Impact of poor nutrition on child development and educational attainment Dr Michelle McKinley (R.Nutr Public Health) Senior Lecturer, Centre for Public Health School of Medicine, Dentistry & Biomedical Science m.mckinley@qub.ac.uk Adapted by Samantha Emsley for level 2 E.Y.E.

Today, we will discuss the: Impact of poor nutrition in early life Effect of nutrition interventions on learning & performance of school age children Breakfast Fish oils Multivitamins/minerals School food interventions Conclusion

Impact of poor nutrition

Why is good nutrition in early life so important? Optimal growth Optimal cognitive development Optimal health Prevention of chronic disease in later life

The first 9 months can shape the rest of your life……. Critical periods before and during pregnancy when specific nutrients are needed for optimal development. Risks of a number of chronic diseases in adulthood such as hypertension, diabetes, heart disease may have their origins before birth.

Promoting optimal health through the lifecourse

Low iodine levels in Uk pregnant women Low maternal iodine status was associated with an increased risk of suboptimum scores for verbal IQ at age 8 years, and reading accuracy, comprehension and reading score at age 9 years 2013;382:331-37

Brain development Diet provides the building blocks and fuel for the brain. Very rapid brain growth happens in the last trimester of pregnancy and first 2 years of life. Malnutrition in the first year of life has a lasting effect on both behaviour and cognition Motor skills and language develop more slowly Intelligence scores and school performance are poorer Early malnutrition associated with higher incidence of aggressive behaviour when children aged 9-15 years Further peaks of brain growth have been found at 7, 12 and 15 years of age

Impact of poor nutrition in early life Vitamin / mineral deficiencies Growth stunting Impaired cognitive development Childhood obesity Childhood type 2 diabetes

Diet of UK schoolchildren Most children in the UK are consuming: too much saturated fat, sugar and salt too little fibre and fruit and vegetables - ~ 80-90% of children aged 11-18 yrs in the UK are not meeting the 5-a-day recommendation Few meeting oily fish recommendation Micronutrients of concern – Iron, zinc, magnesium, iodine, vitamin D Energy imbalance

Global Prevalence of Overweight in Boys Prior to 1990 < 5 % 5-9.9% 10-14.9% 15-19.9% 20-24.9% 25-29.9% ≥30% Self Reported data © International Association for the Study of Obesity

Global Prevalence of Overweight in Boys 2000-2008 < 5 % 5-9.9% 10-14.9% 15-19.9% 20-24.9% 25-29.9% ≥30% Self Reported data © International Association for the Study of Obesity, London 2010

Global Prevalence of Overweight in Girls Prior to 1990 < 5 % 5-9.9% 10-14.9% 15-19.9% 20-24.9% 25-29.9% ≥30% Self Reported data © International Association for the Study of Obesity, London 2010

Global Prevalence of Overweight in Girls 1990-1999 < 5 % 5-9.9% 10-14.9% 15-19.9% 20-24.9% 25-29.9% ≥30% Self Reported data © International Association for the Study of Obesity, London 2010

Global Prevalence of Overweight in Girls 2000-2008 < 5 % 5-9.9% 10-14.9% 15-19.9% 20-24.9% 25-29.9% ≥30% Self Reported data © International Association for the Study of Obesity, London 2010

Social disparities in childhood obesity Source: www.oecd.org

US Childhood Obesity Campaign

Childhood obesity in UK & Ireland UK and Ireland - about 1 in 3 children are considered overweight or obese by the time they finish primary school By 2050 - 55% of boys and 70% of girls could be overweight/ obese

Breakfast Young people are more likely to skip breakfast than any other meal Breakfast skipping increases with age Girls at secondary school highest at-risk group for skipping breakfast (Hoyland et al, 2012. Nutrition Bulletin) Children who eat breakfast are more likely to meet daily nutrient intake guidelines compared with children who eat breakfast infrequently or skip breakfast

Breakfast Adolphus, Lawton, Dye 2013 Frontiers in Human Neuroscience 36 studies examined effect of breakfast on in-class behaviour & academic performance in children and adolescents 21 studies provided suggestive evidence that: Habitual breakfast and school breakfast programs (SBP) have a positive effect on children’s academic performance Most consistent effects observed for maths performance, most pronounced in undernourished children 11/19 studies reported positive effects on classroom behaviour e.g. less ‘off-task’ and ‘out of seat’ behaviour

School food and learning behaviour in primary schools Six primary schools in Sheffield: 4 intervention, 2 control; 12 week study; years 3, 4 and 5; n=146 Food interventions – new menus, taster sessions, themed weeks, healthy eating workshops Dining environment – changing layout and Q system; redecorating; buying new furniture, artwork and murals Classroom behaviours observed in the hour after lunch at baseline and 12 weeks – ‘on-task’ and ‘off- task’ behavours www.childrensfoodtrust.org.uk

N=156 N=156 “....+ve effect on engagement and concentration and their ability to learn in the classroom after lunch..also suggests pupils less likely to be disengaged” Storey et al. A randomized controlled trial of the effect of school food and dining room modifications on classroom behaviour in secondary school children. Eur J Clin Nutr 2011;65:32-8.

Conclusion

Conclusion The importance of good nutrition in early life for optimal growth and development is irrefutable There is increasing evidence that nutrition interventions in school age children can have a positive effect on cognitive function, learning and classroom behaviour Whole school approach to nutrition – can provide an environment that encourages positive attitudes to food and healthful behaviours among students