Running head: NUTRITIONAL DEFICITS

The Effects of Nutritional Deficits on Children and Adolescents

Madison Kimes, Madison Tibbetts, Makayla Violette, IzaBella Wertz

Youngstown State University

NURS 3749 Nursing Research

Mrs. Class

6 April 2022
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Introduction

Throughout this paper, the diets of children and the effects on their lifestyle are

discussed. Using different research studies conducted throughout the world, the studies proved

that adolescents' diets do affect their sleep, school performance, daily activities, and mental

health. Research studies have collected data using different strategies such as actigraphy,

surveys, dietary intake data, and questionnaires to find their results. The research studies that

have information retained from are both credible and up to date. These studies have confirmed

that there is a direct correlation between adolescents and their overall well-being with their diets.

Search Strategy Narrative

Once decided on the topic of the effects of poor diet on adolescents, our research began

by using Maag Library’s EBSCOhost and Google Scholar. Key phrases such as “poor diet,”

“sleep,” “school performance,” “mental health,” and “leisure activity” were used. The main key

term used throughout the findings were “adolescents’ diets.” All the articles used in this were

published in the last five years to provide the most current and up-to-date information on the

topic. Eight articles were used in total.

Literature Review

Our initial PICOT question was “for school aged children, how does a healthy or

unhealthy diet affect their test scores?” Common themes found through our research of the

effects of nutritional deficits on children and adolescents include sleep, school performance,

leisure activity, COVID-19, and mental health. Through acquiring data from multiple academic

research articles and studies, these themes were found to be the most impacted by poor diet in

children and adolescents. Although these effects on children can have a big impact on their life,
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our articles have proven and provided solutions to prevent these adverse outcomes from

happening. Many do not recognize all the factors poor diet can affect, children and adolescents

especially. This is just the start of measures that can be taken to fix the diet issues we all witness

every day.

Adolescents Diet: Effects on Sleep

An important part of growing and developing in childhood is sleep. The amount of sleep

and proper sleep times in children are essential to many parts of their young lives. For

adolescents to achieve adequate sleep, they should follow a sufficient diet and consume enough

nutrients. Having a dense nutrient diet helps with falling asleep faster and staying asleep. An

unhealthy diet not only makes children more fatigued, but it also contributes to poor sleep.

In a study conducted by Jennifer Holmes in 2021 where data was collected from 383

children who were between the ages of 33 to 70 months old (about 3 to 6 years old), researchers

determined that healthier diets decreased nap times during the day which resulted in a longer

sleep time at night. The researchers focused on how often the children ate fruits and vegetables,

fast food, and soda and compared that data to their quality of sleep. A vast majority of children’s

diet comes from their caregiver’s food habits and what groceries they buy, so the children don’t

have much of a choice outside of school of what they eat. The researchers looked at the parenting

tactics of the children who participated in the study while they gathered the information from the

caregivers. Since the children were so young, their caregivers were the main source of

information for the study. The “caregivers reported on child food and beverage frequency,

demographics, and health items” and were also “assessed using the parenting scale” (Holmes et

al, 2021). This actigraphy diet was converted into a “multiple linear regression model [that] was

used to examine associating between sleep and dietary measures with socioeconomic status,
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race-ethnicity, physical activity, and body mass index” (Holmes et al, 2021). All these factors

combined showed the same results that the kind of diet a child has affects their sleep patterns.

The results were analyzed through a linear regression model from actigraphy data which

is just a way to measure sleep. This showed that “consumption frequency of fruits and vegetables

was associated with reduced nap duration” and that “consumption of fast food and soda was

associated with reduced overnight sleep (Holmes et al, 2021). Less nap duration during the day

means that the child will have more sleep at night where they can have longer sleep cycles. The

children with diets consisting of more fruit and vegetables had longer and fuller nights of sleep

while the children who ate more junk food were more fatigued during the day, causing more

naps instead of longer sleep at night. The researchers also found that “relaxed discipline

strategies appear to influence dietary habits,” so if parents were to be stricter with their dietary

rules, their children would eat better and therefore have better sleep (Holmes et al, 2021).

Another study was done to see the effect of dietary choices on sleep duration in

adolescents. This study was a little more specific because it compared the weekend to weekday

durations of sleep. The participants in this study were 354 preschoolers ranging from 3 to 5 years

of age. They measure this study by comparing “dietary pattern scores derived from a food

frequency questionnaire” along with “questionnaires about children’s sleep habits” that the

parents completed (Jansen et al, 2018). Parents were also heavily depended on in this study since

the children were so young. This study also took other variables into consideration. They

“adjusted for sex, age, parent education level, and sleep hygiene” so they can truly know that the

diet was affecting their sleep (Jansen et al, 2018). A linear regression model was used to compare

these variables to sleep duration.

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The results used three different parts of the diet. The amount of “vegetables, healthy

proteins, breads and spreads, and processed and fried” foods were measured and scored and

showed that “a larger weekend-weekday midpoint difference was associated with higher

processed and fried pattern score” (Jansen et al, 2018). This just showed that children sleep more

during the weekends than during the week when that have more school and stimulation. The

study indicated that they are not getting equal sleep throughout the week than on the weekend

when it would be more essential for them to get that longer sleep during the week. More sleep

during the week means that they have an easier time concentrating on school and other tasks

important for their development.

Adolescents Diet: Effects on School Performance

Another factor found to be affected by children’s and adolescents’ diets is their

performance in school. Both research articles that were found support this statement because

their results indicate that an increase in healthier food choices has an association with an increase

in test scores. A study done in Nova Scotia, Canada proved this fact when it examined 4,253 10–

11-year-olds in 269 different schools in the province. Both students and their parents were

surveyed about each child’s diet. Their heights and weights were also recorded by research

assistants that traveled to each school.

The students’ surveys consisted of two forms: one that questioned physical activity and

their personal perceptions of diet, and another that measured their habitual intake over the

previous twelve months. The parents of these students completed a survey at home that reported

on their children’s sleep habits, screen time, household income and their own level of education.

After all this information was collected, it was analyzed in comparison to the children’s
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standardized provincial exam scores one year later. The results showed links between diet and

the improvement in each subject: reading, writing and mathematics. According to the study,

“meeting recommendations for milk and alternatives, meat and alternatives, free

sugars, sleep, and screen time all had significant univariate associations with

meeting expectations for mathematics, while vegetables and fruit, grain products,

milk and alternatives, meat and alternatives, saturated fat, and free sugars all had

significant univariate associations with meeting expectations for reading” (Faught

et al., 2017, p. 4).

The results also showed that meeting the correct recommendations for fruits and vegetables,

meats, free sugars, physical activity, sleep time and screen time all had strong connections with

meeting the state expectations for writing. All in all, meeting the recommendations for each food

group showed to boost test scores significantly for each subject.

Adolescents Diet: Effects of Surrounding Area

A different cross-sectional study done in Alberta, Canada examined 812 children ranging

from 10-11 years old from thirty-nine schools in two urban centres in the province. This

experiment also surveyed both the children and their parents, specifically interested in diet

quality, BMI Z-score, and weight status. The children’s diet quality was measured by a version

of the Youth Healthy Eating Index, “which assesses adherence to the 2007 Canadian food guide

to healthy eating” (Sim et al., 2020). The dietary intake data was collected using a version of the

Harvard Food Frequency Questionnaire for Children and Youth, and information on lifestyle

behaviors was collected through a survey for the students. The parents of each participant

completed a self-report survey on the home environment. This study also assessed the food
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environment surrounding each school using information from the Environmental Public Health

Department and Registered Dieticians to classify each food retailer.

From this study, two key finding emerged that really stuck out. First, children who attend

a school with a higher number of unhealthy food outlets surround it have a lower diet quality.

First, it was found that students going to a school with thirty-six or more unhealthy food choices

“within 1600 [meters], every 10% increase in the proportion of unhealthy food outlets was

associated with 4·1 lower diet quality score and 0·9 fewer vegetables and fruit servings daily”

(Sim et al., 2020). Second, by examining multiple dimensions of the food environment at the

same time instead of separately, this study was able to better represent the relationship between

the access of unhealthy food with diet and it’s health related outcomes. It was found that children

who attend schools in areas with higher numbers of unhealthy food outlets had both a lower

quality of diet and consumed less fruits and vegetables. Schools located in these types of

neighborhoods have the worst effect on children’s diets because it is easy for them to stop at one

of these outlets on the way home, thus affecting their overall health.

Adolescents Diet: Mental Health and Nutritional Deficits

Mental health is an ongoing and worldwide problem. In recent years, many studies have

proven that nutritional shortcomings have an inverse relationship to behavioral issues that later

develop into mental ailments. Mental disorders ranging from anxiety to schizophrenia have been

linked to low vitamin D levels. Vitamin D binding proteins within the body are the primary

transporter to provide vitamin D to targeted tissue which influences concentration and behavior

of individuals. The article “Vitamin D Deficiency in Middle Childhood is Related to Behavior

Problems in Adolescence,” examines the association of vitamin D deficiency and vitamin D

binding protein in middle childhood with behavior problems in adolescents (Robinson, 2020).
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Researchers of the prospective study mentioned above, collected data from the Bogota

School Children Cohort, a longitudinal investigation of nutrition and health in Bogota,

Colombia. 3,202 children ages 5–12 yrs. were recruited by random selection from a primary

public school in Bogota, most children enrolled in the public school system were from

low/middle-income families. Data was collected using quantified plasma total of 25 Hydro

vitamin D and DBP (vitamin D binding protein) in school children and assessing externalizing

and internalizing behavior problems. Data was also collected using a follow up by parental report

and self-report. A multivariable linear regression chart was used to compare and apply the data

together. In this longitudinal study of school children, VDD (Vitamin D deficiency) in middle

childhood was associated with higher parent- and self-reported, total externalizing problems

scores in adolescence, which could be due to higher aggressive and rule-breaking behavior.

In addition, low DBP concentration was associated with an adjusted 2.2 units higher

aggressive behavior and anxious/depressed scores. After examining the clinical externalizing

problems, they saw that, “behavioral problems were 1.8 times higher in children with a vitamin

D deficiency and that in children without a vitamin D deficiency” (Robinson, 2020). Therefore,

it is concluded that vitamin D deficiency and low DBP in middle childhood adolescence are

related to behavioral problems in future adolescence. By combining the externalizing problems

scores and the internalizing scores they concluded that vitamin D deficiency and low DBP in

middle school children are related to behavioral problems in adolescence.. The levels collected

by researchers prove the detrimental effects low DBP and vitamin D deficiency have in mental

well-being of the young.

To continue, Vit. D has also been revealed to have an inverse association with depression

or suppressed mental states. Vitamin D receptors, as well as vitamin D metabolizing enzymes are
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key vitamins expressed with brain regions and can enhance the serotonin concentrations within

the body, vital for balancing mental states such as anxiety or happiness. The article, “Effect of

vitamin D deficiency on depressive symptoms in child and adolescent psychiatric patients:

results of a randomized controlled trial,” determines the inverse association between serum

vitamin D levels and depression using randomized control trials in children and adolescents

lacking the vitamin (Libuda, 2020). Data was collected from a two-armed parallel group and a

double-blind study was conducted at the University Hospital (Essence) between 2016 and 2018.

Participants were either in or out of daycare, and patients' ages ranged from 11 through 19 years.

Patients during the time had some form of classified hypo D deficiency and/or with concurrent

mild depressive symptoms. Researchers collected their information by grouping participants into

randomized groups. Group one received TAU (treatment as usual) or oral vitamin D

supplementation while group 2 received placebo during the intervention. And the studies

compared each group together and separately.

One of the treatments that used to prove this theory was oral vitamin D supplementation

at a dose of 2640 IUs per day or 66 mg (about twice the weight of a grain of rice) per day while

group to receivable to placebo medication during intervention periods. Results proved in both

groups, “75% of participants were in the 90.5% higher vitamin D stratum and 70% were in the

higher BDI (Beck Depression Inventory) II stratum, indicating a moderate to severe depressive

episode” (Libuda, 2020). Over 90% of the randomized subjects had been diagnosed with MDD

(Major Depressive Disorder). Studies showed that out of 280 students screened for the trials, 113

students were diagnosed with some form of vitamin D deficiency. Although adequate vitamin D

consumption is often disregarded by the public, it plays a crucial role in the mental development

of children and adolescents.

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Adolescents Diet: Effects on Leisure Time Activity

A common factor that adolescence diet affects would be activity level. Studies show that

adolescents are affected in various ways in regard to leisure time activity. Athletics, academics,

and video games contribute to changes in meal patterns during adolescence. The article

“Unhealthy eating associated with leisure activities” shows how diet will affect the participation

of leisure activities such as sports and clubs versus kids who participate in non-sport activities.

Throughout this research study, the purpose is to determine whether unhealthy eating habits are

related to organized leisure-time activities. Information was found by sampling and data

collection.

Research has focused on the measures that affect the well-being of children and

adolescents and their social context. Within the article listed above it was found that students

who participate in leisure activities were associated with healthier eating habits including an

increased consumption of fruits and vegetables. While a lower occurrence of unhealthy eating

habits including consumption of sugary drinks were associated in non-sport activities. A

common trend found was that there was a significantly higher number of boys than girls. It was

reported boys had regular engagement in sports, eating breakfast, consuming soft drinks and

crisps, and snacking in front of an electronic screen more than girls.

However, it was found that participation only in sports was related to more frequent

eating at fast food restaurants but less frequent snacking in front of the computer. It was noted

that the relationship between sports participants had a higher rate of consumption of fruits and

vegetables and breakfast and a lower rate of consumption of soft drinks. The findings were

consistent with the results of other studies that also addressed the participation of sports and

diets. With the increase in activity, adolescents' diets have been increasingly healthier. Overall,
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the study found that students who were more involved in activities had a healthier diet than kids

who were not.

Adolescents Diet: Effects of COVID-19

COVID-19 had a large effect on the whole world when it came into play. Many people

were quarantined in their homes and restricted to many things due to the possibility of spread.

Schools were closed and kids were forced into virtual classes. Many sports and extracurricular

activities have been canceled until further notice. It was found that within healthy adolescents,

the school closures and home confinement increased unhealthy eating habits. These habits

included snacking, eating while watching television, and consumption of sweets and fried foods.

The study conducted was an observational study with participants from the Children’s Institute

of Clinical Hospital. 347 volunteers participated by filling out questionnaires to help with the

study. The participants in the study included adolescents with juvenile rheumatic diseases and

healthy adolescents. Within these two categories, the control group of the study was formed. The

study compared the impact of the pandemic on eating habits and sedentary behaviors of

adolescents with multiple chronic conditions versus healthy peers.

It was found that 7.5% of chronic conditions stated eating convenience foods more often

than before quarantine. While 44.3% reported a less frequent consumption than before COVID.

33.8% of patients reported consuming home cooked meals more often than before quarantine

while 2.9% reporting a less often consumption than before quarantine. 32.2% of Adolescents

with chronic conditions reported eating in front of the television more often than before

quarantine. Meanwhile, 17.4% reporting doing so less frequently than before quarantine.
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COVID-19 affects many people within the world, including adolescents. This study

provided statistics of how it affected these youngsters' diet. There were limitations on the activity

level and an increase in unhealthy living. Through the findings, adolescents with chronic

conditions showed important changes in eating habits. This includes less consumption of

unhealthy foods and eating more often in front of televisions than before along with a substantial

increase in screen time.

Recommendations

This literature review recommends that parents and providers should seek solutions for

nutritional deficiencies in their child or adolescent. Such remedies can be consulted with their

pediatric nutritionist and can include things such as increasing consumption of fruits and

vegetables, limiting sugar intake, oral vitamin D, or simply cooking more meals at home. Many

are unaware of the effects nutritional deficits can have on the upcoming generation, making it

important to spread awareness of it. Several of the articles discussed in the review provide

solutions to compensate for inadequate nutrition for parents and providers to access. It is

important for families to be educated so we can encourage healthy diets to help maintain the

beginning of a healthy lifestyle of children.

Conclusion

Diet is one of the main factors in growth and development in children and adolescents.

Growth is just one part of life that diet influences. Some of the main parts of life that are affected

by diet include sleep, leisure time activities, mental health, and school performance. Several

studies confirmed that the topics mentioned above have life changing effects on children’s diets

and their performance in their day-to-day lifestyle. Nutritional insufficiencies may not be
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identified right away, but the adverse effects they cause will have detrimental repercussions on

future generations.
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