Will supplementing Choline into RUTF diet at an early age improve neurocognitive progress in malnourished Malawian children?
In Malawi, a current study is being overseen by Project Coordinator, Christa Lolley, to determine if the addition of choline, supplemented with DHA, to the diets of malnourished children will improve neurocognition. Choline and DHA are two essential micronutrients for neurocognitive development in young children, and become even more crucial in children experiencing SAM (severe acute malnutrition) or MAM (moderate acute malnutrition). Enrollment began in December of 2023, with an aim to recruit about 3,000 participants in total for the study.
Determining malnourishment severity
The level of severity can be measured several different ways in a malnourished child. The first determining factor is the MUAC (middle upper arm circumference); if under 11.5 cm, the child has SAM, and if it is between 11.5 and 12.5 cm, the child has MAM. The second is the WLZ (weight for length z-score), where the higher the number, the more severely malnourished the child is. The third and final factor is edema, or more specifically, kwashiorkor, where a protein deficiency can cause emaciation all over the body. Any child with kwashiorkor is automatically diagnosed with SAM, which not only has a negative impact on the body, but on neurocognition as well, where children faced with acute malnutrition experience extreme delays in cognitive development. The most crucial time for healthy development is during childhood, characterizing this study as significant for further understanding the impact of malnourishment on the body.
Treatment process
The treatment is given for twelve weeks, and if the child shows progress or is no longer considered SAM/MAM by MUAC, WLZ or edema standards, they progress to their first MDAT (Malawi Development Assessment Tool) after graduation, where each child is evaluated on the basis of four domains. They are tested for gross motor and fine motor skills, language, and finally, sociability. Six months following the program they are tested again to ensure the nutrients continue to have a positive effect on their cognitive development.
The goal
“The goal is to see if they were able to catch up to their healthy peers neurocognitively,” says Christa Lolley. The primary objectives of this study were to determine if choline supplemented into the RUTF diets would improve cognitive development in SAM/MAM Malawian children, and furthermore investigate the effects of choline on cognitive and subdomain development within four weeks of receiving treatment. The whole purpose of the program is to ensure proper neurocognitive advancement, reduce childhood mortality, and give these children the best chance at a healthy life.
