Trials with the supplement ‘NEWSUP’ that is high in antioxidants, vitamins and minerals, protein as well as the cocoa polyphenols and omega 3 oils resulted in notable gains in working memory and blood flow to the brain when given to children under four years of age.
“The strength of the effect we saw was remarkable: with just 23 weeks of supplementation, there was a substantial improvement in executive function, and more than doubling of brain blood flow in a region that is especially vulnerable to malnutrition,” the study’s authors outline in a blog.
“The emerging recognition that nutrition is far more than the sum of calories, protein and essential micronutrients was channelled into concrete plans for a new food supplement that might in theory support regenerative improvements in the brain.”
An increasing body of preclinical research suggests the potential for additional nutrients and specific food constituents in supplementary foods to support regenerative changes in the brain.
Such nutrients of value include polyphenols, including those that cross the blood-brain barrier, are thought to increase cerebral blood flow, reduce cerebral inflammation and oxidative damage.
The omega 3 fatty acids Docosahexaenoic Acid (DHA) and Eicosapentaenoic Acid (EHA) are also involved in myelination, regulation of microglial activation, and other aspects of brain structure and function.
Other nutrients defined as essential that are not included in current supplementary foods include choline, a neurotransmitter precursor and the trace elements chromium and molybdenum, which have essential roles in brain metabolism.
Researchers from Tufts University, Massachusetts General Hospital and the International Partnership for Human Development in the US, enrolled 1,059 children aged 15 months to 7 years of age.
These children lived in 10 villages located in Guinea-Bissau, West Africa, who were randomised to receive one of three meals, served five mornings each week for 23 weeks.
These meals were NEWSUP, a fortified blended food (FBF) used in nutrition programs, and the third was a control meal (a traditional rice breakfast).
Findings revealed that amongst children under four, those in the NEWSUP group increased working memory compared with the control meal (rate ratio 1.20, 95% confidence interval 1.02 to 1.41).
NEWSUP also increased haemoglobin concentration among children with anaemia (adjusted mean difference 0.65 grams per decilitre (g/dL) 95% confidence interval 0.23 to 1.07) compared with the control meal.
Further results saw a decreased body mass index z score gain (−0.23, −0.43 to −0.02), and increased lean tissue accretion (2.98 cm2, 0.04 to 5.92) with less fat (−5.82 cm2, −11.28 to −0.36) compared with FBF.
Additionally, NEWSUP increased the index of cerebral blood flow (CBFi) compared with the control meal and FBF in both age groups combined (1.14 mm2/s×10−8, 0.10 to 2.23).
Among children aged four and older, NEWSUP had no significant effect on working memory or anaemia, but increased lean tissue compared with FBF (4.31 cm2, 0.34 to 8.28, P=0.03).
“These observations suggest that NEWSUP could have long lasting impacts on educational attainment and cognition,” say the researchers led by Dr Susan Roberts, a professor of nutrition at Tufts University.
“The cerebral blood flow increases and oxygen metabolism in children consuming NEWSUP, especially those consuming at least 75% of their supplement, suggest changes in brain health that could be either a cause or a consequence of improved cognitive function.
“Mechanistic studies are needed to examine the underlying causes of improved cerebral blood flow, including the potential for acute effects of plant polyphenols on flow mediated vasodilation and blood flow through production and availability of endothelial nitric oxide.”
In discussing NEWSUP’s effect on haemoglobin increase in children younger than 4 with anaemia, and improved quality of growth (more lean tissue and less fat) the team attributed these changes to “several aspects of the supplement composition, including protein content.
“Greater lean tissue accretion with lower fat accretion might have implications for long term health because young children who experience undernutrition seem to be at greater risk of adult obesity and associated non-communicable diseases.”
In the accompanying blog, the team that includes Maria Angela Franceschini, a professor in radiology at Massachusetts General Hospital and Augusto Braima de Sa, executive director of International Partnership for Human Development in Guinea-Bissau spoke about their hopes for the future.
“Beyond the science, we hope that these results will encourage difficult—but nevertheless important—discussions about the goals of supplementary nutrition programs, including government food assistance for low-income families in affluent countries.
“Should they continue to focus on preventing death in the maximum number of children with the least expensive products or based on these results start to move towards a system that balances consideration of cost with long-term brain and bodily health?” they add.
“And shouldn’t our articulated nutrition goals be the same for all children, irrespective of whether they live in Africa, affluent Boston, or low-income inner cities? If not, why not?”
Published online: doi.org/10.1136/bmj.m2397
“Food supplements may improve brain health among young children in low income countries.”
Authors: Susan Roberts et al.
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