Padmini Ghugre

A Randomized Trial of Iron-Biofortified Pearl Millet in School Children in India

BACKGROUND Iron deficiency is the most widespread nutritional deficiency in the world. OBJECTIVE The objective of this randomized efficacy trial was to determine the effects of iron-biofortified pearl millet (Fe-PM) on iron status compared with control pearl millet (Control-PM). METHODS A randomized trial of biofortified pearl millet (Pennisetum glaucum), bred to enhance iron content, was conducted in 246 children (12-16 y) for 6 mo in Maharashtra, India. Iron status [hemoglobin, serum ferritin (SF), soluble transferrin receptor (sTfR), and total body iron (TBI)], inflammation (C-reactive protein and α-1 acid glycoprotein), and anthropometric indices were evaluated at enrollment and after 4 and 6 mo. Hodges-Lehmann-Sen 95% CIs were used to examine the effect of the Fe-PM on iron status compared with commercially available Control-PM. Linear and binomial regression models were used to evaluate the effects of Fe-PM on iron status and incidence of anemia and iron deficiency, compared with Control-PM. RESULTS At baseline, 41% of children were iron deficient (SF <15 μg/L) and 28% were anemic (hemoglobin <12.0 g/dL). Fe-PM significantly increased SF concentrations and TBI after 4 mo compared with Control-PM. Among children who were iron deficient at baseline, those who received Fe-PM were 1.64 times more likely to become iron replete by 6 mo than were those receiving Control-PM (RR: 1.64, 95% CI: 1.07, 2.49, P = 0.02). The effects of Fe-PM on iron status were greater among children who were iron deficient at baseline than among children who were not iron deficient at baseline. CONCLUSIONS Fe-PM significantly improved iron status in children by 4 mo compared with Control-PM. This study demonstrated that feeding Fe-PM is an efficacious approach to improve iron status in school-age children and it should be further evaluated for effectiveness in a broader population context. This trial was registered at clinicaltrials.gov as NCT02152150.

Mineral content of complementary foods

ObjectiveTo document mineral contents iron, zinc, calcium, energy contents and nutrient densities in complementary foods commonly given to young urban slum children.MethodsInformation on dietary intake was collected from 892 mothers of children aged13-24 months, using 24 hour dietary recall and standardized measures. Three variations of 27 most commonly prepared recipes were analyzed and their energy (Kcal/g) and nutrient densities (mg/100Kcal) were calculated.ResultsConsiderable variations were observed in preparation of all items fed to the children. Cereal-based items predominated their diets with only small amount of vegetables/fruits. Fenugreek was the only leafy vegetable included, but was given to only 1–2% of children. Iron, calcium, zinc contents of staple complementary foods ranged from: 0.33mg to 3.73 mg, 4mg to 64 mg, and 0.35mg to 2.99 mg/100 respectively. Recipes diluted with less water and containing vegetables, spices had higher mineral content. Minerals densities were higher for dals, fenugreek vegetable, khichdi and chapatti. Using the median amounts of the various recipes fed to children, intakes of all nutrients examined especially calcium and iron was low.ConclusionThere is an urgent need to educate mothers about consistency, dilution, quantity, frequency, method of preparation, inclusion of micronutrient-rich foods, energy-dense complementary foods and gender equality.

Nutritional Quality of Diets fed to Young Children in Urban Slums can be Improved by Intensive Nutrition Education

Background Almost half of Indias children under 3 years of age are undernourished and at risk for illness and death. Poor complementary feeding practices contribute substantially to the problem. Promoting appropriate feeding practices is critical for ensuring child survival, health, and nutrition. Nutrition education is a feasible intervention and has the potential to help achieve the Millennium Goals, provided it is implemented appropriately. However, in existing programs, education is too generalized and based on information transfer. Objective To develop and implement a need-based, situation-specific education program for mothers to bring about changes in complementary feeding practices, with emphasis on the quantity and nutritional quality of complementary feeds. Methods Four hundred fourteen mothers or caregivers from five slums in Mumbai participated in a 3-month intervention study. Gaps in complementary feeding practices were identified at baseline. Education was given by trained fieldworkers, first to groups of 8 to 10 mothers or caregivers using innovative modules and demonstrations, followed by weekly monitoring and reinforcement. A simple checklist was used at each follow-up to assess impact, identify practices not adopted, and provide further inputs. Data collected at three follow-ups were compared with baseline and analyzed by SPSS using the chi-square test, the t-test, and ANOVA to assess whether feeding practices of the mothers or caregivers were altered favorably. Conclusions The intervention process used in this study, the modules used, and the use of the checklist as complementary feeding practices. Incorporation of these in existing Growth Monitoring and Promotion programs would help to improve child nutrient intakes and thus reduce the prevalence of undernutrition.

Iron, Oxidative Stress and Health

Iron is an element of crucial importance to living cells. It has incompletely filled ‘d’ orbitals and exists in a range of oxidation states, the most common being ferrous [Fe II (d6)] and ferric [Fe III(d5)] forms. By virtue of this unique electrochemical property, iron is an ideal redox active cofactor for many biological processes and fundamental biochemical activities in all cells. It can associate with proteins; bind to oxygen (O2), transfer electrons and mediate catalytic reactions. Enzymes of the citric acid cycle – succinate dehydrogenase and aconitase are iron-dependent. Iron is a critical component of heme in hemoglobin (Hb), myoglobin, cytochromes as well as iron–sulfur complexes of the electron transport chain. Iron is also required for activity of ribonucleoside reductase, the rate-limiting enzyme of the first metabolic reaction committed to DNA synthesis. Therefore, iron plays an important role in metabolic processes including O2 transport, electron transport, oxidative phosphorylation and energy production, xenobiotic metabolism, DNA synthesis, cell growth, apoptosis, gene regulation and inflammation (Zhang and Enns, 2006; Cairo and Recalcati, 2007; He et al., 2007; Outten and Theil, 2009; Wang and Pantopoulos, 2011). In the central nervous system, iron is required for myelogenesis and myelin maintenance by oligodendrocytes. It is also a necessary cofactor for the synthesis of neurotransmitters, dopamine, norepinephrine and serotonin (He et al., 2007). Therefore deficiency of iron can result in myriad disorders. Even mild iron deficiency can adversely affect cognitive performance, behavior, physical growth of infants, preschool and school age children and physical work capacity and work performance of adults (Brabin et al, 2001; Haas and Brownlie, 2001).

Widespread 25-Hydroxyvitamin D Deficiency in Affluent and Nonaffluent Pregnant Indian Women

Objectives. This cross-sectional study primarily aimed to assess vitamin D adequacy in the third trimester of pregnancy using 25-hydroxyvitamin D (25(OH)D) and explore lifestyle characteristics (sun exposure index, diet, and economic indicators) associated with serum 25(OH)D. The secondary aim was to examine the relationship of serum 25(OH)D with birth weight and gestational age. Methods. Serum 25(OH)D was measured by chemiluminescent immunoassay in 150 pregnant women from Mumbai. Sun exposure index was computed. Dietary calcium, phytate : calcium ratio, and dietary phosphorus was calculated using the 24-hour diet recall method. Results. All women had 25(OH)D levels < 30.00 ng/ml. Multivariable linear regression showed that nonaffluent women had poorer 25(OH)D status than their affluent counterparts (β = −0.20; P = 0.03). Higher sun exposure index was associated with higher 25(OH)D concentrations (β = 0.31; P < 0.001), which remained significant after controlling for covariates. At the bivariate level, mothers of infants weighing <2500 g had lower serum 25(OH)D concentrations compared to mothers whose infants weighed ≥2500 g (P = 0.02). This association became non-significant after controlling for covariates. Conclusions. Vitamin D deficiency was universally prevalent in the cohort studied. There is a need to develop culturally sensitive strategies for improving the 25(OH)D status.

Serum retinol, α-tocopherol, and lipid peroxide concentrations in low-income Indian pregnant mothers.

Serum alpha-tocopherol, retinol, and malondialdehyde concentrations were measured at 7(th) month of pregnancy in 122 women from low socio-economic background. Maternal anthropometric measurements, 24-hour nutrient intakes, and pregnancy outcome were recorded. One-third (34.3 %) of mothers had low birth weight babies and 10 % delivered preterm. Maternal diets were inadequate in all the nutrients, the most limiting being vitamin A. Three-fourths of mothers had intakes less than 25 % of the Indian recommended daily intake (RDI) of 600 microg retinol equivalents/day. Serum alpha-tocopherol concentrations of 98 % were indicative of deficiency and almost half the mothers had low serum retinol concentrations (< or =10 microg/dL). Mean malondialdehyde level was 7.0 +/- 1.4 nmoles/mL. These values are higher than reports in the literature and were attributable to poor intake of most dietary antioxidants. Malondialdehyde concentrations were negatively correlated with serum alpha-tocopherol. Birth weight was positively correlated with maternal weight and biceps skinfold thickness, macronutrient intakes, serum retinol, and alpha-tocopherol concentrations. Preterm delivery was associated with low anthropometric measurements and low nutrient intakes especially vitamin A. Mothers who delivered preterm had significantly lower malondialdehyde concentrations than those who delivered at term. The role of antioxidant nutrients, especially vitamin A and oxidative stress in relation to fetal growth and pregnancy outcome among mothers from low socioeconomic settings requires attention.

Applications of nanotechnology in nutrition: potential and safety issues

Abstract Nanotechnology offers promising solutions for improving nutrition, health and wellbeing by delivering nutrients through a variety of food vehicles with different physicochemical properties including consistency and texture. This review focuses on the digestive, absorptive and postabsorptive fate of nanoparticles (NPs). Nutrients that have received attention include vitamins A, D, E, C, β-carotene, iron and to some extent zinc and calcium. There is tremendous scope for nanotechnological applications to other nutrients eg, amino acids, folic acid, B12, and so on. However, concerted efforts should address the pros and cons of ingesting NPs vis-a-vis chronic exposure and residence time in human body. Studies of storage/shelf life, biocompatibility, bioavailability and risk assessment of different type of nanomaterials are required to gauge safety when different NPs are incorporated in varied food vehicles. Regulations to protect consumers need to be brought in place before commercial applications of NPs.

Folate status and intake of tribal Indian adolescents aged 10 to 17 years

Background Adequate folate intake and levels are advisable throughout life but are of particular importance during adolescence, a period of rapid growth. However, folate insufficiency in economically deprived Indian adolescents is understudied. Objective This cross-sectional study examined the prevalence of folate deficiency and adequacy of folate intake of 224 tribal Indian adolescents (10 to 17 years of age). The secondary aim was to study the association between anemia status and folate status. Methods Radioimmunoassay, multiple-pass 24-hour dietary recall, and HemoCue were used to measure red blood cell (RBC) folate, folate intake, and anemia status, respectively. Results The geometric mean (95% CI) RBC folate concentration (nmol/L) was 360.2 (329.7 to 393.6), and the mean ± SD folate intake (μg/day) and hemoglobin level (g/L) were 159.9 ± 44.7 and 125.4 ± 13.0, respectively. Almost half of boys and girls aged 10 to 12 and 13 to 15 years and 66.7% of girls aged 16 to 17 years were deficient in RBC folate (< 340 nmol/L). The mean ± SD folate intake (μg/day) of girls (139.4 ± 34.5) was lower than that of boys (173.8 ± 45.5) (p < .001). With respect to adequacy of folate intake, a greater proportion of girls in the age group of 13–15 years (78.5% vs 38.6%, p < 0.001) and 16–17 years (100.0% vs 76.9%, p = 0.04) had intakes below their Recommended Dietary Allowance (RDA). No association was observed between folate intake and RBC folate deficiency or between anemia status and RBC folate deficiency. Conclusions Folate insufficiency was widespread in tribal Indian adolescents. There is an urgent need to develop culturally sensitive strategies for improvement.

Acceptability of Iron- and Zinc-Biofortified Pearl Millet (ICTP-8203)-Based Complementary Foods among Children in an Urban Slum of Mumbai, India

Biofortification, a method for increasing micronutrient content of staple crops, is a promising strategy for combating major global health problems, such as iron and zinc deficiency. We examined the acceptability of recipes prepared using iron- and zinc-biofortified pearl millet (FeZnPM) (~80 ppm Fe, ~34 ppm Zn, varietal ICTP-8203), compared to conventional pearl millet (CPM) (~20 ppm Fe, ~19 ppm Zn) in preparation for an efficacy trial. Our objective was to examine the acceptability of FeZnPM compared to CPM among young children and mothers living in the urban slums of Mumbai. Standardized traditional feeding program recipes (n = 18) were prepared with either FeZnPM or CPM flour. The weight (g) of each food product was measured before and after consumption by children (n = 125) and the average grams consumed over a 3-day period were recorded. Mothers (n = 60) rated recipes using a 9-point hedonic scale. Mean intakes and hedonic scores of each food product were compared using t-tests across the two types of pearl millet. There were no statistically significant differences in consumption by children (FeZnPM: 25.27 ± 13.0 g; CPM: 21.72 ± 6.90 g) across the food products (P = 0.28). Overall mean hedonic scores for all recipes were between 7 to 9 points. CPM products were rated higher overall (8.22 ± 0.28) compared to FeZnPM products (7.95 ± 0.35) (P = 0.01). FeZnPM and CPM were similarly consumed and had high hedonic scores, demonstrating high acceptability in this population. These results support using these varieties of pearl millet in a proposed trial [http://Clinicaltrials.gov ID: NCT02233764; Clinical Trials Registry of India (CTRI), reference number REF/2014/10/007731, CTRI number CTRI/2015/11/006376] testing the efficacy of FeZnPM for improving iron status and growth.

BMI, body fat and waist-to-height ratio of stunted v . non-stunted Indian children: a case–control study

OBJECTIVE To compare the BMI, body fat and waist-to-height ratio (WHtR) of stunted and non-stunted children following different growth trajectories from low socio-economic strata in Mumbai, India. DESIGN Cross-sectional, case-control study. Weight, height, skinfold thicknesses and waist circumference were measured. Information regarding the duration of breast-feeding, age at initiation of complementary feeding and income was obtained. Birth weight was obtained from records. BMI, body fat, WHtR and change in weight sd were calculated. SETTING Children who were beneficiaries of anganwadis, Mumbai city, India. SUBJECTS Three hundred and thirty children aged 2-4 years were selected in each of the stunted and non-stunted groups after matching for age and sex. RESULTS After adjusting for birth weight, change in weight sd, duration of breast-feeding, age at complementary feeding initiation and income, stunted children had significantly higher body fat, WHtR and BMI than the non-stunted (P<0·01). The stunted and non-stunted children were classified based on their change in weight sd. Stunted children with no change in weight sd had higher mean body fat, BMI (P<0·01) and WHtR (P<0·05) than their non-stunted counterparts. In the catch-up growth group, stunted children had higher BMI and WHtR than the non-stunted (both P<0·001). In the catch-down growth group, stunted children had higher BMI than the non-stunted (P<0·001). CONCLUSIONS Stunting was seen to increase the tendency of conserving body fat in young children. Such a tendency, if continued during later childhood and adolescence, can increase the risk of obesity and non-communicable diseases.