Rice Fortified with Iron in School Meals Improves Cognitive Performance in Cambodian School Children

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.