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Anitha S, Tsusaka TW, Givens DI, Kane-Potaka J, Botha R, Sulaiman NLB, Upadhyay S, Vetriventhan M, Rajendran A, Parasannanavar DJ, Longvah T, Subramaniam K, Bhandari RK. Does millet consumption contribute to raising blood hemoglobin levels compared to regular refined staples?: a systematic review and meta-analysis. Front Nutr 2024; 11:1305394. [PMID: 38419846 PMCID: PMC10900984 DOI: 10.3389/fnut.2024.1305394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024] Open
Abstract
Millets are recognized for their health and nutritional values, and the United Nations declared 2023 the International Year of Millets. Among the several health and nutritional benefits of millets, their impact on hemoglobin concentration is important since anemia is a major public health issue in many countries. To investigate the effect of millet (including sorghum) consumption on hemoglobin concentration in the blood, a systematic review and meta-analysis were conducted. Thirteen published studies featuring randomized control trials involving 590 individuals in the intervention group and 549 control individuals were eligible for the meta-analysis. The difference-in-differences analysis revealed highly significant (p < 0.01) positive effects of millet consumption on hemoglobin concentration, with an effect size of +0.68 standardized mean difference units. The change in hemoglobin concentration observed in the intervention group was +13.6%, which is statistically significant (p < 0.0005), compared to that in the control group, which was +4.8% and not statistically significant (p = 0.1362). In four studies, the consumption of millets in the intervention group demonstrated a change from mild anemia to normal status among children, whereas there was no change in the control group. The findings provide evidence that the consumption of millets can improve blood hemoglobin concentration, likely resulting from increased iron intake. Further research is needed involving the assessment of iron content and bioavailability to better understand the effect variation among millet types and the mechanisms involved.
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Affiliation(s)
- Seetha Anitha
- Asia-Pacific Association of Agricultural Research Institutions (APAARI), Bangkok, Thailand
- International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), Patancheru, India
| | | | - D Ian Givens
- Institute of Food, Nutrition, and Health, University of Reading, Reading, United Kingdom
| | | | | | | | - Shweta Upadhyay
- Asia-Pacific Association of Agricultural Research Institutions (APAARI), Bangkok, Thailand
| | - Mani Vetriventhan
- International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), Patancheru, India
| | | | | | | | - Kowsalya Subramaniam
- Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore, Tamil Nadu, India
| | - Raj Kumar Bhandari
- National Technical Board of Nutrition, Government of India (GoI), Mumbai, India
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Ghosh S, Palika R, Dasi T, Varshney RK, Parasannanavar DJ, Sen Gupta S, Chitikineni A, Banjara SK, Pullakhandam R, Thomas T, Sachdev HS, Kurpad AV, Kulkarni B. Haemoglobin diagnostic cut-offs for anaemia in Indian women of reproductive age. Eur J Clin Nutr 2023; 77:966-971. [PMID: 37537294 DOI: 10.1038/s41430-023-01308-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The persistent high prevalence of anaemia among Indian women of reproductive age (WRA) despite aggressive long-term iron supplementation could be related to over-diagnosis from an inappropriately high haemoglobin (Hb) diagnostic cut-off. To develop an appropriate cut-off for Indian WRA, we hypothesized that during iron-folic acid (IFA) supplementation to a mixed (anaemic/non-anaemic) WRA population, the positive slope of the Hb-plasma ferritin (PF) response in anaemic women would inflect into a plateau (zero-response) as a non-anaemic status is reached. The 2.5th percentile of the Hb distribution at this inflection point will be the diagnostic Hb cut-off for iron-responsive anaemia. METHOD A hierarchical mixed effects model, with a polynomial mean and variance model to account for intraclass correlation due to repeated measures, was used to estimate the response curve of Hb to PF, or body iron stores, in anaemic and non-anaemic WRA (without inflammation), who were receiving a 90-day IFA supplementation. RESULTS The Hb response curve at low PF values showed a steep increase, which inflected into a plateau at a PF of 10.1 µg/L and attained a steady state at a PF of 20.6 µg/L. The Hb distribution at the inflection was a normal probability distribution, with a mean of 12.3 g/dL. The 2.5th percentile value of this distribution, or the putative diagnostic Hb cut-off for anaemia, was 10.8 g/dL (~11 g/dL). CONCLUSION The derived Hb cut-off is lower than the current adult values of 12 g/dL and could partly explain the persistently high prevalence of anaemia.
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Affiliation(s)
- Santu Ghosh
- St. John's Medical College, Sarjapur Road, Bengaluru, Karnataka, 560 034, India
| | - Ravindranadh Palika
- ICMR-National Institute of Nutrition, Jamai-Osmania, Hyderabad, Telangana, 500007, India
| | - Teena Dasi
- ICMR-National Institute of Nutrition, Jamai-Osmania, Hyderabad, Telangana, 500007, India
| | - Rajeev K Varshney
- International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), Patancheru, Hyderabad, 502 324, India
- State Agricultural Biotechnology Centre, Centre for Crop & Food Innovation, Food Futures Institute, Murdoch University, Murdoch, 6150, Australia
| | | | - Sourav Sen Gupta
- International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), Patancheru, Hyderabad, 502 324, India
| | - Annapurna Chitikineni
- International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), Patancheru, Hyderabad, 502 324, India
- State Agricultural Biotechnology Centre, Centre for Crop & Food Innovation, Food Futures Institute, Murdoch University, Murdoch, 6150, Australia
| | - Santosh Kumar Banjara
- ICMR-National Institute of Nutrition, Jamai-Osmania, Hyderabad, Telangana, 500007, India
| | - Raghu Pullakhandam
- ICMR-National Institute of Nutrition, Jamai-Osmania, Hyderabad, Telangana, 500007, India
| | - Tinku Thomas
- St. John's Medical College, Sarjapur Road, Bengaluru, Karnataka, 560 034, India
| | - Harshpal S Sachdev
- Sitaram Bhartia Institute of Science and Research, New Delhi, 110016, India
| | - Anura V Kurpad
- St. John's Medical College, Sarjapur Road, Bengaluru, Karnataka, 560 034, India
| | - Bharati Kulkarni
- ICMR-National Institute of Nutrition, Jamai-Osmania, Hyderabad, Telangana, 500007, India.
- Division of Reproductive and Child Health and Nutrition, Indian Council of Medical Research, V. Ramalingaswami Bhawan, Ansari Nagar, New Delhi, 110029, India.
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Anitha S, Givens DI, Subramaniam K, Upadhyay S, Kane-Potaka J, Vogtschmidt YD, Botha R, Tsusaka TW, Nedumaran S, Rajkumar H, Rajendran A, Parasannanavar DJ, Vetriventhan M, Bhandari RK. Can Feeding a Millet-Based Diet Improve the Growth of Children?-A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14010225. [PMID: 35011100 PMCID: PMC8747143 DOI: 10.3390/nu14010225] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 02/01/2023] Open
Abstract
Undernutrition, such as stunting and underweight, is a major public health concern, which requires multi-sectoral attention. Diet plays a key role in growth and should optimally supply all required nutrients to support the growth. While millets (defined broadly to include sorghum) are traditional foods, and climate smart nutritious crops, which are grown across Africa and Asia, they have not been mainstreamed like rice, wheat, and maize. Diversifying staples with millets can potentially provide more macro and micro nutrients, compared to the mainstream crops. However, there is little known scientific evidence to prove millets’ efficacy on growth. Therefore, a systematic review and meta-analysis was conducted to collate evidence of the benefits of millets in improving the growth of children. Eight eligible randomized feeding trials were included in the meta-analysis. Results from the randomized effect model showed a significant effect (p < 0.05) of millet-based diets on mean height (+28.2%) (n = 8), weight (n = 9) (+26%), mid upper arm circumference (n = 5) (+39%) and chest circumference (n = 5) (+37%) in comparison to regular rice-based diets over for the period of 3 months to 4.5 years, which was based on largely substituting rice with millets. When an enhanced and diverse diet was served, replacing rice with millet had only minimal growth improvement on chest circumference (p < 0.05). The quality assessment using GRADE shows that the evidence used for this systematic review and meta-analysis had moderate quality, based on eight scoring criteria. These results demonstrate the value of adding millet as the staple for undernourished communities. Further understanding of the efficacy of millets on growth in a wider range of diets is important to develop appropriate dietary programs and improve the nutritional status of various age groups across Africa and Asia.
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Affiliation(s)
- Seetha Anitha
- Smart Food Initiative, International Crops Research Center for the Semi-Arid Tropics (ICRISAT), Hyderabad 502324, India;
- Enabling Systems Transformation (EST), International Crops Research Center for the Semi-Arid Tropics (ICRISAT), Hyderabad 502324, India;
- Correspondence: or ; Tel.: +91-79-9330-0346
| | - David Ian Givens
- Institute for Food, Nutrition and Health, University of Reading, Reading RG6 6EU, UK; (D.I.G.); (Y.D.V.)
| | - Kowsalya Subramaniam
- Food Science and Nutrition, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore 641043, India;
| | - Shweta Upadhyay
- United Nations Children’s Fund (UNICEF), Lilongwe 30375, Malawi;
| | - Joanna Kane-Potaka
- Smart Food Initiative, International Crops Research Center for the Semi-Arid Tropics (ICRISAT), Hyderabad 502324, India;
| | - Yakima D. Vogtschmidt
- Institute for Food, Nutrition and Health, University of Reading, Reading RG6 6EU, UK; (D.I.G.); (Y.D.V.)
| | - Rosemary Botha
- Development Strategy and Governance Division, International Food Policy Research Institute (IFPRI), Lilongwe P.O. Box 31666, Malawi;
| | - Takuji W. Tsusaka
- Ostrom Center for Advanced Studies on Natural Resources Governance, Asian Institute of Technology, Pathumthani 12120, Thailand;
| | - Swamikannu Nedumaran
- Enabling Systems Transformation (EST), International Crops Research Center for the Semi-Arid Tropics (ICRISAT), Hyderabad 502324, India;
| | - Hemalatha Rajkumar
- National Institute of Nutrition (NIN), Hyderabad 500007, India; (H.R.); (A.R.); (D.J.P.)
| | - Ananthan Rajendran
- National Institute of Nutrition (NIN), Hyderabad 500007, India; (H.R.); (A.R.); (D.J.P.)
| | | | - Mani Vetriventhan
- Gene Bank, International Crops Research Center for the Semi-Arid Tropics (ICRISAT), Hyderabad 502324, India;
| | - Raj Kumar Bhandari
- National Technical Board of Nutrition, Government of India (GoI), New Delhi 110001, India;
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Anitha S, Kane-Potaka J, Botha R, Givens DI, Sulaiman NLB, Upadhyay S, Vetriventhan M, Tsusaka TW, Parasannanavar DJ, Longvah T, Rajendran A, Subramaniam K, Bhandari RK. Millets Can Have a Major Impact on Improving Iron Status, Hemoglobin Level, and in Reducing Iron Deficiency Anemia-A Systematic Review and Meta-Analysis. Front Nutr 2021; 8:725529. [PMID: 34722606 PMCID: PMC8551390 DOI: 10.3389/fnut.2021.725529] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
The prevalence of iron deficiency anemia is highest among low and middle-income countries. Millets, including sorghum, are a traditional staple in many of these countries and are known to be rich in iron. However, a wide variation in the iron composition of millets has been reported, which needs to be understood in consonance with its bioavailability and roles in reducing anemia. This systematic review and meta-analysis were carried out to analyze the scientific evidence on the bioavailability of iron in different types of millets, processing, and the impact of millet-based food on iron status and anemia. The results indicated that iron levels in the millets used to study iron bioavailability (both in vivo and in vitro) and efficacy varied with the type and variety from 2 mg/100 g to 8 mg/100 g. However, not all the efficacy studies indicated the iron levels in the millets. There were 30 research studies, including 22 human interventions and 8 in vitro studies, included in the meta-analysis which all discussed various outcomes such as hemoglobin level, serum ferritin level, and absorbed iron. The studies included finger millet, pearl millet, teff and sorghum, or a mixture of millets. The results of 19 studies conducted on anaemic individuals showed that there was a significant (p < 0.01) increase in hemoglobin levels by 13.2% following regular consumption (21 days to 4.5 years) of millets either as a meal or drink compared with regular diets where there was only 2.7% increase. Seven studies on adolescents showed increases in hemoglobin levels from 10.8 ± 1.4 (moderate anemia) to 12.2 ± 1.5 g/dl (normal). Two studies conducted on humans demonstrated that consumption of a pearl millet-based meal significantly increased the bioavailable iron (p < 0.01), with the percentage of bioavailability being 7.5 ± 1.6, and provided bioavailable iron of 1 ± 0.4 mg. Four studies conducted on humans showed significant increases in ferritin level (p < 0.05) up to 54.7%. Eight in-vitro studies showed that traditional processing methods such as fermentation and germination can improve bioavailable iron significantly (p < 0.01) by 3.4 and 2.2 times and contributed to 143 and 95% of the physiological requirement of women, respectively. Overall, this study showed that millets can reduce iron deficiency anemia.
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Affiliation(s)
- Seetha Anitha
- Smart Food Initiative, International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), Patancheru, India
| | - Joanna Kane-Potaka
- Smart Food Initiative, International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), Patancheru, India
| | - Rosemary Botha
- Development Strategy and Governance Division, International Food Policy Research Institute (IFPRI), Lilongwe, Malawi
| | - D Ian Givens
- Institute of Food, Nutrition and Health, University of Reading, Reading, United Kingdom
| | | | | | - Mani Vetriventhan
- Smart Food Initiative, International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), Patancheru, India
| | - Takuji W Tsusaka
- Ostrom Center for Advanced Studies on Natural Resources Governance, Asian Institute of Technology, Pathumthani, Thailand
| | | | | | | | - Kowsalya Subramaniam
- Food Science and Nutrition, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore, India
| | - Raj Kumar Bhandari
- National Technical Board of Nutrition, Government of India (GoI), New Delhi, India
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Anitha S, Kane-Potaka J, Tsusaka TW, Botha R, Rajendran A, Givens DI, Parasannanavar DJ, Subramaniam K, Prasad KDV, Vetriventhan M, Bhandari RK. A Systematic Review and Meta-Analysis of the Potential of Millets for Managing and Reducing the Risk of Developing Diabetes Mellitus. Front Nutr 2021; 8:687428. [PMID: 34395493 PMCID: PMC8355360 DOI: 10.3389/fnut.2021.687428] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/07/2021] [Indexed: 12/22/2022] Open
Abstract
Millets (including sorghum) are known to be highly nutritious besides having a low carbon footprint and the ability to survive in high temperatures with minimal water. Millets are widely recognised as having a low Glycaemic Index (GI) helping to manage diabetes. This systematic review and meta-analyzes across the different types of millets and different forms of processing/cooking collated all evidences. Of the 65 studies that were collected globally, 39 studies with 111 observations were used to analyze GI outcomes and 56 studies were used to analyze fasting, post-prandial glucose level, insulin index and HbA1c outcomes in a meta-analysis. It is evident from the descriptive statistics that the mean GI of millets is 52.7 ± 10.3, which is about 36% lower than in typical staples of milled rice (71.7 ± 14.4) and refined wheat (74.2 ± 14.9). The descriptive, meta and regression analyses revealed that Job's tears, fonio, foxtail, barnyard, and teff were the millets with low mean GI (<55) that are more effective (35–79%) in reducing dietary GI than the control samples. Millets with intermediate GI (55–69) are pearl millet, finger millet, kodo millet, little millet, and sorghum which have a 13–35% lower GI than the control with high GI (>69). A meta-analysis also showed that all millets had significantly (p < 0.01) lower GI than white rice, refined wheat, standard glucose or white wheat bread except little millet which had inconsistent data. Long term millet consumption lowered fasting and post-prandial blood glucose levels significantly (p < 0.01) by 12 and 15%, respectively, in diabetic subjects. There was a significant reduction in HbA1c level (from 6.65 ± 0.4 to 5.67 ± 0.4%) among pre-diabetic individuals (p < 0.01) who consumed millets for a long period. Minimally processed millets were 30% more effective in lowering GI of a meal compared to milled rice and refined wheat. In conclusion, millets can be beneficial in managing and reducing the risk of developing diabetes and could therefore be used to design appropriate meals for diabetic and pre-diabetic subjects as well as for non-diabetic people for a preventive approach.
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Affiliation(s)
- Seetha Anitha
- Smart Food Initiative, International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), Patancheru, India
| | - Joanna Kane-Potaka
- Smart Food Initiative, International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), Patancheru, India
| | - Takuji W Tsusaka
- Organization for Advanced and Integrated Research, Kobe University, Kobe, Japan
| | - Rosemary Botha
- Development Strategy and Governance Division, International Food Policy Research Institute (IFPRI), Lilongwe, Malawi
| | | | - D Ian Givens
- Institute of Food, Nutrition and Health, University of Reading, Reading, United Kingdom
| | | | - Kowsalya Subramaniam
- Food Science and Nutrition, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore, India
| | - Kanaka Durga Veera Prasad
- Smart Food Initiative, International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), Patancheru, India
| | - Mani Vetriventhan
- Smart Food Initiative, International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), Patancheru, India
| | - Raj Kumar Bhandari
- National Technical Board of Nutrition, Government of India (GoI), New Delhi, India
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