Dietary Influences on Cognitive Development during Early Childhood

Cognitive functions are a set of complex mental tasks performed by the brain. These functions include attention, memory, thinking, learning and perception.1 A child’s brain starts developing in the prenatal stage and continues after birth. By the time the child reaches the age of 3 years, the brain functions twice as actively as those of adults. The period from conception through birth to eight years of age is critical for brain development as well as optimum emotional and physical growth of children.2

Nutrient deficiencies during early childhood can go on to have long-term adverse effects on health. Studies have found a connection between improved nutrition and optimal brain function as development is faster than the rest of the body.1

Malnutrition affects 165 million young children globally, leaving them with poor cognition and stunted growth.3 Reports have found that in developing countries, 52% of school-age children are stunted. If timely nutritional interventions are not carried out, almost one billion children will be physically and mentally impaired by the year 2020.4 As per the state of the world’s children global report 2016 by UNICEF, 10 proven interventions have been recognised that have the potential to prevent 900,000 deaths of children under 5 years of age. These interventions include treatment of short-term malnutrition, vitamin A and zinc supplementation, promotion of breastfeeding and complementary feeding.5

According to scientific studies, malnourished children have late admission in school, and suffer from high dropout rates, absenteeism, and poor grades in school.3 In addition, evidence shows that stunting in early life has lasting impact on school performance and IQ scores up to middle adolescent years.6

Inadequate nutrition has also been associated with delayed social and intellectual development. This puts the child at risk of illnesses, lethargy and delayed physical growth. All these factors limit the child’s exposure to the external environment, having a detrimental effect on their overall personality.7

Brain Development in Children

Brain development at birth

At birth, the brain weighs 10% of the neonate’s weight, compared to the adult brain which is about 2% of body weight.8 Brain maturation and neural pathways and connections are gradually developed in early childhood.2 It has been seen that poor nutritional intake before birth as well as in the first years of life can interfere with normal brain development, leading to learning disabilities and mental retardation.2 Malnutrition during brain development leads to decrease in the number of brain cells, number of synapses, and decreased brain size.6

Brain development in early childhood

Brain reaches half of its weight by age of six months and 80% of its final weight by the age of two years.1,2 Myelination of parts of the brain that control higher cognitive functions continues till adolescent period.1 Grey matter reaches its maximum growth between the age 7 to 11. The growth spurt of the frontal lobe of the brain that controls advanced brain functions takes place between 7 and to 9 years of age. Subcortical structures such as basal ganglia, amygdala, and hippocampus continue till late adolescence. They are involved in facilitating higher cognitive functions such as memory and emotions.1 Early childhood is a period where the environment has an important impact on determining the extent to which the brain grows and develops.2 Individual brain development is influenced by a variety of factors, including nutrition. Stunting in early childhood leads to poor mental growth and academic performance in late childhood. 1

 

Below are brain growth milestones during early childhood: 2

Age Milestone
2 to 3.5 years
  • Delight in learning new things
  • Start learning language quickly
  • Gain more control of hands and fingers
  • Become more independent
3.5 to 5 years
  • Have a longer attention span
  • Ask lot of questions
  • Put their physical skills and courage to test
  • Indulge in dramatic play
  • Enjoy playing with friends, don’t like losing in the game
5 to 8 years
  • Are curious about people and working of the world
  • Develop interest in numbers, alphabets, reading and writing
  • Are more confident
  • Use words to express feelings
  • Cooperate with others during playtime
  • Show interest in final product

 

Good nutrition means good-quality diet and smarter brains

In the early years of life, a child has rapidly increasing vocabulary, evolving motor skills, and high attention span. Also, children start making food choices and exert independence concerning what they eat.7 Research studies have emphasised the importance of type of foods in the child’s diet. Children who eat more fish and cereals from age 3 to 7 show higher IQs, compared to children who eat synthetic fats such as margarine.1 Children who consume more salads, fruits, and whole-grains are more intelligent than children who eat more refined and processed foods. Consumption of foods such as legumes, fruits, milk products and eggs in early childhood have been associated with better IQ scores in later years.1,9 Having regular breakfast has been found to be beneficial for cognitive functions and development in children, especially those with poor nutritional status. The volume of grey and white matter in the brain depends on the type of breakfast the child eats.1

Nutrients Affecting Early Brain Development

All nutrients are important for brain growth and function, but certain nutrients have far-reaching effects during early brain development.

Carbohydrates: Carbohydrates are the main source of energy for the brain. The dietary reference intake for carbohydrates has been set at 130 grams per day for children. This value is based on the average minimum amount of glucose used by the brain.10 Carbohydrates aid in production of serotonin that helps children to utilise their brains.11

Protein: Protein plays a role in cell growth and replication. Meat, milk, fish and cheese are good sources of protein7. Along with other nutrients, these play a role in production of brain neurotransmitters, myelination, and development of dendritic arborisation of the developing brain.11,12 Protein and energy deprivation during brain development has been linked to reduction in brain cells, reduced brain size and poor cognitive performance. Lack of protein, along with calorie deficit in the diet, affects brain maturation, resulting in cognitive functional delays and long-lasting brain damage.6

Fats: Brain is composed of 60% fat.11 Long chain polyunsaturated fatty acids (omega 3 fats) play major structural and metabolic roles in the body. Out of these, docosahexaenoic acid (DHA) has a role in transmission of messages, myelination and growth of neurons.13 DHA is found in salmon, walnuts and kiwi. Deficiency has been associated with mental disorders such as attention deficit disorder, dementia, bipolar disorder and schizophrenia7. DHA is accumulated from week 30 of pregnancy till 2 years of age of the child.13 Studies have also proved that children aged 7–9 years, who were given long chain poly unsaturated fatty acids rich diet for 6 months showed higher plasma and red blood cell levels of DHA which correlated with higher verbal learning and reading abilities.15 Arachidonic acid (ARA) is another essential fatty acid which has a role in neuronal firing, signal transmission, and synthesis of brain tissues.13

Iron: One of the most common nutrient deficiencies, iron deficiency anemia affects 30% of the world’s population. Iron is an important brain nutrient and is found in varying concentrations in different parts of the brain.6 Iron requirements are higher during infancy and early childhood compared to adulthood.16 Iron intake is important for brain development, synthesis of neurotransmitters such as dopamine and serotonin, and neuronal metabolism5. Deficiency of iron is associated with low IQ, learning difficulties, poor memory, slow motor development and short attention span.6

Choline: Choline is the precursor of neurotransmitter acetylcholine and is found in brain membranes. It has been found to influence changes in brain structure and function.6 Choline deficiency can cause memory and learning disorders in young children.1 Legumes, eggs, peanuts, salmon, and beef liver are good sources of choline.

Taurine: Taurine is an amino acid which helps in maintaining the structural identity of brain membranes, acts as a neuromodulator and neurotransmitter, and is a neuroprotector.17 Shellfish are rich in taurine. Studies have found that supplementation of taurine in children with a rare neurocognitive disorder, Angelman Syndrome, improves learning difficulties associated with the syndrome.8

Zinc: Zinc is a vital brain nutrient with important roles in brain functioning such as neurogenesis, migration and growth of neurons, and synaptic formation.1 In young children, zinc deficiency is associated with learning, attention, memory, and mood deficits.19

Iodine: Iodine helps in production of thyroid hormone and promotes growth. Deficiency during early years of life can cause mental retardation and loss of IQ. In school-age children, iodine deficiency is linked with poor cognitive performance.6 Rich sources of iodine are fish, seafood, and algae. Although with iodisation of salt, iodine deficiency in children has been controlled to some extent, it is still present in some regions of the world.6 Psychomotor effects of iodine deficiency in children are more visible after the age of 2.5 years.20

Vitamin B12: Vitamin B12 impacts the rate of nerve conduction and helps in conversion of folic acid into its active form.6 It has been found that teenagers who consume macrobiotic diet till the age of 6 years had lower intelligence levels, spatial ability and short-term memory, compared to teenagers who consume omnivorous diet.1 Deficiency of vitamin B12 leads to poor brain function, irritability, brain atrophy, and retarded myelination.6 Children with low consumption of animal foods such as milk, liver, meat, and eggs22 may have vitamin B12 deficiency.6, 21

Vitamin D: Vitamin D has been found to have a role in neurological development. It is a neurosteroid and helps in normal brain development and functioning. Enzymes which convert vitamin D to its active form are found in the brain. Exposure to sunlight is the best source of vitamin D.6 Children with dark colour skin and inadequate consumption of vitamin D fortified foods need to be screened for deficiency.16

Thiamine: Thiamine has a role in cognitive development, nerve conduction and synthesis of neurotransmitters. Deficiency leads to poor intelligence, slow reaction time and poor memory.6 Dietary sources of thiamine include whole-grains, eggs, liver, legumes and nuts.

Pyridoxine: A coenzyme required for production of neurotransmitters such as serotonin and noradrenaline, deficiency of pyridoxine has been linked to structural and functional impairments in the brain. Deficiency of vitamin B6 is linked to seizures, irritability, peripheral neuropathy, epilepsy, and neurotransmitter disease in children.6

Folic acid: Folic acid affects neural stem cell proliferation, and reduces cell death.1 Vegetables, legumes, and milk are good sources of folic acid. Maternal folic acid intake has long-term effects on the child’s neurocognitive development, as it facilitates closure of fetal neural tube. Deficiency is associated with neurocognitive defects, language delay, autism and schizophrenia.6

Vitamin A: Vitamin A includes two types – retinol and beta carotene. Retinol is found in animal foods, and beta carotene in vegetables and fruits. Vitamin A, in the form of retinoic acid, is a signaling molecule in the brain, and its receptors have a role in memory.6

 

Nutrient RDA22 ( 3-8 yrs) Impact of Supplementation in Young Children
Protein 3 yrs – 15.7g/d

4-6 yrs -20.3g/d

8yrs- 29.6g/d

Improvement in cognition 22
Polyunsaturated fats 25g/d (total visible fat) Fish oil supplementation in diets of school children have showed improvement in cognition. 14
Iron 3 yrs – 9mg/d

4-6 yrs -13mg/d

8yrs- 16mg/d

Improvement in cognition and school performance 23
Zinc 3 yrs – 5mg/d

4-6 yrs -7mg/d

8yrs- 8mg/d

Improved neuro-psychological functions 24
Iodine 90mcg/d 25 Supplementation of moderately iodine deficient school age children improves cognitive function 6
Vitamin B12 3-6 yrs – 80-100mcg/d

7-8yrs – 120-140mcg/d

Supplement in children improves neurodevelopment & cognitive function 27
Vitamin D 15mcg/d 26 Supplementation in children with attention deficit hyperactivity disorder was found to improve cognitive function 28
Vitamin A 3 yrs – 400mcg/d

4-6 yrs -600mcg/d

8yrs- 600mcg/d

 

Insufficient evidence in 3-8 yrs children

Thiamine (Vitamin B1) 3 yrs – 0.5mg/d

4-6 yrs -0.7mg/d

8yrs- 0.8mg/d

·         Better intelligence scores

·         Better memory

·         Quicker reaction times 6

Pyridoxine (Vitamin B6) 3 yrs – 0.8mg/d

4-6 yrs -1.1mg/d

8yrs- 1.4 mg/d

 

Insufficient evidence in 3-8 yrs children 6

Folic acid 3-6 yrs- 80-100mcg/d

7-8 yrs- 120-140mcg/d

Supplement in children improves neurodevelopment & cognitive function {Winje BA 2018}

 

For normal cognitive development, an intake of combination of nutrients has been found beneficial. Early childhood is a critical period wherein insufficient macro- and micro-nutrient intake can cause irreversible damage to the brain, resulting in permanent reduction in cognitive capacity. It is therefore, important to screen out children at risk for nutrient deficiencies and take appropriate measures such as supplementation to promote normal brain development.

 

References

  1. Nyaradi A1, Li J, Hickling S, Foster J, Oddy WH. The role of nutrition in children’s neurocognitive development, from pregnancy through childhood. Front Hum Neurosci.2013 Mar;7:97. doi:10.3389/fnhum.2013.00097.
  2. Early childhood development: The key to a full and productive life. UNICEF: New York.
  3. Maalouf-Manasseh Z, Oot L, Sethuraman K. Giving children the best start in life: Integrating nutrition and early childhood development within the first 1,000 days. 2015. Washington, DC: FHI 360/FANTA.
  4. Degarege D, Degarege A, Animut A. Undernutrition and associated risk factors among school age children in Addis Ababa, Ethiopia. BMC Public Health. 2015;15:375.
  5. The State of the World’s Children 2016: A fair chance for every child. United Nations Plaza, New York, NY: UNICEF.
  6. Escolano-Margarit MV, Campoy C. Nutrition and the developing brain. In Swaiman KF, Ashwal S, Ferriero DM, Schor NF, Finkel RS, Gropman AL et al., editors. Swaiman’s pediatric neurology. 6th ed. Philadelphia, PA: Elsevier; 2017. Chapter 47:e952-e959.
  7. Rosales FJ, Reznick JS, Zeisel SH. Understanding the role of nutrition in the brain & behavioral development of toddlers and preschool children: identifying and overcoming methodological barriers. Nutr Neurosci. 2009 October;12(5):190-202.
  8. Hazen EP, Abrams AN, Muriel AC. Child, adolescent, and adult development. In Stern TA, Fava M, Wilens TE, Rosenbaum JF, editors. Massachusetts General Hospital comprehensive clinical psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016. Chapter 5.
  9. Tandon PS, Tovar A, Jayasuriya AT, Welker E, Schober DJ, Copeland K et al. The relationship between physical activity and diet and young children’s cognitive development: a systematic review. Prevent Med Rep. 2016;3:379-90.
  10. Ruottinen S. Carbohydrate intake in children—associations with dietary intakes, growth, serum lipids, and dental health: The STRIP Project. Turun Yliopisto, University of Turku, Turku; 2011.
  11. Rausch R. Nutrition and academic performance in school-age children the relation to obesity and food insufficiency. J Nutr Food Sci. 2013;3:2.
  12. Kar BR, Rao SL, Chandramouli BA. Cognitive development in children with chronic protein energy malnutrition. Behav Brain Funct. 2008;4:31. doi:10.1186/1744-9081-4-31.
  13. Garg P, Pejaver RK, Sukhija M, Ahuja A. Role of DHA, ARA, & phospholipids in brain development: an Indian perspective. Clin EpidemiolGlobal Health. 2017;5:155-62.
  14. Lauritzen L, Brambilla P, Mazzocchi A, Harsløf LBS, Ciappolino V, Agostoni C. DHA effects in brain development and function. Nutrients 2016;8:6. doi:10.3390/nu8010006
  15. Michael J. Weiser, Christopher M. Butt, M. Hasan Mohajeri. Docosahexaenoic Acid and Cognition throughout the Lifespan. Nutrients. 2016 Feb; 8(2): 99.
  16. Parks EP, Maqbool A, Shaikhkhalil A, Groleau V, Dougherty KA, Stallings VA. Nutritional requirements. In Kliegman RM, Stanton B, editors. Nelson textbook of pediatrics, 20th ed., Vol. 2. Philadelphia, PA: Elsevier; 2016: 268-86.e1.
  17. Wu J-Y, Prentice H. Role of taurine in the central nervous system. J Biomed Sci. 2010;17(Suppl 1):S1.
  18. Guzzetti S, Calzari L, Buccarello L, Cesari V, Toschi I, Cattaldo S et al. Taurine administration recovers motor and learning deficits in an Angelman Syndrome mouse model. Int J Mol Sci. 2018;19:1088. doi:10.3390/ijms19041088.
  19. Cusick SE, Georgieff MK. The role of nutrition in brain development: The golden opportunity of the “first 1000 days”. J Pediatr. 2016 August;175:16-21.
  20. Sethi V, Kapil U. Iodine deficiency and development of brain. Indian J Pediatr. 2004;71(4): 325-329.
  21. Narasinga Rao BS. Nutrient requirement and safe dietary intake for Indians. NFI Bulletin. 2010;31(1):1-5.
  22. Prado EL, Dewey KG. Nutrition and brain development in early life. Nutr Rev. 2014;72(4):267-84.
  23. Naseem A, Khan S. A., Lalani N. Impact of iron deficiency on cognitive functions and effect of iron supplement in children between 5-10 years: Indian perspective. Int J Pediatr Res. 2016;3(5):313-22.
  24. Bhatnagar S, Taneja S. Zinc and cognitive development. Br J Nutr. 2001;85(Suppl. 2):S139-45.
  25. National Institutes of Health. Iodine: Fact Sheet for Health Professionals [Internet]. 2018. [updated 2018 Mar 2]. Available from: https://www.nih.gov/
  26. National Institutes of Health. Vitamin D: Fact Sheet for Health Professionals [Internet]. 2018. [updated 2018 Mar 2]. Available from
  27. Winje B.A., Kvestad I, Krishnamachari S, Manji K, Taneja S, Bellinger DC et al. Does early vitamin B12 supplementation improve neurodevelopment and cognitive function in childhood and into school age: a study protocol for extended follow-ups from randomised controlled trials in India and Tanzania. BMJ Open. 2018 Feb 22;8(2):e018962.
  28. Mohammadpour N, Jazayeri S, Tehrani-Doost M, Djalali M, Hosseini M, Effatpanah M et al. Effect of vitamin D supplementation as adjunctive therapy to methylphenidate on ADHD symptoms: a randomized, double blind, placebo-controlled trial. Nutr Neurosci. 2016. http://dx.doi.org/10.1080/1028415X.2016.1262097.

 

Dietary Influences on Cognitive Development during Early Childhood
Cognitive functions are a set of complex mental tasks performed by the brain. These functions include attention, memory, thinking, learning and perception.1 A child’s brain starts developing in the prenatal stage and continues after birth. By the time the child reaches the age of 3 years, the brain functions twice as actively as those of adults. The period from conception through birth to eight years of age is critical for brain development as well as optimum emotional and physical growth of children.2

Nutrient deficiencies during early childhood can go on to have long-term adverse effects on health. Studies have found a connection between improved nutrition and optimal brain function as development is faster than the rest of the body.1
Malnutrition affects 165 million young children globally, leaving them with poor cognition and stunted growth.3 Reports have found that in developing countries, 52% of school-age children are stunted. If timely nutritional interventions are not carried out, almost one billion children will be physically and mentally impaired by the year 2020.4 As per the state of the world’s children global report 2016 by UNICEF, 10 proven interventions have been recognised that have the potential to prevent 900,000 deaths of children under 5 years of age. These interventions include treatment of short-term malnutrition, vitamin A and zinc supplementation, promotion of breastfeeding and complementary feeding.5
According to scientific studies, malnourished children have late admission in school, and suffer from high dropout rates, absenteeism, and poor grades in school.3 In addition, evidence shows that stunting in early life has lasting impact on school performance and IQ scores up to middle adolescent years.6
Inadequate nutrition has also been associated with delayed social and intellectual development. This puts the child at risk of illnesses, lethargy and delayed physical growth. All these factors limit the child’s exposure to the external environment, having a detrimental effect on their overall personality.7
Brain Development in Children
Brain development at birth
At birth, the brain weighs 10% of the neonate’s weight, compared to the adult brain which is about 2% of body weight.8 Brain maturation and neural pathways and connections are gradually developed in early childhood.2 It has been seen that poor nutritional intake before birth as well as in the first years of life can interfere with normal brain development, leading to learning disabilities and mental retardation.2 Malnutrition during brain development leads to decrease in the number of brain cells, number of synapses, and decreased brain size.6
Brain development in early childhood
Brain reaches half of its weight by age of six months and 80% of its final weight by the age of two years.1,2 Myelination of parts of the brain that control higher cognitive functions continues till adolescent period.1 Grey matter reaches its maximum growth between the age 7 to 11. The growth spurt of the frontal lobe of the brain that controls advanced brain functions takes place between 7 and to 9 years of age. Subcortical structures such as basal ganglia, amygdala, and hippocampus continue till late adolescence. They are involved in facilitating higher cognitive functions such as memory and emotions.1 Early childhood is a period where the environment has an important impact on determining the extent to which the brain grows and develops.2 Individual brain development is influenced by a variety of factors, including nutrition. Stunting in early childhood leads to poor mental growth and academic performance in late childhood. 1

Below are brain growth milestones during early childhood: 2
Age Milestone
2 to 3.5 years • Delight in learning new things
• Start learning language quickly
• Gain more control of hands and fingers
• Become more independent
3.5 to 5 years • Have a longer attention span
• Ask lot of questions
• Put their physical skills and courage to test
• Indulge in dramatic play
• Enjoy playing with friends, don’t like losing in the game
5 to 8 years • Are curious about people and working of the world
• Develop interest in numbers, alphabets, reading and writing
• Are more confident
• Use words to express feelings
• Cooperate with others during playtime
• Show interest in final product

Good nutrition means good-quality diet and smarter brains
In the early years of life, a child has rapidly increasing vocabulary, evolving motor skills, and high attention span. Also, children start making food choices and exert independence concerning what they eat.7 Research studies have emphasised the importance of type of foods in the child’s diet. Children who eat more fish and cereals from age 3 to 7 show higher IQs, compared to children who eat synthetic fats such as margarine.1 Children who consume more salads, fruits, and whole-grains are more intelligent than children who eat more refined and processed foods. Consumption of foods such as legumes, fruits, milk products and eggs in early childhood have been associated with better IQ scores in later years.1,9 Having regular breakfast has been found to be beneficial for cognitive functions and development in children, especially those with poor nutritional status. The volume of grey and white matter in the brain depends on the type of breakfast the child eats.1

Nutrients Affecting Early Brain Development
All nutrients are important for brain growth and function, but certain nutrients have far-reaching effects during early brain development.
Carbohydrates: Carbohydrates are the main source of energy for the brain. The dietary reference intake for carbohydrates has been set at 130 grams per day for children. This value is based on the average minimum amount of glucose used by the brain.10 Carbohydrates aid in production of serotonin that helps children to utilise their brains.11
Protein: Protein plays a role in cell growth and replication. Meat, milk, fish and cheese are good sources of protein7. Along with other nutrients, these play a role in production of brain neurotransmitters, myelination, and development of dendritic arborisation of the developing brain.11,12 Protein and energy deprivation during brain development has been linked to reduction in brain cells, reduced brain size and poor cognitive performance. Lack of protein, along with calorie deficit in the diet, affects brain maturation, resulting in cognitive functional delays and long-lasting brain damage.6
Fats: Brain is composed of 60% fat.11 Long chain polyunsaturated fatty acids (omega 3 fats) play major structural and metabolic roles in the body. Out of these, docosahexaenoic acid (DHA) has a role in transmission of messages, myelination and growth of neurons.13 DHA is found in salmon, walnuts and kiwi. Deficiency has been associated with mental disorders such as attention deficit disorder, dementia, bipolar disorder and schizophrenia7. DHA is accumulated from week 30 of pregnancy till 2 years of age of the child.13 Studies have also proved that children aged 7–9 years, who were given long chain poly unsaturated fatty acids rich diet for 6 months showed higher plasma and red blood cell levels of DHA which correlated with higher verbal learning and reading abilities.15 Arachidonic acid (ARA) is another essential fatty acid which has a role in neuronal firing, signal transmission, and synthesis of brain tissues.13
Iron: One of the most common nutrient deficiencies, iron deficiency anemia affects 30% of the world’s population. Iron is an important brain nutrient and is found in varying concentrations in different parts of the brain.6 Iron requirements are higher during infancy and early childhood compared to adulthood.16 Iron intake is important for brain development, synthesis of neurotransmitters such as dopamine and serotonin, and neuronal metabolism5. Deficiency of iron is associated with low IQ, learning difficulties, poor memory, slow motor development and short attention span.6
Choline: Choline is the precursor of neurotransmitter acetylcholine and is found in brain membranes. It has been found to influence changes in brain structure and function.6 Choline deficiency can cause memory and learning disorders in young children.1 Legumes, eggs, peanuts, salmon, and beef liver are good sources of choline.
Taurine: Taurine is an amino acid which helps in maintaining the structural identity of brain membranes, acts as a neuromodulator and neurotransmitter, and is a neuroprotector.17 Shellfish are rich in taurine. Studies have found that supplementation of taurine in children with a rare neurocognitive disorder, Angelman Syndrome, improves learning difficulties associated with the syndrome.8
Zinc: Zinc is a vital brain nutrient with important roles in brain functioning such as neurogenesis, migration and growth of neurons, and synaptic formation.1 In young children, zinc deficiency is associated with learning, attention, memory, and mood deficits.19
Iodine: Iodine helps in production of thyroid hormone and promotes growth. Deficiency during early years of life can cause mental retardation and loss of IQ. In school-age children, iodine deficiency is linked with poor cognitive performance.6 Rich sources of iodine are fish, seafood, and algae. Although with iodisation of salt, iodine deficiency in children has been controlled to some extent, it is still present in some regions of the world.6 Psychomotor effects of iodine deficiency in children are more visible after the age of 2.5 years.20
Vitamin B12: Vitamin B12 impacts the rate of nerve conduction and helps in conversion of folic acid into its active form.6 It has been found that teenagers who consume macrobiotic diet till the age of 6 years had lower intelligence levels, spatial ability and short-term memory, compared to teenagers who consume omnivorous diet.1 Deficiency of vitamin B12 leads to poor brain function, irritability, brain atrophy, and retarded myelination.6 Children with low consumption of animal foods such as milk, liver, meat, and eggs22 may have vitamin B12 deficiency.6, 21
Vitamin D: Vitamin D has been found to have a role in neurological development. It is a neurosteroid and helps in normal brain development and functioning. Enzymes which convert vitamin D to its active form are found in the brain. Exposure to sunlight is the best source of vitamin D.6 Children with dark colour skin and inadequate consumption of vitamin D fortified foods need to be screened for deficiency.16
Thiamine: Thiamine has a role in cognitive development, nerve conduction and synthesis of neurotransmitters. Deficiency leads to poor intelligence, slow reaction time and poor memory.6 Dietary sources of thiamine include whole-grains, eggs, liver, legumes and nuts.
Pyridoxine: A coenzyme required for production of neurotransmitters such as serotonin and noradrenaline, deficiency of pyridoxine has been linked to structural and functional impairments in the brain. Deficiency of vitamin B6 is linked to seizures, irritability, peripheral neuropathy, epilepsy, and neurotransmitter disease in children.6
Folic acid: Folic acid affects neural stem cell proliferation, and reduces cell death.1 Vegetables, legumes, and milk are good sources of folic acid. Maternal folic acid intake has long-term effects on the child’s neurocognitive development, as it facilitates closure of fetal neural tube. Deficiency is associated with neurocognitive defects, language delay, autism and schizophrenia.6
Vitamin A: Vitamin A includes two types – retinol and beta carotene. Retinol is found in animal foods, and beta carotene in vegetables and fruits. Vitamin A, in the form of retinoic acid, is a signaling molecule in the brain, and its receptors have a role in memory.6

Nutrient RDA22 ( 3-8 yrs) Impact of Supplementation in Young Children
Protein 3 yrs – 15.7g/d
4-6 yrs -20.3g/d
8yrs- 29.6g/d Improvement in cognition 22
Polyunsaturated fats 25g/d (total visible fat) Fish oil supplementation in diets of school children have showed improvement in cognition. 14
Iron 3 yrs – 9mg/d
4-6 yrs -13mg/d
8yrs- 16mg/d Improvement in cognition and school performance 23
Zinc 3 yrs – 5mg/d
4-6 yrs -7mg/d
8yrs- 8mg/d Improved neuro-psychological functions 24
Iodine 90mcg/d 25 Supplementation of moderately iodine deficient school age children improves cognitive function 6
Vitamin B12 3-6 yrs – 80-100mcg/d
7-8yrs – 120-140mcg/d Supplement in children improves neurodevelopment & cognitive function 27
Vitamin D 15mcg/d 26 Supplementation in children with attention deficit hyperactivity disorder was found to improve cognitive function 28
Vitamin A 3 yrs – 400mcg/d
4-6 yrs -600mcg/d
8yrs- 600mcg/d
Insufficient evidence in 3-8 yrs children
Thiamine (Vitamin B1) 3 yrs – 0.5mg/d
4-6 yrs -0.7mg/d
8yrs- 0.8mg/d • Better intelligence scores
• Better memory
• Quicker reaction times 6
Pyridoxine (Vitamin B6) 3 yrs – 0.8mg/d
4-6 yrs -1.1mg/d
8yrs- 1.4 mg/d
Insufficient evidence in 3-8 yrs children 6
Folic acid 3-6 yrs- 80-100mcg/d
7-8 yrs- 120-140mcg/d Supplement in children improves neurodevelopment & cognitive function {Winje BA 2018}

For normal cognitive development, an intake of combination of nutrients has been found beneficial. Early childhood is a critical period wherein insufficient macro- and micro-nutrient intake can cause irreversible damage to the brain, resulting in permanent reduction in cognitive capacity. It is therefore, important to screen out children at risk for nutrient deficiencies and take appropriate measures such as supplementation to promote normal brain development.

References

1. Nyaradi A1, Li J, Hickling S, Foster J, Oddy WH. The role of nutrition in children’s neurocognitive development, from pregnancy through childhood. Front Hum Neurosci. 2013 Mar;7:97. doi:10.3389/fnhum.2013.00097.
2. UNICEF. Early childhood development: The key to a full and productive life. UNICEF: New York.
3. Maalouf-Manasseh Z, Oot L, Sethuraman K. Giving children the best start in life: Integrating nutrition and early childhood development within the first 1,000 days. 2015. Washington, DC: FHI 360/FANTA.
4. Degarege D, Degarege A, Animut A. Undernutrition and associated risk factors among school age children in Addis Ababa, Ethiopia. BMC Public Health. 2015;15:375.
5. UNICEF. The State of the World’s Children 2016: A fair chance for every child. United Nations Plaza, New York, NY: UNICEF.
6. Escolano-Margarit MV, Campoy C. Nutrition and the developing brain. In Swaiman KF, Ashwal S, Ferriero DM, Schor NF, Finkel RS, Gropman AL et al., editors. Swaiman’s pediatric neurology. 6th ed. Philadelphia, PA: Elsevier; 2017. Chapter 47:e952-e959.
7. Rosales FJ, Reznick JS, Zeisel SH. Understanding the role of nutrition in the brain & behavioral development of toddlers and preschool children: identifying and overcoming methodological barriers. Nutr Neurosci. 2009 October;12(5):190-202.
8. Hazen EP, Abrams AN, Muriel AC. Child, adolescent, and adult development. In Stern TA, Fava M, Wilens TE, Rosenbaum JF, editors. Massachusetts General Hospital comprehensive clinical psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016. Chapter 5.
9. Tandon PS, Tovar A, Jayasuriya AT, Welker E, Schober DJ, Copeland K et al. The relationship between physical activity and diet and young children’s cognitive development: a systematic review. Prevent Med Rep. 2016;3:379-90.
10. Ruottinen S. Carbohydrate intake in children—associations with dietary intakes, growth, serum lipids, and dental health: The STRIP Project. Turun Yliopisto, University of Turku, Turku; 2011.
11. Rausch R. Nutrition and academic performance in school-age children the relation to obesity and food insufficiency. J Nutr Food Sci. 2013;3:2.
12. Kar BR, Rao SL, Chandramouli BA. Cognitive development in children with chronic protein energy malnutrition. Behav Brain Funct. 2008;4:31. doi:10.1186/1744-9081-4-31.
13. Garg P, Pejaver RK, Sukhija M, Ahuja A. Role of DHA, ARA, & phospholipids in brain development: an Indian perspective. Clin EpidemiolGlobal Health. 2017;5:155-62.
14. Lauritzen L, Brambilla P, Mazzocchi A, Harsløf LBS, Ciappolino V, Agostoni C. DHA effects in brain development and function. Nutrients 2016;8:6. doi:10.3390/nu8010006
15. Michael J. Weiser, Christopher M. Butt, M. Hasan Mohajeri. Docosahexaenoic Acid and Cognition throughout the Lifespan. Nutrients. 2016 Feb; 8(2): 99.
16. Parks EP, Maqbool A, Shaikhkhalil A, Groleau V, Dougherty KA, Stallings VA. Nutritional requirements. In Kliegman RM, Stanton B, editors. Nelson textbook of pediatrics, 20th ed., Vol. 2. Philadelphia, PA: Elsevier; 2016: 268-86.e1.
17. Wu J-Y, Prentice H. Role of taurine in the central nervous system. J Biomed Sci. 2010;17(Suppl 1):S1.
18. Guzzetti S, Calzari L, Buccarello L, Cesari V, Toschi I, Cattaldo S et al. Taurine administration recovers motor and learning deficits in an Angelman Syndrome mouse model. Int J Mol Sci. 2018;19:1088. doi:10.3390/ijms19041088.
19. Cusick SE, Georgieff MK. The role of nutrition in brain development: The golden opportunity of the “first 1000 days”. J Pediatr. 2016 August;175:16-21.
20. Sethi V, Kapil U. Iodine deficiency and development of brain. Indian J Pediatr. 2004;71(4): 325-329.
21. Narasinga Rao BS. Nutrient requirement and safe dietary intake for Indians. NFI Bulletin. 2010;31(1):1-5.
22. Prado EL, Dewey KG. Nutrition and brain development in early life. Nutr Rev. 2014;72(4):267-84.
23. Naseem A, Khan S. A., Lalani N. Impact of iron deficiency on cognitive functions and effect of iron supplement in children between 5-10 years: Indian perspective. Int J Pediatr Res. 2016;3(5):313-22.
24. Bhatnagar S, Taneja S. Zinc and cognitive development. Br J Nutr. 2001;85(Suppl. 2):S139-45.
25. National Institutes of Health. Iodine: Fact Sheet for Health Professionals [Internet]. 2018. [updated 2018 Mar 2]. Available from: https://www.nih.gov/
26. National Institutes of Health. Vitamin D: Fact Sheet for Health Professionals [Internet]. 2018. [updated 2018 Mar 2]. Available from
27. Winje B.A., Kvestad I, Krishnamachari S, Manji K, Taneja S, Bellinger DC et al. Does early vitamin B12 supplementation improve neurodevelopment and cognitive function in childhood and into school age: a study protocol for extended follow-ups from randomised controlled trials in India and Tanzania. BMJ Open. 2018 Feb 22;8(2):e018962.
28. Mohammadpour N, Jazayeri S, Tehrani-Doost M, Djalali M, Hosseini M, Effatpanah M et al. Effect of vitamin D supplementation as adjunctive therapy to methylphenidate on ADHD symptoms: a randomized, double blind, placebo-controlled trial. Nutr Neurosci. 2016. http://dx.doi.org/10.1080/1028415X.2016.1262097.

SUBSCRIBE HERE

The information and references in this article are intended solely for the general information and do not constitute legal or other professional advice on any subject matter. The information contained herein is correct as the date of this document to the best of our knowledge. We suggest that you evaluate any recommendations and suggestions independently. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as referred in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended that require medical treatment under a doctor's care.The content of this article is not intended to offer personal medical advice, diagnose health problems or for treatment purposes. It is not a substitute for professional medical advice. Please consult your health care provider for any advice on medications. These articles have been created and curated by Signutra’s medical team and are property of the Company. Copyright of these articles vests with Company.