Low linoleic acid foods with added DHA given to Malawian children with severe acute malnutrition improve cognition: a randomized, triple-blinded, controlled clinical trial

Kevin Stephenson; Meghan Callaghan-Gillespie; Kenneth Maleta; Minyanga Nkhoma; Matthews George; Hui Gyu Park; Reginald Lee; Iona Humphries-Cuff; R J Scott Lacombe; Donna R Wegner; Richard L Canfield; J Thomas Brenna; Mark J Manary

doi:10.1093/ajcn/nqab363

Low linoleic acid foods with added DHA given to Malawian children with severe acute malnutrition improve cognition: a randomized, triple-blinded, controlled clinical trial

Am J Clin Nutr. 2022 May 1;115(5):1322-1333. doi: 10.1093/ajcn/nqab363.

Authors

Affiliations

¹ Department of Medicine, Washington University, St. Louis, MO, USA.
² Department of Pediatrics, Washington University, St. Louis, MO, USA.
³ Department of Public Health, School of Public Health & Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi.
⁴ Department of Pediatrics, University of Texas at Austin, Austin, TX, USA.
⁵ Project Peanut Butter, Lunzu, Malawi.
⁶ Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA.
⁷ USDA/Agricultural Research Service Children's Nutrition Research Center, Houston, TX, USA.

Abstract

Background: There is concern that the PUFA composition of ready-to-use therapeutic food (RUTF) for the treatment of severe acute malnutrition (SAM) is suboptimal for neurocognitive recovery.

Objectives: We tested the hypothesis that RUTF made with reduced amounts of linoleic acid, achieved using high-oleic (HO) peanuts without added DHA (HO-RUTF) or with added DHA (DHA-HO-RUTF), improves cognition when compared with standard RUTF (S-RUTF).

Methods: A triple-blind, randomized, controlled clinical feeding trial was conducted among children with uncomplicated SAM in Malawi with 3 types of RUTF: DHA-HO-RUTF, HO-RUTF, and S-RUTF. The primary outcomes, measured in a subset of subjects, were the Malawi Developmental Assessment Tool (MDAT) global z-score and a modified Willatts problem-solving assessment (PSA) intention score for 3 standardized problems, measured 6 mo and immediately after completing RUTF therapy, respectively. MDAT domain z-scores, plasma fatty acid content, anthropometry, and eye tracking were secondary outcomes. Comparisons were made between the novel PUFA RUTFs and S-RUTF.

Results: Among the 2565 SAM children enrolled, mean global MDAT z-scores were -0.69 ± 1.19 and -0.88 ± 1.27 for children receiving DHA-HO-RUTF and S-RUTF, respectively (difference 0.19, 95% CI: 0.01, 0.38). Children receiving DHA-HO-RUTF had higher gross motor and social domain z-scores than those receiving S-RUTF. The PSA problem 3 scores did not differ by dietary group (OR: 0.92, 95% CI: 0.67, 1.26 for DHA-HO-RUTF). After 4 wk of treatment, plasma phospholipid EPA and α-linolenic acid were greater in children consuming DHA-HO-RUTF or HO-RUTF when compared with S-RUTF (for all 4 comparisons P values < 0.001), but only plasma DHA was greater in DHA-HO-RUTF than S-RUTF (P < 0.001).

Conclusions: Treatment of uncomplicated SAM with DHA-HO-RUTF resulted in an improved MDAT score, conferring a cognitive benefit 6 mo after completing diet therapy. This treatment should be explored in operational settings. This trial was registered at clinicaltrials.gov as NCT03094247.

Keywords: DHA; MDAT; PUFA; cognition; ready-to-use therapeutic food; severe acute malnutrition.

Publication types

Randomized Controlled Trial

MeSH terms

Child
Cognition
Fast Foods
Humans
Infant
Linoleic Acid
Male
Malnutrition* / drug therapy
Prostate-Specific Antigen
Severe Acute Malnutrition*

Substances

Linoleic Acid
Prostate-Specific Antigen

Associated data

ClinicalTrials.gov/NCT03094247