Skip to main content Accessibility help
×
Home

Undernutrition, fatty acid and micronutrient status in relation to cognitive performance in Indian school children: a cross-sectional study

  • Ans Eilander (a1) (a2), Sumithra Muthayya (a3), Henk van der Knaap (a1), Krishnamachari Srinivasan (a3), Tinku Thomas (a3), Frans J. Kok (a2), Anura V. Kurpad (a3) and Saskia J. M. Osendarp (a1) (a2)...

Abstract

While undernutrition and anaemia have previously been linked to poor development of children, relatively little is known about the role of B-vitamins and fatty acids on cognition. The present study aims to explore the associations between indicators of body size, fatty acid and micronutrient status on cognitive performance in 598 Indian school children aged 6–10 years. Baseline data of a clinical study were used to assess these associations by analyses of variance adjusting for age, sex, school, maternal education and cognitive tester. The Kaufman Assessment Battery for Children II was used to measure four cognitive domains, including fluid reasoning, short-term memory, retrieval ability and cognitive speediness. Scores were combined into an overall measure, named mental processing index (MPI). Body size indicators and Hb concentrations were significantly positively related to cognitive domains and MPI, such that increases of 1 sd in height-for-age and weight-for-age z-scores would each translate into a 0·09 sd increase in MPI, P = 0·0006 and 0·002, respectively. A 10 g/l increase in Hb concentrations would translate into a 0·08 sd increase in MPI, P = 0·0008. Log-transformed vitamin B12 concentrations were significantly inversely associated with short-term memory, retrieval ability and MPI (β (95 % CI) = − 0·124 ( − 0·224, − 0·023), P = 0·02). Other indicators of Fe, iodine, folate and fatty acid status were not significantly related to cognition. Our findings for body size, fatty acids and micronutrients were in agreement with previous observational studies. The inverse association of vitamin B12 with mental development was unexpected and needed further study.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Undernutrition, fatty acid and micronutrient status in relation to cognitive performance in Indian school children: a cross-sectional study
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Undernutrition, fatty acid and micronutrient status in relation to cognitive performance in Indian school children: a cross-sectional study
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Undernutrition, fatty acid and micronutrient status in relation to cognitive performance in Indian school children: a cross-sectional study
      Available formats
      ×

Copyright

Corresponding author

*Corresponding author: Ans Eilander, fax +31 10 4605993, email ans.eilander@unilever.com

References

Hide All
1Martorell, R, Mendoza, F & Castillo, R (1988) Poverty and stature in children. In Linear Growth Retardation in Less Developed Countries, pp. 5773 [Waterlow, JC, editor]. New York: Raven Press.
2Grantham-McGregor, S & Baker-Henningham, H (2005) Review of the evidence linking protein and energy to mental development. Public Health Nutr 8, 11911201.
3Chang, SM, Walker, SP, Grantham-McGregor, S, et al. (2002) Early childhood stunting and later behaviour and school achievement. J Child Psychol Psychiatry 43, 775783.
4Walker, SP, Chang, SM, Powell, CA, et al. (2005) Effects of early childhood psychosocial stimulation and nutritional supplementation on cognition and education in growth-stunted Jamaican children: Prospective Cohort Study. Lancet 366, 18041807.
5Martinez, M (1992) Tissue levels of polyunsaturated fatty acids during early human development. J Pediatr 120, S129S138.
6Yehuda, S (2003) Omega-6/omega-3 ratio and brain-related functions. World Rev Nutr Diet 92, 3756.
7Elmadfa, I, Weichselbaum, E, Konig, J, et al. (2005) European nutrition and health report 2004. Forum Nutr 1220.
8Kris-Etherton, PM, Innis, S, American Dietetic Associations, et al. (2007) Position of the American Dietetic Association and Dietitians of Canada: dietary fatty acids. J Am Diet Assoc 107, 15991611.
9Daniels, JL, Longnecker, MP, Rowland, AS, et al. (2004) Fish intake during pregnancy and early cognitive development of offspring. Epidemiology 15, 394402.
10Oken, E, Wright, RO, Kleinman, KP, et al. (2005) Maternal fish consumption, hair mercury, and infant cognition in a U.S. Cohort. Environ Health Perspect 113, 13761380.
11Hibbeln, JR, Davis, JM, Steer, C, et al. (2007) Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study. Lancet 369, 578585.
12Helland, IB, Smith, L, Saarem, K, et al. (2003) Maternal supplementation with very-long-chain n-3 fatty acids during pregnancy and lactation augments children's IQ at 4 years of age. Pediatrics 111, e39e44.
13Hoffman, DR, Theuer, RC, Castaneda, YS, et al. (2004) Maturation of visual acuity is accelerated in breast-fed term infants fed baby food containing DHA-enriched egg yolk. J Nutr 134, 23072313.
14Lauritzen, L, Jorgensen, MH, Olsen, SF, et al. (2005) Maternal fish oil supplementation in lactation: effect on developmental outcome in breast-fed infants. Reprod Nutr Dev 45, 535547.
15Jensen, CL, Voigt, RG, Prager, TC, et al. (2005) Effects of maternal docosahexaenoic acid intake on visual function and neurodevelopment in breastfed term infants. Am J Clin Nutr 82, 125132.
16Judge, MP, Harel, O & Lammi-Keefe, CJ (2007) Maternal consumption of a docosahexaenoic acid-containing functional food during pregnancy: benefit for infant performance on problem-solving but not on recognition memory tasks at age 9 mo. Am J Clin Nutr 85, 15721577.
17Judge, MP, Harel, O & Lammi-Keefe, CJ (2007) A docosahexaenoic acid-functional food during pregnancy benefits infant visual acuity at four but not six months of age. Lipids 42, 117122.
18Agostoni, C, Zuccotti, CV, Radaelli, G, et al. (2009) Docosahexaenoic acid supplementation and time at achievement of gross motor milestones in healthy infants: a randomized, prospective, double-blind, placebo-controlled trial. Am J Clin Nutr 89, 6470.
19Eilander, A, Hundscheid, DC, Osendarp, SJ, et al. (2007) Effects of n-3 long chain polyunsaturated fatty acid supplementation on visual and cognitive development throughout childhood: a review of human studies. Prostaglandins Leukot Essent Fatty Acids 76, 189203.
20Grantham-McGregor, S & Ani, C (2001) A review of studies on the effect of iron deficiency on cognitive development in children. J Nutr 131, 649S666S.
21Sachdev, HPS, Gera, T & Nestel, P (2005) Effect of iron supplementation on mental and motor development in children: systematic review of randomised controlled trials. Public Health Nutr 8, 117132.
22Beard, JL & Connor, JR (2003) Iron status and neural functioning. Annu Rev Nutr 23, 4158.
23Delange, F (2000) The role of iodine in brain development. Proc Nutr Soc 59, 7579.
24Louwman, MWJ, van Dusseldorp, M, van de Vijver, FJR, et al. (2000) Signs of impaired cognitive function in adolescents with marginal cobalamin status. Am J Clin Nutr 72, 762769.
25Allen, LH, Penland, JG, Boy, E, et al. (1999) Cognitive and neuromotor performance of Guatemalan schoolers with deficient, marginal, and normal plasma vitamin B-12. FASEB J 13, A544.
26Butterworth, CE Jr & Bendich, A (1996) Folic acid and the prevention of birth defects. Annu Rev Nutr 16, 7397.
27Sugden, C (2006) One-carbon metabolism in psychiatric illness. Nutr Res Rev 19, 117136.
28Hutto, BR (1997) Folate and cobalamin in psychiatric illness. Compr Psychiatry 38, 305314.
29Dror, DK & Allen, LH (2008) Effect of vitamin B12 deficiency on neurodevelopment in infants: current knowledge and possible mechanisms. Nutr Rev 66, 250255.
30Muthayya, S, Eilander, A, Transler, C, et al. (2009) Effect of fortification with multiple micronutrients and n-3 fatty acids on growth and cognitive performance in Indian schoolchildren: the CHAMPION (Children's Health and Mental Performance Influenced by Optimal Nutrition) Study. Am J Clin Nutr 89, 17661775.
31World Health Organization Expert Committee on Physical Status (1995) Physical Status: The Use and Interpretation of Anthropometry. WHO Technical Report Series no. 854. Geneva: World Health Organization.
32Grantham-McGregor, S (2005) Can the provision of breakfast benefit school performance? Food Nutr Bull 26, S144S158.
33Kaufman, AS & Kaufman, LN (2004) Kaufman Assessment Battery for Children: Manual, 2nd ed.Circle Pines, MN: AGS Publishing.
34Hughes, D & Bryan, J (2003) The assessment of cognitive performance in children: considerations for detecting nutritional influences. Nutr Rev 61, 413422.
35Malda, M, van de Vijver, FJR, Srinivasan, K, et al. (2008) Adapting a cognitive test for a different culture: an illustration of qualitative procedures. Psychol Sci Q 50, 451468.
36Malda, M, van de Vijver, FJR, Srinivasan, K, et al. (2009) Traveling with cognitive tests: testing the validity of a KABC-II adaptation in India. Assessment (In the Press).
37Lohman, TG, Roche, AF & Martorell, R (1988) Anthropometric Standardization Reference Manual. Champaign, IL: Human Kinetics Publishers.
38Burtis, CA & Ashwood, ER (1996) Fundamentals of Clinical Chemistry. Philadelphia, PA: WB Saunders Company.
39Miale, JB (1982) Laboratory Medicine: Hematology. St Louis, MO: CV Mosby.
40Chen, W, Sperling, MI & Heminger, LA (1987) Vitamin B12. In Methods in Clinical Chemistry, pp. 569573 [Pesce, AJ and Kaplan, LA, editors]. St Louis, MO: CV Mosby.
41Rose, HG & Oaklander, M (1965) Improved procedure for the extraction of lipids from human erythrocytes. J Lipids Res 6, 428431.
42Gentner, PR, Bauer, M & Dieterich, I (1981) Separation of major phospholipids classes of milk without previous isolation from total lipid extracts. J Chromatogr 13, 200204.
43Morrison, WR & Smith, LM (1964) Preparation of fatty acid methyl esters and dimethylacetals from lipids with boron fluoride–methanol. J Lipids Res 5, 600608.
44Pino, S, Fang, SL & Braverman, LE (1996) Ammonium persulfate: a safe alternative oxidizing reagent for measuring urinary iodine. Clin Chem 42, 239243.
45World Health Organization, United Nations Children's Fund & United Nations University (2001) Iron Deficiency Anemia. Assessment, Prevention and Control. A Guide for Programme Managers. Geneva: World Health Organization.
46Zimmermann, MB, Molinari, L & Staubli-Asobayire, F (2005) Serum transferrin receptor and zinc protoporphyrin as indicators of iron status in African children. Am J Clin Nutr 81, 615623.
47Institute of Medicine (IOM) (1998) Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press.
48Jones, KM, Ramirez-Zea, M, Zuleta, C, et al. (2007) Prevalent vitamin B-12 deficiency in twelve-month-old Guatemalan infants is predicted by maternal B-12 deficiency and infant diet. J Nutr 137, 13071313.
49World Health Organization, United Nations Children's Fund & International Council for Control of Iodine Deficiency Disorders (2001) Assessment of Iodine Deficiency Disorders and Monitoring Their Elimination. A Guide for Programme Managers. Geneva: World Health Organization.
50Cook, JD, Flowers, CH & Skikne, BS (2003) The quantitative assessment of body iron. Blood 101, 33593364.
51Muthayya, S, Thankachan, P, Zimmermann, MB, et al. (2007) Low anemia prevalence in school-aged children in Bangalore, South India: possible effect of school health initiatives. Eur J Clin Nutr 61, 865869.
52Isaacs, E & Oates, J (2008) Nutrition and cognition: assessing cognitive abilities in children and young people. Eur J Nutr 47, Suppl. 3, 424.
53Hughes, D & Bryan, J (2003) The assessment of cognitive performance in children: considerations for detecting nutritional influences. Nutr Rev 61, 413422.
54Sigman, M, Neumann, C, Baksh, M, et al. (1989) Relationship between nutrition and development in Kenyan toddlers. J Pediatr 115, 357364.
55Freeman, HE, Klein, RE, Kagan, J, et al. (1977) Relations between nutrition and cognition in rural Guatemala. Am J Public Health 67, 233239.
56Whaley, SE, Sigman, M, Espinosa, MP, et al. (1998) Infant predictors of cognitive development in an undernourished Kenyan population. J Dev Behav Pediatr 19, 169177.
57Powell, C & Grantham-McGregor, SM (1980) The associations between nutritional status, school achievement and school attendance in twelve-year-old children at a Jamaican school. West Indian Med J 29, 247253.
58Sigman, M, Neumann, C, Jansen, AA, et al. (1989) Cognitive abilities of Kenyan children in relation to nutrition, family characteristics, and education. Child Dev 60, 14631474.
59Johnston, FE, Low, SM, de Baessa, Y, et al. (1987) Interaction of nutritional and socioeconomic status as determinants of cognitive development in disadvantaged urban Guatemalan children. Am J Phys Anthropol 73, 501506.
60Grantham-McGregor, SM, Walker, SP, Chang, SM, et al. (1997) Effects of early childhood supplementation with and without stimulation on later development in stunted Jamaican children. Am J Clin Nutr 66, 247253.
61Pollitt, E, Watkins, WE & Husaini, MA (1997) Three-month nutritional supplementation in Indonesian infants and toddlers benefits memory function 8 y later. Am J Clin Nutr 66, 13571363.
62Bakker, EC, Ghys, AJA, Kester, ADM, et al. (2003) Long-chain polyunsaturated fatty acids at birth and cognitive function at 7y of age. Eur J Clin Nutr 57, 8995.
63Rapoport, SI, Rao, JS & Igarashi, M (2007) Brain metabolism of nutritionally essential polyunsaturated fatty acids depends on both the diet and the liver. Prostaglandins Leukot Essent Fatty Acids 77, 251261.
64Mitchell, EA, Aman, MG, Turbott, SH, et al. (1987) Clinical characteristics and serum essential fatty acid levels in hyperactive children. Clin Pediatr (Phila) 26, 406411.
65Stevens, L, Zhang, W, Peck, L, et al. (2003) EFA supplementation in children with inattention, hyperactivity, and other disruptive behaviors. Lipids 38, 10071021.
66Chen, JR, Hsu, SF, Hsu, CD, et al. (2004) Dietary patterns and blood fatty acid composition in children with attention-deficit hyperactivity disorder in Taiwan. J Nutr Biochem 15, 467472.
67Colter, AL, Cutler, C & Meckling, KA (2008) Fatty acid status and behavioural symptoms of attention deficit hyperactivity disorder in adolescents: a case-control study. Nutr J 7, 8.
68Burgess, JR, Stevens, L, Zhang, W, et al. (2000) Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder. Am J Clin Nutr 71, 327S330S.
69Nokes, C, van den Bosch, C & Bundy, DAP (1998) The Effects of Iron Deficiency and Anemia on Mental and Motor Performance, Educational Achievement, and Behavior in Children. An Annotated Bibliography. Washington, DC: International Nutritional Anemia Consultative Group.
70Raman, G, Tatsioni, A, Chung, M, et al. (2007) Heterogeneity and lack of good quality studies limit association between folate, vitamins B-6 and B-12, and cognitive function. J Nutr 137, 17891794.
71Durga, J, van Boxtel, MP, Schouten, EG, et al. (2006) Folate and the methylenetetrahydrofolate reductase 677C → T mutation correlate with cognitive performance. Neurobiol Aging 27, 334343.
72Miller, JW (2006) Assessing the association between vitamin B-12 status and cognitive function in older adults. Am J Clin Nutr 84, 12591260.
73Bjorke Monsen, AL & Ueland, PM (2003) Homocysteine and methylmalonic acid in diagnosis and risk assessment from infancy to adolescence. Am J Clin Nutr 78, 721.
74Obeid, R & Herrmann, W (2006) Mechanisms of homocysteine neurotoxicity in neurodegenerative diseases with special reference to dementia. FEBS Lett 580, 29943005.
75Allen, LH (2008) Causes of vitamin B12 and folate deficiency. Food Nutr Bull 29, S20S34.
76Antony, AC (2003) Vegetarianism and vitamin B-12 (cobalamin) deficiency. Am J Clin Nutr 78, 36.
77Bleichrodt, N & Born, MP (1994) A meta-analysis of research on iodine and its relationship to cognitive development. In The Damaged Brain of Iodine Deficiency, pp. 195200 [Stanbury, JB, editor]. New York: Cognizant Communication Corporation.
78Zimmermann, MB, Connolly, K, Bozo, M, et al. (2006) Iodine supplementation improves cognition in iodine-deficient schoolchildren in Albania: a randomized, controlled, double-blind study. Am J Clin Nutr 83, 108114.

Keywords

Undernutrition, fatty acid and micronutrient status in relation to cognitive performance in Indian school children: a cross-sectional study

  • Ans Eilander (a1) (a2), Sumithra Muthayya (a3), Henk van der Knaap (a1), Krishnamachari Srinivasan (a3), Tinku Thomas (a3), Frans J. Kok (a2), Anura V. Kurpad (a3) and Saskia J. M. Osendarp (a1) (a2)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed