Rice Fortified with Iron in School Meals Improves Cognitive Performance in Cambodian School Children.
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Date
2015
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Abstract
Objectives: Nutritional status can have a large impact on schoolperformance in children, with
micronutrient deficiencies affecting cognitive performance and school attendance through
increased morbidity. The FORISCA-UltraRice+NutriRice Trial in Cambodia tested impact of multimicronutrient
fortified rice (MMFR) through the WFP school meal program (SMP) on micronutrient
status, health and cognitive performance.
Methods: The FORISCA-UltraRice+NutriRice study was a cluster-randomized, double-blinded,
placebo-controlled trial in 9500 schoolchildren. Sixteen schools participating in WFP-SMP were
randomly assigned to receive either MMFR including vitamin A (MMFR+VA), MMFR without VA
(MMFR-VA) or unfortified rice (placebo) as breakfast distributed 6 days/week for 6 months. Four
additional schools not participating in SMP were randomly selected as control group. Cognitive
performance (Raven's Colored Matrices, Block Design and Picture completion), and vitamin A and
iron status were determined in 25% of the schoolchildren.
Results: Cognitive performance was significantly correlated to stunting (P<0.05) and total body iron (TBI) at baseline and endline (P<0.05), but not to vitamin A status. Cognitive performance
improved in all children (P<0.001). Children receiving MMFR-VA (iron without vitamin A) had
significant higher improvements in Block Design scores as compared to children receiving
MMFR+VA (iron plus vitamin A, P<0.001) or control (P=0.022), and tended to be higher than
placebo (P=0.09).
Conclusions: Iron status, as well as chronic nutritional deprivation (stunting) are both important
determinants of cognitive performance in schoolchildren. Improving iron status through fortified
SMP can enhance schoolperformance, but interactions with other micronutrients may modify this
effect. The optimal dose of micronutrients needs to be established. Funded by USDA/FAS, WFPDSM
consortium and IRD.
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Fiorentino Marion, Perignon Marlene, Kuong Khov, Burja Kurt, Kong Kannitha, Parker Megan, Berger Jacques, Wieringa Frank Tammo. Rice Fortified with Iron in School Meals Improves Cognitive Performance in Cambodian School Children. European Journal of Nutrition & Food Safety. 2015 Special issue; 5(5): 769-770.