Background Elevated brain choline is associated with better executive function in preadolescents. Manipulating dietary choline prospectively in preadolescents using egg supplementation could improve executive function via effects on brain cellular and neurotransmitter function. Objective Test the 9-mo impact of egg supplementation on executive function. It was hypothesized that preadolescents who consumed meal/snack replacement products containing powder made from whole eggs would have the largest improvement in executive function after 9-mo compared to those consuming similar products with either added milk powder or gelatin as a placebo. Methods A randomized, parallel groups, double-blinded, placebo-controlled trial design was used. The executive function of 122 preadolescents (58 females) aged 9-13 was analyzed before and after the 9-mo intervention. Primary outcomes were three National Institutes of Health Toolbox-Cognitive Battery measures of executive function: mental flexibility, working memory and selective attention/inhibitory control. Participants were randomized to consume food products with either: (i) whole egg powder, (ii) milk powder, or (iii) gelatin as a placebo, all matched on macronutrient content and used as replacements for commonly consumed foods (i.e., waffles, pancakes, macaroni and cheese, ice cream, and brownies). Hypothesis testing used mixed-effects models that included physical activity and sleep scores as covariates. Results A statistically significant group by time interaction for selective attention and inhibitory control was found (p=0.049) for the milk group. This interaction resulted from no change for the placebo group and an improvement in selective attention and inhibitory control performance for the milk group by a T-score of 5.8; the effect size d was 0.44 standard deviation units. Other comparisons were statistically insignificant. Conclusions Consumption of foods with added milk powder as replacements for snacks or meals for 9-mo improves selective attention/inhibitory control in preadolescents. Replacement foods with added whole egg powder does not impact the 9-mo change in preadolescent executive function. This trial was registered at clinicaltrials.gov as NCT03739424.
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