Abstract：
Malnutrition is associated with reduced learning aptitude and growth during childhood. We examined the impact of providing two school lunch variants, a standard school meal (school feeding, n = 70), or the standard meal with additional micronutrients (school feeding + micronutrient powder (MNP), n = 70), in children attending two schools in northwest Pakistan. A third local government school, where no lunch was provided (no school feeding, n = 70), served as the control. The primary outcome, cognitive function, was assessed using the Raven\'s Coloured Progressive Matrices (RCPM) test, alongside haemoglobin, at three-time points: T1 (baseline, before the initiation of the school lunch programme), T2 and T3 (5 and 12 months, respectively, after the introduction of the school lunch). Data were analysed using linear mixed-effects models to contrast between trial groups, the changes from T1 to T2 and T3. Adjusted for T1 and other co-variates, improvements in the RCPM scores were significantly greater in the school feeding group at T2 (b = 1.61, (95% CI = 0.71-2.52), t = 3.52, p = 0.001) and T3 (b = 1.28, (95% CI = 0.22-2.35), t = 2.38, p = 0.019) compared with no school feeding. In addition, at T2 (b = 1.63, (95% CI = -0.10-3.37), t = 1.86, p = 0.065), there were no significant differences between school feeding + MNP and no school feeding groups. However, improvements in the RCPM scores were significantly greater in the school feeding + MNP group at T3 (b = 2.35, (95% CI = 0.51-4.20), t = 2.53, p = 0.013) compared with no school feeding. The findings indicate an improvement in cognitive performance in children who received a school meal with and without MNP, over a 12-month period. Currently there is no operational school feeding programme at the national or provincial level in Pakistan. Our findings, therefore, highlight the need for school feeding programmes to improve learning opportunities for children from underprivileged communities.
摘要：
营养不良与儿童期学习能力和生长能力下降有关。我们研究了提供两种学校午餐变体的影响，标准的校餐(学校供餐，n=70),或含有额外微量营养素的标准膳食(学校供餐+微量营养素粉(MNP)，n=70),在巴基斯坦西北部两所学校上学的孩子。第三所地方政府学校,没有提供午餐(没有学校供餐，n=70),作为控制。主要结果，认知功能,使用Raven的彩色渐进矩阵(RCPM)测试进行评估，除了血红蛋白，在三个时间点：T1(基线，在学校午餐计划开始之前)，T2和T3（5和12个月，分别,介绍学校午餐后）。使用线性混合效应模型分析数据，以对比试验组，从T1到T2和T3的变化。针对T1和其他协变量进行了调整，在T2时，学校供餐组的RCPM得分改善明显更大（b=1.61，（95％CI=0.71-2.52），t=3.52，p=0.001)和T3(b=1.28，(95%CI=0.22-2.35)，t=2.38，p=0.019）与没有学校供餐相比。此外,在T2（b=1.63，（95%CI=-0.10-3.37），t=1.86,p=0.065),学校供餐+MNP组和无学校供餐组之间没有显着差异。然而,在T3时，学校供餐+MNP组的RCPM得分改善明显更大(b=2.35，(95%CI=0.51-4.20)，t=2.53，p=0.013）与没有学校供餐相比。研究结果表明，在有或没有MNP的情况下接受学校用餐的儿童的认知表现有所改善，在12个月的时间里。目前，巴基斯坦没有在国家或省一级实施学校供餐计划。我们的发现,因此,强调需要学校供餐计划，以改善贫困社区儿童的学习机会。
