膳食補充可改善營養不良兒童的認知功能、腦血流和營養狀況
作者：
小柯機器人發布時間：2020/7/23 16:43:35
美國塔夫茨大學Susan B Roberts團隊研究了膳食補充劑對營養不良幼兒認知功能、腦血流和營養狀況的影響。2020年7月22日，該研究發表在《英國醫學雜誌》上。
為了評估膳食補充劑對改善工作記憶，以及包括營養不良兒童腦血流在內的其他指標的影響，研究組在幾內亞比索的10個村莊進行了一項隨機對照試驗。他們招募了1059名兒童，年齡為15個月至7歲。將其隨機分組，接受監督等熱量服務（約1300 kJ，每周5次早膳，為期23周）的新膳食補充劑（NEWSUP，高植物多酚和歐米茄3脂肪酸，多種高強度微量營養素和高蛋白質含量），或營養計劃中使用的強化混合食品（FBF），或對照餐（傳統米飯早餐）。主要觀察指標是工作記憶，其他指標為血紅蛋白濃度、生長發育、身體組成和腦血流量指數（CBFi）。
在4歲以下的兒童中，與對照餐相比，NEWSUP顯著增加了工作記憶，比率為1.20，對每個治療方案群體的影響更大。與對照餐相比，NEWSUP還顯著提高了貧血兒童的血紅蛋白濃度，降低了體重指數z得分，增加了瘦肉組織積累，且脂肪含量降低。此外，在兩個年齡組中，NEWSUP與對照餐和FBF相比，CBFi顯著增加。在4歲及以上的兒童中，NEWSUP對工作記憶或貧血無明顯影響，但與FBF相比，瘦肉組織增加。
兒童營養不良與長期認知障礙有關。研究結果與當前理解相反，23周的補充餵養可改善生活在低收入國家的弱勢幼兒的執行功能、大腦健康和營養狀況。
附：英文原文
Title: Effects of food supplementation on cognitive function, cerebral blood flow, and nutritional status in young children at risk of undernutrition: randomized controlled trial
Author: Susan B Roberts, Maria A Franceschini, Rachel E Silver, Salima F Taylor, Augusto Braima de Sa, Raimundo Có, Aliu Sonco, Amy Krauss, Amy Taetzsch, Patrick Webb, Sai Krupa Das, C-Y Chen, Beatrice L Rogers, Edward Saltzman, Pei-Yi Lin, Nina Schlossman, William Pruzensky, Carlito Balé, Kenneth Kwan Ho Chui, Paul Muentener
Issue&Volume: 2020/07/22
Abstract: Objective To assess the effects of food supplementation on improving working memory and additional measures including cerebral blood flow in children at risk of undernutrition.
Design Randomized controlled trial.
Setting 10 villages in Guinea-Bissau.
Participants 1059 children aged 15 months to 7 years; children younger than 4 were the primary population.
Interventions Supervised isocaloric servings (≈1300 kJ, five mornings each week, 23 weeks) of a new food supplement (NEWSUP, high in plant polyphenols and omega 3 fatty acids, within a wide variety and high fortification of micronutrients, and a high protein content), or a fortified blended food (FBF) used in nutrition programs, or a control meal (traditional rice breakfast).
Main outcome measurements The primary outcome was working memory, a core executive function predicting long term academic achievement. Additional outcomes were hemoglobin concentration, growth, body composition, and index of cerebral blood flow (CBFi). In addition to an intention-to-treat analysis, a predefined per protocol analysis was conducted in children who consumed at least 75% of the supplement (820/925, 89%). The primary outcome was assessed by a multivariable Poisson model; other outcomes were assessed by multivariable linear mixed models.
Results Among children younger than 4, randomization to NEWSUP increased working memory compared with the control meal (rate ratio 1.20, 95% confidence interval 1.02 to 1.41, P=0.03), with a larger effect in the per protocol population (1.25, 1.06 to 1.47, P=0.009). NEWSUP also increased hemoglobin concentration among children with anemia (adjusted mean difference 0.65 g/dL, 95% confidence interval 0.23 to 1.07, P=0.003) compared with the control meal, decreased body mass index z score gain (0.23, 0.43 to 0.02, P=0.03), and increased lean tissue accretion (2.98 cm2, 0.04 to 5.92, P=0.046) with less fat (5.82 cm2, 11.28 to 0.36, P=0.04) compared with FBF. Additionally, NEWSUP increased CBFi compared with the control meal and FBF in both age groups combined (1.14 mm2/s×108, 0.10 to 2.23, P=0.04 for both comparisons). Among children aged 4 and older, NEWSUP had no significant effect on working memory or anemia, but increased lean tissue compared with FBF (4.31 cm2, 0.34 to 8.28, P=0.03).
Conclusions Childhood undernutrition is associated with long term impairment in cognition. Contrary to current understanding, supplementary feeding for 23 weeks could improve executive function, brain health, and nutritional status in vulnerable young children living in low income countries. Further research is needed to optimize nutritional prescriptions for regenerative improvements in cognitive function, and to test effectiveness in other vulnerable groups.
DOI: 10.1136/bmj.m2397
Source: https://www.bmj.com/content/370/bmj.m2397