|
1
|
Yin J, Cheng L, Hong Y, Li Z, Li C, Ban X, Zhu L, Gu Z. A Comprehensive Review of the Effects of Glycemic Carbohydrates on the Neurocognitive Functions Based on Gut Microenvironment Regulation and Glycemic Fluctuation Control. Nutrients 2023; 15:5080. [PMID: 38140339 PMCID: PMC10745758 DOI: 10.3390/nu15245080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Improper glycemic carbohydrates (GCs) consumption can be a potential risk factor for metabolic diseases such as obesity and diabetes, which may lead to cognitive impairment. Although several potential mechanisms have been studied, the biological relationship between carbohydrate consumption and neurocognitive impairment is still uncertain. In this review, the main effects and mechanisms of GCs' digestive characteristics on cognitive functions are comprehensively elucidated. Additionally, healthier carbohydrate selection, a reliable research model, and future directions are discussed. Individuals in their early and late lives and patients with metabolic diseases are highly susceptible to dietary-induced cognitive impairment. It is well known that gut function is closely related to dietary patterns. Unhealthy carbohydrate diet-induced gut microenvironment disorders negatively impact cognitive functions through the gut-brain axis. Moreover, severe glycemic fluctuations, due to rapidly digestible carbohydrate consumption or metabolic diseases, can impair neurocognitive functions by disrupting glucose metabolism, dysregulating calcium homeostasis, oxidative stress, inflammatory responses, and accumulating advanced glycation end products. Unstable glycemic status can lead to more severe neurological impairment than persistent hyperglycemia. Slow-digested or resistant carbohydrates might contribute to better neurocognitive functions due to stable glycemic response and healthier gut functions than fully gelatinized starch and nutritive sugars.
Collapse
Affiliation(s)
- Jian Yin
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (J.Y.); (Y.H.); (Z.L.); (C.L.); (X.B.); (L.Z.)
| | - Li Cheng
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (J.Y.); (Y.H.); (Z.L.); (C.L.); (X.B.); (L.Z.)
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
| | - Yan Hong
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (J.Y.); (Y.H.); (Z.L.); (C.L.); (X.B.); (L.Z.)
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
| | - Zhaofeng Li
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (J.Y.); (Y.H.); (Z.L.); (C.L.); (X.B.); (L.Z.)
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
| | - Caiming Li
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (J.Y.); (Y.H.); (Z.L.); (C.L.); (X.B.); (L.Z.)
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
| | - Xiaofeng Ban
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (J.Y.); (Y.H.); (Z.L.); (C.L.); (X.B.); (L.Z.)
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
| | - Ling Zhu
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (J.Y.); (Y.H.); (Z.L.); (C.L.); (X.B.); (L.Z.)
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
| | - Zhengbiao Gu
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (J.Y.); (Y.H.); (Z.L.); (C.L.); (X.B.); (L.Z.)
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
| |
Collapse
|
|
2
|
Parolisi S, Montanari C, Borghi E, Cazzorla C, Zuvadelli J, Tosi M, Barone R, Bensi G, Bonfanti C, Dionisi Vici C, Biasucci G, Burlina A, Carbone MT, Verduci E. Possible role of tryptophan metabolism along the microbiota-gut-brain axis on cognitive & behavioral aspects in Phenylketonuria. Pharmacol Res 2023; 197:106952. [PMID: 37804926 DOI: 10.1016/j.phrs.2023.106952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/01/2023] [Accepted: 10/04/2023] [Indexed: 10/09/2023]
Abstract
Cognitive and psychiatric disorders are well documented across the lifetime of patients with inborn errors of metabolism (IEMs). Gut microbiota impacts behavior and cognitive functions through the gut-brain axis (GBA). According to recent research, a broad spectrum of GBA disorders may be influenced by a perturbed Tryptophan (Trp) metabolism and are associated with alterations in composition or function of the gut microbiota. Furthermore, early-life diets may influence children's neurodevelopment and cognitive deficits in adulthood. In Phenylketonuria (PKU), since the main therapeutic intervention is based on a life-long restrictive diet, important alterations of gut microbiota have been observed. Studies on PKU highlight the impact of alterations of gut microbiota on the central nervous system (CNS), also investigating the involvement of metabolic pathways, such as Trp and kynurenine (KYN) metabolisms, involved in numerous neurodegenerative disorders. An alteration of Trp metabolism with an imbalance of the KYN pathway towards the production of neurotoxic metabolites implicated in numerous neurodegenerative and inflammatory diseases has been observed in PKU patients supplemented with Phe-free amino acid medical foods (AA-MF). The present review investigates the possible link between gut microbiota and the brain in IEMs, focusing on Trp metabolism in PKU. Considering the evidence collected, cognitive and behavioral well-being should always be monitored in routine IEMs clinical management. Further studies are required to evaluate the possible impact of Trp metabolism, through gut microbiota, on cognitive and behavioral functions in IEMs, to identify innovative dietetic strategies and improve quality of life and mental health of these patients.
Collapse
Affiliation(s)
- Sara Parolisi
- UOSD Metabolic Diseases, AORN Santobono-Pausilipon, Naples, Italy
| | - Chiara Montanari
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Elisa Borghi
- Department of Health Science, University of Milan, Milan, Italy
| | - Chiara Cazzorla
- Division of Inherited Metabolic Diseases, DIDAS Department of Diagnostic Services, University Hospital, Padua, Italy
| | - Juri Zuvadelli
- Clinical Department of Pediatrics, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Martina Tosi
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy; Department of Health Science, University of Milan, Milan, Italy
| | - Rita Barone
- Child Neuropsychiatry Unit, Department of Clinical and Experimental Medicine, AOU Policlinico "G.Rodolico-San Marco", University of Catania, Catania, Italy
| | - Giulia Bensi
- Paediatrics & Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Cristina Bonfanti
- Rare metabolic disease unit, Pediatric Department, San Gerardo Hospital, Monza, Italy
| | | | - Giacomo Biasucci
- Paediatrics & Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Alberto Burlina
- Division of Inherited Metabolic Diseases, DIDAS Department of Diagnostic Services, University Hospital, Padua, Italy
| | - Maria T Carbone
- UOSD Metabolic Diseases, AORN Santobono-Pausilipon, Naples, Italy
| | - Elvira Verduci
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy; Department of Health Science, University of Milan, Milan, Italy.
| |
Collapse
|
|
3
|
Chronic refined carbohydrate consumption measured by glycemic load and variation in cognitive performance in healthy people. PERSONALITY AND INDIVIDUAL DIFFERENCES 2023. [DOI: 10.1016/j.paid.2023.112138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
|
|
4
|
Grout M, Lovegrove JA, Lamport DJ. A multimeal paradigm producing a low glycemic response is associated with modest cognitive benefits relative to a high glycemic response: a randomized, crossover trial in patients with type 2 diabetes. Am J Clin Nutr 2023; 117:859-869. [PMID: 36841444 DOI: 10.1016/j.ajcnut.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/02/2023] [Accepted: 02/21/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2DM) and poor glucose regulation in the immediate postprandial period are both associated with impairments in cognitive function. There is evidence that foods that generate a better postprandial glycemic response, such as low GI foods (which produce a lower glycemic peak, less variability, and a more sustained decline), are associated with cognitive benefits over the morning. However, the potential impact of consuming multiple meals of this nature over the course of a day on cognition in T2DM has not been explored. OBJECTIVES The primary aim of this research was to investigate whether a multimeal paradigm producing a low glycemic response was associated with cognitive benefits in patients with noninsulin-dependent T2DM relative to a multimeal paradigm producing a high glycemic response. METHODS Twenty-five adults with noninsulin-dependent T2DM (mean age: 57 y) consumed 2 multimeal profiles consisting of a breakfast, lunch, and afternoon snack on 2 separate test days following a randomized, counterbalanced, crossover design. The 2 conditions were a low GI profile (LGIP) and a high GI profile (HGIP). RESULTS Cognitive function, glycemic response, mood, and satiety were assessed over the day from 8:30 to 17:00. Overall, there were limited cognitive effects. However, there was evidence for cognitive benefits in the period before lunch, as demonstrated by better global cognitive and executive functions for the LGIP relative to the HGIP. No clear effects were observed for mood. CONCLUSIONS This study shows that a multimeal paradigm producing a low glycemic response was associated with some benefits for cognitive function in patients with T2DM. CLINICAL TRAIL REGISTRY REFERENCE NCT03360604 (clinical trial.gov).
Collapse
Affiliation(s)
- Matthew Grout
- School of Psychology and Clinical Language Science, University of Reading, United Kingdom
| | - Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Institute of Food, Nutrition and Health, Department of Food and Nutrition Sciences, University of Reading, United Kingdom
| | - Daniel J Lamport
- School of Psychology and Clinical Language Science, University of Reading, United Kingdom.
| |
Collapse
|
|
5
|
The impact of glycaemic load on cognitive performance: A meta-analysis and guiding principles for future research. Neurosci Biobehav Rev 2022; 141:104824. [PMID: 35963545 DOI: 10.1016/j.neubiorev.2022.104824] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022]
Abstract
The effect of breakfast glycaemic load (GL) on cognition was systematically examined. Randomised and non-randomised controlled trials were identified using PubMed, Scopus, and Cochrane Library (up to May 2022). 15 studies involving adults (aged 20 - 80 years) were included. Studies had a low risk, or some concerns, of bias. A random-effects meta-analysis model revealed no effect of GL on cognition up to 119 min post-consumption. However, after 120 min, immediate episodic memory scores were better following a low-GL compared to a high-GL (SMD = 0.16, 95% confidence interval [CI] = -0.00 to 0.32, p = 0.05, I2 = 5%). Subgroup analyses indicated that the benefit was greater in younger adults (<35 years) and those with better GT. A qualitative synthesis of 16 studies involving children and adolescents (aged 5 - 17 years) suggested that a low-GL breakfast may also benefit episodic memory and attention after 120 min. Methodological practises were identified which could explain a failure to detect benefits in some studies. Consequently, guiding principles were developed to optimise future study design.
Collapse
|
|
6
|
Drinking instead of eating as breakfast in South Korea: In which context do people place food with a beverage? Int J Gastron Food Sci 2022. [DOI: 10.1016/j.ijgfs.2022.100477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
|
7
|
Drozdowska A, Sinningen K, Falkenstein M, Rudolf H, Libuda L, Buyken AE, Lücke T, Kersting M. Impact of lunch with carbohydrates differing in glycemic index on children's cognitive functioning in the late postprandial phase: a randomized crossover study. Eur J Nutr 2021; 61:1637-1647. [PMID: 34902050 PMCID: PMC8921027 DOI: 10.1007/s00394-021-02766-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/30/2021] [Indexed: 12/01/2022]
Abstract
Purpose Studies about effects of lunch dietary Glycemic Index (GI) on cognition of schoolchildren are scarce. Our previous CogniDo GI study found no changes of cognition in the early postprandial phase after consumption of two rice types with medium vs. high dietary GI for lunch (i.e., 45 min after starting lunch). This study investigated whether the dietary GI of lunch has an impact on cognition of schoolchildren in the late postprandial phase, 90 min after lunch. Methods A randomized, 2 × 2 crossover intervention study was conducted at a comprehensive school with 5th and 6th grade students. Participants (n = 212) were randomly assigned to either sequence 1 or 2. In the first period, participants of sequence 1 received a dish with high GI rice (GI: 79), those of sequence 2 with medium GI rice (GI: 64)—in the second period, 1 week later, vice versa. Computer-based cognitive testing was performed 90 min after lunch examining tonic alertness, visual search and task switching, and working memory. Treatment effects and treatment effects adjusted for estimated lunch glycemic load (GL) were analyzed using a linear mixed model. Results The selected cognitive parameters were not affected by the GI of lunch 90 min after lunch, neither after intention-to-treat nor in the per-protocol analysis. Adjustment for GL also did not change results. Conclusion The present study revealed no notable differences after the consumption of two rice types with medium vs. high dietary GI for lunch in children’s cognitive function in the late postprandial phase, 90 min after lunch. Clinical trial registration German Clinical Trials Register (DRKS00013597); date of registration: 16/04/2018, retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1007/s00394-021-02766-y.
Collapse
Affiliation(s)
- Alina Drozdowska
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
| | - Kathrin Sinningen
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany.
| | | | - Henrik Rudolf
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Bochum, Germany
| | - Lars Libuda
- Paderborn University, Faculty of Natural Sciences, Institute of Nutrition, Consumption and Health, Nutrition Sciences, 33098, Paderborn, Germany
| | - Anette E Buyken
- Paderborn University, Faculty of Natural Sciences, Institute of Nutrition, Consumption and Health, Public Health Nutrition, 33098, Paderborn, Germany
| | - Thomas Lücke
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
| | - Mathilde Kersting
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
| |
Collapse
|
|
8
|
Granziera F, Guzzardi MA, Iozzo P. Associations between the Mediterranean Diet Pattern and Weight Status and Cognitive Development in Preschool Children. Nutrients 2021; 13:nu13113723. [PMID: 34835979 PMCID: PMC8624841 DOI: 10.3390/nu13113723] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/09/2021] [Accepted: 10/17/2021] [Indexed: 11/16/2022] Open
Abstract
Cognitive dysfunctions are a global health concern. Early-life diet and weight status may contribute to children’s cognitive development. For this reason, we explored the associations between habitual food consumption, body mass index (BMI) and cognitive outcomes in 54 preschool children belonging to the Pisa birth Cohort (PISAC). We estimated groups of foods, nutrients and calorie intakes through a food frequency questionnaire (FFQ) and Italian national databases. Then, we adopted the Mediterranean diet (MD) score to assess relative MD adherence. Cognition was examined using the Griffiths Mental Development Scales-Extended Revised (GMDS-ER). We found that higher, compared to low and moderate, adherence to MD was associated with higher performance scores. Furthermore, white meat consumption was positively related to BMI, and BMI (age–gender specific, z-scores) categories were negatively related to practical reasoning scores. All associations were independent of maternal IQ estimates, parents’ socioeconomic status, exclusive/non-exclusive breastfeeding, actual age at cognitive assessment and gender. In conclusion, in preschool children, very high adherence to MD seemed protective, whereas BMI (reinforced by the intake of white meat) was negatively associated with cognition.
Collapse
Affiliation(s)
- Federico Granziera
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (F.G.); (P.I.)
- Sant’Anna School of Advanced Studies, 56127 Pisa, Italy
| | - Maria Angela Guzzardi
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (F.G.); (P.I.)
- Correspondence: ; Tel.: +39-050-3152789
| | - Patricia Iozzo
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (F.G.); (P.I.)
| |
Collapse
|
|
9
|
Adolphus K, Hoyland A, Walton J, Quadt F, Lawton CL, Dye L. Ready-to-eat cereal and milk for breakfast compared with no breakfast has a positive acute effect on cognitive function and subjective state in 11-13-year-olds: a school-based, randomised, controlled, parallel groups trial. Eur J Nutr 2021; 60:3325-3342. [PMID: 33609174 PMCID: PMC8354968 DOI: 10.1007/s00394-021-02506-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE We tested the acute effect of breakfast (ready-to-eat-cereal [RTEC] and milk) versus (vs.) no breakfast on cognitive function and subjective state in adolescents. METHODS Healthy adolescents (n = 234) aged 11-13 years were recruited to take part in this school-based, acute, randomised, controlled, parallel groups trial with two interventions; Breakfast or No Breakfast. The breakfast intervention consisted of ad libitum intake of RTEC (up to 70 g) with milk (up to 300 ml) administered in a naturalistic school breakfast programme environment. Cognitive function was assessed at baseline and + 70 and + 215 min post-intervention in a group-testing situation, similar to a school classroom context. The CANTAB test battery included: Simple Reaction Time (SRT), 5-Choice Reaction Time (5-CRT), Rapid Visual Information Processing (RVIP), and Paired Associates Learning (PAL; primary outcome). Data collection commenced January 2011 and ended May 2011. This trial was retrospectively registered at www.clinicaltrials.gov as NCT03979027 on 07/06/2019. RESULTS A significant effect of the intervention (CMH[1] = 7.29, p < 0.01) was found for the number of levels achieved on the PAL task. A significant difference between interventions was found when baseline performance reached level 2 (JT, z = 2.58, p < 0.01), such that 100% of participants in the breakfast intervention reached the maximum level 4 but only 41.7% of those in the no breakfast intervention reached level 4. A significant baseline*intervention interaction (F[1,202] = 6.95, p < 0.01) was found for total errors made on the PAL task, indicating that participants who made above-average errors at baseline reduced the total number of errors made at subsequent test sessions following breakfast consumption whilst those in the no breakfast intervention did not. There was a positive effect of breakfast on reaction time and visual-sustained attention. The results also demonstrated interactions of intervention with baseline cognitive performance, such that breakfast conferred a greater advantage for performance when baseline performance was poorer. CONCLUSION Consuming breakfast has a positive acute effect on cognition in adolescents.
Collapse
Affiliation(s)
- Katie Adolphus
- Human Appetite Research Unit, School of Psychology, University of Leeds, Leeds, LS2 9JT, UK.
| | - Alexa Hoyland
- The Kellogg Company, Orange Tower Media City, Salford, Greater Manchester, UK
| | - Jenny Walton
- HarvestPlus, International Food Policy Research Institute, 1201 Eye Street NW, Washington, DC, 20005, USA
| | - Frits Quadt
- Quadt Consultancy BV, Oostvoorne, The Netherlands
| | - Clare L Lawton
- Human Appetite Research Unit, School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Louise Dye
- Human Appetite Research Unit, School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| |
Collapse
|
|
10
|
Hasan F, Jirout J, Garzione S, Kranz S. Changes in Learning Outcomes after Dietary Intervention in Preschoolers: A Pilot Study. Nutrients 2021; 13:1797. [PMID: 34070396 PMCID: PMC8230330 DOI: 10.3390/nu13061797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 11/23/2022] Open
Abstract
The executive functioning skill set, which includes working memory, cognitive flexibility, and inhibitory control, begins developing in early life and continues into adulthood. Preschoolers' abilities to perform those skills may be influenced by diet. The purpose of this study was to explore the acute effects of consuming a low-GI diet compared to the usual childcare diet on preschoolers' self-reported feelings of hunger and fullness and their performance on learning-associated tasks. This study was a prospective feeding trial in n = 20 children 3-4 years of age, completed in a laboratory setting where children attended "day camps" and consumed two days of usual diet (CON) and two days of low-GI (INT) diet. Learning outcomes were evaluated using select learning assessments including the Kansas Reflection-Impulsivity Scale for Preschoolers (KRISP), Track-it, Peg Tapping, and Happy/Sad. Repeated measures, full-factorial analysis of covariance revealed that diet was significantly related to impulsivity (p > 0.05), and univariate analysis of variance indicated that feelings of hunger and fullness differentially affected cognitive constructs in that feeling full improved impulsivity and attention, while feeling hungry improved inhibitory control. These findings highlight that the connection between diet and learning-related skills of children are independently mediated by both diet composition and feelings of hunger and fullness.
Collapse
Affiliation(s)
- Faten Hasan
- Department of Kinesiology, School of Education and Human Development, University of Virginia, Charlottesville, VA 22904, USA;
| | - Jamie Jirout
- Department of Education, Development, Leadership and Foundations, School of Education and Human Development, University of Virginia, Charlottesville, VA 22904, USA;
| | - Sarah Garzione
- College of Arts and Sciences, Formerly University of Virginia, Charlottesville, VA 22904, USA;
| | - Sibylle Kranz
- Department of Kinesiology, School of Education and Human Development, University of Virginia, Charlottesville, VA 22904, USA;
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22904, USA
| |
Collapse
|
|
11
|
Breakfast and Exercise Improve Academic and Cognitive Performance in Adolescents. Nutrients 2021; 13:nu13041278. [PMID: 33924598 PMCID: PMC8068805 DOI: 10.3390/nu13041278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/09/2021] [Accepted: 04/11/2021] [Indexed: 12/19/2022] Open
Abstract
This study examined the combined effects of breakfast and exercise on short-term academic and cognitive performance in adolescents. Eighty-two adolescents (64 female), aged 14–19 years, were randomized to four groups over a 4-hour morning: (i) a group who fasted and were sedentary (F-S); (ii) a group who ate breakfast but were sedentary (B-S); (iii) a group who fasted but completed a 30-min exercise bout (F-E); and (iv) a group who ate breakfast and completed a 30-min exercise bout (B-E). Individuals completed academic and cognitive tests over the morning. Adolescents in B-E significantly improved their mathematics score (B-E: 15.2% improvement on correct answers, vs. F-S: 6.7% improvement on correct answers; p = 0.014) and computation time for correct answers (B-E: 16.7% improvement, vs. F-S: 7.4% improvement; p = 0.004) over the morning compared with the F-S group. The B-E group had faster reaction times for congruent, incongruent and control trials of the Stroop Color-Word Task compared with F-S mid-morning (all p < 0.05). Morning breakfast and exercise combine to improve short-term mathematical task performance and speed in adolescents.
Collapse
|
|
12
|
Flavel M, Jois M, Kitchen B. Potential contributions of the methodology to the variability of glycaemic index of foods. World J Diabetes 2021; 12:108-123. [PMID: 33594331 PMCID: PMC7839170 DOI: 10.4239/wjd.v12.i2.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/03/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
Glycaemic index (GI) testing provides a useful point of comparison between carbohydrate sources. For this comparison to be meaningful, the methods used to determine GI values need to be rigorous and consistent between testing events. This requirement has led to increasing standardization of the GI methodology, with an international standard developed in joint consultation with FAO/WHO (ISO 26642:2010) currently the most up to date document. The purpose of this review is to compare the international standard to methods of published studies claiming to have performed a GI test. This analysis revealed that the international standard permits a wide range of choices for researchers when designing a GI testing plan, rather than a single standardized protocol. It has also been revealed that the literature contains significant variation, both between studies and from the international standard for critical aspects of GI testing methodology. The primary areas of variation include; what glucose specification is used, which reference food is used, how much reference food is given, what drink is given during testing, the blood sampling site chosen and what assay and equipment is used to measure blood glucose concentration. For each of these aspects we have explored some of the methodological and physiological implications of these variations. These insights suggest that whilst the international standard has assisted with framing the general parameters of GI testing, further stan-dardization to testing procedures is still required to ensure the continued relevance of the GI to clinical nutrition.
Collapse
Affiliation(s)
- Matthew Flavel
- Bioactive Division, The Product Makers, Keysborough 3173, Victoria, Australia
- School of Life Sciences, La Trobe University, Bundoora 3086, Australia
| | - Markandeya Jois
- School of Life Sciences, La Trobe University, Bundoora 3086, Australia
| | - Barry Kitchen
- Bioactive Division, The Product Makers, Keysborough 3173, Victoria, Australia
- School of Life Sciences, La Trobe University, Bundoora 3086, Australia
| |
Collapse
|
|
13
|
Cognitive performance, mood and satiety following ingestion of beverages imparting different glycaemic responses: a randomised double-blind crossover trial. Eur J Clin Nutr 2020; 75:602-610. [PMID: 32943769 DOI: 10.1038/s41430-020-00749-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/30/2020] [Accepted: 09/04/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVE The relationship between postprandial glycaemic responses and cognitive performance, mood and satiety are inconsistent. The objective of this study is to compare the effects of different glycaemic responses, induced by beverages with different glycaemic index (GI) (sucrose and isomaltulose), and a non-glycaemic control (sucralose), on cognition, mood and satiety. SUBJECTS/METHODS In this double-blinded, randomised crossover trial, healthy adults (n = 55) received sucrose (GI 65), isomaltulose (GI 32) and sucralose (non-caloric negative control) drinks on separate occasions. The Complex Figure test, the Word Recall test, Trail Making Test Part B and the Stroop test were administered 60 min after beverages ingestion. Mood and satiety were tested along with cognitive performance. RESULTS Comparing between isomaltulose and sucrose, there were no significant differences in the mean (95% CI) for the following: Complex Figure: immediate recall -0.6 (-1.7, 0.5), delayed recall -0.8 (-1.9, 0.3); Word recall: immediate recall 0.2 (-0.7, 1.1), delayed recall 0.5 (-0.4, 1.4); Trail Making: completing time -2.4 (-7.5, 2.7) s; Stroop: time used for correct congruent responses -9 (-31, 14) ms and correct incongruent responses -18 (-42, 6) ms. No differences among beverages were found in the mood and satiety scores with exception that participants felt more energetic 60 min after isomaltulose ingestion (p = 0.028 for difference with sucrose) and hungrier 30 min after isomaltulose ingestion (p = 0.036 for difference with sucrose; p = 0.022 for difference with sucralose). CONCLUSION Under these study conditions there is no convincing evidence for an effect of glycaemic response on cognitive performance, mood or satiety.
Collapse
|
|
14
|
Abstract
The effect on cognitive test scores of generating differences in postprandial glycaemia using test foods or beverages has been inconsistent. Methodological issues may account for some of the variable results requiring further investigation using strong study designs into the relationship between glycaemia and cognitive functioning. The objective of this study was to determine the effects of postprandial glycaemia on cognitive function by examining cognition after consumption of foods that differ only by the rate of digestion of available carbohydrate in a population of young adults. In a double-blind, randomised, crossover trial, sixty-five participants received trifle sweetened either with a higher-glycaemic index (GI) sugar (sucrose; GI 65) or a lower-GI sugar (isomaltulose; GI 34). Cognitive tests were completed prior to trifle consumption, and 60 and 120 min after. There was no between-trifle difference at 60 min in performance on free word recall (0·0 (95 % CI -0·6, 0·5)), short delay word recall (0·0 (95 % CI -0·5, 0·5)), long delay word recall (0·0 (95 % CI -0·6, 0·6)), letter-number sequence recall (0·3 (95 % CI - 0·2, 0·7)) and visuo-spatial recall (-0·2 (95 % CI -0·6, 0·2)) tests. At 120 min, no difference was detected in any of these tests. The participants performed 7·7 (95 % CI 0·5,14·9) s faster in Reitan's trail-making test B 60 min after the higher-GI trifle than the lower-GI trifle (P = 0·037). Our findings of a null effect on memory are generally consistent with other works in which blinding and robust control for confounding have been used.
Collapse
|
|
15
|
Short-term effects of carbohydrates differing in glycemic index (GI) consumed at lunch on children's cognitive function in a randomized crossover study. Eur J Clin Nutr 2020; 74:757-764. [PMID: 32203229 PMCID: PMC8626315 DOI: 10.1038/s41430-020-0600-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 12/02/2022]
Abstract
Background Intervention studies suggest an influence of breakfast dietary glycemic index (GI) on children’s cognition. The Cognition Intervention Study Dortmund-GI-I study examined whether lunch dietary GI might have short-term effects on selected cognitive parameters. Methods A randomized crossover study was performed at a comprehensive school on 2 test days. One hundred and eighty-nine participants (5th and 6th grade) were randomly assigned to one of the two sequences, medium-high GI (m-hGI) or high-medium GI (h-mGI), following block randomization. In the first period, one group received a dish containing hGI rice (GI: 86) ad libitum, the other mGI rice (GI: 62)—1 week later, in the second period, vice versa. Tonic alertness, task switching, and working memory updating were tested with a computerized test battery 45 min after beginning of lunch break. Treatment effects were estimated using the t test for normally distributed data or the Wilcoxon rank-sum test for non-normally distributed data. Results The crossover approach revealed no effects of lunch dietary GI on the tested cognitive parameters in the early afternoon. However, we determined carryover effects for two parameters, and therefore analyzed only data of the first period. The reaction time of the two-back task (working memory updating) was faster (p = 0.001) and the count of commission errors in the alertness task was lower (p = 0.04) in the hGI group. Conclusion No evidence of short-term effects of lunch dietary GI on cognition of schoolchildren was found. Potential positive effects on single parameters of working memory updating and tonic alertness favoring hGI rice need to be verified.
Collapse
|
|
16
|
Edgar CJ, Brooker H. Professor Keith Andrew Wesnes (1950 to 2020). ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2020; 12:e12086. [PMID: 32995463 PMCID: PMC7507086 DOI: 10.1002/dad2.12086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
|
17
|
Adolphus K, Lawton CL, Dye L. Associations Between Habitual School-Day Breakfast Consumption Frequency and Academic Performance in British Adolescents. Front Public Health 2019; 7:283. [PMID: 31824903 PMCID: PMC6879673 DOI: 10.3389/fpubh.2019.00283] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/18/2019] [Indexed: 11/13/2022] Open
Abstract
Studies indicate that breakfast positively affects learning in children. The present study aimed to examine associations between habitual school-day breakfast consumption frequency and academic performance, as measured by the General Certificate of Secondary Education (GCSE). The GCSE is a national academic qualification obtained by most British children during secondary education. Adolescents aged 16-18 years (n = 294; females: 77.2%) completed a retrospective 7-day food diary to report breakfast intake and a questionnaire to report GCSE grades. Breakfast was defined as any food or drink containing ≥5% of total energy expenditure (TEE) consumed up to 10:00 a.m. on school days. Habitual weekly school-day breakfast consumption frequency was categorized as rare (0-1 school days), occasional (2-3 school days), or frequent (4-5 school days). GCSE grades were aggregated into point scores and linear regression models were applied. Participants' GCSE grades in Mathematics and English were analyzed using ordinal logistic regression. Adolescents who rarely consumed breakfast on school days had a significantly lower capped point score (β = -0.13, p < 0.05) and mean point score (β = -0.14, p < 0.05) compared with frequent consumers. Low/middle socio-economic status (SES) adolescents who rarely consumed breakfast were significantly less likely to achieve higher Mathematics grades compared to low/middle SES adolescents who frequently consumed breakfast [adjusted cumulative odds ratio (OR): 0.35 95% confidence interval (CI): 0.17-0.72]. This cross-sectional study demonstrates that habitual school-day breakfast consumption amongst adolescents is a significant correlate of GCSE attainment. The results offer promising associative evidence which warrants further exploration in well controlled studies.
Collapse
Affiliation(s)
- Katie Adolphus
- Human Appetite Research Unit, School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Clare L Lawton
- Human Appetite Research Unit, School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Louise Dye
- Human Appetite Research Unit, School of Psychology, University of Leeds, Leeds, United Kingdom
| |
Collapse
|
|
18
|
Keesing C, Mills B, Rapsey C, Haszard J, Venn B. Cognitive Performance Following Ingestion of Glucose-Fructose Sweeteners That Impart Different Postprandial Glycaemic Responses: A Randomised Control Trial. Nutrients 2019; 11:nu11112647. [PMID: 31689943 PMCID: PMC6893461 DOI: 10.3390/nu11112647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/24/2019] [Accepted: 10/31/2019] [Indexed: 11/29/2022] Open
Abstract
We aimed to investigate the isolated effect of glycaemia on cognitive test performance by using beverages sweetened with two different glucose–fructose disaccharides, sucrose and isomaltulose. In a randomised crossover design, 70 healthy adults received a low-glycaemic-index (GI) isomaltulose and sucralose beverage (GI 32) and a high-GI sucrose beverage (GI 65) on two occasions that were separated by two weeks. Following beverage ingestion, declarative memory and immediate word recall were examined at 30, 80 and 130 min. At 140 min, executive function was tested. To confirm that the glycaemic response of the test beverages matched published GI estimates, a subsample (n = 12) of the cognitive testing population (n = 70) underwent glycaemic response testing on different test days. A significantly lower value of mean (95% CI) blood glucose concentration incremental area under the curve (iAUC) was found for isomaltulose, in comparison to the blood glucose concentration iAUC value for sucrose, the difference corresponding to −44 mmol/L∙min (−70, −18), p = 0.003. The mean (95% CI) difference in numbers of correct answers or words recalled between beverages at 30, 80 and 130 min were 0.1 (−0.2, 0.5), −0.3 (−0.8, 0.2) and 0.0 (−0.5, 0.5) for declarative memory, and −0.5 (−1.4, 0.3), 0.4 (−0.4, 1.3) and −0.4 (−1.1, 0.4) for immediate free word recall. At 140 min, the mean difference in the trail-making test between beverages was −0.3 sec (−6.9, 6.3). None of these differences were statistically or clinically significant. In summary, cognitive performance was unaffected by different glycaemic responses to beverages during the postprandial period of 140 min.
Collapse
Affiliation(s)
- Celeste Keesing
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
| | - Brianna Mills
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
| | - Charlene Rapsey
- Department of Psychological Medicine, Otago Medical School, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
| | - Jillian Haszard
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
| | - Bernard Venn
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
| |
Collapse
|
|
19
|
Jirout J, LoCasale-Crouch J, Turnbull K, Gu Y, Cubides M, Garzione S, Evans TM, Weltman AL, Kranz S. How Lifestyle Factors Affect Cognitive and Executive Function and the Ability to Learn in Children. Nutrients 2019; 11:E1953. [PMID: 31434251 PMCID: PMC6723730 DOI: 10.3390/nu11081953] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/08/2019] [Accepted: 08/14/2019] [Indexed: 12/13/2022] Open
Abstract
In today's research environment, children's diet, physical activity, and other lifestyle factors are commonly studied in the context of health, independent of their effect on cognition and learning. Moreover, there is little overlap between the two literatures, although it is reasonable to expect that the lifestyle factors explored in the health-focused research are intertwined with cognition and learning processes. This thematic review provides an overview of knowledge connecting the selected lifestyle factors of diet, physical activity, and sleep hygiene to children's cognition and learning. Research from studies of diet and nutrition, physical activity and fitness, sleep, and broader influences of cultural and socioeconomic factors related to health and learning, were summarized to offer examples of research that integrate lifestyle factors and cognition with learning. The literature review demonstrates that the associations and causal relationships between these factors are vastly understudied. As a result, current knowledge on predictors of optimal cognition and learning is incomplete, and likely lacks understanding of many critical facts and relationships, their interactions, and the nature of their relationships, such as there being mediating or confounding factors that could provide important knowledge to increase the efficacy of learning-focused interventions. This review provides information focused on studies in children. Although basic research in cells or animal studies are available and indicate a number of possible physiological pathways, inclusion of those data would distract from the fact that there is a significant gap in knowledge on lifestyle factors and optimal learning in children. In a climate where childcare and school feeding policies are continuously discussed, this thematic review aims to provide an impulse for discussion and a call for more holistic approaches to support child development.
Collapse
Affiliation(s)
- Jamie Jirout
- Center for Advanced Study of Teaching and Learning, Charlottesville, VA 22903, USA
| | | | - Khara Turnbull
- Center for Advanced Study of Teaching and Learning, Charlottesville, VA 22903, USA
| | - Yin Gu
- Center for Advanced Study of Teaching and Learning, Charlottesville, VA 22903, USA
| | - Mayaris Cubides
- Center for Advanced Study of Teaching and Learning, Charlottesville, VA 22903, USA
| | - Sarah Garzione
- Department of Kinesiology, Curry School of Education and Human Development, University of Virginia, Charlottesville, VA 22903, USA
| | - Tanya M Evans
- Center for Advanced Study of Teaching and Learning, Charlottesville, VA 22903, USA
| | - Arthur L Weltman
- Department of Kinesiology, Curry School of Education and Human Development, University of Virginia, Charlottesville, VA 22903, USA
| | - Sibylle Kranz
- Department of Kinesiology, Curry School of Education and Human Development, University of Virginia, Charlottesville, VA 22903, USA.
| |
Collapse
|
|
20
|
Álvarez-Bueno C, Martínez-Vizcaíno V, López EJ, Visier-Alfonso ME, Redondo-Tébar A, Cavero-Redondo I. Comparative Effect of Low-Glycemic Index versus High-Glycemic Index Breakfasts on Cognitive Function: A Systematic Review and Meta-Analysis. Nutrients 2019; 11:nu11081706. [PMID: 31344892 PMCID: PMC6723033 DOI: 10.3390/nu11081706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 11/16/2022] Open
Abstract
This systematic review and meta-analysis aims to compare the effect of High-Glycemic Index (GI) versus Low-GI breakfasts on cognitive functions, including memory and attention, of children and adolescents. We systematically searched the MEDLINE (via PubMed), EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases, from their inception until June 2019. Articles comparing the effect of Low-GI versus High-GI breakfasts on the cognitive function (i.e., immediate memory, delayed memory, and attention) of children and adolescents were included. The DerSimonian and Laird method was used to compute the pooled effect sizes (ESs) and their respective 95% confidence intervals (CIs). The pooled ESs were 0.13 (95% CI: −0.11, 0.37) for immediate memory and 0.07 (95% CI: −0.15, 0.28) for delayed memory. For attention, the pooled ES was −0.01 (95% CI: −0.27, 0.26). In summary, GI breakfasts do not affect cognitive domains in children and adolescents.
Collapse
Affiliation(s)
- Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción 1101, Paraguay
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain.
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago 3467987, Chile.
| | - Estela Jiménez López
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
- Department of Psychiatry, Hospital Virgen de La Luz, 16071 Cuenca, Spain
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), 28029 Madrid, Spain
| | | | - Andrés Redondo-Tébar
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción 1101, Paraguay
| |
Collapse
|
|
21
|
Jóźwiak S, Veggiotti P, Moreira J, Gama H, Rocha F, Soares-da-Silva P. Effects of adjunctive eslicarbazepine acetate on neurocognitive functioning in children with refractory focal-onset seizures. Epilepsy Behav 2018; 81:1-11. [PMID: 29454255 DOI: 10.1016/j.yebeh.2018.01.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/07/2018] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE This was a phase-II, randomized, double-blind (DB), placebo-controlled study aimed to evaluate neurocognitive effects of eslicarbazepine acetate (ESL) as adjunctive therapy in pediatric patients with refractory focal-onset seizures (FOS). METHODS Children (6-16years old) with FOS were randomized (2:1) to ESL or placebo. Treatment started at 10mg/kg/day, was up-titrated up to 30mg/kg/day (target dose), and maintained for 8weeks, followed by one-year open-label follow-up. The primary endpoint was change from baseline to the end of maintenance period in the composite Power of Attention assessed with the Cognitive Drug Research (CDR) system. Behavioral and emotional functioning and quality of life (QOL), secondary endpoints, were assessed with Child Health Questionnaire-Parent Form 50 (CHQ-PF50), Child Behavior Checklist (CBCL), and Raven's Standard Progressive Matrices (SPM). Efficacy was evaluated through changes in standardized seizure frequency (SF), responder rate, and proportion of seizure-free patients. Safety was evaluated by the incidence of treatment-emergent adverse events (TEAEs). RESULTS One hundred and twenty-three patients were randomized. A noninferiority analysis failed to reject the null hypothesis that the change from baseline in the Power of Attention score in the ESL group was at least 121ms inferior to the placebo group for all age groups. The CDR scores showed no differences between placebo and ESL in Power of Attention (1868.0 vs 1759.5), Continuity of Attention (1.136 vs -1.786), Quality of Working Memory (-0.023 vs -0.024), and Speed of Memory (-263.4 vs -249.6). Nonsignificant differences between placebo and ESL were seen for CHQ-PF50, CBCL scores, and Raven's SPM. Episodic Memory Index showed significant negative effect on ESL. Efficacy results favored the ESL group (SF least square [LS] means 1.98 vs 4.29). The TEAEs had a similar incidence between treatment groups (41.0% vs 47.5%). CONCLUSIONS Overall ESL did not produce statistically significant effects on neurocognitive and behavioral functioning in patients with epilepsy aged 6 to 16years. Additionally, ESL was effective in reducing seizure frequency and was well-tolerated.
Collapse
Affiliation(s)
- Sergiusz Jóźwiak
- Department of Child Neurology, Warsaw Medical University, Warsaw, Poland; Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland
| | - P Veggiotti
- Child Neurology Department, V. Buzzi Hospital, Milan, Italy; L. Sacco Department, University of Milan, Milan, Italy
| | - J Moreira
- BIAL - Portela & Cª. S.A., Coronado (S. Romão e S. Mamede), Portugal
| | - H Gama
- BIAL - Portela & Cª. S.A., Coronado (S. Romão e S. Mamede), Portugal
| | - F Rocha
- BIAL - Portela & Cª. S.A., Coronado (S. Romão e S. Mamede), Portugal
| | - P Soares-da-Silva
- BIAL - Portela & Cª. S.A., Coronado (S. Romão e S. Mamede), Portugal; Department of Biomedicine, Pharmacology and Therapeutics Unit, Faculty of Medicine, University Porto, Porto, Portugal; MedInUP - Center for Drug Discovery and Innovative Medicines, University Porto, Porto, Portugal.
| |
Collapse
|
|
22
|
Daly-Smith AJ, Zwolinsky S, McKenna J, Tomporowski PD, Defeyter MA, Manley A. Systematic review of acute physically active learning and classroom movement breaks on children's physical activity, cognition, academic performance and classroom behaviour: understanding critical design features. BMJ Open Sport Exerc Med 2018; 4:e000341. [PMID: 29629186 PMCID: PMC5884342 DOI: 10.1136/bmjsem-2018-000341] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/22/2018] [Indexed: 01/10/2023] Open
Abstract
Objective To examine the impact of acute classroom movement break (CMB) and physically active learning (PAL) interventions on physical activity (PA), cognition, academic performance and classroom behaviour. Design Systematic review. Data sources PubMed, EBSCO, Academic Search Complete, Education Resources Information Center, PsycINFO, SPORTDiscus, SCOPUS and Web of Science. Eligibility criteria for selecting studies Studies investigating school-based acute bouts of CMB or PAL on (PA), cognition, academic performance and classroom behaviour. The Downs and Black checklist assessed risk of bias. Results Ten PAL and eight CMB studies were identified from 2929 potentially relevant articles. Risk of bias scores ranged from 33% to 64.3%. Variation in study designs drove specific, but differing, outcomes. Three studies assessed PA using objective measures. Interventions replaced sedentary time with either light PA or moderate-to-vigorous PA dependent on design characteristics (mode, duration and intensity). Only one study factored individual PA outcomes into analyses. Classroom behaviour improved after longer moderate-to-vigorous (>10 min), or shorter more intense (5 min), CMB/PAL bouts (9 out of 11 interventions). There was no support for enhanced cognition or academic performance due to limited repeated studies. Conclusion Low-to-medium quality designs predominate in investigations of the acute impacts of CMB and PAL on PA, cognition, academic performance and classroom behaviour. Variable quality in experimental designs, outcome measures and intervention characteristics impact outcomes making conclusions problematic. CMB and PAL increased PA and enhanced time on task. To improve confidence in study outcomes, future investigations should combine examples of good practice observed in current studies. PROSPERO registration number CRD42017070981.
Collapse
Affiliation(s)
| | | | - Jim McKenna
- School of Sport, Leeds Beckett University, Leeds, UK
| | | | | | - Andrew Manley
- School of Sport, Leeds Beckett University, Leeds, UK
| |
Collapse
|
|
23
|
Palacios OM, Edirisinghe I, Wilcox ML, Burton-Freeman B, Xiao D, Maki KC. A Lean Pork-Containing Breakfast Reduces Hunger and Glycemic Response Compared to a Refined Carbohydrate-Containing Breakfast in Adults with Prediabetes. J Am Coll Nutr 2018; 37:293-301. [DOI: 10.1080/07315724.2017.1396266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Orsolya M. Palacios
- Midwest Biomedical Research, Center for Metabolic and Cardiovascular Health, Glen Ellyn, Illinois, USA
| | - Indika Edirisinghe
- Center for Nutrition Research, Institute for Food Safety and Health, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Meredith L. Wilcox
- Midwest Biomedical Research, Center for Metabolic and Cardiovascular Health, Glen Ellyn, Illinois, USA
| | - Britt Burton-Freeman
- Center for Nutrition Research, Institute for Food Safety and Health, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Di Xiao
- Center for Nutrition Research, Institute for Food Safety and Health, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Kevin C. Maki
- Midwest Biomedical Research, Center for Metabolic and Cardiovascular Health, Glen Ellyn, Illinois, USA
- Center for Nutrition Research, Institute for Food Safety and Health, Illinois Institute of Technology, Chicago, Illinois, USA
| |
Collapse
|
|
24
|
Bernard BN, Louise LC, Louise D. The Effects of Carbohydrates, in Isolation and Combined with Caffeine, on Cognitive Performance and Mood-Current Evidence and Future Directions. Nutrients 2018; 10:E192. [PMID: 29425182 PMCID: PMC5852768 DOI: 10.3390/nu10020192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/26/2018] [Accepted: 01/26/2018] [Indexed: 12/31/2022] Open
Abstract
This review examines the effects of carbohydrates, delivered individually and in combination with caffeine, on a range of cognitive domains and subjective mood. There is evidence for beneficial effects of glucose at a dose of 25 g on episodic memory, but exploration of dose effects has not been systematic and the effects on other cognitive domains is not known. Factors contributing to the differential sensitivity to glucose facilitation include age, task difficulty/demand, task domain, and glucoregulatory control. There is modest evidence to suggest modulating glycemic response may impact cognitive function. The evidence presented in this review identifies dose ranges of glucose and caffeine which improve cognition, but fails to find convincing consistent synergistic effects of combining caffeine and glucose. Whilst combining glucose and caffeine has been shown to facilitate cognitive performance and mood compared to placebo or glucose alone, the relative contribution of caffeine and glucose to the observed effects is difficult to ascertain, due to the paucity of studies that have appropriately compared the effects of these ingredients combined and in isolation. This review identifies a number of methodological challenges which need to be considered in the design of future hypothesis driven research in this area.
Collapse
Affiliation(s)
- Boyle Neil Bernard
- Leeds Nutrition and Behaviour Group, School of Psychology, University of Leeds, Leeds LS2 9JT, UK.
| | - Lawton Clare Louise
- Leeds Nutrition and Behaviour Group, School of Psychology, University of Leeds, Leeds LS2 9JT, UK.
| | - Dye Louise
- Leeds Nutrition and Behaviour Group, School of Psychology, University of Leeds, Leeds LS2 9JT, UK.
| |
Collapse
|
|
25
|
Acute Post-Prandial Cognitive Effects of Brown Seaweed Extract in Humans. Nutrients 2018; 10:nu10010085. [PMID: 29342865 PMCID: PMC5793313 DOI: 10.3390/nu10010085] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/06/2017] [Accepted: 01/10/2018] [Indexed: 12/28/2022] Open
Abstract
(Poly)phenols and, specifically, phlorotannins present in brown seaweeds have previously been shown to inhibit α-amylase and α-glucosidase, key enzymes involved in the breakdown and intestinal absorption of carbohydrates. Related to this are observations of modulation of post-prandial glycemic response in mice and increased insulin sensitivity in humans when supplemented with seaweed extract. However, no studies to date have explored the effect of seaweed extract on cognition. The current randomized, placebo-controlled, double-blind, parallel groups study examined the impact of a brown seaweed extract on cognitive function post-prandially in 60 healthy adults (N = 30 per group). Computerized measures of episodic memory, attention and subjective state were completed at baseline and 5 times at 40 min intervals over a 3 h period following lunch, with either seaweed or placebo consumed 30 min prior to lunch. Analysis was conducted with linear mixed models controlling for baseline. Seaweed led to significant improvements to accuracy on digit vigilance (p = 0.035) and choice reaction time (p = 0.043) tasks. These findings provide the first evidence for modulation of cognition with seaweed extract. In order to explore the mechanism underlying these effects, future research should examine effects on cognition in parallel with blood glucose and insulin responses.
Collapse
|
|
26
|
Edefonti V, Bravi F, Ferraroni M. Breakfast and behavior in morning tasks: Facts or fads? J Affect Disord 2017; 224:16-26. [PMID: 28062077 DOI: 10.1016/j.jad.2016.12.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 11/29/2016] [Accepted: 12/17/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Most of the studies investigating the effects of breakfast on cognitive performance have compared performance in subjects who have or have not consumed this meal. However, characteristics of breakfast itself may influence mental abilities. Moreover, as far as the positive effects of having breakfast is more evident, research may focus on the specific characteristics of an adequate breakfast. METHODS To update an existing systematic review, published at the beginning of 2014, on the role of nutrient composition and/or energy intake at breakfast on the accomplishment of school-related tasks and cognition, we carried out a systematic review of the literature through PUBMED database. RESULTS From the literature search, we identified 39 papers, of which 2 were eligible according to our inclusion criteria. Both the selected papers concerned randomized crossover studies on the acute effect of breakfast carried out in a school setting in the United Kingdom. Both studies compared 2 iso-energetic breakfasts with a similar macronutrient composition; however, the alternative breakfasts were meant to differ in terms of glycemic index or glycemic load. The effects of breakfast composition were investigated on memory, attention, and information processing in both studies. However, different tests and subdomains were considered. LIMITATIONS Studies on these issues are still inconsistent and quantitatively insufficient to draw firm conclusions. CONCLUSIONS While the hypothesis of a better mental performance with breakfast>20% daily energy intake still needs confirmation, there does appear to be extra evidence that a lower postprandial glycemic response is beneficial to mental performance.
Collapse
Affiliation(s)
- Valeria Edefonti
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
| | - Francesca Bravi
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Monica Ferraroni
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
|
27
|
Wilson TJ, Gray MJ, Van Klinken JW, Kaczmarczyk M, Foxe JJ. Macronutrient composition of a morning meal and the maintenance of attention throughout the morning. Nutr Neurosci 2017; 21:729-743. [PMID: 28714768 PMCID: PMC5924415 DOI: 10.1080/1028415x.2017.1347998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND At present, the impact of macronutrient composition and nutrient intake on sustained attention in adults is unclear, although some prior work suggests that nutritive interventions that engender slow, steady glucose availability support sustained attention after consumption. A separate line of evidence suggests that nutrient consumption may alter electroencephalographic markers of neurophysiological activity, including neural oscillations in the alpha-band (8-14 Hz), which are known to be richly interconnected with the allocation of attention. It is here investigated whether morning ingestion of foodstuffs with differing macronutrient compositions might differentially impact the allocation of sustained attention throughout the day as indexed by both behavior and the deployment of attention-related alpha-band activity. METHODS Twenty-four adult participants were recruited into a three-day study with a cross-over design that employed a previously validated sustained attention task (the Spatial CTET). On each experimental day, subjects consumed one of three breakfasts with differing carbohydrate availabilities (oatmeal, cornflakes, and water) and completed blocks of the Spatial CTET throughout the morning while behavioral performance, subjective metrics of hunger/fullness, and electroencephalographic (EEG) measurements of alpha oscillatory activity were recorded. RESULTS Although behavior and electrophysiological metrics changed over the course of the day, no differences in their trajectories were observed as a function of breakfast condition. However, subjective metrics of hunger/fullness revealed that caloric interventions (oatmeal and cornflakes) reduced hunger across the experimental day with respect to the non-caloric, volume-matched control (water). Yet, no differences in hunger/fullness were observed between the oatmeal and cornflakes interventions. CONCLUSION Observation of a relationship between macronutrient intervention and sustained attention (if one exists) will require further standardization of empirical investigations to aid in the synthesis and replicability of results. In addition, continued implementation of neurophysiological markers in this domain is encouraged, as they often produce nuanced insight into cognition even in the absence of overt behavioral changes. ClinicalTrials.gov Identifier: NCT03169283.
Collapse
Affiliation(s)
- Tommy J Wilson
- a The Sheryl and Daniel R. Tishman Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics , Albert Einstein College of Medicine & Montefiore Medical Center , Bronx , NY 10461 , USA.,b The Dominick P. Purpura Department of Neuroscience , Rose F. Kennedy Intellectual and Developmental Disabilities Research Center, Albert Einstein College of Medicine, Rose F. Kennedy Center , Bronx , NY 10461 , USA
| | - Michael J Gray
- d The Graduate Center of the City University of New York , New York , NY 10031
| | | | | | - John J Foxe
- a The Sheryl and Daniel R. Tishman Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics , Albert Einstein College of Medicine & Montefiore Medical Center , Bronx , NY 10461 , USA.,c Department of Neuroscience , The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry , Rochester , NY 14642 , USA
| |
Collapse
|
|
28
|
The impact of diet-based glycaemic response and glucose regulation on cognition: evidence across the lifespan. Proc Nutr Soc 2017; 76:466-477. [DOI: 10.1017/s0029665117000829] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The brain has a high metabolic rate and its metabolism is almost entirely restricted to oxidative utilisation of glucose. These factors emphasise the extreme dependence of neural tissue on a stable and adequate supply of glucose. Whereas initially it was thought that only glucose deprivation (i.e. under hypoglycaemic conditions) can affect brain function, it has become apparent that low-level fluctuations in central availability can affect neural and consequently, cognitive performance. In the present paper the impact of diet-based glycaemic response and glucose regulation on cognitive processes across the lifespan will be reviewed. The data suggest that although an acute rise in blood glucose levels has some short-term improvements of cognitive function, a more stable blood glucose profile, which avoids greater peaks and troughs in circulating glucose is associated with better cognitive function and a lower risk of cognitive impairments in the longer term. Therefore, a habitual diet that secures optimal glucose delivery to the brain in the fed and fasting states should be most advantageous for the maintenance of cognitive function. Although the evidence to date is promising, it is insufficient to allow firm and evidence-based nutritional recommendations. The rise in obesity, diabetes and metabolic syndrome in recent years highlights the need for targeted dietary and lifestyle strategies to promote healthy lifestyle and brain function across the lifespan and for future generations. Consequently, there is an urgent need for hypothesis-driven, randomised controlled trials that evaluate the role of different glycaemic manipulations on cognition.
Collapse
|
|
29
|
Ogoh S. Relationship between cognitive function and regulation of cerebral blood flow. J Physiol Sci 2017; 67:345-351. [PMID: 28155036 PMCID: PMC10717011 DOI: 10.1007/s12576-017-0525-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/23/2017] [Indexed: 12/11/2022]
Abstract
Ageing is the primary risk factor for cognitive deterioration. Given that the cerebral blood flow (CBF) or regulation of cerebral circulation is attenuated in the elderly, it could be expected that ageing-induced cognitive deterioration may be affected by a decrease in CBF as a result of brain ischemia and energy depletion. CBF regulation associated with cerebral metabolism thus likely plays an important role in the preservation of cognitive function. However, in some specific conditions (e.g. during exercise), change in CBF does not synchronize with that of cerebral metabolism. Our recent study demonstrated that cognitive function was more strongly affected by changes in cerebral metabolism than by changes in CBF during exercise. Therefore, it remains unclear how an alteration in CBF or its regulation affects cognitive function. In this review, I summarize current knowledge on previous investigations providing the possibility of an interaction between regulation of CBF or cerebral metabolism and cognitive function.
Collapse
Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-Shi, Saitama, 350-8585, Japan.
| |
Collapse
|
|
30
|
Adolphus K, Bellissimo N, Lawton CL, Ford NA, Rains TM, Totosy de Zepetnek J, Dye L. Methodological Challenges in Studies Examining the Effects of Breakfast on Cognitive Performance and Appetite in Children and Adolescents. Adv Nutr 2017; 8:184S-196S. [PMID: 28096143 PMCID: PMC5227972 DOI: 10.3945/an.116.012831] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Breakfast is purported to confer a number of benefits on diet quality, health, appetite regulation, and cognitive performance. However, new evidence has challenged the long-held belief that breakfast is the most important meal of the day. This review aims to provide a comprehensive discussion of the key methodological challenges and considerations in studies assessing the effect of breakfast on cognitive performance and appetite control, along with recommendations for future research. This review focuses on the myriad challenges involved in studying children and adolescents specifically. Key methodological challenges and considerations include study design and location, sampling and sample section, choice of objective cognitive tests, choice of objective and subjective appetite measures, merits of providing a fixed breakfast compared with ad libitum, assessment and definition of habitual breakfast consumption, transparency of treatment condition, difficulty of isolating the direct effects of breakfast consumption, untangling acute and chronic effects, and influence of confounding variables. These methodological challenges have hampered a clear substantiation of the potential positive effects of breakfast on cognition and appetite control and contributed to the debate questioning the notion that breakfast is the most important meal of the day.
Collapse
Affiliation(s)
- Katie Adolphus
- Human Appetite Research Unit, School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Nick Bellissimo
- Faculty of Community Services, School of Nutrition, Ryerson University, Toronto, Canada
| | - Clare L Lawton
- Human Appetite Research Unit, School of Psychology, University of Leeds, Leeds, United Kingdom
| | | | | | | | - Louise Dye
- Human Appetite Research Unit, School of Psychology, University of Leeds, Leeds, United Kingdom;
| |
Collapse
|
|
31
|
Codella R, Benedini S, Paini S, Caumo A, Adamo M, Terruzzi I, Ferrulli A, Macrì C, Andreoni L, Sterlicchio M, Luzi L. Effect of Sugar versus Mixed Breakfast on Metabolic and Neurofunctional Responses in Healthy Individuals. J Diabetes Res 2017; 2017:9634585. [PMID: 28706955 PMCID: PMC5494586 DOI: 10.1155/2017/9634585] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/28/2017] [Accepted: 03/23/2017] [Indexed: 12/31/2022] Open
Abstract
We investigated the effects of glucose and diverse breakfasts on glucose increment and ghrelin suppression and cognitive processing of sensory information assessed by frontal P300 evoked potentials. In a randomized crossover design, 12 healthy individuals (6M/6F; BMI 22.2 ± 0.4 kg/m2; 27 ± 1.3 years, mean ± SEM) underwent 50 g OGTT (A) and 3 breakfasts (B1: milk and cereals; B2: milk, apple, and chocolate cream-filled sponge cake; B3: milk, apple, bread, and hazelnut chocolate cream) to assess plasma glucose-, insulin-, and ghrelin excursions. An electroencephalography was performed before and 100 min after consumption of each load to measure the latency of frontal P300 evoked potentials as index of cognitive performance. Breakfasts B1 and B2 exhibited significantly lower glycemic and insulinemic responses as compared to A. Breakfast B3 exhibited significantly lower glycemic, but not insulinemic response, as compared to A. Final plasma ghrelin inhibition was more pronounced, albeit not significantly, in all breakfasts with respect to A. P300 latency tended to decrease following each of the three breakfasts, but B3 was the only breakfast capable to elicit a statistically significant reduction in P300 latency with respect to A (p < 0.01), suggesting ameliorated cognitive performance. Such amelioration was correlated with the 2-hour final inhibition of plasma ghrelin concentration (r = 0.61, p = 0.01).
Collapse
Affiliation(s)
- Roberto Codella
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Stefano Benedini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Stefano Paini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Andrea Caumo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Michela Adamo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Ileana Terruzzi
- Diabetes Research Institute, Metabolism, Nutrigenomics and Cellular Differentiation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Anna Ferrulli
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Concetta Macrì
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luca Andreoni
- Neurophysiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Michele Sterlicchio
- Neurophysiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Livio Luzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- *Livio Luzi:
| |
Collapse
|
|
32
|
The acute effect of a baobab fruit ( Adansonia digitata) smoothie on cognitive function in healthy adults. Proc Nutr Soc 2017. [DOI: 10.1017/s0029665117000167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
|
33
|
Sanchez-Aguadero N, Garcia-Ortiz L, Patino-Alonso MC, Mora-Simon S, Gomez-Marcos MA, Alonso-Dominguez R, Sanchez-Salgado B, Recio-Rodriguez JI. Postprandial effect of breakfast glycaemic index on vascular function, glycaemic control and cognitive performance (BGI study): study protocol for a randomised crossover trial. Trials 2016; 17:516. [PMID: 27776536 PMCID: PMC5078881 DOI: 10.1186/s13063-016-1649-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 10/07/2016] [Indexed: 12/24/2022] Open
Abstract
Background Postprandial glycaemic response affects cognitive and vascular function. The acute effect of breakfast glycaemic index on vascular parameters is not sufficiently known. Also, the influence of breakfasts with different glycaemic index on cognitive performance has been mostly studied in children and adolescents with varying results. Therefore, the purpose of this study is to analyse the postprandial effect of high and low glycaemic index breakfasts on vascular function and cognitive performance and their relationship with postprandial glycaemic response in healthy young adults. Methods/design This is a crossover clinical trial targeting adults (aged 20–40 years, free from cardiovascular disease) selected by consecutive sampling at urban primary care health clinics in Salamanca (Spain). Each subject will complete three interventions with a washout period of one week: a control condition (consisting of water); a low glycaemic index breakfast (consisting of dark chocolate, walnuts, yogurt and an apple, with an overall glycaemic index of 29.4 and an energy contribution of 1489 kJ); and a high glycaemic index breakfast (consisting of bread, grape juice and strawberry jam, with an overall glycaemic index of 64.0 and an energy contribution of 1318 kJ). The postprandial effect will be assessed at 60 and 120 minutes from each breakfast including blood sampling and cognitive performance evaluations. Measurements of arterial stiffness and central haemodynamic parameters will be taken at –10, 0, 15, 30, 45, 60, 75, 90, 105 and 120 minutes. Discussion The differences in postprandial glycaemic response due to breakfast glycaemic index could affect vascular parameters and cognitive performance with important applications and implications for the general population. This could provide necessary information for the establishment of new strategies in terms of nutritional education and work performance improvement. Trial registration ClinicalTrials.gov: NCT02616276. Registered on 19 November 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1649-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Natalia Sanchez-Aguadero
- Primary Care Research Unit, The Alamedilla Health Centre, Castilla and León Health Service (SACYL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain. .,Primary Care Research Unit, The Alamedilla Health Centre, Av. Comuneros N° 27, 37003, Salamanca, Spain.
| | - Luis Garcia-Ortiz
- Primary Care Research Unit, The Alamedilla Health Centre, Castilla and León Health Service (SACYL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - Maria C Patino-Alonso
- Department of Statistics, University of Salamanca, Salamanca, Spain.,Primary Care Research Unit, The Alamedilla Health Centre, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Sara Mora-Simon
- Primary Care Research Unit, The Alamedilla Health Centre, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,School of Labor Relations, University of Salamanca Affiliated Centre, Zamora, Spain
| | - Manuel A Gomez-Marcos
- Primary Care Research Unit, The Alamedilla Health Centre, Castilla and León Health Service (SACYL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Rosario Alonso-Dominguez
- Primary Care Research Unit, The Alamedilla Health Centre, Castilla and León Health Service (SACYL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Benigna Sanchez-Salgado
- Primary Care Research Unit, The Alamedilla Health Centre, Castilla and León Health Service (SACYL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Jose I Recio-Rodriguez
- Primary Care Research Unit, The Alamedilla Health Centre, Castilla and León Health Service (SACYL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
| |
Collapse
|
|
34
|
Priebe MG, McMonagle JR. Effects of Ready-to-Eat-Cereals on Key Nutritional and Health Outcomes: A Systematic Review. PLoS One 2016; 11:e0164931. [PMID: 27749919 PMCID: PMC5066953 DOI: 10.1371/journal.pone.0164931] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/04/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In many countries breakfast cereals are an important component of breakfast. This systematic review assesses the contribution of consumption of ready-to eat cereal (RTEC) to the recommended nutrient intake. Furthermore, the effects of RTEC consumption on key health parameters are investigated as well as health promoting properties of RTEC. METHOD The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL have been searched up till 16th of June 2015. Randomized controlled trials were excluded if RTEC were used during hypocaloric diets, if RTEC were eaten at other times than breakfast and if breakfasts included other products than RTEC, milk and fruit. Observational studies were excluded when "breakfast cereals" were not defined or their definition included cooked cereals. From cross-sectional studies only data concerning energy and nutrient intake as well as micronutrient status were used. RESULTS From 4727 identified citations 64 publications met the inclusion criteria of which 32 were cross-sectional studies, eight prospective studies and 24 randomized controlled trials. Consumption of RTEC is associated with a healthier dietary pattern, concerning intake of carbohydrates, dietary fiber, fat and micronutrients, however total sugar intake is higher. Persons consuming RTEC frequently (≥ 5 times/week) have a lower risk of inadequate micronutrient intake especially for vitamin A, calcium, folate, vitamin B 6, magnesium and zinc. Evidence from prospective studies suggests that whole grain RTEC may have beneficial effects on hypertension and type 2 diabetes. Consumption of RTEC with soluble fiber helps to reduce LDL cholesterol in hypercholesterolemic men and RTEC fortified with folate can reduce plasma homocysteine. DISCUSSION One of the review's strengths is its thorough ex/inclusion of studies. Limitations are that results of observational studies were based on self-reported data and that many studies were funded by food-industry. CONCLUSION Consumption of RTEC, especially of fiber-rich or whole grain RTEC, is implicated with several beneficial nutritional and health outcomes. The effect on body weight, intestinal health and cognitive function needs further evaluation. Of concern is the higher total sugar intake associated with frequent RTEC consumption.
Collapse
Affiliation(s)
- Marion G. Priebe
- University Medical Center Groningen, University of Groningen, Center for Medical Biomics, Groningen, The Netherlands
- Nutrition Reviewed, Murnau, Germany
| | | |
Collapse
|
|
35
|
The effect of healthy dietary consumption on executive cognitive functioning in children and adolescents: a systematic review. Br J Nutr 2016; 116:989-1000. [DOI: 10.1017/s0007114516002877] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractA systematic review was conducted to evaluate whether healthier dietary consumption among children and adolescents impacts executive functioning. PubMed, Education Resources Information Center, PsychINFO and Thomson Reuters’ Web of Science databases were searched, and studies of executive functioning among children or adolescents aged 6–18 years, which examined food quality, macronutrients and/or foods, were included. Study quality was also assessed. In all, twenty-one studies met inclusion criteria. Among the twelve studies examining food quality (n 9) or macronutrient intakes (n 4), studies examining longer-term diet (n 6) showed positive associations between healthier overall diet quality and executive functioning, whereas the studies examining the acute impact of diet (n 6) were inconsistent but suggestive of improvements in executive functioning with better food quality. Among the ten studies examining foods, overall, there was a positive association between healthier foods (e.g. whole grains, fish, fruits and/or vegetables) and executive function, whereas less-healthy snack foods, sugar-sweetened beverages and red/processed meats were inversely associated with executive functioning. Taken together, evidence suggests a positive association between healthy dietary consumption and executive functioning. Additional studies examining the effects of healthier food consumption, as well as macronutrients, on executive functioning are warranted. These studies should ideally be conducted in controlled environments and use validated cognitive tests.
Collapse
|
|
36
|
Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification. Case Rep Psychiatry 2016; 2016:7165425. [PMID: 27493821 PMCID: PMC4963565 DOI: 10.1155/2016/7165425] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/26/2016] [Indexed: 12/12/2022] Open
Abstract
Observational evidence suggests that a relationship may exist between high glycemic index diets and the development of anxiety and depression symptoms; however, as no interventional studies assessing this relationship in a psychiatric population have been completed, the possibility of a causal link is unclear. AB is a 15-year-old female who presented with concerns of generalized anxiety disorder and hypoglycemia symptoms. Her diet consisted primarily of refined carbohydrates. The addition of protein, fat, and fiber to her diet resulted in a substantial decrease in anxiety symptoms as well as a decrease in the frequency and severity of hypoglycemia symptoms. A brief return to her previous diet caused a return of her anxiety symptoms, followed by improvement when she restarted the prescribed diet. This case strengthens the hypothesis that dietary glycemic index may play a role in the pathogenesis or progression of mental illnesses such as generalized anxiety disorder and subsequently that dietary modification as a therapeutic intervention in the treatment of mental illness warrants further study.
Collapse
|
|
37
|
Adolphus K, Lawton CL, Champ CL, Dye L. The Effects of Breakfast and Breakfast Composition on Cognition in Children and Adolescents: A Systematic Review. Adv Nutr 2016; 7:590S-612S. [PMID: 27184287 PMCID: PMC4863264 DOI: 10.3945/an.115.010256] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Breakfast is thought to be beneficial for cognitive and academic performance in school children. However, breakfast is the most frequently skipped meal, especially among adolescents. The aim of the current article was to systematically review the evidence from intervention studies for the effects of breakfast on cognitive performance in children and adolescents. The effects of breakfast were evaluated by cognitive domain and breakfast manipulation. A total of 45 studies reported in 43 articles were included in the review. Most studies considered the acute effect of a single breakfast (n = 34). The acute studies looked at breakfast compared with no breakfast (n = 24) and/or comparisons of breakfast type (n = 15). The effects of chronic school breakfast program interventions were evaluated in 11 studies. The findings suggest that breakfast consumption relative to fasting has a short-term (same morning) positive domain-specific effect on cognition. Tasks requiring attention, executive function, and memory were facilitated more reliably by breakfast consumption relative to fasting, with effects more apparent in undernourished children. Firm conclusions cannot be made about the acute effects of breakfast composition and the effects of chronic breakfast interventions because there are too few studies and these largely report inconsistent findings. This review also highlights methodologic limitations of the existing research. These include a lack of research on adolescents, few naturalistic breakfast manipulations or testing environments, small samples, and insensitive cognitive tests.
Collapse
Affiliation(s)
- Katie Adolphus
- Human Appetite Research Unit, School of Psychology, University of Leeds, Leeds, United Kingdom
| | | | | | | |
Collapse
|
|
38
|
Richards G, Smith AP. Breakfast and Energy Drink Consumption in Secondary School Children: Breakfast Omission, in Isolation or in Combination with Frequent Energy Drink Use, is Associated with Stress, Anxiety, and Depression Cross-Sectionally, but not at 6-Month Follow-Up. Front Psychol 2016; 7:106. [PMID: 26903914 PMCID: PMC4746319 DOI: 10.3389/fpsyg.2016.00106] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/19/2016] [Indexed: 11/16/2022] Open
Abstract
A considerable amount of research suggests that breakfast omission and the frequent use of caffeinated energy drinks may be associated with undesirable effects, and particularly so in children and adolescents. The current paper presents cross-sectional and longitudinal data from the Cornish Academies Project to investigate the effects of consuming energy drinks and missing breakfast on stress, anxiety, and depression in a cohort of secondary school children from the South West of England. Questionnaires were administered at two time-points (spaced 6 months apart) to collect information relating to diet and lifestyle over the previous 6 months. Demographic and school data were acquired through the School Information Management System, and single-item measures of stress, anxiety, and depression were administered at the second time-point only. Associations between breakfast and energy drink consumption and stress, anxiety, and depression were investigated, and a multivariate approach was taken so that additional variance from diet, demography, and lifestyle could be controlled for statistically. Cross-sectional analyses showed that breakfast omission was consistently associated with negative outcomes, and that this was largely observed for both those who frequently consumed energy drinks and those who did not. However, cross-lag analyses showed that neither breakfast omission or energy drink consumption, alone or in combination, was predictive of stress, anxiety, or depression at 6-month follow-up. This suggests that associations between breakfast and mental health may be bi-directional rather than breakfast being the causal factor.
Collapse
Affiliation(s)
- Gareth Richards
- Centre for Occupational and Health Psychology, School of Psychology, Cardiff University Cardiff, UK
| | - Andrew P Smith
- Centre for Occupational and Health Psychology, School of Psychology, Cardiff University Cardiff, UK
| |
Collapse
|
|
39
|
Haghighatdoost F, Azadbakht L, Keshteli AH, Feinle-Bisset C, Daghaghzadeh H, Afshar H, Feizi A, Esmaillzadeh A, Adibi P. Glycemic index, glycemic load, and common psychological disorders. Am J Clin Nutr 2016; 103:201-209. [PMID: 26607943 DOI: 10.3945/ajcn.114.105445] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 10/09/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Potential associations between dietary glycemic index (GI) and glycemic load (GL) with psychological disorders remain uncertain. OBJECTIVE We investigated the relations of dietary GI and GL with psychological distress, anxiety, and depression. DESIGN A total of 3363 nonacademic members of the staff of Isfahan University of Medical Sciences were included in this cross-sectional study. GI and GL were assessed by using a validated, self-administered, dish-based, semiquantitative food-frequency questionnaire. Validated Iranian versions of the Hospital Anxiety and Depression Scale and General Health Questionnaire-12 were used to assess anxiety, depression, and psychological distress. RESULTS After control for potential confounders, individuals in the top tertile of GI had greater odds of depression (OR: 1.44; 95% CI: 1.03, 2.02; P-trend = 0.03) and a trend for greater odds of anxiety (OR: 1.52; 95% CI: 0.97, 2.38; P trend = 0.06) compared with those in the first tertile. Higher GL values were linked to lower odds for mental disorders (OR: 0.66; 95% CI: 0.49, 0.90; P-trend = 0.009), depression (OR: 0.69; 95% CI: 0.51, 0.93; P-trend = 0.02), and psychological distress (OR: 0.67; 95% CI: 0.48, 0.92; P-trend = 0.01). Significant interactions were observed between GI and sex for depression (P = 0.01) and psychological distress (P = 0.046) in the crude model. In stratified analyses by sex, after control for potential confounders, a greater GI was linked to a higher odds of depression (OR: 1.52; 95% CI: 1.20, 1.94; P-trend = 0.001) and psychological distress (OR: 1.66; 95% CI: 1.28, 2.14; P-trend = 0.001) in women but not in men. CONCLUSION Our findings support a direct link between the odds of depression and dietary GI but inverse associations between GL and mental disorders, depression, and psychological distress. This trial was registered at clinicaltrials.gov as NCT02362113.
Collapse
Affiliation(s)
- Fahimeh Haghighatdoost
- Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science
| | - Leila Azadbakht
- Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran;
| | | | - Christine Feinle-Bisset
- University of Adelaide Discipline of Medicine and National Health and Medical Research Council Centre of Research Excellence of Translating Nutritional Science to Good Health, Adelaide, Australia
| | | | - Hamid Afshar
- Integrative Functional Gastroenterology Research Center, and
| | - Awat Feizi
- Biostatistics and Epidemiology Department, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Peyman Adibi
- Integrative Functional Gastroenterology Research Center, and
| |
Collapse
|
|
40
|
Meador KJ, Yang H, Piña-Garza JE, Laurenza A, Kumar D, Wesnes KA. Cognitive effects of adjunctive perampanel for partial-onset seizures: A randomized trial. Epilepsia 2016; 57:243-51. [PMID: 26724782 PMCID: PMC4785606 DOI: 10.1111/epi.13279] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 12/01/2022]
Abstract
Objective Assess cognitive effects of adjunctive perampanel in adolescents. Methods In this double‐blind study (ClinicalTrials.gov identifier: NCT01161524), patients aged 12 to <18 years with partial‐onset seizures despite receiving 1–3 antiepileptic drugs were randomized (2:1) to perampanel or placebo. Perampanel was increased weekly in 2‐mg increments to 8–12 mg/day (6‐week titration; 13‐week maintenance). Changes in neuropsychological outcomes were assessed at end of maintenance: Cognitive Drug Research (CDR) System Global Cognition Score (primary end point), five CDR System domain T‐scores (secondary end points), letter fluency, category fluency, and Lafayette Grooved Pegboard Test (LGPT). Results One hundred thirty‐three patients were randomized. In the full analysis set, there were no differences of perampanel (n = 79) vs. placebo (n = 44) in CDR System Global Cognition Score (least squares mean change, −0.6 vs. 1.6; p = 0.145), Quality of Working Memory (1.1 vs. 2.0; p = 0.579), or Power of Attention (−6.9 vs. −2.7; p = 0.219). There were small differences with perampanel vs. placebo in other CDR System domains: improvements in Quality of Episodic Memory (3.0 vs. −1.2; p = 0.012), and worsening in Continuity of Attention (−3.3 vs. 1.6; p = 0.013) and Speed of Memory (0.3 vs. 7.0; p = 0.032). Letter fluency, category fluency, and LGPT were not significantly different between groups. The most frequent adverse events with perampanel were dizziness (30.6%) and somnolence (15.3%). Significance Perampanel did not differ from placebo in the global cognitive score, two of five subdomains, and four other cognitive measures. Perampanel was worse on two and better on one subdomain.
Collapse
Affiliation(s)
- Kimford J Meador
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Haichen Yang
- Eisai Neuroscience and General Medicine PCU, Eisai Inc., Woodcliff Lake, New Jersey, U.S.A
| | | | - Antonio Laurenza
- Eisai Neuroscience and General Medicine PCU, Eisai Inc., Woodcliff Lake, New Jersey, U.S.A
| | - Dinesh Kumar
- Eisai Neuroscience and General Medicine PCU, Eisai Inc., Woodcliff Lake, New Jersey, U.S.A
| | - Keith A Wesnes
- Wesnes Cognition, Streatley on Thames, United Kingdom.,Psychology Department, Northumbria University, Newcastle, United Kingdom
| |
Collapse
|
|
41
|
Ptomey LT, Steger FL, Schubert MM, Lee J, Willis EA, Sullivan DK, Szabo-Reed AN, Washburn RA, Donnelly JE. Breakfast Intake and Composition Is Associated with Superior Academic Achievement in Elementary Schoolchildren. J Am Coll Nutr 2015; 35:326-33. [PMID: 26697955 DOI: 10.1080/07315724.2015.1048381] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine whether breakfast consumption or content affects academic achievement measured by standardized tests. METHODS Baseline data were collected in fall of 2011 from 698 students (50.5% female, age = 7.5 ± 0.6 years) living in the state of Kansas. Academic achievement was assessed using 3 components from the Wechsler Individual Achievement Test (WIAT-III). Prior to taking the WIAT-III, participants completed a breakfast recall of all foods and drinks consumed that morning, which was analyzed using Nutrition Data System for Research (NDS-R). WIAT-III scores were compared between breakfast and non-breakfast consumers in a sample (n = 162) matched for age, sex, race, education level of both parents, household income, body mass index (BMI), and cardiovascular fitness, and Pearson correlations were calculated from all breakfast eaters (n = 617) between test performance and components of the breakfast. RESULTS When compared to non-breakfast consumers, the breakfast consumers had significantly higher scores in all 3 WIAT-III components (all p < 0.05). In breakfast consumers, servings of fruit juice were negatively correlated with reading comprehension and fluency standard score and mathematics standard score (both p < 0.0001), and greater servings of whole grains were significantly related to higher scores in reading comprehension and fluency and mathematics (both p < 0.05). CONCLUSION Both breakfast consumption and the content may be associated with improved standardized test performance in elementary school students.
Collapse
Affiliation(s)
- Lauren T Ptomey
- a Cardiovascular Research Institute, Division of Internal Medicine
| | - Felicia L Steger
- a Cardiovascular Research Institute, Division of Internal Medicine
| | | | - Jaehoon Lee
- c The University of Kansas Medical Center , Kansas City , Kansas.,d Institute for Measurement, Methodology, Analysis, and Policy, Texas Tech University , Lubbock , Texas
| | - Erik A Willis
- a Cardiovascular Research Institute, Division of Internal Medicine
| | | | | | | | | |
Collapse
|
|
42
|
Khan NA, Raine LB, Donovan SM, Hillman CH. IV. The cognitive implications of obesity and nutrition in childhood. Monogr Soc Res Child Dev 2015; 79:51-71. [PMID: 25387415 DOI: 10.1111/mono.12130] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The prevalence of childhood obesity in the United States has tripled since the 1980s and is strongly linked to the early onset of several metabolic diseases. Recent studies indicate that lower cognitive function may be another complication of childhood obesity. This review considers the research to date on the role of obesity and nutrition on childhood cognition and brain health. Although a handful of studies point to a maladaptive relationship between obesity and aspects of cognitive control, remarkably little is known regarding the impact of fat mass on brain development and cognitive function. Further, missing from the literature is the role of nutrition in the obesity-cognition interaction. Nutrition may directly or indirectly influence cognitive performance via several pathways including provision of key substrates for optimal brain health, modulation of gut microbiota, and alterations in systemic energy balance. However, in the absence of malnutrition, the functional benefits of specific nutrient intake on particular cognitive domains are not well characterized. Here, we examine the literature linking childhood obesity and cognition while considering the effects of nutritional intake. Possible mechanisms for these relationships are discussed and suggestions are made for future study topics. Although childhood obesity prevalence rates in some developed countries have recently stabilized, significant disparities remain among groups based on sex and socioeconomic status. Given that the elevated prevalence of pediatric overweight and obesity may persist for the foreseeable future, it is crucial to develop a comprehensive understanding of the influence of obesity and nutrition on cognition and brain health in the pediatric population.
Collapse
|
|
43
|
Kaur B, Ranawana V, Henry J. The Glycemic Index of Rice and Rice Products: A Review, and Table of GI Values. Crit Rev Food Sci Nutr 2015; 56:215-36. [DOI: 10.1080/10408398.2012.717976] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
|
44
|
Cooper SB, Bandelow S, Nute ML, Morris JG, Nevill ME. Breakfast glycaemic index and exercise: combined effects on adolescents' cognition. Physiol Behav 2014; 139:104-11. [PMID: 25446221 DOI: 10.1016/j.physbeh.2014.11.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022]
Abstract
The aim of the present study was to examine the combined effects of breakfast glycaemic index (GI) and a mid-morning bout of exercise on adolescents' cognitive function. Participants were randomly allocated to a high or low GI breakfast group in a mixed research design, where each participant completed two experimental trials (exercise and resting). Forty-two adolescents (12.4±0.5 years old), undertook a bout of exercise (ten repeats of level one of the multi-stage fitness test; exercise trial) or continued to rest (resting trial) following consumption of either a high or low GI breakfast. A battery of cognitive function tests (visual search test, Stroop test and Sternberg paradigm) was completed 30 min before and 45 min following the exercise. Average heart rate during exercise was 170±15 beats·min(-1). On the complex level of the Stroop test, response times improved across the morning following the low GI breakfast on both the exercise and resting trials, though the improvement was greatest on the exercise trial. However, response times only improved on the resting trial following the high GI breakfast (p=0.012). On the 5 letter level of the Sternberg paradigm, response times improved across the morning following the low GI breakfast (regardless of exercise) and only on the exercise trial following the high GI breakfast (p=0.019). The findings of the present study suggest that the combined effects of breakfast GI and exercise in adolescents depend upon the component of cognitive function examined. A low GI breakfast and mid-morning bout of exercise were individually beneficial for response times on the Sternberg paradigm, whereas they conferred additional benefits for response times on the Stroop test.
Collapse
Affiliation(s)
- Simon B Cooper
- Sport, Health & Performance Enhancement (SHAPE) Research Group, Sport Science Department, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, United Kingdom.
| | - Stephan Bandelow
- Institute of Youth Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE11 3TU, United Kingdom.
| | - Maria L Nute
- Institute of Youth Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE11 3TU, United Kingdom.
| | - John G Morris
- Sport, Health & Performance Enhancement (SHAPE) Research Group, Sport Science Department, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, United Kingdom.
| | - Mary E Nevill
- Sport, Health & Performance Enhancement (SHAPE) Research Group, Sport Science Department, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, United Kingdom.
| |
Collapse
|
|
45
|
Zadra JR, Proffitt DR. Implicit associations have a circadian rhythm. PLoS One 2014; 9:e110149. [PMID: 25365254 PMCID: PMC4217730 DOI: 10.1371/journal.pone.0110149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 09/17/2014] [Indexed: 11/19/2022] Open
Abstract
The current study shows that people's ability to inhibit implicit associations that run counter to their explicit views varies in a circadian pattern. The presence of this rhythmic variation suggests the involvement of a biological process in regulating automatic associations—specifically, with the current data, associations that form undesirable social biases. In 1998, Greenwald, McGhee, and Schwartz introduced the Implicit Association Test as a means of measuring individual differences in implicit cognition. The IAT is a powerful tool that has become widely used. Perhaps most visibly, studies employing the IAT demonstrate that people generally hold implicit biases against social groups, which often conflict with their explicitly held views. The IAT engages inhibitory processes similar to those inherent in self-control tasks. Because the latter processes are known to be resource-limited, we considered whether IAT scores might likewise be resource dependent. Analyzing IAT performance from over a million participants across all times of day, we found a clear circadian pattern in scores. This finding suggests that the IAT measures not only the strength of implicit associations, but also the effect of variations in the physiological resources available to inhibit their undesirable influences on explicit behavior.
Collapse
Affiliation(s)
- Jonathan R. Zadra
- Department of Psychology, University of Utah, Salt Lake City, Utah, United States of America
- Department of Psychology, University of Virginia, Charlottesville, Virginia, United States of America
- * E-mail:
| | - Dennis R. Proffitt
- Department of Psychology, University of Virginia, Charlottesville, Virginia, United States of America
| |
Collapse
|
|
46
|
Scholey A, Gibbs A, Neale C, Perry N, Ossoukhova A, Bilog V, Kras M, Scholz C, Sass M, Buchwald-Werner S. Anti-stress effects of lemon balm-containing foods. Nutrients 2014; 6:4805-21. [PMID: 25360512 PMCID: PMC4245564 DOI: 10.3390/nu6114805] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 10/16/2014] [Accepted: 10/23/2014] [Indexed: 11/17/2022] Open
Abstract
Lemon balm (Melissa officinalis) has been used historically and contemporarily as a modulator of mood and cognitive function, with anxiolytic effects following administration of capsules, coated tablets and topical application. Following a pilot study with lemon balm extract administered as a water based drink, which confirmed absorption of rosmarinic acid effects on mood and cognitive function, we conducted two similar double-blind, placebo-controlled, crossover studies. These evaluated the mood and cognitive effects of a standardised M. officinalis preparation administered in palatable forms in a beverage and in yoghurt. In each study a cohort of healthy young adults' self-rated aspects of mood were measured before and after a multi-tasking framework (MTF) administered one hour and three hours following one of four treatments. Both active lemon balm treatments were generally associated with improvements in mood and/or cognitive performance, though there were some behavioral "costs" at other doses and these effects depended to some degree on the delivery matrix.
Collapse
Affiliation(s)
- Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University, Melbourne VIC 3122, Australia.
| | - Amy Gibbs
- Centre for Human Psychopharmacology, Swinburne University, Melbourne VIC 3122, Australia.
| | - Chris Neale
- Centre for Human Psychopharmacology, Swinburne University, Melbourne VIC 3122, Australia.
| | - Naomi Perry
- Centre for Human Psychopharmacology, Swinburne University, Melbourne VIC 3122, Australia.
| | - Anastasia Ossoukhova
- Centre for Human Psychopharmacology, Swinburne University, Melbourne VIC 3122, Australia.
| | - Vanessa Bilog
- Centre for Human Psychopharmacology, Swinburne University, Melbourne VIC 3122, Australia.
| | - Marni Kras
- Centre for Human Psychopharmacology, Swinburne University, Melbourne VIC 3122, Australia.
| | - Claudia Scholz
- Merck Selbstmedikation GmbH, Roesslerstrasse 96, 64293 Darmstadt, Germany.
| | - Mathias Sass
- Rudolf Wild GmbH & Co. KG, Rudolf-Wild-Str. 107-115, D-69214 Eppelheim, Heidelberg, Germany.
| | | |
Collapse
|
|
47
|
The effect of using isomaltulose (Palatinose™) to modulate the glycaemic properties of breakfast on the cognitive performance of children. Eur J Nutr 2014; 54:1013-20. [PMID: 25311061 PMCID: PMC4540784 DOI: 10.1007/s00394-014-0779-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 10/06/2014] [Indexed: 11/15/2022]
Abstract
Purpose Although previous research has associated the glycaemic load (GL) of a meal with cognitive functioning, typically the macro-nutrient composition of the meals has differed, raising a question as to whether the response was to GL or to the energy, nutrients or particular foods consumed. Therefore, the present study contrasted two breakfasts that offered identical levels of energy and macro-nutrients, although they differed in GL. Methods Using a repeated-measures, double-blind design, 75 children aged 5–11 years, from socially deprived backgrounds, attended a school breakfast club and on two occasions, at least a week apart, they consumed a meal sweetened with either isomaltulose (Palatinose™) (GL 31.6) or glucose (GL 59.8). Immediate and delayed verbal memory, spatial memory, sustained attention, reaction times, speed of information processing and mood were assessed 1 and 3 h after eating. Results The nature of the meals did not influence any measure of cognition or mood after an hour; however, after 3 h, children’s memory and mood improved after the lower-GL breakfast. If children had eaten the lower-GL meal on the second day of testing, they were able to process information faster and had better spatial memory later in the morning. Conclusions Towards the end of a morning in school, having consumed a lower-GL breakfast resulted in better mood and aspects of cognitive functioning.
Collapse
|
|
48
|
Lamport DJ, Chadwick HK, Dye L, Mansfield MW, Lawton CL. A low glycaemic load breakfast can attenuate cognitive impairments observed in middle aged obese females with impaired glucose tolerance. Nutr Metab Cardiovasc Dis 2014; 24:1128-1136. [PMID: 24925124 DOI: 10.1016/j.numecd.2014.04.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/07/2014] [Accepted: 04/24/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS There has been no systematic investigation of the individual and combined effects of impaired glucose tolerance (IGT) and obesity on cognitive function in the absence of ageing. The aims were to examine the effects of IGT and increased waist circumference on cognitive function in ostensibly healthy adults, and to investigate whether a low glycaemic load (GL) breakfast can attenuate cognitive impairments in these populations. METHODS AND RESULTS Sixty five females aged 30-50 years were classified into one of four groups following waist circumference (WC) measurements and an oral glucose tolerance test: NGT/low WC (n = 25), NGT/high WC (n = 22), IGT/low WC (n = 9), IGT/high WC (n = 9). Memory, psychomotor and executive functions were examined 30 and 120 min after consuming low GL, high GL and water breakfasts according to a randomised, crossover, counterbalanced design. IGT was associated with impairment of verbal and spatial memory, and psychomotor function relative to females with NGT, independent of waist circumference. Increased waist circumference was associated with impairment of verbal memory and executive function relative to females with low WC, independent of IGT. Consumption of the LGL breakfast attenuated verbal memory impairment in the IGT/high WC group relative to the HGL breakfast and no energy control. CONCLUSION Increased central adiposity and abnormalities in glucose tolerance preceding type 2 diabetes can have demonstrable negative effects on cognitive function, even in ostensibly healthy, middle-aged females. The potential for GL manipulations to modulate glycaemic response and cognitive function in type 2 diabetes and obesity merits further investigation.
Collapse
Affiliation(s)
- D J Lamport
- Institute of Psychological Sciences, University of Leeds, Woodhouse Lane, Leeds LS29JT, UK; School of Psychology and Clinical Language Sciences, Earley Gate, Whiteknights, University of Reading, Reading, UK.
| | - H K Chadwick
- Institute of Psychological Sciences, University of Leeds, Woodhouse Lane, Leeds LS29JT, UK
| | - L Dye
- Institute of Psychological Sciences, University of Leeds, Woodhouse Lane, Leeds LS29JT, UK
| | - M W Mansfield
- St James's Hospital Centre for Diabetes, St James's University Hospital, Leeds LS97TF, UK
| | - C L Lawton
- Institute of Psychological Sciences, University of Leeds, Woodhouse Lane, Leeds LS29JT, UK
| |
Collapse
|
|
49
|
Abstract
There have been no comprehensive reviews of the relation of breakfast cereal consumption to nutrition and health. This systematic review of all articles on breakfast cereals to October 2013 in the Scopus and Medline databases identified 232 articles with outcomes related to nutrient intake, weight, diabetes, cardiovascular disease, hypertension, digestive health, dental and mental health, and cognition. Sufficient evidence was available to develop 21 summary evidence statements, ranked from A (can be trusted to guide practice) to D (weak and must be applied with caution). Breakfast cereal consumption is associated with diets higher in vitamins and minerals and lower in fat (grade B) but is not associated with increased intakes of total energy or sodium (grade C) or risk of dental caries (grade B). Most studies on the nutritional impact are cross-sectional, with very few intervention studies, so breakfast cereal consumption may be a marker of an overall healthy lifestyle. Oat-, barley-, or psyllium-based cereals can help lower cholesterol concentrations (grade A), and high-fiber, wheat-based cereals can improve bowel function (grade A). Regular breakfast cereal consumption is associated with a lower body mass index and less risk of being overweight or obese (grade B). Presweetened breakfast cereals do not increase the risk of overweight and obesity in children (grade C). Whole-grain or high-fiber breakfast cereals are associated with a lower risk of diabetes (grade B) and cardiovascular disease (grade C). There is emerging evidence of associations with feelings of greater well-being and a lower risk of hypertension (grade D), but more research is required.
Collapse
Affiliation(s)
- Peter G Williams
- University of Canberra, Canberra, Australia; and University of Wollongong, Wollongong, Australia
| |
Collapse
|
|
50
|
Edefonti V, Rosato V, Parpinel M, Nebbia G, Fiorica L, Fossali E, Ferraroni M, Decarli A, Agostoni C. The effect of breakfast composition and energy contribution on cognitive and academic performance: a systematic review. Am J Clin Nutr 2014; 100:626-56. [PMID: 24808492 DOI: 10.3945/ajcn.114.083683] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Most studies that assess the effects of breakfast on subsequent mental abilities compared performance in subjects who had or had not consumed this meal. However, characteristics of breakfast itself may induce metabolic and hormonal alterations of the gastrointestinal tract and potentially modify cognitive performance. Moreover, as far as the evidence on the positive effects of having breakfast is becoming more robust, interest may shift to the specific characteristics of an adequate breakfast. OBJECTIVE The objective was to summarize existing evidence on the role of nutrient composition or energy intake at breakfast on the accomplishment of school-related tasks and cognition. DESIGN We conducted a systematic review of the literature through the PubMed database. RESULTS From the literature search, we identified 102 articles, 15 of which met the inclusion criteria. Of these, 3 studies provided information on the relation between cognitive and academic performance and energy intake at breakfast, 11 provided the same information for the macronutrient composition of breakfast, and 1 investigated both the aspects. Eleven studies considered breakfast meals differing in glycemic index/load. Selected studies were generally carried out in well-nourished children and adults of both sexes from general education. They were mostly experimental studies of short duration and had a limited number of subjects. Cognitive and academic performance was investigated by looking at multiple domains, including memory, attention, reasoning, learning, and verbal and math abilities, with a variety of test batteries scheduled at different time points in the morning. Breakfast options differed in terms of included foods and place and time of administration. CONCLUSIONS There is insufficient quantity and consistency among studies to draw firm conclusions. However, whereas the hypothesis of a better and more sustained performance with a breakfast providing >20% daily energy intake still needs substantiation, there does appear to be emerging, but still equivocal, evidence that a lower postprandial glycemic response is beneficial to cognitive performance.
Collapse
Affiliation(s)
- Valeria Edefonti
- From the Section of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (VE, VR, MF, and AD); the Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, Università degli Studi di Udine, Udine, Italy (MP); the Pediatric Clinic (GN and LF) and the Pediatric Emergency Unit (EF), IRCCS Ospedale Maggiore Policlinico, Milan, Italy; the Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AD); and the Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA)
| | - Valentina Rosato
- From the Section of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (VE, VR, MF, and AD); the Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, Università degli Studi di Udine, Udine, Italy (MP); the Pediatric Clinic (GN and LF) and the Pediatric Emergency Unit (EF), IRCCS Ospedale Maggiore Policlinico, Milan, Italy; the Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AD); and the Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA)
| | - Maria Parpinel
- From the Section of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (VE, VR, MF, and AD); the Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, Università degli Studi di Udine, Udine, Italy (MP); the Pediatric Clinic (GN and LF) and the Pediatric Emergency Unit (EF), IRCCS Ospedale Maggiore Policlinico, Milan, Italy; the Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AD); and the Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA)
| | - Gabriella Nebbia
- From the Section of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (VE, VR, MF, and AD); the Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, Università degli Studi di Udine, Udine, Italy (MP); the Pediatric Clinic (GN and LF) and the Pediatric Emergency Unit (EF), IRCCS Ospedale Maggiore Policlinico, Milan, Italy; the Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AD); and the Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA)
| | - Lorenzo Fiorica
- From the Section of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (VE, VR, MF, and AD); the Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, Università degli Studi di Udine, Udine, Italy (MP); the Pediatric Clinic (GN and LF) and the Pediatric Emergency Unit (EF), IRCCS Ospedale Maggiore Policlinico, Milan, Italy; the Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AD); and the Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA)
| | - Emilio Fossali
- From the Section of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (VE, VR, MF, and AD); the Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, Università degli Studi di Udine, Udine, Italy (MP); the Pediatric Clinic (GN and LF) and the Pediatric Emergency Unit (EF), IRCCS Ospedale Maggiore Policlinico, Milan, Italy; the Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AD); and the Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA)
| | - Monica Ferraroni
- From the Section of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (VE, VR, MF, and AD); the Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, Università degli Studi di Udine, Udine, Italy (MP); the Pediatric Clinic (GN and LF) and the Pediatric Emergency Unit (EF), IRCCS Ospedale Maggiore Policlinico, Milan, Italy; the Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AD); and the Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA)
| | - Adriano Decarli
- From the Section of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (VE, VR, MF, and AD); the Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, Università degli Studi di Udine, Udine, Italy (MP); the Pediatric Clinic (GN and LF) and the Pediatric Emergency Unit (EF), IRCCS Ospedale Maggiore Policlinico, Milan, Italy; the Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AD); and the Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA)
| | - Carlo Agostoni
- From the Section of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (VE, VR, MF, and AD); the Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, Università degli Studi di Udine, Udine, Italy (MP); the Pediatric Clinic (GN and LF) and the Pediatric Emergency Unit (EF), IRCCS Ospedale Maggiore Policlinico, Milan, Italy; the Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AD); and the Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA)
| |
Collapse
|