Acceptance and Impact of Millet-Based Mid-Day Meal on the Nutritional Status of Adolescent School Going Children in a Peri Urban Region of Karnataka State in India

Sensory acceptability of biofortified foods and food products: a systematic review

CONTEXT

It is important to understand the sensory acceptability of biofortified food products among target population groups if biofortification is to be realized as a sustainable strategy for mitigation of micronutrient deficiencies, able to be scaled up and applied through programs.

OBJECTIVE

This systemic review aims to summarize and synthesize the sensory acceptability of conventionally bred iron-, zinc-, and provitamin A-biofortified food products.

DATA SOURCES

MEDLINE (PubMed), AGRICOLA, AgEcon, CABI Abstracts (Web of Science), and organizational websites (eg, those of HarvestPlus and CGIAR and their partners) were searched for relevant articles. No access to any market research that may have been internally conducted for the commercial biofortified food products was available.

DATA EXTRACTION

This review identified articles measuring the sensory acceptability of conventionally bred biofortified food products. Extraction of the hedonic ratings of food products was performed.

DATA ANALYSIS

An "Acceptability Index %" was defined based on hedonic scoring to determine an overall rating, and used to categorize biofortified food products as "acceptable" (≥70%) or "not acceptable" (<70%). Additionally, this review narratively synthesized studies using methods other than hedonic scoring for assessing sensory acceptability.

CONCLUSIONS

Forty-nine studies assessed the acceptability of 10 biofortified crops among children and adults, in mostly rural, low-income settings across Africa, Latin America, and India; food products made from mineral and provitamin A-biofortified food products were generally acceptable. Compared with studies on provitamin-A biofortified food products, few studies (1 to 2 each) on mineral-enhanced crops such as rice, cowpeas, lentils, and wheat were found, limiting the generalizability of the findings. Similarly, few studies examined stored biofortified food products. Few commercial food products have so far been developed, although new varieties of crops are being continuously tested and released globally. Certain crop varieties were found to be acceptable while others were not, suggesting that particular varieties should be prioritized for scale-up. Determining sensory acceptability of biofortified food products is important for informing programmatic scale-up and implementation across diverse populations and settings.

Nutritional status of school-age children (5-19 years) in South Asia: A scoping review

Information on malnutrition for school-age children and adolescents (5-19 years) in South Asia is fragmented and inconsistent, which limits the prioritization of nutrition policies, programmes and research for this age group. This scoping review aimed to synthesize existing evidence on the burden of malnutrition for children and adolescents aged 5-19 years in South Asia, and on interventions to improve their nutritional status. Cochrane Library, EMBASE, Medline and Google Scholar were systematically searched for articles published between January 2016 and November 2022. Eligible studies reported the prevalence of undernutrition, overweight/obesity, micronutrient deficiencies and unhealthy dietary intakes, and interventions that aimed to address these in South Asia. In total, 296 articles met our inclusion criteria. Evidence revealed widespread, yet heterogeneous, prevalence of undernutrition among South Asian children and adolescents: thinness (1.9%-88.8%), wasting (3%-48%), underweight (9.5%-84.4%) and stunting (3.7%-71.7%). A triple burden of malnutrition was evident: the prevalence of overweight and obesity ranged from 0.2% to 73% and 0% to 38% (with rapidly rising trends), respectively, alongside persistent micronutrient deficiencies. Diets often failed to meet nutritional requirements and high levels of fast-food consumption were reported. Education, fortification, supplementation and school feeding programmes demonstrated beneficial effects on nutritional status. Comprehensive and regular monitoring of all forms of malnutrition among children and adolescents, across all countries in South Asia is required. Further, more large-scale intervention research is needed to ensure policy and programmes effectively target and address malnutrition among children and adolescents in South Asia.

Formulation and validation of probioticated foxtail millet laddu as a source of antioxidant for biological system using response surface methodology

Probiotics play a critical role in supporting a healthy gut microbiome, which significantly impacts overall health and well-being. While there has been an increase in the availability of probiotic foods in recent years, there may still be limited options and accessibility in certain regions. This study focused on formulating a traditional Indian sweet called laddu enriched with millet and Lactobacillus acidophilus. The formulation of laddu ingredients was optimized using Design Expert software to create an optimal product for testing. The probiotic Lactobacillus acidophilus culture was incorporated into the laddu in three forms: lyophilized, microencapsulated powder, and natural curd. The probiotic foxtail laddu was selected based on specific criteria such as color, odor, and texture. The nutritional analysis revealed that the laddu contained approximately 64.46 g of carbohydrates, 15.13 g of protein, and 5.06 g of fat per 100 g of laddu. A microbial count analysis was performed over a two-month storage period to assess the viability of the incorporated Lactobacillus acidophilus. The results showed that the lyophilized and microencapsulated culture demonstrated good viability, with counts of 6.10 ± 0.09 log CFU/g and 7.43 ± 0.02 log CFU/g, respectively, when stored at 4 °C. In comparison, storage at room temperature resulted in counts of 5.41 ± 0.08 log CFU/g and 6.97 ± 0.02 log CFU/g at the end of the storage period. Based on the findings, the probiotic millet laddu developed in this study has the potential to be a value-added food product that can enhance the overall health of consumers. Incorporating probiotics into traditional food items like laddu offers a convenient and enjoyable way to promote gut health and improve the product's nutritional value.

Options for substantiating protein content claims for conventional foods

In Canada and the United States, front-of-package protein content claims require data to support the quality of the protein. In general, protein quality reflects the product of the amino acid composition of the food protein relative to human amino acid requirements and a measure of digestibility. The currently accepted method in both jurisdictions is the protein digestibility-corrected amino acid score (PDCAAS) that requires the measurement of true fecal protein (nitrogen) digestibility. The latter must be measured in vivo using a rat model. This requirement for animal testing is inconsistent with international efforts to reduce the usage of animals in testing for regulatory purposes. The current commentary positions four options to remove the need to use animal testing for determining protein quality, when considering protein content claim substantiation. These options include (i) a focus on protein quantity alone; (ii) the use of the amino acid score alone, with no correction for digestibility; (iii) the use of a fixed digestibility coefficient to estimate protein quality; and (iv) the use of in vitro methods to measure protein and/or amino acid digestibility. The relative merits and deficiencies of the options are positioned with the goal of encouraging dialogue within the regulatory agencies to move towards alternative approaches for substantiating protein content claims on foods, including those derived from plant-based sources.

Millets (Shrianna) and lifestyle diseases: A healing touch

Traditionally, millets were the earliest food to be domesticated by human beings and it constituted the staple food for various civilisations across Asia and Africa. Somehow, during the course of modernization, the production and consumption of millets has declined significantly. Government of India has taken a lead role and has launched widescale strategies to promote millets in order to make India a global hub for millets. Millets has immense potential in enhancing the socioeconomic and health status of people. Regular consumption of millets translates into better post prandial blood glucose and better HbA1c levels. Millets mitigates atherosclerotic cardiovascular disease (ASCVD) risk by lowering insulin resistance, better glycemic control, lowering non high-density lipoprotein (HDL) cholesterol, lowering BP and by virtue of presence of various antioxidants. There is a need to revive the awareness about nutritive and therapeutic values of millets. Scientific community is increasingly realising the enormous potential of millets in enhancing the nutritional quality of the population and as a tool to halt the global pandemic of lifestyle diseases.

Micronutrient interventions among vulnerable population over a decade: A systematic review on Indian perspective

Background: Micronutrient deficiency has long been recognized as a public health problem, particularly among vulnerable groups such as children, adolescents, pregnant and lactating women. Micronutrient deficiency could not be ruled out in spite of the implementation of various intervention strategies. Different interventions are being used to prevent and treat micronutrient deficiencies at the national and global level. The aim of this study is to systematically review the intervention strategies among different vulnerable age groups in India.

Methods: The review was focused on identifying various interventions published based on the internet databases and the peer-reviewed papers from 2011 to 2021, on the predefined inclusive/exclusive criteria. The major intervention strategies implemented in India were recognized and evaluated based on dietary supplementation, micronutrient supplementation, knowledge interventions and food fortification among various age groups.

Results: The results show that there are still considerable gaps in identifying the effective intervention strategies, research initiatives, programs and policies addressing to tackle micronutrient deficiencies in India. Multiple interventions are effective that could lead the road to innovations in approaches with diverse dietary intake, developing multiple micronutrient supplements, fortifying foods and nutrition interventions to address calcium, zinc, iodine, vitamin D and vitamin A deficiencies among the vulnerable population.

Conclusion: Evidence-based multiple intervention studies covering a large population, in the long term cross-sectional, is the need for the hour to design policies and programs for improving the micronutrient status of vulnerable population in the community.

Dual-Purpose Sorghum: A Targeted Sustainable Crop-Livestock Intervention for the Smallholder Subsistence Farming Communities of Adilabad, India

Sorghum plays an important role in the mixed crop–livestock system of tribal farming communities in Adilabad District, a high climate risk-prone region in India. Currently, the local seed system is limited to landraces and hybrids that are primarily used for domestic grain and fodder purposes. This study aimed to understand the farmers' needs and context, and use this knowledge to deliver relevant, adoptable climate-smart sorghum crop technologies through farmer-participatory approaches (FPAs). We conducted an ex-ante survey with 103 farmer households to understand their preferences and constraints concerning sorghum, their staple food-crop. Farmers expressed taste as the most important characteristic, followed by stover yield, grain yield, drought adaptation, and pest resistance. They identified fodder deficit, loss of seed purity in landraces, and lack of diverse sorghum seed options as critical constraints. Therefore, we chose dual-purpose, open-pollinated sorghum varieties suitable for postrainy/rabi cultivation as the study site's entry point. Accordingly, sixteen popular rabi sorghum varieties were tested at ICRISAT station (2017–18 and 2018–19) for agronomic performance in field conditions under a range of treatments (irrigation and fertilization). The standing crop was also scored by farmer representatives. Additionally, the detailed lysifield study elucidated the plant functions underlying the crop agronomic performance under water stress (plant water use and stay-green score) and an important trait of farmer's interest (relation between stay-green score and in-vitro stover digestibility and relation between grain fat and protein content) The selected varieties– Phule Chitra, CSV22, M35-1 and preferred landrace (Sevata jonna)–were further tested with 21 farmers at Adilabad (2018–20). Participating farmers from both the trials and focus group discussions voiced their preference and willingness to adopt Phule Chitra and CSV22. This article summarizes how system-relevant crop options were selected for subsistence farmers of Adilabad and deployed using participatory approaches. While varieties are developed for wider adoption, farmers adopt only those suitable for their farm, household, and accessible market. Therefore, we strongly advocate FPA for developing and delivering farmer relevant crop technologies as a vehicle to systematically break crop adoption barriers and create a positive impact on household diets, well-being, and livelihoods, especially for smallholder subsistence farmers.

Phytochemical-rich Fractions from Foxtail Millet (Setaria italica (L.) P.Beauv) Seeds Exhibited Antioxidant Activity and Reduced the Viability of Breast Cancer Cells In Vitro by Inducing DNA Fragmentation and Promoting Cell Cycle Arrest

BACKGROUND

The demand for millet-based diets has increased significantly in recent years due to their beneficial effects on human health. Foxtail Millet (Setaria italica (L.) P.Beauv, previously known as Panicum italicum L., referred as FTM in this manuscript) seeds have been not only used as astringent and diuretic agents, but they are also used to treat dyspepsia and rheumatism. Recent studies have shown that solvent extracts from FTM seeds exhibited antioxidant and antiinflammatory activities. However, the nature and antiproliferative potential of phytochemical constituents of solvent extracts are not much explored.

OBJECTIVES

Major objectives of this study are to generate and characterize the phytochemical-rich fractions from Foxtail millet seeds, test the antioxidant activity and antiproliferative potential against cell lines representing carcinomas of the breast, and determine the mechanism(s) of cell growth inhibition.

METHODS

Phytochemical-rich fractions were generated by extracting the seeds using 70% ethanol (FTM-FP) and 10% alkali (FTM-BP). Antioxidant potential was determined by ferric reducing antioxidant power (FRAP) assay and DPPH radical scavenging activity assays. The antiproliferative potential was determined using sulforhodamine-B assay. The impact on cell cycle and DNA fragmentation was analyzed by staining the cells with DAPI followed by analyzing the stained cells using NC-3000.

RESULTS

Analysis of the results showed the presence of phenolics and flavonoids in the FTM-FP and FTM-BP fractions. Both fractions exhibited antiproliferative potential against breast cancer cell lines. Mechanistically, both fractions induced G2/M cell cycle arrest and increased the fragmentation of DNA, which lead to the accumulation of cells in the Sub-G1 phase.

CONCLUSION

In summary, results of this study demonstrated the potential of foxtail millet phytochemical fractions for retarding the proliferative potential of breast cancer cells.

Can Feeding a Millet-Based Diet Improve the Growth of Children?-A Systematic Review and Meta-Analysis

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.

Millets Can Have a Major Impact on Improving Iron Status, Hemoglobin Level, and in Reducing Iron Deficiency Anemia-A Systematic Review and Meta-Analysis

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.

Impacts of school feeding on educational and health outcomes of school-age children and adolescents in low- and middle-income countries: A systematic review and meta-analysis

Background

School feeding programs are ubiquitous in low- and middle-income countries (LMICs) and may have critical implications for the health and education of school-age children and adolescents. This systematic review aimed to assess the impacts of school feeding on educational and health outcomes of children and adolescents in LMICs.

Methods

Interventional studies on the effects of school feeding on nutritional and health outcomes of children and adolescents receiving primary or secondary education in LMICs were included. MEDLINE, EMBASE, CINAHL, the Cochrane Library, and grey literature were searched (through December 2019) to identify eligible studies. We included randomized controlled trials and controlled before-after studies on school feeding conducted in LMICs among children and adolescents aged 6 to 19 who received primary or secondary education. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment. Meta-analyses were performed for outcomes available in three or more independent studies. Subgroup analyses were conducted by study design and school feeding modality whenever possible.

Results

Fifty-seven articles met the inclusion criteria for the review, including 44 randomized controlled trials and 13 controlled before-after studies; 19 articles were included in the meta-analysis. School feeding resulted in a significant increase in height (mean difference = 0.32 cm; confidence interval (CI) = 0.03, 0.61; P = 0.032) and weight (mean difference: 0.58 kg; 95% 95% CI = 0.22, 0.93; P = 0.001) over 12 months, compared to those in the control groups. School feeding also resulted in a significant increase in the percentage of school days attended (2.6%; 95% CI = 1.2%, 3.9%; P < 0.001).

Conclusions

School feeding is an important approach to improving the health and education outcomes of children and adolescents living in LMICs. More well-designed research is needed to establish further the effectiveness of school feeding for nutritional outcomes and academic achievement.

Registration

PROSPERO ID: CRD42020159003.

A Systematic Review and Meta-Analysis of the Potential of Millets for Managing and Reducing the Risk of Developing Diabetes Mellitus

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.

Potential for smart food products in rural Myanmar: use of millets and pigeonpea to fill the nutrition gap

BACKGROUND

The present study examined the potential for 'Smart Food' with respect to contributing to the Sustainable Development Goal 2 of ending malnutrition by 2030, using a small-scale capacity building case study in Oe Be Village, Myingyan district, Mandalay region, Myanmar. Within the study site, refined white rice is the major staple, followed by vegetables and animal source food in inadequate quantities. The protein intake in this particular dry zone community meets only 50% of the daily requirement and even less for those children aged less than 23 months. Therefore, to determine the acceptance and opportunity for legumes and millets which are produced locally, nutritious formulations were introduced for various age groups. In addition, a sensory evaluation of the recipes was conducted to test the acceptance of the nutritious products.

RESULTS

Two weeks of the inclusion of millets and pigeonpea in the diets of children aged 6-23 months had a positive impact on wasting, stunting and underweight (P = 0.002, 0.014 and 0.023, respectively). Moreover, the acceptability of these new food products by the children was found to be high. These results indicate an unexplored opportunity for specific millets rich in iron, zinc and calcium, as well as for pigeonpea rich in protein, if prepared in a culturally acceptable way.

CONCLUSION

The impact and acceptability of this small scale and short-term intervention indicate the potential for Smart Food products in filling the nutrition gap arising from the traditional food consumption habits in the dry zones of Myanmar. © 2019 Society of Chemical Industry.