Abstract
Background
Micronutrients such as vitamins and minerals and long-chain polyunsaturated omega-3 fatty acids (PUFAs) are essential for children’s brain development and cognitive functions. The current study investigated whether milk fortified with micronutrients and PUFA can result in improved cognitive function in mainstream school children.
Methods
One-hundred-and-nineteen children (age 8–14, 58 boys) were randomly allocated to a fortified milk group or a regular full milk control group. Participants consumed 0.6L/day of the milk for 5 months. We recorded relevant biochemical, anthropometric, and cognitive measures (working memory and processing speed) at the start of the study and at follow-up after 5 months.
Results
The fortified milk significantly increased docosahexaenoic acid (DHA) (change from baseline of 28% [95% CI 17–39%] vs. −6% [95% CI − 13 to 0%] in the control group) and serum 25OH-vitamin D concentrations (41% [95% CI 30–52%] vs. 21% [95% CI 11–30%] in the control group). The fortified milk improved working memory on one of two tests (32% [95% CI 17–47%] vs. 13% [95% CI 6–19%] in the control group). The fortified milk also indirectly increased processing speed on one of two tests; this effect was small and completely mediated by increases in 25OH-vitamin D concentrations.
Conclusions
These results suggest that fortifying milk with micronutrients and PUFA could be an effective and practical way to aid children’s cognitive development.
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References
Best C, Neufingerl N, Del Rosso JM, Transler C, van den Briel T, Osendarp S (2011) Can multi-micronutrient food fortification improve the micronutrient status, growth, health, and cognition of schoolchildren? A systematic review. Nutr Rev 69:186–204
Montgomery P, Burton JR, Sewell RP, Spreckelsen TF, Richardson AJ (2013) Low blood long chain omega-3 fatty acids in UK children are associated with poor cognitive performance and behavior: a cross-sectional analysis from the DOLAB study. PloS one 8:e66697
Catena A, Munoz-Machicao JA, Torres-Espinola FJ, Martinez-Zaldivar C, Diaz-Piedra C, Gil A, Haile G, Gyorei E, Molloy AM, Decsi T, Koletzko B, Campoy C (2016) Folate and long-chain polyunsaturated fatty acid supplementation during pregnancy has long-term effects on the attention system of 8.5-y-old offspring: a randomized controlled trial. Am J Clin Nutr 103:115–127
Kirby A, Woodward A, Jackson S (2010) Benefits of omega-3 supplementation for schoolchildren: review of the current evidence. Br Edu Res J 36:699–732
Cordain L, Eaton SB, Sebastian A, Mann N, Lindeberg S, Watkins BA, O’Keefe JH, Brand-Miller J (2005) Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr 81:341–354
Benatti P, Peluso G, Nicolai R, Calvani M (2004) Polyunsaturated fatty acids: biochemical, nutritional and epigenetic properties. J Am Coll Nutr 23:281–302
Georgieff MK (2007) Nutrition and the developing brain: nutrient priorities and measurement. Am J Clin Nutr 85:614S-620S
Darmon N, Drewnowski A (2008) Does social class predict diet quality? Am J Clin Nutr 87:1107–1117
Black MM (2003) Micronutrient deficiencies and cognitive functioning. J Nutr 133:3927S-3931S
Manger MS, McKenzie JE, Winichagoon P, Gray A, Chavasit V, Pongcharoen T, Gowachirapant S, Ryan B, Wasantwisut E, Gibson RS (2008) A micronutrient-fortified seasoning powder reduces morbidity and improves short-term cognitive function, but has no effect on anthropometric measures in primary school children in northeast Thailand: a randomized controlled trial. Am J Clin Nutr 87:1715–1722
Osendarp SJ, Baghurst KI, Bryan J, Calvaresi E, Hughes D, Hussaini M, Karyadi SJ, van Klinken BJ, van der Knaap HC, Lukito W, Mikarsa W, Transler C, Wilson C, NEMO Study Group (2007) Effect of a 12-mo micronutrient intervention on learning and memory in well-nourished and marginally nourished school-aged children: 2 parallel, randomized, placebo-controlled studies in Australia and Indonesia. Am J Clin Nutr 86:1082–1093
Jiao J, Li Q, Chu J, Zeng W, Yang M, Zhu S (2014) Effect of n-3 PUFA supplementation on cognitive function throughout the life span from infancy to old age: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 100:1422–1436
Kirby A, Woodward A, Jackson S, Wang Y, Crawford M (2010) A double-blind, placebo-controlled study investigating the effects of omega-3 supplementation in children aged 8–10 years from a mainstream school population. Res Dev Disabil 31:718–730
Johnson M, Fransson G, Östlund S, Areskoug B, Gillberg C (2017) Omega 3/6 fatty acids for reading in children: a randomized, double-blind, placebo-controlled trial in 9-year-old mainstream schoolchildren in Sweden. J Child Psychol Psychiatry 58:83–93
Richardson AJ, Burton JR, Sewell RP, Spreckelsen TF, Montgomery P (2012) Docosahexaenoic acid for reading, cognition and behavior in children aged 7–9 years: a randomized, controlled trial (the DOLAB Study). PLoS one 7:e43909
Montgomery P, Spreckelsen TF, Burton A, Burton JR, Richardson AJ (2018) Docosahexaenoic acid for reading, working memory and behavior in UK children aged 7–9: a randomized controlled trial for replication (the DOLAB II study). PloS one 13:e0192909
Fonollá J, López-Huertas E, Machado FJ, Molina D, Álvarez I, Mármol E, Navas M, Palacín E, García-Valls MJ, Remón B (2009) Milk enriched with “healthy fatty acids” improves cardiovascular risk markers and nutritional status in human volunteers. Nutrition 25:408–414
Fry AF, Hale S (1996) Processing speed, working memory, and fluid intelligence: evidence for a developmental cascade. Psychological science 7:237–241
Alloway TP, Alloway RG (2010) Investigating the predictive roles of working memory and IQ in academic attainment. J Exp Child Psychol 106:20–29
St Clair-Thompson HL, Gathercole SE (2006) Executive functions and achievements in school: Shifting, updating, inhibition, and working memory. Q J Exp Psychol 59:745–759
Baro L, Fonolla J, Pena J, Martinez-Ferez A, Lucena A, Jiménez J, Boza J, López-Huertas E (2003) n-3 Fatty acids plus oleic acid and vitamin supplemented milk consumption reduces total and LDL cholesterol, homocysteine and levels of endothelial adhesion molecules in healthy humans. Clin Nutr 22:175–182
Carrero JJ, Baro L, Fonolla J, Gonzalez-Santiago M, Martinez-Ferez A, Castillo R, Jimenez J, Boza JJ, Lopez-Huertas E (2004) Cardiovascular effects of milk enriched with omega-3 polyunsaturated fatty acids, oleic acid, folic acid, and vitamins E and B6 in volunteers with mild hyperlipidemia. Nutrition 20:521–527
Silva Ayçaguer L (2000) Sigesmu (Sistema General de simulación y simulación de muestras). Diseno razonado de muestras y captación de datos para la investigación sanitaria. Díaz de Santos (Ed, Madrid
Wechsler D (2004) WISC-IV: Wechsler intelligence scale for children: technical and interpretive manual. Psychological Corporation
Wechsler D, Corral S (2011) WISC-IV Escala de Inteligencia de Wechsler para Niños-IV. Pearson, Madrid
Romeo J, Wärnberg J, García-Mármol E, Rodríguez-Rodríguez M, Diaz LE, Gomez-Martínez S, Cueto B, López-Huertas E, Cepero M, Boza JJ (2011) Daily consumption of milk enriched with fish oil, oleic acid, minerals and vitamins reduces cell adhesion molecules in healthy children. Nutrition, Metab Cardiovasc Dis 21:113–120
Hayes AF (2008) Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Press, New York
Graham J (2012) Missing data: analyses and design. Springer, New York
van Ginkel JR (2014) SPSS syntax for applying rules for combining multivariate estimates in multiple imputation. Leiden University
Preacher KJ, Kelley K (2011) Effect size measures for mediation models: quantitative strategies for communicating indirect effects. Psychol Methods 16:93–115
Buell JS, Dawson-Hughes B (2008) Vitamin D and neurocognitive dysfunction: preventing “D” ecline? Mol Aspects Med 29:415–422
Annweiler C, Allali G, Allain P, Bridenbaugh S, Schott A, Kressig RW, Beauchet O (2009) Vitamin D and cognitive performance in adults: a systematic review. Eur J Neurol 16:1083–1089
Liao K, McCandliss BD, Carlson SE, Colombo J, Shaddy DJ, Kerling EH, Lepping RJ, Sittiprapaporn W, Cheatham CL, Gustafson KM (2016) Event-related potential differences in children supplemented with long-chain polyunsaturated fatty acids during infancy. Developmental Science
Kajarabille N, Hurtado JA, Peña-Quintana L, Peña M, Ruiz J, Diaz-Castro J, Rodríguez-Santana Y, Martin-Alvarez E, López-Frias M, Soldado O (2017) Omega-3 LCPUFA supplement: a nutritional strategy to prevent maternal and neonatal oxidative stress. Maternal & child nutrition 13
Kuratko CN, Barrett EC, Nelson EB, Salem N (2013) The relationship of docosahexaenoic acid (DHA) with learning and behavior in healthy children: a review. Nutrients 5:2777–2810
Campoy C, Escolano-Margarit MV, Ramos R, Parrilla-Roure M, Csabi G, Beyer J, Ramirez-Tortosa MC, Molloy AM, Decsi T, Koletzko BV (2011) Effects of prenatal fish-oil and 5-methyltetrahydrofolate supplementation on cognitive development of children at 6.5 y of age. Am J Clin Nutr 94:1880S–1888S
Acknowledgements
The study was funded by Lactalis Puleva SL. JF is currently employed and ELH was employed by Biosearch Life, which is part of Lactalis. Dafina Petrova is supported by a Juan de la Cierva Fellowship (FJCI-2016-28279) from the Spanish Ministry of Economy, Industry, and Competitiveness. We would like to thank the schools in Granada that participated in the study: I.E.S. Albayzín de Granada, Colegio Diocesano Virgen del Espino de Chauchina (Granada), and C.E.I.P. Cardenal Cisneros de Villanueva Mesía.
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Petrova, D., Bernabeu Litrán, M., García-Mármol, E. et al. Еffects of fortified milk on cognitive abilities in school-aged children: results from a randomized-controlled trial. Eur J Nutr 58, 1863–1872 (2019). https://doi.org/10.1007/s00394-018-1734-x
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DOI: https://doi.org/10.1007/s00394-018-1734-x