Effect of fortification with multiple micronutrients and n-3 fatty acids on growth and cognitive performance in Indian schoolchildren: the CHAMPION (Children's Health and Mental Performance Influenced by Optimal Nutrition) Study. Effect of a 12-mo micronutrient intervention on learning and memory in well-nourished and marginally nourished school-aged children: 2 parallel, randomized, placebo-controlled studies in Australia and Indonesia. Effect of micronutrient supplement on health and nutritional status of schoolchildren: mental function. Dietary micronutrients are associated with higher cognitive function gains among primary school children in rural Kenya. Effects of a multi-micronutrient-fortified beverage, with and without sugar, on growth and cognition in South African schoolchildren: a randomised, double-blind, controlled intervention. Multiple micronutrient-fortified rice affects physical performance and plasma vitamin B-12 and homocysteine concentrations of Indian school children. The effects of regular consumption of a multiple micronutrient fortified milk beverage on the micronutrient status of school children and on their mental and physical performance. Animal source foods improve dietary quality, micronutrient status, growth and cognitive function in Kenyan school children: background, study design and baseline findings. Prenatal micronutrient supplementation and intellectual and motor function in early school-aged children in Nepal. Effect of a Multiple-Micronutrient-Fortified Fruit Powder Beverage on the Nutrition Status, Physical Fitness, and Cognitive Performance of Schoolchildren in the Philippines Maternal Multiple Micronutrient Supplements and Child Cognition: A Randomized Trial in Indonesia Effect of multi-micronutrient-fortified rice on cognitive performance depends on premix composition and cognitive function tested: results of an effectiveness study in Cambodian schoolchildren. Preschool micronutrient supplementation effects on intellectual and motor function in school-aged Nepalese children. Еffects of fortified milk on cognitive abilities in school-aged children: results from a randomized-controlled trial Micronutrient supplementation improves physical performance measures in Asian Indian school-age children. Effect of micronutrient supplement on health and nutritional status of schoolchildren: biochemical status. Using the infrastructure of a conditional cash transfer program to deliver a scalable integrated early child development program in Colombia: cluster randomized controlled trial
BACKGROUND Fortification with multiple micronutrients has been shown to improve growth and cognitive performance among children in developing countries , but it is unknown whether higher concentrations are more effective than lower concentrations . OBJECTIVE We compared the effect of 2 different concentrations of a combination of micronutrients and n-3 ( omega-3 ) fatty acids on indicators of growth and cognitive performance in low-income , marginally nourished schoolchildren in Bangalore , India . DESIGN In a 2-by-2 factorial , double-blind , r and omized controlled trial , 598 children aged 6 - 10 y were individually allocated to 1 of 4 intervention groups to receive foods fortified with either 100 % or 15 % of the Recommended Dietary Allowance of micronutrients in combination with either 900 mg alpha-linolenic acid plus 100 mg docosahexaenoic acid or 140 mg alpha-linolenic acid for 12 mo . Anthropometric and biochemical assessment s were performed at baseline and 12 mo . Cognitive performance was measured at baseline and at 6 and 12 mo . RESULTS The high micronutrient treatment significantly improved linear growth at 12 mo ( 0.19 cm ; 0.01 , 0.36 ) and short-term memory at 6 mo ( 0.11 SD ; 0.01 , 0.20 ) and was less beneficial on fluid reasoning at 6 ( -0.10 SD ; -0.17 , -0.03 ) and 12 ( -0.12 SD ; -0.20 , -0.04 ) mo than was the low micronutrient treatment , whereas no differences were observed on weight , retrieval ability , cognitive speediness , and overall cognitive performance . No significant differences were found between the n-3 treatments . CONCLUSIONS The high micronutrient treatment was more beneficial for linear growth than was the low micronutrient treatment . However , with some small differential effects , higher micronutrient concentrations were as effective as lower concentrations on cognitive performance . This trial was registered at clinical trials.gov as NCT00467909 BACKGROUND Little is known about the combined effect of micronutrients and essential fatty acids on cognitive function in school-aged children . OBJECTIVE We assessed the effect of micronutrients , long-chain n-3 fatty acids , or both on indicators of cognitive performance in well-nourished and marginally nourished school-aged children . DESIGN Two 2-by-2 factorial r and omized controlled double-blind trials were performed home-based in Adelaide , South Australia , and at 6 primary schools in Jakarta , Indonesia . A total of 396 children ( aged 6 - 10 y ) in Australia and 384 children in Indonesia were r and omly allocated to receive a drink with a micronutrient mix ( iron , zinc , folate , and vitamins A , B-6 , B-12 , and C ) , with docosahexanoic acid ( DHA , 88 mg/d ) and eicosapentaenoic acid ( EPA , 22 mg/d ) , or with both or placebo 6 d/wk for 12 mo .  Biochemical indicators were determined at baseline and 12 mo . Cognitive performance was measured at baseline , 6 mo , and 12 mo . RESULTS The micronutrient treatment significantly improved plasma micronutrient concentrations in Australian and Indonesian children . DHA+EPA treatment increased plasma DHA and total plasma n-3 fatty acids in both countries . The micronutrient treatment result ed in significant increases in scores on tests representing verbal learning and memory in Australia ( estimated effect size : 0.23 ; 95 % CI : 0.01 , 0.46 ) . A similar effect was observed among Indonesian girls ( estimated effect size : 0.32 ; 95 % CI : -0.01 , 0.64 ) . No effects were found on tests measuring general intelligence or attention . No effects of DHA+EPA on the factors of cognitive tests were observed . CONCLUSION In well-nourished school-aged children , fortification with multiple micronutrients can result in improvements in verbal learning and memory OBJECTIVE We evaluated the effect of a micronutrient-fortified beverage on mental function in schoolchildren . METHODS This double-blind , placebo-controlled , matched-pair , cluster , r and omized feeding trial assessed baseline before supplementation and after 14 mo in a cohort of 608 children aged 6 to 15 y who received a micronutrient-fortified beverage or placebo .  Children in two classes ( clusters ) in each of nine grade s were assessed for intelligence , attention and concentration , memory , and school achievement . RESULTS Mean intelligence quotient scores of the micronutrient-fortified beverage group and the placebo group at baseline and final follow-up were not significantly different . Mean verbal and performance scores and increments were also not different . After supplementation , attention-concentration increment scores of the micronutrient group were significantly higher ( P < 0.05 ) than those of the placebo group . Mean and incremental scores of the supplemented group on the memory scale were not significantly different from those of the placebo group . CONCLUSIONS Supplementation with a beverage fortified with a range of micronutrients significantly improved attention-concentration over 14 mo , but not intelligence quotient , memory , or school achievement among middle-income schoolchildren 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 , r and omised 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 Raven 's 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 children 's cognitive function Little is known about the effects of combined micronutrient and sugar consumption on growth and cognition . In the present study , we investigated the effects of micronutrients and sugar , alone and in combination , in a beverage on growth and cognition in schoolchildren . In a 2 × 2 factorial design , children ( n 414 , 6 - 11 years ) were r and omly allocated to consume beverages containing ( 1 ) micronutrients with sugar , ( 2 ) micronutrients with a non-nutritive sweetener , ( 3 ) no micronutrients with sugar or ( 4 ) no micronutrients with a non-nutritive sweetener for 8.5 months . Growth was assessed and cognition was tested using the Kaufman Assessment Battery for Children version II ( KABC-II ) subtests and the Hopkins Verbal Learning Test ( HVLT ) . Micronutrients decreased the OR for Fe deficiency at the endpoint ( OR 0.19 ; 95 % CI 0.07 , 0.53 ) . Micronutrients  increased KABC Atlantis ( intervention effect : 0.76 ; 95 % CI 0.10 , 1.42 ) and HVLT Discrimination Index ( 1.00 ; 95 % CI 0.01 , 2.00 ) scores . Sugar  increased KABC Atlantis ( 0.71 ; 95 % CI 0.05 , 1.37 ) and Rover ( 0.72 ; 95 % CI 0.08 , 1.35 ) scores and HVLT Recall 3 ( 0.94 ; 95 % CI 0.15 , 1.72 ) . Significant micronutrient × sugar interaction effects on the Atlantis , Number recall , Rover and Discrimination Index scores indicated that micronutrients and sugar in combination attenuated the beneficial effects of micronutrients or sugar alone . Micronutrients or sugar alone had a lowering effect on weight-for-age z-scores relative to controls ( micronutrients - 0.08 ; 95 % CI - 0.15 , - 0.01 ; sugar - 0.07 ; 95 % CI - 0.14 , - 0.002 ) , but in combination , this effect was attenuated . The beverages with micronutrients or added sugar alone had a beneficial effect on cognition , which was attenuated when provided in combination Fortifying rice with multiple micronutrients could be a promising strategy for combat micronutrient deficiencies in developing countries . We determined the efficacy of extruded rice grains fortified with multiple micronutrients on the prevalence of anemia , micronutrient status , and  physical and cognitive performance  in 6- to 12-y-old , low-income school children in Bangalore , India . In a r and omized , double-blind , controlled trial , 258 children were assigned to 1 of 3 intervention groups to receive rice-based lunch meals fortified with multiple micronutrients with either low-iron ( 6.25 mg ) or high-iron ( 12.5 mg ) concentrations or identical meals with unfortified rice . The meals were provided 6 d/wk for 6 mo . Anthropometric , biochemical , physical performance , and cognitive assessment s were taken at baseline and endpoint . At baseline , study groups were comparable , with 61 % of the children being anemic . However , only < 10 % were deficient in iron , vitamin A , and zinc . After 6 mo , plasma vitamin B-12 and homocysteine concentrations ( both P < 0.001 ) as well as physical performance ( P < 0.05 ) significantly improved in the intervention arms . No between-group differences were observed in hemoglobin concentration , anemia , and deficiencies of other micronutrients or cognitive function after 6 mo , but paired analyses revealed a small reduction in anemia prevalence in children in the low-iron group . The fortified rice was efficacious in improving vitamin B-12 status and physical performance in Indian school children Multiple micronutrient deficiencies exist in school going children in India and bridging the gap between nutrient intake and requirements is an effective way to combat the deficiencies . This study aim ed to test the effect of a multi-micronutrient fortified malt and cocoa based milk beverage on the micronutrient status , cognition , physical performance and nutritional deficiencies of 7 - 10 years old south Indian children . A r and omized , double blind placebo controlled study design was used with normal healthy children from low to middle income families , aged 7 - 10 years r and omly assigned to receive either a multi-micronutrient fortified or an unfortified milk based control drink . The drinks were provided 6 days/week for 5 months . Assessment s included anthropometry , blood biochemistry , physical performance and cognition at baseline and endline . The baseline characteristics of the study groups were similar . The changes in body weight and height were similar between the groups at the end of the study . Levels of vitamin B12 , red cell folate and vitamin B2 significantly improved in the intervention group , while vitamin D , selenium and body iron showed no difference . The Hemoglobin ( Hb ) and serum ferritin levels of the control group decreased at endline , while those in the intervention group maintained their levels . The serum transferrin receptor levels increased in both the groups . The prevalence of iron deficiency and Vitamin B2 deficiency were significantly lower in the intervention group at endline . Overall improvement in cognitive and physical performance was seen in both the groups at endline , with no significant differences between the groups . The micronutrient fortified milk based drink was efficacious in improving the micronutrient status of Vitamin B2 , Vitamin B12 and red cell folate and in preventing a decline in Hb level compared to an unfortified milk based drink . It also reduced anemia and the risk of deficiencies of iron , and B12 , in apparently healthy children . Clinical Trials.gov IdentifierNCT01415557 . Clinical Trial RegistryIndia - REF/2012/12/004332 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 design ed 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 r and omized to four feeding interventions using a local vegetable stew as the vehicle . The groups were design ated 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 r and om effects modeling was used for analysis of outcomes CONTEXT Iron and zinc are important for the development of both intellectual and motor skills . Few studies have examined whether iron and zinc supplementation during gestation , a critical period of central nervous system development , affects children 's later functioning . OBJECTIVE To examine intellectual and motor functioning of children whose mothers received micronutrient supplementation during pregnancy . DESIGN , SETTING , AND PARTICIPANTS Cohort follow-up of 676 children aged 7 to 9 years in June 2007-April 2009 who had been born to women in 4 of 5 groups of a community-based , double-blind , r and omized controlled trial of prenatal micronutrient supplementation between 1999 and 2001 in rural Nepal . Study children were also in the placebo group of a subsequent preschool iron and zinc supplementation trial . INTERVENTIONS Women whose children were followed up had been r and omly assigned to receive daily iron/folic acid , iron/folic acid/zinc , or multiple micronutrients containing these plus 11 other micronutrients , all with vitamin A , vs a control group of vitamin A alone from early pregnancy through 3 months postpartum . These children did not receive additional micronutrient supplementation other than biannual vitamin A supplementation . MAIN OUTCOME MEASURES Children 's intellectual functioning , assessed using the Universal Nonverbal Intelligence Test ( UNIT ) ; tests of executive function , including go/no-go , the Stroop test , and backward digit span ; and motor function , assessed using the Movement Assessment Battery for Children ( MABC ) and finger-tapping test . RESULTS The difference across outcomes was significant ( Bonferroni-adjusted P < .001 ) for iron/folic acid vs control but not for other supplement groups . The mean UNIT T score in the iron/folic acid group was 51.7 ( SD , 8.5 ) and in the control group was 48.2 ( SD , 10.2 ) , with an adjusted mean difference of 2.38 ( 95 % confidence interval [ CI ] , 0.06 - 4.70 ; P = .04 ) . Differences were not significant between the control group and either the iron/folic acid/zinc ( 0.73 ; 95 % CI , -0.95 to 2.42 ) or multiple micronutrient ( 1.00 ; 95 % CI , -0.55 to 2.56 ) groups . In tests of executive function , scores were better in the iron/folic acid group relative to the control group for the Stroop test ( adjusted mean difference in proportion who failed , -0.14 ; 95 % CI , -0.23 to -0.04 ) and backward digit span ( adjusted mean difference , 0.36 ; 95 % CI , 0.01 - 0.71 ) but not for the go/no-go test . The MABC score was lower ( better ) in the iron/folic acid group compared with the control group but not after adjustment for confounders ( mean difference , -1.47 ; 95 % CI , -3.06 to 0.12 ; P = .07 ) . Finger-tapping test scores were higher ( mean difference , 2.05 ; 95 % CI , 0.87 - 3.24 ; P = .001 ) in the iron/folic acid group . CONCLUSION Aspects of intellectual functioning including working memory , inhibitory control , and fine motor functioning among offspring were positively associated with prenatal iron/folic acid supplementation in an area where iron deficiency is prevalent . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00115271 This study aim ed to determine the effect of a multiple-micronutrient-fortified beverage on the micronutrient status , physical fitness , and cognitive performance of schoolchildren . The study was a r and omized , double-blind , placebo-controlled trial of schoolchildren assigned to receive either the fortified or nonfortified beverage with or without anthelmintic therapy .  Data on hemoglobin level , urinary iodine excretion ( UIE ) level , physical fitness , and cognitive performance were collected at baseline and at 16 weeks post-intervention . The fortified beverage significantly improved iron status among the subjects that had hemoglobin levels < 11 g/dl at baseline . The proportion of children who remained moderately to severely anemic was significantly lower among those given the fortified beverage . In the groups that received the fortified product , the median UIE level increased , whereas among those who received the placebo beverage , the median UIE level was reduced significantly . Iron- and /or iodine-deficient subjects who received the fortified beverage showed significant improvements in fitness ( post-exercise reduction of heart rate ) and cognitive performance ( nonverbal mental ability score ) . The study showed that consumption of a multiple-micronutrient-fortified beverage for 16 weeks had significant effects on iron status , iodine status , physical fitness , and cognitive performance among iron- and /or iodine-deficient Filipino schoolchildren .  Anthelmintic therapy improved iron status of anemic children and iodine status of the iron-adequate children at baseline but it had no effect on physical fitness and cognitive performance . The results from the clinical study showed that a multiple-micronutrient-fortified beverage could play an important role in preventing and controlling micronutrient deficiencies OBJECTIVES : We investigated the relative benefit of maternal multiple micronutrient ( MMN ) supplementation during pregnancy and until 3 months postpartum compared with iron/folic acid supplementation on child development at preschool age ( 42 months ) . METHODS : We assessed 487 children of mothers who participated in the Supplementation with Multiple Micronutrients Intervention Trial , a cluster-r and omized trial in Indonesia , on tests adapted and vali date d in the local context measuring motor , language , visual attention/spatial , executive , and socioemotional abilities . Analysis was according to intention to treat . RESULTS : In children of undernourished mothers ( mid-upper arm circumference < 23.5 cm ) , a significant benefit of MMNs was observed on motor ability ( B = 0.39 [ 95 % confidence interval ( CI ) : 0.08–0.70 ] ; P = .015 ) and visual attention/spatial ability ( B = 0.37 [ 95 % CI : 0.11–0.62 ] ; P = .004 ) . In children of anemic mothers ( hemoglobin concentration < 110 g/L ) , a significant benefit of MMNs on visual attention/spatial ability ( B = 0.24 [ 95 % CI : 0.02–0.46 ] ; P = .030 ) was also observed . No robust effects of maternal MMN supplementation were found in any developmental domain over all children . CONCLUSIONS : When pregnant women are undernourished or anemic , provision of MMN supplements can improve the motor and cognitive abilities of their children up to 3.5 years later , particularly for both motor function and visual attention/spatial ability . Maternal MMN but not iron/folic acid supplementation protected children from the detrimental effects of maternal undernutrition on child motor and cognitive development OBJECTIVE Even though current policy is strongly focused on the crucial first ' 1000 days ' , it might be still possible to enhance cognitive function during the pre-adolescent and adolescent years by improving micronutrient status . In Cambodia , nutritional status is poor . Provision of rice fortified with micronutrients through a school meal programme ( SMP ) could be a cost-effective strategy to help improve health and school performance . The present study aim ed to evaluate the effect of three different micronutrient-fortified rice formulations on cognitive function in Cambodian children . SETTING Sixteen Cambodian schools receiving SMP . DESIGN The FORISCA-UltraRice ® +NutriRice ® study was a r and omized , double-blind , placebo-controlled trial . Four groups of four schools were r and omly allocated to receive normal rice , UltraRice ® Original , UltraRice ® New or NutriRice ® . Within each school , 132 children were r and omly selected .  Data on cognitive performance ( picture completion , block design and Raven 's coloured progressive matrices ( RCPM ) ) , anthropometry , parasite infestation and micronutrient status were collected before the intervention and after 6 months . SUBJECTS Cognitive data were available for 1796 children aged 6 - 16 years .  RESULTS All cognitive scores improved after 6 months ( P<0·001 ) . Block design score improvement was significantly higher in children consuming UltraRice ® Original ( P=0·03 ) compared with the other fortified rice groups and placebo . No difference among groups was found on RCPM or picture completion scores . Stunting , parasite infestation and inflammation negatively affected the impact of the intervention . CONCLUSIONS Combined with other interventions , using SMP to distribute fortified rice to schoolchildren may be a cost-effective way to increase cognitive performance and thereby improve school performance and educational achievements OBJECTIVE To examine intellectual and motor functioning of children who received micronutrient supplementation from 12 to 35 months of age . DESIGN Cohort follow-up of children 7 to 9 years of age who participated in a 2 × 2 factorial , placebo-controlled , r and omized trial from October 2001 through January 2006 . SETTING Rural Nepal . PARTICIPANTS A total of 734 children 12 to 35 months of age at supplementation and 7 to 9 years of age at testing . INTERVENTIONS Children received iron plus folic acid ( 12.5 mg of iron and 50 μg of folic acid ) ; zinc ( 10 mg ) ; iron plus folic acid and zinc ; or placebo . MAIN OUTCOME MEASURES Intellectual , motor , and executive function . RESULTS In both the unadjusted and adjusted analyses , iron plus folic acid supplementation had no effect overall or on any individual outcome measures being tested . In the unadjusted analysis , zinc supplementation had an overall effect , although none of the individual test score differences were significant . In the adjusted analysis , the overall difference was not significant . CONCLUSION In rural Nepal , we found that iron plus folic acid or zinc supplementation during the preschool years had no effect on aspects of intellectual , executive , and motor function at 7 to 9 years of age , suggesting no long-term developmental benefit of iron or zinc supplementation during 12 to 35 months of age Background Micronutrients such as vitamins and minerals and long-chain polyunsaturated omega-3 fatty acids ( PUFAs ) are essential for children ’s brain development and cognitive functions . The current study investigated whether milk fortified with micronutrients and PUFA can result in improved cognitive function in mainstream school children . Methods One-hundred- and -nineteen children ( age 8–14 , 58 boys ) were r and omly allocated to a fortified milk group or a regular full milk control group . Participants consumed 0.6L/day of the milk for 5 months . We recorded relevant biochemical , anthropometric , and cognitive measures ( working memory and processing speed ) at the start of the study and at follow-up after 5 months . Results The fortified milk significantly increased docosahexaenoic acid ( DHA ) ( change from baseline of 28 % [ 95 % CI 17–39 % ] vs. −6 % [ 95 % CI − 13 to 0 % ] in the control group ) and serum 25OH-vitamin D concentrations ( 41 % [ 95 % CI 30–52 % ] vs. 21 % [ 95 % CI 11–30 % ] in the control group ) . The fortified milk improved working memory on one of two tests ( 32 % [ 95 % CI 17–47 % ] vs. 13 % [ 95 % CI 6–19 % ] in the control group ) . The fortified milk also indirectly increased processing speed on one of two tests ; this effect was small and completely mediated by increases in 25OH-vitamin D concentrations . Conclusions These results suggest that fortifying milk with micronutrients and PUFA could be an effective and practical way to aid children ’s cognitive development Micronutrients are important in physical work capacity and therefore performance . The impact of a multi-micronutrient-fortified nutritional beverage on physical performance measures among clinical ly healthy school-age children was assessed in a double-blind ( for test and placebo groups ) , placebo-controlled , r and omized trial in children aged between 7 and 10.5 y ( n = 300 ) . The participants with height- and weight-for-age Z-scores between 0 and ≥ -3 were r and omized to 1 of 3 study arms : fortified choco-malt beverage powder ( F ) , matched energy equivalent unfortified placebo ( U ) , and untreated control ( C ) . Participants in the F and C groups were given 40 g fortified ( 19 key vitamins and minerals ) and unfortified choco-malt beverage , respectively , daily for 120 d. Primary efficacy outcomes included endurance and aerobic capacity using a 20-m shuttle test and step test . Other physical performance measures included speed ( 40-m sprint ) , visual reaction time , maximal h and grip , and forearm static endurance . Micronutrient status included thiamin , riboflavin , folate , niacin , iron , pyridoxal phosphate , and vitamins B-12 and C. All measurements were made at baseline and the end of the intervention . There was a within-subject increase in aerobic capacity and whole body endurance ( P < 0.05 ) accompanied by a significant improvement in the status of iron thiamin , riboflavin , pyridoxal phosphate , folate , and vitamins C and B-12 in the F group compared to the within-subject changes in the other 2 groups ( P < 0.05 ) . The study suggests that multiple micronutrient supplementation in similar population s may be beneficial in improving micronutrient status and enhancing aerobic capacity and endurance in children OBJECTIVE We assessed the effect of a daily intake of a micronutrient-fortified beverage for 14 mo on indicators of biochemical status of important micronutrients in schoolchildren . METHODS A double-blind , placebo-controlled , matched-pair , cluster , r and omization study design was used . Biochemical indicators of micronutrient status were evaluated at baseline and at the end of 14 mo on a sub sample in nine matched pairs . Prevalence ( percentage ) of sub clinical deficiency , mean , and mean increments of each indicator were compared between supplemented and placebo groups . RESULTS Extent of inadequacy at baseline was more or less 100 % for folic acid , 65 % for vitamins B2 and B6 , and 55 % for vitamins C and A. Prevalence of anemia among subjects was 55 % , with inadequacy of vitamin B12 being 40 % and that of vitamin D being 30 % . No subject had inadequacy of iodine based on urinary iodine . Supplementation of a micronutrient-enriched beverage for 14 mo significantly improved the status of many of the nutrients . The effect was significant with respect to vitamins A , B2 , and B12 , folic acid , vitamin D , parathyroid hormone , and thyroid-stimulating hormone in children who received the supplement compared with those who received only placebo .  Hemoglobin status improved only in children who had anemia in the supplemented group . CONCLUSIONS Prevalence of multiple sub clinical micronutrient deficiencies are high in middle-income Indian school children . Daily consumption of a micronutrient-enriched beverage had positive effects that were confined to those nutrients that were inadequate at baseline Objective To assess the effectiveness of an integrated early child development intervention , combining stimulation and micronutrient supplementation and delivered on a large scale in Colombia , for children ’s development , growth , and hemoglobin levels . Design Cluster r and omized controlled trial , using a 2 × 2 factorial design , with municipalities assigned to one of four groups : psychosocial stimulation , micronutrient supplementation , combined intervention , or control . Setting 96 municipalities in Colombia , located across eight of its 32 departments . Participants 1420 children aged 12 - 24 months and their primary carers . Intervention Psychosocial stimulation ( weekly home visits with play demonstrations ) , micronutrient sprinkles given daily , and both combined . All delivered by female community leaders for 18 months . Main outcome measures Cognitive , receptive and expressive language , and fine and gross motor scores on the Bayley scales of infant development-III ; height , weight , and hemoglobin levels measured at the baseline and end of intervention . Results Stimulation improved cognitive scores ( adjusted for age , sex , testers , and baseline levels of outcomes ) by 0.26 of a st and ard deviation ( P=0.002 ) . Stimulation also increased receptive language by 0.22 of a st and ard deviation ( P=0.032 ) . Micronutrient supplementation had no significant effect on any outcome and there was no interaction between the interventions . No intervention affected height , weight , or hemoglobin levels . Conclusions Using the infrastructure of a national welfare program we implemented the integrated early child development intervention on a large scale and showed its potential for improving children ’s cognitive development . We found no effect of supplementation on developmental or health outcomes . Moreover , supplementation did not interact with stimulation . The implementation model for delivering stimulation suggests that it may serve as a promising blueprint for future policy on early childhood development . Trial registration Current Controlled trials IS RCT N18991160
The effects of micronutrient interventions on other domains were inconsistent .
Improvement in fluid intelligence among micronutrient-deficient children was consistently reported .
BACKGROUND & AIMS Micronutrients are essential for brain development with deficiencies in specific nutrients linked to impaired cognitive function .
Interventions are shown to be beneficial to children 's mental development , particularly in subjects who were micronutrient-deficient at baseline but results on healthy subjects remain inconsistent .
This systematic review evaluated the effect of micronutrient inventions on different cognitive domains .