Effects of a food-based intervention on markers of micronutrient status among Indian women of low socio-economic status

Community-based interventions addressing multiple forms of malnutrition among adolescents in low- and middle-income countries: a scoping review

BACKGROUND

Community-based interventions hold promise for addressing adolescent malnutrition, but there is limited knowledge of their nature and impact on adolescent nutrition outcomes in low- and middle-income countries (LMICs). This scoping review aimed to characterize community-based adolescent nutrition interventions in LMICs and summarize their effects on adolescent nutrition outcomes.

METHODS

We systematically searched MEDLINE via PubMed, Embase, and CENTRAL through the Cochrane Library for studies published between 2000 and 2023. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Eligible studies included randomized controlled trials and quasi-experimental studies addressing adolescent malnutrition in LMIC community settings, involving adolescents aged 10-19 years. A narrative synthesis was employed to analyze and describe the evidence.

RESULTS

Our review included 37 records from 36 studies conducted in 27 countries. Interventions included micronutrient supplementation, nutrition education, food supplementation and fortification, physical activity education, and multicomponent approaches. The intervention duration ranged from 3 weeks to 2 years, with limited studies grounded in theoretical frameworks. Fifty-seven percent of interventions (n = 21) targeted adolescent girls, indicating a gap in programs for boys and other vulnerable groups, such as out-of-school adolescents and migrants. The intervention delivery agents included research staff and healthcare professionals. The majority of interventions were delivered in person; few utilized social media strategies. Among the studies reviewed, nine out of ten evaluating micronutrient supplementation, six out of seven assessing nutrition education, and seven out of eight examining multicomponent interventions reported improvement in at least one nutrition or diet-related outcome.

CONCLUSIONS

Community-based interventions hold promise for improving adolescent nutritional status in LMICs. However, our review highlights gaps in the evidence base, marked by significant variability in intervention design, delivery, and implementation platforms. This underscores the need for integrated approaches and rigorous evaluations of their implementation outcomes, including acceptability, relevance, feasibility, effectiveness, and sustainability, in addressing adolescent nutrition challenges.

REGISTRATION

The review protocol was registered prospectively with the Open Science Framework on 19 July 2023 ( https://osf.io/t2d78 ).

Small Fish Big Impact: Improving Nutrition during Pregnancy and Lactation, and Empowerment for Marginalized Women

Undernutrition and micronutrient deficiencies such as anemia are considered significant public health challenges in Bangladesh, which enhancing fish consumption is a well-established food-based intervention to address these. This paper documents the establishment of community-based fish chutney production and reports the impact of its consumption on mid-upper arm circumference (MUAC) and hemoglobin (Hb) levels among targeted 150 pregnant and lactating women (PLW) in rural Bangladesh. A fish chutney was developed using locally available ingredients followed by a series of laboratory tests, including nutrient composition, shelf-life and food safety. A community-based fish chutney production process was designed to: (1) supply locally available ingredients for processing; (2) establish two fish drying sites; (3) initiate a community-based production site; and (4) distribute fish chutney to PLW for one year by six women nutrition field facilitators. Then a pre- and post-intervention study was designed for a selected 150 PLW to receive 30 g of fish chutney daily for 12 months. Differences in mean MUAC and Hb levels pre- and post-consumption were analyzed using one-way analysis of variance. Consumption of 30 g of fish-chutney resulted in significant increases of the mean values of Hb levels and MUAC among the targeted PLW.

Body Composition and Cardiometabolic Risk Markers in Children of Women who Took Part in a Randomized Controlled Trial of a Pre-conceptional Nutritional Intervention in Mumbai, India

Background

Maternal nutrition influences fetal development and may permanently alter (“program”) offspring body composition and metabolism, thereby influencing later risk of diabetes and cardiovascular (cardiometabolic) disease. The prevalence of cardiometabolic disease is rising rapidly in India.

Objectives

To test the hypothesis that supplementing low-income Indian women with micronutrient-rich foods preconceptionally and during pregnancy has a beneficial impact on the children's body composition and cardiometabolic risk marker profiles.

Methods

Follow-up of 1255 children aged 5–10 y whose mothers took part in the Mumbai Maternal Nutrition Project [Project “SARAS”; International Standard Randomised Controlled Trial Number (ISRCTN)62811278]. Mothers were randomly assigned to receive a daily micronutrient-rich snack or a control snack of lower micronutrient content, both made from local foods, in addition to normal diet, from before pregnancy until delivery. Children's body composition was assessed using anthropometry and DXA. Their blood pressure, plasma glucose, insulin, and lipid concentrations were measured. Outcomes were compared between allocation groups with and without adjustment for confounding factors.

Results

Overall, 15% of children were stunted, 34% were wasted, and 3% were overweight. In the intention-to-treat analysis, there were no differences in body composition or risk markers between children in the intervention and control groups. Among children whose mothers started supplementation ≥3 mo before conception (the “per protocol” sample) the intervention increased adiposity among girls, but not boys. BMI in girls was increased relative to controls by 2% (95% CI: 1, 4; P = 0.01); fat mass index by 10% (95% CI: 3, 18; P = 0.004); and percent fat by 7% (95% CI: 1, 13; P = 0.01) unadjusted, with similar results in adjusted models.

Conclusions

Overall, supplementing women with micronutrient-rich foods from before pregnancy until delivery did not alter body composition or cardiometabolic risk markers in the children. Subgroup analyses showed that, if started ≥3 mo before conception, supplementation may increase adiposity among female children.

Composição mineral em genótipos de batata-doce de polpas coloridas e adequação de consumo para grupos de risco

Resumo Este estudo objetivou quantificar minerais presentes em genótipos de batata-doce de polpa colorida, selecionados e cultivados pela Embrapa (Empresa Brasileira de Pesquisa Agropecuária), no sul do Rio Grande do Sul, bem como verificar o percentual de adequação de consumo em grupos de risco nutricional. Genótipos de batata-doce cultivados no Banco Ativo de Germoplasma ‒ polpa branca (Rubissol, ILS 12, ILS 10, ILS 24); polpa creme (Cuia, ILS 03, ILS 44); polpa amarela/laranja (Amélia e Beauregard); polpa roxa (ILS 56, ILS 16 e ILS 71) ‒ foram analisados em triplicata. Os minerais foram quantificados por espectrometria de absorção atômica e os resultados foram expressos em miligrama do mineral correspondente a 100 g-1 de amostra úmida. Cálculos dos percentuais de adequação da ingestão diária recomendada de cada genótipo para grupos de risco (crianças entre 4 e 8 anos e gestantes entre 19 e 30 anos), com base no consumo de uma porção média de 200 g diários, foram realizados. As batatas-doces apresentaram grande variação na quantidade de minerais entre os genótipos e o potássio foi o mais abundante em todos estes, com destaque para os genótipos ILS 44, ILS 56 e ILS 71. Os genótipos de coloração roxa se sobressaíram na quantidade de potássio e os de coloração creme, na quantidade de fósforo. O consumo de uma porção média de 200 g de qualquer uma das batatas-doces forneceria 28% da necessidade de magnésio a crianças de 4 a 8 anos, e em torno de 20% das necessidades diárias de magnésio e 10% de potássio para gestantes.

GWAS identifies population-specific new regulatory variants in FUT6 associated with plasma B12 concentrations in Indians

Vitamin B12 is an important cofactor in one-carbon metabolism whose dysregulation is associated with various clinical conditions. Indians have a high prevalence of B12 deficiency but little is known about the genetic determinants of circulating B12 concentrations in Indians. We performed a genome-wide association study in 1001 healthy participants in the Pune Maternal Nutrition Study (PMNS), replication studies in 3418 individuals from other Indian cohorts and by meta-analysis identified new variants, rs3760775 (P = 1.2 × 10⁻²³) and rs78060698 (P = 8.3 × 10⁻¹⁷) in FUT6 to be associated with circulating B12 concentrations. Although in-silico analysis replicated both variants in Europeans, differences in the effect allele frequency, effect size and the linkage disequilibrium structure of credible set variants with the reported variants suggest population-specific characteristics in this region. We replicated previously reported variants rs602662, rs601338 in FUT2, rs3760776, rs708686 in FUT6, rs34324219 in TCN1 (all P < 5 × 10⁻⁸), rs1131603 in TCN2 (P = 3.4 × 10⁻⁵), rs12780845 in CUBN (P = 3.0 × 10⁻³) and rs2270655 in MMAA (P = 2.0 × 10⁻³). Circulating B12 concentrations in the PMNS and Parthenon study showed a significant decline with increasing age (P < 0.001), however, the genetic contribution to B12 concentrations remained constant. Luciferase reporter and electrophoretic-mobility shift assay for the FUT6 variant rs78060698 using HepG2 cell line demonstrated strong allele-specific promoter and enhancer activity and differential binding of HNF4α, a key regulator of expression of various fucosyltransferases. Hence, the rs78060698 variant, through regulation of fucosylation may control intestinal host-microbial interaction which could influence B12 concentrations. Our results suggest that in addition to established genetic variants, population-specific variants are important in determining plasma B12 concentrations.

Vitamin B12 deficiency

Vitamin B₁₂ (B12; also known as cobalamin) is a B vitamin that has an important role in cellular metabolism, especially in DNA synthesis, methylation and mitochondrial metabolism. Clinical B12 deficiency with classic haematological and neurological manifestations is relatively uncommon. However, subclinical deficiency affects between 2.5% and 26% of the general population depending on the definition used, although the clinical relevance is unclear. B12 deficiency can affect individuals at all ages, but most particularly elderly individuals. Infants, children, adolescents and women of reproductive age are also at high risk of deficiency in populations where dietary intake of B12-containing animal-derived foods is restricted. Deficiency is caused by either inadequate intake, inadequate bioavailability or malabsorption. Disruption of B12 transport in the blood, or impaired cellular uptake or metabolism causes an intracellular deficiency. Diagnostic biomarkers for B12 status include decreased levels of circulating total B12 and transcobalamin-bound B12, and abnormally increased levels of homocysteine and methylmalonic acid. However, the exact cut-offs to classify clinical and subclinical deficiency remain debated. Management depends on B12 supplementation, either via high-dose oral routes or via parenteral administration. This Primer describes the current knowledge surrounding B12 deficiency, and highlights improvements in diagnostic methods as well as shifting concepts about the prevalence, causes and manifestations of B12 deficiency.

Improving the health and welfare of people who live in slums

In the first paper in this Series we assessed theoretical and empirical evidence and concluded that the health of people living in slums is a function not only of poverty but of intimately shared physical and social environments. In this paper we extend the theory of so-called neighbourhood effects. Slums offer high returns on investment because beneficial effects are shared across many people in densely populated neighbourhoods. Neighbourhood effects also help explain how and why the benefits of interventions vary between slum and non-slum spaces and between slums. We build on this spatial concept of slums to argue that, in all low-income and-middle-income countries, census tracts should henceforth be designated slum or non-slum both to inform local policy and as the basis for research surveys that build on censuses. We argue that slum health should be promoted as a topic of enquiry alongside poverty and health.

A Daily Snack Containing Leafy Green Vegetables, Fruit, and Milk before and during Pregnancy Prevents Gestational Diabetes in a Randomized, Controlled Trial in Mumbai, India

BACKGROUND

Prospective observational studies suggest that maternal diets rich in leafy green vegetables and fruit may help prevent gestational diabetes mellitus (GDM).

OBJECTIVE

Our objective was to test whether increasing women's dietary intake of leafy green vegetables, fruit, and milk before conception and throughout pregnancy reduced their risk of GDM.

METHODS

Project SARAS ("excellent") (2006-2012) was a nonblinded, individually randomized, controlled trial in women living in slums in the city of Mumbai, India. The interventions included a daily snack made from leafy green vegetables, fruit, and milk for the treatment group or low-micronutrient vegetables (e.g., potato and onion) for the control group, in addition to the usual diet. Results for the primary outcome, birth weight, have been reported. Women were invited to take an oral-glucose-tolerance test (OGTT) at 28-32 wk gestation to screen for GDM (WHO 1999 criteria). The prevalence of GDM was compared between the intervention and control groups, and Kernel density analysis was used to compare distributions of 120-min plasma glucose concentrations between groups.

RESULTS

Of 6513 women randomly assigned, 2291 became pregnant; of these, 2028 reached a gestation of 28 wk, 1008 (50%) attended for an OGTT, and 100 (9.9%) had GDM. In an intention-to-treat analysis, the prevalence of GDM was reduced in the treatment group (7.3% compared with 12.4% in controls; OR: 0.56; 95% CI: 0.36, 0.86; P = 0.008). The reduction in GDM remained significant after adjusting for prepregnancy adiposity and fat or weight gain during pregnancy. Kernel density analysis showed that this was explained by the fact that fewer women in the treatment group had a 2-h glucose concentration in the range 7.5-10.0 mmol/L.

CONCLUSIONS

In low-income settings, in which women have a low intake of micronutrient-rich foods, improving dietary micronutrient quality by increasing intake of leafy green vegetables, fruit, and/or milk may have an important protective effect against the development of GDM. This trial was registered at www.controlled-trials.com as ISRCTN62811278.