Energy and nutrient intake increased by 47-67% when amylase was added to fortified blended foods-a study among 12- to 35-month-old Burkinabe children.

Adding amylase to fortified blended foods can improve energy density, and increase child's energy and nutrient intake. The efficacy of this strategy is unknown for the World Food Programme's Super Cereal Plus (SC+) and Super Cereal (SC) blends. The primary goal of this study was to investigate the increased energy intake from amylase-containing SC+ and SC compared to control porridges in Burkinabe children. Secondly, energy intake from amylase-containing porridges compared to CERELAC® , Vitazom, and eeZeeBAR™ was studied. Thirdly, caregivers' (n = 100) porridge acceptability was investigated. The design was a randomized double-blind controlled cross-over trial studying the effect of amylase addition to SC+ and SC flours on porridge energy and nutrient intake in healthy Burkinabe children aged 12-23 (n = 80) and 24-35 months (n = 40). Amylase added to porridges increased energy density from 0.68 to 1.16 kcal/g for SC+ and from 0.66 to 1.03 kcal/g for SC porridges. Among children aged 12-23 months, mean energy intake from all porridges with amylase (135-164 kcal/meal) was significantly higher compared to control SC+ porridges (84-98 kcal/meal; model-based average). Among children aged 24-35 months, mean energy intakes were also significantly higher from all porridges with amylase added (245-288 kcal/meal) compared to control SC porridges (175-183 kcal/meal). Acceptability of the porridges among caregivers was rated neutral to good, both for amylase-added and non-amylase-containing porridges. These findings suggest that, among 12-35-month-old, adding amylase to fortified blended foods significantly increased energy and consequently nutrient intake per meal by 67% for SC+ and 47% for SC. Moreover, amylase-containing porridges were well accepted by the caregivers.

Both encouraging feeding style and high energy density may increase energy intakes from fermented millet gruels eaten by infants and toddlers in Ouagadougou.

Traditional fermented millet gruel is frequently eaten by children in Burkina Faso as a complementary food or for breakfast. The effects of gruel energy density and feeding style on intakes (amounts and energy) were assessed in children in Ouagadougou. Twenty-three young children (11 infants and 12 toddlers) were given two meals of gruel per day for two periods of 11 consecutive days, first, the traditional fermented gruel (TFG), and second, an improved high energy density fermented gruel (IFG). On the first 10 days of each period, the children were fed as usual, while on the 11th day, the mothers were asked to use encouraging feeding. Intakes of TFG and IFG were also measured once a day for nine days in 25 preschoolers (2-5 years-old). After adjustment for the subject effect, IFG intakes did not significantly differ from TFG intakes in the groups of infants and toddlers, meaning there was a significant increase in energy intakes, which almost doubled. Encouraging feeding increased TFG intakes in both age groups, but IFG intakes only increased in toddlers, whose energy intake tripled compared to that from TFG with the usual feeding style. In preschoolers, mean IFG intakes were lower than TFG intakes and there were no increase in mean energy intakes. Improving fermented gruel and training the mothers to encourage their young children during feeding are two possible strategies to improve food intakes, and hence to better satisfy the children's nutritional needs.

Effect of an improved local ingredient-based complementary food fortified or not with iron and selected multiple micronutrients on Hb concentration.

OBJECTIVE: To assess the effect of an improved local ingredient-based gruel fortified or not with selected multiple micronutrients (MM) on Hb concentration of young children. DESIGN: In a nutrition centre that we opened in their villages, children received either MM supplement (containing iron, zinc, vitamin A, vitamin C and iodine) with the improved gruel (MMGG) or the improved gruel only (GG), twice daily, 6 d/week, for 6 months. We assessed baseline and endpoint Hb concentration and anthropometric indices. SETTING: Kongoussi, a rural and poor district of Burkina Faso. SUBJECTS: In a community-based trial, we randomly assigned 131 children aged 6-23 months with Hb concentrations in the range of 80-109 g/l into two groups. RESULTS: The groups did not differ significantly at baseline. Mean baseline Hb concentration was 89·2 (sd 6·5) g/l and 90·3 (sd 8·4) g/l in the GG and the MMGG, respectively (P = 0·42). It increased to 104·1 (sd 11·4) g/l in the GG (P < 0·001) and 107·6 (sd 14·7) g/l in the MMGG (P < 0·001). The between-group difference of 3·5 (95 % CI -1·0, 8·1) g/l in mean (sd) endpoint Hb concentration was not significant (P = 0·13). The endpoint anthropometric indices were not different between the groups. CONCLUSIONS: This MM supplement had no additional effect on Hb concentration. Thorough studies are needed to evaluate the actual efficacy of the gruel before its introduction into household routine.

A sustainable food support for non-breastfed infants: implementation and acceptability within a WHO mother-to-child HIV transmission prevention trial in Burkina Faso.

OBJECTIVE: To provide HIV-positive mothers who opted for exclusive breastfeeding or formula feeding from birth to 6 months postpartum as a means of prevention of mother-to-child transmission (PMTCT) of HIV with a sustainable infant food support programme (FSP) from 6 to 12 months postpartum. We describe the implementation and assessment of this pilot initiative. DESIGN: The FSP included a 6-month provision of locally produced infant fortified mix (IFM; 418 kJ/100 g of gruel) for non-breastfed infants coupled with infant-feeding and psychosocial counselling and support. Acceptability and feasibility were assessed in a subsample of sixty-eight mother-infant pairs. SETTING: The FSP was developed in collaboration with local partners to support participants in a PMTCT prevention study. Formula was provided for free from 0 to 6 months postpartum. Cessation by 6 months was recommended for breastfeeding mothers. RESULTS: The FSP was positively received and greatly encouraged breastfeeding mothers to cease by 6 months. As recommended, most infants were given milk as an additional replacement food, mainly formula subsidised by safety networks. Among daily IFM consumers, feeding practices were satisfactory overall; however, the IFM was shared within the family by more than one-third of the mothers. Cessation of IFM consumption was observed among twenty-two infants, seventeen of whom were fed milk and five neither of these. CONCLUSIONS: Without any food support most mothers would have been unable to provide appropriate replacement feeding. The food security of non-breastfed infants urgently needs to be addressed in HIV PMTCT programmes. Our findings on a simple cost-effective pioneer intervention provide an important foundation for this process.

Development of an improved local-ingredient-based complementary food and technology transfer to rural housewives.

BACKGROUND: Food technology transfer to rural households, based on local ingredients, is a relevant and sustainable strategy to ensure better nutrition of young children. Objective. To develop an improved mush based on local ingredients and evaluate the potential for transferring its technology to rural housewives. METHODS: We developed a flour-based food using Alicom software and performed laboratory trials to evaluate its actual nutritional quality. Then we recruited housewives from each of the 27 project villages and trained them in flour production and mush preparation twice daily, 6 days a week, for 26 weeks. Mush was sampled during the training session and at weeks 4, 12, and 22 and evaluated for actual flow distance and dry matter content, which served to estimate energy density and iron and zinc contents. RESULTS: The laboratory trials reported average energy densities of 103 kcal/l00 g, iron contents of 2.6 mg/100 kcal, and zinc contents of 1.2 mg/100 kcal. The average (+/- SD) energy densities of the mush samples obtained during the training session and at weeks 4, 12, and 22 were 103.0 +/- 5.6, 103.3 +/- 5.2, 107.9 +/- 11.5, and 101.3 +/- 8.7 kcal/100 g, respectively. The average iron contents were 2.3 +/- 0.5, 2.3 +/- 0.5, 2.6 +/- 0.3, and 1.8 +/- 0.8 mg/ 100 kcal, respectively, and the average zinc contents were 1.6 +/- 0.1, 1.6 +/- 0.1, 1.7 +/- 0.1, and 1.6 +/- 0.2 mg/100 kcal. CONCLUSIONS: Developing a suitable complementary food from local ingredients and educating households in nutrition and use of local products are feasible. Such education should come with measures aimed at improving the accessibility of some ingredients to ensure feasibility and sustainability.

A local-ingredient-based, processed flour to improve the energy, iron and zinc intakes of young children: a community-based intervention.

The present study was undertaken to determine the actual amounts of mush consumed and energy iron and zinc intakes of, and to investigate the attendance rate among, children aged 6-23 months due to an improved mush intervention. A cohort of 208 children from 27 villages was followed up for 6 months. Twice a day, 6 days/week, each mother took her child to the nutrition centre we had opened in her village to receive the mush and fed it to her child. Amounts consumed were 15, 21 and 33 g/kg body weight/meal for children aged 6-8, 9-11 and 12-23 months respectively. The average (standard deviation) attendance rate was 68.0% (25.6%). The median (range) daily intakes from the mush were 213 (25-373) kcal, 5.3 (0.6-9.3) mg, and 2.3 (0.3-4.1) mg for energy, iron and zinc, respectively. This flour and mush production should enter the routines of individual households, supported by a large-scale programme of nutrition education.

Influence of the technological know-how of producers on the biochemical characteristics of red sorghum malt from small scale production units in Ouagadougou (Burkina Faso).

The process of red sorghum malt production was monitored three times in five production units (PU) selected upon their ability to produce malt flours having a high capacity to fluidify high-energy-density gruels. Raw, germinated and degermed seeds were analysed for macronutrient, soluble sugars, phytate and cyanide contents and alpha-amylase activity. Know-how differences between producers lay mainly in the duration and type of equipment used for steeping and germination. Moreover, three PUs applied a maturation step before sun-drying and one PU added ashes to steeped seeds before germination. No significant difference was detected in the proximate composition of malts from the five PUs. For all PUs, traditional malting increased the protein content and decreased the lipid and ash contents, while the fibre content was not affected. Significant increases in sugar contents and in alpha-amylase activity were observed but in variable proportions from one PU to another. The phytate content decreased significantly in all PUs. The cyanide content increased in all PUs but more drastically or less drastically according to the PU. Finally, degerming lowered the cyanide content to an acceptable level for human consumption. The between-PU variability may be due either to the nature and origin of the raw seeds or to technological know-how differences between producers. Further investigations are needed to optimize and standardize the malting process with a view to maximizing alpha-amylase and phytase activities and minimizing the variability of their biochemical characteristics.

Effects of the duration of the habituation period on energy intakes from low and high energy density gruels by Burkinabè infants living in free conditions.

The present study was carried out in Ouagadougou (Burkina Faso) with the aim of determining if the duration of the habituation period (1, 5 or 10 days) to low and high energy density gruels affected the amounts consumed or the energy intakes from gruels consumed by 6-9-month-old infants. Thirty infants were chosen randomly among the eligible children in the study area and randomly assigned to two groups (S1 and S2). Each infant was given successively for 10 consecutive days two experimental gruels, each type of gruel being fed twice a day. The 15 infants in group S1 received low energy density gruel (G1) in the first period and high energy density gruel (G2) in the second, and the 15 infants in group S2 received G2 in the first period and G1 in the second. The two periods of 10 days were separated by 4 days during which the infant received his or her usual foods. The intakes of experimental gruels and other complementary foods were measured on days 1, 5 and 10 of each period. Whatever the type of gruel, the 10-day period of habituation did not result in an increase in the amounts consumed or in the energy intakes from these gruels. The amounts of G1 consumed on day 5 were significantly higher than those of G2 (9.0 vs 6.8 g/kg/meal; p = 0.044). Energy intakes from G2 were significantly higher than those from G1 on days 1 (28.8 vs 18.0 kJ/kg/meal; p = 0.0002), 5 (28.8 vs 19.2 kJ/kg/meal; p = 0.002) and 10 (25.9 vs 15.5 kJ/kg/meal; p = 0.0004). Daily frequencies of breastfeeding (approximately 5.6), water drinking (approximately 3.7) and meals with foods other than experimental gruels were relatively high and did not vary with the duration of the habituation period or the type of gruels. Whatever the type of gruel, the increase in the duration of the habituation period did not increase the amount consumed or energy intakes. The study confirmed that consumption of high energy density gruels led to a 60% increase in energy intakes in comparison with the consumption of low energy density gruels.