Production of Fortified Biscuit With Chickpea and Crushed Peanut for Improving Cognitive Performance
Condition: Cognitive Performance
MeSH terms: Crush Injuries
Study type: Interventional

Summary: 
      It is well known that globally, school-based fortification and school feeding approaches have
      been applied to remedy nutritional deficiencies that impact health in the primary school age
      group.

      Aim of the study: to produce a fortified biscuit with chickpea and crushed peanut. To
      evaluate the effectiveness of the fortified biscuits intake for 4 months in terms of its
      acceptability and impact on cognitive performance for a sample of children aged 8-12 years
      attending rural primary schools in an Egyptian village. The fortified biscuits' effect on
      auditory attention, visual and working memory, and learning ability was evaluated.

      Methodology: This study was an interventional study conducted in two stages: stage one was
      the production of nutritious biscuits that is based on chickpea flour and peanut in addition
      to whole wheat (extract 72 %), wheat germ, cinnamon, milk, and egg. All these constituents
      help in enhancing immunity, fighting viruses, maintaining regular and healthy bowel movement,
      regulating blood sugar and cholesterol levels, and more importantly improving the cognitive
      abilities of school-aged children. During stage two, eighty Children were randomly allocated
      in either chickpea and peanuts biscuits dependent group (40 children) or non-dependent group
      (40 children) to evaluate the impact of the fortified biscuits. All enrolled children and
      their mothers received 5 cognitive stimulation sessions over four months. The cognitive
      performance of primary school-aged children was assessed before and after the interventions
      by a battery of four verbal & non-verbal intelligence psychological tests. These tests
      covered short-term and working memory, visual memory, and the ability for categorization,
      learning for speed of information processing, and auditory attention ability with rising
      levels of difficulty. These tests were: Digit Span, the figural memory tests, Coding and
      Auditory vigilance tests A and B respectively. Five items were used to evaluate the physical
      characteristics of the biscuits: color, odor, taste, consistency, and general acceptance.
    

Detailed description: 
      Nutritional factors are one of the interacting factors to affect all developmental aspects
      among Egyptian children since birth. During the first two years of life, Egyptian studies put
      more emphasis on child nutrition and development with intensive efforts around breastfeeding
      because of being a critical period of rapid change. During this phase, studies were
      implemented to prepare children for subsequent developmental competency in their childhood by
      investigating the risk factors affecting the early cognitive development of Egyptian infants,
      and monitoring their cognitive performance. Later on in life, more emphasis was put on either
      studying factors behind malnutrition or providing educational and nutritional interventions
      to enhance growth and development.

      To address the nutritional needs of school-aged children, global efforts have extensively
      focused on school-based fortification approaches for school feeding programs (SFPs). SFPs are
      linked to Goal number 2 (zero hunger) of the Sustainable Development Goals (SDG). The
      Ministry of Agriculture and Land Reclamation (MOLAR) in Egypt has directed SFP since 1998 to
      attract children in Egyptian rural areas to attend primary schools by providing them
      nutritious subsidized in-school meals as a contribution to breakfast consumption. The
      potential impact goal of targeting children through Food for Education programs (FFE) is to
      increase their educational achievement and subsequently improve their potential future
      efficiency and profit. This program includes governmental primary schools within all
      governorates of Egypt. The close link between nutritional deficiency and diminished cognitive
      performance and subsequently retarded educational accomplishment was the reason behind
      implementing nutritional feeding for Egyptian school-aged children to improve their health,
      cognitive performance, attention span, school attendance, and educational achievement.

      Investments in nutrition and cognitive stimulation programs are thus the keys to optimizing
      child cognitive development and performance. From this perspective, our idea was generated -
      Relying on the consumption of biscuits that are based on natural ingredients (chickpeas &,
      peanuts- for improving the cognitive function of children during the school days is much
      better than relying on drugs.

      Both chickpeas and peanuts are types of legumes that are common in Egypt and the middle east.
      Egypt is a common source for chickpea production in the world where it is mostly consumed as
      whole seeds and several types of traditional food products. Both of them are overlooked as
      nutritious food although they have many health benefits as the more expensive nuts and must
      not be neglected.

      These two beans although being nutritionally overachievers that deserve so much more, Yet,
      they're always moved down to the side-dish zone (e.g puréed of hummus). These two ingredients
      in addition to Wheat germ and Cinnamon could boost mental health improve mood, memory,
      cognitive stimulation, muscle control, and other nervous system and brain activities due to
      their vitamins, minerals, and chemical contents.

      The objectives of the study:

      to produce a fortified biscuit with chickpea and crushed peanut. To evaluate its
      effectiveness in terms of its acceptability and impact on cognitive performance for a sample
      of children aged 8-12 years attending rural primary schools in an Egyptian village after four
      months of daily intake of 3 biscuits per day for 4 months.

      Specific aims To produce Chickpeas and Crushed peanut fortified biscuit To evaluate biscuit
      effect on short-term and working memory To evaluate biscuit effect on visual memory and the
      ability for categorization To evaluate biscuit effect on learning for speed of information
      processing, To evaluate biscuit effect on auditory attention ability with rising levels of
      difficulty.

      Methodology:

      Study design and Setting:

      The study was a pilot community-based intervention that was conducted in El Othmanyia village
      of El Mahala district- Gharbyia governorate.

      Phases of the study and tools:

      This study was conducted in three phases that were done in a simultaneous way. The first
      phase included children recruitment and baseline assessment before intervention:

      Assessment tools (Methods):

      Anthropometric measurements of weight and height were carried out to exclude mal-nourished
      children. All measurements were made according to techniques described in the Anthropometric
      Standardization Reference Manual. Anthropometric measurements were taken during morning hours
      on empty stomach before having breakfast or a school meal, within a minimum of 8 hours after
      micturition and defecation, and after the morning exercises of spine stretching. All scores
      were calculated based on the WHO growth standards with the help of the Anthro-Program of PC.

      Growth assessment according to WHO recommendations

        1. Weight (in kg): by a Seca Scale Balance

        2. Height (in cm): using Stadiometer

        3. BMI (weight/Height2 in meter): calculated Dietary assessment: Detailed nutritional and
           dietary assessment using Diet Quality index assessment questionnaire, Food frequency
           pattern, and 24 hours questionnaires.

      Cognitive performance assessment: Cognitive performance was assessed before and after the
      intervention by a battery of psychological tests that covered verbal & non-verbal
      intelligence, memory, learning, and attention. The children were individually tested by
      trained researchers.

      These tests are:

        1. The Digit Span Test: The effect of the intake of the fortified biscuits with stimulation
           on short-term and working memory was tested by using the Digit Span Test: It is a
           subtest of the Revised Wechsler Intelligence Scale. The digit span memory task is a
           verbal measure of immediate memory and working memory maintenance and manipulation.
           Methodologically, digit span tasks have been proven to be both reliable and valid
           measures of working memory capacity. The Arabic version of the Revised Wechsler
           Intelligence Scale for children was used

        2. Coding test: It is also a subtest of the Revised Wechsler Intelligence Scale for
           children. The children had to substitute symbols for numbers as quickly as possible. The
           score represents the total number of correct symbols written during a fixed time.

        3. The auditory vigilance test: which measures the attention ability. It is a measure of
           the efficiency of identifying signal stimuli in the context of non-signal stimuli. The
           subjects were asked to pay attention while listening to many words from different
           categories like a key, ball, school, etc., and they were asked to give a sign, like
           raising their hands, when they hear certain words, chosen by the administrator. The
           scores of the test were calculated as total right and totally wrong.

        4. The figural memory test: is a measure of free recall of visual objects. The subjects
           were shown a group of different photos like animals, cars, plants, etc., and they were
           asked to mention as many photos as they can.

      Intervention phase 80 children of those who fulfilled the inclusion and the exclusion
      criteria were allocated randomly to either one of two groups (every 40 children),

        1. The chickpea and crushed peanut biscuits dependent group received one daily pack of
           three fortified biscuits as snakes between breakfast and lunch on daily basis for four
           months.

        2. The chickpea and crushed peanut biscuits non-dependent group received nothing

        3. This supplement was accompanied by cognitive stimulation for both the two groups for the
           children and their parents (a monthly session with a total of 4 sessions for each)

      Composition of the fortified biscuits:

      The chickpeas and crushed peanuts fortified biscuit consisted of wheat flour (extract 72%),
      Chickpeas flour, crushed peanuts, wheat germ, Skimmed milk, corn oil, egg, sugar, Cinnamon,
      baking powder, salt, and vanilla. The first four constituents help in enhancing immunity,
      fighting viruses, maintaining regular and healthy bowel movement, regulating blood sugar and
      cholesterol levels, and more importantly improving the cognitive abilities of school-aged
      children.

      Topics of stimulation sessions I. Sessions for mothers • Sessions for students

      • 3. Post Intervention Evaluation Phase This phase included evaluation of the effect of
      consumption of the chickpea and crushed peanut biscuits on the improvement of the cognitive
      abilities
    

Intervention name(s): Chickpeas and crushed peanuts fortified biscuit; Cognitive stimulation for the mothers; Cognitive stimulation for students
Intervention type(s): Dietary Supplement; Other; Other
Intervention description(s): This group received one daily pack of three fortified biscuits as snakes between breakfast and lunch on daily basis for four months. The chickpeas and crushed peanuts fortified biscuit consisted of wheat flour (extract 72%), Chickpea flour, crushed peanuts, wheat germ, Skimmed milk, corn oil, egg, sugar, Cinnamon, baking powder, salt, and vanilla.; I. Sessions for mothers
Informing mothers about the most common causes of poor school achievement
Clarification of mother's and family roles in improving student's cognitive abilities
Defining cognitive functions needed for learning and school achievement
o Attention, perceptive reasoning, memory, problem solving, proper use of language
Identifying sensory functions necessary for the growth of cognitive functions
Explaining factors that assist in academic excellence; Activities to improve focus and visual attention
Activities to improve visual memory
Activities to improve vigilance and auditory attention
Explaining types of memory Causes of weak memory Factors helping in improving memory Nutritional elements improving memory
Training on skills of problem-solving
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Theoretically, fortified biscuits based on chickpea flour and crushed peanuts in addition to wheat germ, and Cinnamon help in enhancing immunity, fighting viruses, maintaining regular and healthy bowel movement, regulating blood sugar and cholesterol levels, and more importantly improving cognitive abilities of school aged children. It is important to practically evaluate the effectiveness of the fortified biscuits intake for 4 months in terms of its acceptability and impact on cognitive performance for a sample of children aged 8-12 years attending rural primary schools in an Egyptian village. Eighty Children were randomly allocated in either chickpea and peanuts biscuits dependent group (40 children) or the non-dependent group (40 children).
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: chickpea; crushed peanut; Wheat germ; Cinnamon; short-term memory; working memory; visual memory; information processing; auditory attention ability