Red palm oil as a source of β-carotene in a school biscuit used to address vitamin A deficiency in primary school children

Impact of Crude Palm Oil Fortified Cookies Supplementation on Anthropometry, Vitamin A and Hematological Status of School Children in India

Abstract. Objectives: Food-based strategies remain the most sustainable solutions for combating micronutrient deficiencies. Crude palm oil being the richest natural source of β-carotene, the study aimed to assess the impact of crude palm oil fortified cookies supplementation on anthropometry, vitamin A and hematological status of school children.

Methods: 444 children (boys-226, girls-218), aged 5-13 years from two Municipal Corporation of Delhi primary schools were enrolled. By draw of lot, children from one of the schools formed the experimental (n = 224; boys-119, girls-105) while other formed the placebo group (n = 220; boys-107; girls-113). Children from the experimental group received six crude palm oil fortified cookies providing 2152 μg of β-carotene while the placebo group received similar but non-fortified cookies each day for 50 school days. Anthropometry, vitamin A, and hematological status were assessed at baseline and post supplementation.

Results: Post supplementation, the number of stunted subjects reduced significantly (p < 0.05) in the experimental group. There was a significant increase in plasma retinol (170.9%; mean change: 1.55 ± 1.30 μmol/L - experimental group vs. 0.45 ± 0.99 μmol/L - placebo group) and β-carotene (p < 0.01; median change from 0.55 to 0.76 μmol/L - experimental group vs. 0.59 to 0.55 μmol/L -placebo group) concentrations of the experimental group. The increase in hematological parameters (mean change in Hemoglobin: 1.64 g/dL in experimental group vs. 2.10 g/dL in placebo group) of both the groups were however, comparable.

Conclusion: To address micronutrient deficiencies particularly in developing nations, the use of crude palm oil should be encouraged through supplementary feeding programs by way of ready-to-eat snacks.

Fortification of staple foods with vitamin A for vitamin A deficiency

BACKGROUND

Vitamin A deficiency is a significant public health problem in many low- and middle-income countries, especially affecting young children, women of reproductive age, and pregnant women. Fortification of staple foods with vitamin A has been used to increase vitamin A consumption among these groups.

OBJECTIVES

To assess the effects of fortifying staple foods with vitamin A for reducing vitamin A deficiency and improving health-related outcomes in the general population older than two years of age.

SEARCH METHODS

We searched the following international databases with no language or date restrictions: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 6) in the Cochrane Library; MEDLINE and MEDLINE In Process OVID; Embase OVID; CINAHL Ebsco; Web of Science (ISI) SCI, SSCI, CPCI-exp and CPCI-SSH; BIOSIS (ISI); POPLINE; Bibliomap; TRoPHI; ASSIA (Proquest); IBECS; SCIELO; Global Index Medicus - AFRO and EMRO; LILACS; PAHO; WHOLIS; WPRO; IMSEAR; IndMED; and Native Health Research Database. We also searched clinicaltrials.gov and the International Clinical Trials Registry Platform to identify ongoing and unpublished studies. The date of the last search was 19 July 2018.

SELECTION CRITERIA

We included individually or cluster-randomised controlled trials (RCTs) in this review. The intervention included fortification of staple foods (sugar, edible oils, edible fats, maize flour or corn meal, wheat flour, milk and dairy products, and condiments and seasonings) with vitamin A alone or in combination with other vitamins and minerals. We included the general population older than two years of age (including pregnant and lactating women) from any country.

DATA COLLECTION AND ANALYSIS

Two authors independently screened and assessed eligibility of studies for inclusion, extracted data from included studies and assessed their risk of bias. We used standard Cochrane methodology to carry out the review.

MAIN RESULTS

We included 10 randomised controlled trials involving 4455 participants. All the studies were conducted in low- and upper-middle income countries where vitamin A deficiency was a public health issue. One of the included trials did not contribute data to the outcomes of interest.Three trials compared provision of staple foods fortified with vitamin A versus unfortified staple food, five trials compared provision of staple foods fortified with vitamin A plus other micronutrients versus unfortified staple foods, and two trials compared provision of staple foods fortified with vitamin A plus other micronutrients versus no intervention. No studies compared staple foods fortified with vitamin A alone versus no intervention.The duration of interventions ranged from three to nine months. We assessed six studies at high risk of bias overall. Government organisations, non-governmental organisations, the private sector, and academic institutions funded the included studies; funding source does not appear to have distorted the results.Staple food fortified with vitamin A versus unfortified staple food We are uncertain whether fortifying staple foods with vitamin A alone makes little or no difference for serum retinol concentration (mean difference (MD) 0.03 μmol/L, 95% CI -0.06 to 0.12; 3 studies, 1829 participants; I² = 90%, very low-certainty evidence). It is uncertain whether vitamin A alone reduces the risk of subclinical vitamin A deficiency (risk ratio (RR) 0.45, 95% CI 0.19 to 1.05; 2 studies; 993 participants; I² = 33%, very low-certainty evidence). The certainty of the evidence was mainly affected by risk of bias, imprecision and inconsistency.It is uncertain whether vitamin A fortification reduces clinical vitamin A deficiency, defined as night blindness (RR 0.11, 95% CI 0.01 to 1.98; 1 study, 581 participants, very low-certainty evidence). The certainty of the evidence was mainly affected by imprecision, inconsistency, and risk of bias.Staple foods fortified with vitamin A versus no intervention No studies provided data for this comparison.Staple foods fortified with vitamin A plus other micronutrients versus same unfortified staple foods Fortifying staple foods with vitamin A plus other micronutrients may not increase the serum retinol concentration (MD 0.08 μmol/L, 95% CI -0.06 to 0.22; 4 studies; 1009 participants; I² = 95%, low-certainty evidence). The certainty of the evidence was mainly affected by serious inconsistency and risk of bias.In comparison to unfortified staple foods, fortification with vitamin A plus other micronutrients probably reduces the risk of subclinical vitamin A deficiency (RR 0.27, 95% CI 0.16 to 0.49; 3 studies; 923 participants; I² = 0%; moderate-certainty evidence). The certainty of the evidence was mainly affected by serious risk of bias.Staple foods fortified with vitamin A plus other micronutrients versus no interventionFortification of staple foods with vitamin A plus other micronutrients may increase serum retinol concentration (MD 0.22 μmol/L, 95% CI 0.15 to 0.30; 2 studies; 318 participants; I² = 0%; low-certainty evidence). When compared to no intervention, it is uncertain whether the intervention reduces the risk of subclinical vitamin A deficiency (RR 0.71, 95% CI 0.52 to 0.98; 2 studies; 318 participants; I² = 0%; very low-certainty evidence) . The certainty of the evidence was affected mainly by serious imprecision and risk of bias.No trials reported on the outcomes of all-cause morbidity, all-cause mortality, adverse effects, food intake, congenital anomalies (for pregnant women), or breast milk concentration (for lactating women).

AUTHORS' CONCLUSIONS

Fortifying staple foods with vitamin A alone may make little or no difference to serum retinol concentrations or the risk of subclinical vitamin A deficiency. In comparison with provision of unfortified foods, provision of staple foods fortified with vitamin A plus other micronutrients may not increase serum retinol concentration but probably reduces the risk of subclinical vitamin A deficiency.Compared to no intervention, staple foods fortified with vitamin A plus other micronutrients may increase serum retinol concentration, although it is uncertain whether the intervention reduces the risk of subclinical vitamin A deficiency as the certainty of the evidence has been assessed as very low.It was not possible to estimate the effect of staple food fortification on outcomes such as mortality, morbidity, adverse effects, congenital anomalies, or breast milk vitamin A, as no trials included these outcomes.The type of funding source for the studies did not appear to distort the results from the analysis.

Red palm olein supplementation on cytokines, endothelial function and lipid profile in centrally overweight individuals: a randomised controlled trial

BACKGROUND/OBJECTIVES

The consumption of antioxidant-rich cooking oil such as red palm olein may be cardioprotective from the perspective of subclinical inflammation and endothelial function.

SUBJECTS/METHODS

Using a crossover design, we conducted a randomised controlled trial in 53 free-living high-risk abdominally overweight subjects, comparing the effects of incorporating red palm olein (with palm olein as control) in a supervised isocaloric 2100 kcal diet of 30% en fat, two-thirds (45 g/day) of which were derived from the test oil for a period of 6 weeks each.

RESULTS

We did not observe a significant change in interleukin-6 (IL-6), in parallel with other pro-inflammatory (tumour necrosis factor-β, interleukin-1β, IL-1β, high sensitivity C-reactive protein, hsCRP) and endothelial function (soluble intercellular adhesion molecules, sICAM, soluble intravascular adhesion molecules, sVCAM) parameters. Interestingly, we observed a significant reduction in oxidised LDL levels (P < 0.0386) while on the red palm olein diet, together with the increase in plasma alpha tocopherol (P < 0.0002), alpha carotene (P < 0.0001) and beta carotene (P < 0.0001) concentrations compared with palm olein diet.

CONCLUSION

Red palm olein did not improve subclinical inflammation and endothelial function despite profound increase in antioxidant levels. The positive improvement in oxidised LDL merits further attention in this group of subjects at risk of developing cardiovascular disease.

Health-promoting effects of red palm oil: evidence from animal and human studies

The fruit of the oil palm tree (Elaeis guineesis) is the source of antioxidant-rich red palm oil. Red palm oil is a rich source of phytonutrients such as tocotrienols, tocopherols, carotenoids, phytosterols, squalene, and coenzyme Q10, all of which exhibit nutritional properties and oxidative stability. Mutagenic, nutritional, and toxicological studies have shown that red palm oil contains highly bioavailable β-carotene and vitamin A and is reasonably stable to heat without any adverse effects. This review provides a comprehensive overview of the nutritional properties of red palm oil. The possible antiatherogenic, antihemorrhagic, antihypertensive, anticancer, and anti-infective properties of red palm oil are examined. Moreover, evidence supporting the potential effectiveness of red palm oil to overcome vitamin A deficiency in children and pregnant women, to improve ocular complications of vitamin A deficiency, to protect against ischemic heart disease, to promote normal reproduction in males and females, to aid in the management of diabetes, to ameliorate the adverse effects of chemotherapy, and to aid in managing hypobaric conditions is presented.

Health Benefits of Using Red Palm Oil in Deep-frying Potatoes: Low Acrolein Emissions and High Intake of Carotenoids

Palm oil is the second largest vegetable oil in terms of world production. Besides, red palm oil (RPO) is nonhydrogenated, has a high oxidative stability and contains high levels of natural antioxidants, such as carotenoids. The main objectives of this study were to study acrolein emissions during deep-frying operations, as an indicator of potentially toxic volatile compounds, and to evaluate the importance of French fries (fried with red palm oil) as an extra source of carotenoids in the diet. The acrolein emission rates from mono-unsaturated oils, such as red palm and olive oils, were much lower than that of poly-unsaturated oils, sunflower. The total carotenoid content of red palm oil, 480 mg/L, makes this oil perfect for developing functional foods round the world and gives the oil a high oxidative stability and long shelf life. Sensory tests proved that RPO French fries were scored positively by regular consumers. Their color was initially considered unusual and got low scores; however, when the flavor was evaluated RPO fries got higher scores than olive or sunflower fries. RPO proved to generate low amounts of potentially toxic volatiles, acrolein, and be an excellent source carotenoids.

Red palm oil as a source of vitamin A for mothers and children: impact of a pilot project in Burkina Faso

Objective:

To demonstrate the effectiveness of the commercial introduction of red palm oil (RPO) as a source of vitamin A (VA) for mothers and children in a non-consuming area, as a dietary diversification strategy.

Design:

A pre–post intervention design (no control area) was used to assess changes in VA intake and status over a 24-month pilot project.

Setting and subjects:

The pilot project involved RPO promotion in 10 villages and an urban area in east-central Burkina Faso, targeting approximately 10?000 women and children aged < 5 years. A random sample of 210 mother–child (12–36-months-old) pairs was selected in seven out of the 11 pilot sites for the evaluation.

Results:

After 24 months, RPO was reportedly consumed by nearly 45% of mothers and children in the previous week. VA intake increased from 235 ± 23 μg retinol activity equivalents (RAE) to 655 ± 144 μg RAE in mothers (41 to 120% of safe intake level), and from 164 ± 14 μg RAE to 514 ± 77 μg RAE in children (36 to 97%). Rates of serum retinol < 0.70 μmoll−1decreased from 61.8 ± 8.0% to 28.2 ± 11.0% in mothers, and from 84.5 ± 6.4% to 66.9 ± 11.2% in children. Those with a lower initial concentration of serum retinol showed a higher serum retinol response adjusted for VA intake.

Conclusions:

Commercial distribution of RPO was effective in reducing VA deficiency in the pilot sites. While it is promising as part of a national strategy, additional public health and food-based measures are needed to control VA malnutrition, which remained high in the RPO project area

The positive impact of red palm oil in school meals on vitamin A status: study in Burkina Faso

Background

Vitamin A (VA) deficiency is widespread in sub-Saharan Africa and school-age children are a vulnerable group. In Burkina Faso, the production and consumption of red palm oil (RPO) is being promoted as a food supplement for VA. The objective of the study was to assess the impact on serum retinol of adding RPO to school lunch in two test zones of Burkina Faso.

Methods

Over one school year, 15 ml RPO was added to individual meals 3 times a week in selected primary schools in two sites. Serum retinol was measured with HPLC at baseline and exactly 12 months later to take account of seasonality. A simple pre-post test design was used in the Kaya area (north-central Burkina), where 239 pupils from 15 intervention schools were randomly selected for the evaluation. In Bogandé (eastern Burkina), 24 schools were randomised for the controlled intervention trial: 8 negative controls (G1) with only the regular school lunch; 8 positive controls (G2) where the pupils received a single VA capsule (60 mg) at the end of the school year; and 8 schools with RPO through the school year (G3). A random sample of 128 pupils in each school group took part in the evaluation.

Results

In Kaya, serum retinol went from 0.77 ± 0.37 μmol/L at baseline to 1.07 ± 0.40 μmol/L one year later (p < 0.001). The rate of low serum retinol (<0.7 μmol/L) declined from 47.2% to 13.1%. In Bogandé, serum retinol increased significantly (p < 0.001) only in the capsule and RPO groups, going from 0.77 ± 0.28 to 0.98 ± 0.33 μmol/L in the former, and from 0.82 ± 0.3 to 0.98 ± 0.33 μmol/L in the latter. The rate of low serum retinol went from 46.1 to 17.1% in the VA capsule group and from 40.4% to 14.9% in the RPO group. VA-deficient children benefited the most from the capsule or RPO. Female sex, age and height-for-age were positively associated with the response to VA capsules or RPO.

Conclusion

RPO given regularly in small amounts appears highly effective in the reduction of VA deficiency. RPO deserves more attention as a food supplement for VA and as a potential source of rural income in Sahelian countries.

The effect of a biscuit with red palm oil as a source of beta-carotene on the vitamin A status of primary school children: a comparison with beta-carotene from a synthetic source in a randomised controlled trial

OBJECTIVE

To determine the effect of a biscuit with red palm oil as a source of beta-carotene on the vitamin A status of primary school children and to compare this with the effect of a biscuit with beta-carotene from a synthetic source.

DESIGN

Randomised controlled trial.

SETTING

A rural community in KwaZulu-Natal, South Africa.

SUBJECTS

A total of 437 primary school children, aged 5--11 y; 400 completed the study.

INTERVENTION

Subjects were randomly assigned to one of three groups, receiving, respectively: (i) a placebo biscuit; (ii) a biscuit with synthetic beta-carotene as a vitamin A fortificant (SB); (iii) a biscuit with red palm oil as a source of beta-carotene (PB); SB and PB supplied 30% of the RDA for vitamin A per serving of three biscuits. Biscuits were distributed daily during the school week; vitamin A status was assessed at baseline and after 3 months.

RESULTS

There was a significant improvement in serum retinol compared to the control group in both the SB and PB groups (P<0.005); the treatment effect for the two groups was equivalent (difference in treatment effect 0.62 microg/dl, with a 90% CI -0.33--1.57).

CONCLUSIONS

A biscuit with red palm oil as a source of beta-carotene is as effective as a biscuit with synthetic beta-carotene in improving the vitamin A status of primary school children. The additional qualities of red palm oil (ie no trans fatty acids; rich source of antioxidants) make it an excellent alternative fortificant for addressing vitamin A deficiency.