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Background: Unhealthy lifestyles in early childhood are a major global health challenge. These lifestyles often persist from generation to generation and contribute to a vicious cycle of health-related and social problems. This design article presents a study evaluating the effects of two novel healthy school interventions. The main outcome measure will be changes in children's body mass index (BMI). In addition, lifestyle behaviours, academic achievement, child well-being, socio-economic differences, and societal costs will be examined.Methods: In close collaboration with various stakeholders, a quasi-experimental study was developed, for which children of four intervention schools (n = 1200) in the southern part of the Netherlands are compared with children of four control schools (n = 1200) in the same region. The interventions started in November 2015. In two of the four intervention schools, a whole-school approach named 'The Healthy Primary School of the Future', is implemented with the aim of improving physical activity and dietary behaviour. For this intervention, pupils are offered an extended curriculum, including a healthy lunch, more physical exercises, and social and educational activities, next to the regular school curriculum. In the two other intervention schools, a physical-activity school approach called 'The Physical Activity School', is implemented, which is essentially similar to the other intervention, except that no lunch is provided. The interventions proceed during a period of 4 years. Apart from the effectiveness of both interventions, the process, the cost-effectiveness, and the expected legal implications are studied. Data collection is conducted within the school system. The baseline measurements started in September 2015 and yearly follow-up measurements are taking place until 2019.Discussion: A whole-school approach is a new concept in the Netherlands. Due to its innovative, multifaceted nature and sound scientific foundation, these integrated programmes have the potential to form a template for primary schools worldwide. The effects of this approach may extend further than the outcomes associated with well-being and academic achievement, potentially impacting legal and cultural aspects in our society.Trial Registration: The study protocol was registered in the database ClinicalTrials.gov on 14-06-2016 with the reference number NCT02800616 . [ABSTRACT FROM AUTHOR]

Introduction: Observational studies have shown a relationship between omega-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) and depression in adolescents. However, n-3 LCPUFA supplementation studies investigating the potential improvement in depressive feelings in adolescents from the general population are missing., Methods: A one-year double-blind, randomized, placebo controlled krill oil supplementation trial was conducted in two cohorts. Cohort I started with 400 mg eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) or placebo, after three months this increased to 800 mg EPA and DHA per day, whilst cohort II started with this higher dose. Omega-3 Index (O3I) was monitored via finger-prick blood measurements. At baseline, six and 12 months participants completed the Centre for Epidemiologic Studies Depression Scale (CES-D) and the Rosenberg Self Esteem questionnaire (RSE). Adjusted mixed models were run with treatment allocation/O3I as predictor of CES-D and RSE scores., Results: Both intention-to-treat and assessing the change in O3I analyses did not show significant effects on CES-D or RSE scores., Conclusion: There is no evidence for less depressive feelings, or higher self-esteem after one year of krill oil supplementation. However, due to a lack of adherence and drop-out issues, these results should be interpreted with caution., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The prenatal exposure to maternal n-6 and n-3 polyunsaturated fatty acids (PUFAs) might influence the development of social competence and internalizing and externalizing behaviours of the child, because of the numerous functions of PUFAs within the nervous system., Methods: To analyse the association of selected maternal PUFAs (i.e., AA, EPA, DHA, total n-6, total n-3, and the n-6:n-3 ratio) measured during gestation with childhood social competence and problem behaviours, we examined 311 mother-child pairs from the Maastricht Essential Fatty Acid Birth (MEFAB) cohort. For each woman, PUFA-specific changes in relative concentrations were calculated by identifying the best-fitting curve of PUFA concentration by linear splines of gestational age. The associations of changes in maternal PUFAs in early and late pregnancy with childhood social competence, total problems, internalizing and externalizing behaviours, measured with the Child Behaviour Checklist 4/18 at age 7, were investigated with linear regression analyses adjusted for maternal and children's socio-demographic characteristics., Results: In late gestation (i.e., from gestational week 30), an increase in AA was associated with higher social competence, while a decrease in total n-6 was associated with lower externalizing behaviours. No other significant associations were found., Discussion: In this prospective study, increasing maternal AA and decreasing total n-6 were associated with improved social competence and externalizing behaviours, respectively, in 7-year old children. Nonetheless, the clinical significance of the identified associations is modest and further investigations are warranted to clarify the relationship between maternal AA and total n-6 during pregnancy and childhood social and behavioural development., (Copyright © 2019. Published by Elsevier Ltd.)

Introduction: Concentrations of the fish fatty acids EPA and DHA are low among Dutch women of reproductive age. As the human brain incorporates high concentrations of these fatty acids in utero, particularly during third trimester of gestation, these low EPA and DHA concentrations may have adverse consequences for fetal brain development and functioning., Methods: Analyses were conducted using longitudinal observational data of 292 mother-child pairs participating in the MEFAB cohort. Maternal AA, DHA, and EPA were determined in plasma phospholipids - obtained in three trimesters - by gas-liquid chromatography. Cognitive function was assessed at 7 years of age, using the Kaufman Assessment Battery for Children, resulting in three main outcome parameters: sequential processing (short-term memory), simultaneous processing (problem-solving skills), and the mental processing composite score. Spline regression and linear regression analyses were used to analyse the data, while adjusting for potential relevant covariates., Results: Only 2% of the children performed more than one SD below the mental processing composite norm score. Children with lower test scores (<25%) were more likely to have a younger mother with a higher pre-gestational BMI, less likely to be breastfed, and more likely to be born with a lower birth weight, compared to children with higher test scores (≥25%). Fully-adjusted linear regression models did not show associations of maternal AA, DHA, or EPA status during any of the pregnancy trimesters with childhood sequential and simultaneous processing., Conclusion: Maternal fatty acid status during pregnancy was not associated with cognitive performance in Dutch children at age 7., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Prenatal exposure to polyunsaturated fatty acids (PUFAs) may influence childhood growth. However, available evidence mostly derived from short-term studies is inconsistent., Objective: To assess whether fetal PUFA exposure is associated with height and body mass index (BMI), a common measure of adiposity, from 6 months to 23 years of age., Methods: In the MEFAB cohort, we assessed cord blood phospholipid n-3 and n-6 PUFA levels, reflecting fetal exposure in late pregnancy. For 250 (45.2% females) participants, we collected a total of 1770 (n= 802 for females) repeated growth measurements from infancy to young adulthood. We examined sex-specific associations of PUFAs with height and BMI at different developmental ages (infant: 6 months; toddler: 2 years; pre-schooler: 4 years; school-aged child: 7 years; adolescent: 12 years; and young adult: 23 years) using fractional polynomial mixed models adjusted for important covariates., Results: Higher n-3 PUFA levels were associated with higher infant length in males (β= 0.44cm [95% CI: 0.07, 0.82] per SD increase), whereas, for females, higher n-6 PUFA concentrations were associated with lower length in infancy (β= -0.69cm [95% CI: -1.08, -0.30] per SD increase). A higher ratio of n-3 to n-6 PUFAs was associated with higher infant length in both sexes (β= 0.40cm [95% CI: 0.01, 0.78] and 0.42cm [95% CI: 0.05, 0.79] per unit increase for males and females, respectively). These associations were not detectable later in childhood and young adulthood. No associations with BMI were found at any time point examined., Conclusions: Our findings suggest a small sex-specific influence of PUFA status at birth on length in infancy, but this does not persist in later life up to young adulthood. PUFA status at birth does not seem to affect BMI from infancy till young adulthood., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Introduction: Long-chain polyunsaturated fatty acids (LCPUFAs) are important for brain functioning and might, thus, influence cognition and school performance. However, research investigating LCPUFAs relationships with school performance is limited. The objective of this study was to determine the association between levels of the LCPUFAs docosahexaenoic acid (DHA), arachidonic acid (AA), eicosapentaenoic acid (EPA) and n-6 docosapentaenoic acid (Osbond acid, ObA) at study entry, 22 weeks of pregnancy, 32 weeks of pregnancy, at partus, in umbilical cord plasma and child's plasma at age 7 and school performance scores at age 7., Methods: Data from the Maastricht Essential Fatty Acid Birth cohort (MEFAB) were used for this study. Fatty acid levels of plasma phospholipids were measured in maternal blood plasma at study entry, 22 weeks of pregnancy, 32 weeks of pregnancy and partus. Childs fatty acid levels of plasma phospholipids were measured a in umbilical cord blood plasma, and in blood plasma of the child at age 7. Scores on national standardised tests for spelling, reading and arithmetic at age 7 were obtained via the school (scores were available for 149, 159 and 155 children, respectively). Associations between LCPUFA levels and school performance scores were analysed with categorical regression analyses with correction for covariates (smoking, maternal education, sex, breastfeeding, maternal intelligence, birth weight and BMI at age 7)., Results: Significant (p<0.001) associations between DHA level at age 7 and both reading (β=0.158) and spelling (β=0.146) were found. Consistent significant negative associations were observed between all maternal DHA plasma levels and arithmetic scores at age 7 (all p<0.001, all β<-0.019). Additional significant negative associations were observed between maternal LCPUFA plasma levels at study entry and both reading and spelling scores at age 7; these associations were less consistent., Conclusion: Plasma DHA levels at age 7 were positively associated with reading and spelling scores at age 7. Consistent significant negative associations between maternal plasma DHA levels and arithmetic scores of the child at age 7 were found. Although this is an observational study, which cannot proof causality, the consistent negative associations observed between maternal plasma DHA levels and the arithmetic scores of the children at age 7 calls upon prudence when considering DHA supplementation during pregnancy., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Fish consumption has shown its benefits for cognitive functioning in the elderly or children with disorders (e.g., autism, ADHD), but has rarely been investigated in relation to cognitive performance and school performance of healthy adolescents. We executed an observational study in 700 Dutch high school students aged 12-18 years. Fish consumption data, end term grades, scores on the Amsterdam Vocabulary Test, and scores on the Youth Self-Report were collected. Results revealed that 13.6% of the Dutch adolescents never ate fish, 6.4% met national guidelines, 16.9% reached half of the norm, and 63.1% did eat fish but too little to meet at least half of the norm. Analysis of variance, controlled for relevant covariates, showed significant differences between the four fish consumption groups in vocabulary (p=.05). A trend for significance was found for end term grades (p=.07). Contrast analyses demonstrated significant quadratic associations between fish consumption and vocabulary (p=.01) and end term grades (p=.01). Thus higher fish intake was associated with more advanced vocabulary and higher end term grades. However, eating more fish than the described norm seemed no longer beneficial., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Depressive symptoms in the community have a considerable impact on quality of life. Although long-chain polyunsaturated fatty acids (LCPUFA) have frequently been implicated in depressed mood, their relationship with quality of life has scarcely been investigated. This study examined the cross-sectional associations between fish consumption and plasma phospholipid LCPUFA status on the one hand, and quality of life, as measured by the Short Form 36 questionnaire, on the other in a population-based sample. The mental health component of quality of life was not associated with LCPUFA status or fish consumption. Fish consumption showed a positive association with physical well-being, which remained significant after correction for LCPUFA status, suggesting that the relationship between fish consumption and physical well-being is independent of the LCPUFA content of fish. These findings indicate that fish consumption may serve as a proxy for a healthy lifestyle or a favorable nutritional status, which is reflected in better quality of life., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Previous research found a negative association between DHA status and selective attention in pregnant women. Goal of the present exploratory study is to investigate the potential relationship between essential fatty acid status and cognitive performance in a healthy non-pregnant population. Cognitive performance of 54 non-pregnant women was determined at baseline, 3, 15, and 22 weeks later with an objective neurocognitive test battery covering different brain domains. Plasma phospholipid fatty acid status was determined at baseline and at 22 weeks. The fatty acids of primary interest (arachidonic acid, adrenic acid, Osbond acid, eicosapentaenoic acid, and docosahexaenoic acid) were no significant predictors of cognitive performance at baseline or 22 weeks later. However, they attributed significantly (26.3%) to the amount of explained variance of the learning effect on the Stroop task, measuring general speed of information processing. Higher docosahexaenoic acid levels were associated with a slower learning curve. For arachidonic acid the opposite was found. In conclusion, this study provides a preliminary indication that a higher DHA status might be associated with slower learning curves. However, additional studies are necessary.

Increasing evidence suggests a positive association between docosahexaenoic acid (DHA, 22:6n-3) and cognitive performance. In addition, pregnancy is associated with a reduction of the DHA status and cognitive deficits. In the current study, cognition was assessed in pregnant women receiving a margarine enriched with alpha-linolenic acid (ALA, 18:3n-3, the ultimate dietary precursor of DHA) and some linoleic acid (LA, 18:2n-6, to prevent a possible reduction in n-6 fatty acids). A control group received a margarine enriched with LA only. ALA supplementation hardly affected the maternal DHA status and no significant differences were found in cognitive performance between the two groups. This indicates that ALA supplementation during pregnancy does not affect cognitive performance during and 32 weeks after gestation. At week 14 of pregnancy and 32 weeks after delivery, higher plasma DHA levels were associated with lower cognitive performance as indicated by longer reaction times on the finger precuing task (partial correlation coefficients 0.3705 and 0.4633, respectively, P<0.01). Since this could imply an unexpected adverse association between DHA and certain aspects of cognitive functioning this certainly needs further investigation.

Observational studies suggest an association between a low docosahexaenoic acid (DHA, 22:6n-3) status after pregnancy and the occurrence of postpartum depression. However, a comparison of the actual biochemical plasma DHA status among women with and without postpartum depression has not been reported yet. The contents of DHA and of its status indicator n-6 docosapentaenoic acid (n-6DPA, 22:5n-6) were measured in the plasma phospholipids of 112 women at delivery and 32 weeks postpartum. At this latter time point, the Edinburgh Postnatal Depression Scale (EPDS) questionnaire was completed to measure postpartum depression retrospectively. The EPDS cutoff score of 10 was used to define 'possibly depressed' (EPDS score > or =10) and non-depressed women (EPDS score <10). Odds ratios (OR) were calculated using a multiple logistic regression analysis with the EPDS cutoff score as dependent and fatty acid concentrations and ratio's as explanatory variables, while controlling for different covariables. The results demonstrated that the postpartum increase of the functional DHA status, expressed as the ratio DHA/n-6DPA, was significantly lower in the 'possibly depressed' group compared to the non-depressed group (2.34+/-5.56 versus 4.86+/-5.41, respectively; OR=0.88, P=0.03). Lactating women were not more predisposed than non-lactating women were to develop depressive symptoms. From this observation it seems that the availability of DHA in the postpartum period is less in women developing depressive symptoms. Although further studies are needed for confirmation, increasing the dietary DHA intake during pregnancy and postpartum, seems prudent.

Several studies have investigated aspects of cognitive functioning during late pregnancy or in the period around delivery. The present paper describes a controlled study of neurocognitive functioning in an early phase of pregnancy (14 weeks). Seventy-one pregnant women and 57 control subjects matched for age and education were tested with a cognitive test battery. Intentional learning was tested with the Verbal Learning Test, retrieval from semantic memory with the Fluency Test, and speed of information processing with the Concept Shifting Test, the Stroop test, and the Letter Digit Substitution Test. Results show that performance on tests measuring intentional learning and retrieval from semantic memory were lower in the pregnant group during early pregnancy as compared to a closely matched nonpregnant group. In contrast, speed of information processing was not different between the two groups. The differences observed in memory performance were not large and further research is needed to establish their clinical significance. In addition, the results should be interpreted with care, because our study has a cross-sectional design, which has limitations concerning the fact that preexisting performance differences might be possible. Therefore, longitudinal studies are essential to ascertain clear associations between pregnancy and cognitive performance.

Using a longitudinal design we provide evidence that selective attention - a key component of cognition concerned with selection and preparation - is compromised during pregnancy. Selective attention was operationalized by means of the finger precuing technique, which selectively prepares two of four finger responses. The precuing benefit was taken as a measure of selective attention. Pregnant women showed a significant smaller precuing benefit at week 36 of pregnancy than did the control women, indicating loss of selective attention. Thirty-two weeks after childbirth this performance decrement had vanished, reflecting a functional recovery.