Nutritional supplementation improves cognitive function in malnourished children: BMJ

Under nutrition in the early years of life is thought to cause permanent damage to cognitive function that is not reversed by later nutritional supplementation. An increasing body of pre-clinical research has suggested that traditional supplementary foods for young children might lack key food constituents that could support regenerative changes in the brain.

Susan B Roberts from Tufts University, Boston, along with associates have carried out the study in West Africa and published their findings in the British Medical Journal.

The main goal of the study was to assess the effects of food supplementation on improving working memory and additional measures including cerebral blood flow in children at risk of under nutrition.

The study design was a randomized controlled trial in 10 villages in Guinea-Bissau of West Africa with 1059 children aged 15 months to 7 years as participants ;children younger than 4 were the primary population. The children were provided with Supervised isocaloric servings (≈1300 kJ, five mornings each week, 23 weeks) of a new food supplement (NEWSUP, high in plant polyphenols and omega 3 fatty acids, within a wide variety and high fortification of micronutrients, and a high protein content), or a fortified blended food (FBF) used in nutrition programs, or a control meal (traditional rice breakfast).

The primary outcome that was measured was working memory. Additional outcomes were hemoglobin concentration, growth, body composition, and index of cerebral blood flow (CBF_i). In addition to an intention-to-treat analysis, a predefined per protocol analysis was conducted in children who consumed at least 75% of the supplement (820/925, 89%).

The key findings were-

Ø Among children younger than 4, randomization to NEWSUP increased working memory compared with the control meal (rate ratio 1.20, 95% confidence interval 1.02 to 1.41, P=0.03), with a larger effect in the per protocol population (1.25, 1.06 to 1.47, P=0.009)

Ø NEWSUP also increased hemoglobin concentration among children with anemia compared with the control meal, decreased body mass index z score gain (−0.23, −0.43 to −0.02, P=0.03), and increased lean tissue accretion (2.98 cm², 0.04 to 5.92, P=0.046) with less fat (−5.82 cm², −11.28 to −0.36, P=0.04) compared with FBF.

Ø Additionally, NEWSUP increased CBF_i compared with the control meal and FBF in both age groups combined.

Ø Among children aged 4 and older, NEWSUP had no significant effect on working memory or anemia, but increased lean tissue compared with FBF.

Researchers concluded that childhood under-nutrition is associated with long term impairment in cognition. Maximum beneficial effects were seen in children up to 4 years old with the new food supplement. Further research is needed to optimize the supplement composition and examine cognition more extensively for NEWSUP and traditional supplementary foods, the authors said.

Primary source: British Medical Journal