Equity implications of rice fortification: a modelling study from Nepal

Assessing food-based strategies to address anaemia in pregnancy in rural plains Nepal: a mixed methods study

Anaemia in pregnancy is a persistent health problem in Nepal and could be reduced through nutrition counselling and strengthened iron folic acid supplementation programmes. We analysed 24-hour diet recall data from 846 pregnant women in rural plains Nepal, using linear programming to identify the potential for optimised food-based strategies to increase iron adequacy. We then conducted qualitative research to analyse how anaemia was defined and recognised, how families used food-based strategies to address anaemia, and the acceptability of optimised food-based strategies. We did 16 interviews of recently pregnant mothers, three focus group discussions with fathers, three focus group discussions with mothers-in-law and four interviews with key informants. Dietary analyses showed optimised diets did not achieve 100 % of recommended iron intakes, but iron intakes could be doubled by increasing intakes of green leaves, egg and meat. Families sought to address anaemia through food-based strategies but were often unable to because of the perceived expense of providing an 'energy-giving' diet. Some foods were avoided because of religious or cultural taboos, or because they were low status and could evoke social consequences if eaten. There is a need for counselling to offer affordable ways for families to optimise iron adequacy. The participation of communities in tailoring advice to ensure cultural relevance and alignment with local norms is necessary to enable its effectiveness.

Human Dietary Exposure to Heavy Metals via Rice in Nepal

The effects of exposure to heavy metals (HMs) in rice on human health have become a global public health concern, particularly in countries where rice is consumed as a staple food. The concentrations of HMs, including cadmium (Cd), arsenic (As), lead (Pb), and copper (Cu), in commercial rice samples (n = 170) were analyzed to estimate the HM exposure of consumers in Nepal. The geometric mean concentrations of Cd, As, Pb, and Cu in commercial rice were 15.5 ± 16.0, 43.4 ± 19.6, 16.0 ± 14.0, and 1066 ± 1210 μg/kg, respectively, all below the maximum allowable concentrations (MACs) recommended by FAO/WHO. Generally, the average estimated daily intakes (EDIs) of Cd, As, Pb, and Cu were all below the oral reference doses (RfDs). However, young age groups were exposed to high levels of HMs, and the average EDI of As and the P99.9 EDIs of Cu and Cd were above the corresponding RfDs. The mean hazard index and total carcinogenic risk were 1.13 and 1.04 × 10^-3 respectively, suggesting a potential non-carcinogenic risk (NCR) and a carcinogenic risk (CR) via rice consumption. Arsenic contributed the most strongly to NCR and Cd to CR. Overall, although the HM levels in rice were generally safe, the Nepalese population may be exposed to an elevated health risk from rice consumption.

Rice: a potential vehicle for micronutrient fortification

The choices of consumer towards food have been changed. Consumer prefers to eat food which is not only safe but also nutritious. Now a day, they like to eat the food which promote their health and help in minimizing nutrition related health hazards. Rice is a staple food in many countries, but most emerging issue is that rice is deficit in minerals. Rice ranks second among cereals in dietary uses around the world. Rice is deficit in iron (Fe) zinc (Zn) and these are important micronutrients for infants, men and women. Fortification of rice with iron and zinc would help to minimize nutrient deficient disorders among humans. Present study is aimed to introduce nutrients rich rice for consumers and also to encourage food-fortification organizations for diverting their focus on rice fortification. In south Asian countries, micronutrient deficiency especially Fe and Zn deficiency is very common. The rice because of its use as a staple food can be utilized as a carrier medium for transporting micronutrients from plants sources to human beings. Hence, rice fortification with microminerals can prove as a miracle for the virtual eradication of nutrition related diseases in humans.

Update on Analytical Methods and Research Gaps in the Use of Household Consumption and Expenditure Survey Data to Inform the Design of Food-Fortification Programs

The lack of nationally representative, individual-level dietary intake data has led researchers to increasingly turn to household-level data on food acquisitions and/or consumption to inform the design of food-fortification programs in low- and middle-income countries (LMICs). These nationally representative, household-level data come from household consumption and expenditure surveys (HCESs), which are collected regularly in many LMICs and are often made publicly available. Our objectives were to examine the utility of HCES data to inform the design of food-fortification programs and to identify best-practice methods for analyzing HCES data for this purpose. To this end, we summarized information needed to design fortification programs and assessed the extent to which HCES data can provide corresponding indicators. We concluded that HCES data are well suited to guide the selection of appropriate food vehicles, but because individual-level estimates of apparent nutrient intakes rely on assumptions about the intrahousehold distribution of food, more caution is advised when using HCES data to select the target micronutrient content of fortified foods. We also developed a checklist to guide analysts through the use of HCES data and, where possible, identified research-based, best-practice analytical methods for analyzing HCES data, including selecting the number of days of recall data to include in the analysis and converting reported units to standard units. More research is needed on how best to deal with composite foods, foods consumed away from home, and extreme values, as well as the best methods for assessing the adequacy of apparent intakes. Ultimately, we recommend sensitivity analyses around key model parameters, and the continual triangulation of HCES-based results with other national and subnational data on food availability, dietary intake, and nutritional status when designing food-fortification programs.

Occurrence of total mercury and methylmercury in rice: Exposure and health implications in Nepal

Emerging studies have indicated that the consumption of rice could be the major methylmercury (MeHg) contributor to human mercury (Hg) exposure. Nonetheless, few studies are available on Hg in rice around the world, especially in countries with heavy rice diet. In this study, total Hg (THg) and MeHg levels in rice samples (n = 172) across Nepal were first investigated. The geometric mean THg was 7.05 ± 7.71 µg/kg with a range of 0.622 µg/kg to 158 µg/kg, and the maximum THg level was up to 791% of the Chinese National Standard Limit for THg in rice (20 µg/kg). The geometric mean MeHg was 0.820 ± 0.660 µg/kg with a range of 0.189 µg/kg to 8.59 µg/kg. Overall, the mean MeHg exposure (0.00445 ± 0.00477 µg/kg bw/day) and inorganic Hg (IHg) exposure (0.0360 ± 0.0739 µg/kg bw/day) were lower than the reference dose (RfD) of 0.1 µg/kg bw/day for MeHg and the provisional tolerable weekly intake (PTWI) of 0.571 µg/kg bw/day for IHg, respectively. Concerning different groups of vulnerable populations, the highest MeHg exposure (0.126 µg/kg bw/day) and IHg exposure (1.57 µg/kg bw/day) of preschoolers (37-50 months old) were approximately 126% of the RfD for MeHg and 275% of the PTWI for IHg. When the pregnant mothers eat the rice without awareness of the Hg content in rice, the mean and highest intelligence quotients (IQs) losses were 9554 and 118659 points, respectively, and the corresponding economic costs due to IQ loss could be 15.1 million USD and 188 million USD in Nepal. The results of rice THg and MeHg levels and corresponding exposure in populations highlighted the occurrence of rice THg and MeHg pollution issues in Nepal. More efforts should be made to protect younger groups in Nepal from high rice Hg exposure. CAPSULE: Owing to the high rice consumption rates relative to body mass, preschoolers (37-50 months) may meet the 126% reference dose (0.1 µg/kg bw/day) for MeHg and 275% provisional tolerable weekly intake (0.571 µg/kg bw/day) for IHg exposure in Nepal.

Addressing anaemia in pregnancy in rural plains Nepal: A qualitative, formative study

Maternal anaemia prevalence in low-income countries is unacceptably high. Our research explored the individual-, family- and community-level factors affecting antenatal care uptake, iron folic acid (IFA) intake and consumption of micronutrient-rich diets among pregnant women in the plains of Nepal. We discuss how these findings informed the development of a home visit and community mobilisation intervention to reduce anaemia in pregnancy. We used a qualitative methodology informed by the socio-ecological framework, conducting semi-structured interviews with recently pregnant women and key informants, and focus group discussions with mothers-in-law and fathers. We found that harmful gender norms restricted women's access to nutrient-rich food, restricted their mobility and access to antenatal care. These norms also restricted fathers' role to that of the provider, as opposed to the caregiver. Pregnant women, mothers-in-law and fathers lacked awareness about iron-rich foods and how to manage the side effects of IFA. Fathers lacked trust in government health facilities affecting access to care and trust in the efficacy of IFA. Our research informed interventions by (1) informing the development of intervention tools and training; (2) informing the intervention focus to engaging mothers-in-law and men to enable behaviour change; and (3) demonstrating the need to work in synergy across individual, family and community levels to address power and positionality, gender norms, trust in health services and harmful norms. Participatory groups and home visits will enable the development and implementation of feasible and acceptable strategies to address family and contextual issues generating knowledge and an enabling environment for behaviour change.