Résumé
Ready-to-eat (RTE) snacks are routinely distributed to pregnant women in India. These provide protein and calories but are low in micronutrients. We investigated whether RTE snacks fortified with leaf concentrate (LC) could improve pregnancy outcomes, including maternal haemoglobin (Hb) concentrations and infants’ birthweight. This randomized controlled two-arm trial was conducted over 18 months: control (sRTE) group received standard 120 g RTE snack (102 g wheat flour, 18 g soya flour); intervention (lcRTE) group received the same snack fortified with 7 g LC. The study was conducted in Jaipur, Rajasthan, India. One hundred and five pregnant women aged 18-35 years were studied. Among the 105 women randomized to the two arms of the trial, 2 (1.9%) were severely anaemic (Hb ≤6.0 g/dL); 55 (53.4%) were moderately anaemic (Hb 6.0-8.0 g/ dL); 34 (33.0%) were mildly anaemic (Hb 8.6-10.9 g/dL); and 12 (11.7%) were not anaemic (Hb ≥11.0 g/dL). In the final month of pregnancy, 83.0% (39/47) of women in the sRTE group had Hb ≤8.5 g/dL compared to 37.8% (17/45) in the lcRTE group (p<0.001). After adjustment for age and baseline Hb concentration, the difference in Hb concentrations due to LC fortification was 0.94 g/dL (95% CI 6.8-12.0; p<0.001). Mean live birthweight in the lcRTE group was 2,695 g (SD 325 g) compared to 2,545 g (297 g) in the sRTE group (p=0.02). The lcRTE snacks increased infants’ birthweight by 133.7 g (95% CI 7.3-260.2; p=0.04) compared to sRTE snacks. Leaf concentrate fortification of antenatal protein-calorie snacks in a low-income setting in India protected against declining maternal haemoglobin concentrations and increased infants’ birthweight when compared with unfortified snacks. These findings require replication in a larger trial.
Résumé
Foliar extracts (FEs) are an alternative to address food and nutrition insecurity. FEs and leaves of cassava, bean, sweet potato and alfalfa were evaluated for nutrient and antinutrient composition and in vitro nutrient bioavailability. Bean FE had a high average ± (SD) iron concentration (1006 ± 8.49 mg/kg), as did cassava FE for zinc (110.1 ± 6.72 mg/kg) and soluble protein (34.23 ± 3.81 g/kg) concentration. For the cassava, bean and alfalfa FEs in vitro protein digestibility was greater than 71.18 percent; in vitro iron dialyzability was less than 2.29 percent; the phytate:zinc molar ratio was less than 0.08, and the in vitro all-trans-β-carotene bioavailability was greater than 23.85 percent. These values suggest a high protein, zinc and all-trans- β -carotene bioavailability and a low iron bioavailability. FEs can be a nutritious alternative for those countries with low dietary diversity.
Los extractos foliares (EF) son utilizados como complemento nutricional en países como Nicaragua y Tanzania. Se evaluaron hojas y EF de yuca, fríjol, batata y alfalfa, y se cuantificó los componentes nutricionales, antinutricionales y biodisponibilidad por métodos in vitro. En promedio (DE), el EF de fríjol tiene una elevada concentración de hierro (1006,23 (8,49) mg/kg); el EF de yuca tiene alta concentración de zinc (110,65 (6,72) mg/ kg) y proteína soluble (34,23 (3,81) g/kg). Así mismo, la digestibilidad in vitro de proteína en los EFs de yuca, fríjol y alfalfa fueron superiores a 71,18 por ciento; hierro dializable in vitro menor a 2,29 por ciento; la relación molar fitato:zinc inferior a 0,08 y la bioaccesibilidad all-trans-β -caroteno superior a 23,85 por ciento. Estos valores sugieren una alta asimilación de proteína, zinc y all-trans-β -caroteno, y una baja asimilabilidad de hierro. Los EFs pueden ser una alternativa nutricional en la alimentación en países que carecen de diversificación alimentaria.