The BiZiFED project: Biofortified zinc flour to eliminate deficiency in Pakistan

Role of Nutrition Information in Acceptance and Willingness to Pay for Biofortified Cereal Food: Implications for Better Health and Sustainable Diet

A range of nutritional needs are met through the use of fortified farm-based foods. Wheat biorfortification with zinc is such an example where biorfortification is carried out for a crucial element like Zinc. Zinc-biofortified wheat (Zn-wheat) has been officially launched in Pakistan since 2016 but its wide-scale dissemination, adoption and consumption have not taken place till to date. On the other hand, essential nutrients deficiencies have wide-ranging implications for public health especially for children and lactating mothers. This study is undertaken to know the reasons for the slow progression of scaling up of biofortified wheat varieties in Pakistan, people’s awareness about biofortified wheat and to recognize the role of information in acceptance and willingness to pay for this wheat. For this purpose, randomly selected 474 households were interviewed from four districts of Punjab province. They were categorized into four groups based on their exposure to information in real and hypothetical cheap talk (game theory context). Study findings reveal that respondents were ready to pay for fortified wheat if they are aware about nutrient aspects and Zn deficiency. Using Discrete Choice Experiment, the preferences for and factors affecting the willingness to pay for fortified wheat are evaluated. Main factors having positive impact include household head’s education and income, having pregnant women and children <5 years age. It was also found that people having valid information about nutrients of a food would be willing to pay more. The study highlights need for policy focus on educating people about nutritional aspects as well as making available biofortified foods to promote healthy living.

Community Perceptions of Zinc Biofortified Flour during an Intervention Study in Pakistan

Zinc-biofortified flour may be a cost-effective approach to improve zinc status of populations in low-resource settings. The success of biofortification programmes is subject to acceptability and uptake by consumers. This study explored community leaders’ and community members’ (n = 72) experiences and attitudes towards the flour provided during a cluster randomised controlled trial of zinc biofortified wheat in rural Pakistan (BiZiFED2). Focus group discussions (n = 12) were conducted and thematic analysis applied using an inductive, semantic, contextualist approach. Five themes were identified: (1) Contribution to food security; (2) Better sensory and baking properties than local flour; (3) Perceived health benefits; (4) Willingness to pay for the flour; and (5) Importance of trusted promoters/suppliers. Although the participants were blind to whether they had received control or biofortified flour, referred to collectively as “study flour”, the results indicated that the study flour performed well in terms of its taste and bread making qualities, with no adverse reports from participants in either arm of the BIZIFED2 RCT. Participants suggested that they would buy the biofortified wheat if this was available at a fair price due to perceived health benefits, reporting positive sensory characteristics and cooking attributes when compared to the flour available in the local markets. Overall, there was a positive reception of the programme and flour among the participants, and members of the community hoped for its continuation and expansion.

Biofortified Wheat Increases Dietary Zinc Intake: A Randomised Controlled Efficacy Study of Zincol-2016 in Rural Pakistan

A new variety of zinc biofortified wheat (Zincol-2016) was released in Pakistan in 2016. The primary aim of this study was to examine the effects of consuming Zincol-2016 wheat flour on biochemical and functional markers of zinc status in a population with widespread zinc deficiency. An individually-randomised, double-blind, placebo-controlled cross over design was used. Fifty households were recruited to participate in the study, with each household included at least one woman of reproductive age (16–49 years) who was neither pregnant nor breast feeding or currently taking nutritional supplements. All households were provided with control flour for an initial 2-week baseline period, followed by the intervention period where households were randomly allocated in a 1:1 ratio to receive biofortified flour (group A; n = 25) and control flour (group B; n = 25) for 8-weeks, then switched to the alternate flour for 8-weeks. The trial has been registered with the ISRCTN (https://www.isrctn.com), ID ISRCTN83678069. The primary outcome measure was plasma zinc concentration, and the secondary outcome measures were plasma selenium and copper concentrations, plasma copper:zinc ratio and fatty acid desaturase and elongase activity indices. Nutrient intake was assessed using 24-h dietary recall interviews. Mineral concentrations in plasma were measured using inductively coupled plasma mass spectrometry and free fatty acids and sphingolipids by mass spectrometry. Linear Mixed Model regression and General Linear Model with repeated measures were used to analyse the outcomes. Based on an average flour consumption of 224 g/day, Zincol-2016 flour provided an additional daily zinc intake of between 3.0 and 6.0 mg for white and whole grain flour, respectively. No serious adverse events were reported. This resulted in significant, increase in plasma zinc concentration after 4 weeks [mean difference 41.5 μg/L, 95% CI (6.9–76.1), p = 0.02]. This was not present after 8 weeks (p = 0.6). There were no consistent significant effects of the intervention on fatty acid desaturase and elongase activity indices. Regular consumption of Zincol-2016 flour increased the daily zinc intake of women of reproductive age by 30–60%, however this was not associated with a sustained improvement in indices of zinc status.

Severity of zinc and iron malnutrition linked to low intake through a staple crop: a case study in east-central Pakistan

Micronutrients deficiency in soil-plant and human is well-addressed; however, little is known about their spatial distribution, magnitude of deficiency and biological nexus. Zinc deficiency (ZnD) and iron-deficiency anemia (FeD) are two serious nutritional concerns which are negatively affecting human health. Herein, a survey-based case study was conducted in major wheat-based cropping system of east-central Pakistan. Soil and grain samples were collected from 125 field-grown wheat from 25 distinct sites/villages and GPS coordinates were taken for mapping. The collected samples were tags according to the names of 25 sites, i.e., UCs (union councils; an administrative unit). The quantified amount of zinc (Zn) or iron (Fe) in soil-wheat grains was compared with their recommended concentrations (RCZn, RCFe) for human nutrition. Additionally, clinical features of ZnD and FeD were diagnosed among local farmers who used to consume these grains, throughout the year, cultivated on their farm, and quantified their deficiency prevalence (ZnDP, FeDP). Results revealed, the collected 64% (0.54 to 5.25 mg kg^-1) soils, and 96% (1.4 to 31 mg kg^-1) grain samples are Zn-deficient (RCZn) along with ZnDP recorded among 68% of population. Meanwhile, FeD is quantified in 76% (1.86 to 15 mg kg^-1) soil, 72% grain (2.1 to 134 mg kg^-1) samples, and FeDP is found among 84% of studied population. A strong and positive correlation is developed in the Zn-or FeDP with their deficiencies in soil and grain by plotting multivariate analysis. In line with spatial distribution pattern, the UCs, namely, 141, 151, 159 and 132 are quantified severe deficient in Zn and Fe, and others are marginal or approaching to deficient level. Our findings rationalize the biological nexus of Zn and Fe, and accordingly, draw attention in the biofortification of staple crop as a win-win approach to combat the rising malnutrition concerns.

Zinc biofortification potential of diverse mungbean [Vigna radiata (L.) Wilczek] genotypes under field conditions

Zinc (Zn) is an important micronutrient for crop plants and essential for human health. The Zn-deficiency is an important malnutrition problem known globally. Biofortified foods could overcome Zn deficiency in humans. Mungbean [Vigna radiata (L.) Wilczek] is an important, pulse crop frequently grown in arid and semi-arid regions of the world. Mungbean could provide essential micronutrients, including Zn to humans. Therefore, it is very important to investigate the impact of Zn fertilization on the yield and grain biofortification of mungbean. Twelve mungbean genotypes (i.e., NM-28, NM-2011, NM-13-1, NM-2006, NM-51, NM-54, NM-19-19, NM-92, NM-121-25, NM-20-21, 7006, 7008) were assessed for their genetic diversity followed by Zn-biofortification, growth and yield under control (0 kg ha-1) and Zn-fertilized (10 kg ha-1) conditions. Data relating to allometric traits, yield components, grain yield and grain Zn contents were recorded. Zinc fertilization improved entire allometric and yield-related traits. Grain yield of different genotypes ranged from 439 to 904 kg ha-1 under control and 536 to 1462 kg ha-1 under Zn-fertilization. Zinc concentration in the grains varied from 15.50 to 45.60 mg kg-1 under control and 18.53 to 64.23 mg kg-1 under Zn-fertilized conditions. The tested genotypes differed in their Zn-biofortification potential. The highest and the lowest grain Zn contents were noted for genotypes NM-28 and NM-121-25, respectively. Significant variation in yield and Zn-biofortification indicated the potential for improvement in mungbean yield and grain Zn-biofortification. The genotypes NM-28 and NM-2006 could be used in breeding programs for improvement in grain Zn concentration due to their high Zn uptake potential. Nonetheless, all available genotypes in the country should be screened for their Zn-biofortification potential.

Agronomic Biofortification of Zinc in Pakistan: Status, Benefits, and Constraints

Micronutrient malnutrition (e.g., zinc) is one of the major causes of human disease burden in the developing world. Zinc (Zn) deficiency is highly prevalent in the Pakistani population (22.1%), particularly in women and children (under 5 years) due to low dietary Zn intake. In Pakistan, wheat is the primary staple food and is poor in bioavailable Zn. However, the number of malnourished populations has decreased over the last decade due to multiplied public awareness, accelerated use of Zn fertilizers (particularly in wheat and rice), initiation of several national/international research initiatives focusing on Zn biofortification in staple crops and availability of supplements and Zn fortified meals merchandise, nonetheless a large number of people are facing Zn or other micronutrient deficiencies in the country. There are few reports highlighting the significant increase in daily dietary Zn uptake in population consuming biofortified wheat (Zincol-2016) flour; indicating the positive prospect of biofortification interventions up scaling in lowering the risk of dietary Zn deficiency in rural and marginalized communities. Zinc fertilizer strategy has not only helped in enhancing the grain Zn concentration, but it also helped in improving crop yield with high economic return. In addition, Zn biofortified seeds have exhibited strong inherent ability to withstand abiotic stresses and produce higher grain yield under diverse climatic conditions. However, there are many constraints (soil, environment, genetic diversity, antinutrients concentration, socioeconomic factors etc.) that hinder the success of biofortification interventions. This review highlights the status of Zn deficiency in Pakistan, the success of agronomic and genetic biofortification interventions. It also discusses the economics of agronomic biofortification and cost effectiveness of Zn fertilization in field conditions in Pakistan and the potential of Zn biofortified seeds against abiotic stresses. Furthermore, it also highlights the constraints which limit the sustainability of biofortification interventions.

Biofortification of wheat with zinc for eliminating deficiency in Pakistan: study protocol for a cluster-randomised, double-blind, controlled effectiveness study (BIZIFED2)

INTRODUCTION

Micronutrient deficiencies, commonly referred to as 'hidden hunger', affect more than two billion people worldwide, with zinc and iron-deficiency frequently reported. The aim of this study is to examine the impact of consuming zinc biofortified flour (Zincol-2016) on biochemical and functional measures of status in adolescent girls and children living in a low-resource setting in Pakistan.

METHODS AND ANALYSIS

We are conducting a pragmatic, cluster-randomised, double-blind, controlled trial. A total of 482 households have been recruited from two catchment areas approximately 30-40 km distance from Peshawar. Household inclusion criteria are the presence of both an adolescent girl, aged 10-16 years, and a child aged 1-5 years. The study duration is 12 months, divided into two 6-month phases. During phase 1, all households will be provided with locally procured flour from standard varieties of wheat. During phase 2, clusters will be paired, and randomised to either the control or intervention arm of the study. The intervention arm will be provided with zinc biofortified wheat flour, with a target zinc concentration of 40 mg/kg. The control arm will be provided with locally procured wheat flour from standard varieties with an expected zinc concentration of 20 mg/kg. The primary outcome measure is plasma zinc concentration. Secondary outcomes include anthropometric measurements, biomarkers of iron and zinc status, and the presence and duration of respiratory tract infections and diarrhoea.

ETHICS AND DISSEMINATION

Ethical approval was granted from the University of Central Lancashire STEMH Ethics Committee (reference number: STEMH 1014) and Khyber Medical University Ethics Committee (DIR/KMU-EB/BZ/000683). The final study methods will be published in peer-reviewed journals, alongside the study outcomes. In addition, findings will be disseminated to the scientific community via conference presentations and abstracts and communicated to the study participants through the village elders at an appropriate community forum.

TRIAL REGISTRATION NUMBER

ISRCTN17107812; Pre-results.

Additive interactions of nanoparticulate ZnO with copper, manganese and iron in Pisum sativum L., a hydroponic study

Widespread occurrence of ZnO nanoparticles in environment follows the growing number of applications either in technology or agriculture. The impact of five forms of nanoparticulate ZnO on copper, manganese and iron uptake by Pisum sativum L. cultivated in Hoagland solutions was investigated. Plants were collected after twelve days of zinc administration. Effect of bulk ZnO has also been studied. Initial zinc concentration was 100 mg L^-1. Nanoparticles were characterized by the Transmission Electron Microscopy, Dynamic Light Scattering and Zeta potential measurements. Metal contents were analyzed using the Atomic Absorption Spectrometry with flame atomization for samples digested in a microwave closed system. Analysis of variance indicated that zinc species at either molecular or nanoscale levels altered Cu, Mn and Fe uptake and their further transport in pea plants. In particular, significant reduction of Mn and Fe combined with the Cu increase was observed. Additive interactions originated by nanoparticles affect the heavy metals uptake and indicate pollutants migration pathways in plants. Unfortunately, regulations for the plant cultivation were formulated when anthropogenic nanoparticles were not in common use. They underestimate complexity of metals interactions in either plant or habitat. Our results indicate that these additive interactions cannot be neglected and deserve further investigations.

Zinc status and its requirement by rural adults consuming wheat from control or zinc-treated fields

Human zinc (Zn) deficiency is prevalent in areas where cereals dominate in the diet. Soil Zn application may enhance the concentration of Zn in wheat grains and dietary Zn intake by target populations. However, its value has never been practically quantified in Zn nutrition of any population group. We, therefore, studied farming families in rural Punjab (Pakistan). The selected adults (n = 156, grouped based on age and gender) were Zn undernourished (as assessed by estimated Zn bioavailability in their diet) and their plasma Zn levels also indicated Zn deficiency. On average, wheat consumption by the adults contributed about 68% in total Zn and 93% in total phytate intakes. Soil Zn application to wheat fields significantly increased Zn and decreased phytate concentration in chapati (flatbread made of whole-wheat flour). From dietary phytate intakes by the adults, we calculated desired chapati Zn concentration and dietary Zn intake that would meet their daily Zn requirement. The physiological Zn requirements of adult women and men were estimated to be achieved by intake of, respectively, 10.4-15.3 mg Zn d^-1 (37-46 mg Zn kg^-1 in chapati) and 14.4-23.3 mg Zn d^-1 (41-52 mg Zn kg^-1 in chapati). It was evident that soil Zn application aiming at optimum grain yield of wheat significantly improved Zn nutrition of the studied adults, but not up to desired levels. High Zn applications (via soil and/or foliage) to wheat and growing cultivars specifically selected for Zn biofortification may be needed to optimise Zn nutrition in rural Pakistan.