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NFS 430 Consumption of Iron-Biofortified Beans Positively Affects Cognitive Performance in 18- to 27-Year- Old Rwandan Female College Students in an 18-Week Randomized Controlled Efficacy Trial SHORT TITLE: IRON BIOFORTIFICATION FOR COGNITIVE
Consumption of Iron-Biofortified Beans Positively Affects Cognitive Performance in 18- to 27-Year- Old Rwandan Female College Students in an 18-Week Randomized Controlled Efficacy Trial
SHORT TITLE: IRON BIOFORTIFICATION FOR COGNITIVE BENEFIT
STUDY ANALYSIS BY: JESSICA M. PAGE NFS 430
HYPOTHESIS
MURRAY-KOLB WENGER LUNG'AHO HAAS SCOTT* RHOTEN*
PH.D., THE PENNSYLVANIA STATE UNIVERSITY, ‘03. MS, THE PENNSYLVANIA STATE UNIVERSITY, ‘98. PH.D., EXPERIMENTAL PSYCHOLOGY, STATE UNIVERSITY OF NEW YORK AT BINGHAMTON, ‘94. PH.D., DOCTOR OF PHILOSOPHY, FOOD SCIENCE AND INTERNATIONAL NUTRITION, CORNELL. PH.D., BIOLOGICAL ANTHROPOLOGY, PENNSYLVANIA STATE UNIVERSITY. PH.D. IN PROGRESS, DOCTOR OF LAW, PENN LAW ‘18. MS, ENV STUDIES, UNIVERSITY OF PENNSYLVANIA, ‘15. MS, PH.D. CANDIDATE, UNIVERSITY OF OKLAHOMA. (SENIOR OUTCOMES RESEARCHER AT ICON)
❖ WRA 18 mg/d
❖
10% ABS: 1.8 mg/d Absorbed
❖ Not All Sources Equal
❖
Meat vs. Plants: 50% vs. 10%
❖ 2/3: Hemoglobin of RBCs ❖ ¼: Stores of Ferritin + Hemosiderin ❖ Remaining: Myoglobin &
Enzymes (RedOx)
❖#1 Most Common Nutrient
Deficiency
❖IDA 34% of Population, 2 Billion
People
❖High in Rwanda
❖Highest in WRA and Pregnant
CAUSES:
❖ Low Iron Intake
❖ Meat, Beans, Greens, Nuts
❖ Poor Absorption
❖ Heme vs. Non-heme Iron
❖ Increased Requirements ❖ Chronic Blood Loss
❖ IRON STORES ARE USED
UP
❖ SUPPLY OF IRON TO
THE TISSUES IS DECREASED
❖ DECREASED ABILITY OF
CELLS TO GET ENERGY
❖ HGB <120 G/L
❖ Reduced Physical Work
Capacity
❖ Reduced Cognition
❖Learning ❖Memory ❖Attention
❖ Fatigue & Dizziness ❖ Palpitations ❖ Brittle Nails/Koilonychia ❖ Pallor ❖ Increased Maternal Mortality
❖Diet Change
❖ Fortified Foods
❖Supplementation ❖IV Iron Therapy ❖Blood Transfusions ❖ Iron Biofortified Crops
❖Identify High Micronutrient
Crops
❖Conventional Breeding ❖Variety Blending
❖ Increased Target Nutrients ❖ High Yield ❖ Climate & Pest Guards
❖290 Varieties of 12 Crops ❖Iron, Zinc, Vitamin A ❖Beans, Sweet Potato,
Rice, Wheat, Corn, Pearl Millet
❖ PURPOSE:
"...to determine the efficacy of iron-biofortified beans in improving cognition in WRA compared with control beans."
❖ HYPOTHESIS:
"...iron repletion by way of a biofortified staple food (beans) would produce improvements in cognitive performance in WRA."
DESIGN
❖ Randomized
Controlled Efficacy Trial
❖ Double Blinding ❖ 18-Week
Intervention: January 7-May 23, 2013
LOCATION SAMPLING
❖ University of
Rwanda
❖ Huye Campus ❖ Butare, Rwanda ❖ Parent Study ❖ Recruitment: "Healthy"
& Iron Depleted (SF<20 μg/L)
❖ 2-Tailed 5% Type I Error
rate & 90% Power
❖ = 60 subjects/group
INCLUSIONS
❖ Females ❖ Attending UR ❖ Serum Ferritin <20 μg/L
EXCLUSONS
❖ Males ❖ Age <18 & >27 ❖ BMI <16 ❖ Hgb <90 g/L ❖ SF >20 μg/L ❖ Major
Medical Conditions
❖ Iron Supplements ❖ Interfering
Medications
❖ Pregnant/Lactating
STARTING SAMPLE: n=239 120 Biofortified + 119 Control
ANALYSIS SAMPLE: n=150 72 Biofortified + 78 Control
GROUPS
❖ Randomly Assigned ❖ 1 of 4 Color Groups ❖ 2 Intervention, 2
Control
❖ Intervention: 86.1
mg/kg Iron Beans
❖ Control: 50.1
mg/kg Iron Beans
MEALS
❖ 2x / Day ❖ Buffet-Style Campus
Dining
❖ 2-Week Rotating
Menu
❖ Served 175g Beans by
Plate Color
❖ Ad Libitum ❖ Weighed Pre & Post ❖ Breakfast/Snack 24-Hour
Recalls
❖ 3-Day Nutrient Intakes
MEAL CONTENTS
❖ STARCHES
❖ White Potatoes ❖ Sweet Potatoes ❖ Rice ❖ Pasta ❖ Cassava ❖ Maize Porridge ❖ Plantains
❖ VEGETABLES
❖ Cabbage ❖ Cassava Greens
❖ DRINK
❖ Water Only
❖ SUNDAYS
❖ Ice Cream ❖ Fruit
❖ NO MEAT
BASELINE & ENDLINE with Random Serial Sampling
❖ Whole Blood Samples &
CBC
❖ Hct ❖ MCV ❖ MCHC ❖ RDW ❖ Serum Ferritin (SF) ❖ Total Body Iron (BI) ❖ Ratio TfR : SF ❖ C-Reactive Protein(CRP) ❖ α-1-acid Glycoprotein(AGP)
DEFINITIONS Anemia:
❖ Hgb <120 g/L
Iron Deficiency:
❖SF <15 μg/L, TfR >8.3 mg/L
❖BI <0 mg/kg
❖ Computer-Based Tests
❖60-90 minutes
❖ Baseline
❖ 3 Weeks In
❖ Endline
❖ 3 Weeks Before Trial End
❖Tasks:
❖Taps Iron-Dependent
Cortical Systems
❖Used On Humans in
Research
❖External Validity Check
❖ SRT: Speed of simplest reaction time. ❖ GNG: Assesses inhibitory control and sustained
❖ ANT: Tests alerting, orienting, and executive
control.
❖ SMS: Tests short-term memory; 1, 3, or 6 symbols
and recalling those previously seen.
❖ CRT: Short-term visual memory, shown common
STATISTICS BLOOD
Chi-Square: Group
Differences at Baseline
44% ID Anemia 92% Iron Deficient ❖ No differences between: ❖ Groups ❖ Sub-sample & Larger
Sample
STATISTICS BLOOD
Group Comparison:
Raw Means
Hemoglobin
Sig Increase Biofortified
❖ Serum Ferritin
❖ Sig Increase in Both,
Higher in Biofortified
Body Iron
Sig Increase Biofortified
❖ Confirmed Effect: ❖ Hgb ❖ Ferritin ❖ Body Iron ❖ None for: ❖ Transferrin
Receptor
STATISTICS TESTS
❖ SRT, GNG, ANT Accuracy
VERY High (98-99%)
❖ Non-Sig Effects for SRT &
GNG
❖ 1 ANT (RT, orienting)
Variable with Group Effect
STATISTICS TESTS
❖ CRT: Biofortified Sig
Improvement
❖ Faster Reactions &
Remembered Old Images Better
❖ PCC: More Adaptable
❖ SMS: Biofortified Sig
Improvement
❖ Decreased Slope &
Intercept
❖ =Memory Speed &
Efficiency Improved
STATISTICS Z-SCORES
❖ Per Protocol Analysis
❖ Significant Results Only ❖ Z-Scores Shows Grand
Mean Change
ANALYSIS EXCLUSION
❖ 160: Intervention
& Cognitive Tests
❖ 150: Complete
Data
❖ 10 Excluded ❖ 6.25% Attrition
______________
❖ 6.49% Biofortified
& 6.02% Control
❖ 17% Larger
Improvement in Speed
MEMORY RETRIEVAL
❖ 7-Fold:
Memory Speed
❖ 68% Greater
Improvement
❖ Memory Efficacy
❖ 2-Fold: Specificity ❖ 2-Fold: Speed ❖ 3-Fold: Memory
Search Efficiency
SELECTIVE ATTENTION SPEED MEMORY SEARCH P < 0.01
NORMAL BEAN INTAKE
❖ May Consume
More in Trial
❖ Not Representative
Average Intake
HOMOGENOUS SAMPLE
❖All WRA ❖All Medical Students
❖Not General
Population
❖ Generalizability
Limited
CLINICAL
❖ Hospital Diets for ID
Anemia
❖ Biofortified Beans ❖ Vitamin C
❖ Prescribing Biofortified
Beans for IDA Improvements
PUBLIC
❖ Developing Countries
❖ Cost Effective ❖ Nutritionally Dense
❖ Malnutrition ❖ Nutrient Deficiencies ❖ HarvestPlus: Reach 1 Billion
People, 2030
References for Research Paper
❖ Murray-Kolb LE, Wenger MJ, Scott SP, Rhoten
SE, Lung'aho MG, Haas JD. Consumption of Iron-Biofortified Beans Positively Affects Cognitive Performance in 18- to 27- Year-Old Rwandan Female College Students in an 18-Week Randomized Controlled Efficacy Trial. J Nutr. 2017;147(11):2109-2117. Doi:10.3945/jn.117.255356.
References for Information
❖ Crops. Biofortification: The Nutrition Revolution Is Now. https://www.harvestplus.org/what-we-
do/crops. Published November 8, 2018. Accessed November 10, 2018.
❖ Haas JD, Luna SV, Lungaho MG, et al. Consuming Iron Biofortified Beans Increases Iron Status in
Rwandan Women after 128 Days in a Randomized Controlled Feeding
❖ Iron. Nutrient Reference Values. https://www.nrv.gov.au/nutrients/iron. Published September 4,
❖ More S, Shivkumar VB, Gangane N, Shende S. Effects of iron deficiency on cognitive function in
school going adolescent females in rural area of Central India. Anemia. 2013;2013:1-5. doi:10.1155/2013/819136.
❖ Stoltzfus RJ, Dreyfuss ML. Guidelines for the use of iron supplements to prevent and treat iron
deficiency anemia. World Health
lementation.pdf?ua=1&ua=1. Published 1998. Accessed October 24, 2018.
References for Pictures
❖ https://www.walmart.com/ip/Nature-s-Blend-Ferrous-Gluconate-5-gr-Elemental-Iron-324-mg-
100-Tablets/156396557
❖ http://www.haimanotgb.com/pinto-beans/ ❖ https://www.yourgenome.org/facts/what-is-selective-breeding ❖ https://www.harvestplus.org/content/iron ❖ https://www.kisspng.com/png-iron-deficiency-anemia-iron-deficiency-human-iron-
273852/preview.html