Devika Suri

Effect of lysine supplementation on health and morbidity in subjects belonging to poor peri-urban households in Accra, Ghana.

BACKGROUND Lysine affects diarrhea and anxiety via effects on serotonin receptors, enhanced intestinal repair, and sodium chloride-dependent opioid peptide transport. OBJECTIVE The objective was to investigate the effects of lysine supplementation on morbidity, growth, and anxiety in children and adults of peri-urban areas of Accra, Ghana. DESIGN In a double-blind randomized trial, the effect of lysine supplementation (1 g lysine/d) compared with that of placebo was examined in 2 groups of men, women, and children (n = 271). Primary outcomes included diarrheal and respiratory morbidity, growth, and anxiety and complement C3, C-reactive protein, serum cortisol, transferrin, and ferritin values. Independent-sample t tests, odds ratios, generalized estimating equations, 4-parameter sinusoid regression, and generalized linear models were used. RESULTS Thirty percent of men, 50% of women, and 15% of children were at risk of lysine inadequacy. Supplementation in children reduced diarrheal episodes [19 lysine, 35 placebo; odds ratio (OR): 0.52; 95% CI: 0.29, 0.92; P = 0.046] and the total number of days ill (21 lysine, 47 placebo; OR: 0.44; 95% CI: 0.26, 0.74; P = 0.034). Mean days ill per child per week (0.058 ± 0.039 lysine, 0.132 ± 0.063 placebo; P = 0.017) were negatively associated with weight gain with control for baseline weight and study group (P = 0.04). Men had fewer coryza episodes (23 lysine, 39 placebo; OR: 0.60; 95% CI: 0.36, 1.01; P = 0.05), total number of days ill (lysine: 130; placebo: 266; OR: 0.51; 95% CI: 0.28, 0.93; P = 0.03), and mean days ill per person per week (lysine: 0.21 ± 0.23; placebo: 0.41 ± 0.35; P = 0.04). Serum ferritin (P = 0.045) and C-reactive protein (P = 0.018) decreased in lysine-supplemented women but increased in placebo-supplemented women. CONCLUSION Lysine supplementation reduced diarrheal morbidity in children and respiratory morbidity in men in Ghana.

Improving complementary feeding in Ghana: reaching the vulnerable through innovative business--the case of KOKO Plus.

Reaching vulnerable populations in low‐resource settings with effective business solutions is critical, given the global nature of food and nutrition security. Over a third of deaths of children under 5 years of age are directly or indirectly caused by undernutrition. The Lancet series on malnutrition (2013) estimates that over 220,000 lives of children under 5 years of age can be saved through the implementation of an infant and young child feeding and care package. A unique project being undertaken in Ghana aims to bring in two elements of innovation in infant and young child feeding. The first involves a public–private partnership (PPP) to develop and test the efficacy and effectiveness of the delivery of a low‐cost complementary food supplement in Ghana called KOKO Plus™. The second involves the testing of the concepts of social entrepreneurship and social business models in the distribution and delivery of the product. This paper shares information on the ongoing activities in the testing of concepts of PPPs, social business, social marketing, and demand creation using different delivery platforms to achieve optimal nutrition in Ghanaian infants and young children in the first 2 years of life. It also focuses on outlining the concept of using PPP and base‐of‐the‐pyramid approaches toward achieving nutrition objectives.

Effects of Different Processing Methods on the Micronutrient and Phytochemical Contents of Maize: From A to Z

Maize is a staple human food eaten by more than a billion people around the world in a variety of whole and processed products. Different processing methods result in changes to the nutritional profile of maize products, which can greatly affect the micronutrient intake of populations dependent on this crop for a large proportion of their caloric needs. This review summarizes the effects of different processing methods on the resulting micronutrient and phytochemical contents of maize. The majority of B vitamins are lost during storage and milling; further loss occurs with soaking and cooking, but fermentation and nixtamalization (soaking in alkaline solution) can increase bioavailability of riboflavin and niacin. Carotenoids, found mainly in the kernel endosperm, increase in concentration after degermination, while other vitamins and minerals, found mainly in the germ, are reduced. Mineral bioavailability can be improved by processing methods that reduce phytic acid, such as soaking, fermenting, cooking, and nixtamalization. Losses of micronutrients during processing can be mitigated by changes in methods of processing, in addition to encouraging consumption of whole-grain maize products over degermed, refined products. In some cases, such as niacin, processing is actually necessary for nutrient bioavailability. Due to the high variability in the baseline nutrient contents among maize varieties, combined with additional variability in processing effects, the most accurate data on nutrient content will be obtained through analysis of specific maize products and consideration of in vivo bioavailability.

Serum retinol concentrations demonstrate high specificity after correcting for inflammation but questionable sensitivity compared with liver stores calculated from isotope dilution in determining vitamin A deficiency in Thai and Zambian children.

BACKGROUND The WHO estimates that 190 million preschool children have vitamin A deficiency (VAD). Serum retinol (SR) concentration is a common indicator of vitamin A (VA) status, but SR is homeostatically controlled and suppressed during inflammation, which may lead to misdiagnosis. OBJECTIVE The sensitivity and specificity of SR compared with VA total liver reserves (TLRs) were evaluated for VAD in children from Thailand (n = 37) and Zambia (n = 128). SR was adjusted for inflammation in the Zambian children. DESIGN Each child was classified as VA-deficient or not based on cutoffs of <0.1 μmol VA/g liver with the use of retinol isotope dilution and <0.7 μmol/L for SR concentrations. Four categories of infection status in the Zambian children were based on elevated C-reactive protein (CRP) and α1-acid glycoprotein (AGP). Sensitivity and specificity were calculated with the use of unadjusted and inflammation marker-adjusted SR cutoffs. RESULTS VAD was 65% and 0% according to TLRs and SR, respectively, in Thai children and 0% and 17%, respectively, in Zambian children. No true positive VAD cases occurred; thus, sensitivity was 0% and indeterminable, respectively; specificity was 100% and 82.8%, respectively. CRP was elevated in 26.6% of Zambian children, whereas 97.7% had elevated AGP, categorizing them as having no infection (2.3%) or in early (26.6%) or late (58.6%) convalescence. With the use of marker-adjusted SR cutoffs of 0.6 μmol/L for late convalescence and 0.5 μmol/L for early convalescence, the adjusted prevalence of SR deficiency was 2.3%, increasing specificity to 97.3%. CONCLUSIONS No cases of VAD were identified by both TLRs and SR (true positives) in Thai or Zambian children. Specificity of SR to evaluate VAD was high, but additional research is needed to investigate sensitivity. Adjusting SR cutoffs for inflammation improved specificity by reducing false positives. SR as a VAD indicator may depend on infection rates, which should be taken into consideration. These studies were registered at clinicaltrials.gov as NCT01061307 (for Thailand) and NCT01814891 (for Zambia).

Optimization of the Nutrient Content and Protein Quality of Cereal—Legume Blends for Use as Complementary Foods in Ghana

Background Nutritionally adequate complementary foods made from locally available ingredients are of high priority in developing countries, including Ghana. The majority of complementary foods in these countries are cereal-based and are unable to meet the nutrient intakes recommended by the World Health Organization. Objective To evaluate the nutrient content and protein quality of local cereal—legume blends for complementary foods against recommendations and to determine the quantities of additional ingredients required to meet needs by using linear programming. Methods Nine cereal—legume combinations (maize, sorghum, or millet combined with cowpea, peanut, or soybean) and koko (a traditional Ghanaian maize-based complementary food) were evaluated based on the macronutrient targets for a daily ration of complementary food for the age group 12 to 24 months: 264 kcal, 6.5 g of protein, and 8.2 to 11.7 g of fat. Protein quality was assessed by the Protein Digestibility Corrected Amino Acid Score (PDCAAS). Linear programming was then used to determine the amounts of additional oil, sugar, and lysine needed to meet macronutrient requirements. Results No traditional cereal—legume food met all complementary food macronutrient requirements on its own. Cereal—legume blends made with peanut or cowpeas were low in quality protein, while those with soybean were low in fat. Lysine was the limiting amino acid (PDCAAS 0.50 to 0.82) in all blends. Adding lysine increased utilizable protein by 1% to 10% in soybean blends, 35% to 40% in peanut blends, and 14% to 24% in cowpea blends. Peanut—maize, peanut—millet, and all soybean—cereal blends were able to meet macronutrient targets; most micronutrients remained below recommended levels. Conclusions Traditional cereal—legume blends made from locally available ingredients do not meet energy, quality protein, and fat recommendations for complementary foods; however, such complementary food blends may be optimized to meet nutrient requirements by using linear programming as a tool to determine the exact levels of fortificants to be added (including, but not limited to, added fat, amino acids, and micronutrients).

Protein Quality Workshop: importance of protein quality in prevention and treatment of child malnutrition.

Devika Suri is affiliated with the Nevin Scrimshaw International Nutrition Foundation, Boston, Massachusetts, USA; Shelley Marcus is affiliated with Tufts University, Boston; Shibani Ghosh and Irwin Rosenberg are affiliated with Tufts University and the Nevin Scrimshaw International Nutrition Foundation; Anura Kurpad is affiliated with St. John’s Research Institute, Bangalore, India. Please direct queries to the corresponding author: Irwin Rosenberg, Tufts University, 150 Harrison Ave., Boston, MA 02111 USA; e-mail: Irwin.rosenberg@tufts.edu. The Protein Quality Workshop was sponsored by the United States Agency for International Development (USAID) and was coorganized by the Food Aid Quality Review (FAQR) team at the Tufts University Friedman School of Nutrition Science and Policy and the Nevin Scrimshaw International Nutrition Foundation. The workshop was held May 16 and 17, 2012, at the Tufts University/United States Department of Agriculture Human Nutrition Research Center on Aging in Boston.

The Role of Dairy in Effectiveness and Cost of Treatment of Children With Moderate Acute Malnutrition: A Narrative Review

Background: Dairy is recommended in specially formulated supplementary foods to treat children with moderate acute malnutrition (MAM) but with limited evidence and added cost. Objective: Review studies of ready-to-use foods (RUFs) versus fortified blended foods (FBFs) to determine whether inclusion of dairy modifies the comparative effectiveness and cost. Methods: We reviewed literature comparing FBF and RUF in treatment of MAM among children younger than 5 years in developing countries. Outcomes of recovery from MAM, weight, and length gain were compared among treatment categories: FBF with dairy (FBF+), FBF without dairy (FBF−), RUF with dairy (RUF+), and RUF without dairy (RUF−). Supplement cost was compared per 500 kcal. Results: Eight studies were included. Rations were heterogeneous in energy and type of dairy. Overall, RUF+, RUF−, and FBF+ performed similarly, with higher recovery and weight gain compared with FBF−. RUF+ had higher recovery (in 5 of 6 comparisons), weight gain (4 of 4), and length gain (1 of 4) versus FBF−. The RUF+ had higher recovery (1 of 2) versus FBF+, with no other differences. The RUF− versus FBF+ had no differences (0 of 2). The RUF− had higher recovery (1 of 2), weight gain (2 of 2) versus FBF−. Four studies reported supplement costs, which averaged US

Program changes are effective and cost-effective in increasing the amount of oil used in preparing corn soy blend porridge for treatment of moderate acute malnutrition in Malawi

0.15 (FBF−), US

Self-report vs. direct measures for assessing corn soy blend porridge preparation and feeding behavior in a moderate acute malnutrition treatment program in southern Malawi

0.18 (FBF+), US

Concerns when serum retinol concentration is the primary biological indicator of vitamin A status in intervention studies

0.18 (RUF−), and US