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Associations of diet quality with cognition in children – the Physical Activity and Nutrition in Children Study

  • Eero A. Haapala (a1), Aino-Maija Eloranta (a1) (a2), Taisa Venäläinen (a1), Ursula Schwab (a2) (a3), Virpi Lindi (a1) and Timo A. Lakka (a1) (a4) (a5)...

Evidence on the associations of dietary patterns with cognition in children is limited. Therefore, we investigated the associations of the Baltic Sea Diet Score (BSDS) and the Dietary Approaches to Stop Hypertension (DASH) score with cognition in children. The present cross-sectional study sample included 428 children aged 6–8 years (216 boys and 212 girls). The BSDS and the DASH score were calculated using data from 4 d food records, higher scores indicating better diet quality. Cognition was assessed by the Raven's Coloured Progressive Matrices (CPM) score, a higher score indicating better cognition. Among all children, the BSDS (standardised regression coefficient β = 0·122, P =0·012) and the DASH score (β = 0·121, P =0·015) were directly associated with the Raven's CPM score. Among boys, a lower BSDS (β = 0·244, P< 0·001) and a lower DASH score (β = 0·202, P= 0·003) were related to a lower Raven's CPM score. Boys in the lowest quartile of the BSDS (22·5 v. 25·3, P= 0·029) and the DASH score (22·4 v. 25·7, P= 0·008) had a lower Raven's CPM score than those in the highest quartile of the corresponding score. Among girls, the BSDS or the DASH score were not associated with cognition. In conclusion, a poorer diet quality was associated with worse cognition in children, and the relationship was stronger in boys than in girls.

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Corresponding author
* Corresponding author: Dr E. A. Haapala, fax +35817 162 131, email
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1 Nyaradi, A, Li, J, Hickling, S, et al. (2013) The role of nutrition in children's neurocognitive development, from pregnancy through childhood. Front Hum Neurosci 7, 97.
2 Burkhalter, TM & Hillman, CH (2011) A narrative review of physical activity, nutrition, and obesity to cognition and scholastic performance across the human lifespan. Adv Nutr 2, 201206.
3 Taras, H (2005) Nutrition and student performance at school. J Sch Health 75, 199213.
4 Féart, C, Samieri, C, Allès, B, et al. (2013) Potential benefits of adherence to the Mediterranean diet on cognitive health. Proc Nutr Soc 72, 140152.
5 Baym, CL, Khan, NA, Monti, JM, et al. (2014) Dietary lipids are differentially associated with hippocampal-dependent relational memory in prepubescent children. Am J Clin Nutr 99, 10261032.
6 Zhang, J, Hebert, J & Muldoon, M (2005) Dietary fat intake is associated with psychosocial and cognitive functioning of school-aged children in the United States. J Nutr 135, 19671973.
7 Khan, NA, Raine, LB, Drollette, ES, et al. (2015) Dietary fiber is positively associated with cognitive control among prepubertal children. J Nutr 145, 143149.
8 Diamond, A (2013) Executive functions. Annu Rev Psychol 64, 135168.
9 Tangney, CC & Scarmeas, N (2012) The good, bad, and ugly? How blood nutrient concentrations may reflect cognitive performance. Neurology 78, 230231.
10 Allès, B, Samieri, C, Féart, C, et al. (2012) Dietary patterns: a novel approach to examine the link between nutrition and cognitive function in older individuals. Nutr Res Rev 25, 207222.
11 Sacks, FM, Obarzanek, EVA, Windhauser, MM, et al. (1995) Rationale and design of the Dietary Approaches to Stop Hypertension trial (DASH). A multicenter controlled-feeding study of dietary patterns to lower blood pressure. Ann Epidemiol 5, 108118.
12 Wengreen, H, Munger, R, Cutler, A, et al. (2013) Prospective study of Dietary Approaches to Stop Hypertension- and Mediterranean-style dietary patterns and age-related cognitive change: the Cache County Study on memory, health and aging. Am J Clin Nutr 98, 12631271.
13 Kesse-guyot, E, Andreeva, VA, Lassale, C, et al. (2013) Mediterranean diet and cognitive function?: a French study. Am J Clin Nutr 97, 369376.
14 Vassiloudis, I, Yiannakouris, N, Panagiotakos, DB, et al. (2014) Academic performance in relation to adherence to the Mediterranean diet and energy balance behaviors in Greek primary schoolchildren. J Nutr Educ Behav 46, 164170.
15 Kanerva, N, Kaartinen, NE, Schwab, U, et al. (2013) Adherence to the Baltic Sea diet consumed in the Nordic countries is associated with lower abdominal obesity. Br J Nutr 109, 520528.
16 Nyaradi, A, Li, J, Hickling, S, et al. (2013) Diet in the early years of life influences cognitive outcomes at 10 years: a prospective cohort study. Acta Paediatr 102, 11651173.
17 Eloranta, A-M, Lindi, V, Schwab, U, et al. (2012) Dietary factors associated with overweight and body adiposity in Finnish children aged 6–8 years: the PANIC Study. Int J Obes 36, 950955.
18 National Public Health Institute (2006) Picture Book of Food Portion Sizes. Helsinki, Finland: The National Public Health Institute.
19 Rastas, M, Seppänen, R, Knuts, L, et al. (1997) Nutrient Composition of Foods. Helsinki, Finland: The Social Insurance Institution.
20 Wardle, J, Guthrie, CA, Sanderson, S, et al. (2001) Development of the children's eating behaviour questionnaire. J Child Psychol Psychiatry 42, 963970.
21 Raven, J, Raven, J & Court, J (1998) Coloured Progressive Matrices. Manual for Raven's Progressive Matrices and Vocabulary Scales. London: Oxford Psychologist Press Ltd.
22 Lintu, N, Tompuri, T, Viitasalo, A, et al. (2014) Cardiovascular fitness and haemodynamic responses to maximal cycle ergometer exercise test in children 6–8 years of age. J Sports Sci 32, 652659.
23 Haapala, EA, Poikkeus, A-M, Tompuri, T, et al. (2014) Associations of motor and cardiovascular performance with academic skills in children. Med Sci Sports Exerc 46, 10161024.
24 Väistö, J, Eloranta, A-M, Viitasalo, A, et al. (2014) Physical activity and sedentary behaviour in relation to cardiometabolic risk in children: cross-sectional findings from the Physical Activity and Nutrition in Children (PANIC) Study. Int J Behav Nutr Phys Act 11, 55.
25 Haapala, EA, Poikkeus, A-M, Kukkonen-Harjula, K, et al. (2014) Associations of physical activity and sedentary behavior with academic skills – a follow-up study among primary school children. PLOS ONE 10, e107031.
26 Saari, A, Sankilampi, U, Hannila, M-L, et al. (2011) New Finnish growth references for children and adolescents aged 0 to 20 years: length/height-for-age, weight-for-length/height, and body mass index-for-age. Ann Med 43, 235248.
27 Cole, T, Bellizzi, M, Flegal, K, et al. (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320, 12401243.
28 Tompuri, TT, Lakka, TA, Hakulinen, M, et al. (2015) Assessment of body composition by dual-energy X-ray absorptiometry, bioimpedance analysis and anthropometrics in children: the Physical Activity and Nutrition in Children study. Clin Physiol Funct Imaging 35, 2133.
29 Tanner, J (1962) Growth at Adolescence. Oxford: Blackwell.
30 Malina, RM, Bouchard, C & Bar-Or, O (2004) Growth, Maturation, and Physical Activity, 2nd ed. Champaign: Human Kinetics.
31 Fung, TT, Chiuve, SE, Mccullough, ML, et al. (2008) Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Intern Med 168, 713720.
32 Sirin, SR (2005) Socioeconomic status and academic achievement: a meta-analytic review of research. Rev Educ Res 75, 417453.
33 Hillman, CH, Pontifex, MB, Castelli, DM, et al. (2014) Effects of the FITKids randomized controlled trial on executive control and brain function. Pediatrics 134, e1063e1071.
34 Haapala, EA (2013) Cardiorespiratory fitness and motor skills in relation to cognition and academic performance in children – a review. J Hum Kinet 36, 5568.
35 Reinert, KRS, Po'e, EK & Barkin, SL (2013) The relationship between executive function and obesity in children and adolescents: a systematic literature review. J Obes 2013, 820956.
36 Jernigan, T, Baare, W, Stiles, J, et al. (2011) Postnatal brain development: structural imaging of dynamic neurodevelopmental processes. Prog Brain Res 189, 7792.
37 Diamond, A (2000) Close interrelation of motor development and cognitive development and of the cerebellum and prefrontal cortex. Child Dev 71, 4456.
38 Smithers, LG, Golley, RK, Mittinty, MN, et al. (2013) Do dietary trajectories between infancy and toddlerhood influence IQ in childhood and adolescence? Results from a prospective birth cohort study. PLOS ONE 8, e58904.
39 Gale, CR, Martyn, CN, Marriott, LD, et al. (2009) Dietary patterns in infancy and cognitive and neuropsychological function in childhood. J Child Psychol Psychiatry 50, 816823.
40 Lucas, A, Morley, R & Cole, TJ (1998) Randomised trial of early diet in preterm babies and later intelligence quotient. BMJ 317, 14811487.
41 Hu, FB, Rimm, EB, Stampfer, MJ, et al. (2000) Prospective study of major dietary patterns and risk of coronary heart disease in men. Am J Clin Nutr 72, 912921.
42 Yates, KF, Sweat, V, Yau, PL, et al. (2012) Impact of metabolic syndrome on cognition and brain: a selected review of the literature. Arterioscler Thromb Vasc Biol 32, 20602067.
43 Frisardi, V, Panza, F, Seripa, D, et al. (2010) Nutraceutical properties of Mediterranean diet and cognitive decline: possible underlying mechanisms. J Alzheimer's Dis 22, 715740.
44 Wu, A, Ying, Z & Gomez-Pinilla, F (2004) The interplay between oxidative stress and brain-derived neurotrophic factor modulates the outcome of a saturated fat diet on synaptic plasticity and cognition. Eur J Neurosci 19, 16991707.
45 Markham, JA, Mullins, SE & Koenig, JI (2013) Periadolescent maturation of the prefrontal cortex is sex-specific and is disrupted by prenatal stress. J Comp Neurol 521, 18281843.
46 Isaacs, EB, Gadian, DG, Sabatini, S, et al. (2008) The effect of early human diet on caudate volumes and IQ. Pediatr Res 63, 308314.
47 Patton, G & Viner, R (2007) Adolescent health 1: pubertal transitions in health. Lancet 369, 11301139.
48 Knudsen, EI (2004) Sensitive periods in the development of the brain and behavior. J Cogn Neurosci 16, 14121425.
49 Lassek, WD & Gaulin, SJC (2011) Sex differences in the relationship of dietary fatty acids to cognitive measures in American children. Front Evol Neurosci 3, 18.
50 Stea, TH & Torstveit, MK (2014) Association of lifestyle habits and academic achievement in Norwegian adolescents: a cross-sectional study. BMC Public Health 14, 829.
51 Adolphus, K, Lawton, CL & Dye, L (2013) The effects of breakfast on behavior and academic performance in children and adolescents. Front Hum Neurosci 7, 425.
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British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
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