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

Background: Little is known about the combined effect of micronutrients and essential fatty acids on cognitive function in schoolaged 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 randomized 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 randomly 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 resulted 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. Am J Clin Nutr 2007;86:1082–93.