Relationship between Nutrition and Cognitive Development

Abstract
This paper investigates the effects of varied nutritional intake and its impacts on cognitive development in 50 6th grade students in Philadelphia. Participants for this study were selected based on their body mass index (BMI). Groups consisted of students whose BMI was18.5 or less, 25.0 or over, and an additional control group. All students, excluding the control group, were given treatment, consisting of three nutritional meals every day for a month. Students’ GPA and current grades were recorded before and after treatment. Potential findings consist of an increase in overall GPA and test scores subsequent to adequate nutritional intake. Additional findings consist of an increase in focusability and a decrease in irritability. 

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Malnutrition in Preschool Years and its Impact on Their Development 
Various studies have investigated the short and long term effects of malnutrition in children and the consequential effects in their development. Food plays a significant role in the first 1,000 days of a child’s life, including the prenatal years of a child’s development (McCarthy, 2018). In the United States, malnutrition is prevalent in more than half of American households (Bowers, Francis, & Kraschnewski 2018). Bower et al.’s (2018) summary article reviewing the dual burden of malnutrition in the United States, it isn’t uncommon that households suffering from malnutrition will consist of both underweight and overweight children. Malnutrition not only affects a child’s growth, but social advancement as well. Undernutrition has been linked to poor school achievement and behavioral abnormalities, as well as other impairments (Martins, Florencio, Grillo, et al., 2018). Nutritional stress as a result of food insecurity, can induce chronological physical stress and weaken the body (Martins et al., 2018). The subsequent impact of malnutrition, stress and food insecurity may contribute to negative impacts on a child’s social, emotional and cognitive development. 
Literature Review
1970’s researchers discussed the increased dependence amongst processed foods in addition to a decrease in physical activity (Popkin, Adair, & Ng, 2013). It was not until diabetes, hypertension and obesity became more prevalent, that a shift in attitude began to change towards diet (Popkin et al., 2013). Malnutrition in forms such as obesity were rampant in the United States. Processed foods were easily accessible and affordable for those of lower status and income. Although hunger and malnutrition would be the obvious consequence of low-income households, research states that obesity may be the larger threat (Popkin et al., 2013). Worldwide, obesity as well as obese behaviors has impacted over a billion adults (Popkin et al., 2013). One of America’s largest contributors to obesity is added sugars in both food and beverages. Ultimately, the sugar dilemma primarily affects those who are middle to lower income families, especially in the 1970’s (Popkin et al., 2013). 
Malnutrition and obesity share many similarities, as both outcomes occur in settings of low-income families. Fifty-three percent of American households consisting of an underweight person, there is often an overweight or obese person (Bowers et al., 2018). This nutrient deficiency can affect a child negatively in a plethora of ways. Researchers investigated the effects of protein malnutrition on rat participants to explore the negative effects of inadequate nutritional intake (Alamy, & Bengelloun, 2012).
Researchers explored the effects of protein malnutrition in developing rats and discovered that protein deficiency can lead to functional and behavioral deficits (Alamy, & Bengelloun, 2012). Subsequent vulnerability to malnutrition can lead to general body weight loss, brain weight loss and changes in neurogenesis (Alamy, & Bengelloun, 2012). Additionally, malnutrition can result in deficits in learning and retention (Fukuda et al., 2002 as cited by Alamy & Bengelloun, 2019). Exploring the negative effects of protein malnutrition in rats allows researchers to gain greater knowledge of the effects of malnutrition in humans and its subsequent effects (Alamy, & Bengelloun, 2012).
With the negative impacts of inadequate nutritional consumption, it is evident that these poor-quality diets begin early. Dietary guidelines consist of one cup to a cup and a half of fruits and 1 and a half to two cups of vegetables a day and U.S. children are not fulfilling this protocol (Ang, Wolf, & Koch, et al., 2019). Most children, especially impressionable students such as middle school aged children, are especially not meeting this requirement.
During a developing child’s middle school years, the transition to middle school results in a fluctuation of emotions and self-concept (Onetti, Fernandez-Garcia, & Castillo-Rodriguez, 2019). Physical, social and emotional changes affect an adolescent’s personality (Onetti et al.,) Adequate nutritional intake is important during this stage in the developing child’s life, to ensure appropriate maturity and academic success. Researchers explored the transition through these impressionable years and its relation to food. Developing negative attitudes centering eating leads to psychological deficits (Onetti et al., 2019). Girls may be at higher risk than boys, but eating disturbances aren’t subject to females only (Onetti et al., 2019). Negative eating habits can result to a fluctuation in a child’s BMI, putting them at risk for health implications. Health implications can consist of learning deficits, poor social interactions, cognitive and behavioral deficits and delayed reaction times. (Alamy, & Bengelloun, 2012).
If children with low BMI are provided sufficient meals each day, consisting of the appropriate amount of nutrients a child needs on a daily basis, the child will perform better in an academics setting. This paper will examine the impact of adequate nutrients and a child’s academic performance.  
Method
Design
Participants will be selected based on BMI and then categorized into appropriate groups. Groups consisted of students whose BMI is 18.5 or less, 25.0 or over, and a control group. Students whose BMI that falls between 18.5 and 25.0 were considered healthy. Six groups will be designed consisting of groups who receive treatment as well as a control to match the underweight group, the healthy group and the overweight group of students. Family of individuals participating in the study will be entered for the chance to win a month’s supply of food for their family sponsored by Blue Apron subsequent to Blue Aprons individual monthly food supply. IRB approval will be required of each school.
Participants
Participants will include one hundred 6th grade, 50 males and 50 females, across five different schools in Philadelphia. Students’ ages will range from 11 to 12 years old. Philadelphia schools will consist of three public schools and two charter schools. Students’ ethnic backgrounds will vary among Caucasian, Hispanic/Latino, Asian and African American. Students taking medication for attention deficits will be excluded from the study. 
Instrument and Measures
The BMI of each student will be measured to calculate the current health status of each participant. BMI can be inaccurate if the individual is either pregnant or has ample amount of muscle. Students whose BMI is 18.5 or less are considered underweight. Students whose BMI is 25.0 and over are considered overweight. Students who fall in between 18.5 and 25.0 are considered healthy. Parents and students were asked to sign consent forms for students. Parents will also be asked to respond to a survey consisting of five-point Likert Scale questions regarding the parent’s income as well as questions regarding the child’s daily eating habits. Questions consisted of, “Is your child a picky eater?” Parents will be asked to answer, “all of the time, most of the time, sometimes, rarely or never,” to survey questions. 
Children’s’ tests scores prior to the experiment will be recorded as well as a standardized test consisting of 3 sections. Sections will be composed of algebra, literature comprehension and mathematical comprehension. Students will also be asked to complete a survey consisting of five-point Likert scale questions regarding the student’s personality and academic security. Both the children and the parents will not be notified that test scores are accounted for throughout the study. Students who are receiving additional tutoring outside of the classroom will continue to receive additional help to ensure that results are consistent with preexisting academic conditions.
After the 30-day meal plan, students will be tested again, using the same standardized test that was used prior to the treatment. Students’ scores will potentially increase consequential to treatment.
Procedure
The students will be given a food plan for one month consisting of three meals a day. Meals will meet adequate dietary guidelines, per the Center for Disease Control. Appropriate protein, fruit, vegetable and fiber intake will be calculated among each participant. Parents are to provide only dinner for students. The schools will administer breakfast and lunch for participants. No outside meals or snacks are to be administered throughout this period of time. Students must be monitored on their food intake. Students will be tested throughout month span to periodically upkeep on academic performance. Teachers are to record any behaviors that may contradict regular behavior. Grades and GPA are to be recorded throughout the 30 days to test for improvements. Interactions among the students will also observed.
Parents will work with researchers and Blue Apron to construct an appropriate meal plan for each child. Children will also have the choice to choose between nutritional options. Breakfast and lunch will be served in school to guarantee monitoring of meals. Parents will be instructed of the 30-day meal plan requirements and will be required to cook dinner at home. Blue Apron meals will be delivered weekly to ensure freshness. Weekly checkups will be required of both parents and students to ensure meal intake.
Discussion
Expected findings 
Prior research indicates that adequate nutrition is a crucial component to cognitive development. Failure to provide proper nutrients can result in learning deficits and poor school achievement (Martins, et al., 2018). Previous research records the tie between low socioeconomic status and increased fat and sugar in students’ diets in comparison to those with higher socioeconomic status. Findings should consist of an increase in GPA and test scores among students receiving treatment as well as a decrease in irritability. 
Strengths and Limitations
Previous research has focused on specific nutrients such as Iron, Zinc etc, but lack research on the impact of overall diet in children. Conducting an experiment that focuses primarily on nutritional intake, this may skew different results. Compensation such as a subscription to blue apron may decrease the possibility of mortality threats among subjects. By conducting the study at both home and in a school setting, there are better chances of increasing ecological validity. 
Confounding variables such as outside foods could affect the conclusiveness of the study. The Hawthorne effect is another possible limitation, as the children may show improved test scores as a result of surplus attention in contrast to their previous settings. It is crucial that the study is representative of a larger population. Although the study is limited to 50 students, representation of a larger population is important to ensure external validity. The students selected with a BMI ranging from underweight to obese should eliminate this variable. However, specific schools selected could skew these results. 
Implications 
Considering the importance of diet and malnutrition in children across the globe, focusing on nutrition in an academic setting is paramount. Students dietary fulfillments will result in academic achievement and prosperity. Failure to fulfill adequate nutritional intake can limit successful performance.
Future Directions
Research regarding diet, attention and memory is scarce. Future studies should explore the possibility of altering a child’s nutritional intake to test for improvements in cognitive function. Advanced brain imaging successive to nutritional diet plans could be examined to explore the effects of diet and brain function. Due to limited resources, brain imaging could not be conducted for this study.
References
Alamy, Meryem, and Wail A. Bengelloun. “Malnutrition and Brain Development: An Analysis of the Effects of Inadequate Diet during Different Stages of Life in Rat.” ScienceDirect, www-sciencedirect-com.libproxy.temple.edu/science/article/pii/S0149763412000590.
Ang, Ian Yi Han, et al. “School Lunch Environmental Factors Impacting Fruit and Vegetable Consumption.” Journal of Nutrition Education and Behavior, Elsevier, 5 Oct. 2018, www.sciencedirect.com/science/article/pii/S1499404618307462.
Bowers, et al. “The Dual Burden of Malnutrition in the United States and the Role of Non-Profit Organizations.” US National Library of Medicine National Institutes of Health, www.ncbi.nlm.nih.gov/pmc/articles/PMC6214863/.
“Childhood Nutrition Facts.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 29 May 2019, www.cdc.gov/healthyschools/nutrition/facts.htm.
Chung, Young-Chul, et al. “Improved Cognitive Performance Following Supplementation with a Mixed-Grain Diet in High School Students: A Randomized Controlled Trial.” Nutrition, Elsevier, 29 Dec. 2011, www.sciencedirect.com/science/article/pii/S089990071100195X.
Cusick, Sarah E., and Michael K. Georgieff. “The Role of Nutrition in Brain Development: The Golden Opportunity of the ‘First 1000 Days.’” US National Library of Medicine National Institutes of Health, www.ncbi.nlm.nih.gov/pmc/articles/PMC4981537/.
Department of Health & Human Services. “Body Mass Index (BMI).” Better Health Channel, Department of Health & Human Services, 16 Apr. 2018, www.betterhealth.vic.gov.au/health/healthyliving/body-mass-index-bmi.
LC, Fernald, and Neufeld LM. “Overweight with Concurrent Stunting in Very Young Children from Rural Mexico: Prevalence and Associated Factors.” US National Library of Medicine National Institutes of Health , 2007.
McCarthy, Claire. “The Crucial Brain Foods All Children Need.” Harvard Health Publishing, 2018, www.health.harvard.edu/blog/brain-food-children-nutrition-2018012313168.
O’Neil, et al. “Relationship Between Diet and Mental Health in Children and Adolescents: A Systematic Review.” US National Library of Medicine National Institutes of Health, www.ncbi.nlm.nih.gov/pmc/articles/PMC4167107/.
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