Solutions to Enhance Health with Alternative Treatments (SEHAT) protocol: a double-blinded randomised controlled trial for gut microbiota-targeted treatment of severe acute malnutrition using rice bran in ready-to-use therapeutic foods in Indonesia.

INTRODUCTION: Current formulations of ready-to-use therapeutic foods (RUTFs) to treat severe acute malnutrition (SAM) in children focus on nutrient density and quantity. Less attention is given to foods targeting gut microbiota metabolism and mucosal barrier functions. Heat-stabilised rice bran contains essential nutrients, prebiotics, vitamins and unique phytochemicals that have demonstrated favourable bioactivity to modulate gut microbiota composition and mucosal immunity. This study seeks to examine the impact of RUTF with rice bran on the microbiota during SAM treatment, recovery and post-treatment growth outcomes in Jember, Indonesia. Findings are expected to provide insights into rice bran as a novel food ingredient to improve SAM treatment outcomes. METHODS AND ANALYSIS: A total of 200 children aged 6-59 months with uncomplicated SAM (weight-for-height z-scores (WHZ) <-3, or mid-upper arm circumference (MUAC) <115 mm or having bilateral pitting oedema +/++) or approaching SAM (WHZ<-2.5) will be enrolled in a double-blinded, randomised controlled trial. Children in the active control arm will receive a locally produced RUTF; those in the intervention arm will receive the local RUTF with 5% rice bran. Children will receive daily RUTF treatment for 8 weeks and be monitored for 8 weeks of follow-up. Primary outcomes include the effectiveness of RUTF as measured by changes in weight, WHO growth z-scores, MUAC and morbidity. Secondary outcomes include modulation of the gut microbiome and dried blood spot metabolome, the percentage of children recovered at weeks 8 and 12, and malnutrition relapse at week 16. An intention-to-treat analysis will be conducted for each outcome. ETHICS AND DISSEMINATION: The findings of this trial will be submitted to peer-reviewed journals and will be presented at relevant conferences. Ethics approval obtained from the Medical and Health Research Ethical Committee at the Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Madain Yogyakarta Ref. No.: KE/FK/0546/EC/2022 and KE/FK/0703/EC/2023 and from Colorado State University IRB#1823, OHRP FWA00000647. TRIAL REGISTRATION NUMBER: NCT05319717.

Kidney Bean Substitution Ameliorates the Nutritional Quality of Extruded Purple Sweet Potatoes: Evaluation of Chemical Composition, Glycemic Index, and Antioxidant Capacity.

The extrusion process may influence the nutritional profiles of carbohydrate-rich food ingredients, including the glycemic index (GI) and antioxidant capacity. This study aimed to evaluate the nutritional profile of extruded purple sweet potato (EPSP) substituted with kidney bean flour (KBF) (0, 30, and 40%). These foods were further characterized by their proximate composition, resistant starch, polyphenols, GI, and antioxidant capacities. The 40% KBF substitution enhanced the protein and fiber contents of the EPSP by up to 8% and 6%, respectively. Moreover, it also revealed that EPSP with 40% KBF substitution had a low-GI category (53.1), while the 0 and 30% substitution levels had a high-GI category, i.e., 77.4 and 74.7, respectively. However, the extrusion processing reduced the anthocyanin content and antioxidant capacity of purple sweet potato flour containing 40% KBF by 48% and 19%, respectively. There was a significant relationship between the GI values of proteins, fats, and fibers (p < 0.05). The insignificant effect of resistant starch and phenol contents on GI value was recorded due to the low concentrations of those components. KBF substitution could ameliorate the profile of protein, fiber, and GI, but not for antioxidant capacity. The other innovative processes for preserving antioxidant capacity might improve the product quality.

School Lunch Programs and Nutritional Education Improve Knowledge, Attitudes, and Practices and Reduce the Prevalence of Anemia: A Pre-Post Intervention Study in an Indonesian Islamic Boarding School.

Indonesians face serious health issues that arise from malnutrition, particularly in children who are under unfavorable dietary environments. The present study established a school meal program consisting of dietary and educational interventions and evaluated its impact on promoting continuous improvement in dietary behavior among junior and senior high school students in Indonesia. A total of 319 students belonging to an Islamic Boarding School participated in the pre-post intervention study for 9 months. All participants were assessed based on their Knowledge, Attitude, and Practice (KAP). A subgroup of 115 participants who were anemic and underweight was examined for dietary intake, nutrition status, and hemoglobin level. The KAP test scores for both nutrition and hygiene showed a significant increase for all students and the undernutrition group post-intervention. Protein, iron, and vitamin C intake significantly improved. Although there were no significant improvements in nutrition status, there was a significant increase in the hemoglobin level and a reduction in the prevalence of anemia from 42.6% to 21.7%. Thus, school meal program that combines dietary and educational interventions may effectively improve anemia in undernourished students as well as enhance the knowledge, attitudes, and practices related to health, nutrition, and hygiene in junior and senior high school students.

Analysis of the Effect of Fish Bars Made of Bilih Fish (Mystacoleuseus padangensis Blkr) Flour to Reduce Oxidative Stress in a Diabetic Rat Model.

This study aims to analyze the effect of Bilih fish bars (BFB) on oxidative stress based on the levels of MDA and SOD in diabetic rat models. This study used a Randomized Complete Design (RCD). Forty white male rats of the Sprague-Dawley strain were placed into the following five groups: normal and diabetic rats that were fed either the standard feed and metformin, BFB, BFB, and metformin or BFF with a zinc dose of 0.54 mg. A single dose of STZ (40 mg/kg) was used to induce diabetes in the rats. The intervention lasted for 30 d. The differences in MDA and SOD levels between groups were determined with one-way ANOVA followed by Duncan's New Multiple Range Test, and the significance of the statistical level was set at p<0.05. The intervention with BFB and metformin, BFB, and BFF resulted in a decrease in blood glucose levels. The levels of MDA in rats that received the intervention with Bilih fish were 8.236±0.46 µmol/L for the BFB group and 8.266±0.66 µmol/L for the BFF group, which were both lower compared to the control normal rats (8.279±0.51 µmol/L). The levels of SOD in rats that received the intervention with BFB and BFF were higher compared to the diabetic rats with standard feed, but this increase was not significant (p>0.05). BFB and BFF lowered blood sugar levels and decreased the oxidative stress levels based on MDA levels in a diabetic rat model.

Nutritional status of lactating women in Bogor district, Indonesia: cross-sectional dietary intake in three economic quintiles and comparison with pre-pregnant women.

The way in which women accommodate for their increased nutritional needs during the lactation period is poorly investigated. In a cross-sectional study involving 220 lactating women (LW), equally distributed in economic quintiles (Q2, Q3, Q4), we investigated whether habitual dietary intake of LW differed from that of 200 pre-pregnant women (PPW) studied using the same methodology. Differences in dietary intake and nutrition sufficiency according to economic status were also investigated. Dietary intake data were collected using 2×24-h dietary recalls and FFQ. Energy, protein, Fe, Ca, Zn and vitamins A and C intakes were calculated utilising local food composition tables and were compared against Indonesian recommendations for adequacy. Energy and protein intakes 25 % of LW. For Q2-LW, this proportion was >50 %, except for protein. LW across all studied economic quintiles approximately doubled their vegetable intake, and 71 % of LW indicated a belief that this enhances lactation performance. Biochemical status parameters were analysed in a subset of forty-five women. Anaemia as well as Fe, Zn and Se deficiencies were prevalent among LW, supporting the nutrient intake deficiency data. Despite increasing intakes in LW compared with PPW, habitual diets in the study area do not provide for daily nutrient requirements in substantial proportions for both LW and PPW across all investigated economic groups.

Nutritional status of pre-pregnant and pregnant women residing in Bogor district, Indonesia: a cross-sectional dietary and nutrient intake study.

The diet of Indonesian women of childbearing age is relatively poor, posing increased risk for suboptimal pregnancy outcome. In a cross-sectional study including 403 women in three economic quintiles (Q), we investigated differences in dietary intake and nutrition sufficiency according to economic status and whether regular dietary intakes of pregnant women (PW, n 203) differ from that of pre-pregnant women (PPW, n 200). Dietary intake data were collected using 2×24 h dietary recall and FFQ. Energy, protein, Fe, Ca, Zn, vitamin A and vitamin C intakes were calculated utilising Food Composition Tables and compared with Indonesian recommendations for adequacy. Energy and protein intakes <70 % and Fe, Ca, Zn, vitamin A and vitamin C intakes <77 % of the local recommendation were considered insufficient. A higher intake of milk/dairy products (Q3, Q4), fruits and vegetables (Q2) and snacks (Q3) in PW was observed compared with PPW, but insufficient to meet nutrient requirements. Nutrient intake calculations showed insufficiency in 26 % of PPW for protein and up to 70 % for Fe. Deficient nutrient intakes in PW were found in 49 % of the subjects for energy and up to 85 % for Fe. Energy and protein intakes decreased with decreasing economic quintiles in PPW and PW. Ca and vitamin A intakes were lower in Q2 compared with Q4. The proportion of animal protein in Q2-PW was low (31 %). Biochemical status parameters in a subset showed that anaemia and Fe and Zn deficiencies were prevalent among PPW and PW. Habitual diets in the study area did not meet the nutrient requirements for both PPW and PW across the investigated economic groups.