.1% were mildly underweight, 20.1% were moderately underweight while 4.0% were severely underweight. Overall nutritional status (using weight for age Z scores) significantly affects school performance (p<0.05). Only 26.0% of the pupils were of normal height for age, the rest were stunted. Complications for pregnancy was found to significantly affect later school performance (p<0.05). Birth complications also significantly affected later school performance (p<0.05). There was no significant association between duration of breast feeding and later school performance (p>0.05). Of the social factors that influence health and nutrition, level of maternal education was found to have a significant effect on school performance of pupils (p<0.05). Prenatal and postnatal conditions were found to affect school performance of children. Sustainable human development will therefore start with effective education of women which will produce a multiplier effect on succeeding generations. Investment in female education is an effective means of improving the quality of children, their school performance and their future performance and quality of life in adulthood. Early childhood nutrition and academic achievement: a longitudinal analysis. P. Glewwe, H.G. file:////CSCSRVLNH5DSS1/Shared_Data/Share/Content Co....05cb/Nutrition, Learning and Behavior in Children.htm (22 of 35)10/11/2005 3:21:27 PM Nutrition, Learning and Behavior in Children: Jacoby, E.M. King. Journal of Public Economics, 81(2001):345-368. 2001. NAL Call Number: HB9.J6 Abstract: This paper uses a longitudinal data set following a large sample of Filipino children from birth through the end of their primary education to examine the connection between nutrition and learning. Results indicated that better nourished children performed better in schools. The increased performance was attributed partly to the entrance of well-nourished children into school earlier, but, to a greater extent, because they had a greater learning productivity in school. A cost benefit analysis is provided. Malnutrition at age 3 years and lower cognitive ability at age 11 years: independence from psychosocial adversity. J. Liu et al. Archives of Pediatrics and Adolescent Medicine, 157(6): 593-600. 2003. NAL Call Number: RJ1.A63 Abstract: Early malnutrition is linked to poor cognition, but long-term effects have not been extensively examined and psychosocial confounds have not always been controlled. A prospective, longitudinal study of a birth cohort of 1559 children originally assessed at age 3 years for malnutrition (low hemoglobin level, angular stomatitis, kwashiorkor, and sparse, thin hair) were followed up to age 11 years. The sample consisted of a community of 1559 children (51.4% boys and 48.6% girls) born between September 1, 1969, and August 31, 1970, in 2 towns in the island of Mauritius, with 68.7% Indians and 25.7% Creoles (African origin). Verbal and spatial ability measured at ages 3 and 11 years and reading, scholastic ability, and neuropsychologic performance measured at age 11 years. Malnourished children had poorer cognition at both ages. Deficits were stable across time, applied to all sex and ethnic groups, and remained after controlling for multiple measures of psychosocial adversity. Children with 3 indicators of malnutrition had a 15.3-point deficit in IQ at age 11 years. Malnutrition at age 3 years is associated with poor cognition at age 11 years independent of psychosocial adversity. Promoting early childhood nutrition could enhance long-term cognitive development and school performance, especially in children with multiple nutritional deficits. B. Articles dated Pre2000 Breakfast and cognition: an integrative summary. E. Pollitt, R. Mathews. American Journal of Clinical Nutrition, 67(4): 804S 813S. 1998. NAL Call Number: 389.8 J824 Description: In this supplement, the papers presented at the International Symposium on Breakfast and Performance in Napa, CA in 1995 are summarized and integrated with data published since that time. The papers report on research conducted in the United States and abroad, conducted on adults and children. In particular, the focus is on issues of research design, measurements, mechanisms, potential effect modifiers (eg. age), and relevance for public policy. No definitive conclusions can be drawn from the existing data on either the long and short term benefits of breakfast on cognition and school learning or the mechanisms that mediate this relation. The pooled data suggest that omitting breakfast interferes with cognition and learning, an effect that is more pronounced in nutritionally at risk children than in well nourished children. At the very least, breakfast consumption improves school attendance and file:////CSCSRVLNH5DSS1/Shared_Data/Share/Content Co....05cb/Nutrition, Learning and Behavior in Children.htm (23 of 35)10/11/2005 3:21:27 PM Nutrition, Learning and Behavior in Children: enhances the quality of the students' diets. Fasting and cognition in well and undernourished schoolchildren: a review of three experimental studies. E. Pollitt, S. Cueto, E.R. Jacoby. American Journal of Clinical Nutrition, 67(4): 779S 784S. 1998. NAL Call Number: 389.8 J824 Description: This paper reviews three experiments on the effects of an overnight and morning fast on attention and memory processes among 9 11 year old children. Two of the experiments focused on middle class, well nourished boys and girls in the United States; the third involved boys from low income families with and without nutritional risk in Huaraz, Peru. All experiments used the same crossover design and followed similar experimental procedures to control the subjects' intakes and motor activity during the study period. The children were admitted to a research center on two different evenings, approximately 7 d apart. After arrival the children ate dinner, played table games or watched television, and went to bed. They were awakened at 0730 and, by design, were either served breakfast (approximately 2301 kJ) or not. At 1100 they took psychologic tests that assessed recall from working memory and competence in discriminating visual stimuli. At 1200 the children were discharged. The consequences of the overnight and morning fast, particularly among the children who were nutritionally at risk, included slower stimulus discrimination, increased errors, and slower memory recall. We propose that these alterations result from a state of metabolic stress in which homeostatic mechanisms work to maintain circulating glucose concentrations. Malnutrition, brain development, learning, and behavior. N.S. Scrimshaw. Nutrition Research, 18 (2): 351 379. 1998. NAL Call Number: QP141-A1N88 Description: Three widely prevalent nutritional deficiencies are recognized to have the potential for permanent adverse effects on learning and behavior: protein energy, iron, and iodine. Supplementation with adequate protein and calories during the first two years of life improves the cognitive performance of poorly nourished children, and the benefits may be even more robust years later when the children become adolescents and young adults. Iron deficiency is the most common global nutritional problem; among the earliest functions to be affected are those associated with the brain enzymes involved in cognition and behavior. The effects of iron deficiency during infancy appear to be irreversible. At older ages iron deficiency is intellectually and educationally disadvantageous independently of ethnicity and of physical and social environment. Even in areas where cases of cretinism due to iodine deficiency in the mother are few, the linear growth of the infant, its intellectual capacity, and certain other of its neurological functions are permanently compromised to varying degrees. In addition to these three most prevalent forms of deficiency, recent evidence suggests that cow's milk and infant formulas may lack sufficient omega 3 fatty acids for optimal development of the preterm infant and the neonate. Nutritional deficiencies are also potential contributors to impaired cognition in the elderly. Investments in education and community development would be more effective if the physical and cognitive capacity of underprivileged populations were not impaired by malnutrition. Nutrition, anaemia, geohelminth infection and school achievement in rural Jamaican primary school children. S.E. Hutchinson, et al. European Journal of Clinical Nutrition, 51(11): 729 735. 1997. file:////CSCSRVLNH5DSS1/Shared_Data/Share/Content Co....05cb/Nutrition, Learning and Behavior in Children.htm (24 of 35)10/11/2005 3:21:27 PM Nutrition, Learning and Behavior in Children: NAL Call Number: QP141.A1J68 Abstract: The objective was to determine whether nutritional status, anemia and geohelminth infections were related to school achievement and attendance in Jamaican children. Design: A cross sectional study using a randomly selected sample. Subjects: Eight hundred children aged 9 13 y randomly selected from those enrolled in grade 5 in 16 primary schools in rural Jamaica. Results: The mean height for age of the children was 0.37 z score +/ 1.0 s.d. with 4.9% having heights for age < 2 s.d. of the NCHS references. Anemia (Hb < 11 g/dl) was present in 14.7% of the children, 38.3% were infected with Trichuris trichiura and 19.4% with Ascaris lumbricoides. Achievement levels on the Wide Range Achievement Test were low, with children performing at grade 3 level. In multilevel analyses, controlling for socioeconomic status, children with Trichuris infections had lower achievement levels than uninfected children in spelling, reading and arithmetic (P < 0.05). Children with Ascaris infections had lower scores in spelling and reading (P < 0.05) Height for age (P < 0.01) was positively associated with performance in arithmetic. Ascaris infection (P < 0.001) and anemia (P < 0.01) predicted poorer school attendance, Conclusion: Despite mild levels, under nutrition and geohelminth infections were associated with achievement, suggesting that efforts to increase school achievement levels in developing countries should include strategies to improve the health and nutritional status of children. Nutrition, health, and child development: research advances and policy recommendations. Pan American Health Organization, Tropical Metabolism Research Unit of the University of the West Indies (Mona, Jamaica), and World Bank. Washington, D.C.: Pan American Health Organization, 1998 NAL Call Number: RJ131 .N88 ISBN: 9275115664 Abstract: Examines how and to what extent nutrition, health, and stimulation can affect children's cognitive and social developments and their ability to learn in school. Explores such topics as undernutrition, iron and iodine deficiencies, neonatal feeding, short term food deprivation, parasitic infections, and psychosocial deprivation. Nutrition in early life and the fulfillment of intellectual potential. E. Pollitt. Journal of Nutrition, 125 (4S): 1111S 1118S. 1995. NAL Call Number: 389.8 J82 Description: The effects of early supplementary feeding on cognition are investigated using data collected during two periods in four Guatemalan villages. The first was the institute of Nutrition of Central America and Panama (INCAP) longitudinal study from 1969 to 1977 and the second was a cross sectional follow up of former participants carried out in 1988 1989. The principal objective of these studies was to assess the differential effect of two dietary supplements, Atole containing 163 kcal/682 kJ and 11.5 g protein per cup or 180 mL and Fresco containing 59 kcal/247 kJ and 0 g protein per cup, that were given to mothers, infants and young children. Performance was assessed on a battery of psychoeducational and information processing tests that were administered during adolescence. Consistent differences between groups were observed on psychoeducational tests. Subjects receiving Atole scored significantly higher on tests of knowledge, numeracy, reading and vocabulary than those given Fresco. Atole ingestion also was associated with faster reaction time in information processing tasks. In addition, there were significant interactions between type of dietary supplement and socioeconomic status (SES) of subjects. In Atole villages, there were no differences in performance file:////CSCSRVLNH5DSS1/Shared_Data/Share/Content Co....05cb/Nutrition, Learning and Behavior in Children.htm (25 of 35)10/11/2005 3:21:27 PM Nutrition, Learning and Behavior in Children: between subjects in the lowest and highest SES categories. On the other hand, performance in Fresco villages was best in the highest compared with the lowest SES group. After close scrutiny of alternative hypotheses, it is concluded that dietary changes produced by supplementation provide the strongest explanation for the test performance differences observed in the follow up between subjects exposed to Atole and those exposed to Fresco supplementation. Results and implications of the INCAP follow up study. R. Martorell. Journal of Nutrition, 125(4S): 1127S 1138S. 1995. NAL Call Number: 389.8 J82 Description: This article is a critical synthesis of 12 papers included in this supplement. The set deals with the short and long term effects of improving nutrition in Guatemalan villages characterized by deficient diets, high rates of infection and pronounced growth retardation in the first 3 y of life. The data reviewed come from two studies carried out over two decades: the Institute of Nutrition of Central America and Panama (INCAP) longitudinal study (1966 1977) and its follow up (1988 1989). The longitudinal study included a nutrition intervention that improved the energy and nutrient intakes of women and preschool children. Its effects included improved birthweights, reduced infant mortality rates and improved growth rates in children <3 y of age. Growth rates from 3 to 7 y of age, similar to those of well nourished children, were not affected by the intervention. The follow up study was conducted when the subjects were 11 27 y old. Among the long term effects found were greater stature and fat free mass, particularly in females, improved work capacity in males and enhanced intellectual performance in both genders. The nutrition intervention did not, on the other hand, accelerate maturation during adolescence, as measured by skeletal age or age at menarche. It is concluded that improved nutrition in early childhood has important long term effects in the adolescent and adult. Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. M.A. Mendez and L.S. Adair. Journal of Nutrition, 129(8): 1555 1562. 1999. NAL Call Number: 389.8 J82 Abstract: Undernutrition in infancy and early childhood is thought to adversely affect cognitive development, although evidence of lasting effects is not well established. With the use of data from the Cebu Longitudinal Health and Nutrition Study, the relationship between stunting in the first 2 y of life and later cognitive development, focusing on the significance of severity, timing and persistence of early stunting was assessed. The sample included > 2000 Filipino children administered a cognitive ability test at ages 8 and 11 y. Stunting status was determined on the basis of anthropometric data collected prospectively between birth and age 2 y. Children stunted between birth and age 2 y had significantly lower test scores than non-stunted children, especially when stunting was severe. The shortfall in test scores among children stunted in the first 2 y was strongly related to reduced schooling, which was the result of a substantial delay in initial enrollment as well as higher absenteeism and repetition of school years among stunted children. Interactions between stunting and schooling were not significant, indicating that stunted and non-stunted children benefit similarly from additional schooling. After multivariate adjustment, severe stunting at age 2 y remained significantly associated with later deficits in cognitive ability. The timing of stunting was also related to test performance, largely because children stunted very early also tended to be severely stunted (chi(2) P = 0.000). Deficits in children's scores were smaller at age 11 y than at age 8 y, suggesting that adverse effects may decline over time. Results file:////CSCSRVLNH5DSS1/Shared_Data/Share/Content Co....05cb/Nutrition, Learning and Behavior in Children.htm (26 of 35)10/11/2005 3:21:27 PM Nutrition, Learning and Behavior in Children: emphasize the need to prevent early stunting and to provide adequate schooling to disadvantaged children. Timing and vulnerability in research on malnutrition and cognition. E. Pollitt. Nutrition Reviews, 54 (2,pt.2): S49 S55. 1996. NAL Call Number: 389.8 N953 Description: This paper focuses on the effects of intrauterine growth retardation type I (IUGR-1) and early supplementary feeding on cognition in late childhood and adolescence. The intent is to test whether the timing of these nutritional events partially determines the nature and scope of the adverse effects. This report also examines whether the timing of the measurement of a functional outcome (e.g., attention) determines the magnitude of the cognitive delay observed. Timing, therefore, is considered for both the predictor and the outcome. The data used are from two longitudinal studies, one in rural Guatemala and the other in Cali, Colombia. While the Guatemala study provided information on the effects of IUGR and supplementary feeding, the data from the Cali study are relevant solely to the issue of nutritional intervention. C. Micronutrients, Learning and Behavior in Developing Nations Articles dated 2000 -present A developmental view of the effects of an energy and micronutrient supplement in undernourished children in Indonesia. Pollitt, E., Jahari, A., and Walka, H. European Journal of Clinical Nutrition, 54 (S2): S107 S113. 2000. NAL Call Number: QP141.A1J68 Abstract: This paper presents the results of a structural equation model testing whether the longitudinal data of the Pangalengan subjects fit the theoretical model regarding the intellectual delay of undernourished children. Two cohorts of children were randomly assigned to three treatments: E = 1171 kJ + 12 mg iron; M = 12 mg iron + 209 kJ; S = 104 kJ. Supplementation was given for 6 months in six tea plantations in Indonesia. Subjects included a cohort of 2 month olds (n = 53) and an 18 month olds (n = 83) recruited from day care centers. Inclusion criteria were: no chronic disease; length for age = < 1 standard deviation (s.d.) and weight for length between 1 and 2 s.d. of the median of the reference of the World Health Organization. Twenty four hour dietary intakes were assessed using the weighted individual inventory technique. Body weight and length were obtained using standard procedures; motor development was assessed with the Bayley Scale and with a custom made scale for motor development leading to bipedal locomotion. Four hour observations were made of the child's interactions with the environment. Carrying a child in the arms and exploratory behavior were used as indicators of caregiving and exploration. All measurements were obtained every 2 months. Results indicated that the original model did not fit the data. The model was then modified with the inclusion of two new pathways: from activity and from motor development to mental development. Following these adjustments the model fit the data for each cohort and for both cohorts combined. Effects of an energy and micronutrient supplement on mental development and behavior under file:////CSCSRVLNH5DSS1/Shared_Data/Share/Content Co....05cb/Nutrition, Learning and Behavior in Children.htm (27 of 35)10/11/2005 3:21:27 PM Nutrition, Learning and Behavior in Children: natural conditions in undernourished children in Indonesia. E. Pollitt, et al. European Journal of Clinical Nutrition, 54(S2): S80 S90. 2000. NAL Call Number: QP141.A1J68 Abstract: This paper reports the effects of an energy and micronutrient supplement on mental development and on the social cognitive and emotionally regulatory behaviors of nutritionally at risk infants and toddlers in Pangalengan, Indonesia. Two cohorts of children were randomly assigned to three treatments: E = 1171 kJ + 12 mg iron; M = 12 mg iron + 209 kJ; S = 104 kJoule. Supplementation was given for 12 months at six tea plantations in Pangalengan, West Java. A 12 month old (N = 53) and an 18 month old (N = 83) cohort were recruited from day care centers. Twenty children who received S belonged to the 12 and 18 month old cohort. Inclusion criteria were: no chronic disease; length for age ltoreq 1 standard deviation (s.d.) and weight for length between 1 and 2 s.d. of the median of the reference of the World Health Organization. Evaluations of intake were made at baseline and every 2 months thereafter. Motor development was assessed with the Bayley Scale and with a custom made scale to assess gross motor development leading to bipedal locomotion. Four hours of continuous observations were made of the child's interaction with the social and physical environment. In the 12 month old cohort, as compared with the M and S groups, the children who received the E supplement walked at an earlier age, had higher scores in the Bayley Scale and showed more mature social cognitive and emotional regulatory behaviors. Similar intergroup differences were observed in the 18 month old cohort in social cognition and regulation of emotions. Effects of haemoglobin and serum ferritin on cognitive function in school children. R. Sungthong, L. Mo-suwan, and V. Chongsuvivatwong. Asia Pacific Journal of Clinical Nutrition, 11(2): 117-122. 2002. NAL Call Number: QP141.A1 A74 Abstract: The association between iron deficiency anemia and cognitive function impairment has been widely reported in young children, but whether the impairment is a result of iron deficiency per se or a combination of iron deficiency and anemia, and how these conditions interact, is still questionable. Four hundred and twenty-seven school children from two schools in socioeconomically deprived communities were selected in southern Thailand. Iron status was determined by hemoglobin and serum ferritin concentrations. Cognitive function in this study was measured by IQ test and school performance, including Thai language and mathematics scores, using z-scores based on distributions within the same grade and school. Data on demography and socioeconomic status were collected by questionnaire answered by the parents. Linear regression models were used to investigate the effect of anemia and iron deficiency, reflected by hemoglobin and serum ferritin concentration, on cognitive function and school performance. We found that cognitive function increased with increased hemoglobin concentration in children with iron deficiency, but did not change with hemoglobin concentration in children with normal serum ferritin level. Children with iron deficiency anemia had consistently the poorest cognitive function (IQ, 74.6 points; Thai language score, 0.3 SD below average; and mathematics score, 0.5 SD below average). Children with non-anemic iron deficiency but with high hemoglobin levels had significantly high cognitive function (IQ, 86.5 points; Thai language score, 0.8 SD above average; and mathematics score, 1.1 SD above average). This study found a dose-response relationship between hemoglobin and cognitive function in children with iron deficiency, whereas no similar evidence was found in iron sufficient children. file:////CSCSRVLNH5DSS1/Shared_Data/Share/Content Co....05cb/Nutrition, Learning and Behavior in Children.htm (28 of 35)10/11/2005 3:21:27 PM Nutrition, Learning and Behavior in Children: D. Articles Dated Prior to 2000 A preliminary report: effects of zinc and micronutrient repletion on growth and neuropsychological function of urban Chinese children. J.G. Penland, et al. Journal of the American College of Nutrition, 16(3): 268 272. 1997. NAL Call Number: RC620.A1J6 Abstract: Zinc is essential for growth and cognition of experimental animals. Past research found zinc repletion improved growth of stunted Chinese children. Therefore we measured effects of zinc repletion on growth and neuropsychological functions of children. It was a double blind randomized controlled treatment trial. The setting was elementary schools in low income districts of Chongqing, Qingdao and Shanghai. Three hundred seventy two 6 to 9 year old first graders were given one of the following interventions treatments: 20 mg zinc, 20 mg zinc with micronutrients, or micronutrients alone. The micronutrient mixture was based on guidelines of the US NAS/NRC. Treatments were assigned to classrooms of 40 or more children each, and administered by teachers 6 days per week for 10 weeks. Outcome was measured by changes in knee height and neuropsychological functions. Results indicated that zinc alone had the least effect on growth while zinc with micronutrients had the largest effect; micronutrients alone had an intermediate effect. Zinc containing treatments improved neuropsychological functions, but micronutrients alone had little effect. The findings confirm the essentiality of zinc for growth of children, and show, for the first time, the essentiality of zinc for neuropsychological functions of children. In addition, the need for repletion of other potentially limiting nutrients in studies examining the effects of specific nutrients on growth and neuropsychological functions was confirmed. Effects of repletion with zinc and other micronutrients on neuropsychologic performance and growth of Chinese children. H.H. Sandstead, et al. American Journal of Clinical Nutrition, 68(2S): 470S 475S. 1998. NAL Call Number: 389.8 J824 Description: The knowledge that zinc is essential for growth and neuropsychologic performance and a report of zinc responsive stunting in Chinese children prompted this project. This article summarizes findings from a 10 wk, double blind, controlled trial of zinc repletion in 740 urban, 6 9 y old first graders from low income families in Chongqing, Qingdao, and Shanghai, People's Republic of China. Treatments were 20 mg Zn alone (Z), 20 mg Zn with micronutrients (ZM), and micronutrients alone (M). The M mixture was based on National Research Council guidelines. Nutrients that might interfere with zinc retention were excluded or given in lower amounts. Main outcomes were changes in neuropsychologic performance and knee height. Hemoglobin, serum ferritin, plasma and hair zinc, and whole blood and hair lead were also measured. Anemia was not common, and serum ferritin concentrations were usually within the range of normal. Mean baseline plasma zinc concentrations were marginal in children from Chongqing and Qingdao and normal in children from Shanghai. After treatment with ZM or M plasma zinc increased. Hair zinc tended to decrease after all treatments. Mean baseline whole blood lead concentrations were slightly below the limit considered excessive for children by the US Centers for Disease Control and Prevention. Neuropsychologic performance and growth were file:////CSCSRVLNH5DSS1/Shared_Data/Share/Content Co....05cb/Nutrition, Learning and Behavior in Children.htm (29 of 35)10/11/2005 3:21:27 PM Nutrition, Learning and Behavior in Children: most improved after treatment with ZM. These findings were consistent with the presence of zinc and other micronutrient deficiencies. V. School Meals Programs in Developing Nations Cognitive and behavioural effects of a school breakfast. L.M. Richter, C. Rose, and R.D. Griesel. South African Medical Journal, 87(1S): 93 100. 1997. Abstract: The cognitive and behavioral effects of a school breakfast were explored in a study of 55 children in Grade II and Standard 1 at a farm school outside Johannesburg, South Africa. A previous study had confirmed widespread undernutrition and micronutrient deficiencies among the children. For comparative purposes, 55 children at an inner city school, among whom no signs of undernutrition were found, were assessed in the same way. Three different types of measures of attention, distractibility, short term memory and activity level were used: psychometric testing of the children; teacher ratings of children's classroom behavior, and coded video recorded classroom behavior. A pre and post test design was employed to assess the effects of a school breakfast, continually in place in the experimental school for a period of 6 weeks. The results indicated significant change from pre to post test assessment among the experimental children in respect of the psychometric measures, teacher rated hyperactivity and video recorded classroom behavior. With regard to the latter measure, the children showed a decline in both the occurrence and duration of off task and out of seat behavior, and an increase in active participation in class and positive peer interaction. While the children in the comparison group also showed some changes from pre to post test, probably attributable to the effects of observation, familiarity with the test materials and developmental change, the changes were not generalized or consistent. The findings support the conclusion that a school breakfast programs had a beneficial effect on the cognitive and behavioral performance of socially disadvantaged, undernourished children in their first 2 years of school. Does school breakfast benefit children's educational performance? L. Fernald, C.C. and Ani, S. Grantham McGregor. Africa Health, 19(6): 19 20. 1997. Description: Primary school enrollment in Africa has doubled to reach 59% and secondary school enrolment has tripled to reach 38% in the last 3 decades, however failure rate in some countries is high. The poor school attainment levels are related to a poor nutritional status. The possible mechanisms whereby school performance could be affected by giving breakfast are discussed in this paper. One possible mechanism would be to provide breakfast at school, a probable result of which could be to increase the nutritional status of the child, increase school attendance and enrollment, decrease hunger and therefore produce metabolic changes which would improve the child's cognitive ability, resulting in an overall increase in school performance. Laboratory studies have shown that missing breakfast can detrimentally affect the cognitive function. Short and long term studies on providing breakfast at schools in Jamaica and Sweden have shown beneficial effects in learning and attendance. It is concluded that missing breakfast detrimentally affects the cognition of children, especially if they are undernourished. It is suggested that educational facility improvement programs need to be integrated with those aimed at improving children's health and nutrition. file:////CSCSRVLNH5DSS1/Shared_Data/Share/Content Co....05cb/Nutrition, Learning and Behavior in Children.htm (30 of 35)10/11/2005 3:21:27 PM Nutrition, Learning and Behavior in Children: Evaluation of school feeding programs: some Jamaican examples. S.M. Grantham McGregor, S. Chang, and S.P. Walker. American Journal of Clinical Nutrition, 67(4): 785S 789S. 1998. NAL Call Number: 389.8 J824 Description: It is hypothesized that giving children a daily breakfast at school may improve their scholastic achievement through several mechanisms: increasing the time spent in school, improving certain cognitive functions and attention to tasks, and, perhaps indirectly, improving nutritional status. Two Jamaican studies showed that providing breakfast to students at school improved some cognitive functions, particularly in undernourished children. However, changes in classroom behavior varied depending on the quality of the school. Children in better organized schools concentrated on tasks for longer periods and made fewer undesirable movements, whereas in poorly organized schools the children's behavior deteriorated. Studies to date have provided insufficient evidence to determine whether children's long term scholastic achievement is improved by eating breakfast daily. Well designed, randomized, controlled, long term trials are essential for determining public policy on the implementation of school feeding programs. Health and nutrition considerations in education planning. The cost and effectiveness of schoolbased interventions. J. Leslie, D.T. Jamison. Food and Nutrition Bulletin. 12(3): 204-214. 1990. NAL Call Number: TX341.F622 Description: This paper discusses intervention packages and their costs, and then briefly overviews, from an economic perspective, the strength of the claim of health and nutrition interventions for schoolage children on scarce resources. The authors conclude that, given what is known about the probable effect of health and nutrition interventions for learning and attendance, and given the relatively modest cost of a carefully signed, carefully targeted program, the implication for educational planners is clear: more investment in child health and nutrition will pay off well for education. Cost-benefit analyses suggest that appropriate health and nutrition interventions in the schools are likely to prove to be very high-yield investments. Nutrition and education: a randomized trial of the effects of breakfast in rural primary school children. C.A. Powell, et al. American Journal of Clinical Nutrition, 68(4): 873 9. 1998. NAL Call Number: 389.8 J824 Abstract: Hunger during school may prevent children in developing countries from benefiting from education. Although many countries have implemented school feeding programs, few programs have been rigorously evaluated. We conducted a randomized, controlled trial of giving breakfast to undernourished and adequately nourished children. The undernourished group comprised 407 children in grades 2 5 in 16 rural Jamaican schools (weights for age < or = 1 SD of the National Center for Health Statistics references) and the adequately nourished group comprised 407 children matched for school and class (weights for age > 1 SD). Both groups were stratified by class and school, then randomly assigned to breakfast or control groups. After the initial measurements, breakfast was provided every school day for 1 school year. Children in the control group were given one quarter of an orange and the same amount of attention as children in the breakfast group. All children had their heights and weights measured and were given the Wide Range Achievement Test before and after the intervention. School attendance was taken from the schools' registers. Compared with the control group, height, weight, and attendance improved significantly in the breakfast group. Both groups made poor progress in Wide file:////CSCSRVLNH5DSS1/Shared_Data/Share/Content Co....05cb/Nutrition, Learning and Behavior in Children.htm (31 of 35)10/11/2005 3:21:27 PM Nutrition, Learning and Behavior in Children: Range Achievement Test scores. Younger children in the breakfast group improved in arithmetic. There was no effect of nutritional group on the response to breakfast. In conclusion, the provision of a school breakfast produced small benefits in children's nutritional status, school attendance, and achievement. Greater improvements may occur in more undernourished populations; however, the massive problem of poor achievement levels requires integrated programs including health and educational inputs as well as school meals. School breakfast and cognition among nutritionally at risk children in the Peruvian Andes. E. Pollitt, E. Jacoby, S. Cueto. Nutrition Reviews, 54(4pt.2): S22 S26. 1996. NAL Call Number: 389.8 N953 Description: This paper describes and presents the main findings and conclusions of two studies conducted in Huaraz which were launched to assess the educational and nutritional impact of the School Breakfast Program. The first study tested the effects of breakfast on cognition among 54 elementary schoolchildren (ages 9-11) who were either well nourished or nutritionally at risk. The second study was a field evaluation of the feeding program in 10 rural schools on the periphery of Huaraz. Conclusions were drawn that the brain is sensitive to drops in the short term availability of nutrients, and that an overnight and morning fast produces a physiological state accompanied by changes in brain function, particularly working memory. This is particularly true among nutritionally at-risk children. School feeding in Jamaica: a review of its evaluation. D.T. Simeon. American Journal of Clinical Nutrition, 67(4): 790S 794S. 1998. NAL Call Number: 389.8 J824 Description: This paper reviews two studies that evaluated the school feeding program in Jamaica. The first examined 115 children aged 12 13 y who were enrolled in three classes in a poor, rural school. One class was served the standard school meal at 0900 whereas the other two classes served as controls. The outcome variables included school achievement, attendance, and weight gain. After one semester, the class receiving the meal showed improved arithmetic scores and school attendance compared with the control classes; however, they showed no weight gain. The academic improvement remained significant after school attendance was controlled for. It was therefore hypothesized that the gains in arithmetic resulted from the alleviation of hunger in the classroom. The other study, conducted in a metabolic ward, examined the effects of missing breakfast on cognitive function in 90 children aged 9 10 y and of differing nutritional status. Using a crossover design, the investigators tested each child on two mornings 1 wk apart, once after serving them breakfast and second without. Breakfast, consisting of the school program meal, was served at 0800. When severely malnourished, stunted, or wasted children received no breakfast, their performance in various cognitive tests deteriorated. These results indicate that alleviation of hunger was one of the mechanisms by which school feeding improved academic achievement in the previous study. Undernourished children are more likely to benefit from school feeding programs than are adequately nourished children. When science and politics listen to each other: good prospects from a new school breakfast program in Peru. E.R. Jacoby, S. Cueto, E. Pollitt. American Journal of Clinical Nutrition, 67(4): 795S 797S. 1998. NAL Call Number: 389.8 J824 file:////CSCSRVLNH5DSS1/Shared_Data/Share/Content Co....05cb/Nutrition, Learning and Behavior in Children.htm (32 of 35)10/11/2005 3:21:27 PM Nutrition, Learning and Behavior in Children: Description: This article provides an overview of a school breakfast program implemented in 1993 in the Peruvian Andes. The program, designed by the Instituto de Investigacion Nutricional in Lima and supported by the government of Peru, constitutes a clear departure from previous school feeding programs, which were heavily politicized and poorly documented. From the program's inception, nutritionists, managers, and social scientists have collaborated to produce a sound nutritional design, efficient distribution mechanisms, and effective evaluation methods. During the program's first year, controlled evaluations conducted in several Andean regions documented improved dietary intake and a significant decline in the prevalence of anemia. An educational evaluation also found improved verbal skills, higher school attendance, and lower dropout rates among recipients of the school breakfast. The results have prompted the Peruvian government to continue supporting the program, thus setting a new standard for the effective management of social expenditure in the context of economic adjustment.