Effect of Peanut Paste-based Ready-to-use School Meals With and Without Milk on Fluid Cognition in Northern Ghana: A Randomized Controlled Trial

Kevin B Stephenson; Donna R Wegner; Tamara G Hershey; Tasha Doty; Ephious Davis; Matilda Steiner-Asiedu; Firibu K Saalia; Issah Shani; Mark J Manary

doi:10.1016/j.ajcnut.2023.08.001

Effect of Peanut Paste-based Ready-to-use School Meals With and Without Milk on Fluid Cognition in Northern Ghana: A Randomized Controlled Trial

Am J Clin Nutr. 2023 Oct;118(4):782-791. doi: 10.1016/j.ajcnut.2023.08.001. Epub 2023 Aug 9.

Authors

Kevin B Stephenson¹, Donna R Wegner², Tamara G Hershey³, Tasha Doty⁴, Ephious Davis², Matilda Steiner-Asiedu⁵, Firibu K Saalia⁵, Issah Shani⁵, Mark J Manary⁶

Affiliations

¹ Department of Medicine, Washington University, St. Louis, MO, United States. Electronic address: k.stephenson@wustl.edu.
² Department of Pediatrics, Washington University, St. Louis, MO, United States.
³ Departments of Psychiatry and Radiology, Washington University, St. Louis, MO, United States.
⁴ Program in Occupational Therapy, Washington University, St. Louis, MO, United States.
⁵ Department of Nutrition and Food Science, University of Ghana, Accra, Ghana.
⁶ Department of Pediatrics, Washington University, St. Louis, MO, United States. Electronic address: manarymj@wustl.edu.

Abstract

Background: Few studies have investigated the role of school feeding in low- and middle-income countries as a means of improving childhood cognition. Peanut/milk ready-to-use food (PM-RUF) or cowpea offers an affordable, scalable option that might improve cognition.

Objectives: To determine whether micronutrient-fortified PM-RUF or peanut/cowpea ready-to-use food (PC-RUF) would improve fluid cognition as assessed by 4 tests from the National Institutes of Health Toolbox Cognitive Battery when compared with a micronutrient-fortified millet porridge (FP) after a year of school feeding.

Methods: An individually randomly assigned, investigator-blinded, controlled clinical trial was conducted at 6 schools in Mion District in rural northern Ghana. Eight hundred seventy-one school children aged 5-12 y were randomly assigned and allocated to receive PM-RUF (n = 282), PC-RUF (n = 292), or FP (n = 297), each providing ∼400 kcal/d. The primary outcomes were 4 fluid cognition test scores: Dimensional Change Card Sort test, Flanker Inhibitory Control and Attention test, Pattern Comparison Processing Speed test, and a modified List Sorting Working Memory test. Secondary outcomes included a composite median ranking of the 4 primary outcomes and anthropometry changes.

Results: Among the 871 participants (median age, 8.8 y; 47% female), 795 (91%) completed endline cognitive testing. Median attendance rates exceeded 87% in all groups. PM-RUF group demonstrated better fluid cognition on the Dimensional Change Card Sort test [odds ratio (OR): 1.5; 95% CI: 1.1, 2.0; P = 0.016] and Pattern Comparison Processing Speed test (OR: 1.4; 95% CI: 1.0, 1.9; P = 0.026) than FP, whereas there were no significant differences on Flanker Inhibitory Control and Attention or List Sorting Working Memory tests. PC-RUF group demonstrated no improvement over FP on any cognitive tests. PM-RUF group had superior fluid cognition composite median rankings (OR: 1.5; 95% CI: 1.1, 2.0; P = 0.007).

Conclusions: Among rural Ghanaian children aged 5-12 y, PM-RUF compared with FP resulted in superior fluid cognition. This trial was registered at clinicaltrials.gov as NCT04349007.

Keywords: Ghana; cognition; low- and middle-income countries; milk; peanut paste; ready-to-use foods; school feeding.

Associated data

ClinicalTrials.gov/NCT04349007