title: Micronutrient-Fortified Milk and Academic  Performance among Chinese Middle School Students:  A Cluster-Randomized Controlled Trial.
abstract: Many children suffer from nutritional deficiencies that may negatively affect their academic performance. This cluster-randomized controlled trial aimed to test the effects of micronutrient-fortified milk in Chinese students. Participants received either micronutrient-fortified (n = 177) or unfortified (n = 183) milk for six months. Academic performance, motivation, and learning strategies were estimated by end-of-term tests and the Motivated Strategies for Learning Questionnaire. Blood samples were analyzed for micronutrients. In total, 296 students (82.2%) completed this study. Compared with the control group, students in the intervention group reported higher scores in several academic subjects (p < 0.05), including languages, mathematics, ethics, and physical performance at the end of follow-up. Students in the intervention group showed greater self-efficacy and use of cognitive strategies in learning, and reported less test anxiety (p < 0.001). Moreover, vitamin B2 deficiency (odds ratio (OR) = 0.18, 95% confidence interval (CI): 0.11~0.30) and iron deficiency (OR = 0.34, 95% CI: 0.14~0.81) were less likely in the students of the intervention group, whereas vitamin D, vitamin B12, and selenium deficiencies were not significantly different. "Cognitive strategy" had a partial mediating effect on the test scores of English (95% CI: 1.26~3.79) and Chinese (95% CI: 0.53~2.21). Our findings suggest that micronutrient-fortified milk may improve students' academic performance, motivation, and learning strategies.
authors.affiliation: Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China. wangxiaoqin@mail.xjtu.edu.cn.
authors.forename: Xiaoqin
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China. huizhaozhao93@163.com.
authors.forename: Zhaozhao
authors.initials: Z
authors.lastname: Hui
authors.affiliation: Department of Nursing, Shaanxi Provincial Tumor Hospital, Xi'an 710061, China. Daixling113@126.com.
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Dai
authors.affiliation: Department of Medicine, University of Tennessee Medical Center, Knoxville, TN 37996, USA. pdterry@utk.edu.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Terry
authors.affiliation: Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China. zymoon95@126.com.
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China. wysun201314195@163.com.
authors.forename: Mei
authors.initials: M
authors.lastname: Ma
authors.affiliation: Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China. wangmx601@mail.xjtu.edu.cn.
authors.forename: Mingxu
authors.initials: M
authors.lastname: Wang
authors.affiliation: Xi'an Tie Yi High School, Xi'an 710000, China. dengfu01@126.com.
authors.forename: Fu
authors.initials: F
authors.lastname: Deng
authors.affiliation: Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China. 232guwei@mail.xjtu.edu.cn.
authors.forename: Wei
authors.initials: W
authors.lastname: Gu
authors.affiliation: Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China. shuangyan724@163.com.
authors.forename: Shuangyan
authors.initials: S
authors.lastname: Lei
authors.affiliation: Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China. ch@163.com.
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China. wysun201314195@163.com.
authors.forename: Mingyue
authors.initials: M
authors.lastname: Ma
authors.affiliation: Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China. zhbin@mail.xjtu.edu.cn.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000453:epidemiology; D000818:Animals; D044466:Asian People; D015992:Body Mass Index; D002648:Child; D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D004032:Diet; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D005527:Food, Fortified; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000097:blood; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000178:diet therapy / Q000453:epidemiology*; D018977:Micronutrients / Q000008:administration & dosage / Q000097:blood / Q000172:deficiency*; D008892:Milk / Q000737:chemistry*; D009752:Nutritional Status; D015995:Prevalence; D012256:Riboflavin / Q000008:administration & dosage / Q000097:blood; D012257:Riboflavin Deficiency / Q000097:blood / Q000453:epidemiology; D012643:Selenium / Q000008:administration & dosage / Q000097:blood / Q000172:deficiency; D013334:Students; D011795:Surveys and Questionnaires; D014801:Vitamin A / Q000008:administration & dosage / Q000097:blood; D014805:Vitamin B 12 / Q000008:administration & dosage / Q000097:blood; D014807:Vitamin D / Q000008:administration & dosage / Q000097:blood
chemical_list: D018977:Micronutrients; D014801:Vitamin A; D014807:Vitamin D; D007501:Iron; D012643:Selenium; D014805:Vitamin B 12; D012256:Riboflavin
keywords: fortified  milk;   academic  performance;   micronutrient;   middle  school  students;   motivated strategies for learning