Back in August I wrote about how diet can impact the brain and behaviour in children.  Nutrition for the brain is something I am very interested in and those of you who follow this blog will see that there is a lot of scientific evidence to show that what we eat can make a difference to mood and feelings as well as brain structure and function.

A very recent review study (1) has concluded that multi-nutrient supplementation may be associated with a small but significant increase in a measure of intelligence and academic performance in healthy schoolchildren.  The authors of the study do state however that “more research is required, however, before public health recommendations can be given” (1).

The researchers undertook the study because “Although multiple micronutrient interventions have been shown to benefit children's intellectual development, a thorough evaluation of the totality of evidence is currently lacking to direct public health policy” (1).  The aim of the research was to review the present literature on the effects of multiple-nutrient supplements on cognitive (mental/intellectual) performance in school aged children (children aged up to 18).  The researchers looked at data from trials published between 1970 and 2008 – quite a huge body of work!  As stated above, they found that multi-nutrient supplements seemed to have a small but significant positive effect on academic performance. 

The important aspect of these kinds of research studies, in my opinion, is that they show that nutrition does impact the brain, thinking, mood and therefore perhaps academic performance.  Limitations of such studies include the quality of the supplement, the quantity and also the actual diet of the child.  If you read the post from August you will see that overall diet quality is very important to the brain.  A good supply of daily vegetables, fruits, unrefined and unprocessed foods and healthy omega 3 fats as well as a protein supply with each meal is a great way to look after body and mind.  Regular exercise is also crucial for mood. 

In terms of supplements, they can never replace a healthy diet.  If you are considering supplements I would suggest a good quality multivitamin-mineral supplement, I like food-state supplements as they are made from ‘food’ and not chemicals and are easily absorbed into the body.  In addition to this I think that a daily omega 3 fatty acid supplement is definitely worth considering – these fats really are essential for the brain.  The most effective of the omega 3 fatty acids for brain function seem to be the long chain omega 3 fats EPA and DHA which are found in oily fish such as salmon, trout, mackerel and sardines.  These can be purchased as an oil or in capsule form.  Many of the oils are made easy for children to take as they are flavoured and have no fishy taste or smell.  For vegetarians and vegans flaxseed oil can be taken – this is a shorter chain omega 3 fat and not as effective, since the body has to work hard to convert it into the longer chain structure – however, it is certainly worth taking.  This kind of fat can be found in good amounts in walnuts and flaxseeds.  Vegan EPA and DHA is now being produced from algae, it is expensive but available to buy from some retailers and online.

(1)Eilander A et al.  2010.  Multiple micronutrient supplementation for improving cognitive performance in children: systematic review of randomized controlled trials.  American Journal of Clinical Nutrition.  91: 115-130
Written by Ani Kowal

Following a healthy eating regimen during pregnancy is highly important for the health of both mother and unborn child.  A recent study (1) has emphasised that it is important for pregnant women to include plenty of vegetables as part of their diet.  The study found that daily vegetable consumption by pregnant women was associated with a reduced risk of type I diabetes (insulin dependent diabetes) in their children.

The study (1) assessed and followed 5724 infants and looked at the diet their mothers consumed during pregnancy.  The children were given assessments at age 1, 2.5 and 5 years of age for diagnosis of type 1 diabetes (insulin dependent diabetes).  Low daily consumption of vegetables by the pregnant mother (vegetables were eaten 3-5times per week) was associated to an increased risk of type 1 diabetes in the child when compared to a higher vegetable consumption during pregnancy.

In essence the study found that pregnant women who eat vegetables (at least once) every day seem to have children who are less likely to develop type 1 diabetes.  This is only an association study and does not prove that vegetables protect against diabetes but it is informative and further supports the importance of eating well during pregnancy.  In a press release (2) one of the study researchers commented "This is the first study to show a link between vegetable intake during pregnancy and the risk of the child subsequently developing type 1 diabetes, but more studies of various kinds will be needed before we can say anything definitive,"  "We cannot say with certainty on the basis of this study that it's the vegetables themselves that have this protective effect, but other factors related to vegetable intake, such as the mother's standard of education, do not seem to explain the link," "Nor can this protection be explained by other measured dietary factors or other known risk factors."  It therefore seems plausible that the myriad of nutrients and flavonoids in vegetables are having some kind of action within the growing foetus.

My interest in nutrition prior to, and during, pregnancy started when I was studying for my first degree.  We learned about the work of David Barker who was a researcher at Southampton University.  His hypothesis, which was known as ‘Barker’s hypothesis’ at the time, suggests that maternal diet affects foetal growth and is associated with chronic conditions in the child later in life.  It is suggested that what a pregnant mother consumes during pregnancy might affect the risk of her child developing conditions such as heart disease, stroke and diabetes (3).  This idea is now more widely known as the ‘Developmental Origins of Adult Health and Disease’ hypothesis.  Both over- and under- nutrition and eating during pregnancy can affect the growth and later health, and perhaps weight, of the child (4).  It is important to remember that what you eat during pregnancy not only affects you, the mother, it may also affect the health of the next generation and may directly contribute to cycles of obesity as well as other conditions (4)

As I have mentioned in previous posts relating to pregnancy, if you are pregnant you may wish to consider taking a multi-nutrient supplement specifically designed for pregnant women together with a fish oil (or flaxseed oil) supplement to provide omega 3 fatty acids.  Taking these sorts of supplements may help to make-up for any shortfalls in the diet but cannot be viewed as an alternative to a healthy diet.  Always check with your doctor of health professional before taking any supplements during pregnancy.

(1)Brekke et al.  2009.  Daily vegetable intake during pregnancy negatively associated to islet autoimmunity in the offspring-The ABIS study. Pediatric Diabetes, 2009; DOI: 10.1111/j.1399-5448.2009.00563.x Published Online: 16 Sep 2009
(2) University of Gothenburg (2009, October 27). Vegetables Can Protect Unborn Child Against Diabetes. ScienceDaily. Retrieved October 28, 2009, from http://www.sciencedaily.com/releases/2009/10/091027132422.htm
(3) Barker, D.J.P. (1997). "Maternal Nutrition, Fetal Nutrition, and Disease in Later Life". Nutrition, '13', pg. 807
(4)McMillen C et al.  2009.  Developmental Origins of Adult Health and Disease: The Role of Periconceptional and Foetal Nutrition.  Basic & Clinical Pharmacology & Toxicology.
102 (2): 82 – 89
Written by Ani Kowal

Children everywhere are starting to get ready to go back to school after their long summer holidays.  Nutrition and diet can impact the body and health in many ways, the most apparent concerns for parents of school aged children are immune health and brain function/behaviour.

In July I wrote about probiotics and prevention/treatment of childhood colds and last year I wrote about boosting immune health in children going back to school.  Today I wanted to have another look at behaviour and the brain.  Previously I have written about ADHD, particularly with regards the importance of omega 3 fatty acids for brain function.  The brain is a highly complex organ.  In infancy and childhood the brain is growing rapidly and it requires a lot of energy.  There is a mounting body of evidence to suggest that diet can influence the development and functioning of the brain (1).  This influence may well start with the diet of the mother during pregnancy and then in the infant in early life, however later in childhood nutritional intervention may well make a difference to brain function and cannot be discounted.

There is increasing evidence that the missing of breakfast has negative behavioural and attention consequences later in the morning and it is also thought that meals of a low rather than high glycaemic load are beneficial with regards child behaviour.  There are also findings of an association between a tendency to develop low blood sugar (glucose) and aggression in children(2). 

Glycaemic index and glycaemic load are terms used to characterise foods and diets based on their effects on blood glucose levels.  Foods that release sugar quickly into the bloodstream have what is known as a high Glycaemic Index (GI), meals that favour a spike in blood sugar levels are said to have a high Glycaemic Load (GL).  White bread, potatoes, processed/refined carbohydrates have a high glycaemic index i.e. they tend to cause a rapid surge in blood sugar.  Vegetables, whole-grain high-fibre carbohydrates, create a more gradual change in blood sugar levels and are considered to have a low glycaemic index.  For the classification of more food examples please visit the website 'The Glycemic Index', there you will find a database where you can search for specific foods and find out more about GI and health.

Certain nutrients have greater effects on brain development than do others and hence may have more of an impact on childhood behaviour and brain function. The important nutrients include protein (which is so important for proper growth in childhood), certain fats (especially omega 3 fats), iron, zinc, copper, iodine, selenium, vitamin A, choline, and folate (3).  There is evidence that sub-clinical deficiencies of vitamins and minerals may influence anti-social behaviour and intelligence but the evidence is still controversial(4).The B vitamins, Folate and B12 (cobalamin), are vital for the brain.  Deficiencies have negative consequences on the developing brain, and behaviour, during infancy; and deficits of both vitamins are associated with a greater risk of depression during adulthood (5).  Recently vitamin D has also received attention with regards brain functioning.  As you can see a myriad of nutrients are important for the brain and they probably work and act synergistically, this makes clinical trials difficult to carry out.  However, there have been three well-designed studies which have reported that vitamin/mineral supplementation in children can reduce anti-social behaviour (2).

It is difficult to conclusively say which vitamins/minerals are most important and whether or not supplementation can help children – this is because behaviour is difficult to standardise and measure in a trial-setting.  Also psychological and environmental influences will be having an effect.  Needless to say our bodies are complex, we require various nutrients in correct proportions in order to stay optimally healthy.  Many children in the UK fall short of achieving recommended 5 portions of fruit and vegetable daily which is worrying for health and many children do not eat oily fish (the best source of omega 3 fatty acids) at all.  If you are concerned that your child is not eating a consistently healthy diet you may wish to consider a food-state multivitamin and mineral supplement that has been formulated specifically for children together with an omega 3 fatty acid supplement – easy to take liquid fish oils are now available for children which are naturally flavoured (usually lemon or orange).  Flaxseed oil and omega 3 supplements produced from algae are available for vegetarian/vegan children.

A UK based study concludes: “Whilst the importance of diet in educational attainment remains under investigation, the evidence for promotion of lower-fat, -salt and -sugar diets, high in fruits, vegetables and complex carbohydrates, as well as promotion of physical activity remains unequivocal in terms of health outcomes for all schoolchildren”(6)

(1)Benton D.  2008.  Eur J Nutr.  The influence of children's diet on their cognition and behavior. Eur J Nutr.  47 Suppl 3:25-37.
(2) Benton D.  2007.  The impact of diet on anti-social, violent and criminal behaviour. Neurosci Biobehav Rev. 31(5):752-74.
(3)Georgieff MK.  2007.  Nutrition and the developing brain: nutrient priorities and measurement.  Am J Clin Nutr.  85(2):614S-620S.
(4)Benton D.  2008.  Micronutrient status, cognition and behavioral problems in childhood.  Eur J Nutr. 47 Suppl 3:38-50.
(5)Black MM.  2008.  Effects of vitamin B12 and folate deficiency on brain development in children.  Food Nutr Bull.  29(2 Suppl):S126-31.
(6)Ells LJ et al.  2008.  A systematic review of the effect of dietary exposure that could be achieved through normal dietary intake on learning and performance of school-aged children of relevance to UK schools. Br J Nutr.  100(5):927-36.

Written by Ani Kowal

Many schools are on their half-term break this week and children will, no doubt, be enjoying their extra sleep and relaxation time.  If the weather is good there will be ample opportunity for outdoor pursuits but I wonder how many children will be running around outside and how many will opt for the TV or video games?  The childhood obesity problem in the UK is serious and ever increasing.  Today I would like to share some recent evidence which shows that schools can play a major role in the prevention of overweight and obesity in children.

The first paper I would like to discuss comes from a group of researchers at Ulm University in Germany (1).  They have put together a school-based programme for the prevention of cardiovascular (heart) risk factors and obesity in primary school children.  The programme “Ulm Research on Metabolism, Exercise and Lifestyle in children (URMEL-ICE)” is a one-year course which fully involves the whole school including the teachers.  The daily educational course aims to:
-Encourage a reduction of TV viewing time 
-Encourage a reduction of energy rich, sugar-added, drinks
-Provide nutritional education
-Encourage physical activity during the school day

The programme has provided consistently beneficial results, with children showing an average reduction of fat mass of 260g after a year.  The findings were presented at the ESC (European Society of Cardiology) Congress 2008 which took place in Munich.

The group responsible for developing the intervention programme wrote a press release (1) to accompany the presentation given at the congress.  In it they detailed how overweight and obesity are increasingly prevalent among our children, representing a very serious public health concern.  To date treatment programmes have not been very effective.  The key lies in PREVENTION which really must take priority.  Obesity is not just a matter of aesthetics, it represents serious risks for health complications such as diabetes, heart disease and cancers as well as psychological problems.  One key to preventing obesity across all ages is physical activity.  In children an increase in physical activity has been linked with improvements in bone health, reduced risk of heart disease, reduced fat mass, increased self esteem and mental health.  However, around 30% of boys and 40% of girls in the UK do not meet the current physical activity guideline of 60minutes of moderate activity daily (2).

School based interventions could be really useful in helping to stop and hopefully reverse the trend in obesity and inactivity among children in the UK.

The German researchers (1) go on to say that school-based intervention programmes have been shown to provide the most success in large-scale reduction in the prevalence of childhood overweight and obesity, especially if they are performed with involvement of stakeholders and political support.  The reasons that a school-based course seems to be particularly effective include the following:
-A large number of children can be monitored and hence influenced in a school based setting.
- Children are at school for a large proportion of the week and much of their eating and exercise therefore takes place in school time.
-Regular time spent on health education can influence children’s behaviour towards the desired aim of healthy living.
-Intervention in school a school setting means that children have their friends around them and this can be encouraging and supportive and may enhance motivation.
-Teachers can function as a role models and guide children’s behaviour.
-Children themselves may take their new healthy knowledge into the ‘outside world’ to motivate their family and friends in healthy lifestyle changes, further strengthening the support and motivation.

The teaching of healthy eating and nutritional principles and encouraging fun physical activity is so important in early life as it tends to set up life-long healthy patterns of behaviour.  Slowly schools in the UK are introducing really great measures to promote healthy eating and healthy living and I hope this continues and develops over the coming years.  Until now much of the work on primary school-based intervention studies has been conducted abroad in the USA and other parts of Europe, these studies are useful but cultural differences mean that they are not as applicable here in the UK.  However, a UK study (3) published last month, in January 2009, has found that primary schools represent a suitable setting for the promotion of healthy lifestyles to children aged 7-11.

The UK study (3) was set up in order to evaluate the effect of a school-based healthy lifestyles intervention on physical activity, fruit and vegetable consumption, body composition, health knowledge, and psychological variables.  The study lasted for 10 months and involved 8 primary schools including 589 7-11 year old children, 4 were given a programme to follow and 4 acted as a control (no lifestyle programme was conducted).  The 4 schools following the programme were given CD-rom learning and teaching resource for teachers; an interactive website for pupils, teachers and parents; two highlight physical activity events (1 mile school runs/walks); a local media campaign; and a summer activity wall planner and record.  Children in the schools following the intervention programme significantly increased their daily total time in moderate-to-vigorous physical activity compared to the children in the control schools.  Older school children participating in the programmed showed a significant slowing in the rate of increase in estimated percent body fat, body mass index (BMI) and waist circumference.  The authors conclude that the intervention produced positive changes in physical activity levels and body composition and that schools represent suitable settings for the promotion of healthy lifestyles.  However the authors of the study also highlight the need for more work, particularly focussed on dietary change, in a variety of schools and social settings.

The study found that the so called ‘highlight events’ such as one mile walks or runs appeared to be crucial in the programme, they provided focus goals and motivation for the children.  The intervention programme also seemed to be so useful because everyone in the school, from the pupils to the teachers and parents, became actively involved, children also received summer activity suggestions aimed at encouraging them to continue the physical and dietary recommendations when not in school.  Parents felt that wearing pedometers helped their children to become more active and that their children were more aware of why they should be more active, how much activity they were undertaking and why they should consume more fruit and vegetables (3).

For information on school-based help in the UK I would suggest that you visit the Health Education Trust website.  The Health Education Trust is a charity that promotes the development of health education for young people in the UK.  They have many resources including information for schools, children, parents and teachers.

(1)The European Society of Cardiology Press Office: Press release, 1st September 2008
(2) Department of Health. At least five a week: Evidence of the impact of physical activity and its relationship to health. A report from the Chief Medical Officer. London: HM Government Stationary Office; 2004.
(3)Gorley T et al.  2009.  Effect of a school-based intervention to promote healthy lifestyles in 7-11 year old children.  Int J Behav Nutr Phys Act.  6:5

Written by Ani Kowal