Consumption of Iron-Biofortified Beans Positively Affects Cognitive - PowerPoint PPT Presentation

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 BENEFIT STUDY ANALYSIS BY: JESSICA M. PAGE

• AUTHORS • BACKGROUND • PURPOSE & HYPOTHESIS DISCUSSION • RESEARCH METHODS OUTLINE • RESULTS • LIMITATIONS • IMPLICATIONS • REFERENCES

AUTHORS CREDENTIALS

PH.D . , THE PENNSYLVANIA STATE UNIVERSITY, ‘03. MS, THE PENNSYLVANIA STATE UNIVERSITY, ‘98. MURRAY-KOLB PH.D ., EXPERIMENTAL PSYCHOLOGY, STATE WENGER UNIVERSITY OF NEW YORK AT BINGHAMTON, ‘94. PH.D. , DOCTOR OF PHILOSOPHY, FOOD SCIENCE LUNG'AHO AND INTERNATIONAL NUTRITION, CORNELL. HAAS PH.D. , BIOLOGICAL ANTHROPOLOGY , PENNSYLVANIA STATE UNIVERSITY. SCOTT* PH.D. IN PROGRESS , DOCTOR OF LAW , PENN LAW ‘18. MS, ENV STUDIES, UNIVERSITY OF PENNSYLVANIA, ‘15. RHOTEN* MS, PH.D. CANDIDATE , UNIVERSITY OF OKLAHOMA. (SENIOR OUTCOMES RESEARCHER AT ICON)

IRON DEFICIENCY ANEMIA & BIOFORTIFICATION BACKGROUND

IRON OXYGEN TRANSPORT ❖ 2/3: Hemoglobin of RBCs ❖ WRA 18 mg/d ❖ ¼: Stores of Ferritin + Hemosiderin 10% ABS: 1.8 mg/d Absorbed ❖ ❖ Not All Sources Equal ❖ Remaining: Myoglobin & Enzymes (RedOx) Meat vs. Plants: 50% vs. 10% ❖

IRON DEFICIENCY ANEMIA PREVALENCE ❖ #1 Most Common Nutrient Deficiency ❖ IDA 34% of Population, 2 Billion People ❖ High in Rwanda ❖ Highest in WRA and Pregnant

IRON DEFICIENCY ANEMIA CAUSES CAUSES : ❖ Low Iron I ntake ❖ Meat, Beans, Greens, Nuts ❖ Poor Absorption ❖ Heme vs. Non-heme Iron ❖ Increased Requirements ❖ Chronic Blood Loss

❖ IRON STORES ARE USED UP IRON ❖ SUPPLY OF IRON TO DEFICIENCY THE TISSUES IS DECREASED ANEMIA ❖ DECREASED ABILITY OF DEFINITION CELLS TO GET ENERGY ❖ HGB <120 G/L

IRON DEFICIENCY ANEMIA EFFECTS ❖ Reduced Physical Work ❖ Fatigue & Dizziness Capacity ❖ Palpitations ❖ Reduced Cognition ❖ Brittle Nails/Koilonychia ❖ Learning ❖ Pallor ❖ Memory ❖ Increased Maternal Mortality ❖ Attention

IRON DEFICIENCY ANEMIA TREATMENTS ❖ Diet Change ❖ Iron Biofortified Crops ❖ Fortified Foods ❖ Supplementation ❖ IV Iron Therapy ❖ Blood Transfusions

BIOFORTIFICATION HARVESTPLUS ❖ Identify High Micronutrient ❖ 290 Varieties of 12 Crops Crops ❖ Iron , Zinc, Vitamin A ❖ Conventional Breeding ❖ Beans , Sweet Potato, ❖ Variety Blending Rice, Wheat, Corn, Pearl ❖ Increased Target Nutrients Millet ❖ High Yield ❖ Climate & Pest Guards

PURPOSE & HYPOTHESIS

STUDY PURPOSE & HYPOTHESIS ❖ PURPOSE: ❖ HYPOTHESIS: "...to determine the efficacy of "... iron repletion by way of a iron-biofortified beans in biofortified staple food ( beans ) improving cognition in WRA would produce improvements in cognitive performance in compared with control beans." WRA."

RESEARCH METHODS

RESEARCH METHODS DESIGN DESIGN LOCATION SAMPLING ❖ Randomized ❖ University of ❖ Parent Study Rwanda Controlled Efficacy ❖ Recruitment: "Healthy" Trial ❖ Huye Campus & Iron Depleted (SF<20 μg /L) ❖ Double Blinding ❖ Butare, Rwanda ❖ 2-Tailed 5% Type I Error ❖ 18-Week Intervention: rate & 90% Power January 7-May 23, ❖ = 60 subjects/group 2013

RESEARCH METHODS SCREENING INCLUSIONS EXCLUSONS ❖ Major ❖ Males ❖ Females Medical Conditions ❖ Age <18 & >27 ❖ Attending UR ❖ Iron Supplements ❖ BMI <16 ❖ Serum Ferritin <20 μg /L ❖ Interfering ❖ Hgb <90 g/L Medications ❖ SF >20 μg /L ❖ Pregnant/Lactating STARTING SAMPLE: n=239 120 Biofortified + 119 Control

S A M P L E ANALYSIS SAMPLE: n=150 72 Biofortified + 78 Control

RESEARCH METHODS INTERVENTION 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

RESEARCH METHODS INTERVENTION MEALS ❖ 2x / Day ❖ Ad Libitum ❖ Buffet-Style Campus ❖ Weighed Pre & Post Dining ❖ Breakfast/Snack 24-Hour ❖ 2-Week Rotating Recalls Menu ❖ 3-Day Nutrient Intakes ❖ Served 175g Beans by Plate Color

RESEARCH METHODS INTERVENTION MEAL CONTENTS ❖ STARCHES ❖ VEGETABLES ❖ NO MEAT ❖ White Potatoes ❖ Cabbage ❖ Sweet Potatoes ❖ Cassava Greens ❖ DRINK ❖ Rice ❖ Pasta ❖ Water Only ❖ Cassava ❖ SUNDAYS ❖ Maize Porridge ❖ Ice Cream ❖ Plantains ❖ Fruit

RESEARCH METHODS BLOOD TESTS BASELINE & ENDLINE with Random Serial Sampling ❖ Whole Blood Samples & CBC ❖ Total Body Iron (BI) ❖ Hct ❖ Ratio TfR : SF ❖ MCV ❖ MCHC ❖ C-Reactive Protein(CRP) ❖ RDW ❖ α -1-acid Glycoprotein(AGP) ❖ Serum Ferritin (SF)

RESEARCH METHODS BLOOD TESTS DEFINITIONS Anemia: ❖ Hgb <120 g/L Iron Deficiency : ❖ SF <15 μg /L, TfR >8.3 mg/L or ❖ BI <0 mg/kg

RESEARCH METHODS COGNITIVE TESTS ❖ Computer-Based Tests ❖ Tasks: ❖ 60-90 minutes ❖ Taps Iron-Dependent Cortical Systems ❖ Baseline ❖ Used On Humans in ❖ 3 Weeks In Research ❖ Endline ❖ External Validity Check ❖ 3 Weeks Before Trial End

❖ SRT: Speed of simplest reaction time. T E ❖ GNG: Assesses inhibitory control and sustained attention. Press button with proper stimulus. S ❖ ANT: Tests alerting, orienting, and executive control. T ❖ SMS: Tests short-term memory; 1, 3, or 6 symbols and recalling those previously seen. S ❖ CRT: Short-term visual memory, shown common objects. Speed, accuracy, and efficiency of recognition.

RESEARCH RESULTS

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

ANOVA ❖ 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

RESULTS ATTRITION ANALYSIS EXCLUSION ❖ 160: Intervention ❖ 6.25% Attrition & Cognitive Tests ______________ ❖ 150: Complete ❖ 6.49% Biofortified Data & 6.02% Control ❖ 10 Excluded

RESULTS SUMMARY SELECTIVE MEMORY MEMORY ATTENTION SPEED SEARCH RETRIEVAL ❖ 17% Larger ❖ 7-Fold: ❖ 2-Fold: Speed Improvement in Memory Speed ❖ 3-Fold: Memory Speed ❖ 68% Greater Search Efficiency Improvement ❖ Memory Efficacy P < 0.01 ❖ 2-Fold: Specificity

RESEARCH LIMITATIONS

LIMITATIONS HOMOGENOUS SAMPLE NORMAL BEAN INTAKE ❖ All WRA ❖ May Consume More in Trial ❖ All Medical Students ❖ Not Representative ❖ Not General of Population's Population Average Intake ❖ Generalizability Limited

CLINICAL & PUBLIC IMPLICATIONS

IMPLICATIONS CLINICAL PUBLIC ❖ Hospital Diets for ID ❖ Developing Countries Anemia ❖ Cost Effective ❖ Biofortified Beans ❖ Nutritionally Dense ❖ Vitamin C ❖ Malnutrition ❖ Prescribing Biofortified ❖ Nutrient Deficiencies Beans for ❖ HarvestPlus: Reach 1 Billion IDA Improvements People, 2030

THANK YOU.

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 Trial. JNutr . 2016;146(8):1586-1592. doi:10.3945/jn.115.224741. ❖ Iron. Nutrient Reference Values. https://www.nrv.gov.au/nutrients/iron. Published September 4, 2014. Accessed November 10, 2018. ❖ 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 Organization. http://www.who.int/nutrition/publications/micronutrients/guidelines_for_Iron_supp lementation.pdf?ua=1&ua=1. Published 1998. Accessed October 24, 2018.