The effect of beverages varying in glycaemic load on postprandial glucose responses, appetite and cognition in 10-12-year-old school children

Perspective: The Benefits of Including Flavored Milk in Healthy Dietary Patterns

The Dietary Guidelines for Americans recommend two-and-a-half cup equivalents of low-fat and fat-free dairy foods per day for children 4-8 y and 3 cup equivalents per day for adolescents aged 9-18 and adults. Currently, the Dietary Guidelines for Americans recognizes 4 nutrients as being of public concern because of suboptimal levels in the diet. These include calcium, dietary fiber, potassium, and vitamin D. In the American diet, dairy foods are leading contributors of calcium, vitamin D, and potassium. Milk, because of its unique nutrient package that provides shortfall nutrients to the diets of children and adolescents, remains an underpinning of dietary recommendations and is included with school meals. Despite this, milk consumption is declining, and >80% of Americans do not meet recommendations for dairy. Data indicate that children and adolescents who consume flavored milk are more likely to consume more dairy and adhere to healthier overall dietary patterns. Flavored milk, however, receives more scrutiny than plain milk because of its contribution of added sugar and calories to the diet and concerns over childhood obesity. Therefore, the purpose of this narrative review is to describe trends in beverage consumption in children and adolescents aged 5-18 y and highlight the science that has examined the impact of including flavored milk in overall healthy dietary patterns within this population.

Inflammation, Executive Function, and Adiposity in Children With or at Risk for Obesity: A Pilot Study

OBJECTIVE

Obesity is associated with executive function (EF) deficits across the lifespan. Higher body mass index (BMI), obesity severity, and poorer adherence and weight outcomes in obesity treatment have all been associated with EF deficits. Adult literature has begun to emphasize neuroinflammation in obesity as a possible pathway to later cognitive impairment in EF. However, pediatric obesity literature has yet to establish associations between peripheral inflammation and EF. Thus, the present study examined associations and variability in inflammation, EF, and adiposity in children with or at risk for obesity. Additionally, inflammation was examined as a mediator of the relationship between adiposity and EF.

METHODS

Children (N = 39) aged 8-12 years with BMI ≥ 50th percentile were recruited. The NIH Toolbox Cognitive Battery was used to assess performance-based EF. Peripheral inflammation was assessed in fasted sera. Dual-energy X-ray absorptiometry scans were conducted to assess body composition. Linear regression and Hayes' PROCESS Model 4 (Hayes, 2017) were used to evaluate associations between adiposity and inflammation, inflammation and EF, and whether adiposity effects EF through its effect on inflammation.

RESULTS

Positive associations were identified between adiposity and inflammation, and negative to null associations were identified between inflammation and EF. Medium indirect effects of adiposity on EF through inflammation were detected.

CONCLUSION

Pilot evidence suggests greater adiposity is linked with greater inflammation, which in turn is associated with less EF in some domains. Directionality and causality cannot yet be established, but with replication, findings may inform efforts to target EF in pediatric obesity.

Acute Benefits of Acidified Milk Drinks with 10-g and 15-g Protein on Shifting and Updating Performances in Young Adults: A Randomized Controlled Trial

BACKGROUND

Accumulating evidence has shown that protein-rich milk drinks can rapidly improve cognitive performance. However, the optimum doses of milk protein that are needed to improve cognitive function remain to be investigated.

OBJECTIVE

This study aimed to determine whether acidified milk drinks with 10-g and 15-g milk protein have acute benefits on key cognitive functions in healthy young adults.

DESIGN

In this double-blinded randomized control trial, 66 young adults were randomly assigned to one of three groups (0-g, 10-g, and 15-g milk protein groups). Key cognitive functions (processing speed, inhibition, shifting, updating, and working memory capacity) were assessed before and 15 and 60 min after the drink intake.

RESULTS

We found that the shifting performance improved at 15 min after intake of the acidified 10-g and 15-g milk protein drinks compared to intake of the 0-g milk protein drink, and this acute effect of the acidified 15-g milk protein drink lasted for 60 min. In addition, updating performance improved at 60 min after intake of the acidified 10-g and 15-g milk protein drinks compared to intake of the 0-g milk protein drink.

CONCLUSION

Our findings suggest that the acidified 10-g and 15-g milk protein drinks have an acute benefit on shifting and updating performance in healthy young adults.

Protein quality and glycemic indexes of mango drinks fortified with a soybean/maize protein isolate with three levels of urease activity fed to weanling rats

Introduction

Public health professionals established a direct link between obesity and the rise in high caloric beverage intake. Current recommendations promote the elimination of sweet fruit drinks from the population's diet. One way of evading this is by modifying the drink's nutritional characteristics regarding nutrient uptake and utilization.

Objectives

evaluate the protein quality of a soy/maize protein (SMP) and its physiological effects on nutrient intake and to assess glycemic indexes (GIs) of mango based drinks prepared with sucrose or stevia.

Materials and methods

Mango drinks were supplemented with different sources of protein (three SMP thermally treated to contain different urease activities (UA) or whey protein concentrate (WPC)) that were sweetened with sucrose or stevia/sucralose. The protein digestibility, net protein absorption (NPA), biological value (BV), net protein utilization (NPU) value and protein efficiency ratio (PER) were assessed with weanling rats. Moreover, the GIs of the mango drinks were measured in the same animal model.

Results

PER and NPA evaluated in a rat model showed that increased levels of UA decreased Biological (BV) and Net Protein Utilization (NPU) values. The GIs of the mango drinks significantly diminished with the addition of 3.5% of SMP, but unexpectedly the substitution of sucrose by stevia/sucralose did not significantly change the glycemic response.

Conclusion

the SMP isolate can be used to improve the nutritional profile and lower GIs of mango drinks.

The impact of glycaemic load on cognitive performance: A meta-analysis and guiding principles for future research

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.

Association between dietary quality and executive functions in school-aged children with autism spectrum disorder

BACKGROUND

It is well known that children with autism spectrum disorder (ASD) had executive functions deficit. However, it is still unclear whether the poor dietary quality is related to the impairment of executive functions. The current study aimed to explore the association between dietary quality and executive functions in children with ASD.

METHODS

A total of 106 children with ASD (7.7 ± 1.3 years) and 207 typically developing (TD) children (7.8 ± 1.3 years) were enrolled from Guangzhou, China. The Chinese version of Behavior Rating Scale of Executive function (BRIEF), the working memory subscales of the Chinese version of Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), and the Stroop Color-Word Test (SCWT) were used to measure the participant's executive functions. The food frequency questionnaire (FFQ) was used to collect the dietary intake information, and the Chinese Diet Balance Index (DBI_16) was used to evaluate the dietary quality. Generalized linear models were used to estimate the association between dietary quality and executive functions.

RESULTS

In children with ASD, Low Bound Score (LBS) was positively correlated with the working memory subscale score of BRIEF (β = 0.23, 95% CI: 0.02-0.44, P < 0.05), while High Bound Score (HBS) and LBS were positively correlated with the organizable subscale score of BRIEF (β = 0.44, 95% CI: 0.11-0.77, P < 0.01; β = 0.19, 95% CI: 0.01-0.37, P < 0.05). Compared to TD children, children with ASD had a higher proportion of moderate and high levels of insufficient dietary intake (moderate level, 37.7% vs. 23.2%, high level, 4.7% vs. 1.4%) and moderate level of unbalanced dietary intake (36.8% vs.21.3%), higher scores on all subscales of BRIEF (P < 0.01), and lower score on the working memory (81.3 ± 32.3 vs. 104.6 ± 12.5, P < 0.01), while there was no difference on the SCWT.

CONCLUSION

Poor dietary quality was associated with the impairment of working memory and organizational capacity in children with ASD. This study emphasized the importance of dietary quality in executive functions among children with ASD, and attention should be paid to improving their dietary quality.

Assessment of Glycemic Response to Model Breakfasts Varying in Glycemic Index (GI) in 5-7-Year-Old School Children

Reduced Glycemic Index (GI) of breakfast has been linked to improved cognitive performance in both children and adult populations across the morning. However, few studies have profiled the post-prandial glycemic response (PPGR) in younger children. The aim of this study was to assess PPGR to breakfast interventions differing in GI in healthy children aged 5-7 years. Eleven subjects completed an open-label, randomized, cross-over trial, receiving three equicaloric test beverages (260 kcal) consisting of 125 mL semi-skimmed milk and 50 g sugar (either glucose, sucrose, or isomaltulose). On a fourth occasion, the sucrose beverage was delivered as intermittent supply. PPGR was measured over 180 min using Continuous Glucose Monitoring (CGM). The incremental area under the curve (3h-iAUC) was highest for the glucose beverage, followed by intermittent sucrose (-21%, p = 0.288), sucrose (-27%, p = 0.139), and isomaltulose (-48%, p = 0.018). The isomaltulose beverage induced the smallest Cmax (7.8 mmol/L vs. >9.2 mmol/L for others) and the longest duration with moderate glucose level, between baseline value and 7.8 mmol/L (150 vs. <115 min for others). These results confirm that substituting mid-high GI sugars (e.g., sucrose and glucose) with low GI sugars (e.g., isomaltulose) during breakfast are a viable strategy for sustained energy release and glycemic response during the morning even in younger children.

The potential nutrition-, physical- and health-related benefits of cow's milk for primary-school-aged children

Cow's milk is a naturally nutrient-dense foodstuff. A significant source of many essential nutrients, its inclusion as a component of a healthy balanced diet has been long recommended. Beyond milk's nutritional value, an increasing body of evidence illustrates cow's milk may confer numerous benefits related to health. Evidence from adult populations suggests that cow's milk may have a role in overall dietary quality, appetite control, hydration and cognitive function. Although evidence is limited compared with the adult literature, these benefits may be echoed in recent paediatric studies. This article, therefore, reviews the scientific literature to provide an evidence-based evaluation of the associated health benefits of cow's milk consumption in primary-school-aged children (4-11 years). We focus on seven key areas related to nutrition and health comprising nutritional status, hydration, dental and bone health, physical stature, cognitive function, and appetite control. The evidence consistently demonstrates cow's milk (plain and flavoured) improves nutritional status in primary-school-aged children. With some confidence, cow's milk also appears beneficial for hydration, dental and bone health and beneficial to neutral concerning physical stature and appetite. Due to conflicting studies, reaching a conclusion has proven difficult concerning cow's milk and cognitive function; therefore, a level of caution should be exercised when interpreting these results. All areas, however, would benefit from further robust investigation, especially in free-living school settings, to verify conclusions. Nonetheless, when the nutritional-, physical- and health-related impact of cow's milk avoidance is considered, the evidence highlights the importance of increasing cow's milk consumption.

Effects of a high-intensity interval training session and chocolate milk on appetite and cognitive performance in youth aged 9-13 years

BACKGROUND/OBJECTIVES

To investigate the separate and combined effects of a single session of high intensity interval training (HIIT) and chocolate milk on appetite and cognitive performance in youth aged 9-13 years. Blood glucose, salivary cortisol, and subjective emotions were measured to evaluate potential underlying mechanisms contributing to changes in appetite and cognitive performance.

SUBJECTS/METHODS

Using a 2 × 2 repeated measures design, 20 youth (n = 12 girls and n = 8 boys; age = 11.4 ± 0.3 years) performed HIIT on a cycle ergometer (7 × 60 s bouts, interspersed by 60 s active recovery) or sitting, followed by consumption of 163 kcal chocolate milk or water. Capillary blood glucose, salivary cortisol, cognitive performance, and subjective appetite and emotions were assessed at baseline and at several time points post-treatment.

RESULTS

Subjective appetite decreased from baseline following chocolate milk consumption compared water (p = 0.04), and increased from baseline after HIIT compared to sitting (p = 0.01). Participants recalled more words during a short-term memory task and had faster reaction times during an attention task following HIIT compared to sitting (Δ = 1.1 ± 0.02 words, p = 0.03; and Δ = 117.9 ± 23.1 ms, p = 0.01, respectively). Blood glucose increased from baseline following chocolate milk consumption compared to water (at 10 min: Δ = 1.0 ± 0.33 vs. Δ = 0.29 ± 0.060 mmol/L; p < 0.0001).

CONCLUSIONS

Our findings that HIIT may have a positive effect on aspects of cognitive performance suggest that youth should engage in HIIT-like exercise during recesses and lunch at school to attenuate declines in cognitive performance throughout the day. Registered at https://clinicaltrials.gov (NCT03305107).

Varying roles of glucoregulatory function measures in postprandial cognition following milk consumption

PURPOSE

Past work suggests milk consumption may facilitate cognition in children and college students with higher fasting glucose compared to other beverages (e.g., fruit juice). However, no studies have evaluated this phenomenon in adults, or considered other measures of glucoregulatory function. This open-label study assessed the role of glucoregulatory function in postprandial cognition after milk intake in adults. We hypothesized participants with lower fasting or post-consumption plasma glucose following a glucose excursion challenge (glucose response) would demonstrate better cognition following beverages of higher (juice) versus lower (milk) or no (water) glycemic content.

METHODS

Forty-four nondiabetic, overnight-fasted adults attended three laboratory visits, ingesting 237 mL of 2% fat milk, apple juice, or water at each visit in a randomized, counterbalanced, crossover design. Participants completed cognitive testing (CNS Vital Signs) at baseline and 30, 90, and 150 min post-ingestion; primary outcomes were CNS Vital Signs composite scores. Fasting and post-consumption plasma glucose levels were assessed, with glucose response indexed as the change in plasma glucose from baseline to 30 min after juice (ΔGlucose).

RESULTS

Mixed modeling revealed participants with higher fasting glucose demonstrated better complex attention after water versus juice at 30 min, but better performance after juice versus water at 150 min (p = 0.02). Participants with a larger ΔGlucose demonstrated better processing speed (p = 0.01) 30 min after milk versus water; this effect also reversed at 150 min.

CONCLUSION

Different methods of measuring glucoregulatory function reveal its differing roles in postprandial cognition. Time since ingestion may also determine which beverages best optimize cognition.

The effect on satiety of ingesting isosweet and isoenergetic sucrose- and isomaltulose-sweetened beverages: a randomised crossover trial

Generating feelings of satiety may be important in maintaining weight control. It has been hypothesised that the circulating concentration of glucose is a major determinant of satiety, yet the relationship between postprandial glycaemia and satiety is inconclusive. Our aim was to assess satiety following ingestion of beverages differing in glycaemic index (GI) containing either 50 g of sucrose (GI 65) or isomaltulose (PalatinoseTM) (GI 32). The beverages were matched for sweetness using a triangle sensory test. Seventy-seven participants were randomised to the order in which they received each beverage, 2 weeks apart. A standard lunch was given at 12.00 hours. Satiety was measured using 100-mm visual analogue scales (VAS) administered at 14.00 hours (baseline) and at 30, 60, 90, 120, 150 and 180 min after ingesting the beverage. Weighed diet records were kept from 17.00 to 24.00 hours. Mean differences for isomaltulose compared with sucrose AUC VAS were ‘How hungry do you feel?’ 109 (95 % CI –443, 661) mm × min; ‘How satisfied do you feel?’ 29 (95 % CI –569, 627) mm × min; ‘How full do you feel?’ −91 (95 % CI –725, 544) mm × min and ‘How much do you think you can eat?’ 300 (95 % CI –318, 919) mm × min. There was no between-treatment difference in satiety question responses or in dietary energy intake −291 (95 % CI −845, 267) kJ over the remainder of the day. In this experiment, feelings of satiety were independent of the GI of the test beverages. Any differences in satiety found between foods chosen on the basis of GI could be attributable to food properties other than the glycaemic-inducing potential of the food.

How Lifestyle Factors Affect Cognitive and Executive Function and the Ability to Learn in Children

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.

A critical review of the role of milk and other dairy products in the development of obesity in children and adolescents

Existing reviews suggest that milk and other dairy products do not play a role in the development of obesity in childhood, but they do make an important contribution to children's nutrient intake. It is thus curious that public health advice on the consumption of dairy products for children is often perceived as unclear. The present review aimed to provide an overview of the totality of the evidence on the association between milk and other dairy products, and obesity and indicators of adiposity, in children. Our search identified forty-three cross-sectional studies, thirty-one longitudinal cohort studies and twenty randomised controlled trials. We found that milk and other dairy products are consistently found to be not associated, or inversely associated, with obesity and indicators of adiposity in children. Adjustment for energy intake tended to change inverse associations to neutral. Also, we found little evidence to suggest that the relationship varied by type of milk or dairy product, or age of the children, although there was a dearth of evidence for young children. Only nine of the ninety-four studies found a positive association between milk and other dairy products and body fatness. There may be some plausible mechanisms underlying the effect of milk and other dairy products on adiposity that influence energy and fat balance, possibly through fat absorption, appetite or metabolic activity of gut microbiota. In conclusion, there is little evidence to support a concern to limit the consumption of milk and other dairy products for children on the grounds that they may promote obesity.

Effect of potatoes and other carbohydrate-containing foods on cognitive performance, glycemic response, and satiety in children

Dietary carbohydrates have been shown to influence cognitive performance and satiety in children. However, it remains unclear whether the carbohydrate source is a primary determinant of cognitive performance and satiety. The objective was to compare the effects of white potatoes and other carbohydrate-containing foods on cognitive performance, glycemic response, and satiety in children. On 6 separate mornings, in random order, children (n = 22) consumed 50 g of available carbohydrates from microwaved mashed potatoes (prepared from fresh potatoes then frozen), deep-fried potato strips (French fries), hash browns, white rice, white beans, or skipped a meal. Cognitive performance, glycemic response, and satiety were measured over 180 min. Cognitive performance was measured using a battery of tests assessing verbal declarative memory, spatial memory, short-term memory, working memory, and information processing speed. Although cognitive performance after the treatment meals did not differ from meal skipping, children recalled more words after French fries (9.1 ± 0.4 words) compared with mashed potatoes (8.2 ± 0.3 words; p = 0.001) and white rice (8.4 ± 0.3 words; p = 0.04) on the verbal declarative memory test. Blood glucose concentrations were higher after white rice compared with white beans, mashed potatoes, and hash browns (p < 0.05). Change from baseline subjective average appetite (mm/kcal) was lower after mashed potatoes compared with all other treatment meals (p < 0.05). In conclusion, verbal declarative memory was higher after French fries and subjective average appetite was lower after mashed potatoes. Future longitudinal studies are needed to confirm these short-term findings and to elucidate the mechanism of action.

The impact of diet-based glycaemic response and glucose regulation on cognition: evidence across the lifespan

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.

Methodological Challenges in Studies Examining the Effects of Breakfast on Cognitive Performance and Appetite in Children and Adolescents

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.

The Effects of Breakfast and Breakfast Composition on Cognition in Children and Adolescents: A Systematic Review

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.