No Bwibo

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.

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.

Kenyan School Children Have Multiple Micronutrient Deficiencies, but Increased Plasma Vitamin B-12 Is the Only Detectable Micronutrient Response to Meat or Milk Supplementation

Animal source foods (ASF) can provide micronutrients in greater amounts and more bioavailable forms compared to plant source foods, but their intake is low in many poor populations. However, the impact of ASF on micronutrient status of undernourished populations has not been assessed. Supplemental meat (60-85 g/d), milk (200-250 mL/d) or energy (isocaloric with the meat and milk, 240-300 kcal/d) were randomly assigned to 555 undernourished school children aged 5-14 y in a rural malaria-endemic area of Kenya, at one school meal daily for one school year. Blood and stool samples were collected at baseline and after 1 y to assess stool parasites, malaria, hemoglobin, serum or plasma C-reactive protein, ferritin, iron, zinc, copper, vitamin B-12, folate and retinol, and erythrocyte riboflavin. At baseline, there was a high prevalence of micronutrient deficiencies (iron, zinc, vitamins A and B-12 and riboflavin), yet plasma ferritin was low in few children, and none had low serum copper. At the end of the year of supplementation, plasma vitamin B-12 concentrations were significantly increased in children fed the Meat or Milk meal; prevalence of severe plus moderate deficiency fell from 80.7% at baseline to 64.1% in the Meat group and from 71.6 to 45.1% in the Milk group, respectively. No significant improvement was observed in the status of other micronutrients compared to the Energy and Control groups, although malaria and other infections may have obscured effects. Supplementation with small amounts of meat or milk reduced the high prevalence of vitamin B-12 deficiency in these children.

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.

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.

Dietary micronutrients are associated with higher cognitive function gains among primary school children in rural Kenya.

With the exception of iodine and Fe, there is still very limited information on the effect of micronutrients on cognitive function, especially among school-age children. The present analysis evaluates the relationship between dietary Fe, Zn and B vitamins (B12, B6, folate and riboflavin) and gains in cognitive test scores among school children in rural Kenya. Data for the present study were obtained from The Child Nutrition Kenya Project, a 2-year longitudinal, randomised controlled feeding intervention study using animal source foods. Dietary nutrient values were based on monthly and bimonthly 24 h recall data collected during the study period. In longitudinal regression analyses, available Fe, available Zn, vitamin B12 and riboflavin showed significant relationships with improved cognitive test scores, after controlling for confounders such as energy intake, school, socio-economic status and morbidity. Available Fe intake was associated with significantly higher gains in Ravens Coloured Progressive Matrices test scores over time. Available Zn intake was associated with significantly higher gains in digit span-total test scores over time, while vitamin B12 and riboflavin intakes were each associated with significantly higher gains in digit span-forward test scores over time. This analysis demonstrates the influence of improved dietary micronutrient status on school childrens cognitive function.

Caregiver Child Interaction Patterns in Two Cultures in Relation to Nutritional Intake

The major focus of the present project was the relation between caregiver behaviour towards toddlers, and caregiver and toddler nutritional intake across two cultures. Kenyan subjects were 110 toddlers, 18-30 months of age and their caregivers; Egyptian subjects were 153 toddlers, 18-30 months of age and their caregivers. Based on monthly observations and maternal report, food intake values were calculated for both mothers and toddlers in both countries. In Kenya, based on bimonthly observations, five measures of caregiver behaviour were collected; based on monthly observations, nine measures of caregiver behaviour were collected in Egypt. Results indicated that in both countries caregiver behaviours toward their toddlers were driven primarily by toddler rather than by maternal intake. However, the specific pattern of relations differed across each culture. Specifically, in Egypt, more adequately nourished toddlers received more appropriate stimulation from caregivers. In Kenya, more adequately nourished toddlers had less physical contact with their caregivers and their caregivers responded verbally to their vocalisations less than they did for poorly nourished toddlers.