Hidden hunger - a narrative review

Efficacy of a Personalized mHealth App in Improving Micronutrient Supplement Use Among Pregnant Women in Karachi, Pakistan: Parallel-Group Randomized Controlled Trial

BACKGROUND

Micronutrient deficiencies in folate, ferritin, calcium, and vitamin D are common during pregnancy in low- and middle-income countries, often due to inadequate diets. Micronutrient supplementation can address this need, whereas innovative awareness strategies in antenatal practices could enhance supplement use compliance.

OBJECTIVE

We evaluated the efficacy of a personalized mobile health (mHealth) intervention, hypothesizing a 30% improvement in supplement use in the intervention group compared to a conventional face-to-face counseling group.

METHODS

In an unblinded randomized controlled trial, we enrolled 306 first-trimester pregnant women from Aga Khan University Hospital between January 2020 and September 2021 who owned smartphones with internet connection. Women on regular medications or with dietary restrictions or critical illnesses were excluded. The intervention group received personalized micronutrient supplement use coaching through an mHealth app (PurUmeed Aaghaz) as thrice-a-week push messages and tailored recommendations over a 24-week period. The comparison group received standard face-to-face counseling at 6, 12, 18, and 24 weeks after enrollment. Baseline sociodemographic, obstetrics, anthropometric, dietary, and lifestyle data were collected through face-to-face interviews. At each follow-up, participants reported their weekly use of folic acid, iron, calcium, and vitamin D supplements, scored as 0 (daily), 1.5 (4-6 times weekly), and 3 (≤3 times weekly). Scores were summed to calculate the cumulative supplement use score (CSUS; 0-12), with higher scores indicating greater inadequacy. Every fourth woman was invited for biochemical micronutrient assessment. Data were analyzed using Stata (version 14), with random-effects linear and logistic panel regression to compare CSUS and supplement use between the 2 groups from baseline to endline.

RESULTS

Of 153 participants per group, 107 (69.9%) in the intervention and 125 (81.7%) in the nonintervention group completed the study. After 24 weeks, the intervention group showed a greater but insignificant reduction in mean CSUS compared to the nonintervention group (β=-.27, 95% CI -0.65 to 0.12; P=.17). Daily supplement use improved by 20% versus 22.4% for folic acid, 11.2 times versus 2.1 times for iron, 1.2 times versus 14.2 times for calcium, and 3 times versus 1.3 times for vitamin D in the intervention versus nonintervention group, respectively. Multivariable analysis showed higher, though insignificant, odds of sufficient folic acid (adjusted odds ratio [aOR] 1.26, 95% CI 0.68-2.36; P=.46) and iron (aOR 1.31, 95% CI 0.95-1.81; P=.10) use in the intervention group, whereas vitamin D use was significantly higher (aOR 1.88, 95% CI 1.43-2.47; P<.001). Calcium intake improved in the nonintervention group (aOR 0.59, 95% CI 0.44-0.79; P<.001). Anemia decreased in the intervention group, whereas ferritin, calcium, and vitamin D deficiencies persisted or worsened, particularly in the nonintervention group.

CONCLUSIONS

An appropriately implemented mHealth intervention can improve antenatal vitamin D supplementation. Affordable, accessible, and personalized counseling through mHealth could ameliorate micronutrient status during pregnancy.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04216446; https://clinicaltrials.gov/study/NCT04216446.

[Association between food insecurity and infant development at age 18 months in the urban area of Pelotas, Rio Grande do Sul State, Brazil]

This study aimed to evaluate the association between household food insecurity and child development at age 18 months in the municipality of Pelotas, Rio Grande do Sul State, Brazil. This longitudinal study was carried out with a population-based sample of 465 mothers and infants from Pelotas. Infants' cognitive, motor, socioemotional, and language developments were assessed by the Bayley Scales of Infant and Toddler Development, third edition. The Brazilian Food Insecurity Scale was used to define food safety/insecurity, which classifies households into four categories: food security or mild, moderate, or severe food insecurity. The results of the adjusted analysis showed that food insecurity only affected motor and socioemotional developments at age 18 months. Each increase in food insecurity score decreased that of motor development by 2.30 points on average (95%CI: -4.31; -0.48) at age 18 months. Similarly, each increase in food insecurity score decreased that of socioemotional development by 4.05 points on average (95%CI: -7.34; -0.76). Results show that food insecurity was associated with lower motor and socioemotional developments at age 18 months and stress the importance of the right to adequate food and to environments that provide stimulating experiences for child development.

Drought Response in the Transcriptome and Ionome of Wild and Domesticated Lablab purpureus L. Sweet, an Underutilized Legume

Hunger remains a prevalent issue worldwide, and with a changing climate, it is expected to become an even greater problem that our food systems are not adapted to. There is therefore a need to investigate strategies to fortify our foods and food systems. Underutilized crops are farmed regionally, are often adapted to stresses, including droughts, and have great nutritional profiles, potentially being key for food security. One of these crops, Lablab purpureus L Sweet, or lablab, is a legume grown for humans or as fodder and shows remarkable drought tolerance. Understanding of lablab's molecular responses to drought and drought's effects on its nutritional qualities is limited and affects breeding potential. Using transcriptomics at three time points, changes in gene expression in response to drought were investigated in wild and domesticated lablab. The effect of drought on the elemental profile of lablab leaves was investigated using ionomics to assess drought's impact on nutritional quality. Differences in drought response between wild and domesticated lablab accessions were revealed, which were mainly due to differences in the expression of genes related to phosphorus metabolic response, cell wall organization, and cellular signaling. The leaves of wild and domesticated lablab accessions differed significantly in their elemental concentrations, with wild accessions having higher protein, zinc, and iron concentrations. Drought affected the concentration of some elements, with potential implications for the use of lablab under different environments. Overall, this study is an important first step in understanding drought response in lablab with implications for breeding and improvement of drought-tolerant lablab.

Impact of chickpea biofortification on the bioaccessibility of micronutrients and their relationship to obesity-linked biological activities

Micronutrient deficiencies are a critical factor in the development of obesity. This work aimed to determine the Se and Zn bioaccessibility on biofortified chickpea flour and evaluate their impact on the antioxidant and anti-inflammatory activities. The greatest increase (235 %) in isoflavones was observed in the ZnSO4-treatment compared to the control. Malonylated-formononetin-glucoside was the major isoflavone (43 %-50 %) found in the treatments. Na2SeO3-treated seeds showed the highest Se accumulation, while the greatest Zn accumulation was found in ZnSO4-treated seeds. Se bioaccesibility followed the order: Germinated Control>ZnSO4 > ZnSeO3 > ZnSO₄ + Na2SeO3 > Na2SeO3, while in the seeds biofortified with Zn salts showed the order: Germinated Control>ZnSeO3 > ZnSO₄ + Na2SeO3 > Na2SeO3 > ZnSO4. All treatments showed antioxidant activity. Na2SeO3-treatment (15.625 μg/mL) showed a significant reduction of 52 % in NO production compared to the Germinated Control. These findings demonstrated the biological value of food biofortification in providing minerals in the diet to combat the oxidative stress characteristic of obesity.

Heterologous Expression of Sunflower HaHPT and HaTMT Genes Enhances Rice-Grain Vitamin E Content

Insufficient dietary vitamin intake can lead to severe health conditions in humans. Improving the vitamin E (VE) content of food crops such as rice through breeding is an economical and effective means to alleviate this problem. In this study, Homogentisate phytyltransferase (HPT) and γ-tocopherol methyltransferase (γ-TMT), two genes derived from sunflower (Helianthus annuus L., a high VE species), were introduced into an elite rice (Oryza sativa L.) cultivar "Ningjing 7" for biofortification. We verified the successful expression of the two genes in multiple transformation events. High-performance liquid chromatography revealed that transgenic plants expressing either HaHPT alone or HaHPT and HaTMT accumulate more VE compared with the wild type. We also revealed that the level of α-tocopherol, the form of VE with the highest biological activity, had increased to 2.33 times in transgenic HaTMT plants compared with the wild type. Transcriptome analysis revealed that the expression levels of some chlorophyll synthesis pathway genes related to VE precursor synthesis significantly increased during grain filling in transgenic rice grains. No difference in agronomic traits was observed between the transgenic plants and their wild type except for a slightly reduced plant height associated with the transgenic plants. These data demonstrate that the heterologous expression of HaHPT gene is effective in increasing the total VE content, while HaTMT plays an important role in the relative abundance of α-tocopherol in rice grains. This study demonstrates a promising strategy for breeding rice with elevated VE content via metabolic engineering.

Food Insecurity and Nutritional Inadequacy in Children and Adolescents of Basic Education Schools of Cantagalo District in São Tomé and Príncipe, Central Africa

Food insecurity (FI) is a critical socioeconomic and public health problem globally, particularly affecting children's nutritional status and development. This cross-sectional study aimed to assess the prevalence of nutritional inadequacy among children and adolescents in the Cantagalo district of São Tomé and Príncipe (STP), in Central Africa. It also assessed their households' FI situation and examined sociodemographic, anthropometric, and nutritional characteristics associated with severe FI. Data included 546 children/adolescents (51.8% males, aged 9-15 years) from the eight public basic education schools. A structured questionnaire provided sociodemographic data, while anthropometric measurements assessed nutritional status. Dietary intake data were gathered using a single 24 h dietary recall, and the adjusted prevalences of nutritional inadequacy were obtained using version 2.0 of the PC-Software for Intake Distribution Estimation (PC-SIDE®). The Household Food Insecurity Access Scale was used to assess FI, and households were classified as severely or non-severely food insecure. Multivariable binary logistic regression models adjusted for potential confounders identified factors related to FI. Children's/adolescents' thinness was exhibited in 34.1% of participants, and over 95% had inadequate intake of essential micronutrients, including iron. Notably, 73.7% were severely food insecure. A higher severity of FI was positively associated with a lower intake of iron and certain household head characteristics, such as being female or older, and negatively associated with having a home garden.