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Reyes SM, Brockway MM, McDermid JM, Chan D, Granger M, Refvik R, Sidhu KK, Musse S, Monnin C, Lotoski L, Geddes DT, Jehan F, Kolsteren P, Allen LH, Hampel D, Eriksen KG, Rodriguez N, Azad MB. Human Milk Micronutrients and Child Growth and Body Composition in the First 2 years: A Systematic Review. Adv Nutr 2024; 15:100082. [PMID: 37315898 PMCID: PMC10831887 DOI: 10.1016/j.advnut.2023.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023] Open
Abstract
Human milk (HM) provides a plethora of nutritional and non-nutritional compounds that support infant development. For many compounds, concentrations vary substantially among mothers and across lactation, and their impact on infant growth is poorly understood. We systematically searched MEDLINE, Embase, the Cochrane Library, Scopus, and Web of Science to synthesize evidence published between 1980 and 2022 on HM components and anthropometry through 2 y of age among term-born infants. Outcomes included weight-for-length, length-for-age, weight-for-age, body mass index (in kg/m2)-for-age, and growth velocity. From 9992 abstracts screened, 144 articles were included and categorized based on their reporting of HM micronutrients, macronutrients, or bioactive components. Micronutrients (vitamins and minerals) are reported here, based on 28 articles involving 2526 mother-infant dyads. Studies varied markedly in their designs, sampling times, geographic and socioeconomic settings, reporting practices, and the HM analytes and infant anthropometrics measured. Meta-analysis was not possible because data were sparse for most micronutrients. The most-studied minerals were zinc (15 articles, 1423 dyads) and calcium (7 articles, 714 dyads). HM iodine, manganese, calcium, and zinc concentrations were positively associated with several outcomes (each in ≥2 studies), whereas magnesium (in a single study) was negatively associated with linear growth during early lactation. However, few studies measured HM intake, adjusted for confounders, provided adequate information about complementary and formula feeding, or adequately described HM collection protocols. Only 4 studies (17%) had high overall quality scores. The biological functions of individual HM micronutrients are likely influenced by other HM components; yet, only 1 study analyzed data from multiple micronutrients simultaneously, and few addressed other HM components. Thus, available evidence on this topic is largely inconclusive and fails to address the complex composition of HM. High-quality research employing chronobiology and systems biology approaches is required to understand how HM components work independently and together to influence infant growth and to identify new avenues for future maternal, newborn, or infant nutritional interventions.
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Affiliation(s)
- Sarah M Reyes
- Manitoba Interdisciplinary Lactation Centre, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Meredith Merilee Brockway
- Manitoba Interdisciplinary Lactation Centre, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Deborah Chan
- Manitoba Interdisciplinary Lactation Centre, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Matthew Granger
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rebecca Refvik
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Karanbir K Sidhu
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suad Musse
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Caroline Monnin
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Larisa Lotoski
- Manitoba Interdisciplinary Lactation Centre, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Donna T Geddes
- School of Molecular Sciences, the University of Western Australia, Perth, Western Australia, Australia
| | - Fyezah Jehan
- Department of Pediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium
| | - Lindsay H Allen
- Department of Nutrition, University of California, Davis, Davis, CA, USA; United States Department of Agriculture, Western Human Nutrition Research Center, Agriculture Research Service, Davis, CA, USA
| | - Daniela Hampel
- Department of Nutrition, University of California, Davis, Davis, CA, USA; United States Department of Agriculture, Western Human Nutrition Research Center, Agriculture Research Service, Davis, CA, USA
| | - Kamilla G Eriksen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Natalie Rodriguez
- Manitoba Interdisciplinary Lactation Centre, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Meghan B Azad
- Manitoba Interdisciplinary Lactation Centre, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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2
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Brockway MM, Daniel AI, Reyes SM, Granger M, McDermid JM, Chan D, Refvik R, Sidhu KK, Musse S, Patel PP, Monnin C, Lotoski L, Geddes D, Jehan F, Kolsteren P, Allen LH, Hampel D, Eriksen KG, Rodriguez N, Azad MB. Human Milk Macronutrients and Child Growth and Body Composition in the First Two Years: A Systematic Review. Adv Nutr 2024; 15:100149. [PMID: 37981047 PMCID: PMC10831902 DOI: 10.1016/j.advnut.2023.100149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 10/16/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023] Open
Abstract
Among exclusively breastfed infants, human milk (HM) provides complete nutrition in the first mo of life and remains an important energy source as long as breastfeeding continues. Consisting of digestible carbohydrates, proteins, and amino acids, as well as fats and fatty acids, macronutrients in human milk have been well studied; however, many aspects related to their relationship to growth in early life are still not well understood. We systematically searched Medline, EMBASE, the Cochrane Library, Scopus, and Web of Science to synthesize evidence published between 1980 and 2022 on HM components and anthropometry through 2 y of age among term-born healthy infants. From 9992 abstracts screened, 57 articles reporting observations from 5979 dyads were included and categorized based on their reporting of HM macronutrients and infant growth. There was substantial heterogeneity in anthropometric outcome measurement, milk collection timelines, and HM sampling strategies; thus, meta-analysis was not possible. In general, digestible carbohydrates were positively associated with infant weight outcomes. Protein was positively associated with infant length, but no associations were reported for infant weight. Finally, HM fat was not consistently associated with any infant growth metrics, though various associations were reported in single studies. Fatty acid intakes were generally positively associated with head circumference, except for docosahexaenoic acid. Our synthesis of the literature was limited by differences in milk collection strategies, heterogeneity in anthropometric outcomes and analytical methodologies, and by insufficient reporting of results. Moving forward, HM researchers should accurately record and account for breastfeeding exclusivity, use consistent sampling protocols that account for the temporal variation in HM macronutrients, and use reliable, sensitive, and accurate techniques for HM macronutrient analysis.
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Affiliation(s)
- Meredith Merilee Brockway
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, University of Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Canada; Faculty of Nursing, University of Calgary, Canada
| | - Allison I Daniel
- Centre for Global Child Health, Hospital for Sick Children, Canada; Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Sarah M Reyes
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, University of Manitoba, Canada
| | - Matthew Granger
- Department of Food and Human Nutritional Sciences, University of Manitoba, Canada
| | | | - Deborah Chan
- Department of Pediatrics and Child Health, University of Manitoba, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Canada
| | - Rebecca Refvik
- Department of Food and Human Nutritional Sciences, University of Manitoba, Canada
| | - Karanbir K Sidhu
- Department of Food and Human Nutritional Sciences, University of Manitoba, Canada
| | - Suad Musse
- Department of Food and Human Nutritional Sciences, University of Manitoba, Canada
| | - Pooja P Patel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, USA
| | - Caroline Monnin
- Neil John Maclean Health Sciences Library, University of Manitoba, Canada
| | - Larisa Lotoski
- Department of Pediatrics and Child Health, University of Manitoba, Canada
| | - Donna Geddes
- School of Molecular Sciences, The University of Western Australia, Australia
| | - Fyezah Jehan
- Department of Pediatrics, Aga Khan University, Pakistan
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Belgium
| | - Lindsay H Allen
- Western Human Nutrition Research Center, Agriculture Research Service, United States Department of Agriculture, USA; Department of Nutrition, University of California, Davis, USA
| | - Daniela Hampel
- Western Human Nutrition Research Center, Agriculture Research Service, United States Department of Agriculture, USA; Department of Nutrition, University of California, Davis, USA
| | - Kamilla G Eriksen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Natalie Rodriguez
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, University of Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Canada
| | - Meghan B Azad
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, University of Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Canada.
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Nankumbi J, Grant F, Sibeko L, Mercado E, O'Neil K, Cordeiro LS. Effects of Food-Based Approaches on Vitamin A Status of Women and Children: A Systematic Review. Adv Nutr 2023; 14:1436-1452. [PMID: 37634852 PMCID: PMC10721510 DOI: 10.1016/j.advnut.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 08/02/2023] [Accepted: 08/15/2023] [Indexed: 08/29/2023] Open
Abstract
Vitamin A deficiency (VAD) increases risk for morbidity and mortality. Food-based approaches offer one strategy to improve vitamin A status. This systematic review assessed evidence of the effects of food-based approaches on the vitamin A status of women and children under 5 y. VAD was defined as clinical ocular symptoms, such as loss of vision, and/or retinol plasma or serum concentration <0.70 μmol/L. Searches on food-based approaches to improve vitamin A status were conducted for the period 2011-2022 on PubMed, CINHAL, Web of Science, and Google Scholar using PRISMA guidelines. English-language publications were included. Case studies, unpublished dissertations, and non-peer-reviewed studies were excluded. This review comprises 24 of 27,322 identified studies; 23 included studies focused on provitamin A carotenoids. There were 17,214 participants across the 24 studies with sample sizes ranging from 8 to 3571 individuals. Intervention studies spanned from 3 wk to 2 y. Fifteen (63%) studies were randomized control trials, 7 were cross-sectional, and 2 were longitudinal studies. Most studies (N = 21) used biochemical measurements, for example, serum retinol, to assess vitamin A status; other studies used clinical symptoms (for example, xerophtalmia) or dietary intake. Thirteen (54%) studies reported a statistically significant effect of food-based interventions (N = 8) or an association of diet (N = 5) on vitamin A status. This systematic review indicated that some food-based interventions improved vitamin A status, thus offering a safe and effective delivery mechanism for vitamin A. There appeared to be significant association between vitamin A status and consumption of foods with high concentrations of preformed vitamin A and provitamin A carotenoids. Differences across studies in regard to the period of evaluation, food approaches used, and statistical power may explain the lack of effectiveness of food-based approaches on vitamin A status in some studies.
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Affiliation(s)
- Joyce Nankumbi
- Department of Nutrition, University of Massachusetts, Amherst, MA, United States
| | | | - Lindiwe Sibeko
- Department of Nutrition, University of Massachusetts, Amherst, MA, United States
| | - Evelyn Mercado
- Department of Psychology and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Kristina O'Neil
- Department of Nutrition, University of Massachusetts, Amherst, MA, United States
| | - Lorraine S Cordeiro
- Department of Nutrition, University of Massachusetts, Amherst, MA, United States.
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Birol E, Foley J, Herrington C, Misra R, Mudyahoto B, Pfeiffer W, Diressie MT, Ilona P. Transforming Nigerian Food Systems Through Their Backbones: Lessons From a Decade of Staple Crop Biofortification Programing. Food Nutr Bull 2023; 44:S14-S26. [PMID: 36016479 DOI: 10.1177/03795721221117361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article presents the evolution of the biofortification program in Nigeria over the last decade and the role of interdisciplinary research in informing cost-effective, efficient, and inclusive development; implementation; and scaling of this program. Launched in 2011 to improve Nigeria's food systems to deliver accessible and affordable nutrients through commonly consumed staples, the Nigeria biofortification program was implemented through an effective partnership between the CGIAR and public, private, and civil society sectors at federal, state, and local levels. By the end of 2021, several biofortified varieties of Nigeria's 2 main staples, namely cassava and maize, were officially released for production by smallholders, with several biofortified varieties of other key staples (including pearl millet, rice, and sorghum) either under testing or in the release pipeline. In 2021, the program was estimated to benefit 13 million Nigerians consuming biofortified cassava and maize varieties. The evidence on the nutritional impact, consumer and farmer acceptance, and cost-effective scalability of biofortified crops documented by the program resulted in the integration of biofortified crops in several key national public policies and social protection programs; private seed and food company products/investments, as well as in humanitarian aid.
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Affiliation(s)
- Ekin Birol
- Georgetown University, Walsh School of Foreign Service, Global Human Development, Washington, DC, USA
| | - Jennifer Foley
- HarvestPlus, c/o International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Caitlin Herrington
- Department of Agricultural, Food and Resource Economics, Michigan State University, East Lansing, MI, USA
| | - Rewa Misra
- HarvestPlus, c/o International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Bho Mudyahoto
- HarvestPlus, c/o International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Wolfgang Pfeiffer
- HarvestPlus, c/o International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Michael Tedla Diressie
- HarvestPlus, c/o International Food Policy Research Institute (IFPRI), Washington, DC, USA
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5
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Zhang H, Ren X, Yang Z, Lai J. Vitamin A Concentration in Human Milk: A Meta-Analysis. Nutrients 2022; 14:nu14224844. [PMID: 36432530 PMCID: PMC9699574 DOI: 10.3390/nu14224844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
Humans require vitamin A (VA). However, pooled VA data in human milk is uncommon internationally and offers little support for dietary reference intake (DRIs) revision of infants under 6 months. As a result, we conducted a literature review and a meta-analysis to study VA concentration in breast milk throughout lactation across seven databases by August 2021. Observational or intervention studies involving nursing mothers between the ages of 18 and 45, with no recognized health concerns and who had full-term infants under 48 months were included. Studies in which retinol concentration was expressed as a mass concentration on a volume basis and determined using high-, ultra-, or ultra-fast performance liquid chromatography (HPLC, UPLC, or UFLC) were chosen. Finally, 76 papers involving 9171 samples published between 1985 and 2021 qualified for quantitative synthesis. Results from the random-effects model showed that the VA concentration of healthy term human milk decreased significantly as lactation progressed. VA (µg/L) with 95% CI at the colostrum, transitional, early mature and late mature stages being 920.7 (744.5, 1095.8), 523.7 (313.7, 733.6), 402.4 (342.5, 462.3) and 254.7 (223.7, 285.7), respectively (X2 = 71.36, p < 0.01). Subgroup analysis revealed no significant differences identified in VA concentration (µg/L) between Chinese and non-Chinese samples at each stage, being 1039.1 vs. 895.8 (p = 0.64), 505.7 vs. 542.2(p = 0.88), 408.4 vs. 401.2 (p = 0.92), 240.0 vs. 259.3 (p = 0.41). The findings have significant implications for the revision of DRIs for infants under six months.
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Affiliation(s)
- Huanmei Zhang
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- China-DRIs Expert Committee on Human Milk Composition, Chinese Nutrition Society, Beijing 100050, China
| | - Xiangnan Ren
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- China-DRIs Expert Committee on Human Milk Composition, Chinese Nutrition Society, Beijing 100050, China
| | - Zhenyu Yang
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- China-DRIs Expert Committee on Human Milk Composition, Chinese Nutrition Society, Beijing 100050, China
| | - Jianqiang Lai
- China-DRIs Expert Committee on Human Milk Composition, Chinese Nutrition Society, Beijing 100050, China
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Correspondence:
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6
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OUP accepted manuscript. Nutr Rev 2022; 80:2029-2050. [DOI: 10.1093/nutrit/nuac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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7
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Garg M, Sharma A, Vats S, Tiwari V, Kumari A, Mishra V, Krishania M. Vitamins in Cereals: A Critical Review of Content, Health Effects, Processing Losses, Bioaccessibility, Fortification, and Biofortification Strategies for Their Improvement. Front Nutr 2021; 8:586815. [PMID: 34222296 PMCID: PMC8241910 DOI: 10.3389/fnut.2021.586815] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 04/28/2021] [Indexed: 12/19/2022] Open
Abstract
Around the world, cereals are stapled foods and good sources of vitamins A, B, and E. As cereals are inexpensive and consumed in large quantities, attempts are being made to enrich cereals using fortification and biofortification in order to address vitamin deficiency disorders in a vulnerable population. The processing and cooking of cereals significantly affect vitamin content. Depending on grain structure, milling can substantially reduce vitamin content, while cooking methods can significantly impact vitamin retention and bioaccessibility. Pressure cooking has been reported to result in large vitamin losses, whereas minimal vitamin loss was observed following boiling. The fortification of cereal flour with vitamins B1, B2, B3, and B9, which are commonly deficient, has been recommended; and in addition, region-specific fortification using either synthetic or biological vitamins has been suggested. Biofortification is a relatively new concept and has been explored as a method to generate vitamin-rich crops. Once developed, biofortified crops can be utilized for several years. A recent cereal biofortification success story is the enrichment of maize with provitamin A carotenoids.
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Affiliation(s)
- Monika Garg
- Agri-Biotechnology, National Agri-Food Biotechnology Institute (NABI), Mohali, India
| | - Anjali Sharma
- Agri-Biotechnology, National Agri-Food Biotechnology Institute (NABI), Mohali, India
| | - Shreya Vats
- Agri-Biotechnology, National Agri-Food Biotechnology Institute (NABI), Mohali, India
| | - Vandita Tiwari
- Agri-Biotechnology, National Agri-Food Biotechnology Institute (NABI), Mohali, India
| | - Anita Kumari
- Agri-Biotechnology, National Agri-Food Biotechnology Institute (NABI), Mohali, India
| | - Vibhu Mishra
- Food Engineering and Nutrition, Center of Innovative and Applied Bioprocessing, Mohali, India
| | - Meena Krishania
- Food Engineering and Nutrition, Center of Innovative and Applied Bioprocessing, Mohali, India
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Palmer AC, Jobarteh ML, Chipili M, Greene MD, Oxley A, Lietz G, Mwanza R, Haskell MJ. Biofortified and fortified maize consumption reduces prevalence of low milk retinol, but does not increase vitamin A stores of breastfeeding Zambian infants with adequate reserves: a randomized controlled trial. Am J Clin Nutr 2021; 113:1209-1220. [PMID: 33693468 DOI: 10.1093/ajcn/nqaa429] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 12/16/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Replacement of conventional staples with biofortified or industrially fortified staples in household diets may increase maternal breast milk retinol content and vitamin A intakes from complementary foods, improving infant total body stores (TBS) of vitamin A. OBJECTIVES To determine whether biofortified or industrially fortified maize consumption by Zambian women and their breastfeeding infants could improve milk retinol concentration and infant TBS. METHODS We randomly assigned 255 lactating women and their 9-mo-old infants to a 90-d intervention providing 0 µg retinol equivalents (RE)/d as conventional maize or ∼315 µg RE/d to mothers and ∼55 µg RE/d to infants as provitamin A carotenoid-biofortified maize or retinyl palmitate-fortified maize. Outcomes were TBS, measured by retinol isotope dilution in infants (primary), and breast milk retinol, measured by HPLC in women (secondary). RESULTS The intervention groups were comparable at baseline. Loss to follow-up was 10% (n = 230 mother-infant pairs). Women consumed 92% of the intended 287 g/d and infants consumed 82% of the intended 50 g/d maize. The baseline geometric mean (GM) milk retinol concentration was 1.57 μmol/L (95% CI: 1.45, 1.69 μmol/L), and 24% of women had milk retinol <1.05 μmol/L. While mean milk retinol did not change in the biofortified arm (β: 0.11; 95% CI: -0.02, 0.24), the intervention reduced low milk retinol (RR: 0.42; 95% CI: 0.21, 0.85). Fortified maize increased mean milk retinol (β: 0.17; 95% CI: 0.04, 0.30) and reduced the prevalence of low milk retinol (RR: 0.46; 95% CI: 0.25, 0.82). The baseline GM TBS was 178 μmol (95% CI: 166, 191 μmol). This increased by 24 µmol (± 136) over the 90-d intervention period, irrespective of treatment group. CONCLUSIONS Both biofortified and fortified maize consumption improved milk retinol concentration. This did not translate into greater infant TBS, most likely due to adequate TBS at baseline. This trial was registered at clinicaltrials.gov as NCT02804490.
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Affiliation(s)
- Amanda C Palmer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Modou L Jobarteh
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, CA, USA
| | | | - Matthew D Greene
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anthony Oxley
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Georg Lietz
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rose Mwanza
- Provincial Medical Office for Central Province, Kabwe, Zambia
| | - Marjorie J Haskell
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, CA, USA
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9
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Haskell MJ, Young R, Adu-Afaruwah S, Lartey A, Okronipa HET, Maleta K, Ashorn U, Jorgensen JM, Fan YM, Arnold CD, Allen LH, Ashorn P, Dewey KG. Small-Quantity Lipid-Based Nutrient Supplements Do Not Affect Plasma or Milk Retinol Concentrations Among Malawian Mothers, or Plasma Retinol Concentrations among Young Malawian or Ghanaian Children in Two Randomized Trials. J Nutr 2021; 151:1029-1037. [PMID: 33561214 PMCID: PMC8030706 DOI: 10.1093/jn/nxaa439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/09/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Vitamin A (VA) deficiency is prevalent in preschool-aged children in sub-Saharan Africa. OBJECTIVES We assessed the effect of small-quantity lipid-based nutrient supplements (SQ-LNS) given to women during pregnancy and lactation and their children from 6 to 18 mo of age on women's plasma and milk retinol concentrations in Malawi, and children's plasma retinol concentration in Malawi and Ghana. METHODS Pregnant women (≤20 wk of gestation) were randomized to receive daily: 1) iron and folic acid (IFA) during pregnancy only; 2) multiple micronutrients (MMN; 800 μg retinol equivalent (RE)/capsule), or 3) SQ-LNS (800 μg RE/20g) during pregnancy and the first 6 mo postpartum. Children of mothers in the SQ-LNS group received SQ-LNS (400 μg RE/20 g) from 6 to 18 mo of age; children of mothers in the IFA and MMN groups received no supplement. Plasma retinol was measured in mothers at ≤20 and 36 wk of gestation and 6 mo postpartum, and in children at 6 and 18 mo of age. Milk retinol was measured at 6 mo postpartum. VA status indicators were compared by group. RESULTS Among Malawian mothers, geometric mean (95% CI) plasma retinol concentrations at 36 wk of gestation and 6 mo postpartum were 0.97 μmol/L (0.94, 1.01 μmol/L) and 1.35 μmol/L (1.31, 1.39 μmol/L), respectively; geometric mean (95% CI) milk retinol concentration at 6 mo postpartum was 1.04 μmol/L (0.97, 1.13 μmol/L); results did not differ by intervention group. Geometric mean (95% CI) plasma retinol concentrations for Malawian children at 6 and 18 mo of age were 0.78 μmol/L (0.75, 0.81 μmol/L) and 0.81 μmol/L (0.78, 0.85 μmol/L), respectively, and for Ghanaian children they were 0.85 μmol/L (0.82, 0.88 μmol/L) and 0.88 μmol/L (0.85, 0.91 μmol/L), respectively; results did not differ by intervention group in either setting. CONCLUSIONS SQ-LNS had no effect on VA status of mothers or children, possibly because of low responsiveness of the VA status indicators.
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Affiliation(s)
| | - Rebecca Young
- Institute for Global Nutrition, University of California, Davis, Davis, CA, USA,Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Seth Adu-Afaruwah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Harriet Eyram Teiko Okronipa
- Institute for Global Nutrition, University of California, Davis, Davis, CA, USA,Department of Nutrition, University of California, Davis, Davis, CA, USA,Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Kenneth Maleta
- Department of Public Health, Blantyre, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Malawi
| | - Ulla Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Josh M Jorgensen
- Institute for Global Nutrition, University of California, Davis, Davis, CA, USA,Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Yue-Mei Fan
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Charles D Arnold
- Institute for Global Nutrition, University of California, Davis, Davis, CA, USA,Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Lindsay H Allen
- Institute for Global Nutrition, University of California, Davis, Davis, CA, USA,Department of Nutrition, University of California, Davis, Davis, CA, USA,USDA, ARS Western Human Nutrition Research Center, Davis, CA, USA
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Kathryn G Dewey
- Institute for Global Nutrition, University of California, Davis, Davis, CA, USA,Department of Nutrition, University of California, Davis, Davis, CA, USA
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Afolami I, Mwangi MN, Samuel F, Boy E, Ilona P, Talsma EF, Feskens E, Melse-Boonstra A. Daily consumption of pro-vitamin A biofortified (yellow) cassava improves serum retinol concentrations in preschool children in Nigeria: a randomized controlled trial. Am J Clin Nutr 2020; 113:221-231. [PMID: 33184647 PMCID: PMC7779233 DOI: 10.1093/ajcn/nqaa290] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/22/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vitamin A deficiency is a public health problem in sub-Saharan Africa. Pro-vitamin A biofortified (yellow) cassava has the potential to contribute significantly to improve vitamin A status, especially in populations that are difficult to reach with other strategies. OBJECTIVES The study aimed at determining the efficacy of biofortified cassava to improve vitamin A status of Nigerian preschool children. METHODS An open-label randomized controlled trial was conducted in southwestern Nigeria. In total, 176 preschool children (aged 3-5 y) were randomized into 2 parallel arms comprising an experimental group (n = 88), fed foods prepared from biofortified (yellow) cassava, and a control group (n = 88), fed foods prepared from white cassava, twice a day, 6 d a week for 93 d. RESULTS A total of 159 children completed the trial (yellow cassava group, n = 80; white cassava group, n = 79). Children consumed 221 and 74 µg/d retinol activity equivalents from intervention foods in the yellow and white cassava groups, respectively. The treatment effect on serum retinol concentrations at the end of the feeding trial was 0.06 µmol/L (95% CI: 0.004, 0.124 µmol/L), after adjustment for baseline retinol concentrations, inflammation, and asymptomatic malaria status. No significant treatment effects were detected for serum β-carotene (adjusted effect: 3.9%; 95% CI: -0.6%, 8.6%) and gut permeability (adjusted effect: 0.002; 95% CI: -0.089, 0.092), but a significant effect was detected for hemoglobin concentrations (adjusted effect: 3.08 g/L; 95% CI: 0.38, 5.78 g/L). CONCLUSIONS Daily consumption of β-carotene from biofortified cassava improved serum retinol and hemoglobin concentrations modestly in Nigerian preschool children. This study was registered with clinicaltrials.gov as NCT02627222.
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Affiliation(s)
- Ibukun Afolami
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands,Department of Human Nutrition and Dietetics, University of Ibadan, Ibadan, Nigeria
| | - Martin N Mwangi
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands,Training and Research Unit of Excellence, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Folake Samuel
- Department of Human Nutrition and Dietetics, University of Ibadan, Ibadan, Nigeria
| | | | | | - Elise F Talsma
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Edith Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
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11
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Lockyer S, White A, Buttriss JL. Biofortified crops for tackling micronutrient deficiencies - what impact are these having in developing countries and could they be of relevance within Europe? NUTR BULL 2018. [DOI: 10.1111/nbu.12347] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | - A. White
- British Nutrition Foundation; London UK
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12
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Dror DK, Allen LH. Retinol-to-Fat Ratio and Retinol Concentration in Human Milk Show Similar Time Trends and Associations with Maternal Factors at the Population Level: A Systematic Review and Meta-Analysis. Adv Nutr 2018; 9:332S-346S. [PMID: 29846525 PMCID: PMC6008956 DOI: 10.1093/advances/nmy021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Vitamin A in human milk is critical for meeting infant requirements and building liver stores needed after weaning. A number of studies have measured milk retinol, but only a subset have corrected for fat, which serves as the retinol carrier in breast milk. The purpose of the present work was to review and analyze studies in which human-milk retinol concentrations were reported in relation to milk fat and to compare these results with unadjusted breast-milk retinol concentrations in terms of time trends over the course of lactation, influences of maternal nutritional and constitutional factors, and effects of maternal vitamin A supplementation. A systematic approach was used to search the available literature by using the US National Library of Medicine's MEDLINE/PubMed bibliographic search engine. Observational and intervention studies were included if the research was original and the retinol-to-fat ratio (retinol:fat) in human milk was measured at ≥1 time point during the first 12 mo of lactation. Retinol:fat and retinol were highest in colostrum, declined rapidly in early lactation, and achieved statistical stability by 2 and 4 wk lactation, respectively. In mature milk, retinol concentration was positively correlated with milk fat (r = 0.61, P = 0.008). Breast-milk retinol:fat and retinol were positively associated with maternal vitamin A intake but were associated with plasma retinol only when dietary intake was inadequate. Postpartum supplementation with high-dose vitamin A (200,000-400,000 IU) resulted in significantly higher breast-milk retinol:fat for 3 mo and retinol for 6 mo (P < 0.05). In populations, the 2 indexes show similar trends and associations with maternal factors. Future studies should monitor how the uptake of retinol into the mammary gland affects maternal vitamin reserves, particularly in women who are at risk of vitamin A deficiency.
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Affiliation(s)
- Daphna K Dror
- US Department of Agriculture, Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA
| | - Lindsay H Allen
- US Department of Agriculture, Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA
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13
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Keikha M, Bahreynian M, Saleki M, Kelishadi R. Macro- and Micronutrients of Human Milk Composition: Are They Related to Maternal Diet? A Comprehensive Systematic Review. Breastfeed Med 2017; 12:517-527. [PMID: 28880568 DOI: 10.1089/bfm.2017.0048] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study aims at systematically reviewing the observational and interventional studies on the association of maternal macro- and micronutrient intake with breast milk content. METHODS We systematically searched the Medline via PubMed, Scopus, and ISI Web of Knowledge till October 2016 with the following search strategy: ("human milk" OR "breast milk" OR "breast milk composition" OR "human breast milk composition" OR "composition breast milk" OR "mother milk" OR "human breast milk") AND ("maternal diet" OR "maternal nutrition"). We also searched Google scholar for increasing the sensitivity of our search. The search was not limited to title and abstract due to the possibility that the desired outcome might have been considered a secondary aim. We excluded conference papers, editorials, letters, commentary, short survey, and notes. The search was refined to English language, and we did not consider any time limitation. To increase the sensitivity and to select more studies, the reference list of the published studies was checked as well. RESULTS This review included 59 observational and 43 interventional studies on maternal diet related to breast milk composition. Different studies determined the associations and effects of some maternal dietary intake of micro and macronutrients and its reflection in human milk. CONCLUSION Maternal dietary intake, particularly fatty acids, and some micronutrients, including fat soluble vitamins, vitamin B1, and vitamin C, was related to their content in breast milk composition.
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Affiliation(s)
- Mojtaba Keikha
- 1 Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences , Shahroud, Iran
| | - Maryam Bahreynian
- 2 Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Mohammad Saleki
- 3 Students' Research Center, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Roya Kelishadi
- 2 Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences , Isfahan, Iran
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Greene MD, Kabaghe G, Musonda M, Palmer AC. Retail Sugar From One Zambian Community Does Not Meet Statutory Requirements for Vitamin A Fortification. Food Nutr Bull 2017; 38:594-598. [PMID: 28978232 DOI: 10.1177/0379572117733841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Industrial food fortification is a major strategy to improve dietary micronutrient intakes and prevent deficiencies. Zambia introduced mandatory sugar fortification with vitamin A, at a target of 10 mg/kg, in 1998. Representative surveys conducted since that time do not support marked improvement in vitamin A status. OBJECTIVE To describe vitamin A concentrations in retail sugar, as well as vendor practices, perceptions of fortified foods, and sugar use practices. METHODS We conducted a census of sugar vendors in one Zambian community, capturing information on vendors, available brands and packaging options, and storage conditions. We purchased all brands and package types of sugar available at each vendor. In a 15% subsample, we conducted semi-structured interviews with vendor-consumer pairs. We tested 50% of sugar samples at random for vitamin A using an iCheck portable fluorimeter. RESULTS The distribution of vitamin A in sugar in market samples was highly skewed, with a median of 3.1 mg/kg (25th-75th percentiles: 1.8-5.5) and a range from 0.2 to 29.9 mg/kg. Only 11.3% of samples met the 10 mg/kg statutory requirement. Sugar was primarily repackaged and sold in small quantities, with rapid turnover of stocks. Perceptions of fortification by vendors and consumers were generally positive. CONCLUSIONS Vitamin A in fortified sugar fell well below statutory requirements. Our data point to challenges at regional depot and/or poor adherence to fortification standards at the factory level. A renewed commitment to monitoring and enforcement will be required for Zambia to benefit from a food fortification strategy.
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Affiliation(s)
- Matthew D Greene
- 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gladys Kabaghe
- 2 National Food and Nutrition Commission, Lusaka, Zambia
| | - Mofu Musonda
- 2 National Food and Nutrition Commission, Lusaka, Zambia
| | - Amanda C Palmer
- 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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15
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Taleon V, Mugode L, Cabrera-Soto L, Palacios-Rojas N. Carotenoid retention in biofortified maize using different post-harvest storage and packaging methods. Food Chem 2017; 232:60-66. [PMID: 28490117 PMCID: PMC5437647 DOI: 10.1016/j.foodchem.2017.03.158] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/17/2017] [Accepted: 03/29/2017] [Indexed: 11/29/2022]
Abstract
Orange maize is being promoted as a source of provitamin A carotenoids (pVAC) in Zambia. Carotenoid retention in orange maize grains stored in metal silos, multilayer polyethylene and common woven bags, and maize meal packaged in single and multilayer polyethylene bags was evaluated. Significant differences in total pVAC retention were found between grain storage methods (48.1-57.2%) after 6months of storage. Total pVAC retention in hammer meal (73.1-73.5%) was higher than in breakfast meal (64.3-69.3%) after 4months of storage; however, no differences in pVAC retention were found between meal types when stored in single and multilayer polyethylene bags. In general, β-cryptoxanthin (βCX) had higher retention than β-carotene (βC). Potential contribution of stored orange maize to the estimated average requirement of children and women was 26.5% and 24.3%, respectively. Orange maize meal can provide significant amounts of provitamin A to diets of Zambians even after 4months of storage.
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Affiliation(s)
- Víctor Taleon
- HarvestPlus, c/o IFPRI 2033 K Street, NW, Washington, DC 20006-1002, USA.
| | - Luke Mugode
- Department of Food Science, Postharvest Technology Research Laboratory, Stellenbosch University, Private Bag X1, Stellenbosch 7602, South Africa
| | - Luisa Cabrera-Soto
- Global Maize Program, International Maize and Wheat Improvement Center (CIMMYT), CIMMYT Research Station, Km. 45 Carretera Mexico-Veracruz, El Batan, Texcoco CP 56237, Edo. de México, Mexico
| | - Natalia Palacios-Rojas
- Global Maize Program, International Maize and Wheat Improvement Center (CIMMYT), CIMMYT Research Station, Km. 45 Carretera Mexico-Veracruz, El Batan, Texcoco CP 56237, Edo. de México, Mexico
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16
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Girard AW, Grant F, Watkinson M, Okuku HS, Wanjala R, Cole D, Levin C, Low J. Promotion of Orange-Fleshed Sweet Potato Increased Vitamin A Intakes and Reduced the Odds of Low Retinol-Binding Protein among Postpartum Kenyan Women. J Nutr 2017; 147:955-963. [PMID: 28404834 PMCID: PMC5404208 DOI: 10.3945/jn.116.236406] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/14/2016] [Accepted: 03/07/2017] [Indexed: 01/09/2023] Open
Abstract
Background: Orange-fleshed sweet potato (OFSP) improves vitamin A (VA) status of young children; research with pregnant and lactating women is limited.Objective: We examined the effectiveness of the Mama SASHA (Sweetpotato Action for Security and Health in Africa) program to improve nutrition knowledge, diets, and nutritional status of pregnant and lactating women (PLW) in Western Kenya.Methods: Eight health facilities were allocated to the Mama SASHA intervention or comparison arms. PLW in intervention facilities received enhanced nutrition counseling at health clinics, were linked with community-based maternal support groups, and received vouchers for OFSP vine cuttings. Control PLW received clinic-based nutrition counseling only. A total of 505 women in early and midpregnancy, attending their first antenatal care visit, and with no previous engagement in project activities were enrolled from the 8 facilities. Nutrition and health-seeking knowledge, food security, dietary patterns, and anthropometric measurements were collected at 4 time points at ≤9 mo postpartum. VA intakes were assessed with multipass 24-h recalls in a subsample of 206 mothers at 8-10 mo postpartum. VA status was assessed by using serum retinol-binding protein (RBP). Impacts were estimated with multilevel mixed models adjusted for clustering and differences at enrollment.Results: At enrollment, 22.9% of women had RBP <1.17 μmol/L. By 9 mo postpartum, intervention women had significantly higher intakes of VA [adjusted difference = 297.0 retinol activity equivalent (RAE) units; 95% CI: 82, 513 RAE units; P = 0.01; n = 206], greater consumption of VA-rich fruit and vegetables in the previous 7 d (difference-in-difference estimate: 0.40 d; 95% CI: 0.23, 0.56 d; P < 0.01), and a 45% reduction in the odds of RBP <1.17 μmol/L (OR: 0.55; 95% CI: 0.33, 0.92; P = 0.01).Conclusion: Promotion of OFSP to PLW through health services is a feasible strategy to improve women's nutrition knowledge, VA intakes, and maternal RBP.
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Affiliation(s)
- Amy Webb Girard
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA;
| | | | - Michelle Watkinson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | | | - Donald Cole
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; and
| | - Carol Levin
- Department of Global Health, University of Washington, Seattle, WA
| | - Jan Low
- International Potato Center, Nairobi, Kenya
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17
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Palmer AC, Healy K, Barffour MA, Siamusantu W, Chileshe J, Schulze KJ, West KP, Labrique AB. Provitamin A Carotenoid-Biofortified Maize Consumption Increases Pupillary Responsiveness among Zambian Children in a Randomized Controlled Trial. J Nutr 2016; 146:2551-2558. [PMID: 27798345 DOI: 10.3945/jn.116.239202] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/09/2016] [Accepted: 09/14/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Impaired dark adaptation is an early functional indicator of vitamin A deficiency that may be prevented by regular dietary intake of foods containing provitamin A carotenoids. OBJECTIVE We tested the impact of provitamin A carotenoid-biofortified maize consumption (∼15 μg β-carotene/g) on dark adaptation in Zambian children. METHODS We used a cluster-randomized trial of children aged 4-8 y (n = 1024) in Mkushi District, Zambia, and compared the regular consumption (2 meals/d, 6 d/wk for 6 mo) of biofortified orange maize (OM) to white maize (WM). The primary outcome was the serum retinol response. In a random sample (n = 542), we used a digital pupillometer to test pre- and postintervention responses to graded light stimuli (-2.9 to 0.1 log cd/m2) in a dark-adapted state. RESULTS At baseline, 11.7% of the children had serum retinol <0.7 μmol/L, 14.4% had impaired dark adaptation (pupillary threshold ≥ -1.11 log cd/m2), and 2.3% had night blindness. The mean ± SD pupillary responsiveness to light stimuli was poorer at baseline in the OM group (16.1% ± 6.6%) than the WM group (18.1% ± 6.4%) (P = 0.02) but did not differ at follow-up (OM: 17.6% ± 6.5%; WM: 18.3% ± 6.5%). Among children with serum retinol <1.05 μmol/L at baseline, there was greater improvement in pupillary responsiveness in the OM group (2.2%; 95% CI: 0.1%, 4.3%) than the WM group (0.2%; 95% CI: -1.1%, 1.5%; P = 0.01), but there were no differences in children with adequate baseline status. We found no effect of treatment on pupillary threshold or night blindness. CONCLUSIONS The regular consumption of provitamin A carotenoid-biofortified maize increased pupillary responsiveness among children with marginal or deficient vitamin A status, providing evidence of a functional benefit to consuming this biofortified crop. This trial was registered at clinicaltrials.gov as NCT01695148.
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Affiliation(s)
- Amanda C Palmer
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD;
| | - Katherine Healy
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Maxwell A Barffour
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | | | | | - Kerry J Schulze
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Alain B Labrique
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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