title: Utilization of the PICO framework to improve searching PubMed for clinical questions 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. 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. Effect of iron-, iodine-, and beta-carotene-fortified biscuits on the micronutrient status of primary school children: a randomized controlled trial. Iodine supplementation improves cognition in iodine-deficient schoolchildren in Albania: a randomized, controlled, double-blind study. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Cognitive and mood effects in healthy children during 12 weeks' supplementation with multi-vitamin/minerals. Iodine supplementation improves cognition in mildly iodine-deficient children. A randomized controlled trial of the effect of antihelminthic treatment and micronutrient fortification on health status and school performance of rural primary school children Effect of a Multiple-Micronutrient-Fortified Fruit Powder Beverage on the Nutrition Status, Physical Fitness, and Cognitive Performance of Schoolchildren in the Philippines Multivitamin/Mineral supplementation does not affect standardized assessment of academic performance in elementary school children. Behavioural responses of young anaemic Indian children to iron-folic acid supplements. Effect of fortification with multiple micronutrients and n-3 fatty acids on growth and cognitive performance in Indian schoolchildren: the CHAMPION (Children's Health and Mental Performance Influenced by Optimal Nutrition) Study. The effect of vitamin-mineral supplementation on juvenile delinquency among American schoolchildren: a randomized, double-blind placebo-controlled trial. Effect of micronutrient supplement on health and nutritional status of schoolchildren: mental function. Decreased parasite load and improved cognitive outcomes caused by deworming and consumption of multi-micronutrient fortified biscuits in rural Vietnamese schoolchildren.
abstract: Background Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results BACKGROUND Reductions in iodine and zinc deficiencies and improvements in hemoglobin were achieved from a micronutrient-fortified seasoning powder consumed in school lunches by children in northeast Thail and . OBJECTIVE The objective was to determine whether fortification with 4 micronutrients in a school lunch results in changes in children 's growth , morbidity , and cognitive function compared with no fortification . DESIGN In a r and omized controlled trial of 569 children aged 5.5 - 13.4 y from 10 schools , we compared the efficacy of a seasoning powder fortified with or without 5 mg Fe , 5 mg Zn , 50 mug I , and 270 mug vitamin A per serving consumed with a school lunch 5 d/wk . Here we report on results of the secondary functional outcomes . RESULTS The groups were comparable concerning compliance and loss to follow-up . The intervention had no statistically significant effect on anthropometric measures over 31 wk , but reduced the incidence of respiratory-related illnesses [ rate ratio ( RR ) : 0.83 ; 95 % CI : 0.73 , 0.94 ] , symptoms of runny nose ( RR : 0.80 ; 95 % CI : 0.70 , 0.92 ) , cough ( RR : 0.80 ; 95 % CI : 0.66 , 0.96 ) , and diarrhea ( RR : 0.38 ; 95 % CI : 0.16 , 0.90 ) . For the visual recall test , those in the fortified group recalled 0.5 more items ( 95 % CI : 0.1 , 0.9 ) than did the controls . There were no statistically significant differences between groups in the results of the digits forward and backward tests or in school grade s at the conclusion of the 2 semesters . CONCLUSION The beneficial effects on morbidity and visual recall over a short period , in addition to some biochemical improvements , highlight the potential of this micronutrient-fortified seasoning powder supplied in a school lunch . This trial was registered at clinical trials.gov as ACTRN12605000341628 BACKGROUND Little is known about the combined effect of micronutrients and essential fatty acids on cognitive function in school-aged children . OBJECTIVE We assessed the effect of micronutrients , long-chain n-3 fatty acids , or both on indicators of cognitive performance in well-nourished and marginally nourished school-aged children . DESIGN Two 2-by-2 factorial r and omized controlled double-blind trials were performed home-based in Adelaide , South Australia , and at 6 primary schools in Jakarta , Indonesia . A total of 396 children ( aged 6 - 10 y ) in Australia and 384 children in Indonesia were r and omly allocated to receive a drink with a micronutrient mix ( iron , zinc , folate , and vitamins A , B-6 , B-12 , and C ) , with docosahexanoic acid ( DHA , 88 mg/d ) and eicosapentaenoic acid ( EPA , 22 mg/d ) , or with both or placebo 6 d/wk for 12 mo .  Biochemical indicators were determined at baseline and 12 mo . Cognitive performance was measured at baseline , 6 mo , and 12 mo . RESULTS The micronutrient treatment significantly improved plasma micronutrient concentrations in Australian and Indonesian children . DHA+EPA treatment increased plasma DHA and total plasma n-3 fatty acids in both countries . The micronutrient treatment result ed in significant increases in scores on tests representing verbal learning and memory in Australia ( estimated effect size : 0.23 ; 95 % CI : 0.01 , 0.46 ) . A similar effect was observed among Indonesian girls ( estimated effect size : 0.32 ; 95 % CI : -0.01 , 0.64 ) . No effects were found on tests measuring general intelligence or attention . No effects of DHA+EPA on the factors of cognitive tests were observed . CONCLUSION In well-nourished school-aged children , fortification with multiple micronutrients can result in improvements in verbal learning and memory BACKGROUND Deficiencies of iron , iodine , and vitamin A are prevalent worldwide and can affect the mental development and learning ability of schoolchildren . OBJECTIVE The aim of this study was to determine the effect of micronutrient-fortified biscuits on the micronutrient status of primary school children . DESIGN Micronutrient status was assessed in 115 children aged 6 - 11 y before and after consumption of biscuits ( fortified with iron , iodine , and beta-carotene ) for 43 wk over a 12-mo period and was compared with that in a control group ( n = 113 ) who consumed nonfortified biscuits .  Cognitive function , growth , and morbidity were assessed as secondary outcomes . RESULTS There was a significant between-group treatment effect on serum retinol , serum ferritin , serum iron , transferrin saturation , and urinary iodine ( P < 0.0001 ) and in hemoglobin and hematocrit ( P < 0.05 ) . The prevalence of low serum retinol concentrations ( < 0.70 micromol/L ) decreased from 39.1 % to 12.2 % , of low serum ferritin concentrations ( < 20 microg/L ) from 27.8 % to 13.9 % , of anemia ( hemoglobin < 120 g/L ) from 29.6 % to 15.6 % , and of low urinary iodine concentrations ( < 100 microg/L ) from 97.5 % to 5.4 % . There was a significant between-group treatment effect ( P < 0.05 ) in cognitive function with the digit span forward task ( short-term memory ) . Fewer school days were missed in the intervention than in the control group because of respiratory- ( P = 0.097 ) and diarrhea-related ( P = 0.013 ) illnesses . The intervention had no effect on anthropometric status [ corrected ] . CONCLUSIONS Fortified biscuits result ed in a significant improvement in the micronutrient status of primary school children from a poor rural community and also appeared to have a favorable effect on morbidity and cognitive function [ corrected ] BACKGROUND Iodine is required for the production of thyroid hormones , which are necessary for normal brain development and cognition . Although several r and omized trials examined the effect of iodine supplementation on cognitive performance in schoolchildren , the results were equivocal . OBJECTIVE We aim ed to ascertain whether providing iodized oil to iodine-deficient children would affect their cognitive and motor performance . DESIGN In a double-blind intervention trial , 10 - 12-y-old children ( n = 310 ) in primary schools in rural southeastern Albania were r and omly assigned to receive 400 mg I ( as oral iodized oil ) or placebo . We measured urinary iodine ( UI ) , thyroid-stimulating hormone ( TSH ) , and total thyroxine ( TT4 ) concentrations and thyroid gl and volume ( by ultrasound ) . The children were given a battery of 7 cognitive and motor tests , which included measures of information processing , working memory , visual problem solving , visual search , and fine motor skills .  Thyroid ultrasound and the biochemical and psychological tests were repeated after 24 wk . RESULTS At baseline , the children 's median UI concentration was 43 microg/L ; 87 % were goitrous , and nearly one-third had low concentrations of circulating TT4 . Treatment with iodine markedly improved iodine and thyroid status : at 24 wk , median UI in the treated group was 172 microg/L , mean TT4 was approximately 40 % higher , and the prevalence of hypothyroxinemia was < 1 % . In the placebo group after the intervention , these variables did not differ significantly from baseline . Compared with placebo , iodine treatment significantly improved performance on 4 of 7 tests : rapid target marking , symbol search , rapid object naming , and Raven 's Coloured Progressive Matrices ( P < 0.0001 ) . CONCLUSION Information processing , fine motor skills , and visual problem solving are improved by iodine repletion in moderately iodine-deficient schoolchildren Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Adequate levels of vitamins and minerals are essential for optimal neural functioning . A high proportion of individuals , including children , suffer from deficiencies in one or more vitamins or minerals . This study investigated whether daily supplementation with vitamins/minerals could modulate cognitive performance and mood in healthy children . In this r and omised , double-blind , placebo-controlled , parallel groups investigation , eighty-one healthy children aged from 8 to 14 years underwent laboratory assessment s of their cognitive performance and mood pre-dose and at 1 and 3 h post-dose on the first and last days of 12 weeks ' supplementation with a commercially available vitamins/mineral product ( Pharmaton Kiddi ) . Interim assessment s were also completed at home after 4 and 8 weeks at 3 h post-dose . Each assessment comprised completion of a cognitive battery , delivered over the Internet , which included tasks assessing mood and the speed and accuracy of attention and aspects of memory ( secondary , semantic and spatial working memory ) . The vitamin/mineral group performed more accurately on two attention tasks : ' Arrows ' choice reaction time task at 4 and 8 weeks ; ' Arrow Flankers ' choice reaction time task at 4 , 8 and 12 weeks . A single task outcome ( Picture Recognition errors ) evinced significant decrements at 12 weeks . Mood was not modulated in any interpretable manner . Whilst it is possible that the significant improvements following treatment were due to non-significant numerical differences in performance at baseline , these results would seem to suggest that vitamin/mineral supplementation has the potential to improve brain function in healthy children . This proposition requires further investigation BACKGROUND The effects of severe iodine deficiency during critical periods of brain development are well documented . There is little known about the consequences of milder forms of iodine deficiency on neurodevelopment . OBJECTIVE The objective was to determine whether supplementing mildly iodine-deficient children with iodine improves cognition . DESIGN A r and omized , placebo-controlled , double-blind trial was conducted in 184 children aged 10 - 13 y in Dunedin , New Zeal and . Children were r and omly assigned to receive a daily tablet containing either 150 microg I or placebo for 28 wk .  Biochemical , anthropometric , and dietary data were collected from each child at baseline and after 28 wk . Cognitive performance was assessed through 4 subtests from the Wechsler Intelligence Scale for Children . RESULTS At baseline , children were mildly iodine deficient [ median urinary iodine concentration ( UIC ) : 63 microg/L ; thyroglobulin concentration : 16.4 microg/L ] . After 28 wk , iodine status improved in the supplemented group ( UIC : 145 microg/L ; thyroglobulin : 8.5 microg/L ) , whereas the placebo group remained iodine deficient ( UIC : 81 microg/L ; thyroglobulin : 11.6 microg/L ) . Iodine supplementation significantly improved scores for 2 of the 4 cognitive subtests [ picture concepts ( P = 0.023 ) and matrix reasoning ( P = 0.040 ) ] but not for letter-number sequencing ( P = 0.480 ) or symbol search ( P = 0.608 ) . The overall cognitive score of the iodine-supplemented group was 0.19 SDs higher than that of the placebo group ( P = 0.011 ) . CONCLUSIONS Iodine supplementation improved perceptual reasoning in mildly iodine-deficient children and suggests that mild iodine deficiency could prevent children from attaining their full intellectual potential . The trial was registered with the Australia New Zeal and Clinical Trials Register as ACTRN12608000222347 Summary Single interventions for helminthic infections and micronutrient deficiencies are effective , but it is not clear whether combined interventions will provide equal , additive or synergistic effects to improve children 's health . The study objective was to determine the impact of single and combined interventions on nutritional status and scholastic and cognitive performance of school children . A double-blind , r and omized , placebo-controlled trial in 11 rural South African primary schools r and omly allocated 579 children aged between 8 and 10 years into six study groups , half of whom received antihelminthic treatment at baseline . The de-wormed and non-de-wormed arms were further divided into three groups and given biscuits , either unfortified or fortified with vitamin A and iron or with vitamin A only , given daily for 16 weeks . The outcome measures were anthropometric , micronutrient and parasite status , and scholastic and cognitive test scores . There was a significant treatment effect of vitamin A on serum retinol ( p < 0.01 ) , and the suggestion of an additive effect between vitamin A fortification and de-worming . Fortified biscuits improved micronutrient status in rural primary school children ; vitamin A with de-worming had a greater impact on micronutrient status than vitamin A fortification alone and antihelminthic treatment significantly reduced the overall prevalence of parasite infection . The burden of micronutrient deficiency ( anaemia , iron and vitamin A ) and stunting in this study population was low and , coupled with the restricted duration of the intervention ( 16 weeks ) , might have limited the impact of the interventions This study aim ed to determine the effect of a multiple-micronutrient-fortified beverage on the micronutrient status , physical fitness , and cognitive performance of schoolchildren . The study was a r and omized , double-blind , placebo-controlled trial of schoolchildren assigned to receive either the fortified or nonfortified beverage with or without anthelmintic therapy .  Data on hemoglobin level , urinary iodine excretion ( UIE ) level , physical fitness , and cognitive performance were collected at baseline and at 16 weeks post-intervention . The fortified beverage significantly improved iron status among the subjects that had hemoglobin levels < 11 g/dl at baseline . The proportion of children who remained moderately to severely anemic was significantly lower among those given the fortified beverage . In the groups that received the fortified product , the median UIE level increased , whereas among those who received the placebo beverage , the median UIE level was reduced significantly . Iron- and /or iodine-deficient subjects who received the fortified beverage showed significant improvements in fitness ( post-exercise reduction of heart rate ) and cognitive performance ( nonverbal mental ability score ) . The study showed that consumption of a multiple-micronutrient-fortified beverage for 16 weeks had significant effects on iron status , iodine status , physical fitness , and cognitive performance among iron- and /or iodine-deficient Filipino schoolchildren .  Anthelmintic therapy improved iron status of anemic children and iodine status of the iron-adequate children at baseline but it had no effect on physical fitness and cognitive performance . The results from the clinical study showed that a multiple-micronutrient-fortified beverage could play an important role in preventing and controlling micronutrient deficiencies Limited research suggests that micronutrient supplementation may have a positive effect on the academic performance and behavior of school-aged children . To determine the effect of multivitamin/mineral supplementation on academic performance , students in grade s three through six ( approximate age range=8 to 12 years old ) were recruited from 37 parochial schools in northern New Jersey to participate in a double-blind , placebo-controlled clinical trial conducted during the 2004 - 2005 academic school year . Participants were r and omized to receive either a st and ard children 's multivitamin/mineral supplement ( MVM ) or a placebo . MVM or placebo was administered in school only during lunch or snack period by a teacher or study personnel who were blinded to group assignment . The main outcome measured was change in scores on Terra Nova , a st and ardized achievement test administered by the State of New Jersey , at the beginning of March 2005 compared to March 2004 . Compared with placebo , participants receiving MVM supplements showed no statistically significant improvement for Terra Nova National Percentile total scores by treatment assignment or for any of the subject area scores using repeated measures analysis of variance . No significant improvements were observed in secondary end points : number of days absent from school , tardiness , or grade point average . In conclusion , the in-school daily consumption of an MVM supplement by third- through sixth- grade inner-city children did not lead to improved school performance based upon st and ardized testing , grade point average , and absenteeism 1 . Behavioural responses of young anaemic Indian children to iron-folic acid supplements were assessed in two separate studies using the Indian adaptation of Wechsler 's ( 1967 ) intelligence scale for children ( WISC ) . 2 . The first study was an exploratory study in which the cognitive behaviour of 5 - 8-year-old children of both sexes was assessed before and after supplementation with 20 mg elemental Fe and 0.1 mg folic acid given daily for a period of 60 d. 3 . The supplemented children showed a significant improvement in haemoglobin ( Hb ) as well as the WISC scores while the control children who did not receive any supplements failed to show an improvement either in Hb or in the WISC scores . However , within the supplemented group when the initially-anaemic children were compared with the initially-non-anaemic ones , only the 7-year-old anaemic children performed significantly poor in the tests than the non-anaemic group of the same age . The study raised the possibility that in addition to increasing the blood Hb levels , Fe-folic acid supplements may have additional benefits in improving the cognitive performance of children . 4 . In the second study , cognitive behaviour of fourteen matched pairs of anaemic children in the age-range of 5 - 6 years was assessed before and after supplementation with 40 mg Fe and 0.2 mg folic acid given daily in two divided doses or sugar placebos for a period of 60 d. The tester did not know the groups to which each child belonged . 5 . The supplemented children showed a significant improvement in Hb as well as in the verbal and performance IQ of WISC . The control children showed no improvement in Hb but their verbal IQ improved significantly . However , there was no significant improvement in their performance IQ . 6 . The results indicated that Fe-folic acid supplements to anaemic children not only raised Hb levels but also improved intelligence test results , particularly in the performance section BACKGROUND Fortification with multiple micronutrients has been shown to improve growth and cognitive performance among children in developing countries , but it is unknown whether higher concentrations are more effective than lower concentrations . OBJECTIVE We compared the effect of 2 different concentrations of a combination of micronutrients and n-3 ( omega-3 ) fatty acids on indicators of growth and cognitive performance in low-income , marginally nourished schoolchildren in Bangalore , India . DESIGN In a 2-by-2 factorial , double-blind , r and omized controlled trial , 598 children aged 6 - 10 y were individually allocated to 1 of 4 intervention groups to receive foods fortified with either 100 % or 15 % of the Recommended Dietary Allowance of micronutrients in combination with either 900 mg alpha-linolenic acid plus 100 mg docosahexaenoic acid or 140 mg alpha-linolenic acid for 12 mo . Anthropometric and biochemical assessment s were performed at baseline and 12 mo . Cognitive performance was measured at baseline and at 6 and 12 mo . RESULTS The high micronutrient treatment significantly improved linear growth at 12 mo ( 0.19 cm ; 0.01 , 0.36 ) and short-term memory at 6 mo ( 0.11 SD ; 0.01 , 0.20 ) and was less beneficial on fluid reasoning at 6 ( -0.10 SD ; -0.17 , -0.03 ) and 12 ( -0.12 SD ; -0.20 , -0.04 ) mo than was the low micronutrient treatment , whereas no differences were observed on weight , retrieval ability , cognitive speediness , and overall cognitive performance . No significant differences were found between the n-3 treatments . CONCLUSIONS The high micronutrient treatment was more beneficial for linear growth than was the low micronutrient treatment . However , with some small differential effects , higher micronutrient concentrations were as effective as lower concentrations on cognitive performance . This trial was registered at clinical trials.gov as NCT00467909 CONTEXT Numerous studies conducted in juvenile correctional institutions have reported that violence and serious antisocial behavior have been cut almost in half after implementing nutrient-dense diets that are consistent with the World Health Organization 's guidelines for fats , sugar , starches , and protein ratios . Two controlled trials tested whether the cause of the behavioral improvements was psychological or biological in nature by comparing the behavior of offenders who either received placebos or vitamin-mineral supplements design ed to provide the micronutrient equivalent of a well-balanced diet . These r and omized trials reported that institutionalized offenders , aged 13 to 17 years or 18 to 26 years , when given active tablets produced about 40 % less violent and other antisocial behavior than the placebo controls . However , generalization could not be made to typical schoolchildren without a controlled trial examining violence and antisocial behavior in public schools . OBJECTIVES To determine if schoolchildren , aged 6 to 12 years , who are given low dose vitamin-mineral tablets will produce significantly less violence and antisocial behavior in school than classmates who are given placebos . DESIGN A stratified r and omized , double-blind , placebo-controlled trial with pretest and post-test measures of antisocial behavior on school property . SETTING S AND SUBJECTS Two " working class , " primarily Hispanic elementary schools in Phoenix , Arizona . Approximately half of the potential schoolchildren participated , i.e. , 468 students aged 6 to 12 years . INTERVENTION Daily vitamin-mineral supplementation at 50 % of the U.S. recommended daily allowance ( RDA ) for 4 months versus placebo . The supplement was design ed to raise vitamin-mineral intake up to the levels currently recommended by the National Academy of Sciences for children aged 6 to 11 years . OUTCOME MEASURE Violent and nonviolent delinquency as measured by official school disciplinary records . RESULTS Of the 468 students r and omly assigned to active or placebo tablets , the 80 who were disciplined at least once between September 1st and May 1st served as the research sample . During intervention , the 40 children who received active tablets were disciplined , on average , 1 time each , a 47 % lower mean rate of antisocial behavior than the 1.875 times each for the 40 children who received placebos ( 95 % confidence interval , 29 % to 65 % , < 5 .020 ) . The children who took active tablets produced lower rates of antisocial behavior in 8 types of recorded infractions : threats/fighting , v and alism , being disrespectful , disorderly conduct , defiance , obscenities , refusal to work or serve , endangering others , and nonspecified offenses . CONCLUSION Poor nutritional habits in children that lead to low concentrations of water-soluble vitamins in blood , impair brain function and subsequently cause violence and other serious antisocial behavior . Correction of nutrient intake , either through a well-balanced diet or low-dose vitamin-mineral supplementation , corrects the low concentrations of vitamins in blood , improves brain function and subsequently lowers institutional violence and antisocial behavior by almost half . This paper adds to the literature by enabling previous research to be generalized from older incarcerated subjects with a history of antisocial behavior to a normal population of younger children in an educational setting OBJECTIVE We evaluated the effect of a micronutrient-fortified beverage on mental function in schoolchildren . METHODS This double-blind , placebo-controlled , matched-pair , cluster , r and omized feeding trial assessed baseline before supplementation and after 14 mo in a cohort of 608 children aged 6 to 15 y who received a micronutrient-fortified beverage or placebo .  Children in two classes ( clusters ) in each of nine grade s were assessed for intelligence , attention and concentration , memory , and school achievement . RESULTS Mean intelligence quotient scores of the micronutrient-fortified beverage group and the placebo group at baseline and final follow-up were not significantly different . Mean verbal and performance scores and increments were also not different . After supplementation , attention-concentration increment scores of the micronutrient group were significantly higher ( P < 0.05 ) than those of the placebo group . Mean and incremental scores of the supplemented group on the memory scale were not significantly different from those of the placebo group . CONCLUSIONS Supplementation with a beverage fortified with a range of micronutrients significantly improved attention-concentration over 14 mo , but not intelligence quotient , memory , or school achievement among middle-income schoolchildren Micronutrient deficiencies are associated with impaired growth and cognitive  function  . A school-based fortification program might benefit schoolchildren but a high prevalence of parasite infestation might affect effectiveness . A r and omized , double-blind , placebo-controlled 2 × 2 factorial trial was conducted to assess the efficacy of multi-micronutrient fortified biscuits with or without de-worming on growth , cognitive function , and parasite load in Vietnamese schoolchildren . Schoolchildren ( n = 510 ) , 6 - 8 years of age were r and omly allocated to receive albendazole or placebo at baseline and four months of multi-micronutrient fortified biscuits ( FB ) or non-fortified biscuits .  Children receiving FB for four months scored higher on two cognitive tests : Raven 's Colored Progressive Matrices and the Digit Span Forward test . Children receiving albendazole plus FB had the lowest parasite load after four months . In children receiving FB , mid-upper arm circumference was slightly improved ( + 0.082 cm ) but there were no differences in other indexes of anthropometry . Combining multi-micronutrient fortified biscuits with de-worming is an effective strategy
target: The effects of micronutrient interventions on other domains were inconsistent .
  Improvement in fluid intelligence among micronutrient-deficient children was consistently reported .
background: BACKGROUND & AIMS Micronutrients are essential for brain development with deficiencies in specific nutrients linked to impaired cognitive function .
  Interventions are shown to be beneficial to children 's mental development , particularly in subjects who were micronutrient-deficient at baseline but results on healthy subjects remain inconsistent .
  This systematic review evaluated the effect of micronutrient inventions on different cognitive domains .