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It is widely assumed that nutrition can affect school performance in children, yet evidence remains limited and inconclusive. In high-income countries the role of dietary quality, iron and n-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) are nutritional issues that may be of relevance to cognitive functions. Few studies have investigated the effect of school meals on cognition and academic performance in high-income countries. Most previous school meal studies investigated the effects of healthier options in school cafeteria and did not consider effects on dietary intake or biomarkers of iron and n-3 LCPUFA-status. Furthermore, methodological issues in earlier studies question the validity of the results. The OPUS School Meal Study was a cluster-randomized controlled cross-over trial implemented in third and fourth grade at nine Danish schools. The three-month intervention consisted of a healthy school meal program based on the New Nordic Diet, which was compared with the usual packed lunch from home (control). At baseline and at the end of each study period, several measurements were performed including weight, height and blood sampling as well as a 7-day assessment of both physical activity and dietary intake. Moreover, we assessed student performance in d2-test of attention and Danish standard tests in reading and mathematics. Hemoglobin concentration, serum ferritin concentration and whole blood fatty acid composition were employed as biomarkers of iron and n-3 LCPUFA-status. The overall purpose of this PhD thesis was to investigate the effect of serving healthy school meals on attention and academic performance in 8-11-year-old children. Moreover, the role of n-3 LCPUFA-status and iron status was explored, as well as whether the effect of the intervention differed depending on household education level, sex and baseline reading skills of the child.

It is widely assumed that nutrition can affect school performance in children, yet evidence remains limited and inconclusive. In high-income countries the role of dietary quality, iron and n-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) are nutritional issues that may be of relevance to cognitive functions. Few studies have investigated the effect of school meals on cognition and academic performance in high-income countries. Most previous school meal studies investigated the effects of healthier options in school cafeteria and did not consider effects on dietary intake or biomarkers of iron and n-3 LCPUFA-status. Furthermore, methodological issues in earlier studies question the validity of the results. The OPUS School Meal Study was a cluster-randomized controlled cross-over trial implemented in third and fourth grade at nine Danish schools. The three-month intervention consisted of a healthy school meal program based on the New Nordic Diet, which was compared with the usual packed lunch from home (control). At baseline and at the end of each study period, several measurements were performed including weight, height and blood sampling as well as a 7-day assessment of both physical activity and dietary intake. Moreover, we assessed student performance in d2-test of attention and Danish standard tests in reading and mathematics. Hemoglobin concentration, serum ferritin concentration and whole blood fatty acid composition were employed as biomarkers of iron and n-3 LCPUFA-status. The overall purpose of this PhD thesis was to investigate the effect of serving healthy school meals on attention and academic performance in 8-11-year-old children. Moreover, the role of n-3 LCPUFA-status and iron status was explored, as well as whether the effect of the intervention differed depending on household education level, sex and baseline reading skills of the child.