1. The impact of Quality Protein Maize (QPM) on
school children’s weight and height: Results from
an effectiveness trial in Colombia
Helena Pachón1, Sayda Milena Pico Fonseca1, Jorge E. Gómez2 ,
Freddy Escobar Pinto1
1 Centro Internacional de Agricultura Tropical (CIAT), Colombia
2 Independent consultant, Colombia

2. Introduction
Biofortification is the process of
increasing the nutrient
concentration of staple crops [1].
One of the first biofortified crops
was Quality Protein Maize
(QPM).
Due to a naturally occurring
mutation, Q has a g
, QPM greater
concentration than common maize
(CM) of lysine and tryptophan,
Photo: Catherine Bermudez Kandianis
two of the limiting amino acids in
cereals [2].
l 2
[1] Nestel P, Bouis HE, Meenakshi JV, Pfeiffer W. Biofortification of staple food crops. J Nutr, 136:1064–1067, 2006.
136:1064 1067,
[2] Mertz ET, Bates LS, Nelson OE. Mutant gene that changes protein composition and increases lysine content of maize
endosperm. Science, 145:279-280, 1964.

3. QPM: More Amino Acids in
Endosperm
http://www.nativeaccess.com/ancestral/corn/summer.html

4. Amino Acid Concentration
Lysine and Tryptophan Levels as a Percentage of Total Protein in Whole
d h l f l h l
Grain Flour of Normal and QPM, and FAO Requirements for Children
Source: Krivanek et al., 2007

5. Maize Released in Colombia (2010)

6. Greater Tryptophan
Imbachí-Narvaez et al., 2010

7. Same Digestibility
Coupled with
p
higher tryptophan
(and lysine) levels,
this suggests
gg
greater uptake of
the amino acids by
the human body
Imbachí-Narvaez et al., 2010

8. Introduction
Compared with CM, QPM, or its predecessor, opaque-2 maize,
improves by 10% the weight and height of mildly to moderately
malnourished preschool children [3].
The nutritional impact of QPM in school-age children has never
been studied
studied.
[3] Gunaratna NS, De Groote H, Nestel P, Pixley KV, McCabe GP. A meta-analysis of community based studies on quality protein
maize. Food Policy. 35(3):202-210, 2010.

9. Objective
Evaluate the impact on school children’s weight and height of
consuming QPM through a government-supported school-
feeding program.
Photo: Neil Palmer

10. Methods
Ethical approval was received
from the Universidad de
f h U i id d d
Antioquia in Colombia.
A multi-stage process was
followed to identify schools
and children to participate in
the study from a rural,
predominantly indigenous
municipality in southwestern
Colombia.
Photo: Neil Palmer

11. Study Design

12. Intervention
There were three intervention groups; the intervention was at the
school level
level.
In a quasi-experimental design, schools were assigned to receive
QPM seed (SEED) for planting (n=4), QPM for consuming
(n 3),
(n=3), or CM for consuming (n=5).
(n 5).
Selection into the SEED group was by convenience; these schools
were beneficiaries of two government feeding programs.
Among the remaining 8 schools, assignation into the QPM or CM
schools
consumption groups was random; these schools were beneficiaries
of one government program.
In the consumption schools, all children in the school received the
schools
assigned maize during the school-feeding program.
Only a subset of these children were measured at baseline and
endline.

13. Study Design

14. Intervention
For 12 mo, QPM and CM groups
received sufficient maize for all
i d ffi i t i f ll
children in the school to
consume 35 g/school d and
during vacation, 35 g/family
member/d.
The SEED group received 3 kg
of QPM seed to produce ~600
kg of maize. Distribution of
maize for consumption began in
September 2009. Insufficient
water due to a prolonged dry
season i 2009 resulted in crop
in l di
failure for 3 of the 4 SEED
schools. Photo: Neil Palmer

15. Measurements
Enumerators, blind to the
schools
schools’ intervention group,
group
measured children’s weight to
the nearest 0.1 kg and height
to the nearest 0.1 cm at
baseline and endline.
Z scores were calculated using
WHO AnthroPlus v1.0.1.
At baseline, children’s parents
were surveyed about
sociodemographics, food
security, diet and other
characteristics.

16. Measurements
Milled maize, as provided
to the schools and
families, was periodically
analyzed for tryptophan,
which is highly correlated
with lysine concentration
[4].
At h h l h
A the schools, the
amount of maize-
containing foods served to
and consumed b children
d d by h ld
was measured near
baseline and endline.
[4] Vivek BS, Krivanek AF, Palacios-Rojas N, Twumasi-Afriyie S, Diallo AO. Breeding Quality Protein Maize
(QPM): Protocols for developing QPM cultivars. Mexico: CIMMYT, 2008.

17. Results
Photos: Neil Palmer

18. Baseline Characteristics
At baseline, there were differences among the
intervention groups i child gender, age, i di
i i in hild d indigenous or
not, school grade and height (P<0.05).
The groups were similar with respect to child weight
weight,
having consumed animal-source foods in the past 7 d,
appetite in the past mo, household socioeconomic strata,
the relationship between number who work and number
who live in the household, number of household assets,
household food security, and the time needed to travel to
the closest health unit (P>0.05).
At baseline, 33.7% of the children were stunted (height-
for-age Z <-2).

19. Impact on Children’s Weight & Height
Children gained 2-3 kg and ~6 cm during the study,
regardless of the intervention group.
Using an intention-to-treat analysis, these results did not
change after adjusting for the cluster design and covariates
covariates.
Weight (kg) Height (cm)
Intervention
Group (n) Baseline Endline Difference* Baseline Endline Difference*
SEED (n=119)
CM (n=75)
QPM (n=80)
* Different letters in the difference column signal statistically significant differences (P<0.05)

20. Discussion
Contrary to
expectations,
expectations the
three intervention
groups had similar
weight and h i ht
i ht d height
gains.
Several questions
q
were explored to
identify the reason(s)
for these findings.
g
Photo: Neil Palmer

21. Did the children have the potential to
respond to the intervention?
d t th i t ti ?
Yes, 33.7% had low height-for-age at baseline and children grew 2-
3 kg and 6 cm during this period
period.
Photo: Neil Palmer

22. Was the intervention delivered daily to
the hild ?
th children?
No, schools provided maize 21-89% of the academic year.
Intervention School Days school in Days maize served,
Group session
session*, n (%) n (%)
1
QPM 2
3
1
2†
CM 3
4†
5
* Schools closed due to teacher strikes, inclement weather or cultural events.
† Estimates provided by food preparers in schools as notebooks with this information were lost or stolen.

23. Was the intervention delivered differentially
based on intervention group?
b d i t ti ?
Yes, CM schools served maize on average 13.5 d more than QPM
schools.
schools
Intervention School Days school in Days maize served, n (%)
Group session
session*, n (%)
1
QPM 2
3
1
2†
CM 3
4†
5
* Schools closed due to teacher strikes, inclement weather or cultural events.
† Estimates provided by food preparers in schools as notebooks with this information were lost or stolen.

24. Did children consume 35 g/d of maize
at school?
t h l?
No, they consumed between 16-110 g/d.
Intervention School Recipe Children, n Maize consumed
group (g), mean (SD)
1 Mazamorra
QPM 2 Mazamorra
3 Mazamorra
1 Mazamorra
1 Masitas
CM 2 Mazamorra
3 p
Maize soup
4 Maize soup
1 Mazamorra
2 Mazamorra
SEED
3 Mazamorra
4 Mazamorra

25. Was the quantity of maize consumed
different based on intervention group?
diff tb d i t ti g ?
Yes, CM schools served ~3 times more maize than QPM schools.
Intervention School Recipe Children, n Maize consumed (g), mean (SD)
group
1 Mazamorra
QPM 2 Mazamorra
3 Mazamorra
1 Mazamorra
1 Masitas
CM 2 Mazamorra
3 p
Maize soup
4 Maize soup
1 Mazamorra
2 Mazamorra
SEED
3 Mazamorra
4 Mazamorra

26. Was there more tryptophan in the QPM
than
th CM?
Yes, 28% more.
Tryptophan Levels: Mean + SD
Milled QPM Milled CM

27. Was this difference observed in previous studies
that obtained nutritional impact of QPM?
No, >42% differences in tryptophan concentration between CM and
QPM were observed in other studies [5 8]
[5-8].
Photo: Neil Palmer
[5] Graham GG, Lembcke J, Lancho E Morales E Quality protein maize: Digestibility and utilization by
GG J E, E.
recovering malnourished infants. Pediatrics, 83:416-421, 1989.
[6] Akuamoa-Boateng A. Quality protein maize infant feeding trials in Ghana. Ghana: Ghana Health Service,
2002.
[7] Ortega Alemán EdC, Coulson Romero AJ, Ordóñez Argueta LI, Pachón H. Efectos de la ingesta de maíz
de alta calidad de proteína (QPM) versus maíz convencional en el crecimiento y la morbilidad de niños
nicaragüenses d
i ü desnutridos d 1 a 5 años d edad. A h L ti
t id de ñ de d d Arch Latinoamer N t 58(4) 377 385 2008.
Nutr, 58(4):377-385, 2008
[8] Morales Guerra M. Efecto del consumo de maíz de alta calidad proteínica en niño(a)s de familias
indígenas de las regiones Mazateca y Mixe del estado de Oaxaca: Una estrategia agronómica de desarrollo
entre campesinos que practican agricultura de subsistencia. PhD Thesis. Mexico: Institución de Enseñanza e
Investigación en Ciencias Agrícolas, 2002.

28. Conclusion
Under real-life conditions, QPM
did not improve school children’s
nutritional status. This could be due
to the intervention not being
delivered as planned in a school-
feeding program, with respect to
the amino acid concentration in the
milled maize, the number of days it
was served to children, and the
children
quantity offered.
Photo: Neil Palmer

29. Acknowledgements
Edgar Burbano, Marlene
Rosero, Jacinto Azcárate
Data-collection teams
CIAT’s N
CIAT’ Nutrition Q l
Quality
Laboratory
Participating schools
schools,
principals, parents and children
Municipal and departmental
p p
government agencies
Funding provided by the
AgroSalud Project (CIDA
7034161) Photo: Neil Palmer

30. Video
http://www.youtube.com/watch?v=w5oyFBqobpM; Neil Palmer