Complementary feeding: a global perspective

Cereal-based fermented foods as microbiota-directed products for improved child nutrition and health in sub-Saharan Africa

Several strategies, programs and policies have long been developed and implemented to alleviate child malnutrition in sub-Saharan African countries. However, stunting and wasting still persist at an alarming rate, suggesting that alternative strategies are needed to induce faster progress toward the 2030 SDGs targets of reducing malnutrition. Gut microbiota-directed intervention is now being recognized as an unconventional powerful approach to mitigate malnutrition and improve overall child health. In an African setting, manufactured probiotic and synbiotic foods or supplements may not be successful owing to the non-affordability and high attachment of African populations to their food tradition. This review analyses the potential of indigenous fermented cereal-based products including porridges, doughs, beverages, bread- and yoghurt-like products, to be used as microbiota-directed foods for over 6 months children. The discussion includes relevant strategies to effectively enhance the beneficial effects of these products on gut microbiota composition for improved child health and nutrition in sub-Saharan Africa. Characterization of probiotic features and general safety of food processing in sub-Saharan Africa as well as randomized clinical studies are still lacking to fully ascertain the health effects and suitability of these fermented foods in preventing and treating child malnutrition and diarrhea.

Antimicrobial Resistance Genes (ARGs), the Gut Microbiome, and Infant Nutrition

The spread of antimicrobial resistance genes (ARGs) is a major public health crisis, with the ongoing spread of ARGs leading to reduced efficacy of antibiotic treatments. The gut microbiome is a key reservoir for ARGs, and because diet shapes the gut microbiome, diet also has the potential to shape the resistome. This diet-gut microbiome-resistome relationship may also be important in infants and young children. This narrative review examines what is known about the interaction between the infant gut microbiome, the infant resistome, and infant nutrition, including exploring the potential of diet to mitigate infant ARG carriage. While more research is needed, diet has the potential to reduce infant and toddler carriage of ARGs, an important goal as part of maintaining the efficacy of available antibiotics and preserving infant and toddler health.

The Facilitators and Barriers of Adopting Amylase-Rich Flour to Enhance Complementary Foods in the Kersa District Community of Eastern Ethiopia

Achieving the optimal transition to a family diet over the first two years of life has remained a challenge in Ethiopia. The use of amylase-rich flour (ARF) can improve complementary foods. However, utilisation requires an effective delivery strategy for upskilling the community to use ARF. The aim of this study was to explore facilitators and barriers of cascading ARF skills to improve complementary foods. The study was conducted in Gale Mirga kebele of Kersa district in Eastern Ethiopia in 2016. The study utilised exploratory qualitative research that used participatory action. Focus group discussions (FGDs) were conducted with the Health Development Army (HDA) leaders, religious leaders, and observation of participatory complementary food demonstrations. Cultural acceptability and the presence of HDA structure that supports skill development were identified as key facilitators to ARF use. On the other hand, the potential barriers to expanding ARF skill were lack of sustainability of external skill support for HDA leaders, perceived time constraints, unsuitable demonstration settings, cooking method, and large group size. The indigenous community's knowledge of germination has not been used to improve complementary foods. The universal use of ARF requires integration into the Health Extension Programme (HEP) with support and supervision for HDA leaders.

Effectiveness of provision of animal-source foods for supporting optimal growth and development in children 6 to 59 months of age

BACKGROUND

Adequate nutrients early in life promote cognitive development and are critical for proper growth and functioning. The effect of individual nutrients consumed through food is often not the same as consuming the same nutrients in supplementary form due to 'food synergy', the biological and chemical interrelations that occur between nutrients. Animal-source foods, such as eggs, meat, fish, and dairy, are energy dense and contain multiple micronutrients and essential fatty acids with high bioavailability. The benefits of animal-source foods may include higher food synergy relative to fortified foods as well as decreasing dependence on external suppliers of fortified foods.

OBJECTIVES

To assess the effectiveness of animal-source foods compared to any other feeding interventions or no intervention in improving growth and developmental outcomes in children aged 6 to 59 months.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL, 18 other databases, and three trials registers up to August 2018. We also contacted authors and known experts in the field for assistance in identifying ongoing or unpublished data, and searched the reference lists of included studies and reviews, and websites of relevant organizations, for other studies that may not have been captured by our electronic searches.

SELECTION CRITERIA

We included randomized controlled trials and quasi-randomized controlled trials of any duration, where children between 5 months and 59 months (6 years) of age were provided with an animal-source food (e.g. consumption of milk, meat, or eggs), prepared with any cooking method, compared with any intervention or no intervention.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial eligibility using prespecified criteria, extracted data, assessed risk of bias, and graded the quality of the evidence using the GRADE approach.

MAIN RESULTS

Study characteristicsWe included 6 studies that analyzed data from 3036 children aged 5 to 50 months. The studies were conducted in China, the Democratic Republic of Congo, Ecuador, Guatemala, Pakistan, the USA, and Zambia, and lasted between 5 and 12 months. Three studies were funded, in part, by government entities; one study was supported by a nonprofit organization. Two studies did not report a funding source.Three studies compared the effects of feeding an animal-source food with a fortified (iron or iron and zinc), or unfortified cereal; two used a control group with no intervention; one compared a meat-based diet to a dairy-based diet. The types of animal-source foods tested included yogurt, eggs, cheese, lyophilized (freeze-dried) beef product, ground and frozen pork, puréed and jarred beef with gravy or pork, and powdered whey protein.We judged four studies to be at unclear risk of bias overall; three studies because they were funded by an industry with a plausible interest in the outcome of the intervention; and one study because there was insufficient information to assess five of the seven bias 'Risk of bias' domains. We judged two of the six studies to be at high risk of bias overall; one study because there was significant baseline imbalance in length-for-age z scores (LAZ) between groups and evidence of selective reporting; the other study because there there was both a significant baseline imbalance in LAZ and weight-for-age z scores (WAZ) between groups, and a large-scale social media campaign that may have influenced care received at home in the control group.Key resultsAnimal-source foods versus cereal-based foods or no interventionFive studies (2972 children) measured change in linear growth with either height-for-age z scores (HAZ) or LAZ. Three studies (592 children) reported a significant increase in HAZ and LAZ in the intervention group compared to the control group. Two studies (2380 children) reported a decline in LAZ in both groups. In one study (1062 children) there was no difference between the groups in the rate of decline; in the other (1318 children) the decrease in LAZ was significantly smaller in the intervention group.Five studies (2972 children) measured weight gain using WAZ. Three studies (592 children) reported a significant increase in WAZ in the intervention group compared to the control group. In two studies (2380 children), WAZ decreased in both groups. In one of these studies (1318 children), the decrease in the intervention group was significantly smaller than in the control group. In the other study (1062 children), there was no difference between the groups.Three studies (1612 children) reported impacts on all-cause morbidity, but metrics were inconsistent between studies. One study with yogurt (402 children) reported a significant reduction in duration and incidence of diarrhea and upper respiratory infections in the intervention group. One study with eggs (148 children) reported a significant increase in the incidence of diarrhea in the intervention group, but this may have been due to cultural associations with eggs and gastrointestional problems. There were no other significant differences in fever, respiratory infections, or skin conditions between groups. The third study (1062 children) found no differences between intervention and control groups across morbidity measures.No studies reported data on anemia.Meat-based diet versus dairy-based dietOne study (64 children) measured change in LAZ and WAZ in infants fed either a meat-based diet or dairy-based diet. There was a significant increase in LAZ among infants consuming the meat-based diet and a significant decrease in LAZ among infants consuming a dairy-based diet. WAZ increased in both groups, with no significant difference between groups.The study did not assess all-cause morbidity or anemia.Quality of the evidenceWe rated the quality of the evidence as very low overall due to baseline imbalances between intervention and control groups, high heterogeneity in meta-analysis, and imprecision due to wide confidence intervals and inconsistent direction of effects. We have little confidence in the results; further research is likely to change the estimate of magnitude and direction of treatment effect.

AUTHORS' CONCLUSIONS

Given the limited quality of the evidence, we are uncertain of the effects of the provision of animal-source food versus cereal products or no intervention on the growth or development of children. More adequately powered trials with deliberately selected animal-source foods are needed.

Transition from F-75 to ready-to-use therapeutic food in children with severe acute malnutrition, an observational study in Uganda

BACKGROUND

World Health Organization now recommends the transition from F-75 to ready-to-use therapeutic foods (RUTF) in the management of severe acute malnutrition (SAM). We described the transition from F-75 to RUTF and identified correlates of failed transition.

METHODS

We conducted an observational study among children aged 6-59 months treated for SAM at Mulago hospital, Kampala, Uganda. Therapeutic feeding during transition phase was provided by first offering half of the energy requirements from RUTF and the other half from F-75 and then increasing gradually to RUTF as only energy source. The child was considered to have successfully transitioned to RUTF if child was able to gradually consume up to 135 kcal/kg/day of RUTF in the transition phase on first attempt. Failed transition to RUTF included children who failed the acceptance test or those who had progressively reduced RUTF intake during the subsequent days. Failure also included those who developed profuse diarrhoea or vomiting when RUTF was ingested.

RESULTS

Among 341 of 400 children that reached the transition period, 65% successfully transitioned from F-75 to RUTF on first attempt while 35% failed. The median (IQR) duration of the transition period was 4 (3-8) days. The age of the child, mid-upper arm circumference, weight-for-height z-score and weight at transition negatively predicted failure. Each month increase in age reflected a 4% lower likelihood of failure (OR 0.96 (95% CI 0.93; 0.99). Children with HIV (OR 2.73, 95% CI 1.27; 5.85) and those rated as severely ill by caregiver (OR 1.16, 95% CI: 1.02; 1.32) were more likely to fail. At the beginning of the rehabilitation phase, the majority (95%) of the children eventually accepted RUTF while only 5% completed rehabilitation in hospital on F-100.

CONCLUSION

Transition from F-75 to RUTF for hospitalized children with SAM by gradual increase of RUTF was possible on first attempt in 65% of cases. Younger children, severely wasted, HIV infected and those with severe illness as rated by the caregiver were more likely to fail to transit from F-75 to RUTF on first attempt.

Assessing human weaning practices with calcium isotopes in tooth enamel

Weaning practices differ among great apes and likely diverged during the course of human evolution, but behavioral inference from the fossil record is hampered by a lack of unambiguous biomarkers. Here, we show that early-life dietary transitions are recorded in human deciduous tooth enamel as marked variations in Ca isotope ratios (δ^44/42Ca). Using a sequential microsampling method along the enamel growth axis, we collected more than 150 enamel microsamples from 51 deciduous teeth of 12 different modern human individuals of known dietary histories, as well as nine enamel samples from permanent third molars. We measured and reconstructed the evolution of ⁴⁴Ca/⁴²Ca ratios in enamel from in utero development to first months of postnatal development. We show that the observed variations of δ^44/42Ca record a transition from placental nutrition to an adult-like diet and that Ca isotopes reflect the duration of the breastfeeding period experienced by each infant. Typically, the δ^44/42Ca values of individuals briefly or not breastfed show a systematic increase during the first 5-10 mo, whereas individuals with long breastfeeding histories display no measurable variation in δ^44/42Ca of enamel formed during this time. The use of Ca isotope analysis in tooth enamel allows microsampling and offers an independent approach to tackle challenging questions related to past population dynamics and evolution of weaning practices in hominins.

A Qualitative Analysis of Barriers and Facilitators to Optimal Breastfeeding and Complementary Feeding Practices in South Kivu, Democratic Republic of Congo

BACKGROUND

Suboptimal infant and young child feeding (IYCF) practices are determinants of poor child nutritional status. In the Democratic Republic of Congo, few children are fed according to international guidelines; this combined with endemic poverty and food insecurity have contributed to the high prevalence of child undernutrition.

OBJECTIVE

To characterize IYCF practices and barriers and enablers to optimal child feeding in South Kivu.

METHODS

Focus group discussions, structured and in-depth interviews with women of reproductive age, mothers of children <2 years, and health workers were conducted in 2012 as part of formative research for the US Agency for International Development (USAID)-funded Jenga Jamaa II multiyear assistance program.

RESULTS

Although breastfeeding was prevalent, few mothers engaged in optimal feeding practices. Barriers included poverty, high work burden, lack of decision-making power in the household, and perceived milk insufficiency. Health provider guidance and mothers' motivation to breastfeed and feed nutrient-dense foods emerged as facilitators to optimal practices.

CONCLUSIONS

Structural factors, especially long hours working in agricultural fields, impeded mothers' ability to feed their children optimally. Interventions to address child nutrition and improve IYCF practices should take into account these factors, in addition to food access, nutrition education, and behavior change.

Malawian Mothers Consider Lipid-Based Nutrient Supplements Acceptable for Children throughout a 1-Year Intervention, but Deviation from User Recommendations Is Common

BACKGROUND

Lipid-based nutrient supplements (LNSs) offer a vehicle to improve children's diets in low-income countries where complementary foods are typically deficient in essential nutrients. Sustained acceptability by the intended users is essential for achieving growth-promoting effects.

OBJECTIVE

We aimed to determine the sustained acceptability of LNSs among 6- to 18-mo-old children in Malawi.

METHODS

In the context of a trial testing the growth-promoting effect of different formulations and doses of LNSs, we delivered LNSs to the homes of the children biweekly according to the randomization protocol. We defined acceptability to include adherence to feeding recommendations and mothers' experiences of feeding LNSs to their child. We conducted brief interviews each week with the mothers. At 2 time points we conducted knowledge, attitudes, and practices (KAP) interviews. In addition, we conducted repeated in-depth interviews with a subset of mothers.

RESULTS

Of the 1612 children who received the LNS intervention, we analyzed adherence data from 1478 (91.7%) children and KAP data at 2 time points (child's age of 12 and 18 mo) from 839 (52.1%) of the children. The mean ± SD overall adherence (proportion of days when the study child reportedly consumed LNSs considering only those weeks when the supplement had been successfully delivered to the home) was 92.4 ± 9.6%, and there was no difference between children receiving milk-containing or milk-free LNSs. There was also no increasing or decreasing trend over time in any of the groups. Sharing and deviation from other feeding recommendations were common. Maternal experiences were mostly very positive.

CONCLUSIONS

The acceptability of LNS products was good and was sustained for 12 mo in this rural Malawian population. However, sharing of the products with family members and deviation from other feeding recommendations were frequent, which means that individually targeted children were likely to receive less than the intended dose of the LNS. This trial was registered at clinicaltrials.gov as NCT00945698.

Protein quality, hematological properties and nutritional status of albino rats fed complementary foods with fermented popcorn, African locust bean, and bambara groundnut flour blends

The objective of this study was to determine protein quality and hematological properties of infant diets formulated from local food materials. The food materials were obtained locally, fermented, and milled into flour. The flours were mixed as 70% popcorn and 30% African locust bean (FPA), 70% popcorn and 30% bambara groundnut (FPB), and 70% popcorn, 20% bambara groundnut, and 10% African locust bean (FPAB). Proximate analysis, protein quality, hematological properties, and anthropometric measurements of the animals fed with the formulations were investigated. The protein contents of the formulated diets were significantly higher than that of Cerelac (a commercial preparation) (15.75 ± 0.01 g/100 g) and ogi (traditional complementary food) (6.52 ± 0.31 g/100 g). The energy value of FPAB (464.94 ± 1.22 kcal) was higher than those of FPA (441.41 ± 3.05 kcal) and FPB (441.48 ± 3.05 kcal). The biological value (BV) of FPAB (60.20%) was the highest followed by FPB (44.24%) and FPA (41.15%); however, BV of the diets was higher than that of ogi (10.03%) but lower than that of Cerelac (70.43%). Net protein utilization (NPU) of the formulations was 41.16-60.20%, whereas true protein digestibility was 41.05-60.05%. Metabolizable energy (232.98 kcal) and digestible energy (83.69 kcal) of FPAB were the highest, whereas that of FPA had the lowest values. The protein digestibility values corrected for amino acid score of the diets (0.22-0.44) were lower than that of Cerelac (0.52), but higher than that of ogi (0.21). The growth patterns and hematological properties (packed cell volume, red blood cells, hemoglobin, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, and mean corpuscular volume) of the formulated diets were higher than those of ogi, but lower than those of Cerelac. In conclusion, we established that the FPAB food sample was rated best in terms of protein quality over the other formulated diets. Therefore, a FPAB blend may be used as a substitute for ogi.

Randomized controlled trial of the effectiveness of a soybean-maize-sorghum-based ready-to-use complementary food paste on infant growth in South Kivu, Democratic Republic of Congo

BACKGROUND

Evidence of the effectiveness of lipid-based ready-to-use complementary foods (RUCF) at improving linear growth among infants aged 6-12 mo is scarce, and further work is warranted.

OBJECTIVE

The objective was to assess the effectiveness of a fortified soybean-maize-sorghum RUCF paste compared with a fortified corn soy blend (UNIMIX) porridge on the prevalence of underweight and stunting among infants in South Kivu Province, Democratic Republic of Congo.

DESIGN

Infants were randomly assigned at 6 mo of age to receive either RUCF (n = 691) or UNIMIX (n = 692) for 6 mo. In addition to admission and monthly anthropometric measurements, hemoglobin, triglyceride, and cholesterol were measured at enrollment and at the end of the study.

RESULTS

No significant differences in the prevalence of stunting (RUCF: 48.6%; UNIMIX: 46.4%; P = 0.31), the prevalence of underweight (RUCF: 20.4%; UNIMIX: 18.2%; P = 0.42), or weight gain (RUCF: 1.2 ± 0.7 kg; UNIMIX: 1.3 ± 0.7 kg; P = 0.08) were found. A small but statistically significant difference in length gain (RUCF: 5.2 ± 2.0; UNIMIX: 5.4 ± 2.0; P = 0.03) was found. No significant differences in the concentrations of hemoglobin, serum triglyceride, and serum cholesterol were found between the 2 groups.

CONCLUSION

No significant differences were found between the RUCF and UNIMIX in the reduction of the prevalence of stunting and underweight at 12 mo of age among rural Congolese infants. This trial was registered at controlled-trials.com as ISRCTN20267635.

Anemia em crianças de 6 a 59 meses e fatores associados no Município de Jordão, Estado do Acre, Brasil

Examinou-se a prevalência e fatores associados à anemia em estudo transversal com 429 crianças de 6 a 59 meses do Município de Jordão, Estado do Acre, Brasil. Modelos múltiplos de regressão de Poisson foram utilizados com seleção hierárquica das variáveis independentes. A anemia foi altamente prevalente (57,3%; IC95%: 52,5%-62,1%). Ter idade entre 6 e 23,9 meses [razão de prevalência - RP (IC95%): 1,40 (1,09-1,74)], morar na área rural [RP: 1,23 (1,04-1,44)], morar em domicílio com 5 a 14 crianças [RP: 1,23 (1,04-1,44)], ter mãe que fumou na gravidez [RP: 1,29 (1,09-1,53)], mãe anêmica [RP: 1,18 (1,00-1,39)] e apresentar déficit de altura para idade [RP: 1,19 (1,01-1,39)] foram fatores associados ao risco de anemia, e ter mãe que trabalha fora [RP: 0,78 (0,64-0,94)] foi fator de proteção. A anemia é um grave problema de saúde pública nesse município. Estratégias multissetoriais de combate à pobreza, aumento da cobertura e qualidade de serviços de assistência à saúde materno-infantil devem ser implementados.

Alimentação complementar e estado nutricional de crianças menores de dois anos atendidas no Programa Saúde da Família em Acrelândia, Acre, Amazônia Ocidental Brasileira

Com objetivo de investigar o estado nutricional e alimentação complementar em crianças de 6 a 24 meses, residentes na Amazônia Ocidental Brasileira, um estudo transversal foi realizado na área urbana do Município de Acrelândia, Estado do Acre, com 164 crianças. As prevalências de déficit de estatura/idade e anemia foram de 12% e 40%, respectivamente, e de deficiência de ferro isolada, de 85%. Os níveis séricos das vitaminas A e B12 estavam baixos em 15% e 12% das crianças, respectivamente. Houve baixo consumo alimentar dos seguintes nutrientes (% de crianças abaixo das recomendações): ácido fólico (33%), vitamina C (40%), vitamina A (42%), zinco (46%) e ferro (71%). A biodisponibilidade de ferro da dieta foi de 8%. Observou-se baixo consumo de frutas, hortaliças e carnes, com consumo excessivo de leite de vaca e mingau.

In Vitro Estimates of Iron Bioavailability in Some Kenyan Complementary Foods

Background

Iron-deficiency anemia is by far the most widespread micronutrient deficiency disease in the world, affecting more than 2 billion people. Although there are multiple causes of anemia, its high prevalence among children—especially in developing countries such as Kenya—is attributed to an inadequate intake of dietary iron.

Objective

The main objective of this study was to assess the amount of bioavailable iron in Kenyan complementary foods and to determine whether strategies such as food diversification using locally available foods would improve the bioavailability of iron from these foods.

Methods

The in vitro iron bioavailability system/ Caco-2 cell model that mirrors the gastric and intestinal digestion of humans was used in this study to estimate the amount of bioavailable iron in the porridges.

Results

The addition of cassava significantly increased the amount of ferritin formation in a cereal-based home recipe from 36.74 to 67.58 ng/mg. The in vitro data suggests that home recipes can provide an equal or greater amount of bioavailable iron as the commercially available nonfortified porridge products. However, in vitro assessment showed that the nonfortified recipes had less bioavailable iron than Cerelac, a commercially available fortified complementary food that provides about 26% of the RDA of iron for infants 6 and 7 months of age per serving ( p < .0001).

Conclusions

In addition to diet diversity, more approaches to address iron inadequacy of complementary foods are required to improve the bioavailability of iron from the Kenyan complementary foods analyzed.

Protein and hematological evaluations of infant formulated from cooking banana fruits (Musa spp, ABB genome) and fermented bambara groundnut (Vigna subterranean L. Verdc) seeds

Protein-energy malnutrition is regarded as one of the public health problems in developing countries as a result of poor feeding practices due to poverty. This study, therefore, aimed at evaluating nutritional quality of a potential weaning food formulated from locally available food materials. The cooking banana fruit (CB) and bambara groundnut seeds (BG) were purchased from local market in Akure, Ondo State, Nigeria. The CB and BG were processed into flours, mixed in ratios of 90:10, 80:20, 70:30 and 60:40 and subjected into proximate, sensory and biochemical analyses using standard procedures. Nutrend (a commercial formula) and ogi (corn gruel, a traditional weaning food) were used as control. The nutritient composition (g/100 g) of the food samples were ranged as follows: moisture 2.94-6.94, protein 7.02-16.0, ash 1.76-2.99, fat 0.76-8.45, fibre 1.52-3.75, carbohydrate 63.84-88.43 and energy 1569.8-1665.7 kcal. The biological value (BV), net protein retention (NPR), protein efficiency ratio (PER) and feed efficiency ratio (FER) of the experimental food samples were significantly (p<0.05) lower than nutrend, but higher than ogi. The haematological variables of rats fed with formulated food samples, commercial formula (nutrend) and traditional weaning food (ogi) were not significantly (p>0.05) influenced by the dietary treatment. However, the values obtained for red blood cell (RBC), white blood cell (WBC), pack cell volume (PCV) and erythrocyte sedimentation rate (ESR) were higher in the experimental food samples than the commercial food. The growth rate of animals fed with experimental food samples were lower than those fed with the nutrend, but higher than those fed with ogi. In conclusion, the nutritional quality of CB and fermented BG mix of 60:40 ratio was better than ogi; and comparable to the nutrend. This implies that it can be used to replace low quality traditional weaning food and the expensive commercial weaning formula.

Unlocking evidence of early diet from tooth enamel

Recent developments in microspatial analysis of enamel chemistry provide the resolution needed to reconstruct detailed chronological records of an individual's early life history. Evidence of nutritional history, residential mobility, and exposure to heavy metals can potentially be retrieved from archaeological and even fossil teeth. Understanding the pattern and timing of incorporation of each trace element or stable isotope into enamel is crucial to the interpretation of the primary data. Here, we use laser ablation inductively coupled plasma mass spectrometry and ArcGIS software to map variation in calcium-normalized strontium intensities across thin sections of enamel from exfoliated deciduous teeth. Differences in calcium-normalized strontium intensities across each tooth reflect variation in tooth mineralization, implying that sampling location must be taken into account in interpreting results. Chronologically consistent shifts in calcium-normalized strontium intensities in teeth from children with known nursing histories reflect the onset and duration of breastfeeding and the introduction of nonmaternal sources of food. This tool is likely to be valuable for studying weaning and nursing behavior in the past. The distribution of normalized strontium intensities presented here is consistent with a model for the differential incorporation of strontium and calcium into enamel during the secretory and maturational phases of formation.

Processing of complementary food does not increase hair zinc levels and growth of infants in Kilosa district, rural Tanzania

A community-based, randomized, placebo-controlled, double-blind trial was conducted from March 2001 to March 2002 in Kilosa, a rural district of Morogoro Region in Tanzania. One hundred and fifty-eight infants were selected randomly from lists of local Maternal and Child Health Care Centres and received either processed complementary food (PCF) or unprocessed complementary food (UPCF) from age 6 to 12 months. Processing increased Zn solubility and energy density of the porridge prepared from the complementary food (CF) as determined in vitro. Phytate:Zn molar ratio of the PCF and UPCF was 25·8 and 47·5, respectively. Under the study conditions, the processing of CF did not improve Zn status as measured by hair analysis. No significant correlations were found between hair Zn values and anthropometric measurements. Our findings suggest that processing alone of cereal-based CF may be insufficient to ensure an adequate supply of Zn to improve growth and Zn status of infants. Dietary modification to tackle Zn deficiencies in similar target groups may therefore only be successful when other Zn-rich foods such as meat and fish are included.

Quantitative approaches to nutrient density for public health nutrition

Nutrient density, the vitamin or mineral content of a food or diet per unit energy, has long been a useful concept in the nutritional sciences. However, few nutritionists have applied the idea in quantitative, population-based nutrition planning and assessment. This paper discusses the conceptual issues related to the calculation of a nutrient density value that, if consumed, should meet the nutrient needs of most individuals in a population or sub-population, and outlines several methods for estimating this value. The paper also discusses the potential influence on the estimate's validity of factors such as skewed distributions and correlated energy intake and nutrient requirement.

Evaluation of the simultaneous effects of processing parameters on the iron and zinc solubility of infant sorghum porridge by response surface methodology

The purpose of this study was to improve the micronutrient quality of indigenous African infant flour using traditional techniques available in the region. Response surface methodology was used to study the effect of duration of soaking, germination, and fermentation on phytate and phenolic compounds (PC), pH, viscosity, and the in vitro solubility (IVS) of iron and zinc in infant sorghum flour. The phytate and the PC concentrations of the flour were significantly modified as a result of the duration of germination and fermentation and their mutual interaction. These modifications were accompanied by a significant increase in % IVS Zn after 24 h of sprouting. Except for the interaction of soaking and fermentation, none of the processing parameters exerted a significant effect on the % IVS Fe. The viscosity of the porridge prepared with the flour decreased significantly with the duration of germination, making it possible to produce a porridge with high energy and nutrient density. The use of germination in combination with fermentation is recommended in the processing of cereals for infant feeding in developing countries.

Iron solubility compared with in vitro digestion-Caco-2 cell culture method for the assessment of iron bioavailability in a processed and unprocessed complementary food for Tanzanian infants (6-12 months)

The Fe solubility test is a commonly used, easy and relatively cheap in vitro tool for predicting Fe bioavailability in food matrices. However, the outcome of a recent field trial comparing the effect on Fe status of Tanzanian infants of processed v. unprocessed complementary foods (CF), with otherwise the same composition, challenged the validity of this test for predicting Fe bioavailability. In the solubility test, significant more soluble Fe was observed in processed compared with unprocessed foods (mean 18.8 (sem 0.21) v. 4.8 (sem 0.23) %; P<0.001). However, in the field trial, no significant difference in Fe status was seen between processed and unprocessed CF groups after 6 months' follow-up. Therefore, twenty-four samples of these CF (twelve processed and twelve unprocessed batches) were analysed in triplicate for Fe availability using an in vitro digestion-Caco-2 cell culture method and results were compared with solubility results. Significantly more soluble Fe was presented to Caco-2 cells in the processed compared with unprocessed samples (mean 11.5 (sem 1.16) v. 8.5 (sem 2.54) %; P=0.028), but proportionally less Fe was taken up by the cells (mean 3.0 (sem 0.40) v. 11.7 (sem 2.22) %; P=0.007). As a net result, absolute Fe uptake was lower (not significantly) in processed compared with unprocessed CF (mean 1.3 (sem 0.16) v. 3.4 (sem 0.83) nmol/mg cell protein; P=0.052). These data clearly demonstrate that the Fe solubility test was not a good indicator of Fe bioavailability in these particular food matrices. In contrast, the results of an in vitro Caco-2 model supported the effects observed in vivo.

Agriculture: the real nexus for enhancing bioavailable micronutrients in food crops

Human existence requires that agriculture provide at least 50 nutrients (e.g., vitamins, minerals, trace elements, amino acids, essential fatty acids) in amounts needed to meet metabolic demands during all seasons. If national food systems do not meet these demands, mortality and morbidity rates increase, worker productivity declines, livelihoods are diminished and societies suffer. Today, many food systems within the developing world cannot meet the nutritional needs of the societies they support mostly due to farming systems that cannot produce enough micronutrients to meet human needs throughout the year. Nutrition transitions are also occurring in many rapidly developing countries that are causing chronic disease (e.g., cancer, heart disease, stroke, diabetes, and osteoporosis) rates to increase substantially. These global developments point to the need to explicitly link agricultural technologies to human health. This paper reviews some ways in which agriculture can contribute significantly to reducing micronutrient malnutrition globally. It concludes that it is imperative that close linkages be forged between the agriculture, nutrition and health arenas in order to find sustainable solutions to micronutrient malnutrition with agriculture becoming the primary intervention tool to use in this fight.

Breeding for micronutrients in staple food crops from a human nutrition perspective

Over three billion people are currently micronutrient (i.e. micronutrient elements and vitamins) malnourished, resulting in egregious societal costs including learning disabilities among children, increased morbidity and mortality rates, lower worker productivity, and high healthcare costs, all factors diminishing human potential, felicity, and national economic development. Nutritional deficiencies (e.g. iron, zinc, vitamin A) account for almost two-thirds of the childhood death worldwide. Most of those afflicted are dependent on staple crops for their sustenance. Importantly, these crops can be enriched (i.e. 'biofortified') with micronutrients using plant breeding and/or transgenic strategies, because micronutrient enrichment traits exist within their genomes that can to used for substantially increasing micronutrient levels in these foods without negatively impacting crop productivity. Furthermore, 'proof of concept' studies have been published using transgenic approaches to biofortify staple crops (e.g. high beta-carotene 'golden rice' grain, high ferritin-Fe rice grain, etc). In addition, micronutrient element enrichment of seeds can increase crop yields when sowed to micronutrient-poor soils, assuring their adoption by farmers. Bioavailability issues must be addressed when employing plant breeding and/or transgenic approaches to reduce micronutrient malnutrition. Enhancing substances (e.g. ascorbic acid, S-containing amino acids, etc) that promote micronutrient bioavailability or decreasing antinutrient substances (e.g. phytate, polyphenolics, etc) that inhibit micronutrient bioavailability, are both options that could be pursued, but the latter approach should be used with caution. The world's agricultural community should adopt plant breeding and other genetic technologies to improve human health, and the world's nutrition and health communities should support these efforts. Sustainable solutions to this enormous global problem of 'hidden hunger' will not come without employing agricultural approaches.

HIV transmission through breastfeeding: problems and prevention

The greatest burden of HIV infection in women and their children is disproportionately borne by the poorest countries, especially in sub-Saharan Africa. Breastfeeding is a major health-promoting factor for infants and children in developing countries but the risk of mother-to-child transmission (MTCT) of HIV by this route is challenging traditional practices and health policies in low-resource countries. Maternal and infant factors contributing to the risk of MTCT through breastfeeding are still poorly understood and not well researched. Factors identified include: advanced clinical stages of infection in the mother; high maternal plasma HIV-1 load; presence of mastitis; and infant oral thrush. In many developing countries, international agencies are providing support and recommendations for preventing MTCT of HIV-1 by breastfeeding. Preventive strategies supported by WHO/UNICEF and charitable agencies in some sentinel centres in sub-Saharan Africa include routine antenatal voluntary counselling and testing (VCT), PCR testing of infants of seropositive mothers at 6 weeks of age, various combinations of a shortened period (3-6 mths) of exclusive breastfeeding, perinatal administration of antiretrovirals (ARV) such as nevirapine and provision of affordable and safe infant replacement feeds (presently given free by UNICEF in some centres). Many problems, however, have hindered effective implementation of these interventions. In many poor communities, even where VCT facilities are available, acceptance of HIV testing is low because there is fear of stigmatisation by the spouse, family or community and compliance with complex drug regimens is therefore poor. Other problems include the exorbitant cost of antiretroviral drugs, inadequately resourced health care systems and unavailability or poor acceptance of safe breast-milk alternatives. The rate of mixed feeding is high and so the risk of MTCT is increased. Continued promotion of exclusive breastfeeding for at least 6 months, irrespective of HIV status, followed by a properly prepared, high energy, nutritious complementary diet, with the possibility of early weaning to an animal milk formula, still appears to be the most appropriate option for the poor in countries with high levels of MTCT not deriving any benefit from the above strategies. While a longer period of breastfeeding would probably increase the risk of MTCT in vulnerable communities, a shorter duration would certainly increase infant morbidity and mortality. Results of investigations of the efficacy of ARV for protecting the infants of HIV-infected mothers during the breastfeeding period are awaited.

Contemporary Trends in Infant Feeding Research

▪ Abstract  This review examines current research in the subfields of anthropology and related disciplines on the biocultural process of breastfeeding and broader questions of infant and young-child feeding. The themes of sexuality, reproduction, embodiment, and subjective experience are then linked to the problems women who breastfeed face in bottle-feeding cultures. Anthropologists have contributed to policy-relevant debates concerning women's work and scheduling in relation to infant care and exclusive breastfeeding. The extensive ethnographic work on children's transition to consuming household foods demonstrates the need to integrate research on breastfeeding with research on complementary feeding. Current debates around HIV and chemical residues in breastmilk call for a critical examination of the effects of globalization and corporate control on infant feeding practices. The literature shows how the narrow specialty of infant feeding has broad implications for the discipline.

Genetic selection for enhanced bioavailable levels of iron in bean (Phaseolus vulgaris L.) seeds

The bioavailability of Fe from 24 select genotypes of bean (Phaseolus vulgaris L.) seeds containing a range of concentrations of Fe, myo-inositol pentaphosphate plus phytic acid (IP5+IP6), and tannins was studied using a rat model. Bean accessions, selected from field trials for their variations in Fe, phytate, and tannin seed concentrations, were grown in a greenhouse in nutrient solutions radiolabeled with (59)Fe. Mature seeds were autoclaved and lyophilized. Test meals (containing 1 g of dried bean, 0.5 g of sucrose, and 1 g of basal Fe-deficient diet) were fed to marginally Fe-depleted weanling rats over a 3-h period; rats were radioassayed in a gamma-spectrometer immediately after feeding and daily thereafter for the next 10 d. Radioiron retention data were used to calculate percent Fe absorption (i.e., Fe bioavailability) from the meals. Seed Fe concentrations ranged from 52 to 157 microg g(-)(1) dry weight. There was a tendency to also select for higher Zn concentrations in the beans when selecting for high Fe concentrations. The Fe bioavailability to rats from test meals depended on the genotype and varied from 53% to 76% of the total Fe. Bean genotypes with higher seed Fe concentrations resulted in increased amounts of bioavailable Fe to rats. There was no significant correlation between the Fe concentration in different bean genotypes and Fe bioavailability to rats attributable to variations in IP5+IP6 or tannins, even though these antinutrients varied widely (i.e., from 19.6 to 29.2 micromol of IP5+IP6 g(-)(1) and from 0.35 to 2.65 mg of tannins g(-)(1)) in the test meals. Other unknown seed factors (i.e., antinutrients or promoter substances) may be contributing factors affecting Fe bioavailability from bean seeds.