Animal Source Foods Promote Cognitive Function, School Performance, Increased Muscle Growth and Activity in Kenyan School Children: from Observational to Evidence-based Findings. Presented by Charlotte Neumann (UCLA) at the GL-CRSP End of Program Conference on June 17, 2009, Naivasha, Kenya.

1. Animal Source Foods Promote Cognitive
Function, School Performance, Increased
Muscle Growth and Activity in Kenyan
Children: From Observational to Evidence-
Based Findings
Charlotte Neumann, UCLA
Nimrod Bwibo, University of Nairobi
Constance Gewa, George Mason University

2. Evolution of research on malnutrition
and growth and development
• 1970s: protein deficiency
• 1980s-90s: energy deficiency (mild to moderate)
most prevalent nutritional challenge
• 1990s onward: poor diet quality with multiple
micronutrient deficiencies
• 2000s onward: food-based approaches to energy,
protein and micronutrient
deficiencies

3. Nutritional Benefits of Animal Source
Foods (ASF)1
• Macronutrients
– Relatively high fat content increases energy
density
– High quality complete and readily digestible
protein containing all essential amino acids
– Presence of heme protein enhances iron and
zinc absorption and when mixed with plant foods
– High concentrations of very long chain (vic)
omega 3 and other fatty acids
• Particularly in fish
• Substantial amounts in red meat (beef, pork, lamb,
goat, etc.)
1
meat (of a wide variety), fish, fowl, milk, eggs

4. Nutritional Benefits of Animal Source
Foods (ASF)1
• Micronutrients (intrinsically high in
meat)
– Zinc and Iron present in bioavailable forms
– Vitamin B12 present almost exclusively in
meat and milk
– Riboflavin
– Lysine
– Calcium, particularly in milk and fish
– Preformed Vitamin A in milk, eggs, and fish
1
meat (of a wide variety), fish, fowl, milk, eggs

5. Importance of ASF in Developing
Countries
• Infants and young children
– PEM and multiple micronutrient deficiencies
coexist in a high % of children
– Infants weaned onto bulky, dilute, plant-based
dishes with low protein, lysine, and multiple
micronutrient content
• Nonhuman milk consumed in small quantities
• Anemia prevalent due to iron plus other nutritional
deficiencies, parasites, and infection

6. Importance of ASF in Developing
Countries
• Multiple functional impacts
– Maternal malnutrition with fetal growth restriction and
LWB
– Growth retardation with stunting and reduced lean body
mass
– Impaired resistance to infection with acquired
immunodeficiency
– Cognitive development, physical activity, and
behaviors negatively affected
– Anemia with reduced work capacity and physical activity
– Calcium deficiency
• Rickets in children limiting physical activity
• Osteomalacia in women = pelvic deformity
The addition of meat and animal products can improve/prevent
adverse outcomes.

7. Nutrition Collaborative Research Support
Program (CRSP)
• Nutrition CRSP awarded to UC Berkeley by USAID
– Three country projects selected for parallel longitudinal
observational studies on mild-moderate energy malnutrition
and human function
• UCLA and U of Nairobi - rural Kenya
• Purdue U, U of Arizona, Nutrition Institute (Cairo), U of
Kansas - semi-rural Egypt
• U of Connecticut, U of Florida, Instituto Nacional de la
Nutricion (Mexico) - rural Mexico
• Forerunner to GLCRSP studies – 1984-1993
– Does mild/moderate energy malnutrition negatively affect
mother-child interactions and care giving, and the child’s
cognitive function, behavior, and physical activity?

8. Methods
• Longitudinal observational study of infants, toddlers,
schoolers, and biologic parents for one year
• Data obtained:
– Weekly measures
• Morbidity
– Monthly measures
• Quantitative food intake
• Anthropometry, including head circumference and MUAC
– Every 3-6 months measures
• Cognitive testing
• Physical activity measures
– Annual measures
• SES census
• Tested literacy of parents

9. Some key findings
• Mother-child interactions and child care taking were negatively
affected by low maternal energy intake and anemia
• Shorter and lighter infants and those with poor weight gain were
significantly less sociable, carried more by their mothers, and
had lower motor scores at 6 months than taller and heavier
infants
• Energy intake and meat intake in toddlers (18-30 months) were
positively associated with their Bayley’s test scores and also
predicted their cognitive performance at age 5 years
• Greater physical activity during free play was positively related to
energy meat intake over time in school-aged children
• Better nourished children during free-play were happier and
showed more leadership behavior than less well-nourished
children
• Greater on task behaviors in classroom in the meat group
• The other projects found similar but less striking findings

10. Study 2 – 1998-present
• Findings from observational studies called for a randomized
controlled intervention study to test the causative role of
dietary meat on:
– cognitive function - physical growth - behavior
– school performance - physical activity - morbidity
• Funding, USAID-Global Livestock CRSP (GLCRSP) – M.W.
Demment, PhD, Director (UC Davis)
– Planning Grant 1997-1998
– A randomized controlled feeding intervention (1998-2003) study
collaborators, UCLA, U of Nairobi, and UC Davis
• PIs: Charlotte Neumann and Nimrod Bwibo
• Co-PIs: Suzanne Murphy and Marian Sigman
• Co-investigators: Lindsay Allen and Shannon Whaley
• The study was carried out in the same area (Embu District)
as the earlier observational study with many of the same staff

11. Main Hypotheses
Children supplemented with animal foods will:
– Perform better on measures of cognitive function
– Improve school performance (test scores)
– Show improved growth in all dimensions
– Decreased morbidity
– Be more physically active
– Exhibit positive behavior during free-play (leadership,
initiative, etc.)
than those children
Receiving plant-based supplements and the Control
group

12. Methods
• Randomized, controlled feeding intervention study
of 1st and 2nd grade children to one of four isocaloric
feedings:
– Meat added to githeri*
– Milk with githeri
– Githeri with added oil
– Control; no school feeding
• Two cohorts from the same schools and the same
grades were enrolled exactly one year apart and
each followed for 2 years
– N ~ 500 in cohort 1
– N ~ 375 in cohort 2
*githeri: traditional dish of maize, beans, greens

13. Methods
• Testing of functional outcome measures:
– Cognitive - Raven’s Progressive Matrices, WISC-R,
Verbal Meaning Test, Digit Span
– Observational Methods for activity and behavior
• Timed observations for 30 minutes/session during free play
• Strictly defined activity levels and behaviors
• Quality control on 15% subsample (high % agreement)
– End term test scores on zone wide examinations
– Morbidity – recall and direct observation
– Growth – anthropometrics (weight, height, MUAC, derived
arm muscle area)
– Biochemical micronutrient status and Hemoglobin
• Independent variables – food intake & malaria status

14. Selected key findings - Cognitive
• Raven’s Progressive Matrices: Steepest rate of
increase on Raven’s test score in Meat group
(statistically significant)
• Arithmetic skills: the Meat group and the
Githeri group performed significantly better
than Milk and Control groups
• No significant differences were seen in verbal
or digit span

15. Raven’s Scores
21
20
Raven’s
Control
Scores
Calorie
19
Milk
Meat
18
17
-0.5 0 0.5 1 1.5 2
Relative years in study

16. School end term test scores
• Meat and Milk groups showed the greatest
increase compared to all other groups in:
– Individual Subject Test Scores (p <0.05)
– Combined Test Scores (p <0.05)
• Scores were controlled for baseline scores,
school, attendance, cognitive scores, gender,
age, SES, height, maternal literacy, home
food intake

17. Change in Total Test Scores by
Group (over 5 school terms)
*
*
*
*Statistically significant, p < 0.05
Adjusted for age, gender, maternal literacy*, height, home food intake, SES, attendance*

18. Change in Subject Test Scores by
Group
* *
* *
* * * **
**
* *
* **
*
*
*Statistically significant, p < 0.05
Adjusted for age, gender, maternal literacy*, height, home food intake, SES, attendance*

19. Change in Subject Test Scores by
Group
(over 5 school terms)
Total
Math English Kiembu Kiswahili Geog. Science Arts Test
Meat *9.37 *5.68 *7.72 3.36 *6.08 -1.47 *9.26 *45.71
Milk *5.74 -1.03 2.97 *5.13 *6.17 -0.66 *6.96 *26.35
Energy 2.26 *-7.58 0.82 *-5.48 -1.53 *-6.66 *4.16 -6.07
Control 3.14 *-9.66 -0.81 *-6.21 *-3.87 *-6.56 *3.31 *-18.67
*Statistically significant, p < 0.05
Adjusted for age, gender, maternal literacy*, height, home food intake, SES, attendance*.

20. Physical Growth
• Arm muscle area (lean body mass)
– The Meat group showed the steepest and highly
significant gain compared to all other groups
• Weight
– Child who received meat, milk as energy gained
significantly more weight than those in the Control
group
• Height
– No significant differences were seen
– In stunted children and in 6-7 year olds, Milk group
showed better linear growth

21. ARM MUSCLE AREA (cm2)
githeri plus oil

22. Physical Activity and Behavior
• Greatest increase in high levels of activity and
on going activity in Meat group
• Greatest decrease in low levels of physical
activity in Meat group
• The Meat group compared to all other groups
showed:
• Greatest increase in initiative
• Greatest increase in leadership
• Greatest increase in peer involvement
• Greatest increase in positive affect

24. Playground % Initiates

26. Morbidity
• Control group had the highest illness frequency
occurrences and the least decline over time
• Meat group had the significantly greatest declines in
diarrhea and typhoid occurrences
• Milk group had the significantly greatest decline in
upper respiratory infections
• For malaria and total illnesses, the significantly
greatest declines were seen in the Plain Githeri and
the Meat groups
– The vitamin A fortified oil used in the Plain Githeri
may have reduced morbidity occurrences

27. Summary
• This first RCT with meat supplementation
shows:
– Increased cognitive and school performance
– Increased high levels of physical activity
– Increased initiative and leadership behaviors
– Increased mid-upper arm muscle area (lean body
mass)
– Decreased morbidity
• All supplemented groups improved overall
weight gain compared to the Control group

28. Implications
• For optimal learning and school performance children
need diets of adequate quantity and quality
• Improved nutrition quality (through inclusion of
Animal Source Foods) is an investment in human
capital, leadership initiative, and economic
development
• Nutrition is critical for a productive work force
• Findings are also relevant to developed countries
where restrictive vegetarian diets are used, especially
for children
• A sizeable challenge is how to put affordable meat in
the table for the family

29. Acknowledgment
• Financial support for this project comes
primarily from USAID Grant No. PCE-
G-00-98-00036-00 through the Global
Livestock Collaborative Support Program.
The opinions expressed herein are those
of the authors and do not necessarily
reflect the views of the U.S. Agency for
International Development.