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Еffects of fortified milk on cognitive abilities in school-aged children: results from a randomized-controlled trial



Micronutrients such as vitamins and minerals and long-chain polyunsaturated omega-3 fatty acids (PUFAs) are essential for children’s brain development and cognitive functions. The current study investigated whether milk fortified with micronutrients and PUFA can result in improved cognitive function in mainstream school children.


One-hundred-and-nineteen children (age 8–14, 58 boys) were randomly allocated to a fortified milk group or a regular full milk control group. Participants consumed 0.6L/day of the milk for 5 months. We recorded relevant biochemical, anthropometric, and cognitive measures (working memory and processing speed) at the start of the study and at follow-up after 5 months.


The fortified milk significantly increased docosahexaenoic acid (DHA) (change from baseline of 28% [95% CI 17–39%] vs. −6% [95% CI − 13 to 0%] in the control group) and serum 25OH-vitamin D concentrations (41% [95% CI 30–52%] vs. 21% [95% CI 11–30%] in the control group). The fortified milk improved working memory on one of two tests (32% [95% CI 17–47%] vs. 13% [95% CI 6–19%] in the control group). The fortified milk also indirectly increased processing speed on one of two tests; this effect was small and completely mediated by increases in 25OH-vitamin D concentrations.


These results suggest that fortifying milk with micronutrients and PUFA could be an effective and practical way to aid children’s cognitive development.

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  1. Best C, Neufingerl N, Del Rosso JM, Transler C, van den Briel T, Osendarp S (2011) Can multi-micronutrient food fortification improve the micronutrient status, growth, health, and cognition of schoolchildren? A systematic review. Nutr Rev 69:186–204

    Article  PubMed  Google Scholar 

  2. Montgomery P, Burton JR, Sewell RP, Spreckelsen TF, Richardson AJ (2013) Low blood long chain omega-3 fatty acids in UK children are associated with poor cognitive performance and behavior: a cross-sectional analysis from the DOLAB study. PloS one 8:e66697

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Catena A, Munoz-Machicao JA, Torres-Espinola FJ, Martinez-Zaldivar C, Diaz-Piedra C, Gil A, Haile G, Gyorei E, Molloy AM, Decsi T, Koletzko B, Campoy C (2016) Folate and long-chain polyunsaturated fatty acid supplementation during pregnancy has long-term effects on the attention system of 8.5-y-old offspring: a randomized controlled trial. Am J Clin Nutr 103:115–127

    Article  CAS  PubMed  Google Scholar 

  4. Kirby A, Woodward A, Jackson S (2010) Benefits of omega-3 supplementation for schoolchildren: review of the current evidence. Br Edu Res J 36:699–732

    Article  Google Scholar 

  5. Cordain L, Eaton SB, Sebastian A, Mann N, Lindeberg S, Watkins BA, O’Keefe JH, Brand-Miller J (2005) Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr 81:341–354

    Article  CAS  PubMed  Google Scholar 

  6. Benatti P, Peluso G, Nicolai R, Calvani M (2004) Polyunsaturated fatty acids: biochemical, nutritional and epigenetic properties. J Am Coll Nutr 23:281–302

    Article  CAS  PubMed  Google Scholar 

  7. Georgieff MK (2007) Nutrition and the developing brain: nutrient priorities and measurement. Am J Clin Nutr 85:614S-620S

    PubMed  Google Scholar 

  8. Darmon N, Drewnowski A (2008) Does social class predict diet quality? Am J Clin Nutr 87:1107–1117

    Article  CAS  PubMed  Google Scholar 

  9. Black MM (2003) Micronutrient deficiencies and cognitive functioning. J Nutr 133:3927S-3931S

    PubMed  PubMed Central  Google Scholar 

  10. Manger MS, McKenzie JE, Winichagoon P, Gray A, Chavasit V, Pongcharoen T, Gowachirapant S, Ryan B, Wasantwisut E, Gibson RS (2008) A micronutrient-fortified seasoning powder reduces morbidity and improves short-term cognitive function, but has no effect on anthropometric measures in primary school children in northeast Thailand: a randomized controlled trial. Am J Clin Nutr 87:1715–1722

    Article  CAS  PubMed  Google Scholar 

  11. Osendarp SJ, Baghurst KI, Bryan J, Calvaresi E, Hughes D, Hussaini M, Karyadi SJ, van Klinken BJ, van der Knaap HC, Lukito W, Mikarsa W, Transler C, Wilson C, NEMO Study Group (2007) Effect of a 12-mo micronutrient intervention on learning and memory in well-nourished and marginally nourished school-aged children: 2 parallel, randomized, placebo-controlled studies in Australia and Indonesia. Am J Clin Nutr 86:1082–1093

    Article  CAS  PubMed  Google Scholar 

  12. Jiao J, Li Q, Chu J, Zeng W, Yang M, Zhu S (2014) Effect of n-3 PUFA supplementation on cognitive function throughout the life span from infancy to old age: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 100:1422–1436

    Article  CAS  PubMed  Google Scholar 

  13. Kirby A, Woodward A, Jackson S, Wang Y, Crawford M (2010) A double-blind, placebo-controlled study investigating the effects of omega-3 supplementation in children aged 8–10 years from a mainstream school population. Res Dev Disabil 31:718–730

    Article  CAS  PubMed  Google Scholar 

  14. Johnson M, Fransson G, Östlund S, Areskoug B, Gillberg C (2017) Omega 3/6 fatty acids for reading in children: a randomized, double-blind, placebo-controlled trial in 9-year-old mainstream schoolchildren in Sweden. J Child Psychol Psychiatry 58:83–93

    Article  PubMed  Google Scholar 

  15. Richardson AJ, Burton JR, Sewell RP, Spreckelsen TF, Montgomery P (2012) Docosahexaenoic acid for reading, cognition and behavior in children aged 7–9 years: a randomized, controlled trial (the DOLAB Study). PLoS one 7:e43909

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Montgomery P, Spreckelsen TF, Burton A, Burton JR, Richardson AJ (2018) Docosahexaenoic acid for reading, working memory and behavior in UK children aged 7–9: a randomized controlled trial for replication (the DOLAB II study). PloS one 13:e0192909

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Fonollá J, López-Huertas E, Machado FJ, Molina D, Álvarez I, Mármol E, Navas M, Palacín E, García-Valls MJ, Remón B (2009) Milk enriched with “healthy fatty acids” improves cardiovascular risk markers and nutritional status in human volunteers. Nutrition 25:408–414

    Article  CAS  PubMed  Google Scholar 

  18. Fry AF, Hale S (1996) Processing speed, working memory, and fluid intelligence: evidence for a developmental cascade. Psychological science 7:237–241

    Article  Google Scholar 

  19. Alloway TP, Alloway RG (2010) Investigating the predictive roles of working memory and IQ in academic attainment. J Exp Child Psychol 106:20–29

    Article  PubMed  Google Scholar 

  20. St Clair-Thompson HL, Gathercole SE (2006) Executive functions and achievements in school: Shifting, updating, inhibition, and working memory. Q J Exp Psychol 59:745–759

    Article  Google Scholar 

  21. Baro L, Fonolla J, Pena J, Martinez-Ferez A, Lucena A, Jiménez J, Boza J, López-Huertas E (2003) n-3 Fatty acids plus oleic acid and vitamin supplemented milk consumption reduces total and LDL cholesterol, homocysteine and levels of endothelial adhesion molecules in healthy humans. Clin Nutr 22:175–182

    Article  CAS  PubMed  Google Scholar 

  22. Carrero JJ, Baro L, Fonolla J, Gonzalez-Santiago M, Martinez-Ferez A, Castillo R, Jimenez J, Boza JJ, Lopez-Huertas E (2004) Cardiovascular effects of milk enriched with omega-3 polyunsaturated fatty acids, oleic acid, folic acid, and vitamins E and B6 in volunteers with mild hyperlipidemia. Nutrition 20:521–527

    Article  CAS  PubMed  Google Scholar 

  23. Silva Ayçaguer L (2000) Sigesmu (Sistema General de simulación y simulación de muestras). Diseno razonado de muestras y captación de datos para la investigación sanitaria. Díaz de Santos (Ed, Madrid

    Google Scholar 

  24. Wechsler D (2004) WISC-IV: Wechsler intelligence scale for children: technical and interpretive manual. Psychological Corporation

  25. Wechsler D, Corral S (2011) WISC-IV Escala de Inteligencia de Wechsler para Niños-IV. Pearson, Madrid

    Google Scholar 

  26. Romeo J, Wärnberg J, García-Mármol E, Rodríguez-Rodríguez M, Diaz LE, Gomez-Martínez S, Cueto B, López-Huertas E, Cepero M, Boza JJ (2011) Daily consumption of milk enriched with fish oil, oleic acid, minerals and vitamins reduces cell adhesion molecules in healthy children. Nutrition, Metab Cardiovasc Dis 21:113–120

    Article  CAS  Google Scholar 

  27. Hayes AF (2008) Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Press, New York

    Google Scholar 

  28. Graham J (2012) Missing data: analyses and design. Springer, New York

    Book  Google Scholar 

  29. van Ginkel JR (2014) SPSS syntax for applying rules for combining multivariate estimates in multiple imputation. Leiden University

  30. Preacher KJ, Kelley K (2011) Effect size measures for mediation models: quantitative strategies for communicating indirect effects. Psychol Methods 16:93–115

    Article  PubMed  Google Scholar 

  31. Buell JS, Dawson-Hughes B (2008) Vitamin D and neurocognitive dysfunction: preventing “D” ecline? Mol Aspects Med 29:415–422

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Annweiler C, Allali G, Allain P, Bridenbaugh S, Schott A, Kressig RW, Beauchet O (2009) Vitamin D and cognitive performance in adults: a systematic review. Eur J Neurol 16:1083–1089

    Article  CAS  PubMed  Google Scholar 

  33. Liao K, McCandliss BD, Carlson SE, Colombo J, Shaddy DJ, Kerling EH, Lepping RJ, Sittiprapaporn W, Cheatham CL, Gustafson KM (2016) Event-related potential differences in children supplemented with long-chain polyunsaturated fatty acids during infancy. Developmental Science

  34. Kajarabille N, Hurtado JA, Peña-Quintana L, Peña M, Ruiz J, Diaz-Castro J, Rodríguez-Santana Y, Martin-Alvarez E, López-Frias M, Soldado O (2017) Omega-3 LCPUFA supplement: a nutritional strategy to prevent maternal and neonatal oxidative stress. Maternal & child nutrition 13

  35. Kuratko CN, Barrett EC, Nelson EB, Salem N (2013) The relationship of docosahexaenoic acid (DHA) with learning and behavior in healthy children: a review. Nutrients 5:2777–2810

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Campoy C, Escolano-Margarit MV, Ramos R, Parrilla-Roure M, Csabi G, Beyer J, Ramirez-Tortosa MC, Molloy AM, Decsi T, Koletzko BV (2011) Effects of prenatal fish-oil and 5-methyltetrahydrofolate supplementation on cognitive development of children at 6.5 y of age. Am J Clin Nutr 94:1880S–1888S

    Article  CAS  PubMed  Google Scholar 

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The study was funded by Lactalis Puleva SL. JF is currently employed and ELH was employed by Biosearch Life, which is part of Lactalis. Dafina Petrova is supported by a Juan de la Cierva Fellowship (FJCI-2016-28279) from the Spanish Ministry of Economy, Industry, and Competitiveness. We would like to thank the schools in Granada that participated in the study: I.E.S. Albayzín de Granada, Colegio Diocesano Virgen del Espino de Chauchina (Granada), and C.E.I.P. Cardenal Cisneros de Villanueva Mesía.

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Correspondence to Dafina Petrova.

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Petrova, D., Bernabeu Litrán, M., García-Mármol, E. et al. Еffects of fortified milk on cognitive abilities in school-aged children: results from a randomized-controlled trial. Eur J Nutr 58, 1863–1872 (2019).

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  • Fortified milk
  • Omega-3
  • PUFA
  • Micronutrients
  • Cognitive abilities
  • Working memory