Rice Fortified with Iron in School Meals Improves Cognitive Performance in Cambodian School Children
Marion Fiorentino *
Institute de Recherche pour le Développement, Montpellier, France and Department of Fisheries Post-Harvest Technologies and Quality Control, Fisheries Administration, Phnom Penh, Cambodia.
Marlene Perignon
Institute de Recherche pour le Développement, Montpellier, France.
Khov Kuong
Department of Fisheries Post-Harvest Technologies and Quality Control, Fisheries Administration, Phnom Penh, Cambodia and Copenhagen University, Copenhagen, Denmark.
Kurt Burja
World Food Program, Phnom Penh, Cambodia.
Kannitha Kong
World Food Program, Phnom Penh, Cambodia.
Megan Parker
PATH, Seattle, USA.
Jacques Berger
Institute de Recherche pour le Développement, Montpellier, France.
Frank Tammo Wieringa
Institute de Recherche pour le Développement, Montpellier, France.
*Author to whom correspondence should be addressed.
Abstract
Objectives: Nutritional status can have a large impact on schoolperformance in children, with micronutrient deficiencies affecting cognitive performance and school attendance through increased morbidity. The FORISCA-UltraRice+NutriRice Trial in Cambodia tested impact of multi-micronutrient fortified rice (MMFR) through the WFP school meal program (SMP) on micronutrient status, health and cognitive performance.
Methods: The FORISCA-UltraRice+NutriRice study was a cluster-randomized, double-blinded, placebo-controlled trial in 9500 schoolchildren. Sixteen schools participating in WFP-SMP were randomly assigned to receive either MMFR including vitamin A (MMFR+VA), MMFR without VA (MMFR-VA) or unfortified rice (placebo) as breakfast distributed 6 days/week for 6 months. Four additional schools not participating in SMP were randomly selected as control group. Cognitive performance (Raven's Colored Matrices, Block Design and Picture completion), and vitamin A and iron status were determined in 25% of the schoolchildren.
Results: Cognitive performance was significantly correlated to stunting (P<0.05) and total body iron (TBI) at baseline and endline (P<0.05), but not to vitamin A status. Cognitive performance improved in all children (P<0.001). Children receiving MMFR-VA (iron without vitamin A) had significant higher improvements in Block Design scores as compared to children receiving MMFR+VA (iron plus vitamin A, P<0.001) or control (P=0.022), and tended to be higher than placebo (P=0.09).
Conclusions: Iron status, as well as chronic nutritional deprivation (stunting) are both important determinants of cognitive performance in schoolchildren. Improving iron status through fortified SMP can enhance schoolperformance, but interactions with other micronutrients may modify this effect. The optimal dose of micronutrients needs to be established. Funded by USDA/FAS, WFP-DSM consortium and IRD.