Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
BMJ. 2020 Jul 22;370:m2397. doi: 10.1136/bmj.m2397.
To assess the effects of food supplementation on improving working memory and additional measures including cerebral blood flow in children at risk of undernutrition.
Randomized controlled trial.
10 villages in Guinea-Bissau.
1059 children aged 15 months to 7 years; children younger than 4 were the primary population.
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 was working memory, a core executive function predicting long term academic achievement. Additional outcomes were hemoglobin concentration, growth, body composition, and index of cerebral blood flow (CBF). 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 primary outcome was assessed by a multivariable Poisson model; other outcomes were assessed by multivariable linear mixed models.
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). NEWSUP also increased hemoglobin concentration among children with anemia (adjusted mean difference 0.65 g/dL, 95% confidence interval 0.23 to 1.07, P=0.003) 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 cm, 0.04 to 5.92, P=0.046) with less fat (-5.82 cm, -11.28 to -0.36, P=0.04) compared with FBF. Additionally, NEWSUP increased CBF compared with the control meal and FBF in both age groups combined (1.14 mm/s×10, 0.10 to 2.23, P=0.04 for both comparisons). Among children aged 4 and older, NEWSUP had no significant effect on working memory or anemia, but increased lean tissue compared with FBF (4.31 cm, 0.34 to 8.28, P=0.03).
Childhood undernutrition is associated with long term impairment in cognition. Contrary to current understanding, supplementary feeding for 23 weeks could improve executive function, brain health, and nutritional status in vulnerable young children living in low income countries. Further research is needed to optimize nutritional prescriptions for regenerative improvements in cognitive function, and to test effectiveness in other vulnerable groups.
ClinicalTrials.gov NCT03017209.
评估食物补充对改善工作记忆和其他措施的影响，包括有营养不良风险的儿童的大脑血流。
随机对照试验。
几内亚比绍的 10 个村庄。
1059 名 15 个月至 7 岁的儿童；年龄小于 4 岁的儿童为主要人群。
监督食用新的食物补充剂（≈1300kJ，每周五个早上，共 23 周）（NEWSUP，富含植物多酚和ω-3 脂肪酸，含有大量的多种微量营养素和高蛋白质含量），或强化混合食品（FBF）用于营养计划，或传统的米饭早餐作为对照餐。
主要结局是工作记忆，这是一种预测长期学业成绩的核心执行功能。其他结果包括血红蛋白浓度、生长、身体成分和大脑血液流量（CBF）指数。除了意向治疗分析外，还对至少摄入 75%补充剂的儿童进行了预先设定的方案分析（820/925，89%）。主要结局通过多变量泊松模型进行评估；其他结局通过多变量线性混合模型进行评估。
在年龄小于 4 岁的儿童中，与对照餐相比，NEWSUP 随机分配增加了工作记忆（比率比 1.20，95%置信区间 1.02 至 1.41，P=0.03），在方案人群中效果更大（1.25，1.06 至 1.47，P=0.009）。与对照餐相比，NEWSUP 还增加了贫血儿童的血红蛋白浓度（调整平均差异 0.65g/dL，95%置信区间 0.23 至 1.07，P=0.003），降低了体重指数 z 得分增加（-0.23，-0.43 至-0.02，P=0.03），并增加了瘦组织积累（2.98cm，0.04 至 5.92，P=0.046），同时减少了脂肪（-5.82cm，-11.28 至-0.36，P=0.04），与 FBF 相比。此外，与对照餐和 FBF 相比，NEWSUP 增加了两组儿童的大脑血液流量（1.14mm/s×10，0.10 至 2.23，两者比较 P=0.04）。在 4 岁及以上的儿童中，NEWSUP 对工作记忆或贫血没有显著影响，但与 FBF 相比，增加了瘦组织（4.31cm，0.34 至 8.28，P=0.03）。
儿童期营养不良与长期认知障碍有关。与目前的认识相反，23 周的补充喂养可以改善脆弱的生活在低收入国家的幼儿的执行功能、大脑健康和营养状况。需要进一步研究以优化改善认知功能的营养处方，并在其他脆弱群体中测试有效性。
ClinicalTrials.gov NCT03017209。
