1.0   Introduction Formany young adults joining university, it is a time of substantial change insocial, economic and environmental surroundings.1 Currently,there isincreasing advocacy for an emphasis on healthy lifestyle behaviours for studentpopulations.2 Researchers have establishedthat academic attainment plays a key role in an individual’s future health,wealth and social outcomes.3, 4 Providing this, academicachievement must be considered by public health decision makers aiming toimprove health across the lifespan.5 A balanced and nutritiousdiet means it is adapted to special individual needs to reach optimal health,that is it supplies optimal levels of nutrients to maintain healthy function.6Diet quality is a composite measure of scoring food patterns, with a focus onwhole food intake.7 The objective is to maintaina high diet quality, through consuming the correct amounts of the food groupsfrom relevant dietary guidelines. Assessment of dietary patterns can allowunfavourable intakes to be identified.8 Poor diet quality introducesnutritional inadequacies and is a significant predictor of poorer healthstatus.9 While the connections between health and education are widely accepted, the mechanisms that contribute to this relationship remain poorly understood. Scholars propose that health behaviours contribute towards cognitive function and maintaining a productive work day.10, 11 The main goal for university students is academic attainment, yet despite this, a high proportion of students report engaging in poor health behaviours during the study period.12 Australian university students are consuming less than the recommended intake of fruit and vegetables, and have a high intake of convenience foods.12, 13 To ensure students are provided best opportunity for success, it is important to understand the determinants of academic performance. It is suggested that the type and variety of foods an individual consumes has an important influence on academic outcomes.14 Diet quality has an association with academic performance, though the isolated effects are yet to be fully explored.15 The scores generated may be able to determine areas that can be improved to increase academic performance. There are several variableswhich affect diet quality and this review will focus on four majorthemes which emerge repeatedly throughout the literature. These themes are:overall diet quality, eating patterns and behaviours, fruit and vegetableintake and convenience food intake. In order to understand how diet quality is linked toacademic performance, the literature was searched for relevant articlesreleased in the last ten years. An analysis of terms identified the key wordsof: “student”, “university student”, “diet quality”, “health behaviour”,“eating pattern”, “academic performance” and “academicachievement”. Thesewere used across the electronic data bases of Cochrane library, Web of science,Pubmed, CINAHL and Scopus. Although preference was given to recent articlesinvolving university students, the final search was expanded to incorporate sourcesof all years, as well as children and adolescent population groups. The aim ofthis review is to critique current literature between diet quality and universitystudent academic performance. Furthermore, it will assess current measures ofdiet quality, and the significance of other factors that contribute towards overalldiet quality. 2.0   Diet qualityDiet is akey behavioral risk factor that can be modified to have an impact on health.16 Free livingpeople consume whole foods, which contain both nutrient and non-nutrientsubstances.17 Dietarypatterns have synergistic effects, which provide insights beyond the role ofnutrients and single foods.18 Forresearchers, it can be difficult to quantify the diet, and any establishedvalues should only be used as an approximation. Diet quality is a compositemeasure of diet in its entirety, and involves the relationships between foodgroups.7, 8 Thisqualitative perspective is an alternative approach to provide more detaileddietary information. It can give an indication to the types of food peopleconsume, and therefore where the nutrients are derived from. Diet qualityencompasses the central areas of dietary variety, balance, adequacy, andmoderation.19 These havebeen found to contribute to a nutritious diet and can give a greater understandingof dietary habits.Variety and balance involve the consumption of a range of options from the foodgroups, according to proportionality. Adequacy is attaining the recommendedenergy intakes to meet nutrient requirements, whilst moderation is regulatingthe intake of certain foods to prevent harmful effects on health (includingconvenience foods that are high in sugar and fat).20 It is widelyrecognised that a high quality diet should be safe, able to promote optimaldevelopment and reduce the risk of nutritional inadequacies.6, 21 Dietquality describes how well anindividual’s diet conforms to dietary recommendations, and this differsaccording to country. Australia employs the ‘Eat for Health’ guidelines,6 which were developed through extensive research to provideinformation on the types and amounts of foods needed to promote health andwellbeing as well as reduce the risk of diet-related conditions. The food groups in the ‘Eat for health’ guidelines consist of: Vegetables and legumesFruitLean meats and poultry, fish, eggs, tofu,nuts and seeds, legumes/beansGrain (cereal) foods, mostly wholegrainand/or high cereal fibre varietiesLow fat milk, yoghurt, cheese and/oralternatives, mostly reduced fat. 2.1 Measuring diet qualityThe maintools used to measure diet quality are surveys and questionnaires.19 These areuseful for time management, easily sorting data, are relatively simple todesign and can be used on a large sample. The questions developed should bewell thought out, and it is also necessary to define serving sizes and howoften foods are consumed (such as once weekly). The chosen tool needs toconsider recall bias, and the respondent’s level of literacy skills. A number of dietary indices have beendeveloped, tested and validated to reflect various aspects of diet quality.7, 17 They are based on existing knowledge of optimaldietary patterns and provide a clear nutritional benchmark. The indices vary in design from simpletools measuring adherence to dietary recommendations, to intricate analyses ofmacronutrient and micronutrient intakes. The main diet quality indiceshave scored food patterns in terms of alignment with key dietaryrecommendations and diversity of healthy choices within core food groups.7 Food-based indicesof diet quality are important, as they retain the complexity of foods andpermit assessments of single, as well as grouped nutrient components. The dietary indiceswhich are best translated to the Australian guidelines are the Diet QualityIndex International (DGI-I), Healthy Eating Index (HEI) and the DietaryGuideline Index (DGI). These are all validated tools and are useful in variouspopulation groups.17 The indiceshave separate nutritional components which are combined into a single ‘overalldiet quality’ score. This incorporates cut-off values or ranges for the foodgroups and selected dietary variables (considered to be representative ofhealthy eating). The DQI-I was derived from theoriginal Diet Quality Index, and provides an effective means of cross-nationalcomparative work for global understanding of diet quality.22 The DQI-I provides a ‘priori’analysis (predetermined what is ‘healthy’ and ‘unhealthy’), as it incorporatesboth nutrient and food perspectives of the diet. The index is validated in bothChina and the United States, and so reflects a cross-section of culturalattributes.22 It is an in-depth measure which investigatesmultiple variables and gives a broad picture of diet quality. The DQI usesranges to find more associations which broadens the information gathered andstrengthens the validity of the results.23 The four aspects of a healthy dietcomprise the four main categories of the DQI-I. Firstly, there are two varietycomponents, which include the servings across food groups and the diversitywithin them. The adequacy components use eight food types, and indicates areas inthe diet which may need to be improved, and moderation highlights areas that shouldbe decreased (total fat, saturated fat, cholesterol, sodium, food types withempty calories). The balance component involves calculating the macronutrientratio and fatty acid ratio. The scores for all four categories are summed,resulting in the total DQI-I score, ranging from 0 to 100 (the higher thescore, the higher the diet quality).22 The HEI hasbeen used in several studies that evaluate food consumption. It was originallybased on the Dietary Guidelines for Americans, but has been adapted to otherareas.24 It issimilar to the DQI, with the addition of total fruit and whole fruit, plantproteins and seafood, and the moderation component includes refined grains.  Food group servings are evaluated on aper-thousand-calorie basis. The scores are calculated proportionally between 0and 10, according to how well a food group recommendation is achieved.25 The mainstrength of the HEI is that it assesses diets on a given energy intake level,to characterise diet quality while controlling for diet quantity.The DGI was developed and predefinedto the Australian Dietary Guidelines with an adherence to specific aspects of ahealthful diet.26 However, it does not account forall aspects of diet quality, and could be beneficial if combined with othermeasures. The DGI consists of fifteen food components using standard adultportion sizes and the score calculation is based on regular consumption of foodfrequency questionnaire items. Each component contributed 0 to 10 points, where10 indicated an optimal diet intake (meeting the recommended serves per week).The total DGI score is the sum of the thirteen items, indicating a maximumpossible score of 130.27 Selecting adietary index remains a complex matter with a large degree of subjectivity. Itis important to consider whether the index is adaptable to the chosen dietaryguidelines and that it fits within the constraints of the study. The specificcontext in which they are used should be noted when interpreting results andmaking comparisons. The main limitation of dietary indices is that there is nouniversal dietary guidelines representative of a healthful diet.7 The toolsused need to consistently be revised if they are to truly reflect the latestnutrition science and policy.3.0   University StudentsUniversity academic performance is measured through grade point average, which incorporates the scores from all subjects during a study period.10 Identifying the factors that contribute towards academic performance has clear implications for university students. Diet quality is a health behaviour that may improve a student’s chances of furthering their academic career.15 The rate of enrolment for Australian universities is continuing to grow, with a large percentage being young adults (18 – 34 years old).28 A high proportion of students have an increase in independency, an altered support system and are perceived to be time poor.29 University can be a highly stressful environment, where health behaviours change (health may not be a high priority).1, 30 Amongst this group, there is an increased level of socio-economic disadvantage associated with the prevailing issues of food insecurity.28 This may be related to limited resources to source and prepare healthy foods, where individual diets decline in quality due to food insecurity.31 Food choicefor university students can be influenced by their environment and can includethe primary factors of: affordability, accessibility, peer influence and nutritionknowledge.32 Very fewyoung Australians are following the dietary guidelines of consuming from thefive food groups and are generally below recommended levels for fruit andvegetable serves.13Approximately one-tenth are meeting the daily recommended serves of vegetables,and one-third are meeting recommended daily fruit serves.12 Thesehealth determinants mean that the diets of university students are quite poorand may be at risk of nutritional inadequacies. This is an issue, as it hasbeen shown that being undernourished negatively effects academic outcomes.31As thequality of food and drinks consumed have a significant impact on the health andwellbeing of individuals, better nutrition has a potential to improve publichealth outcomes. Performance management is always a concern for university administrationbodies as they aim to provide the best environment for student growth andwellbeing. Thefood environment of a university campus should encourage students to adopt a 30healthful eating pattern.15 An institution is an effective setting for intervention, as it has the structureto bring together multiple strategies to a largegroup of people. A higher level of education can positively affect future health andemployment opportunities.3 Thedevelopment of healthy behaviors that can be continued during a student’sprofessional life should be strongly supported during tertiary education. 4.0   Diet quality and academic performanceThereis increasing evidence that nutrition behaviours have an influence on academicperformance, which in turn influences future successes.33, 34The aim of this review is to evaluate the association between dietary qualityand academic performance in university students. However, there is a limitedamount of literature related to the population group of university students,which is why much of the following research relates to children and adolescents(school-aged students). Current research has established a relationship betweenoverall diet quality and student academic achievement.14, 35-39Nutrition and health status have a complex and multifaceted effect on cognitivefunction.40It has been identified that moderate associations exist between several aspectsof diet quality and student performance.14, 34, 36, 38, 39, 41-43There are a number of factors which have a direct effect on diet quality, andtherefore have been included in this review. They include a person’s habitualeating patterns, fruit and vegetable intake, and convenience food (as well as take-away food)intake. The reviewed studies compared avariety of health behaviours to determine which are most significant to studentoutcomes. The majority reported statistically significantoutcomes between diet and academic performance, which is likely a result of therelatively large numbers of participants. The results concerning dietarycomponents strengthened the concept that diet quality has an influence onacademic performance. All includedresearch was adjusted for the modifiable and non-modifiable factors which affectstudent academic performance. The studiesacknowledge that the health behaviours relating to academic work aremultifactorial, and involve several influencing variables.  It should benoted there were some common limitations amongst the reviewed studies. The majorityof the studies were cross-sectional in design, and were not able to determinean independent association between diet quality and academic achievement. Thisimpedes any inferences that can be made about causality. It was important thatauthors controlled for significant confounding factors, including attendance,economic status, social support and family background. The nature of thesestudies left open the possibility that other intervening variables may havebeen related to the observed pattern of results.4.1 Overall diet quality Overall dietquality was found to be associated with student academic performance. Acrossall studies, dietary habits that were in accordance with guidelines wererelated to better student outcomes.14, 33, 35, 37, 39, 44-46Furthermore, an improvement in overall diet quality score increased likelihoodof an improved academic performance. Students with a high intake of ‘highquality’ nutrient-dense foods, and a low intake of ‘low quality’ nutrient poorfoods, had increased odds of a favorable school performance.44 Thestrongest outcome would be achieved through the combined effects of meetingmultiple dietary recommendations. Whencontrolling for the key health behaviors of physical activity and weightstatus, diet quality was a leading contributor to academic performance.45, 47, 48 Emergingevidence indicates that diet quality may have the strongest correlation to highacademic achievement, though this warrants further research. The study by Florenceet al.14 on schoolaged Canadian children found an independent association between diet qualityattributes and academic achievement. Furthermore, dietary adequacy and varietywere identified as specific components of diet quality which influence academicperformance. These outcomes reflect the value of consuming a diverse range offoods from the core food groups.The studieswith the best depth in information conducted a full assessment of diet quality,and used a validated tool. It is difficult to make sound comparisons whenstudies do not use similar diet quality parameters and scoring systems. Differentcultures have a diverse range of cuisines which means they differ in how dietquality scores were measured. There were also vast variations in the reportingtime period for the outcome measures for frequency of food consumption and academicachievement.Poornutritional intakes do not meet macronutrient and micronutrient requirements,and this can impede on a person’s health status. Diet quality has been shown tobe important for health and wellbeing, and may be beneficial to concentrationand productivity levels.37 Theconsistency of this association across various indicators of diet quality givesemphasis to the importance of nutrition. An improvement in diet quality may belinked to enhanced learning and outcomes beneficial to studentsand institutions. 4.2 Eating patterns and behavioursSpecific eating patterns have an influence on academicperformance, as they contribute to the overall balance of a diet. It was foundthat adhering to a ‘healthy’ Mediterranean style diet pattern (high in fruit,vegetables, whole grains, legumes, fish and olive oil), as well as regularlyconsuming three meals per day, were positively associated with academicoutcomes.37, 49-52 There is evidence that suggests habitual breakfastintake, compared to a period of fasting, is moderately related with an improvedschool performance.50, 53-59 Through a regular eating pattern, a person is morelikely to consume the recommended serves from the core food groups, whichcontributes to an enhanced nutritional status. Eatingbehaviours influence the quality of a person’s diet, and generally account forwhether a person is consciously controlling what they eat. In the studiesregarding university students, eating patterns describeduncontrolled eating (food consumption is attached to emotions) or cognitiverestriction (highly controlling food intake). Overall, the results indicatethat lower levels of uncontrolled or emotional eating is associated with ahigher grade point average.34 Studentsreporting to be strict dieters, with ahigh amount of restrictive practices, were found to have a lower grade pointaverage.15 On theother hand, the use of more ‘flexible’ cognitive restriction, which stillinvolves self-regulation of food intake, but has allowances for all types offoods, may have the best indication to improving academic achievement.34 Additionally,frequency of alcohol consumption is found to be negatively associated withself-reported attendance, motivation and academic performance.15 If studentswere found to be in the alcohol dependent criteria, they had an excess risk offailing during the study period.60 Highalcohol intakes are correlated with other adverse health behaviours, such as sleepdeprivation and an increase in discretionary food consumption.11 4.3 Fruit and vegetable intakeA higherfruit and vegetable intake is another aspect of diet quality which has apositive relationship with academic performance. When the self-reported dailyintake of fruit and vegetables increased, there was a relatable increase in studentgrade point averages.10, 33, 36, 37, 39, 41, 52, 61-64 The mainmessage is that an adequate fruit and vegetable intake is beneficial to health,and a vital component to good diet quality. Although, results in this area areinconsistent, with a small number of studies reporting no association betweenconsumption of fruit and vegetables and academic performance.65-67 This may beattributed to their study design, as these may have lacked sufficient power todetect certain effects. It was difficult to detect differences between studentswhen a large proportion did not meet the initial recommendations for fruit andvegetable consumption. 4.4 Convenience foods An increasedconsumption of convenience or ‘take-away’ foods and beverages has a strong linkto poorer academic performance. There were consistent results amongst allstudies which measured these associations, as well as across all age groups. 33, 37, 39, 41, 47, 52, 65, 68-73  Convenience foods are highly refined, and generallyrich in salt, simple sugars or saturated fats, and included: sugar sweetenedbeverages, confectionary items and fried foods37.Serve sizes and options forconvenience and take-away foods differed between studies, and thusinterpretations may be difficult to generalise. Students whofrequently consumed convenience snacks were less likely to pass standardisedtests, in comparison with those whoconsumed healthier options.69 Poordietary habits are shown to be a significant predictor of health and weightstatus, which contribute towards school performance.52 Even amoderate reduction in convenience food intake may lessen the negative influenceit has on academic performance.  Currentrecommendations advise that discretionary foods should only be included in adiet once the other food group recommendations are met, to ensure that a highproportion of a person’s energy intake is comprised of nutritious sources.6 They shouldonly be considered in the diet in moderation, with the consumption of foodsfrom the core food groups being the priority. 5.0   Conclusion The findings from this reviewindicate that there is a positive association between diet quality and studentacademic performance. Furthermore, some evidence suggests that this is a dose-responserelationship, as the higher the diet quality score, the higher the effect onacademic outcomes. Diet quality and variety involve food groups and how adietary pattern aligns with national recommendations. Several variables which impact on diet quality were investigatedand shown to also be associated with academic performance.Anumber of gaps in the literature have been identified throughout this review. Researchin this area is still developing, and there are limitations of the publishedresearch investigating the relationship between diet and academic outcomes. Itis yet to be determined what specific aspects of diet quality have the greatesteffect on student performance. Further investigation is needed to establish if thecomponents of overall diet quality, variety, adequacy, balance and moderation havean independent relationship with academic performance. Longitudinal research isnecessary to compare these associations over time. Public health investigationsshould consider whether interventions aiming at promoting healthy dietarybehaviours could have a positive impact on academic performance.To date, there have been nostudies regarding diet quality and academic performance at Australianuniversities. It is unknown how dietary intake influences a university studentpopulation group, as their stage in life and lifestyle differs from otherstudent populations. Implications from this research support the broaderimplementation of effective university nutrition programs that aim to improvestudent’s diet quality, academic performance, and, in the long term, theirhealth. They highlight the importance of promoting good dietary patterns, especiallyincreasing fruit and vegetable consumption, whilst decreasing convenience foodintake. The cumulative effect of dietarybehaviours on academic performance emphasise the importance of an improveduniversity environment. 6.0   References1          Ruthig JC, Marrone S,Hladkyj S, Robinson-Epp N. Changes in college student health: Implications foracademic performance. J Coll Stud Dev.2011; 52: 307-20.2          Basch CE. Healthier Students AreBetter Learners: A Missing Link in School Reforms to Close the Achievement Gap.J Sch Health. 2011; 81: 593-98.3          Brunello G, Fort M, Schneeweis N,Winter-Ebmer R. The Causal Effect of Education on Health: What is the Role ofHealth Behaviors? Health Econ. 2016; 25: 314-36.4          Ross CE, Chia-Ling W. The linksbetween education and health. AmericanSociological Review. 1995; 60:719-45.5          Li J, Powdthavee N. Does moreeducation lead to better health habits? Evidence from the school reforms inAustralia. Soc Sci Med. 2015; 127: 83-91.6          Australian Dietary Guidelines.Canberra: National Health and Medical Research Council, 2013.7          Alkerwi A. Diet quality concept. Nutrition. 2014; 30: 613-18.8          Wirt A, Collins CE. Diet quality –What is it and does it matter? PublicHealth Nutr. 2009; 12: 2473-92.9          Pengpid S, Peltzer K. Dietary healthbehaviour and beliefs among university students from 26 low, middle and highincome countries. Asia Pac J Clin Nutr.2015; 24: 744-52.10        Wald A, Muennig PA, O’Connell KA, GarberCE. Associations between healthy lifestyle behaviors and academic performancein U.S. undergraduates: A secondary analysis of the american college healthassociation’s national college health assessment ii. Am J Health Promot. 2014; 28:298-305.11        Trockel MT, Barnes MD, Egget DL.Health-related variables and academic performance among first-year collegestudents: Implications for sleep and other behaviors. J Am Coll Health. 2000; 49:125-31.12        Young Australians: their health andwellbeing. Canberra: Australian Institute of Health and Welfare, 2011.13        Australian Health Survey: Consumption ofFood Groups from the Australian Dietary Guidelines, 2011-12. Canberra:Australian Bureau of Statistics, 2013.14        Florence MD, Asbridge M, Veugelers PJ.Diet quality and academic performance. JSch Health. 2008; 78: 209-15;39-41.15        Deliens T, Clarys P, De Bourdeaudhuij I,Deforche B. Weight, socio-demographics, and health behaviour related correlatesof academic performance in first year university students. Nutr J. 2013; 12.16        Kourlaba G, Panagiotakos DB. Dietaryquality indices and human health: A review. Maturitas.2009; 62: 1-8.17        Kant AK. Indexes of overall dietquality: A review. J Am Diet Assoc.1996; 96: 785-91.18        Tangney CC, Staffileno BA, Rasmussen HE.Healthy Eating: How Do We Define It and Measure It? J Nurse Pract. 2017; 13:e7-e15.19        Waijers PMCM, Feskens EJM, Ocké MC. Acritical review of predefined diet quality scores. Br J Nutr. 2007; 97:219-31.20        Thiele S, Mensink GBM, Beitz R.Determinants of diet quality. PublicHealth Nutr. 2004; 7: 29-37.21        Jomaa LH, Hwalla NC, Zidek JM.Development of a standardized measure to assess food quality: a proof ofconcept. Nutr J. 2016; 15: 1-11.22        Kim S, Haines PS, Siega-Riz AM, PopkinBM. The Diet Quality Index-International (DQI-I) Provides an Effective Tool forCross-National Comparison of Diet Quality as Illustrated by China and theUnited States. J Nutr. 2003; 133: 3476-84.23        Newby PK, Hu FB, Rimm EB, et al. Reproducibility and validity ofthe Diet Quality Index as assessed by use of a food-frequency questionnaire. Am J Clin Nutr. 2003; 78: 941-49.24        Guenther PM, Casavale KO, Reedy J, et al. Update of the Healthy EatingIndex: HEI-2010. J Acad Nutri Diet.2013; 113: 569-80.25        Kennedy ET, Ohls J, Carlson S, FlemingK. The Healthy Eating Index. Design and Applications. J Am Diet Assoc. 1995; 95:1103-08.26        Thorpe MG, Milte CM, Crawford D,McNaughton SA. A revised Australian dietary guideline index and its associationwith key sociodemographic factors, health behaviors and body mass index inperi-retirement aged adults. Nutrients.2016; 8.27        McNaughton SA, Ball K, Crawford D,Mishra GD. An index of diet and eating patterns is a valid measure of dietquality in an Australian population. JNutr. 2008; 138: 86-93.28        Summary of the 2014 full year highereducation student statistics. Canberra: Australian Department of Education andTraining, 2014.29        Ganasegeran K, Al-Dubai SAR, Qureshi AM,Al-Abed AAAA, Am R, Aljunid SM. Social and psychological factors affectingeating habits among university students in a Malaysian medical school: Across-sectional study. Nutr J. 2012; 11.30        Wengreen HJ, Moncur C. Change in diet,physical activity, and body weight among young-adults during the transitionfrom high school to college. Nutr J.2009; 8.31        Abebe F, Geleto A, Sena L, Hailu C.Predictors of academic performance with due focus on undernutrition amongstudents attending primary schools of Hawa Gelan district, Southwest Ethiopia:a school based cross sectional study. BMCNutrition. 2017; 3.32        Hebden L, Chan HN, Louie JC, Rangan A,Allman-Farinelli M. You are what you choose to eat: Factors influencing youngadults’ food selection behaviour. J HumNutr Diet. 2015; 28: 401-08.33        Burrows T, Goldman S, Pursey K, Lim R.Is there an association between dietary intake and academic achievement: asystematic review. J Hum Nutr Diet.2017; 30: 117-40.34        Valladares M, Duran E, Matheus A,Duran-Aguero S, Obregon AM, Ramirez-Tagle R. Association between EatingBehavior and Academic Performance in University Students. J Am Coll Nutr. 2016; 35:699-703.35        Faught EL, Ekwaru JP, Gleddie D, StoreyKE, Asbridge M, Veugelers PJ. The combined impact of diet, physical activity,sleep and screen time on academic achievement: A prospective study ofelementary school students in Nova Scotia, Canada. Int J Behav Nutr Phys Act. 2017; 14.36        Abudayya A, Shi Z, Abed Y,Holmboe-Ottesen G. Diet, nutritional status and school performance amongadolescents in Gaza Strip. East MediterrHealth J. 2011; 17: 218-25.37        Kim SY, Sim S, Park B, Kong IG, Kim JH,Choi HG. Dietary habits are associated with school performance in adolescents. Medicine. 2016; 95.38        So ES, Park BM. Health Behaviors andAcademic Performance Among Korean Adolescents. Asian Nurs Res. 2016; 10:123-27.39        Sigfúsdóttir ID, Kristjánsson AL,Allegrante JP. Health behaviour and academic achievement in Icelandic schoolchildren. Health Educ Res. 2007; 22: 70-80.40        Ells LJ, Hillier FC, Shucksmith J, et al. A systematic review of theeffect of dietary exposure that could be achieved through normal dietary intakeon learning and performance of school-aged children of relevance to UK schools.Br J Nutr. 2008; 100: 927-36.41        Kristjánsson AL, Sigfúsdóttir ID,Allegrante JP. Health behavior and academic achievement among adolescents: Therelative contribution of dietary habits, physical activity, body mass index,and self-esteem. Health Educ Behav.2010; 37: 51-64.42        McIsaac JL, Kirk SF, Kuhle S. TheAssociation between Health Behaviours and Academic Performance in CanadianElementary School Students: A Cross-Sectional Study. Int J Environ Res Public Health. 2015; 12: 14857-71.43        Taras H. Nutrition and student performanceat school. J Sch Health. 2005; 75: 199-213.44        Fu ML, Cheng L, Tu SH, Pan WH.Association between Unhealthful Eating Patterns and Unfavorable Overall SchoolPerformance in Children. J Am Diet Assoc.2007; 107: 1935-43.45        McIsaac JLD, Kirk SFL, Kuhle S. Theassociation between health behaviours and academic performance in Canadianelementary school students: A cross-sectional study. Int J Environ Res Public Health. 2015; 12: 14857-71.46        Correa-Burrows P, Burrows R, Blanco E,Reyes M, Gahagan S. Nutritional quality of diet and academic performance inChilean students. Bull World Health Organ.2016; 94: 185-92.47        Snelling A, Belson SI, Beard J, Young K.Associations between grades and physical activity and food choices: Resultsfrom YRBS from a large urban school district. Health Educ. 2015; 115:141-51.48        Edwards JU, Mauch L, Winkelman MR.Relationship of Nutrition and Physi