A higher proportion of iron-rich leafy vegetables in a typical Burkinabe maize meal does not increase the amount of iron absorbed in young women

Determinants of dietary patterns of Ghanaian mother-child dyads: A Demographic and Health Survey

Having a comprehensive understanding of a population's dietary patterns is a key component of any effective strategy for preventing malnutrition, planning, and putting nutrition interventions and policies into place. It's interesting to note that information on dietary patterns of Ghana's vulnerable subpopulations of women and children is lacking. The purpose of this study is to characterize the dietary patterns of women (15-49 years old) and their young children (0-3 years old), as well as to investigate into the socioeconomic and demographic factors influencing the characterized dietary patterns. The sociodemographic information and food consumption of mother-child dyads (n = 1,548) were collected for this nationally representative cross-sectional study. Principal component analysis and multiple variable logistic regression were used, respectively, to determine the dietary patterns of dyads and the determinants of the identified dietary patterns. For women and children, respectively, four dietary patterns ('Beverage & sugary based', 'Meat based', 'Indigenous- tuber based' and 'Indigenous- grain based') and two ('Indigenous' and 'Milk, Meat, & cereal based') emerged. Ethnicity, wealth quintiles, parity, seasonality, dyad's age, body mass index, education, residency, marital status, and household size were the socioeconomic / demographic determinants of the dietary patterns. To sum up for women and children, meat based and indigenous staple based dietary patterns were identified, with several important socioeconomic and demographic variables acting as predictors of the dietary patterns. The identified dietary patterns and their determinants may serve as a basis for nutrition intervention and policies for women and children in Ghana.

Can consumption of local micronutrient- and absorption enhancer-rich plant foods together with starchy staples improve bioavailable iron and zinc in diets of at-risk African populations?

Iron and zinc deficiencies remain prevalent in developing countries, often due to monotonous starchy diets that are low in bioavailable minerals. This review addresses the question as to whether consumption of starchy staple foods in Africa together with micronutrient-dense and absorption enhancer-rich plant foods can enhance iron and zinc bioavailability in the diets of at-risk populations. While green leafy vegetables (GLVs) fortification of starchy staples can improve mineral contents, especially iron, it may not improve bioavailable iron and zinc, due to GLVs' high contents of mineral absorption inhibitors, notably polyphenols, phytate and calcium. Fruits, although low in minerals, could improve bioavailable iron and zinc in the staples because of their high ascorbic and citric acid and/or β-carotene contents, which can form soluble chelates with the minerals. More human studies are needed to establish whether such a technology or fortification strategy can improve bioavailable iron and zinc in African-type plant-based diets.

Associations of Food and Nutrient Intake with Serum Hepcidin and the Risk of Gestational Iron-Deficiency Anemia among Pregnant Women: A Population-Based Study

Hepcidin is a regulator of iron metabolism. Diet affects the body's iron status, but how it influences hepcidin concentrations and the risk of gestational iron-deficiency anemia (IDA) remains unclear. We investigated relationships of food and nutrient intake with serum hepcidin levels in relation to the iron status at a population scale. A retrospective cross-sectional study was conducted based on data obtained from the Nationwide Nutrition and Health Survey in pregnant women, Taiwan (2017~2020). In total, 1430 pregnant women aged 20~45 years with a singleton pregnancy were included. Data from blood biochemistry, 24-h dietary recall, and a food frequency questionnaire were collected during a prenatal checkup. Adjusted multivariate linear and logistic regression analyses were employed to measure the beta coefficient (ß) and 95% confidence interval (CI) of serum hepcidin and the odds ratio (OR) of IDA. In IDA women, serum hepcidin levels were positively correlated with the intake frequency of Chinese dim sum and related foods (β = 0.037 (95% CI = 0.015~0.058), p = 0.001) and dark leafy vegetables (β = 0.013 (0.001~0.025), p = 0.040), but they were negatively correlated with noodles and related products (β = -0.022 (-0.043~-0.001), p = 0.038). An adjusted multivariate logistic regression analysis showed that dietary protein [OR: 0.990 (0.981~1.000), p = 0.041], total fiber [OR: 0.975 (0.953~0.998), p = 0.031], and rice/rice porridge [OR: 1.007 (1.00~1.014), p = 0.041] predicted gestational IDA. Total carbohydrates [OR: 1.003 (1.000~1.006), p = 0.036], proteins [OR: 0.992 (0.985~0.999), p = 0.028], gourds/shoots/root vegetables [OR: 1.007 (0.092~1.010), p = 0.005], and to a lesser extent, savory and sweet glutinous rice products [OR: 0.069 (0.937~1.002), p = 0.067] and dark leafy vegetables [OR: 1.005 (0.999~1.011), p = 0.088] predicted IDA. The risk of IDA due to vegetable consumption decreased with an increasing vitamin C intake (p for trend = 0.024). Carbohydrates and vegetables may affect the gestational iron status through influencing hepcidin levels. Vitamin C may lower the risk of gestational IDA due to high vegetable consumption.

Potential of moringa leaf and baobab fruit food-to-food fortification of wholegrain maize porridge to improve iron and zinc bioaccessibility

Food-to-food fortification (FtFF) with moringa leaf (iron source) and/or baobab fruit (citric acid and ascorbic acid source) (each 13-15 g/100 g porridge dry basis (db)) was studied to improve iron and zinc nutritive quality in African-type wholegrain maize-based porridges using in vitro dialysability assay. Moringa FtFF decreased percentage and total bioaccessible iron and zinc, by up to 84% and 45%, respectively. Moringa was very high in calcium, approximately 3% db and calcium-iron-phytate complexes inhibit iron bioavailability. Baobab FtFF increased percentage and total bioaccessible iron and zinc, especially in porridges containing carrot + mango (β-carotene source) and conventionally fortified with FeSO₄, by up to 111% and 60%, respectively. The effects were similar to those when ascorbic and citric acids were added as mineral absorption enhancers. While moringa FtFF could be inhibitory to iron and zinc bioavailability in cereal-based porridges, baobab fruit FtFF could improve their bioavailability, especially in combination with conventional iron fortification.

Iron Absorption from Iron-Biofortified Sweetpotato Is Higher Than Regular Sweetpotato in Malawian Women while Iron Absorption from Regular and Iron-Biofortified Potatoes Is High in Peruvian Women

BACKGROUND

Sweetpotato and potato are fast-maturing staple crops and widely consumed in low- and middle-income countries. Conventional breeding to biofortify these crops with iron could improve iron intakes. To our knowledge, iron absorption from sweetpotato and potato has not been assessed.

OBJECTIVE

The aim was to assess iron absorption from regular and iron-biofortified orange-fleshed sweetpotato in Malawi and yellow-fleshed potato and iron-biofortified purple-fleshed potato in Peru.

METHODS

We conducted 2 randomized, multiple-meal studies in generally healthy, iron-depleted women of reproductive age. Malawian women (n = 24) received 400 g regular or biofortified sweetpotato test meals and Peruvian women (n = 35) received 500 g regular or biofortified potato test meals. Women consumed the meals at breakfast for 2 wk and were then crossed over to the other variety. We labeled the test meals with 57Fe or 58Fe and measured cumulative erythrocyte incorporation of the labels 14 d after completion of each test-meal sequence to calculate iron absorption. Iron absorption was compared by paired-sample t tests.

RESULTS

The regular and biofortified orange-fleshed sweetpotato test meals contained 0.55 and 0.97 mg Fe/100 g. Geometric mean (95% CI) fractional iron absorption (FIA) was 5.82% (3.79%, 8.95%) and 6.02% (4.51%, 8.05%), respectively (P = 0.81), resulting in 1.9-fold higher total iron absorption (TIA) from biofortified sweetpotato (P < 0.001). The regular and biofortified potato test meals contained 0.33 and 0.69 mg Fe/100 g. FIA was 28.4% (23.5%, 34.2%) from the regular yellow-fleshed and 13.3% (10.6%, 16.6%) from the biofortified purple-fleshed potato meals, respectively (P < 0.001), resulting in no significant difference in TIA (P = 0.88).

CONCLUSIONS

FIA from regular yellow-fleshed potato was remarkably high, at 28%. Iron absorbed from both potato test meals covered 33% of the daily absorbed iron requirement for women of reproductive age, while the biofortified orange-fleshed sweetpotato test meal covered 18% of this requirement. High polyphenol concentrations were likely the major inhibitors of iron absorption. These trials were registered at www.clinicaltrials.gov as NCT03840031 (Malawi) and NCT04216030 (Peru).

Food-based indicators are related to iron and iodine deficiencies of mother-toddler dyads during the lean season in northern Ghana

Fe and iodine deficiencies are among the common forms of nutritional deficiencies globally and cause detrimental effects on mother and child. In developing countries, strategies to address these problems rarely use preventative dietary approaches. This cross-sectional study aims to ascertain whether dietary diversity score (DDS) and dietary patterns (DP) can predict the associated risk (AR) of Fe and iodine deficiencies in mother-toddler dyads during the dry/lean season in northern Ghana. Data were collected from women (15-49 years; n 118) and their toddlers (6-23 months, n 121). Dyads DDS and DP were calculated from their food intake recall. Multivariable logistic regression models were used to examine whether DDS, DP and socio-demographic factors predict higher odds of Fe and iodine deficiencies in dyads. DDS and DP predicted Fe and iodine deficiencies AR. Compared with DDS ≥4, women with DDS <4 have higher odds of Fe deficiency (ID) (adjusted OR (AOR) 1·82, 95 % CI 1·03, 3·21) and iodine deficiency (AOR 9·73, 95 % CI 3·19, 29·67). Two DP emerged in principal component analyses, 'rural elites diet' predicted ID risk in mothers (AOR 8·65, 95 % CI 1·76, 42·39), while 'indigenous diet' predicted iodine deficiency risk (AOR 11·41, 95 % CI 1·36, 95·97) in mothers only. The AR of Fe and iodine deficiencies in vulnerable populations may be predicted by diet-based measures in northern Ghana. We recommend further research into DDS and DP to predict Fe and iodine status of mother-toddler dyads in Ghana.

Conventional and food-to-food fortification: An appraisal of past practices and lessons learned

Food fortification is an important nutrition intervention to fight micronutrient deficiencies and to reduce their incidence in many low- and middle-income countries. Food fortification approaches experienced a significant rise in the recent years and have generated a lot of criticism. The present review aimed to shed light on the actual effect of food fortification approaches on the reduction of malnutrition. A set of 100 articles and reports, which have dealt with the impact of food fortification on malnutrition, were included in this review. This review identified a broad selection of local raw materials suitable for a food-to-food fortification approach.

Micronutrient-fortified rice can be a significant source of dietary bioavailable iron in schoolchildren from rural Ghana

Iron deficiency and anemia are prominent contributors to the preventable disease burden worldwide. A substantial proportion of people with inadequate dietary iron rely on rice as a staple food, but fortification efforts are limited by low iron bioavailability. Furthermore, using high iron fortification dosages may not always be prudent in tropical regions. To identify alternative fortification formulations with enhanced absorption, we screened different iron compounds for their suitability as rice fortificants, measured in vitro gastric solubility, and assessed dietary iron bioavailability using stable isotopic labels in rural Ghanaian children. Isotopic incorporation in red blood cells indicates that in the two age groups of children investigated (4 to 6 and 7 to 10 years), formulations provided 36 and 51% of the median daily requirement in absorbed iron, respectively. We describe approaches to enhancing iron bioavailability from fortified rice, which can substantially contribute to the prevention of iron deficiency in rice-eating populations.

Hibiscus sabdariffa Meal Improves Iron Status of Childbearing Age Women and Prevents Stunting in Their Toddlers in Northern Ghana

Globally, iron deficiency (ID) is the most common form of nutritional deficiency, particularly in young children and childbearing age women. ID can lead to stunting and impaired cognitive development in children, as well as adverse maternal health and birth outcomes. In this study, the efficacy of an alternative food-to-food fortification utilizing indigenous iron-rich food sources was investigated in a quasi-experimental study. Childbearing age women (15–49 years, intervention-Kassena Nankana West district: n = 60; control-Builsa North district: n = 60) and their toddlers (6–24 months) consumed Hibiscus sabdariffa leaf meals (HSM, 1.71 mg Fe/100 g meal) three times a week for 12 weeks during the dry/lean season in Northern Ghana. We found that feeding the HSM (1.9 kg/day) improved iron status of women of childbearing age with time (p = 0.011), and protected stunting among toddlers during the dry/lean season (p = 0.024), which is the period with the worst food and nutrition insecurity. Compared with the control group, the number of stunted toddlers declined in the intervention group.

Assessment of inhibitory factors on bioaccessibility of iron and zinc in pearl millet (Pennisetum glaucum (L.) R. Br.) cultivars

The variations in iron and zinc bioaccessibility as influenced by inhibitory factors in 13 pearl millet cultivars were evaluated. The results indicated that iron and zinc contents ranged between 5.59-13.41 and 2.11-5.19 mg/100 g. Polyphenols, flavonoids and phytic acid were highest in GHB744 (781 mg/100 g), HHB223 (116 mg/100 g) and HHB226 (1.080 g/100 g) respectively. Insoluble fiber content range from 9.36 to 12.89 g/100 g. Iron and zinc bioaccessibility was the highest in local Anantapur (17.95%) and GHB744 (15.19%) cultivar with low phytic acid. HHB226 exhibited high β-carotene and phytase activity. In this study, the cultivars with high iron and zinc content also possessed high inhibitory factors which affected bioaccessibility. However, the bioaccessibility of iron did not seem to depend on the phytic acid: iron ratio alone. Further, a trend was observed in cultivars with low iron: zinc ratio had increased iron bioaccessibility. On the contrary, phytic acid: zinc ratio appears to play a significant role in zinc bioaccessibility. Certain cultivars with high iron content also had high phytase activity and β-carotene content which could be exploited for further technological treatments to enhance the bioaccessibility of iron and zinc.

Nutrient and Total Polyphenol Contents of Dark Green Leafy Vegetables, and Estimation of Their Iron Bioaccessibility Using the In Vitro Digestion/Caco-2 Cell Model

Dark green leafy vegetables (DGLVs) are considered as important sources of iron and vitamin A. However, iron concentration may not indicate bioaccessibility. The objectives of this study were to compare the nutrient content and iron bioaccessibility of five sweet potato cultivars, including three orange-fleshed types, with other commonly consumed DGLVs in Ghana: cocoyam, corchorus, baobab, kenaf and moringa, using the in vitro digestion/Caco-2 cell model. Moringa had the highest numbers of iron absorption enhancers on an “as-would-be-eaten” basis, β-carotene (14169 μg/100 g; p < 0.05) and ascorbic acid (46.30 mg/100 g; p < 0.001), and the best iron bioaccessibility (10.28 ng ferritin/mg protein). Baobab and an orange-fleshed sweet potato with purplish young leaves had a lower iron bioaccessibility (6.51 and 6.76 ng ferritin/mg protein, respectively) compared with that of moringa, although these three greens contained similar (p > 0.05) iron (averaging 4.18 mg/100 g) and β-carotene levels. The ascorbic acid concentration of 25.50 mg/100 g in the cooked baobab did not enhance the iron bioaccessibility. Baobab and the orange-fleshed sweet potato with purplish young leaves contained the highest levels of total polyphenols (1646.75 and 506.95 mg Gallic Acid Equivalents/100 g, respectively; p < 0.001). This suggests that iron bioaccessibility in greens cannot be inferred based on the mineral concentration. Based on the similarity of the iron bioaccessibility of the sweet potato leaves and cocoyam leaf (a widely-promoted “nutritious” DGLV in Ghana), the former greens have an added advantage of increasing the dietary intake of provitamin A.

Sodium pyrophosphate enhances iron bioavailability from bouillon cubes fortified with ferric pyrophosphate

Fe fortification of centrally manufactured and frequently consumed condiments such as bouillon cubes could help prevent Fe deficiency in developing countries. However, Fe compounds that do not cause sensory changes in the fortified product, such as ferric pyrophosphate (FePP), exhibit low absorption in humans. Tetra sodium pyrophosphate (NaPP) can form soluble complexes with Fe, which could increase Fe bioavailability. Therefore, the aim of this study was to investigate Fe bioavailability from bouillon cubes fortified with either FePP only, FePP+NaPP, ferrous sulphate (FeSO4) only, or FeSO4+NaPP. We first conducted in vitro studies using a protocol of simulated digestion to assess the dialysable and ionic Fe, and the cellular ferritin response in a Caco-2 cell model. Second, Fe absorption from bouillon prepared from intrinsically labelled cubes (2·5 mg stable Fe isotopes/cube) was assessed in twenty-four Fe-deficient women, by measuring Fe incorporation into erythrocytes 2 weeks after consumption. Fe bioavailability in humans increased by 46 % (P<0·005) when comparing bouillons fortified with FePP only (4·4 %) and bouillons fortified with FePP+NaPP (6·4 %). Fe absorption from bouillons fortified with FeSO4 only and with FeSO4+NaPP was 33·8 and 27·8 %, respectively (NS). The outcome from the human study is in agreement with the dialysable Fe from the in vitro experiments. Our findings suggest that the addition of NaPP could be a promising strategy to increase Fe absorption from FePP-fortified bouillon cubes, and if confirmed by further research, for other fortified foods with complex food matrices as well.

The type of fortificant and the leaf matrix both influence iron and zinc bioaccessibility in iron-fortified green leafy vegetable sauces from Burkina Faso

Leafy vegetable sauces from Burkina Faso were assessed as a potential vehicle for food fortification. First, iron and zinc bioaccessibility were measured by dialysability method in amaranth and Jew's mallow sauces and in traditional whole dishes consisting of maize paste plus leafy vegetable sauces. Iron dialysability and solubility were higher in amaranth than in Jew's mallow sauce, pointing to a marked effect of the matrix. Iron dialysability was hardly affected by the maize paste contrary to zinc dialysability, which was reduced. Second, iron and zinc bioaccessibility was assessed in the same sauces fortified with NaFeEDTA or iron sulfate. Added iron, i.e. iron supplied by fortification, represented 60% of total iron at the low fortification level and 80% at high level. In amaranth sauces with the high level of fortification using NaFeEDTA and iron sulfate, fractional dialysable iron reached respectively 66% and 26% compared to only 8.1% in the unfortified sauce. Similarly, in Jew's mallow sauces, fractional dialysable iron was 57% and 5% respectively with NaFeEDTA and iron sulfate and less than 1% in the unfortified sauce. Concomitantly, fractional dialysable zinc increased by respectively 20% and 40% in amaranth and Jew's mallow sauces fortified with NaFeEDTA whereas it remained unchanged with iron sulfate. Iron fortification could be an efficient way to greatly increase the available iron content of green leafy vegetable sauces and for this purpose NaFeEDTA is more effective than iron sulfate whatever the food matrix.

Food-Based Interventions to Modify Diet Quality and Diversity to Address Multiple Micronutrient Deficiency

Global data indicate a high prevalence of hidden hunger among population. Deficiencies of certain micronutrients such as folic acid, iodine, iron, and vitamin A have long lasting effects on growth and development and therefore have been a National priority from many decades. The strategy implemented so far limits to the use of supplemental sources or fortified foods in alleviating the burden of deficiencies. These approaches however undermine the food-based strategies involving dietary diversification as the long-term sustainable strategy. There is lack of understanding on the level of evidence needed to implement such strategies and the level of monitoring required for impact evaluation. Dietary diversity concerns how to ensure access for each individual to a quality and safe diet with adequate macro- and micronutrients. The key to success in using dietary diversity as a strategy to tackle hidden hunger is in integrating it with the principles of bioavailability, translated to efficient food synergies with due emphasis on food accessibility, affordability, and outdoor physical activity/life style modifications. Promoting enabling environment and sustainable agriculture is crucial for practicing dietary diversification with behavior change communication as an integral segment. It can be concluded that food-based strategies require careful understanding of the factors associated with it and moderate it to form an effective strategy for controlling multiple micronutrient deficiencies.

A Survey of Plant Iron Content-A Semi-Systematic Review

Iron is an essential mineral nutrient for all living organisms, involved in a plurality of biological processes. Its deficit is the cause of the most common form of anemia in the world: iron deficiency anemia (IDA). This paper reviews iron content in various parts of 1228 plant species and its absorption from herbal products, based on data collected from the literature in a semi-systematic manner. Five hundred genera randomly selected from the Angiosperms group, 215 genera from the Pteridophytes groups and all 95 Gymnosperm genera as listed in the Plant List version 1.1 were used as keywords together with the word "iron" in computerized searches. Iron data about additional genera returned by those searches were extracted and included in the analysis. In total, iron content values for a number of 1228 species, 5 subspecies, and 5 varieties were collected. Descriptive and inferential statistics were used to compare iron contents in various plant parts (whole plant, roots, stems, shoots, leaves, aerial parts, flowers, fruits, seeds, wood, bark, other parts) and exploratory analyses by taxonomic groups and life-forms were carried out. The absorption and potential relevance of herbal iron for iron supplementation are discussed.