Effects of blending ratio variation on macronutrient compositions and sensory acceptability of dabi teff-field pea-based novel composite complementary flours

The response of a mixed system is determined by the proportions of the various ingredients that add up to one, not by the combination's total amount. This research aimed at examining the effects of blending ratio variation on the macro-composition and sensory acceptability of dabi teff-field pea-based novel composite complementary flours. Standard methods (AOAC, 2016, Official Methods of Analysis of the Association of Official Analytical Chemists) were used to determine macronutrients. The sensory attributes were evaluated using a 5-point hedonic scale. The ingredients were constrained at 0%-30% for field pea, 20%-35% for dabi teff, and 5%-20% for maize, while the remaining were set constant at 5% linseed, 15% oats, and 25% barley. D-optimal was used to examine the effects of blending ratio variation on the responses. All the responses were significantly different (p < .05) among the blends except for fat content, ranging from 14.58% to 17.21% for protein, 4.22% to 5.59% fat, 2.01% to 2.60% ash, 2.68% to 3.96% fiber, 68.08% to 70.76% utilizable carbohydrate, and 378.82 to 386.9 kcal/100 g gross energy. The sensory acceptability score ranged from 3.4 to 4.4. The linear model was significant (p < .05) and adequate to describe variation in moisture, protein, and ash contents. An increase in the ratio of field pea significantly increased (p < .05) protein, ash, fiber, and energy. The interactive effect between dabi teff and field pea significantly increased the sensory acceptability of the blends. These findings showed that varied proportions of the ingredients had a significant effect on the responses, and were used to develop a wholesome product to combat protein-energy malnutrition among children.

Vitamin E deficiency in childhood: a narrative review

Vitamin E is an important nutrient from the earliest stages of life. It plays key roles as an antioxidant and in the maintenance of the immune system, among others. Vitamin E deficiency (VED), which occurs more frequently in children, is rarely addressed in the literature. This narrative review aims to summarise the chemistry, biology, serum indicators and clinical trials that have evaluated the impact of fortification and other relevant aspects of vitamin E, in addition to the prevalence of its deficiency, in children worldwide. Vitamin E intake in recommended amounts is essential for this nutrient to perform its functions in the body. Serum α-tocopherol is the most widely used biochemical indicator to assess the prevalence of VED. VED has been associated with symptoms secondary to fat malabsorption and may lead to peripheral neuropathy and increased erythrocyte haemolysis. Reduced concentrations of α-tocopherol may be caused by the combination of diets with low amounts of vitamin E and inadequate consumption of fats, proteins and calories. The lowest prevalence of VED was found in Asia and the highest in North America and Brazil. High proportions of VED provide evidence that this nutritional deficiency is a public health problem in children and still little addressed in the international scientific literature. The planning, evaluation and implementation of health policies aimed at combatting VED in the paediatric population are extremely important.

Optimization of dabi teff-field pea based energy and protein dense novel complementary food with improved sensory acceptability using D-optimal mixture design

Protein-energy malnutrition is unacceptably high among children in developing countries due to inadequate required nutrients and poor quality of complementary foods characterized by low protein and energy density and often monotonous. Thus, this research was aimed at examining the potential of including dabi teff, the underutilized/forgotten crop into pre-processed local food crops viz., germinated maize, roasted barley, roasted field pea, dehulled oats and linseed to develop energy and protein-dense optimized novel complementary food with improved sensory acceptability. Nutrisurvey software was employed to define ranges and they were constrained at 20-35% dabi teff, 0-30% field pea and 5-20% maize, while the rest were set constant at 25% barley, 15% oats and 5% linseed. Eleven experimental runs were generated from the six mixture components using D-optimal mixture design, Stat-Ease Design Expert ® software version 11. A 5-point Hedonic scale was used to evaluate the sensory attributes. 'Scheffe' regression was used to fit and test model adequacy and numerical multi-response optimization was performed to identify optimal points using the Design expert. Field pea and linseed contained significantly higher (P < 0.05) protein at 20.95% and 20.57%. The newly formulated products contained significantly higher protein (1.4-1.6 times) and protein density (1.31-1.56 times) as compared to the control and fulfilled the recommended standard. The optimal was identified at 34.66% dabi teff, 25% barley, 15% oats, 15.34% field pea, 5% linseed and 5% maize flour ratios with response values at overall optimization to be 5.57% moisture, 15.74% protein, 5.09% fat, 2.26% ash, 2.88% fiber, 73.05% carbohydrate, 380.43 kcal/100 g energy and 4.12 sensory acceptability score and it contained an energy density of 1.27 kcal/g and protein density of 4.14 g/100kacl. These findings showed that optimized dabi teff-field pea based novel complementary food can be used as a sustainable food-based strategy to combat protein-energy malnutrition among children in developing countries.

Sweetpotato-based infant foods produce porridge with lower viscosity and aflatoxin level than cereal-based complementary blends

The viscosity, protein, and total aflatoxins contents in orange-fleshed sweetpotato (OFSP) and cereal-based commercial complementary formulations and the effect of dilution on the protein content of the formulations were investigated. Standard procedures were used for the determination of these parameters. Over 80% of the formulations had a viscosity above the recommended consistency of 1000-3000 cP for feeding young children. The consistency of OFSP-legume porridge was significantly (2392.5 cP; p < 0.001) lower, about 1.7 and 3.4 times than cereal-only and cereal-legume blends, respectively. All the complementary flours, except the cereal-only, met the proposed protein requirement of 6 to 11 g per 100 g for feeding children aged 6 to 23 months on an as-is basis. However, the protein content in the porridges on an as-would-be-eaten basis was about 6% lower than the as-is basis value. About 38% of the complementary foods had total aflatoxin level above the acceptable limit of 10 ppb, mainly in blends containing peanuts, maize, or both. Adding more water to meet the required thickness of cereal-only and cereal-legume porridges diluted the protein content. More efforts are needed from regulatory bodies and all stakeholders to ensure complementary foods are safe in terms of mycotoxin levels, particularly those containing maize, peanut, or both as ingredients.

Food Fortification of Instant Pulse Porridge Powder with Improved Iron and Zinc Bioaccessibility Using Roselle Calyx

Undernutrition and mineral deficiencies negatively impact both the health and academic performance of school children, while diets high in phytic acid and some phenolics inhibit the absorption of minerals such as iron and zinc. This study developed instant porridge powders rich in iron and zinc using pregelatinized chickpea flour (PCPF) and pregelatinized foxtail millet flour (PFMF) and assessed the potential of utilizing roselle calyx powder (RCP) as a source of organic acids to enhance its iron and zinc bioaccessibility. Physical properties, nutrients, mineral inhibitors and in vitro iron and zinc bioaccessibility of different proportions of PCPF, PFMF and RCP in instant porridge powders were evaluated. Three instant porridge powder formulations including instant chickpea powder (ICP) using PCPF, instant composite flour (ICF) using PCPF and PFMF and instant pulse porridge powder (IPP) using PCPF, PFMF and RCP were developed. Results show that all instant porridge powders were accepted by sensory evaluation, while different ingredients impacted color, consistency and the viscosity index. Addition of RCP improved the bioaccessibility of iron (1.3-1.6-fold) and zinc (1.3-1.9-fold). A 70 g serving of these instant porridge powders substantially contributed to daily protein, iron and zinc requirement for children aged 7-9 years. These porridge powders hold potential to serve as school meals for young children in low-to-middle income countries.

Anaemia, iron and vitamin A status among South African school-aged children living with and without HIV

Background. Data on iron and vitamin A deficiency are scarce in school-aged children living with HIV (HIV+) compared with children without HIV (HIV–). Both deficiencies can contribute to anaemia. Objective. To assess anaemia, iron and vitamin A status in a sample of HIV+ and HIV– school-aged children in South Africa. Methods. In this comparative cross-sectional study, biomarkers for anaemia (haemoglobin), iron (plasma ferritin (PF), soluble transferrin receptor), vitamin A (retinol-binding protein (RBP)) and inflammatory status (C-reactive protein, α-1-acid glycoprotein) were measured in 8 - 13-year-old children from Cape Town living with (n=143) and without HIV (n=148). Measurements of PF and RBP were adjusted for inflammation using a regression-correction approach. Results. HIV+ children had higher prevalences of anaemia (29% v. 14%; odds ratio (OR) = 2.6; 95% confidence interval (CI) 1.4 - 4.9; p=0.002), iron-deficient erythropoiesis (20% v. 9%; OR=2.5; 95% CI 1.2 - 5.0; p=0.013) and iron deficiency anaemia (11% v. 4%; OR=2.9; 95% CI 1.1 - 7.7; p=0.035) than HIV– children. Marginal vitamin A deficiency was noted in 52% of HIV+ and 57% of HIV– children (p=0.711). Subclinical inflammation was more prevalent in HIV+ than HIV– children (p=0.012). Conclusion. Anaemia, iron-deficient erythropoiesis and iron deficiency anaemia were more prevalent in HIV+ than HIV– children. Prevalence of marginal vitamin A deficiency was high in both groups. Efforts to improve micronutrient status and mitigate nutritional determinants of anaemia in HIV+ children from resource-limited settings should be prioritised.

Comparison of yield, chemical composition and farinograph properties of common and ancient wheat grains

The chemical composition of 4 spring wheat species was analyzed: einkorn (Triticum monococcum) (local cv.), emmer (Triticum dicoccon) (Lamella cv.), spelt (Triticum spelta) (Wirtas cv.), and common wheat (Triticum aestivum) (Rospuda cv.). Mean emmer and einkorn yield was significantly lower than that of common wheat. The analyses of the wheat grain included the content of total protein, crude ash, crude fat, crude fibre, carbohydrates, phosphorus, potassium, magnesium, calcium, copper, iron, manganese, and zinc. The grains of the tested ancient wheats were richer in protein, lipids, crude fibre, and crude ash than the common wheat grains. The significantly highest levels of crude protein, ether extract, and crude ash were found in einkorn. As the protein concentration in the grain increased, the calcium, magnesium, and potassium levels increased, and the zinc and manganese levels decreased. Genotypic differences between the studied wheats were reflected in the concentrations of the minerals and nutrients, an observation which can be useful in further cross-linkage studies. Dough made from common wheat and spelt flour showed better performance quality classifying it to be used for bread production. In turn, flour from emmer and einkorn wheat may be intended for pastry products, due to short dough development time and constancy as well as high softening.

Examining Associations of HIV and Iron Status with Nutritional and Inflammatory Status, Anemia, and Dietary Intake in South African Schoolchildren

The etiology of multifactorial morbidities such as undernutrition and anemia in children living with the human immunodeficiency virus (HIV) (HIV+) on antiretroviral therapy (ART) is poorly understood. Our objective was to examine associations of HIV and iron status with nutritional and inflammatory status, anemia, and dietary intake in school-aged South African children. Using a two-way factorial case-control design, we compared four groups of 8 to 13-year-old South African schoolchildren: (1) HIV+ and low iron stores (inflammation-unadjusted serum ferritin ≤ 40 µg/L), n = 43; (2) HIV+ and iron sufficient non-anemic (inflammation-unadjusted serum ferritin > 40 µg/L, hemoglobin ≥ 115 g/L), n = 41; (3) children without HIV (HIV-ve) and low iron stores, n = 45; and (4) HIV-ve and iron sufficient non-anemic, n = 45. We assessed height, weight, plasma ferritin (PF), soluble transferrin receptor (sTfR), plasma retinol-binding protein, plasma zinc, C-reactive protein (CRP), α-1-acid glycoprotein (AGP), hemoglobin, mean corpuscular volume, and selected nutrient intakes. Both HIV and low iron stores were associated with lower height-for-age Z-scores (HAZ, p < 0.001 and p = 0.02, respectively), while both HIV and sufficient iron stores were associated with significantly higher CRP and AGP concentrations. HIV+ children with low iron stores had significantly lower HAZ, significantly higher sTfR concentrations, and significantly higher prevalence of subclinical inflammation (CRP 0.05 to 4.99 mg/L) (54%) than both HIV-ve groups. HIV was associated with 2.5-fold higher odds of iron deficient erythropoiesis (sTfR > 8.3 mg/L) (95% CI: 1.03–5.8, p = 0.04), 2.7-fold higher odds of subclinical inflammation (95% CI: 1.4–5.3, p = 0.004), and 12-fold higher odds of macrocytosis (95% CI: 6–27, p < 0.001). Compared to HIV-ve counterparts, HIV+ children reported significantly lower daily intake of animal protein, muscle protein, heme iron, calcium, riboflavin, and vitamin B₁₂, and significantly higher proportions of HIV+ children did not meet vitamin A and fiber requirements. Compared to iron sufficient non-anemic counterparts, children with low iron stores reported significantly higher daily intake of plant protein, lower daily intake of vitamin A, and lower proportions of inadequate fiber intake. Along with best treatment practices for HIV, optimizing dietary intake in HIV+ children could improve nutritional status and anemia in this vulnerable population. This study was registered at clinicaltrials.gov as NCT03572010.

The Development of a Quantified Food Frequency Questionnaire for Assessing Iron Nutrition in Schoolchildren from Resource-Limited Settings in Cape Town, South Africa

Children are vulnerable to developing iron deficiency anemia, especially in resource-limited settings. Information on habitual dietary intake informs dietary interventions aimed at improving iron deficiency. Dietary assessment in school-aged children is challenging and requires concerted efforts to mitigate the pitfalls of long complex methods. Nested within an intervention trial, we aimed to obtain dietary intake information to assess iron nutrition in 8 to 13-year-old children from resource-limited settings in Cape Town, South Africa. Following careful consideration of the study objective, participant characteristics, research setting, available resources, and features of the different dietary intake assessment methods, we identified an iron quantified food frequency questionnaire (QFFQ) as the best method to obtain the information. The QFFQ reflected the study population's habitual intake and the nutrients of interest (protein, iron, vitamin A, vitamin C, calcium, zinc, and fiber). In addition, strategies such as interview-administration of the QFFQ, interviewing the child participant and caregiver together, simplifying frequency reporting, a strategic food list order and a variety of interesting portion size estimation aids collectively supported dietary intake assessment in this young study population. Using a methodical, multiphase approach and strategies that promote participant engagement, we developed the QFFQ, achieved interview success, and obtained comparable data.

The impact of vitamin D food fortification and health outcomes in children: a systematic review and meta-regression

OBJECTIVE

Vitamin D (vitD) deficiency is a global childhood health problem. Food fortification is a promising strategy to curb vitD deficiency. We aimed to assess the effectiveness of utilizing vitD fortification in staple foods to improve 25hydroxyvitamin D (25(OH)D) concentration and to reduce the prevalence of vitD deficiency among healthy children.

METHODS

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the use of vitD fortified food products compared to no fortification among healthy children aged 1-18 years old. We searched Medline, Embase, Global Health, and Cochrane (CENTRAL) databases from database inception until May 2019. Independently, six reviewers in pairs screened titles and abstracts, assessed the full text for eligibility, and performed data extraction and quality assessment. The primary outcome is the impact of fortification on 25(OH)D concentration. The secondary outcomes included the impact of fortification on the prevalence of vitD deficiency, school performance, cognitive function, school absences, infection rate, hospital admission length, and compliance with fortified food product consumption.

RESULTS

We identified 2229 articles. After assessing eligibility, 20 RCTs met the inclusion criteria. The eligible RCTs assessed the fortification of milk, cereal, juice, bread, yogurt, and cheese compared with no fortification. All RCTs, except for three, had a low risk of bias. Food fortification improved 25(OH)D concentration by a mean difference (MD) of 15.51 nmol/L (95% confidence interval (CI) 6.28, 24.74; I² = 99%), which resulted in a mean increase of 3 nmol/l for every 100 IU of vitD, when adjusted for baseline 25(OH)D concentration and country latitude. Additionally, the prevalence of vitD deficiency decreased by a risk ratio of 0.53 (95% CI 0.41, 0.69; I² = 95%), and cognitive function improved by a MD of 1.22 intelligence quotient (IQ) points (95% CI 0.65, 1.79; I² = 0%). The overall evidence quality was high.

CONCLUSION

VitD food fortification is an effective way to improve 25(OH)D concentration, prevent vitD deficiency, and improve IQ levels.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017057631.

Iron, Catechin, and Ferulic Acid Inhibit Cellular Uptake of β-Carotene by Reducing Micellization

Green leafy vegetables have low β-carotene bioavailability, which we hypothesized to be, at least in part, due to high contents of fiber, minerals, and phenolics. We investigated the effects of pectin (40-120 μg/mL), iron (50-150 μg/mL), ferulic acid (30-90 μg/mL), and catechin (50-150 μg/mL), in a model system, on β-carotene micellization (in vitro digestion) and intestinal absorption (Caco-2 cell model). Iron, pectin, ferulic acid, and catechin on average reduced ( p < 0.05) β-carotene micellization (1.49 ± 0.05 μmol/L) by 66.9, 59.3, 43.2, and 51.7%, respectively. Iron reduced micellization by precipitating bile salts from solution and ferulic acid and catechin by inhibition of pancreatic lipase. β-Carotene uptake by Caco-2 cells (2.63 ± 0.22%) was reduced ( p < 0.05) by 37.4, 70.1, 77.0, and 75.1%, respectively, when it was digested with pectin, iron, ferulic acid, or catechin. However, when individual test compounds were added to already micellized β-carotene, they did not inhibit β-carotene uptake. The large reductions in β-carotene micellization observed in vitro warrant further investigation in humans using model green leafy vegetable systems to elucidate their relevance under real-life conditions.

Optimal formulations of local foods to achieve nutritional adequacy for 6-23-month-old rural Tanzanian children

Background: Achieving nutritional goals of infants and young children while maintaining the intake of local and culture-specific foods can be a daunting task. Diet optimisation using linear goal programming (LP) can effectively generate optimal formulations incorporating local and culturally acceptable foods.

Objective: The primary objective of this study was to determine whether a realistic and affordable diet that achieves dietary recommended intakes (DRIs) for 22 selected nutrients can be formulated for rural 6–23-month-old children in Tanzania.

Design: Dietary intakes of 400 children aged 6–23 months were assessed using a weighed dietary record (WDR), 24-hour dietary recalls and a 7-days food record. A market survey was also carried out to estimate the cost per 100 g of edible portion of foods that are commonly consumed in the study area. Dietary and market survey data were then used to define LP model parameters for diet optimisation. All LP analyses were done using linear program solver (LiPS) version 1.9.4 to generate optimal food formulations.

Results: Optimal formulations that achieved DRIs for 20 nutrients for children aged 6–11 months and all selected nutrients for children aged 12–23 months were successfully developed at a twofold cost of the observed food purchase across age groups. Optimal formulations contained a mixture of ingredients such as wholegrain cereals, Irish potatoes, pulses and seeds, fish and poultry meat as well as fruits and vegetables that can be sourced locally.

Conclusions: Our findings revealed that given the available food choices, it is possible to develop optimal formulations that can improve dietary adequacy for rural 6–23-month-old children if food budget for the child’s diets is doubled. These findings suggest the need for setting alternative interventions which can help households increase access to nutrient-dense foods that can fill the identified nutrient gaps.

The Challenges and Opportunities Associated with Biofortification of Pearl Millet (Pennisetum glaucum) with Elevated Levels of Grain Iron and Zinc

Deficiencies of essential micronutrients such as iron and zinc are the cause of extensive health problems in developing countries. They adversely affect performance, productivity and are a major hindrance to economic development. Since many people who suffer from micronutrient deficiencies are dependent on staple crops to meet their dietary requirements, the development of crop cultivars with increased levels of micronutrients in their edible parts is becoming increasingly recognized as a sustainable solution. This is largely facilitated by genetics and genomic platforms. The cereal crop pearl millet (Pennisetum glaucum), is an excellent candidate for genetic improvement due to its ability to thrive in dry, semi-arid regions, where farming conditions are often unfavorable. Not only does pearl millet grow in areas where other crops such as maize and wheat do not survive, it contains naturally high levels of micronutrients, proteins and a myriad of other health benefitting characteristics. This review discusses the current status of iron and zinc deficiencies and reasons why interventions such as fortification, supplementation, and soil management are neither practicable nor affordable in poverty stricken areas. We argue that the most cost effective, sustainable intervention strategy is to biofortify pearl millet with enhanced levels of bioavailable iron and zinc. We discuss how naturally occurring genetic variations present in germplasm collections can be incorporated into elite, micronutrient rich varieties and what platforms are available to drive this research. We also consider the logistics of transgenic methods that could facilitate the improvement of the pearl millet gene pool.

Enhancing Vitamin A Intake in Young Children in Western Kenya: Orange-Fleshed Sweet Potatoes and Women Farmers Can Serve as Key Entry Points

In western Kenya, where vitamin A deficiency is common and the white sweet potato is an important secondary staple, orange-fleshed sweet potatoes were introduced and their consumption was promoted, along with other vitamin A–rich foods. Ten women's groups grew a number of varieties of sweet potato on group plots in on-farm trials. Five of the groups also received an intervention consisting of nutritional education, individual counseling, and participatory rapid appraisal techniques to promote vitamin A consumption, while the other five formed the control group that received no additional promotion. Changes in consumption of children under five years of age were assessed before and after a one-year intervention period using the Helen Keller International food-frequency method. Varieties were tested for yield, agronomic performance, taste and appearance, and dry matter content. They were also assessed for β-carotene content in the forms of boiled and mashed puree, sweet potato flour, and processed products. Children in the intervention group consumed vitamin A–rich foods almost twice as frequently as control children (93% more), especially orange-fleshed sweet potatoes, mangoes, dark-green leafy vegetables, butter, and eggs. The yields of orange-fleshed sweet potatoes were at least twice those of white sweet potatoes, as were the taste and appearance ratings. The dry matter content of the varieties exceeded 25%, except for one that was preferred as a weaning food. β-Carotene values were high enough that one cup of boiled and mashed sweet potato fed daily to children of weaning age would alone meet their requirement of vitamin A, even using the higher 12:1 β-carotene:retinol conversion. Orange-fleshed sweet potatoes produced and prepared by women farmers can serve as a key food-based entry point for reducing vitamin A deficiency.

Carotenoid-Rich Bananas: A Potential Food Source for Alleviating Vitamin A Deficiency

This review article points out that bananas are an important food for many people in the world. Thus, banana cultivars rich in provitamin A carotenoids may offer a potential food source for alleviating vitamin A deficiency, particularly in developing countries. Many factors are associated with the presently known food sources of vitamin A that limit their effectiveness in improving vitamin A status. Acceptable carotenoid-rich banana cultivars have been identified in Micronesia, and some carotenoid-rich bananas have been identified elsewhere. Bananas are an ideal food for young children and families for many regions of the world, because of their sweetness, texture, portion size, familiarity, availability, convenience, versatility, and cost. Foods containing high levels of carotenoids have been shown to protect against chronic disease, including certain cancers, cardiovascular disease, and diabetes. Because the coloration of the edible flesh of the banana appears to be a good indicator of likely carotenoid content, it may be possible to develop a simple method for selecting carotenoid-rich banana cultivars in the community. Research is needed on the identification of carotenoid-rich cultivars, targeting those areas of the world where bananas are a major staple food; investigating factors affecting production, consumption, and acceptability; and determining the impact that carotenoid-rich bananas may have on improving vitamin A status. Based on these results, interventions should be undertaken for initiating or increasing homestead and commercial production.

Dietary Approaches to the Control of Vitamin A Deficiency: An Introduction and Overview

As a public health problem, deficiency of vitamin A occurs when the habitual intake of bioavailable vitamin A is too little to meet physiological needs under prevailing conditions. Needs are increased during growth periods and when frequent infections cause inefficient utilization of the vitamin. Historical records and recent experience document that improved dietary intake, even when most vitamin A activity comes from provitamin A carotenoids, can correct the problem, especially when such diets contain adequate fat and the subjects are relieved of heavy worm infestation. An epidemiologic evaluation of the entire food chain, consisting of production, procurement, processing, and consumption, provides the framework for selecting suitable dietary approaches. These approaches include homestead food production, centrally or home-based fortified foods, and educational approaches promoting dietary diversification and modification of preparation practices to conserve the vitamin and render it more bioavailable. Even agricultural approaches that select and propagate germ plasma from varieties with increased micronutrient density can be utilized, including, in the future, genetic modifications to increase micronutrient density of vegetable and staple crops. Usually a mixture of intervention strategies will be most effective, particularly when social marketing accompanies efforts to increase consumer acceptance and compliance. Where the ecological and economic context prohibits dietary approaches, or where acute deficiency necessitates an immediate therapeutic response, distribution of vitamin A supplements is needed until suitable food-based approaches become feasible.

Forests, Trees, and Micronutrient-Rich Food Consumption in Indonesia

Micronutrient deficiency remains a serious problem in Indonesia with approximately 100 million people, or 40% of the population, suffering from one or more micronutrient deficiencies. In rural areas with poor market access, forests and trees may provide an essential source of nutritious food. This is especially important to understand at a time when forests and other tree-based systems in Indonesia are being lost at unprecedented rates. We use food consumption data from the 2003 Indonesia Demographic Health Survey for children between the ages of one and five years and data on vegetation cover from the Indonesian Ministry of Forestry to examine whether there is a relationship between different tree-dominated land classes and consumption of micronutrient-rich foods across the archipelago. We run our models on the aggregate sample which includes over 3000 observations from 25 provinces across Indonesia as well as on sub-samples from different provinces chosen to represent the different land classes. The results show that different tree-dominated land classes were associated with the dietary quality of people living within them in the provinces where they were dominant. Areas of swidden/agroforestry, natural forest, timber and agricultural tree crop plantations were all associated with more frequent consumption of food groups rich in micronutrients in the areas where these were important land classes. The swidden/agroforestry land class was the landscape associated with more frequent consumption of the largest number of micronutrient rich food groups. Further research needs to be done to establish what the mechanisms are that underlie these associations. Swidden cultivation in is often viewed as a backward practice that is an impediment to food security in Indonesia and destructive of the environment. If further research corroborates that swidden farming actually results in better nutrition than the practices that replace it, Indonesian policy makers may need to reconsider their views on this land use.

Protein and micronutrient supplementation in complementing pubertal growth

For several reasons, adolescence is considered as a nutritionally critical period of life. The dramatic increase in physical growth and development puts greater pressure on the need for nutrients, as it is during this period when adolescents experience a weight gain equivalent to 65% of their weight at the beginning of the period or 40% of their final weight, and a height gain equivalent to 15% of their adult height. The requirement of some of the nutrients is as high as, or higher in adolescents than in any other age groups. Moreover, adolescence is a time where the life-style and food habits are influenced by socio-cultural factors resulting in an imbalance in nutrient intake and nutrient inadequacy can result in delayed sexual maturation and can arrest or slow linear growth. With the increasing prevalence of hidden malnutrition among Indian children, adolescence can be the second opportunity to catch up growth and cover the deficits suffered during childhood and to meet the demands of physical and cognitive growth and development, provide adequate stores of energy for illnesses and pregnancy, and prevent adult onset of nutrition-related diseases. Adolescents should be recognized as a priority target group as an integral part of health promotion and optimal nutrition through balanced diet and nutrient supplementation should be promoted in conjunction with healthy eating habits and physical activity.

Effects of phytases and dehulling treatments on in vitro iron and zinc bioavailability in faba bean (Vicia faba L.) flour and legume fractions

In vitro digestions were performed on faba bean flours with decreased phytate contents and on 2 dephytinized or nondephytinized faba bean fractions, a dehulled faba bean fraction, and a hull fraction with low and high fiber and tannin contents, respectively. In vitro bioavailability iron and zinc was defined as the relative amount of iron and zinc that became soluble after enzymatic treatment. Faba bean samples were sequentially digested with enzymes, including amylase, pepsin, pancreatin, and bile, under certain conditions following the enzymatic degradation procedure. Iron and zinc in vitro bioavailability of whole faba bean flours were significantly improved by phytate degradation, even if the phytate were not all degraded. Total dephytinization of dehulled faba bean led to an obvious increase in iron and zinc in vitro bioavailability, but that of hulls had no effect on either iron or zinc in vitro bioavailability. Fibers and tannins other than phytate are more important in chelating a high proportion of iron and zinc in faba bean hulls.

In vitro solubility of calcium, iron and zinc in relation to phytic acid levels in rice-based consumer products in China

In vitro solubility of calcium, iron and zinc in relation to phytic acid (PA) levels in 30 commercial rice-based foods from China was studied. Solubility of minerals and molar ratios of PA to minerals varied with degrees of processing. In primary products, [PA]/[Ca] values were less than 5 and [PA]/[Fe] and [PA]/[Zn] similarly ranged between 5 and 74, with most values between 20 and 30. [PA]/[mineral] molar ratios in intensively processed products were lower. Solubility of calcium ranged from 0% to 87%, with the lowest in brown rice (12%) and the highest in infant foods (50%). Iron solubility in two-thirds of samples was lower than 30%, and that of zinc narrowly ranged from 6% to 30%. Solubility of minerals was not significantly affected by [PA]/[mineral]. At present, neither primary nor intensively processed rice-based products are good dietary sources of minerals. Improvements should be attempted by dephytinization, mineral fortification or, preferably, combination of both.

A Review of Interventions Based on Dietary Diversification or Modification Strategies with the Potential to Enhance Intakes of Total and Absorbable Zinc

Dietary diversification or modification has the potential to prevent deficiencies of zinc and other coexisting limiting micronutrients simultaneously, without risk of antagonistic interactions. In this review, we have addressed the following. The first section focuses on strategies with the potential to enhance intake and/or bioavailability of zinc, and includes interventions (with and without nutrition education) based on agriculture, production or promotion of animal-source foods through animal husbandry or aquaculture, and commercial and household processing strategies to enhance zinc absorption. Outcome indicators include intakes of foods or nutrients (although rarely zinc) and, in some cases, zinc status, or zinc-related functional responses. The next two sections address whether dietary diversification or modification can achieve increases in absorbable zinc that are sufficient to enhance zinc status or zinc-related functional responses in breastfed infants and toddlers and in older children and women of reproductive age. Evidence for the impact of dietary diversification or modification on behavior change and on nutritional status in the short and long term, and the possible role of modifying factors (e.g., baseline nutritional status, socioeconomic status, infection, sex, age, and life-stage group) is the emphasis of the next section. The following section highlights the evidence for three potential adverse effects of dietary diversification or modification: aflatoxin contamination from germinated cereals, loss of water-soluble nutrients, and displacement of breastmilk. Finally, an example of a dietary diversification or modification program (Homestead Food Production) developed and implemented by Helen Keller International is given, together with the critical steps needed to scale up dietary diversification or modification for programs and future research needs.

Efficacy of a community-based dietary intervention to enhance micronutrient adequacy of high-phytate maize-based diets of rural Malawian children

Objective

To evaluate the efficacy of a community-based dietary intervention to reduce risk of micronutrient inadequacies in high-phytate maize-based Malawian diets.

Design

Quasi-experimental post-test design with a non-equivalent control group.

Setting

Four villages in Mangochi District, Southern Malawi.

Participants

Households with children aged 3–7 years in two intervention (n = 200) and two control (n = 81) villages participated in a 6-month intervention employing dietary diversification, changes in food selection patterns, and modifications to food processing to reduce the phytate content of maize-based diets. Baseline comparability between the groups was confirmed via assessment of sociodemographic characteristics, anthropometry, knowledge and practices, morbidity, haemoglobin and hair zinc. After 12 months, knowledge and practices and dietary intakes were assessed by interactive 24-hour recalls, one during the food plenty and a second during the food shortage season. Nutrient adequacy for the two groups was compared via dietary quality indicators and predicted prevalence of inadequate intakes using the probability approach.

Results

Intervention children had diets that were significantly more diverse and of a higher quality than those of controls. Median daily intakes of protein, calcium, zinc (total and available), haem iron, vitamin B12 and animal foods (grams; % of total energy) were higher (P<0.05) whereas phytate intakes, phytate/zinc and phytate/iron molar ratios were lower (P<0.01) in the intervention group; some spread of knowledge and practices to controls occurred.

Conclusions

Our community-based dietary strategies reduced the predicted prevalence of inadequate intakes of protein, calcium, zinc and vitamin B12, but not iron, in children from Malawian households with very limited resources.

Agricultural biodiversity, nutrition, and health: making a difference to hunger and nutrition in the developing world

BACKGROUND

In spite of the strides made globally in reducing hunger, the problems of micronutrient deficiencies and coexisting obesity and related cardiovascular and degenerative diseases constitute a formidable challenge for the future. Attempts to reverse this trend with single-nutrient intervention strategies have met with limited success, resulting in renewed calls for food-based approaches. The deployment of agricultural biodiversity is an approach that entails greater use of local biodiversity to ensure dietary diversity.

OBJECTIVE

To outline a new strategy proposed by the International Plant Genetic Resources Institute (IPGRI) that employs agricultural biodiversity as the primary resource for food security and health.

METHODS

The authors carried out a meta-analysis to review and assemble existing information on the nutritional and healthful properties of traditional foods based on a diverse set of case studies and food composition and nutritional analysis studies. The methods highlight particular examples of foods where analysis of nutrient and non-nutrient composition reveals important traits to address the growing problems of malnutrition associated with the rise of chronic diseases. Finally, the authors analyze social, economic, and cultural changes that undermine the healthful components of traditional diets.

RESULTS

Based on this multidisciplinary and comparative approach, the authors suggest a holistic food-based approach that combines research to assess and document nutritional and healthful properties of traditional foods, investigating options in which nutritionally valuable traditional foods can contribute to better livelihoods, and ways that awareness and promotional campaigns can identify healthful components of traditional diets that fit the needs of urban and market-oriented consumers.

CONCLUSIONS

There is an urgent need for agricultural research centers, national agricultural research systems, universities, and community-based organizations to work together under a shared policy framework with the aim of developing a strong evidence base linking biodiversity, nutrition, and health. Although these initiatives are still ongoing, the gains realized in small-scale and local pilot efforts have encouraged IPGRI to work with local partners toward the implementation of scale-up efforts in various regions.

Children Aged 6 to 60 Months in Nepal May Require a Vitamin A Supplement Regardless of Dietary Intake from Plant and Animal Food Sources

The purpose of this survey was to explore the relationship between the prevalence of the health indicators of malnutrition, diarrhea, and acute respiratory infection and the consumption of vitamin A–rich food and the supplementation status of three groups of children in Nepal (supplemented, supplemented only once, and never supplemented). A trained female community health worker interviewed mothers about vitamin A–rich food feeding practices to children aged 6 to 60 months using a standardized questionnaire and then estimated the nutritional status of the children using mid-upper-arm circumference measurements and recording the incidence of diarrhea and acute respiratory infection from mothers’ interviews. Regardless of the amount of vitamin A–rich foods consumed, children who were regularly supplemented with high doses of vitamin A were protected against malnutrition, diarrhea, and acute respiratory infection at a higher rate than children who were supplemented only once or were never supplemented. Regularly providing a high-dose (200,000 IU) capsule of vitamin A to children aged 6 to 60 months, including those who eat vitamin A–rich foods, may be effective in decreasing the prevalence of morbidity from malnutrition, diarrhea, and acute respiratory infection.

Control of vitamin A deficiency in Vietnam: achievements and future orientation

Vitamin A deficiency is one of the major nutritional deficiencies in Vietnam. The first survey, conducted in 1985-1988 showed that the prevalence of severe xerophthalmia was seven times higher than the cutoff point established by the World Health Organization (WHO) to define vitamin A deficiency as a public health problem. The result of this survey strongly convinced the government to launch a program to control vitamin A deficiency, which started in 1988. The program strategies included nutrition education, universal distribution of high-dose vitamin A capsules to children aged 6 to 36 months in combination with national immunization days, and promotion of production and consumption of vitamin A-rich foods at the family level. The implementation network was set up based on the existing preventive health structure at all administrative levels. Organizations such as the women's union and other social sectors have participated actively in the program. Surveys conducted in 1994 and 1998 showed that the prevalence of clinical xerophthalmia was significantly lower than that identified in the baseline survey and below the WHO criteria for a public health problem. The achievements of our program have demonstrated that an effective vitamin A supplementation program can be implemented successfully by the preventive health network with active community participation. In the coming years, it will be important for our program to develop approaches other than vitamin A supplementation in order to maintain the past achievements.

Food-based strategies to meet the challenges of micronutrient malnutrition in the developing world

The purpose of the present paper is to review the evidence in favour of food-based strategies to meet the challenges of micronutrient malnutrition in the developing world. Increasing dietary diversification is the most important factor in providing a wide range of micronutrients, and to achieve this objective in a development context requires an adequate supply, access and consumption of a variety of foods. Diets in developing countries generally lack many nutrients, including energy (inadequate amounts of food), so that strategies need to also emphasize an increase in total food intake, in addition to a greater variety. Agricultural and food policies tend to be oriented to primary agricultural productions, but they could also be formulated to promote and support home gardens and small livestock production for the explicit purpose of increasing the household consumption of micronutrient-rich foods. The adoption of 'desirable' dietary patterns for nutrition improvement, e.g. appropriately formulated to meet micronutrient needs, could be used in the formulation of agricultural policies and programmes. This process could be achieved through support for integrated farming systems oriented to assuring household food security, but also based on a variety of foods that will meet total dietary (including micronutrient) needs. Thus, availability of energy-rich staples, animal and/or fish as major sources of protein, and vitamin-, mineral- and phytonutrient-rich fruit and vegetables could constitute the types of production envisaged. The cultivation of edible indigenous plants as additional sources of micronutrients could also be added. The low bioavailability of some key micronutrients from foods, such as Fe, are substantially enhanced with the right food combinations and with appropriate food processing and preparation techniques. Simple appropriate technology for the preservation of micronutrient-rich foods would need further development and promotion for their year-round availability. Linking community development policies to national programmes for the alleviation of hunger and malnutrition, with an emphasis on increasing the variety of foods consumed, is probably the best strategy for improving micronutrient malnutrition sustainably.