Effects of food supplementation on cognitive function, cerebral blood flow, and nutritional status in young children at risk of undernutrition: randomized controlled trial

Abstract

ObjectiveTo assess the effects of food supplementation on improving working memory and additional measures including cerebral blood flow in children at risk of undernutrition.DesignRandomized controlled trial.Setting10 villages in Guinea-Bissau.Participants1059 children aged 15 months to 7 years; children younger than 4 were the primary population.InterventionsSupervised 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).Main outcome measurementsThe 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 (CBFi). 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.ResultsAmong 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 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. Additionally, NEWSUP increased CBFi compared with the control meal and FBF in both age groups combined (1.14 mm2/s×10−8, 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 cm2, 0.34 to 8.28, P=0.03).ConclusionsChildhood 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.Trial registrationClinicalTrials.gov NCT03017209.

Importance of EPA and DHA Blood Levels in Brain Structure and Function

“…The authors concluded that, “daily supplementation with ≥450 mg DHA + EPA per day and an increase in the Omega-3 Index >6% makes it more likely to show efficacy on cognition in children and adolescents.” [ 3 ]. This conclusion is supported by more recent findings: In children both older and younger than 4 years with undernutrition, a food supplement containing 171 mg EPA and 255 mg DHA per day, and many other components, improved brain blood flow, and parameters of complex brain function, like executive function in a 23-week randomized intervention trial [ 69 ]. The latter findings also point towards the positive effects of supplementing with EPA and DHA in children diagnosed to have a deficit by determining a low Omega-3 Index.…”

Breakfast: A Crucial Meal for Adolescents’ Cognitive Performance According to Their Nutritional Status. The Cogni-Action Project

“…Moreover, a high-quality breakfast has been related to a lower risk of obesity [ 4 ]. Thereby, both a nutrient deficit and obesity have been linked to lower cognitive functioning during childhood [ 8 , 9 , 10 ]. Having a regular breakfast and improving its quality could enhance children’s cognitive performance [ 11 , 12 ] through enhanced episodic and visual memory, attention, and other cognitive skills [ 13 , 14 , 15 ].…”

Can Natural Products Exert Neuroprotection without Crossing the Blood–Brain Barrier?

“…Vascular changes leading to enhanced blood flow have received significant attention as mechanisms explaining brain health impact of polyphenols [ 95 , 109 , 159 ]. Polyphenols have been linked to an enhancement of cerebral blood flow and brain oxygenation in clinical trials [ 81 , 160 , 161 , 162 ]. Again, such vascular effects do not require entry of polyphenols into the CNS.…”