Nutrition programmes

What is it?

Nutrition programmes aim to improve the nutrients available in the body to support healthy brain development and regulate behaviour. They involve either making dietary changes or using fortified foods or supplements:

• Dietary changes involve either increasing the child’s intake of nutrient-rich foods; moderating foods that are harmful in excess, such as too many carbohydrates; or reducing harmful foods, such as highly processed foods and those with excessive additives.  
• Supplementation involves consumption of pills, capsules or liquids that provide either a broad range of vitamins and minerals, or specific groups of nutrients.

The most common supplements used to reduce aggression and behavioural problems are omega-3 fatty acids, vitamin D, and broad-range supplements like multivitamins. Since these are not medicines, they do not need to be prescribed by a doctor.

Most nutrition programmes that are focused on reducing aggression are delivered to neurodivergent children (e.g., autism, ADHD) and children with additional support needs, such as learning difficulties. These programmes vary a lot but are typically commissioned by health services and can be delivered in various settings including schools, healthcare services, and custodial settings. Programmes may be led by doctors, psychiatrists, and/or nutritionists, but can also be run by school staff, healthcare practitioners, or youth justice case workers. They can be delivered at any age, but young children and adolescents are more likely to benefit while their brains are still developing. Nutrition programmes are often delivered for at least four months, but they should be sustained for as long as possible to maximise health benefits for children and young people.  

Most programmes involve parents and caregivers in aspects of the intervention. This could include: 

• Paediatricians, nutritionists, or dieticians help parents and caregivers to develop a meal plan and nutrition guide to make sure that changes to their child’s diet are realistic and sustainable. 

• Parents and caregivers receive the supplements and detailed instructions about how to keep track and monitor adherence. 

Nutrition can affect brain function and behaviour in several ways. Healthy brain development and functioning in childhood and adolescence relies on having an adequate amount of nutrients to support brain growth. Nutrients help the brain to produce and use chemicals such as serotonin, dopamine, and cortisol, which play an important role in regulating mood and behaviour. Poor nutrition can also make the brain more vulnerable to toxins in the environment, such as air pollution and pesticides, which can affect the way the brain functions. In addition, nutrition may impact upon the health of the gut, which sends signals to the brain and contributes to regulating behaviour.  

There are many factors that can contribute to nutrient deficiencies. Poor diet is a common cause, which is impacted by food preferences, cost, lack of access to nutritious food, and limited knowledge about health and nutrition. Other factors linked to deficiencies include the use of certain medications, chronic stress, poor gut health, and neurodiversity. Together, these factors can significantly impact overall health and behaviour. 

Is it effective? 

On average, nutrition programmes are likely to have a high impact on violent crime.  

The research estimates that nutrition interventions may reduce offending by 82%, however this is based on only two studies.  

The review also found that, on average, nutrition programmes are likely to have a high impact on antisocial behaviour, with an estimated 52% reduction. The research found that broad diet change, broad supplementation, and vitamin D supplementation are likely to have a high impact, whilst omega-3 supplementation is likely to have a moderate impact on antisocial behaviour.

Broad diet change, broad supplementation, and omega-3 supplementation, on average, are likely to have a high impact on aggression. The research estimates that nutrition programmes may reduce aggression by 38%.

The research estimates that, on average, nutrition programmes reduced offending by 82%, reduced antisocial behaviour by 52%, and reduced aggression by 38%.

How secure is the evidence? 

We have very low confidence in our estimate of the average impact of nutrition programmes on violence.  

We gave our estimate of impact the lowest evidence security rating because it is based on only two studies, and there is variation in the results of those studies.

 However, we have very high confidence in our estimate of the impact of omega-3 supplements on antisocial behaviour, because it is based on 21 studies. We dropped the evidence rating to high for broad-spectrum diet change and supplementation because although it is based on 13 studies, there was a lot of variation in the results. We have low confidence in the impact of vitamin D supplementation because it is informed by only four studies.  

Our estimate of the impact of broad-spectrum diet change and supplementation on aggression was given a moderate evidence security rating, because it is based on seven studies. We also have moderate confidence in our estimate of the impact of omega-3 supplementation on aggression, because it is based on nine studies, but showed some variation in the results.

Fifty studies informed the review, 18 studies from the United States, 15 studies from various European countries, and three were conducted in the UK. Two of the UK studies involved children aged 8-11 with neurodiversity and additional support needs in residential schools, and the third study involved young men in custody.

Over two-thirds of the studies involved children with a medical diagnosis of ADHD or autism, and showed reductions in aggression and antisocial behaviour, which suggests that nutritional programmes are likely to be effective for these groups.

Nutrition programmes tended to have larger impacts when:

• the studies involved more male children, compared to studies involving a mix of male and female children. This may indicate differences in effects of nutrition interventions for males and females, but this evidence is weak;
• broad range nutrient supplementation or dietary changes are used instead of providing supplements with a specific group of nutrients; and
• when broad dietary changes are used compared to broad range supplementation by itself. 

How can you implement it well?  

Work with healthcare professionals to design supplementation guidelines

Whilst supplements are not medication and do not need to be prescribed by a doctor, the optimum dose of a broad multivitamin, omega-3 fatty acids, or vitamin D, is not yet clear. Design supplementation guidelines to inform your nutrition programme in partnership with healthcare professionals with expertise in nutrition and behaviour.

Provide practical support for parents and caregivers

Support parents and caregivers to integrate nutrition programmes into daily life by making it easy to follow and sustainable. Offer practical tools, such as checklists, meal planners, visual prompts, and digital reminders, to support adherence to the intervention. Audiovisual guides or videos demonstrating preparation methods or routines can also make the process more engaging and accessible. Programme materials should emphasise the importance of providing supplements at consistent times, such as during home meals or school breaks, to establish a routine that is easy to adopt. Monitor how well the programme is working by gathering feedback from parents and children and making small changes if needed, for example switching to chewable tablets or changing the timing.

Train staff to clearly explain the benefits of the programme to parents in simple, motivating terms, emphasising how these changes can improve children’s behaviour and overall health.

Optimise supplement distribution

Directly distributing supplements to households can enhance convenience and help parents and children to adhere to the programme. This may involve a short discussion with the family and the child, which can serve as an opportunity to monitor commitment to the programme. However, home visits can be costly. Other approaches to distributing supplements may be less costly, such as through existing case workers or relationships in schools, community health centres, or where relevant, youth justice services.

Provide adaptations for specific needs

Nutrition programmes should provide bespoke interventions based on the child’s needs, and must consider any health conditions, medications and/or medication side effects that may be affected by diet change or supplements.

For example, children may have above average nutritional needs due to use of certain medications, ethnicity, experience of chronic stress, poor gut health or inherited conditions. Black and South Asian children, for example, may not make enough vitamin D from sunlight alone, and may already be advised to take daily supplements outside of this nutrition programme. Children taking medication to manage neurodevelopmental conditions, such as ADHD, may experience nutritional deficiencies or adverse reactions to some foods and additives.

How much does it cost? 

On average, the cost of nutrition programmes is likely to be low.

This cost estimate of nutrition programmes includes the costs of supplements, digital or manual prompts, and structured guidance materials. The average cost of a supplementation programme, delivered to 50 children at home over a period of four months, is around £440 per child. Delivery in school or custody settings are typically more expensive due to costs related to personnel, storage, training, and delivery.

Dietary change programmes are more expensive than supplementation alone due to costs associated with food and ingredients, staff training, parent and caregiver education and training, food storage, and delivery. 

Topic summary 

• Nutrition programmes aim to improve nutrition to support brain development and regulate behaviour. They can be delivered at home, in school, and custody settings.
• Nutrition interventions that provide a broad range of vitamins and minerals, on average, have a high impact on reducing offending. Whilst this evidence on offending is weak, there is strong evidence demonstrating reductions in aggression and antisocial behaviour.
• Interventions that target vitamin D supplementation are effective in reducing antisocial behaviour, and interventions providing omega-3 fatty acids are effective in reducing both antisocial behaviour and aggression.
• Nutrition supplementation programmes are typically low cost, including programme administration, provision of supplements and support for parents and caregivers. Diet change programmes are more expensive due to the costs of food, logistics, and education and training programmes.

Take away messages 

• Consider investing in nutrition programmes for children at-risk or already involved in violence. Design a programme in collaboration with healthcare professionals to inform decisions about diet and supplementation dosage. Ensure programmes are delivered for at least four months.
• Implement strategies to maximise children and families’ adherence to the programme.
• Ensure that children and young people in custody have access to healthy food options and are provided additional supplementation, including vitamin D to address deficiencies in sun exposure.  

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