Animal Source Foods Promote Cognitive
Function, School Performance, Increased
  Muscle Growth and Activity in Kenyan
Child...
Evolution of research on malnutrition
     and growth and development

• 1970s:         protein deficiency

• 1980s-90s:  ...
Nutritional Benefits of Animal Source
               Foods (ASF)1
• Macronutrients
      – Relatively high fat content inc...
Nutritional Benefits of Animal Source
               Foods (ASF)1

• Micronutrients (intrinsically high in
  meat)
      –...
Importance of ASF in Developing
              Countries
• Infants and young children
  – PEM and multiple micronutrient de...
Importance of ASF in Developing
                Countries
• Multiple functional impacts
   – Maternal malnutrition with fe...
Nutrition Collaborative Research Support
             Program (CRSP)
• Nutrition CRSP awarded to UC Berkeley by USAID
   –...
Methods
• Longitudinal observational study of infants, toddlers,
  schoolers, and biologic parents for one year
• Data obt...
Some key findings
• Mother-child interactions and child care taking were negatively
  affected by low maternal energy inta...
Study 2 – 1998-present
• Findings from observational studies called for a randomized
  controlled intervention study to te...
Main Hypotheses
Children supplemented with animal foods will:
  –   Perform better on measures of cognitive function
  –  ...
Methods
• Randomized, controlled feeding intervention study
  of 1st and 2nd grade children to one of four isocaloric
  fe...
Methods
• Testing of functional outcome measures:
   – Cognitive - Raven’s Progressive Matrices, WISC-R,
     Verbal Meani...
Selected key findings - Cognitive

• Raven’s Progressive Matrices: Steepest rate of
  increase on Raven’s test score in Me...
Raven’s Scores
          21



          20
Raven’s
                                                              Control
...
School end term test scores

• Meat and Milk groups showed the greatest
  increase compared to all other groups in:
  – In...
Change in Total Test Scores by
       Group (over 5 school terms)


           *
                               *




    ...
Change in Subject Test Scores by
              Group


     *                                                             ...
Change in Subject Test Scores by
               Group
                            (over 5 school terms)

                 ...
Physical Growth

• Arm muscle area (lean body mass)
  – The Meat group showed the steepest and highly
    significant gain...
ARM MUSCLE AREA (cm2)



    githeri plus oil
Physical Activity and Behavior

• Greatest increase in high levels of activity and
  on going activity in Meat group
• Gre...
Playground % Initiates
Morbidity
• Control group had the highest illness frequency
  occurrences and the least decline over time
• Meat group had...
Summary
• This first RCT with meat supplementation
  shows:
  – Increased cognitive and school performance
  – Increased h...
Implications
• For optimal learning and school performance children
  need diets of adequate quantity and quality
• Improv...
Acknowledgment
• Financial support for this project comes
  primarily from USAID Grant No. PCE-
  G-00-98-00036-00 through...
Animal Source Foods Promote Cognitive Function, School Performance, Increased Muscle Growth and Activity in Kenyan School ...
Animal Source Foods Promote Cognitive Function, School Performance, Increased Muscle Growth and Activity in Kenyan School ...
Animal Source Foods Promote Cognitive Function, School Performance, Increased Muscle Growth and Activity in Kenyan School ...
Animal Source Foods Promote Cognitive Function, School Performance, Increased Muscle Growth and Activity in Kenyan School ...
Animal Source Foods Promote Cognitive Function, School Performance, Increased Muscle Growth and Activity in Kenyan School ...
Animal Source Foods Promote Cognitive Function, School Performance, Increased Muscle Growth and Activity in Kenyan School ...
Animal Source Foods Promote Cognitive Function, School Performance, Increased Muscle Growth and Activity in Kenyan School ...
Animal Source Foods Promote Cognitive Function, School Performance, Increased Muscle Growth and Activity in Kenyan School ...
Animal Source Foods Promote Cognitive Function, School Performance, Increased Muscle Growth and Activity in Kenyan School ...
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Animal Source Foods Promote Cognitive Function, School Performance, Increased Muscle Growth and Activity in Kenyan School Children: from Observational to Evidence-based Findings

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Animal Source Foods Promote Cognitive Function, School Performance, Increased Muscle Growth and Activity in Kenyan School Children: from Observational to Evidence-based Findings. Presented by Charlotte Neumann (UCLA) at the GL-CRSP End of Program Conference on June 17, 2009, Naivasha, Kenya.

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Animal Source Foods Promote Cognitive Function, School Performance, Increased Muscle Growth and Activity in Kenyan School Children: from Observational to Evidence-based Findings

  1. 1. Animal Source Foods Promote Cognitive Function, School Performance, Increased Muscle Growth and Activity in Kenyan Children: From Observational to Evidence- Based Findings Charlotte Neumann, UCLA Nimrod Bwibo, University of Nairobi Constance Gewa, George Mason University
  2. 2. Evolution of research on malnutrition and growth and development • 1970s: protein deficiency • 1980s-90s: energy deficiency (mild to moderate) most prevalent nutritional challenge • 1990s onward: poor diet quality with multiple micronutrient deficiencies • 2000s onward: food-based approaches to energy, protein and micronutrient deficiencies
  3. 3. Nutritional Benefits of Animal Source Foods (ASF)1 • Macronutrients – Relatively high fat content increases energy density – High quality complete and readily digestible protein containing all essential amino acids – Presence of heme protein enhances iron and zinc absorption and when mixed with plant foods – High concentrations of very long chain (vic) omega 3 and other fatty acids • Particularly in fish • Substantial amounts in red meat (beef, pork, lamb, goat, etc.) 1 meat (of a wide variety), fish, fowl, milk, eggs
  4. 4. Nutritional Benefits of Animal Source Foods (ASF)1 • Micronutrients (intrinsically high in meat) – Zinc and Iron present in bioavailable forms – Vitamin B12 present almost exclusively in meat and milk – Riboflavin – Lysine – Calcium, particularly in milk and fish – Preformed Vitamin A in milk, eggs, and fish 1 meat (of a wide variety), fish, fowl, milk, eggs
  5. 5. Importance of ASF in Developing Countries • Infants and young children – PEM and multiple micronutrient deficiencies coexist in a high % of children – Infants weaned onto bulky, dilute, plant-based dishes with low protein, lysine, and multiple micronutrient content • Nonhuman milk consumed in small quantities • Anemia prevalent due to iron plus other nutritional deficiencies, parasites, and infection
  6. 6. Importance of ASF in Developing Countries • Multiple functional impacts – Maternal malnutrition with fetal growth restriction and LWB – Growth retardation with stunting and reduced lean body mass – Impaired resistance to infection with acquired immunodeficiency – Cognitive development, physical activity, and behaviors negatively affected – Anemia with reduced work capacity and physical activity – Calcium deficiency • Rickets in children limiting physical activity • Osteomalacia in women = pelvic deformity The addition of meat and animal products can improve/prevent adverse outcomes.
  7. 7. Nutrition Collaborative Research Support Program (CRSP) • Nutrition CRSP awarded to UC Berkeley by USAID – Three country projects selected for parallel longitudinal observational studies on mild-moderate energy malnutrition and human function • UCLA and U of Nairobi - rural Kenya • Purdue U, U of Arizona, Nutrition Institute (Cairo), U of Kansas - semi-rural Egypt • U of Connecticut, U of Florida, Instituto Nacional de la Nutricion (Mexico) - rural Mexico • Forerunner to GLCRSP studies – 1984-1993 – Does mild/moderate energy malnutrition negatively affect mother-child interactions and care giving, and the child’s cognitive function, behavior, and physical activity?
  8. 8. Methods • Longitudinal observational study of infants, toddlers, schoolers, and biologic parents for one year • Data obtained: – Weekly measures • Morbidity – Monthly measures • Quantitative food intake • Anthropometry, including head circumference and MUAC – Every 3-6 months measures • Cognitive testing • Physical activity measures – Annual measures • SES census • Tested literacy of parents
  9. 9. Some key findings • Mother-child interactions and child care taking were negatively affected by low maternal energy intake and anemia • Shorter and lighter infants and those with poor weight gain were significantly less sociable, carried more by their mothers, and had lower motor scores at 6 months than taller and heavier infants • Energy intake and meat intake in toddlers (18-30 months) were positively associated with their Bayley’s test scores and also predicted their cognitive performance at age 5 years • Greater physical activity during free play was positively related to energy meat intake over time in school-aged children • Better nourished children during free-play were happier and showed more leadership behavior than less well-nourished children • Greater on task behaviors in classroom in the meat group • The other projects found similar but less striking findings
  10. 10. Study 2 – 1998-present • Findings from observational studies called for a randomized controlled intervention study to test the causative role of dietary meat on: – cognitive function - physical growth - behavior – school performance - physical activity - morbidity • Funding, USAID-Global Livestock CRSP (GLCRSP) – M.W. Demment, PhD, Director (UC Davis) – Planning Grant 1997-1998 – A randomized controlled feeding intervention (1998-2003) study collaborators, UCLA, U of Nairobi, and UC Davis • PIs: Charlotte Neumann and Nimrod Bwibo • Co-PIs: Suzanne Murphy and Marian Sigman • Co-investigators: Lindsay Allen and Shannon Whaley • The study was carried out in the same area (Embu District) as the earlier observational study with many of the same staff
  11. 11. Main Hypotheses Children supplemented with animal foods will: – Perform better on measures of cognitive function – Improve school performance (test scores) – Show improved growth in all dimensions – Decreased morbidity – Be more physically active – Exhibit positive behavior during free-play (leadership, initiative, etc.) than those children Receiving plant-based supplements and the Control group
  12. 12. Methods • Randomized, controlled feeding intervention study of 1st and 2nd grade children to one of four isocaloric feedings: – Meat added to githeri* – Milk with githeri – Githeri with added oil – Control; no school feeding • Two cohorts from the same schools and the same grades were enrolled exactly one year apart and each followed for 2 years – N ~ 500 in cohort 1 – N ~ 375 in cohort 2 *githeri: traditional dish of maize, beans, greens
  13. 13. Methods • Testing of functional outcome measures: – Cognitive - Raven’s Progressive Matrices, WISC-R, Verbal Meaning Test, Digit Span – Observational Methods for activity and behavior • Timed observations for 30 minutes/session during free play • Strictly defined activity levels and behaviors • Quality control on 15% subsample (high % agreement) – End term test scores on zone wide examinations – Morbidity – recall and direct observation – Growth – anthropometrics (weight, height, MUAC, derived arm muscle area) – Biochemical micronutrient status and Hemoglobin • Independent variables – food intake & malaria status
  14. 14. Selected key findings - Cognitive • Raven’s Progressive Matrices: Steepest rate of increase on Raven’s test score in Meat group (statistically significant) • Arithmetic skills: the Meat group and the Githeri group performed significantly better than Milk and Control groups • No significant differences were seen in verbal or digit span
  15. 15. Raven’s Scores 21 20 Raven’s Control Scores Calorie 19 Milk Meat 18 17 -0.5 0 0.5 1 1.5 2 Relative years in study
  16. 16. School end term test scores • Meat and Milk groups showed the greatest increase compared to all other groups in: – Individual Subject Test Scores (p <0.05) – Combined Test Scores (p <0.05) • Scores were controlled for baseline scores, school, attendance, cognitive scores, gender, age, SES, height, maternal literacy, home food intake
  17. 17. Change in Total Test Scores by Group (over 5 school terms) * * * *Statistically significant, p < 0.05 Adjusted for age, gender, maternal literacy*, height, home food intake, SES, attendance*
  18. 18. Change in Subject Test Scores by Group * * * * * * * ** ** * * * ** * * *Statistically significant, p < 0.05 Adjusted for age, gender, maternal literacy*, height, home food intake, SES, attendance*
  19. 19. Change in Subject Test Scores by Group (over 5 school terms) Total Math English Kiembu Kiswahili Geog. Science Arts Test Meat *9.37 *5.68 *7.72 3.36 *6.08 -1.47 *9.26 *45.71 Milk *5.74 -1.03 2.97 *5.13 *6.17 -0.66 *6.96 *26.35 Energy 2.26 *-7.58 0.82 *-5.48 -1.53 *-6.66 *4.16 -6.07 Control 3.14 *-9.66 -0.81 *-6.21 *-3.87 *-6.56 *3.31 *-18.67 *Statistically significant, p < 0.05 Adjusted for age, gender, maternal literacy*, height, home food intake, SES, attendance*.
  20. 20. Physical Growth • Arm muscle area (lean body mass) – The Meat group showed the steepest and highly significant gain compared to all other groups • Weight – Child who received meat, milk as energy gained significantly more weight than those in the Control group • Height – No significant differences were seen – In stunted children and in 6-7 year olds, Milk group showed better linear growth
  21. 21. ARM MUSCLE AREA (cm2) githeri plus oil
  22. 22. Physical Activity and Behavior • Greatest increase in high levels of activity and on going activity in Meat group • Greatest decrease in low levels of physical activity in Meat group • The Meat group compared to all other groups showed: • Greatest increase in initiative • Greatest increase in leadership • Greatest increase in peer involvement • Greatest increase in positive affect
  23. 23. Playground % Initiates
  24. 24. Morbidity • Control group had the highest illness frequency occurrences and the least decline over time • Meat group had the significantly greatest declines in diarrhea and typhoid occurrences • Milk group had the significantly greatest decline in upper respiratory infections • For malaria and total illnesses, the significantly greatest declines were seen in the Plain Githeri and the Meat groups – The vitamin A fortified oil used in the Plain Githeri may have reduced morbidity occurrences
  25. 25. Summary • This first RCT with meat supplementation shows: – Increased cognitive and school performance – Increased high levels of physical activity – Increased initiative and leadership behaviors – Increased mid-upper arm muscle area (lean body mass) – Decreased morbidity • All supplemented groups improved overall weight gain compared to the Control group
  26. 26. Implications • For optimal learning and school performance children need diets of adequate quantity and quality • Improved nutrition quality (through inclusion of Animal Source Foods) is an investment in human capital, leadership initiative, and economic development • Nutrition is critical for a productive work force • Findings are also relevant to developed countries where restrictive vegetarian diets are used, especially for children • A sizeable challenge is how to put affordable meat in the table for the family
  27. 27. Acknowledgment • Financial support for this project comes primarily from USAID Grant No. PCE- G-00-98-00036-00 through the Global Livestock Collaborative Support Program. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Agency for International Development.

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