RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BENGALURU, KARNATAKA.
SYNOPSIS PERFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1.
NAME OF THE CANDIDATE AND Ms. SREELAKSHMI S,
GEETHANJALI,
ADDRESS
SENGUPTHA ROAD,
OTTAPALAM,
PALAKKAD.
KERALA- 679101
2.
NAME OF THE INSTITUTION
M.S RAMAIAH INSTITUTE OF
NURSING
EDUCATION
AND
RESEARCH, BANGALORE
3.
COURSE
OF
STUDY
AND M.Sc. NURSING
SUBJECT
CHILD HEALTH NURSING
DATE OF ADMISSION
10-06-2010
4.
5.
TITLE OF THE STUDY:
CORRELATION BETWEEN NUTRITIONAL STATUS AND MEMORY
AMONG SCHOOL CHILDREN.
1
6. BRIEF RESUME OF INTENDED WORK
“The groundwork of all happiness is the good health.” – Leigh Hunt
INTRODUCTION:
Nutrition is the process of ingesting and assimilating the nutrients. Food is a
concern of the mankind beginning from the time of conception and extending through
the entire life span of the individual. Food supplies the energy for physical activity
and other metabolic needs of the body. Nutrients are necessary for maintaining
growth of the individual and for repair of the worn out and aging tissues.1
Nutritional status of an individual is often the result of many interrelated
factors. It is influenced by the adequacy of food intake both in terms of quality and
quantity and also by the physical health of the individual. Nutritional status during
school age is a major determinant of nutritional and health status in adult life.
Globally, health hazards associated with undernutrition and micronutrient
deficiencies remain a major public health problem. The past three decades have
witnessed the emergence of overnutrition as a problem in school-age children in
developed countries and in affluent urban segments in developing countries.2
Anthropometric
measurements
such
as
height,
weight,
mid
arm
circumference, skin fold thickness are valuable indicators of nutritional status. World
Health Organization has recommended various indices based on anthropometry to
evaluate nutritional status of school children. Body Mass Index (BMI) is the most
appropriate variable for nutritional status.3
Malnutrition is associated with both structural and functional pathology of the
brain. It results in tissue damage, growth retardation, disorderly differentiation,
reduction in synapses and synaptic neurotransmitters, delayed myelination and
reduced overall development of dendritic arborization of the developing brain. There
2
are deviations in the temporal sequences of brain maturation, which in turn disturb the
formation of neuronal circuits .Long term alterations in brain function have been
reported which could be related to long lasting cognitive impairments associated with
malnutrition.4
Stunting in early childhood is common in developing countries and is
associated with poorer cognition and school achievement in later childhood.2
Cognition is the mental action or process of acquiring knowledge through thought,
experience and senses. The components of cognition involves attention, memory,
executive functions, visuo-spatial functions, comprehension, learning, motor speed
and expressive speech. A wide range of cognitive deficits has been observed in
malnourished children in India.4
Out of these, memory implies the encoding, storage, and retrieval of
information, which is very important from a developmental perspective because the
capacity to hold information and process it supports various higher level
accomplishments such as language, categorization, and social cognition.4
The differential nature of cognitive deficits associated with malnutrition
suggests that different areas of the brain are compromised to different degrees. A
neuropsychological assessment would be able to delineate the pattern of brain
dysfunction. Neuropsychological measures can demonstrate delay in normally
developing cognitive processes as well as permanent cognitive deficits. Short-term
working memory would certainly appear to be a prime target as an index of how
nutrition affects cognitive development in young children.2
3
6.1 NEED FOR THE STUDY:
Census 2001 has recorded that in India one fifth of the population comprises
of children between 5-14 years of age, which includes the primary and secondary
school age. Population projections indicate that over the next decade this age group
will show by far the largest increase in numbers. It is therefore essential that over the
next decade efforts should be focused on improving the health and nutritional status
of school-age children, so that they reach adult life with optimal nutrition and health
status.3
Malnutrition is a major problem in our country as 52% of our children were
malnourished in 2006. National Family Welfare Survey , (2005-06), shows that 40%
of Indian children under 3 years are underweight , 45% are having stunted growth
and 23% are having muscle wasting. Proportion of children who are stunted or
underweight increases rapidly with the child’s age. The World Health Organization
cites malnutrition as the gravest single threat to the world's public health. There were
923 million malnourished people in the world in 2007. On the average, a child dies
every 5 seconds as a direct or indirect result of malnutrition - 700 every hour - 16 000
each dayand 6 million each year. Hence, 60% of all child deaths are due to
malnutrition (2002-2008 estimates).3About 35% of preschool children in sub-Saharan
Africa are reported to be stunted.5
A study was conducted in 2007 which aimed at identifying the prevalence of
malnutrition among 500 children studying at Government schools of Azad Nagar
Bangalore. Children aged 8-14 years studying in class 1st – 8th were selected.
Anthropometric data and eating habits of children were collected. Compared to WHO
standards, mean BMI of school children in Azad Nagar and its surrounding area was
inferior at all ages. The prevalence of malnutrition was 68%. Males recorded a higher
4
rate of malnutrition 57.94% (197) than females 42.06% (143). The study revealed that
average of Government School children in Azad Nagar is underweighed. Poor
nutrition of the children do not only affects the cognitive development of children but
also is likely to reduce the work capacity in the future.6
A study was conducted in UK to assess the effect of breakfast in reducing the
declines in attention and memory over the morning in schoolchildren. Twenty-nine
schoolchildren were tested throughout the morning on 4 successive days, having a
different breakfast each day (either of the cereals Cheerios or Shreddies, glucose drink
or No breakfast). A series of computerized tests of attention, working memory and
episodic secondary memory was conducted prior to breakfast and again 30, 90, 150
and 210 min later. The glucose drink and no breakfast conditions were followed by
declines in attention and memory, but the declines were significantly reduced in the
two cereal conditions. This study provides objective evidence that a typical breakfast
of cereal rich in complex carbohydrates can help maintain mental performance over
the morning.7
The social competence, visual motor coordination and memory functions of
1336 rural primary school children in India, between the age group 6-8 yr were
studied in relation to their nutritional status and socio-environmental factors. Children
with grades, I, II and III malnutrition scored 4.4, 8.5 and 11.8 points lower
respectively as compared to those in normal nutrition. Stunted wasted rural children
performed poorly on areas like communication, socialization and occupation.
Environmental factors like family size and type, economic sufficiency, and father's
education also played a significant role in determining the social competence in girls.
Observations on memory test indicated that malnutrition had a significant but very
weak relationship with immediate and delayed memory. The boys in grade II
5
malnutrition had significantly lower immediate memory scores, as compared to
normal boys. Further, for delayed memory, boys in grade II malnutrition scored
poorly for pictures and words.8
Children are the wealth of any nation as they constitute one of the important
segments of the population. Although various government schemes are set up to
combat the nutritional problems, they have not had the expected impact in reducing
malnutrition or micronutrient deficiencies. The foundation of good health and a sound
mind is laid during the school age period. Normal cognitive abilities like attention,
concentration and most importantly the memory are essential factors which directly or
indirectly determine the scholastic and overall acheivements of an individual. These
are the basic milestone of an individual and it is responsible for many changes that
take place during the later life. Moreover school age is considered as the dynamic
period of growth and development because children undergo physical, mental,
emotional, and social changes. The school children are easily accessible, capacitive
and responsive group. Keeping in view all these facts, student researcher has taken up
this study to assess and define the relation between nutritional status and memory of
school children.
6.2 REVIEW OF LITERATURE
A cross-sectional study was conducted among 598 school children in India,
aged 6-10 years to explore the association of Undernutrition, fatty acid and
micronutrient status with cognitive performance. Baseline data of the clinical study
were used to assess the associations with age, sex, school, maternal education and
cognitive tests. The Kaufman Assessment Battery for Children II was used to measure
four cognitive domains, including fluid reasoning, short-term memory, retrieval
6
ability and cognitive speediness. Scores were combined into an overall measure,
named mental processing index (MPI). Body size indicators and Hemoglobin
concentrations were significantly positively related to cognitive domains and MPI.9
A study was conducted in Iran, to evaluate the relationship between
breakfast pattern and short-term memory in school students. A total of 150 junior high
school girls were taken from four schools in Shiraz. They filled out the socioeconomic questionnaires as well as food frequency questionnaires for breakfast and
provided two-three day breakfast records in two different seasons. Their short-term
memories were evaluated by Wechsler test. The results of the study showed that there
was no correlation between parents job, students mean age and their school grades
with their memory scores. Food record analysis showed no correlation between fat,
cholesterol, protein, vitamin B6, B12, calorie and iodine intake in breakfast and
memory scores, but there was a positive correlation between carbohydrate, iron and
vitamin B3 intake in breakfast and memory scores, similarly there was a positive
correlation between B12 intake in the breakfast and students' average school grades
during the year.10
A Cross-sectional study was conducted by the National Institute of Nutrition
(Indian Council of Medical Research), Hyderabad, India, to study the relationship of
breakfast to the attention-concentration, immediate recall memory, nutritional status
and academic achievement of school children. 379 urban, 11 to 13 years old school
children studying in 6th, 7th and 8th grades from two schools catering to middle class
families in Hyderabad city were selected. Letter Cancellation test, immediate memory
from the PGI Memory Scale, school marks of the previous year and nutritional status,
were assessed. Comparison between groups indicated significant differences in the
letter cancellation (LC) total scores, with the regular breakfast group achieving the
7
highest mean scores compared to the no breakfast group (P< 0.05). Marks scored by
the regular breakfast group in subjects - Science, English and total Percentage were
significantly higher compared to those scored by the children in the no breakfast
group. Regular breakfast eating habit and weight for age percent were significantly
associated with immediate recall memory score.11
A study was conducted to test the efficacy of a multiple micronutrient food
supplement (MMFS) on the nutrition status of school children and its effect on
cognition, at Chennai. The efficacy of the MMFS was assessed in 7-11 year old
school children by a pre-post test design. In the experimental group (N=51), the food
in the school kitchen was cooked with the MMFS for the residential school children
for a period of one year. The control group (N=72) consisted of day scholars who did
not eat at the school. A battery of 7 memory tests, were administered to all the
children. Results revealed that there was a significant (P<0.05) improvement in the
experimental group in hemoglobin, hematocrit and red cell count whereas in the
control group there was a statistically significant decline (P<0.05) in hemoglobin and
red cell count. In 5 tests out of the 7 memory tests and in the letter cancellation test
for attention, the mean change in scores in the experimental group is significantly
more than the control group. Thus the study showed that the MMFS was effective in
improving the nutrition status and cognition in children.2
A cross sectional study was conducted in Spain, to evaluate the long lasting
consequences of early and severe undernutrition on the development of basic
cognitive functions. Attention, memory and problem-solving capacity were assessed
in a group of 16 school children, who were severely undernourished during the first
two years of age. They were compared with a group of 16 children with normal
growth. All subjects, age 8 to 10, had a normal intellectual coefficient and they
8
belonged to the same socioeconomic level. The children who were undernourished
during infancy presented lower scores in memory and in problems solving. They also
had a worse performance than the control group in the same response time, when
attention was evaluated. The results suggested that early severe undernutrition had
deleterious effects on basic cognitive functions.12
STATEMENT OF THE PROBLEM
A correlational study to assess the relationship between nutritional status and memory
among school children in selected schools at Bangalore.
6.3 THE OBJECTIVES OF THE STUDY
1. To assess the nutritional status among school children in selected Schools,
Bangalore.
2. To assess the memory among school-age children in selected Schools,
Bangalore.
3. To find the relation between nutrition status and memory among school
children.
4. To find the association between nutritional status among School children
and selected demographic variables.
5. To find the association between memory among School children and
selected socio-demographic variables.
9
6.4 HYPOTHESES
H01 -There is no significant relation between the nutritional status and memory
among school children.
H02- There is no significant association between the nutritional status among
school children and selected socio-demographic variables.
H03 – There is no significant association between the memory among school
children and selected socio-demographic variables.
6.5 OPERATIONAL DEFINITONS
RELATIONSHIP- refers to the way in which nutritional status and memory
are associated to each other.
NUTRITIONAL STATUS –refers to the state of nourishment of school
children as a result of the foods consumed and their use by the body, assessed
by the IAP (Indian Academy of Pediatrics)
classification and calculation of
body mass index using anthropometric measurements such as height and
weight.
MEMORY – refers to the ability of the brain to retain and to use knowledge
gained from past experience which is essential to the process of learning,
assessed using modified NIMHANS Memory Assessment scale.
SCHOOL CHILDREN – refers to the children aged between 7-11 years who
are studying in selected Schools at Bangalore.
10
6.6 ASSUMPTIONS
 School children may have varying levels of nutritional status.
 There may be positive relationship between nutritional status and memory
among school children.
6.7 DELIMITATIONS
Study is delimited to
1. School children in age group of 7-11 years and studying selected
Schools at Bangalore.
2. Four weeks period of data collection.
7. MATERIALS AND METHODS
7.1 SOURCE OF DATA:
School children studying in selected Schools, Bangalore.
7.2 METHOD OF DATA COLLECTION:
7.2.1
TYPE OF STUDY/RESEARCH APPROACH:
Descriptive survey approach.
7.2.2
RESEARCH DESIGN:
Correlational descriptive survey design.
7.2.3
VARIABLES:
Study variables – Nutritional status and Memory
11
Attribute variables - Age, Gender, class of study, type of food habit,
type of family, ordinal position in the family, number of siblings ,
occupation of parents, type of school, mid- day meal programme,
additional nutrient supplementation at school.
7.2.4
SAMPLING TECHNIQUE:
Simple random sampling technique.
7.2.5
SAMPLE AND SAMPLE SIZE:
Fifty school children between 7-11 years.
7.2.6
SELECTION CRITERIA:
Inclusion criteria – school children who:
are willing to participate in the study.
can understand and respond in Kannada or English
are in the age group of 7-11 years.
are studying in 2nd to 6th class.
Exclusion criteria –School children who:
are absent on the day of data collection.
are having clinically diagnosed mental disorder.
are not willing to participate.
7.2.7
DURATION OF THE STUDY:
Four weeks of data collection.
7.2.8
TOOL OR INSTRUMENT:
Section A: Socio-demographic profile such as, age, gender, class of
study, type of food habit, type of family, ordinal position in the family,
12
number of siblings, occupation of parents, type of school, mid- day
meal programme, additional nutrient supplementation at school.
Section B: Nutritional assessment using Body Mass Index calculation
and IAP (Indian Academy of Pediatrics) classification.
Section C: Memory assessment using modified NIMHANS memory
scale.
7.2.9 DATA COLLECTION PROCEDURE:
Formal permission will be obtained from the concerned school
authority. Subjects will be taken from the selected schools using
simple random sampling technique. After explaining about self and
regarding the purpose of study assent will be taken from the
participants. Anthropometric measurements of each subject will be
taken. Nutritional status of the subjects will be assessed using the,
using IAP (Indian Academy of Pediatrics) classification and BMI
(Body Mass Index) calculation. Also the memory assessment of each
subject will be done using modified NIMHANS memory assessment
scale.
7.2.10 PLAN FOR STATISTICAL ANALYSIS:
The data will be entered into the master sheet. Keeping the objectives
of the main study in view, the descriptive and inferential statistics will
be done.
Descriptive statistics: The mean, mean percentage and standard
deviation will be calculated.
13
Inferential statistics:
Correlation will be made between the
nutritional status scores and the memory scores using Karl Pearson’s
correlation coefficient.
7.3 Does the study require any investigation or intervention on patient or
human? If so, describe briefly.
Yes, the study assesses the nutritional status among school children
using anthropometric measurements and memory assessment using the
modified NIMHANS memory scale.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Ethical clearance will be obtained from concerned ethical committee
and assent will be obtained from the school children.
14
8. LIST OF REFERENCES
1. Ghai OP, Gupta P, Paul VK. Ghai essential pediatrics. 6th ed. New Delhi:
CBS; 2005. p. 93-4.
2. Vinod KM, Rajagopalan S. Trial using multiple micronutrient food
supplement and its effect on cognition. Indian J Pediatr [serial online] 2008 Jul
[cited 2010 Sep 16]; 75(7):671-8. Available from: URL :
http://www.ncbi.nlm.nih.gov/pubmed/18716734
3. Nutrition and Physical Performance in school age children. [Online]. 2008
[cited
2010
Jul
22];[34
screens].
Available
from:
URL:
http://nutritionfoundationofindia.res.in/workshop_symposia/nutritoin%20and%20p
hysical%20acitvity%20%20background%20paper%20and%20abstracts/Abstract.pdf
4. Udani PM. Brain and various facets of child development. Indian J Pediatr
1992;59(4):165-86.
5. Raghavan KV, Singh D, Swaminathan MC. Heights and weights of well
nourished Indian school children. Indian J Med Res. 1971;59(4):648-54.
6. Dr Izharul Hasan. A Study of prevalence of malnutrition in government
School children in the field area of Azad nagar Bangalore. Indian J Pediatr
[serial online] 2007 Dec [cited 2010 Oct 26]; 74(7):[21 screens]. Available
from: URL :http://precedings.nature.com/documents/5009/version/1
7. Wesnes KA, Pincock C, Richardson D, Helm G, Hails S. Breakfast reduces
declines in attention and memory over the morning in schoolchildren. Appetite
[serial online] 2003 Dec [cited 2010 Oct 15]; 41(3):329-31. Available from:
URL :http://www.whymilk.com/benefits_of_breakfast.php
8. Upadhyaya SK, Agarwal KN, Agarwal DK. Influence of malnutrition on
social maturity, visual motor coordination and memory in rural school
15
children. Indian J Med Res [serial online] 2000 May [cited 2010 Sep
24];90(6):320-7. Available from:
URL:http://www.ncbi.nlm.nih.gov/pubmed/2628300
9. Eilander A, Muthayya S, Srinivasan K, Thomas T, Kurpad AV, Osendarp SJ.
Undernutrition, fatty acid and micronutrient status in relation to cognitive
performance in Indian school children: a cross-sectional study. Br J Nutr
[serial online] 2010 Apr [cited 2010 Oct 14];103(7):1056-64. Available from:
URL:http://www.ncbi.nlm.nih.gov/pubmed/20003612
10. Ahmadi A, Sohrabi Z, Eftekhari MH. Evaluating the relationship between
breakfast pattern and short-term memory in junior high school girls. Pak J Biol
Sci [serial online] 2009 May [cited 2010 Sep 30];12(9):742-5. Available from:
URL:http://scialert.net/fulltext/?doi=pjbs.2009.742.745
11. Gajre NS, Fernandez S, Balakrishna N, Vazir S. Breakfast eating habit and its
influence on attention-concentration, immediate memory and school
achievement. Indian J Pediatr [serial online] 2008 Oct [cited 2010 Oct
21];45(10):824-8. Available from:
URL:http://www.pjbs.org/pjnonline/fin1603.pdf
12. López I, de Andraca I, Perales CG, Heresi E, Castillo M, Colombo M.
Breakfast omission and cognitive performance of normal, wasted and stunted
schoolchildren. Eur J Clin Nutr [serial online] 1993 Aug [cited 2010 Oct
21];47(8):533-42. Available from:
URL:http://www.ncbi.nlm.nih.gov/pubmed/8404789
13. Jacques Diouf. The State of Food Insecurity in the World 2004: Monitoring
Progress Towards World Food Summit and Millennium Development Goals.
Food and Agriculture Organization of the United Nations. 2004; 43(5): 4.
16
14. Van Petten C. Relationship between hippocampal volume and memory ability
in healthy individuals across the lifespan: review and meta-analysis.
Neuropsychologia. 2004;42(10):1394–413.
15. Ghani AR, Verma IC, Ghai OP, Seth V. Physical growth of school children in
Delhi. Indian J Pediatr. 1971;38(286):411-23
16. Grantham-McGregor, S. & Ani, C. The role of micronutrients in psychomotor
and cognitive development. Br Med J. 1999;55: 511–527.
17. Upadhyaya SK, Saran A, Agarwal DK, Singh MP, Agarwal KN: Growth and
behaviour development in rural infants in relation to malnutrition and
environment. Indian Pediatr 1992, 29:595-606.
18. Leenstra T, Petersen LT, Kariuki SK, Oloo AJ, Kager PA, Kuile FO.
Prevalence and severity of malnutrition and age at menarche: cross-sectional
studies in adolescent schoolgirls in western Kenya. Eur J Clin Nutr
2005;59(12):41-8.
19. Levitsky DA, Strupp BJ. Malnutrition and the brain: undernutrition and
behavioural development in children. J nutr 1995;125(16):37-9.
20. Balaji LN, Dustagheer A. Nutrition scenario in India -implications for clinical
practice. J Indian Med Assoc 2000;98(9):536-8, 542.
17
9
SIGNATURE
OF
THE
CANDIDATE
10
REMARKS OF THE GUIDE
This study enquires the relationship
between nutritional status and
memory. Through this awareness can
be created regarding importance of
good nutrition.
11
NAME AND DESIGNATION OF
( In Block Letters)
11.1
GUIDE
Mr. RK MUNISWAMY
ASSOCIATE PROFESSOR
CHILD HEALTH NURSING
11.2
SIGNATURE
11.3
CO-GUIDE( IF ANY)
11.4
SIGNATURE
11.5
HEAD OF THE DEPARTMENT
Mr. RK MUNISWAMY
ASSOCIATE PROFESSOR
CHILD HEALTH NURSING
11.6
SIGNATURE
12.1
REMARKS OF THE PRICIPAL
Nutritional status determines the
health status of children. The present
study tries to test the relationship
between nutritional status and
memory.
12.2
SIGNATURE
18