Reformulation of therapeutic diets boosts brain development, IQ in children
Photo by Reginald Lee/University of Washington
The results of a major clinical trial in Africa, led by Mark Manary, MD, professor of pediatrics at Washington University School of Medicine in St. Louis, have prompted changes in global guidelines for therapeutic diets. A study in Malawi showed that altering the fatty acid composition of nutrient-rich therapeutic foods improved cognition and increased IQ scores in severely malnourished children.
The brain health of millions of malnourished children will benefit from changes in global guidelines for the formulation of ready-to-eat therapeutic foods, the standard of care for severe malnutrition in developing countries. in a position to receive.
Results from a large clinical trial in Africa led by Mark Manary, M.D.A professor of pediatrics at Washington University School of Medicine in St. Louis prompted the change. In this study, conducted in Malawi, sub-Saharan Africa, altering the fatty acid composition of nutritious therapeutic foods can improve cognition and increase IQ scores in severely malnourished children. At the same time, it has been shown to improve language and motor skills.
Specifically, Manary and his colleagues at WashU found that adding an omega-3 fatty acid called docosahexaenoic acid (DHA) to therapeutic diets and reducing the amount of linoleic acid, a polyunsaturated omega-6 fatty acid, could improve nutritional outcomes. It has been shown to bring the greatest benefit to children with ataxia. DHA is an increasingly popular dietary supplement in the United States, touted as an addition to some types of yogurt, milk, and infant formula.
Based on these findings, the Global Commission on Food Safety Standards has called for the reconstitution of ready-to-eat therapeutic foods (RUTFs) to contain DHA and reduce the amount of linoleic acid. adopted the guidelines.
“Imagine the effect of improving the brain development of millions of children,” said Manary, professor of pediatrics Helen B. Roberson. “Our ultimate mission is to change world policy, and that’s what we’ve accomplished. Children deserved nothing more.”
The new guidelines went into effect in January and, although voluntary, are expected to be followed by manufacturers of ready-to-eat therapeutic foods. They were approved in late 2022 by a meeting of international public health leaders of the Codex Alimentarius Commission, a group formed by the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations. This commission sets food safety standards followed by most countries in the world, making it essentially the global equivalent of the US Food and Drug Administration.
But Manary’s scientifically-backed pleas to rebuild RUTF were largely ignored. Researchers had to fight for it.
“The brain is the most important organ in the body,” Manary said. “When opportunities existed to build stronger brains and improve the lives of our children, we couldn’t take no as an answer.”
millions of malnourished children
Globally, more than 16 million children under the age of five suffer from severe acute malnutrition, and nearly one million children die each year. This condition is a form of starvation that causes excessive leanness and swelling in the body, while endangering organ systems, including the brain. Using food to fight child malnutrition in Africa. The food does not require cooking or refrigeration, making it ideal for malnourished children who often live in extreme poverty.
The food is distributed in foil packets to children suffering from severe malnutrition but not sick enough to be hospitalized. A study by Mannery et al. found that therapeutic diets saved the lives of millions of malnourished children, with recovery rates of 85% to 90%.However, severe malnutrition often causes cognitive impairment. Therefore, Mannery and colleagues have continued their research in the hope of finding ways to prevent or reduce cognitive problems associated with severe malnutrition. I got
The Malawi trial involved malnourished children aged 6 months to 5 years, and the results were so dramatic that Manary’s pediatric malnutrition experts called for a restructuring of the RUTF. It has decided to petition the Codex Alimentarius for the preparation of international guidelines.
Sleepless weekends change global policy
Online from St. Louis, Manary presented a case to change RUTF to the Codex Alimentarius Commission in November 2021.
“Reformulating and standardizing ready-to-use therapeutic foods enriched with DHA and reduced in omega-6s can help severely malnourished children reach their neurocognitive potential. virtual attendees Kevin Stevenson, MD, a Washington University instructor in medicine who has been integral to the study since 2009. A major collaborator is J. Thomas Brenna, Ph.D., a nutritional chemist and professor of pediatrics at the University of Texas at Austin.
Despite the clear evidence, benefits, and minimal costs, the panel’s response to the researchers’ findings has been “lukewarm,” Manary said.
“While no one outright challenged our recommendations, our appeal seemed like a smaller detail in the larger process of looking at therapeutic food data and ingredients.” he said.
A gavel was slammed into the desk.
The issue has been raised.
It’s over.
or not. A few minutes later, the researchers started an impromptu Zoom meeting.
Mannery and Stevenson rallied their colleagues and stressed that the Codex Commission’s meetings would continue for several more days. “Technically, the problem is not solved,” Stephenson told colleagues. “But if we don’t act quickly, it will be over.”
Mannery added: Restoring brain development in children is too important to ignore. ”
During the Zoom meeting, Stevenson suggested that the team prepare a petition to email to world leaders in pediatrics, nutrition, global health, neuroscience and fatty acid biochemistry. I called dozens of country representatives on the commission, doctors, scientists, and leaders of child advocacy and health organizations, including the United Nations Children’s Fund (also known as UNICEF). Humanitarian and development assistance for children.
The researchers decided to share the details of the clinical trial so that everyone can understand the need to change RUTF with respect to DHA and omega-6.
The findings persuaded the FDA and other national food safety agencies to ask the Codex Alimentarius Commission to change the RUTF guidelines. The petition, labeled “Urgent,” was signed by 75 experts within days of its drafting. UNICEF representatives further strengthened this objective by reaching out to key Codex leaders.
All of this happened over a sleepless weekend. it had to be done. The committee was scheduled to reconvene the following Monday.
Advocacy efforts have proven successful. Codex Alimentarius has revived this issue.
At the reconvened meeting, Manary made an impassioned plea.
After 45 minutes, a Codex Alimentarius panel recommended reconstituting RUTF to include DHA to reduce omega-6 fatty acid levels. The new guidelines he put into effect on January 1st.
Additionally, WHO has formally adopted new guidelines for countries to fortify RUTF with DHA and reduce the amount of linoleic acid.
“There was no question that we had to stick around to change the policy,” Manary said. “Children’s lives are at stake.”
