MANITOWOC PUBLIC SCHOOL DISTRICT
Manitowoc, Wisconsin
January, 2003
NUTRITION AND STUDENT PERFORMANCE AND BEHAVIOR: AN ANNOTATED BIBLIOGRAPHY
Benton, D, Parker PY. “Breakfast, Blood Glucose, and Cognition.” American Journal of Clinical Nutrition. April, 1998.
This article compares the findings of three studies that explored the role of increased blood glucose in improving memory function for subjects who ate breakfast. “An initial improvement in memory function for the subjects was found to correlate with blood glucose concentrations. In subsequent studies, morning fasting was found to adversely affect the ability to recall a word list and to read aloud, as well as recall items while counting backwards. Failure to eat breakfast did not affect performance on an intelligence test. It was concluded that breakfast consumption preferentially influences tasks requiring aspects of memory.”
Black S. “Nutrition and Learning.” American School Board Journal.American School Board Journal. February, 2000.
Studies by Tufts University's Center on Hunger and Poverty show conclusive links between nutrition and children's cognitive development. “Poor nutrition has long term consequences.”
Breakly J. “The Role of Diet and Behavior in Childhood.” Journal of Pediatrics and Child Health. 1997.
This review summarizes research from 1985 to 1995 on the relationship between diet and behavior. “The research has shown that diet definitely affects some children. Symptoms which may change include those seen in attention deficit disorder and attention deficit hyperactivity disorder, sleep problems and physical symptoms, with later research emphasizing particularly changes in mood.”
“Children's Nutrition and Learning.” Educational Resources Information Center (ERIC).
June, 1994
This article digests various research studies. Among the conclusions reported are:
“Several studies have found effects of hunger and poor nutrition on cognitive ability. One such study found that among fourth grade students, those who had the least protein in their diets had the lowest achievement scores.”
“A laboratory study that involved healthy, well-nourished school-aged children found a negative effect of morning fasting on cognitive performance. A test of the speed and accuracy of response on problem-solving tasks given to children who did or did not eat breakfast found that skipping breakfast had an adverse influence on their performance on the tests.”
“Children who are hungry or undernourished also have more difficulty fighting infection. Therefore, they are more likely to become sick, miss school, and fall behind in class.”
“Community Nutrition Institute School Breakfast Program Helps Student Performance.” Nutrition Week. November, 1989.
“This study investigates the relationship of providing school breakfasts to student performance. The results showed improved test scores and absenteeism but increased tardiness.”
Grantham-McGregor, SM; Walker, SP; Chang, S. “Nutritional Deficiencies and Later Behavioral Development.” Proceedings of the Nutrition Society. February, 2000.
This article reviews the literature concerning the long-term effects of nutritional deficiencies in early life. The conclusion is that there is substantial evidence to support a link between poor nutrition and “long-term deficits in cognition and school achievement.” But, the authors warn that all of these conditions are associated with poverty and poor health-factors that may account for the association.
Hutchinson, SE; Powell, CA; Walker, SP; Chang, SM; and Grantham-McGregor, SM. “Nutrition, Anaemia, Geohelminth Infection and School Achievement in Rural Jamaican Primary School Children.” Journal of Clinical Nutrition. November, 1997.
A number of the studies that were reviewed dealt with children in other countries, especially underdeveloped countries in which undernutrition was very wide spread. We have included this annotation as a representation of those research efforts and the conclusions which were reached in all of them. Time and again, these studies reached the same conclusions:
This study focused on children from Jamaica and concluded that “efforts to increase school achievement levels in developing countries should include strategies to improve health and nutritional status of children.”
“Impact of Hunger and Malnutrition on Student Achievement.” School Food Service Review. 1989.
Although limited research on the relationship between hunger and learning had been completed by the date of the publication of this article in 1989, the authors do provide a list of what they term to be “non-controversial conclusions.”
Kanarek, R. “Psychological Effects of Snacks and Altered Meal Frequency.” British Journal of Nutrition. April, 1997.
An interesting study that reports: “Studies have demonstrated that breakfast intake generally is associated with an improvement in cognitive performance later in the morning, while lunch intake is associated with impairment in mid-afternoon performance on mental tasks and more negative reports of mood.” The conclusion is that more work needs to be done to see if other factors such as age, gender, activity level, meal composition, personality factors, stress at meal time have an effect on cognitive behavior.
Keinmann RE; Hall S; Green H; Korzec-Ramirez D; Pagano, Me; Murphy JM. “Diet, Breakfast, and Academic Performance in Children.” Annals of Nutrition and Metabolism. 2002.
97 inner city students were the subjects of this study. At the beginning of the study, 33% of these children were considered to be nutritionally at risk. These children had significantly poorer attendance, punctuality, and grades at school, more behavior problems, and were less likely to eat breakfast at school. Six months after the study began, students who had decreased their nutritional risk showed significant improvements in math grades and behavior than children who did not decrease their nutritional risk. Conclusion: “Participation in a school breakfast program enhanced daily nutrient intake and improvements in nutrient intake were associated with significant improvements in student academic performance and psychological functioning and decreases in hunger.”
Kennedy, E and Cooney, E. “Development of the Child Nutrition Programs in the United States.” Symposium: Accomplishments in Child Nutrition during the 20th Century.
This paper provides the history of child nutrition programs in the United States. Also, one section summarizes recent research on the impact of these programs.
Kesner, Rebecca. “From Sweets to Soup.” Here's How.
This article is an example of an interesting, but rather unscientific news story:
“Seven years ago, Whitefish Central School, which serves nearly 700 students in grades 4 through 8, was viewed as the toughest school in the district. Now student fights are rare and suspensions and expulsions have been virtually eliminated. While there are other causes for this improvement, Anderson [the principal] believes that a large share of credit is due to the nutritional changes the school has made in the past three years.”
“Three years ago . . . Anderson asked his staff to start noticing what their students ate for lunch. They found that the cafeteria, in order to stay in the black, was selling a lot of high-sugar, high-fat items. . . . As Anderson and his staff became aware of what children were eating, and started linking it to data about discipline problems in the two periods of lunch, nutrition became a critical concern.”
Essentially, the school created a healthy ala carte menu including bagels, pretzels, salads, soup, juice, bottled water, fruit, yogurt, and salads-with no decrease in cafeteria revenue. They also extended the lunch period by a few minutes and worked to get their students to change the tone of their lunch period. “Lunch is enjoyable now,” Anderson reported.
[There's considerable research to support the concept that it is not just improved nutrition that results because of participation in a hot lunch program; other benefits include increased knowledge about the importance of nutrition and the application of that knowledge to out-of-school eating and the creation of a lunch room atmosphere that encourages eating slowly, having pleasant conversations, and enjoying lunch together. The hot lunch programs that really positively affect student performance and behavior provide nutritious lunches in an orderly and pleasant atmosphere.]
Kleinmann RE, Murphy JM, Little M, Pgano M, Wehler CA, Regal K, and Jellinek MS. “Hunger in Children in the United States: Potential Behavioral and Emotional Correlates.” Pediatrics. 1998.
This study involved 300 families in Pittsburgh and surrounding area to show the emotional and behavioral impacts of domestic hunger. Researchers from Harvard Medical School and Massachusetts General Hospital “examined the relationship between hunger and psychosocial functions among low-income, school-aged children. Analysis showed that virtually all behavioral, emotional, and academic problems were more prevalent in hungry children. Aggression and anxiety had the strongest degree of association.”
This is a study similar to others that have already been annotated, but makes a significant attempt to isolate the poverty variable and to concentrate just on the effects of nutrition. The conclusion is: Children from families that report multiple experiences of food insufficiency and hunger are more likely to show behavioral, emotional, and academic problems on a standardized measure of psychosocial dysfunction than children from the same low-income communities whose families do not report experiences of hunger. Although causality cannot be determined from a cross-section design, the strength of these findings suggests the importance of greater awareness on the part of health care providers and public health officials of the role of food sufficiency and hunger in the lives of poor children.”
“The Link Between Nutrition and Cognitive Development in Children.” The Center on Hunger and Poverty. Brandeis University.
This study draws a series of conclusions very similar to those of a study with the same title from Tufts University.
The Link Between Nutrition and Cognitive Development in Children. The Center on Hunger, Poverty, and Nutrition Policy. Tufts University School of Nutrition. 1995.
The following conclusions are the result of a comprehensive review of recent scientific literature on the relationship between nutritional status and cognitive development during childhood. Forty-eight research studies were cited with dates ranging from 1978 to 1994.
“Recent research provides compelling evidence that undernutrition during any period of childhood can have detrimental effects on the cognitive development of children and their later productivity as adults. In ways not previously known, undernutrition impacts the behavior of children, their school performance, and their overall cognitive development.”
“Even nutritional deficiencies of a relatively short-term nature influence children's behavior, ability to concentrate, and to perform complex tasks.”
Murphy JM, Pagano ME, Nachmani J, Sperling P, Kane S, and Leinfman RE. “The Relationship of School Breakfast to Psychosocial and Academic Functioning.” Archives of Pedatrics and Adolescent Medicine. 1998.
The effects of a school breakfast program were evaluated in three schools in the Baltimore and Philadelphia schools. Evaluations were made before and four months after the start of this program. 42% had improved math grades and lower rates of absence and tardiness. “The results suggest that greater participation in the school breakfast program is associated with improved academic performance and behavior.”
Murphy, JM; Wehler, CA; Pagano, ME; Little, M; Kleinman, RE; Jellinek, MS. “Relationship Between Hunger and Psychosocial Functioning in Low-Income American Children.” Journal of American Academy of Child and Adolescent Psychiatry. February, 1998.
The study concludes that “hungry and at-risk for hunger children were twice as likely as non-hungry children to be classified as having impaired functioning by parent and child report. Teachers reported higher levels of hyperactivity, absenteeism, and tardiness among hungry/at-risk children than not-hungry children. Intermittent experiences of food insufficiency and hunger . . . are associated with poor behavioral and academic functioning in low-income children.”
Olson, CM. “Nutrition and Health Outcomes Associated with Food Insecurity and Hunger.” Journal of Nutrition. February, 1999.
This study concludes: “In low-income school-age children from two large urban areas of the United States, risk of hunger and hunger were associated with compromised psychosocial functioning, controlled for maternal education and estimated household income.” Notably, this study makes an effort to remove the variables of income and the level of education attained by the mother-two variables sited as possible contributing factors in other studies.
Pelican, S.; O'Connell, LH; Lewis, C; Byrd-Bredbenner, C. Relationships of Hunger and Malnutrition to Learning Ability and Behavior. The Pennsylvania State University Nutrition Education Center.
This study has “drawn information from a variety of sources to examine the relationships of malnutrition and hunger to learning ability and behavior. These resources range from international research studies and clinical findings to classroom observations and federal legislation.”
“Research has shown that children who suffer from either severe or mild-to-moderate undernutrition perform poorly on perceptual, cognitive, and psychological tests.” For example, children with iron deficiency or other forms of undernutrition exhibit behavior changes such as apathy, decreased activity, fatigue, and inattentiveness. “These behavior changes interfere with the child's interaction with his/her environment which may, in turn, lead to further learning and behavioral problems.”
“Additionally, undernutrition increases a child's susceptibility to illness and infection which, in turn, disrupt the learning process.”
Also, the study finds that “a favorable, supportive environment can contribute substantially to a reversal of the negative effects of malnutrition. Second, without nutritional and/or environmental improvements, learning and behavioral impairments continue throughout childhood and may be permanent.”
“Hungry children [not children who are undernourished, but actually hungry] are reported to be apathetic, inattentive, and disruptive. The hunger resulting specifically from lack of breakfast has been associated with adverse effects on emotional behavior, arithmetic and reading ability, and physical work output.”
“Although participation in School Lunch or School Breakfast Programs does not ensure academic success or 'normal' behavior, such programs represent a substantial nationwide effort to alleviate or prevent undernutrition and hunger, and the associated impairments in learning ability and behavior. In addition to nutritious food, these programs can provide a supportive, stimulating environment which itself appears to be conducive to learning.”
Pollitt, E. “Malnutrition and Infection in the Classroom: Summary and Conclusions.” Food and Nutrition Bulletin. Cambridge, MA: The United Nations University. September, 1990.
This article is an overview of the evidence discussed in a book by the same name. “It demonstrates that poor nutrition and health pose a significant educational problem and suggests means to address the problem.”
Pollitt, E; Rudolph L; Leigbel, MD; and Greenfield, D. “Brief Fasting, Stress, and Cognition in Children.” The American Journal of Clinical Nutrition. August, 1981.
This is undoubtedly the most scientific of the studies that we have read. Its conclusions, therefore, are carefully worded: “The evidence presented does not show a systematic cognitive advantage or disadvantage of the fasted over the fed state. However, these data are a basis from which to conclude that brief fasting does induce arousal changes which in turn have a qualitative effect over cognitive function. Moreover, these data are one more piece of evidence which suggest that brain function can no longer be held to be unaffected by subtle alterations in nutritional status.”
Rosenberg, IH; Mayer, J. “Statement on the Link Between Nutrition and Cognitive Development in Children 1998.” Nutrition-Cognition National Advisory Committee. 1998.
This paper was prepared via a comprehensive review of recent scientific literature on the relationship between nutrition and cognitive development during childhood. Here are some of the conclusions:
“We have now learned that even moderate undernutrition, the type seen most frequently in the United States, can have lasting effects on the cognitive development of children. Inadequate nutrition is a major cause of impaired cognitive development, and is associated with increased educational failure among impoverished children.”
“In ways not previously known, undernutrition impacts the behavior of children, their school performance, and their overall cognitive development.” When children are undernourished, “energy is first reserved for maintenance of critical organ development, second for growth, and last for social activity and cognitive development.”
“Children who attend school hungry have diminished attention spans and are unable to perform tasks as well as their nourished peers. In these cases, the full value of the education provided is lost.”
“In general new research findings show that lack of sufficient food during childhood, even on a relatively mild basis, is far more serious than previously thought. It can produce cognitive impairments in children which may last a lifetime. But the evidence also suggests that adequate nutrition can prevent many of these undesirable outcomes, and is capable of modifying harm that actually has occurred.”
“USDA research shows that children who participate in school lunch have superior nutritional intake compared to those who do not.”
“Children who participated in the School Breakfast Program were shown to have significantly higher standardized achievement test scores than eligible non-participants. Children getting school breakfast also had significantly reduced absence and tardiness rates.”
Schoenthaler, SJ; Bier, ID; Young, K; Nichols, D; Jansenns, S. “The Effect of Vitamin-mineral Supplementation on the Intelligence of American Schoolchildren: A Randomized, Double-Blind Placebo-Controlled Trial.” The Journal of Medicine. February, 2000.
“Many medical, nutrition, and education professionals have long suspected that poor diet impairs the academic performance of Western schoolchildren; academic performance often improves after improved diet. However, others have suggested that such academic gains may be due to psychological effects rather than nutrition. To resolve the issue, two independent research teams conducted randomized trials in which children were given placebos or low-dose vitamin-mineral tablets designed to raise nutrient intake to the equivalent of a well-balanced diet. Both teams reported significantly greater gains in nonverbal intelligence among the supplemented groups. The finds were important because of the apparent inadequacy of diet they revealed and the magnitude of the potential for increased intelligence.”
“This study confirms that vitamin-mineral supplementation modestly raised the nonverbal intelligence of some groups of Western schoolchildren by 2 to 3 points but not that of most Western schoolchildren, presumably because the majority were already adequately nourished. Because nonverbal is closely associated with academic performance, it follows that schools with children who consume substandard diets should find it difficult to produce academic performance equal to those schools with children who consume diets that come closer to providing the nutrients suggested in the U.S. RDA.”
“School Breakfast Programs: Energizing the Classroom.” Minnesota Department of Children, Families, and Learning. 1997.
This study was performed by The Center for Applied Research and Educational Development at the University of Minnesota and concluded that:
Story, M; Neumark-Sztainer, D. “Diet and Adolsecent Behavior: Is There a Relationship?” Adolescent-Medicine. June, 1998.
“Behavioral problems such as hyperactivity, learning disabilities, mental illness, aggressive and antisocial behavior, and juvenile delinquency have been linked to the potential influence of foods or nutrients.” This article highlights the implications of those links for practitioners.
“Studying the Nutrition-Brain-Behavior Connection,” Nutrition and the Brain. October, 2002.
“The Study of how nutrition affects the brain and behavior is relatively new. Scientists have just begun to understand how changes in particular nutrients alter the brain and how these neural changes than affect intelligence, mood, and the way people act. Experiments that investigate this nutrition-brain-behavior interaction, particularly those that study the effects of malnutrition, are difficult for several reasons:
Having written that, this research study asserts: “Without the correct amount and balance of particular building blocks, your brain will not work properly.”