The Link between Nutrition, Physical Activity (PA) and Academic Achievement (AA)
Breakfast and AA
Hunger and Behavioral Problems
Undernourishment and Health Risks
Lack of PA and Low Self-Esteem
Obesity, Health Risks and Low Self-Esteem
Nutrition and AA
Summary of Key Studies
Effects of Nutrition on Behavior
General and Major Findings
PA and AA
Summary of Key Studies
Effects of PA on Behavior
The General and Major Findings
The “Easy-Nutrition-and-PA-Guide” for optimal AA (for children and parents)
Cross-Word-Puzzle: Are You a Fruit and Veggie-Monster?
Appendix 1: Nutrition and AA
Appendix 2: PA and AA
Appendix 3: Food Guide Pyramid
Appendix 4: Activity Pyramid
Appendix 5: Power Point Presentation..Attachment
It has been documented that children from all socioeconomic backgrounds are at risk for poor nutrition and lack of physical activity (PA). On one hand, many children from low-income families are not getting enough to eat each day due to a lack of resources. On the other hand, children from middle and upper income levels consume enough food, but their diets are high in fat, sugar, and sodium, and they do not participate in PA. As a result of this combination, many children today face an increased risk for under-nutrition, obesity, heart disease and other chronic diseases. Finally, educators and health professionals agree that poor diet, eating habits and lack of PA, also affect academic performance. (56)
The fact that a hungry child cannot learn has been documented in numerous studies.
Indeed, this research has found that even moderate under-nutrition and an immense lack of PA can have lasting effects on children's ability to learn and school performance (5).
Undernourished and untrained children tend to attain lower scores on standardised tests, are more likely to become sick, miss school, and to fall behind in class. Also, hungry children have low energy, are more irritable, and have difficulty concentrating, which interferes with learning (7).
Therefore, school feeding and PA programs were established by several schools and public and private organizations to provide proper nourishment and the possibility of practicing PA. In addition it helps preventing the negative effects of hunger and malnutrition.
The School Breakfast Programs was established as a pilot project in 1966 in response to the needs of children arriving at school without having eaten breakfast. Now permanent, breakfast programs help states provide daily breakfast to millions of students in thousands of schools. The positive impact of this program cannot be underestimated. Not only do many teachers report that students are more alert and perform better in class after eating a nutritious breakfast, but published studies also found that breakfast programs are associated with significant improvements in academic functioning among school children. (38)
PA programs can substantially improve children’s ability to learn and their state of health by making PA a part of their daily lives. Being physically active early in life has many physical, social, and emotional benefits and can lead to a reduced incidence of chronic diseases in adulthood. In addition teachers report improved attentiveness and concentration and parents report improved interest in school and scholastic performance when students participate in PA. (44)
The fact is that nutrition and PA influence academic performance. Research has shown that healthy nutrition and daily PA lead to improved scholastic performance, attentiveness, concentration, and interest in school. In addition students who participate in nutrition and PA programs appear calmer in class and more energetic when studying.
However, providing a nutritious breakfast and lunch or promoting PA in school is only part of the solution to improving nutrition and PA among young people. Promoting healthy eating habits and activity among children and youth requires a comprehensive approach, and school health programs can play a key role in increasing pupils’ ability and intention to learn.
Historically, the relationship between the mind and body has been studied from either a dualistic or a holistic perspective. Early Greek and Hebrew philosophers adopted a dualistic perspective and viewed the mind and the body as two distinct entities. However, since then, most philosophers and researchers have taken a holistic perspective, considering the mind and the body as two interrelated, inseparable entities. In recent years, controversy has shifted from the question of whether there is a link between the mind and body to the question of what the precise causal relationship is between these two components. In particular, research has focused upon the idea that there is a causal link between the body and the mind such that exercising the body has a beneficial effect on the performance capabilities of the brain.
Piaget (1936) was one of the first to suggest that motor development is an important determinant of intellectual development in children. Other early theorists have also adopted this holistic approach and have come to similar conclusions. For example, the perceptual-motor concepts of Kephart (1960) suggest that children who have learning disabilities may actually be suffering from perceptual-motor problems. Additionally, Gestalt psychologists have influenced the entire field of education through their emphasis on the idea that "an individual functions as a whole within the environment and thus must be treated accordingly" (Kirkendall, 1986).
Although theories have been proposed that suggest that the body can influence the mind, until recently, actual mechanisms that could support this causal link were not known. Contemporary researchers examining the influence of exercise and nutrition on cognitive functioning have taken advantage of advances in the field of neuropsychology and have used animal research to discover the mechanisms that could explain this link. One such mechanism is cerebral blood flow. Research on humans that has used modern methods (i.e., Xenon clearance techniques) and moderate-to-high intensities of exercise has shown large increases in cerebral blood
flow as a function of exercise (Jørgensen, Perko, Hanel, Schroeder, & Secher, 1992). It has been suggested that these increases in cerebral blood flow then benefit the cognitive functioning of the organism because they result in an increased supply of necessary nutrients to the brain (e.g., glucose, oxygen) (Chodzko-Zajko, 1991).
Fitness and good nutrition are hallmarks of successful learning and high achievement by students. They are critically important during the rapid mental and physical growth and development that occurs from birth through adolescence. Childhood and adolescence are critical times for the development of good dietary habits and PA, which can be an investment in the future.
This point is most important for the youngest in society. Children, who study hard at school, who want to utilize 100% of their power, need to scoop all energy out of the resources that is given them in form of their body.
Because of improving student health can increase the capacity to learn, reduce absenteeism and improve physical fitness and mental alertness, it is important to think about intelligent nutrition and PA programs.
The quality of children’s diet is declining, while at the same time the emphasis on test scores and the concern about disciplinary problems in schools are increasing. Can the quality of children’s food intake affect their academic performance? Can their ability to perform be increased by a daily level of PA? Can diet and exercise affect student behavior?
The Link between Nutrition, PA and AA
Breakfast and AA
Many students start school with no breakfast or an inadequate breakfast. Qualitative surveys on breakfast consumption completed by Wisconsin students showed that approximately 10 percent of students at the elementary level, 25 percent in middle school and 30 percent of high school students started school without breakfast. (1) Many other students came to school with an inadequate breakfast.
Studies show that omitting breakfast interferes with cognition and learning, an effect that is more pronounced in nutritionally at-risk children. A landmark study examined the effects of school breakfast on academic performance among 1,023 low-income third through fifth grade students. Results showed that children who participated in the study had significantly improved standardized test scores, and showed improvements in math, reading and vocabulary scores. In addition, rates of absenteeism and tardiness were reduced among participants. (2)
Hunger and Behavioral Problems
An estimated four million American children experience prolonged periodic food insufficiency and hunger each year, representing eight percent of the children under the age of 12 in this country. The Community Childhood Hunger Identification Project (CCHIP) study 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 with hunger. (3)
The three-year Universal School Breakfast Program pilot study in six Minnesota elementary schools showed a general increase in composite math and reading scores, and improved student behavior, reduced morning trips to the nurse and increased student attendance and test scores. (4)
Undernourishment and Health Risks
Even moderate under-nutrition can have lasting effects on children's cognitive development and school performance (5). Chronically undernourished children attain lower scores on standardized achievement tests, especially tests of language ability (6). When children are hungry or undernourished, they have difficulty resisting infection and therefore are more likely than other children to become sick, to miss school, and to fall behind in class (5,6), they are irritable and have difficulty concentrating, which can interfere with learning (7), and they have low energy, which can limit their PA (7). Some reports have estimated that millions of children in the United States experience hunger over the course of a year (8), but no scientific consensus currently exists on how to define or measure hunger (9).
Lack of PA and Low Self-Esteem
Nearly half of young people ages 12-21 do not engage in PA on a regular basis. PA is consistently related to higher levels of self-esteem and lower levels of anxiety and stress.
Several studies have shown the positive effects of PA programs on physical fitness and school performance.
In 1988, a detailed study conducted in Quebec by Shepard et al. concluded that systematic PA in children over a period of several years resulted in improvements in a number of variables linked with physical fitness: aerobic strength, physical work capacity (PWC), and muscular strength. The investigators also observed improvements in grades compared to the participants in the control group. There are other studies that argue that PA also improves school performance in children with learning disorders.
Monitoring over a two-year period revealed that one of the effects of exercise was an improvement in classroom behavior, which may have been associated with greater attention in class and thus an improvement in academic performance. The intimate mechanisms whereby physical exercise can influence academic performance require broader studies, since confounding factors may be present that should be identified. In summary, systematic and enjoyable physical exercise from the early years on greatly benefits growth, as well as physical, intellectual, and psychological development, and constitutes a basic pillar of health promotion. (10)
Obesity, Health Risks and Low Self-Esteem
Historically, a fat child meant a healthy child, one who was likely to survive the rigors of undernourishment and infection. In the past decade, however, excessive fatness has arguably become the primary childhood health problem in developed nations, and to some degree, in other parts of the world.
The prevalence of overweight among young people ages 6-17 years in the United States has more than doubled in the past 20 years, (11) and that trend is continuing. Over 4.7 million, or 11 percent of youth ages 6-17 years are seriously overweight. (12) Overweight causes low self-esteem, which may lead to depression followed by gluttony.
As many as 30,000 children have Type 2 diabetes, a type of diabetes that was once almost entirely limited to adults. (13) It is well known that overweight in adults increases the risk for cardiovascular disease and premature death. A recent study in Pediatrics reported that more than one fourth of children, ages 5-10, had one or more adverse cardiovascular disease risk factors. That number rose to nearly 61 percent among overweight children of the same age and to. Twenty-seven percent of overweight children had two or more risk factors. (14)
The total costs of diseases associated with obesity have been estimated at almost $100 billion per year or approximately eight percent of the national health care budget. (15)
Nutrition and AA
Summary of Key Studies
- Short-Term Effects
Conners CK, Blouin A G. Nutritional effects on behavior of children. J Psychiat Res
Objectives: To determine the effect of breakfast on cognitive performance in school children.
Subjects: 10 well nourished normal American children, aged 9-11 y.
Methods: Subjects underwent 4 test sessions over a period of 4 weeks, and their performance was tested three times during each session. For two sessions, subjects received a standard breakfast, and for two sessions the subjects received no breakfast. Cognitive tests involved continuous performance tasks and arithmetic testing.
Results: Subjects performed better on the arithmetic tests and on the continuous performance tasks when they had consumed breakfast, although not all differences were reported as significant.
Conclusions: The authors stated that valuable conclusions could only be made following many different kinds of testing strategies, other than just the one illustrated.
Pollitt E, Leibel RL, Greenfield D. Brief fasting, stress, and cognition in children. Am J Clin
Objectives: To determine the effects of breakfast omission on speed and accuracy in a problem solving situation in school children.
Subjects: 22 girls and 10 boys, well nourished, mean age 10.4 y, from middle-class backgrounds.
Methods: Subjects were admitted twice to a clinical research center. The night before testing, subjects consumed a standard dinner, and upon awakening consumed either a 535 kcal breakfast or no breakfast in the morning before testing. Blood was drawn in the evening and following testing the next day. Cognitive testing was done using the matching familiar figures test (MMFT), the continuous performance task (CPT), and the Hagen Central-Incidental task (HCI).
Results: There were statistically significant differences between the no-breakfast (NBR) and the breakfast (BR) groups for -hydroxybutyrate, lactate, and free fatty acids. Breakfast omission had a negative effect on accuracy of responses in problem solving, but had a beneficial effect on immediate recall in short-term memory .
Conclusions: The authors concluded that there was not a systematic cognitive advantage or disadvantage of the fed over the fasted state. However, based on the blood results in combination with the test results, the authors stated that brief fasting induces arousal changes, which in turn have a qualitative effect over cognitive function.
Vaisman N, Voet H, Akivis A, Vakil E. Effect of breakfast timing on the cognitive functions of elementary school students. Arch Pediatr Adolesc Med 1996;150:1089-1092.
Objectives: To examine the effect of breakfast consumption and breakfast timing on selected cognitive functions of elementary school students.
Subjects: 569 Israeli school children, aged 11-13 y, 51% of them male, all from varying socioeconomic backgrounds.
Methods: Tests were conducted on two separate days. For the first session, students (491) recorded their breakfast consumption on the test day. They were then subjected to a battery of cognitive tests (Rey Auditory- Verbal Learning Test) measuring learning and memory: immediate recall, delayed recall, recognition, memory of temporal order, ability to cope with interferences, and visual memory. Two thirds of the students (322 students) were then assigned to a group that received 30 g of sugared cornflakes and 200 ml of milk for 14 days and were asked not to eat breakfast at home. The other third (181 students) served as controls and were not served breakfast nor were given breakfast instructions. The second testing session on day 15 consisted of similar cognitive tests as performed in session one. Control subjects were asked if they had consumed breakfast on the test day.
Results: For session one, no differences in cognitive test results were observed between students who did or did not consumed breakfast on the test day. For session two, following 14 days of breakfast delivery, children were separated into groups of those who had eaten breakfast at school, those who had eaten at home, and those who had skipped breakfast. Children who had eaten the school breakfast, served close to the testing time, performed significantly better on the cognitive tests compared to children who had either eaten at home or who had not eaten at all.
There were no differences between breakfast skippers and those children who ate breakfast at home.
Conclusions: The authors concluded that the timing of breakfast consumption influenced the test results. They speculated that the level of blood glucose might have been higher in the students who had consumed breakfast at school; however, glucose was not measured.
Wyon DP, Abrahamsson L, Jartelius M, Fletcher R.l An experimental study of the effects of energy intake at breakfast on the test performance of 10-year-old children in school. Intl J of Food SciNutr 1997;48:5-12.
Objectives: To determine the effect of breakfast consumption on the cognitive capacity of school children.
Subjects: 195 Swedish school children, aged 10 y, from five different schools.
Methods: Children were randomly assigned to receive standard breakfasts in two different orders over four days. Breakfast consisted of either 567 kcal or 832 kcal for girls and boys respectively, or 147 kcal or 197 kcal for girls and boys respectively. All students were tested during both high calorie and low calorie conditions. Tests used were addition, multiplication, grammatical reasoning, number checking, and creativity. Students also responded to a questionnaire regarding their impression of hunger following the previous days breakfast. Mood and physical endurance was also assessed.
Results: Significant and positive effects of the larger breakfast were found in the creativity test and in voluntary endurance. In tests of addition, error rates were negatively correlated to energy intake and in number checking, work rate increased with energy intake. No significant effects were found in multiplication or grammatical reasoning. Students reported feeling hungrier following the lower energy breakfast.
Conclusions: The authors concluded that reduced energy intake negatively affected creative thinking and voluntary physical endurance. Additionally, children who ate more of the nutritionally inadequate breakfast made fewer addition mistakes. The authors noted that energy intakes were self selected to a certain degree, and as such motivation to perform during testing may have been a confounding variable.
- Long-Term Effects
Meyers AF, Sampson AE, Weitzman M, Rogers BL, Kayne H School Breakfast Program and school performance. AJDC 1989;143:1234-1239.
Objectives: To examine the effect of participation in the School Breakfast Program (SBP) on test scores, tardiness, and absenteeism of low-income children.
Subjects: Children it grades 3-6 in 16 elementary schools in Massachusetts eligible for the SBP based on family income.
Methods: Results for students were compared between two school years, during which time the SBP was implemented. Students were tested using the Comprehensive Tests of Basic Skills (CTBS), a standardized achievement test, and their rates of tardiness and absenteeism were assessed.
Results: Between the two testing times, increases in overall CTBS scores and language sub-scores, were significantly greater for program participants than non-participants. Increases in mathematics and reading approached significance. Tardiness rates decreased for participants and increased for non-participants. Controlling for other factors, the SBP contributed positively to CTBS scores and negatively to tardiness and absence rates.
Conclusions: The authors concluded that these findings suggest that the implementation of the SBP positively affects the academic performance of low-income school children The authors noted that the results can not be directly applied to dissimilar populations.
Minnesota Department of Children, Families, and Learning. School breakfast programs: Energizing the classroom. A summary of the Three Year Study of the Universal School Breakfast Pilot Program in Minnesota Schools. 1998.
Objectives: To determine the impact of a universal breakfast program in elementary schools on student performance, attendance, and classroom behavior.
Subjects: Students enrolled in 6 American elementary schools into which the universal breakfast program was introduced.
Methods: Evaluation of the program took place prior to, during, and at the completion of the Universal School Breakfast Pilot Program. In 6 elementary schools, student performance was monitored in various areas including discipline, test scores, and attendance. Teacher and parent perceptions of the program were also assessed.
Results: Participation in the universal breakfast program, around 75% of students, was much greater than the state average of 12% in schools with a targeted breakfast program. School saw an average of 40-50% decline in discipline referrals that administrators attributed to the breakfast program. Overall, there was a general increase in composite math and reading percentile scores following the three-year period in participating students.
Conclusions: Overall, the program was concluded to be successful, with improved student performance and behavior as well as a high percentage of parent and teacher support.
Powell CA, Walker SP, Chang SM, Grantham-McGregor SM. Nutrition and education: A randomized trial of the effects of breakfast in rural primary school children. Am J Clin Nutr 1998;68:873-879.
Objectives: To determine the effect of breakfast on attendance, nutritional status, and achievement in arithmetic, spelling, and reading in school children of differing degrees of nourishment.
Subjects: 407 under-nourished (weight for age below -1 SD of the National Center for Health Statistics references) school children and 407 adequately nourished (weight for age above -1 SD of the National Center for Health Statistics references) school children from rural Jamaican towns.
Methods: All subjects underwent testing at the beginning of the school year prior to the intervention. Subjects were then randomly assigned to receive either a full breakfast (576- 703 kcal) or a placebo (18kcal). The intervention lasted the entire school year when the subjects were retested. Subjects were tested in reading, spelling, and arithmetic. Subjects attendance rate and weight and height were also measured.
Results: Children who received breakfast showed small yet significant improvements in both nutritional status and attendance compared with those who received the placebo. Younger children who received breakfast also showed improvement in arithmetic.
Conclusions: The authors concluded that breakfast consumption produced small improvements in children’s arithmetic performance, school attendance, and nutritional status. The authors stated that changes seen may have been small based on the mild rather than severe malnutrition of the undernourished children.
Simeon D. School feeding in Jamaica: A review of its evaluation. Am J Clin Nutr 1998;67(S):790S-794S.
Study 1 (Powell C, Grantham-McGregor S, Elston M. An evaluation of giving the Jamaican government school meal to a class of children. Hum Nutr Clin Nutr 1983~7C:381-388.) Objectives: To determine the effects of the Jamaican school meal on achievement, attendance, and physical growth of Jamaican school children over one term.
Subjects: Grade 7 Jamaican school children, aged 12-13 y, from a rural school not participating in the School Feeding Program.
Methods: Children were separated into 3 groups: school meal recipients (44), syrup drink recipients (33), and those who received nothing (38); the latter two groups served as the control.
Tests were conducted at the start of the first semester, at the start of the second semester to coincide with the introduction of the feeding period, and at the end of the second semester, following the 3-month experimental period. School achievement was assessed using the Wide Range Achievement Test that tested arithmetic, spelling, and reading.
Results: Provision of breakfast resulted in higher achievement in arithmetic and higher attendance rates. The achievement in arithmetic was independent of attendance and weight gain. There were no differences in weight gain between the groups.
Conclusions: Breakfast consumption alleviated hunger and most likely contributed to improvements in arithmetic.
- Nutritional Status
Chandler AK, Walker SP, Connolly K, Grantham-McGregor SM. School breakfast improves Verbal fluency in undernourished Jamaican children. J Nutr 1995;125:894-900.
Objectives: To determine the short-term effects of breakfast consumption on the cognitive performance of mildly undernourished versus adequately nourished children.
Subjects: 100 adequately nourished (weight for age> -1 SD of the National Center for Health Statistics references) Jamaican grade 3 and 4 children and 100 mildly undernourished (weight for age < -1 SD of the National Center for Health Statistics references) Jamaican grade 3 and 4 children.
Methods: A cross-over design was used so each child was tested twice on separate occasions, once after consuming breakfast (2174 kJ) and once after consuming a placebo (63 kJ). Following consumption of the meal, children underwent cognitive tests including: visual searching, working memory, verbal fluency, and information processing speed.
Results: Undernourished children performed better in verbal fluency when they received breakfast. No other significant treatment effects were noted. Conclusions: Authors stated that the findings that the verbal fluency of undernourished children was affected by omission of breakfast were robust based on the protocol and method of analysis.
Grantham-McGregor SM, Chang S, Walker P. Evaluation of school feeding programs: some Jamaican examples. Am J Clin Nutr 1998:67(S):785S-789S.
Objectives: To determine the effect of breakfast consumption on in-class cognitive function and behavior.
Subjects: l00 Undernourished (weight for age below -1 SD of the National Center for Health Statistics references) and 100 adequately nourished (weight for age above -1 SD of the National Center for Health Statistics references) Jamaican school children, 8-11 y.
Methods: In a cross over experiment, classrooms of children received either a government breakfast or a placebo for one week, separated by a two week washout. Cognitive testing, including visual search, digit span, verbal fluency, and information processing was conducted at the end of each treatment week. Behavior, including attention span and talking without permission, was assessed through classroom monitoring.
Results: Nutritional status (undernourished versus nourished) had ID effect on cognitive status. Undernourished children perform significantly better following consumption of breakfast. Changes in classroom behavior depended on the school. Better organized schools saw improved attention with breakfast whereas in poorly organized schools the behavior deteriorated. Conclusions: The authors concluded that omission of breakfast has a greater detrimental effect in undernourished as compared to adequately nourished children.
- Observational Studies
Ragno MB, Andrada GN. Teachers perceptions of the School Breakfast Program. State of Connecticut, Department of Education, 1994.
Objectives: To assess teachers perception of a school breakfast program in the state of Connecticut.
Subjects: l00 Connecticut schools operating the United Stated School Breakfast Program (SBP). Grade 1 to 3 teachers from these schools evaluated the effects of the program on the students and on the school day.
Methods: 300 teachers were randomly selected to receive a questionnaire, 190 responded. Teachers responded to several types of questions regarding general perceptions of the program and student behavior.
Results: 87% of teachers reported that the SBP had a positive influence on the school day. 91 % reported being aware of student hunger prior to the SBP and 86% stated that the SBP alleviated that hunger. 77% of teachers reported no change in attendance rates. 74%, 72%, 68%, and 67% reported that the SBP enhanced student attentiveness, energy level, concentration, and motivation, respectively. 61% reported that there might have been children who were hungry that were not participating in the SBP .
Conclusions: Overall, the teachers perceptions of the SBP were positive. Concerns were raised over reasons for non-participation.