Priyanka Azim Premji Institute for Assessment and Accreditation

1. EFFECT OF DIETARY NUTRIENTS ON COGNITIVE ABILITIES- POTENTIAL IMPLICATIONS FOR IMPROVEMENT IN LEARNING LEVEL AMONG SCHOOL CHILDREN Priyanka AzimPremji Institute for Assessment and Accreditation

2. Human Child Development in India-Some Facts Nutrition Education • Availability of Nutrients <1200 C • RDA -1375..1390 (6Y) • 42% of the world’s undernourished children live in India • PCM in 46% preschool children • Stunted – 43 % (33*) • Underweight – 48% (43*) • Wasted – 17% • Obese – 10% • Anemic – 70% • (WB, UNICEF, NFHS, HUGAMA…..) • *best districts in HUNGAMA. • Enrolment in class I - 98.3% • School Attendance • 11-14 Yr – 70 % (G) 80% (B) • 15-16 Yr - 49 % (G) 34% (B) • 53% of Std 5 children in rural India could read a Std 2 level text and 36% could solve a 3 digit by 1 digit div problem* • India ranks 2nd last in quality of education among among developing countries** • (*- ASER, ** AEP based on data from UNESCO, IMF, WEF, Financial Times) Is there a strong connection between nutrition and learning? Does Nutrition during early years influence performance in later stage ?

3. Literature Consulted • Journals • American Journal of Clinical Nutrition • American Journal of Psychology • Journal of Nutrition • Pediatrics ………… Full Research Articles - 39 Books and Reports – 23 Behavioral Psychologists, BehaviouralGeneticists, Neurologists, Clinical Nutritionists,….. .. E. Pollitt, R. Plomin, M.K. Georgiff, M.M. Black, T. Bouchardt, Jr. Bouchardt, R.J. Haier, Mc-Gregor Grantham, … Organisations working in child nutrition (in India) NIN , Hyderabad ICMR CFTRI, Mysore St. Johns Inst of Med Sciences Some SAUs with ICDS……

4. What shapes intellectual abilities ? Brain Structure & Chemistry Genes Nutrition Socioeconomic & cultural factors Environment

5. Nature or nurture- What contributes more ? • Intelligence is heritable trait, but more than 50% of variance is due to non genetic factors • Even genetic traits, require certain enzymes and hormones at a particular life stage for expression • Heritability for general intelligence • in children – 0.45 ( r for identical twins – 0.80) • for verbal tests - 0.60 • for spatial and speed-of-processing tests- 0.50 • for memory tests - only 0.40 • Broad domains of cognitive ability viz. verbal, perceptual, organizational abilities, generally show higher genetic influence than memory and special abilities. • Specific gene(s) that contribute directly to Intelligence - ?? Intelligence level can be altered by providing proper nutrition and stimulating environment at critical stages of development

6. What does Neuroscience Say ? Discrimination Attention Learning Generalisation Head size; brain vol; intercranialvol ; brain wt : body wt; size, shape, activity of lobes/regions; GM-WM, thickness of cerebral cortex …. Memory Language Thinking Problem solving “Intelligence is not much related to structure & function of brain but how efficiently information is processed by integrating information from verbal, visual, spatial, and executive processes.”

7. From Nutrients to……. Learning Peer interaction Concentration Attention Alertness Motivation Brain Neurons Biochemicals Metabolism Elec. impulses Carbohydrates…Glucose Protein …..AA Oil and Fat ….EFA Vitamins… B-1,2,3,6,9.. Minerals…..Fe, Zn, I, Mg K S A IQ CAT GRE GATE Cognition Neurons are more efficient in formation of synapses in more intelligent individuals

8. Nutrients with evident role in neural processes • Protein • Structural and functional proteins • AAs asp acid, choline, glut acid, tryp in blood are used to produce and release dopamine, seratonin, acetylcholine, etc • Enzymes mediate these processes Vit B1- Myelin sheath: B6 and B12 – neurotransmitters & myelin B9 – for bioavailability of iron : Vit C – seratonin, dopamine : E protects FA Iodine • Fats and FAs • Constitute 50% of brain • EFAs like omega-3 - production, maintenance & function of brain cells • Synapse is rich in DHA Iron Hb ensures continuous oxygen supply to the brain Vit A Carbohydrates Glucose metabolism Mg Zinc Constituent of grey matter

9. Impact of Nutrients on Intelligence & Academic Achievement • Time frame for neural and cognitive development is almost same • Malnutrition & nutritional deficiencies during this critical phase can have an irreversible impact on brain structure and function • Prolonged poor nutritional intake during infancy & preschool age affects behavioural pattern in later stage and adversely impacts developmental processes like learning, cognitive and motor abilities • IQ of malnourished children is significantly lower than IQ of normal nourished children • Severely malnourished children exhibit • Language retardation • delayed development of the ability to integrate auditory & visual stimuli CONT.

10. Stunting an important predictor of child development, is associated with late enrolment, drop out , poor school outcome and also reduced productivity & human capital in adulthood • Anemic children are usually poor in vocabulary and reading tests • Iron, zinc & I deficiency reduces learning ability & school achievement • Even mild deficiency of iodine may lead to significant loss in IQ • IQ of school children who had iron deficiency during infancy < children who were well nourished during infancy • An association between early childhood deficiency of vit B1 , B12 and reduced scores on cognitive tests in adolescence. • Food supplements might/might not be helpful, sometimes they are utilized by body to compensate physical growth, but fail to impact cognition

11. Report from US • Skipping breakfast can adversely affect problem-solving tasks. • Due to school breakfast program, students had fewer unpunctuality, fewer absences and higher Math grades. • It was inferred that Math grades which require problem solving skills improved when students were regularly eating breakfast. Skipping breakfast & short term hunger has been found to have profound effect on classroom achievement, reading, writing and emotional behaviour • children those had inadequate fruits and vegetables intake showed poor school performance than those who had an adequate intake Schools can’t ignore the importance of healthy food habits since 35% of student’s daily calories are consumed at school

12. Limitations of education-nutrition studies • Inclusion of wasted children gives misleading results. • They require immediate medical/clinical intervention • Supplementary nutrients have less impact on cognitive performance among well nourished children • Strong and complicated link with socioeconomic factors, & • It’s difficult to separate changes due to other factors like parental education, social/ family problems, motivation, etc. • Difficult to determine effect of a particular nutrient. • For ethical reasons, a person cannot be restricted to take a particular nutrient (control group) • People respond to different diets differently. • The concept of intelligence and IQ differs among researchers.

13. ?? Intervention ?? • Intervention for improvement in education without taking care of nutrition may not lead to sustainable change • Again Nutrition improvement programmes cannot be effective without provision of sanitation & pure drinking water. • Holistic intervention for pre-school and school age children • Balanced diets with nutritional supplements can result in improved academic performance. • Demands well-planned multidisciplinary research & intervention keeping ethical issues in view CONT.

14. Anthropometric measures provide a holistic picture of health status, growth and development, but for individual nutrients, biochemical methods are reliable. • Adequate level of glucose needs to be sustained throughout the day & requires meal-plan accordingly. • Form and dosage of meal and food supplements needed to be planned with nutritionists and medical experts. • Single intervention/approach may not lead to desirable change, health-hygiene, nutrition and education issues need to walk hand in hand…..

15. Interventions at National & International level US (ByUSDA) National School Lunch Prog The School Breakfast Prog Fresh Fruit & Veg Prog Special Milk Prog Summer Food Service Prog Finland (Nutrition for learning) Free school dinners in elementary and secondary schools nationwide since 1948 Australia The Healthy Eating Schools (HES) UK School dinners in both state & private schools ICDS Free meal or pre-school children Ministry of Human Welfare • Mid-day Meal Scheme • NP-NSPE Centrally Sponsored Scheme in 1995 • 2002 to all primary schools • 2008 to upper –primary

16. National Nutrition Programs need to be scaled up & reoriented towards ----Nutrition for Learning ThankS