Nutrigenomics, PUFA, Iron and Cognition Amongst Under-two-year-old Indonesian Children

NCT ID: NCT01504633

Last Updated: 2014-02-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

240 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-12-31

Study Completion Date

2014-12-31

Brief Summary

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Rationale: Review on the positive effect of long chain polyunsaturated fatty acids (LCPUFA), especially docosahexanoic acid (DHA), supplementation on cognitive function in human using randomized controlled trials (RCTs) showed that results in RCTs were mixed and inconsistent. It has been suggested that the effect may be subtle, which is currently difficult to detect, but could be significant, or there may be individual variation which mediate the effect.

Objectives: This study aims to assess gene-nutrient inter-relation in explaining the effect of LCPUFAs i.e. DHA and/or iron on cognitive functioning of children \<24mo in Indonesia. Specifically the study's objectives are: (1) to assess effect of LCPUFA (as DHA oil) and iron (as iron supplement) in altering gene expressions, and (2) to assess the mediating effect of genes involved in fatty acid and iron metabolism in improving serum LCPUFA, alpha-linolenic acids (ALA), DHA and cognitive function.

Study design and study population: The study is a double-blind randomized controlled trial with children aged less than 24 months (window of opportunity). The study area is in East Lombok district, in West Nusa Tenggara province, Indonesia where nutrient intake including iron and presumably LCPUFA, is not optimal.

Intervention: The study is an intervention study, consisting of four groups: DHA, iron, DHA+iron, and placebo (60 subjects/group = 240 subjects in total). Capsule containing 100mg/d DHA or its placebo and syrup containing 16mg/d iron will be given daily for 24 weeks. Before and after the intervention child cognition (as Bayley Mental Developmental Index or MDI score), serum PUFA level, iron status (haemoglobin, transferrin receptor, ferritin), inflammation status (CRP, AGP), gene expression profiles, and potential confounders of child cognition such as lengt-for-age, weight-for-length, and weight-for-age Z-scores, stimulation/home environment, maternal characteristics will be collected.

Study outcome: The primary study outcomes will be cognitive score (as Bayley Mental Developmental Index or MDI score) and gene expression profiles. Secondary study outcomes will be serum PUFA level, iron status (haemoglobin, TfR, ferritin).

Nature and extent of the burden and risks benefit and group relatedness:

Subjects, who will be included into the study will invest 14 hours. The consumption of iron is not associated with any increased risk of iron overload both for infectious (including malaria) and chronic diseases nor consumption of n-3 fatty acids EPA and DHA exceed the US Food and Drug Administrator (FDA) Generally Recognized as Save (GRAS) limit. Venous blood of 5 mL will be drawn at baseline and endline. During screening, children with severe anaemia (Hb\<70g/L) will be excluded from the study and referred to the local public health center for further treatment.

Detailed Description

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Conditions

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Cognitive Ability, General

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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DHA+EPA Group

DHA/EPA capsule (100mg DHA + 20mg) and placebo syrup per day

Group Type EXPERIMENTAL

DHA/EPA and iron supplementation

Intervention Type DIETARY_SUPPLEMENT

24-week supplementation consisting of daily dosage of DHA/EPA or placebo capsule and iron/placebo syrup Capsule: DHA/EPA (100mg DHA + 20mg per day) or placebo Syrup: Fe syrup (16mg elemental iron per day) or placebo

Fe Group

Placebo capsule and Fe syrup (16mg elemental iron) per day

Group Type EXPERIMENTAL

DHA/EPA and iron supplementation

Intervention Type DIETARY_SUPPLEMENT

24-week supplementation consisting of daily dosage of DHA/EPA or placebo capsule and iron/placebo syrup Capsule: DHA/EPA (100mg DHA + 20mg per day) or placebo Syrup: Fe syrup (16mg elemental iron per day) or placebo

DHA/EPA+Fe Group

DHA/EPA capsule (100mg DHA + 20mg) and Fe syrup (16mg elemental iron) per day

Group Type EXPERIMENTAL

DHA/EPA and iron supplementation

Intervention Type DIETARY_SUPPLEMENT

24-week supplementation consisting of daily dosage of DHA/EPA or placebo capsule and iron/placebo syrup Capsule: DHA/EPA (100mg DHA + 20mg per day) or placebo Syrup: Fe syrup (16mg elemental iron per day) or placebo

Placebo Group

Placebo capsule and placebo syrup

Group Type EXPERIMENTAL

DHA/EPA and iron supplementation

Intervention Type DIETARY_SUPPLEMENT

24-week supplementation consisting of daily dosage of DHA/EPA or placebo capsule and iron/placebo syrup Capsule: DHA/EPA (100mg DHA + 20mg per day) or placebo Syrup: Fe syrup (16mg elemental iron per day) or placebo

Interventions

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DHA/EPA and iron supplementation

24-week supplementation consisting of daily dosage of DHA/EPA or placebo capsule and iron/placebo syrup Capsule: DHA/EPA (100mg DHA + 20mg per day) or placebo Syrup: Fe syrup (16mg elemental iron per day) or placebo

Intervention Type DIETARY_SUPPLEMENT

Eligibility Criteria

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Inclusion Criteria

* Child aged 12 to 17months old
* Both father and mother of Sasak ethnicity
* Currently breastfed

Exclusion Criteria

* Birth weight \<2500 grams (LBW)
* Congenital malformation and/or disorder that interfered with adequate functioning in daily life
* Hemoglobin value below 70 g/L
* Malaria
* Maternal depression
Minimum Eligible Age

12 Months

Maximum Eligible Age

16 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Wageningen University

OTHER

Sponsor Role collaborator

Indonesia University

OTHER

Sponsor Role lead

Responsible Party

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Umi Fahmida

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Umi Fahmida, PhD

Role: PRINCIPAL_INVESTIGATOR

SEAMEO Regional Center for Food and Nutrition (RECFON) University of Indonesia

Locations

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SEAMEO Regional Center for Food and Nutrition (RECFON) University of Indonesia

Jakarta, DKI Jakarta, Indonesia

Site Status

Countries

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Indonesia

References

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Reference Type BACKGROUND
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McCann JC, Ames BN. An overview of evidence for a causal relation between iron deficiency during development and deficits in cognitive or behavioral function. Am J Clin Nutr. 2007 Apr;85(4):931-45. doi: 10.1093/ajcn/85.4.931.

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Murray-Kolb LE, Beard JL. Iron deficiency and child and maternal health. Am J Clin Nutr. 2009 Mar;89(3):946S-950S. doi: 10.3945/ajcn.2008.26692D. Epub 2009 Jan 21.

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Oloyede OB, Folayan AT, Odutuga AA. Effects of low-iron status and deficiency of essential fatty acids on some biochemical constituents of rat brain. Biochem Int. 1992 Aug;27(5):913-22.

Reference Type BACKGROUND
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Smuts CM, Tichelaar HY, van Jaarsveld PJ, Badenhorst CJ, Kruger M, Laubscher R, Mansvelt EP, Benade AJ. The effect of iron fortification on the fatty acid composition of plasma and erythrocyte membranes in primary school children with and without iron deficiency. Prostaglandins Leukot Essent Fatty Acids. 1995 Jan;52(1):59-67. doi: 10.1016/0952-3278(95)90098-5.

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Shinta D; Asmarinah; Adhiyanto C, Htet MK, Fahmida U. The Association of TMPRSS6 Gene Polymorphism and Iron Intake with Iron Status among Under-Two-Year-Old Children in Lombok, Indonesia. Nutrients. 2019 Apr 19;11(4):878. doi: 10.3390/nu11040878.

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Fahmida U, Htet MK, Adhiyanto C, Kolopaking R, Yudisti MA, Maududi A, Suryandari DA, Dillon D, Afman L, Muller M. Genetic variants of FADS gene cluster, plasma LC-PUFA levels and the association with cognitive function of under-two-year-old Sasaknese Indonesian children. Asia Pac J Clin Nutr. 2015;24(2):323-8. doi: 10.6133/apjcn.2015.24.2.17.

Reference Type DERIVED
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Related Links

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http://seameo-recfon.org/

South East Asia Ministers of Education Organization, Regional Center for Food and Nutrition, University of Indonesia

Other Identifiers

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NUPICO-Indonesia

Identifier Type: -

Identifier Source: org_study_id

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