Charlotte G. Neumann

Animal Source Foods Improve Dietary Quality, Micronutrient Status, Growth and Cognitive Function in Kenyan School Children: Background, Study Design and Baseline Findings

A previous longitudinal three-country study in Egypt, Kenya and Mexico found significant positive associations between intake of animal source foods (ASF) and growth, cognitive development and physical activity. To test for a causal relationship, a controlled school feeding intervention study was designed to test the hypotheses that ASF would improve micronutrient status, growth and cognitive function in Kenyan primary school children. Twelve rural Kenyan schools with 554 children were randomized to four feeding interventions using a local vegetable stew as the vehicle. The groups were designated as Meat, Milk, Energy and Control, who received no feedings. Feeding was carried out on school days for seven terms during 21 mo. Preintervention baseline measures included nutritional status, home food intake, anthropometry, biochemical measures of micronutrient status, malaria, intestinal parasites, health status and cognitive and behavioral measures. The measurements of each child were repeated at intervals over 2 y. Baseline data revealed stunting and underweight in approximately 30% of children and widespread inadequate intakes and/or biochemical evidence of micronutrient deficiencies, particularly of iron, zinc, vitamins A and B-12, riboflavin and calcium. Little or no ASF were eaten and fat intake was low. Malaria was present in 31% of children, and hookworm, amebiasis and giardia were widely prevalent. The outcomes measured were rates of change or increase during the intervention in cognitive function, growth, physical activity and behavior and micronutrient status. Hierarchical linear random effects modeling was used for analysis of outcomes.

Contribution of animal source foods in improving diet quality and function in children in the developing world

Abstract Mild to moderate protein-energy malnutrition (PEM) is prevalent throughout the developing world. Children are particularly susceptible to malnutrition, which contributes to poor growth, diminished mental development, and illness. The recognition that micronutrient deficiencies frequently co-exist with PEM is receiving increasing attention. In this regard, diet quality, or the ability of a given diet to provide the entire complement of high-quality protein, energy, minerals, trace metals, and vitamins necessary to meet requirements, is as significant as diet quantity alone. Animal source foods supply not only high-quality and readily digested protein and energy, but are also a compact and efficient source of readily available micronutrients. This review covers information derived from field studies, both observational and interventions, regarding intake of animal products, such as meat and milk, and also the major constituent micronutrients, iron, zinc, vitamins B 12 and A and their role on child growth, cognitive development and health.

Cognitive abilities of Kenyan children in relation to nutrition, family characteristics, and education.

The purpose of this study was to determine whether nutritional factors, family characteristics, and the duration of schooling were associated with cognitive and attentional capacities in children growing up in rural Kenya. Food intake was measured by direct observation and weighment twice monthly over the course of a year. Families were characterized in terms of socioeconomic status and the literacy of the parents. Children who were better nourished had higher composite scores on a test of verbal comprehension and the Ravens matrices. Better-nourished females were more attentive during classroom observations than malnourished female schoolchildren. Family characteristics and duration of school participation were associated with cognitive abilities for both boys and girls. For the children considered as a group, cognitive scores were best predicted by a combination of factors including duration of schooling, food intake, physical stature, and SES.

The Impact of Dietary Intervention on the Cognitive Development of Kenyan School Children

Previous observational studies in developing countries have suggested that diet quality, particularly increased animal source food (ASF) consumption, is positively associated with child cognitive development. This report presents findings from a study in rural Kenya, designed to test the impact of three different diets on the cognitive development of school children. Twelve schools with a total of 555 Standard 1 children (equivalent to U.S. Grade 1) were randomized to one of four feeding interventions: Meat, Milk, Energy or Control (no feeding). Feeding continued for seven school terms (21 mo), and cognitive tests were administered before the commencement of feeding and during every other term of feeding. Hierarchical linear random effects models and associated methods were used to examine the effects of treatment group on changes in cognitive performance over time. Analyses revealed that children receiving supplemental food with meat significantly outperformed all other children on the Ravens Progressive Matrices. Children supplemented with meat, and children supplemented with energy, outperformed children in the Control group on tests of arithmetic ability. There were no group differences on tests of verbal comprehension. Results suggest that supplementation with animal source food has positive effects on Kenyan childrens cognitive performance. However, these effects are not equivalent across all domains of cognitive functioning, nor did different forms of animal source foods produce the same beneficial effects. Implications of these findings for supplementation programs in developing countries are discussed.

Food Supplements Have a Positive Impact on Weight Gain and the Addition of Animal Source Foods Increases Lean Body Mass of Kenyan Schoolchildren

Observational studies of dietary patterns and growth and studies with milk supplementation have shown that children consuming diets containing animal source foods grow better. This study evaluates the growth of 544 Kenyan schoolchildren (median age 7.1 y) after 23 mo of food supplementation with a meat, milk or energy supplement (approximately 1255 kJ) compared to a control group without a supplement. Multivariate analyses controlled for covariates compared gain in weight, height, weight-for-height Z-score (WHZ), height-for-age Z-score (HAZ), mid-upper-arm circumference, triceps and subscapular skinfolds, mid-upper-arm muscle and mid-upper-arm fat area. Children in each of the supplementation groups gained approximately 0.4 kg (10%) more weight than children in the Control group. Children in the Meat, Milk and Energy groups gained 0.33, 0.19 and 0.27 cm more, respectively, in mid-upper-arm circumference than children in the Control group. Children who received the Meat supplement gained 30-80% more mid-upper-arm muscle area than children in the other groups, and children who received the milk supplement gained 40% more mid-upper-arm muscle area than children who did not receive a supplement. No statistically significant overall effects of supplementation were found on height, HAZ, WHZ or measures of body fat. A positive effect of the milk supplement on height gain could be seen in the subgroup of children with a lower baseline HAZ (< or = -1.4). The results indicate that food supplements had a positive impact on weight gain in the study children and that the addition of meat increased their lean body mass.

Relationship between nutrition and development in Kenyan toddlers

The relationship between mild to moderate malnutrition, as measured by food intake and anthropometric status, and developmental outcome was explored in 110 Kenyan toddlers. Developmental outcome was assessed at 30 months of age by the Bayley Mental and Motor scales and by evaluation of play behaviors. Verbalization and play during months 15 to 30 were also evaluated. Family background and home rearing conditions were assessed, and these variables were separated from the correlations between nutrition and outcome by partial correlation methods. Food intake was related to anthropometric status, play behaviors, and total amount of verbalization and play even when the potentially confounding effects of certain family background and home rearing variables were covaried. Food intake was not related to Bayley Mental and Motor scores, but measures of length and weight were, even when family background and home rearing variables were held constant. Mild to moderate malnutrition does appear to affect the childs development adversely even when other environmental characteristics, which also relate to development, are considered.

Decreased rosette-forming lymphocytes in malnutrition and intrauterine growth retardation

The percentage of peripheral blood lymphocytes which spontaneously form rosettes with sheep red blood cells (thymus-dependent lymphocytes) was studied as a sensitive measure of cellular immunity in patients with two forms of malnutrition. The percentage and absolute number of rosette-forming cells was markedly decreased in 10 children with severe protein-calorie malnutrition (16.6%±2.7 SE) p

A school salad bar increases frequency of fruit and vegetable consumption among children living in low-income households

OBJECTIVE To measure change in fruit and vegetable (F&V) consumption among elementary-school children after the introduction of a salad bar programme as a lunch menu option in the US Department of Agricultures (USDA) reimbursable lunch programme in Los Angeles Unified School District (LAUSD). DESIGN A cross-sectional sample of children was interviewed before and after a salad bar intervention (1998 and 2000, respectively) utilising a 24-hour food recall questionnaire. Frequencies of F&V consumption were calculated. SETTING The evaluation took place in three LAUSD elementary schools participating in the salad bar programme and the USDA reimbursable lunch programme. SUBJECTS Three hundred and thirty-seven children in 2nd-5th grade (7-11 years old). RESULTS After the salad bar was introduced, there was a significant increase in frequency (2.97 to 4.09, P < 0.001) of F&V consumed among the children studied. The increase in frequency of F&V consumed was almost all due to an increase during lunch (84%). Mean energy, cholesterol, saturated fat and total fat intakes were significantly lower in the children after the salad bar was introduced in the schools compared with the intakes in the children before the salad bar was introduced. CONCLUSION A salad bar as a lunch menu option in the USDA reimbursable lunch programme can significantly increase the frequency of F&V consumption by elementary-school children living in low-income households.

School Snacks Containing Animal Source Foods Improve Dietary Quality for Children in Rural Kenya

Provision of a snack at school could help alleviate the micronutrient malnutrition that is common among schoolchildren in developing countries. The Child Nutrition Project was designed to compare the efficacy of three school snacks in improving growth and cognitive function of children in rural Kenya. The snacks provided approximately 20% of the childrens energy requirement, and were composed of equicaloric portions of githeri (a vegetable stew) alone (Energy group), githeri plus milk (Milk group) or githeri plus meat (Meat group). A fourth group of children served as Controls. When nutrient intakes from three, 24-h dietary recalls collected before feeding were compared to three, 24-h recalls conducted after feeding began, intakes of vitamin B-12, riboflavin, vitamin A and calcium increased more in the Milk group than in the Control group, whereas intakes of vitamin B-12, vitamin A, calcium, available iron and available zinc increased more than those of Controls for children in the Meat group. At most of the time points examined, total energy intake increased more for the Meat group than for the other two feeding groups, because the additional energy provided by the Milk and Energy snacks was partially balanced by a decrease in the energy content of foods consumed at home. This decrease did not occur to the same extent for the Meat group, so both dietary quantity and dietary quality improved. For the Milk group, only dietary quality improved. For the Energy group, there were no significant changes in the total days diet compared to the Control group.

Intake of micronutrients high in animal-source foods is associated with better growth in rural Kenyan school children.

Observational studies have shown that children in developing countries consuming diets containing high amounts of bioavailable nutrients, such as those found in animal-source foods, grow better. The present study investigated which specific nutrients from the diet of Kenyan school children predicted their growth. The children (n 544, median age 7 years) participated in a 2-year long food supplementation study with animal-source foods. Height gain during the intervention period was positively predicted by average daily intakes of energy from animal-source foods, haem Fe, preformed vitamin A, Ca and vitamin B12. Weight gain was positively predicted by average daily intakes of energy from animal-source foods, haem Fe, preformed vitamin A, Ca and vitamin B12. Gain in mid-upper-arm muscle area was positively predicted by average daily intakes of energy from animal-source foods and vitamin B12. Gain in mid-upper-arm fat area was positively predicted by average daily intakes of energy from animal-source foods. Gain in subscapular skinfold thickness was not predicted by any of the nutrient intakes. Negative predictors of growth were total energy and nutrients that are contained in high amounts in plant foods. The study shows that growth was positively predicted by energy and nutrients that are provided in high amounts and in a bioavailable form in meat and milk, and their inclusion into the diets of children in developing countries should be part of all food-based programmes in order to improve micronutrient status and growth.