Improved therapeutic foods improve cognition in malnourished children – Washington University School of Medicine in St. Louis

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DHA, an omega-3 fatty acid, can improve language, social, motor skills

Reginald Lee / Washington University

A dietary supplement that is popular in the United States and added to some types of yogurt, milk, and infant formula can significantly improve the cognition of severely malnourished children, according to a study by researchers at Washington University School of Medicine in St. Louis. Louis.

The researchers found that when the omega-3 fatty acid known as docosahexaenoic acid (DHA) was added to an internationally prescribed, nutritionally dense therapeutic food (RUTF) similar to peanut butter, the children’s general cognition improved. The children who ate the DHA-fortified food surpassed those who did not, in terms of gross and fine motor skills, language skills and social skills – all related to brain health.

In addition, reducing the amount of linoleic acid – a polyunsaturated omega-6 fatty acid – in food also helped children’s neurological abilities. This is because the chemical composition of the omega-6 fatty acid prevents the production of the brain-enhancing DHA, the latter of which is essential for brain development during pregnancy and early childhood and is also associated with improved vision, heart health and immune system function. .

“This is the first evidence of the cognitive effects of ready-to-use therapeutic foods showing DHA and reduced omega-6 are needed to increase brain power in children with severe acute malnutrition,” said the study’s senior author, Mark J. Manary. , MD, Helene B. Roberson Professor of Pediatrics. “We believe that therapeutic foods should be reformulated and standardized to include DHA and reduced omega-6. All children have a right to our best efforts to reach their neurocognitive potential.”

The results were published online Nov. 2 in The American Journal of Clinical Nutrition.

Globally, more than 16 million children under the age of 5 suffer from severe acute malnutrition. The condition is a form of hunger that primarily affects children from poor areas in Africa and Asia and causes excessive thinning or swelling of the body, while also compromising organ systems, including the brain.

Severe acute malnutrition kills about 1 million children each year.

Nearly two decades ago, Manary launched an effort in Africa to combat severe malnutrition using a peanut butter-based therapeutic food enriched with micronutrients known to restore body and muscle mass. The energy-dense food with low moisture content consists of peanuts, milk, vegetable oils and sugar, and like peanut butter, it requires no preparation and does not spoil under ambient conditions. Such characteristics make food ideal for people living in extreme poverty or in areas affected by a natural disaster, political unrest, or other situations that cause food shortages.

Outpatient nutrition programs serving this ready-to-use therapeutic food have saved the lives of hundreds of thousands of malnourished children. Previous data have shown that children with severe acute malnutrition who were treated with food recovered at rates of 85% to 90%. But Manary and others caring for malnourished children have faced challenges in effectively addressing the cognitive problems associated with severe malnutrition, such as speech problems, mobility problems and behavioral problems.

The malnourished brain requires additional special nutrients to restore normal function, namely omega-3 polyunsaturated fatty acids, which are most commonly found in fish and breast milk, Manary said. DHA makes up 10% of the brain substance and is the most important nutrient for the brain.

“Adding it to the therapeutic food along with reducing omega-6, which is antagonistic to omega-3, increased cognition in starving children,” Manary said.

The clinical feeding trial was conducted from October 2017 to December 2020 at 28 rural clinics in Malawi in sub-Saharan Africa. It involved 2,565 children aged 6 months to 5 years with uncomplicated severe malnutrition, meaning they were diagnosed as severely malnourished but still had good appetite, were not hospitalized and showed no signs of serious infection.

Children were randomly assigned to one of three ready-to-use therapeutic foods: the original standard version with higher levels of omega-6; a version with reduced amounts of omega-6 and increased omega-3; and a version that contained DHA with reduced omega-6. The experimental researchers, the families, and the researchers who analyzed the data did not know which groups the children were assigned to.

The treatments lasted about eight weeks. Six months after treatment ended, the researchers compared cognition in the malnourished children. They measured cognition using the Malawi Development Assessment Tool, a standardized, scientifically validated battery of exercises that test language skills, social interaction, and gross and fine motor skills.

“Cognition was superior in the children who received the therapeutic food with additional omega-3 and DHA compared to the other two groups,” Manary said. “Their scores were higher across the board. We noted an improvement that was 22% greater than in those who received standard ready-to-use therapeutic foods.

“For half of the children, cognition is completely restored, but without low omega-6 plus DHA, severely malnourished children would be 10 IQ points below average,” he added.

Researchers also measured DHA levels in children’s blood immediately after completing ready-to-use therapeutic food therapy. After four weeks, DHA levels dropped by 25% in children given standard foods, probably due to the high amount of omega-6 fatty acids. (Manary noted that these DHA levels would fall by significantly larger margins if the children did not get any ready-to-use therapeutic food at all). Meanwhile, after four weeks, DHA levels rose by 49% among children receiving the DHA-fortified food.

“This suggests that the lack of DHA limited cognitive improvement,” Manary said. “It’s great news in the sense that the DHA-fortified therapeutic food was able to recover malnourished brains better than before, and those benefits can last for six months to a year or more.”

On November 8 and 9, the researchers will present their findings to the World Health Organization, which sets out international guidelines for the treatment of malnutrition and other diseases. In addition, in early December, they will share their research to advocate for improvements in the formulation of ready-to-use therapeutic foods distributed worldwide during a meeting of the Codex Alimentarius, an international food safety organization that sets standards followed by most of nations of the world. Manary and his colleagues plan to encourage that all therapeutic food that is ready for use should be made with reduced amounts of omega-6 fatty acids and fortified with DHA.

“Our goal is to change global policy,” Manary said. “These children deserve nothing less.”

Washington University’s Kevin Stephenson, MD, a fellow in the Department of Medicine, and Meghan Callaghan-Gillespie, who holds a master’s degree in public health and is a clinical research implementation coordinator in the Department of Pediatrics, are the lead authors of the study.

Stephenson K, Callaghan-Gillespie M, Maleta K, Nkhoma M, George M, Park HG, Lee R, Humpheries-Cuff I, Lacombe RJS, Wegner DR, Canfield RL, Brenna JT, Manary MJ. Foods low in linoleic acid with added DHA given to Malawian children with severe acute malnutrition improve cognition: A randomized, triple-blind, controlled clinical trial. American Journal of Clinical Nutrition. Published online November 2, 2021.

Information: Manary is the Associate Editor for AJCN.

The research is supported by funds from unorthodox philanthropy and open philanthropy. Wiley Companies supported the work of a donation of ingredients for one of the studio foods. The finances played no role in the study’s design, implementation, analysis or interpretation.

The Washington University School of Medicine’s 1,700 faculty physicians are also the medical staff at Barnes-Jewish and St. Louis Children’s Hospitals. The School of Medicine is a leader in medical research, teaching and patient care, consistently ranked among the best medical schools in the country by US News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s Hospitals is the School of Medicine affiliated with BJC HealthCare.

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