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Efficacy of a community-based dietary intervention to enhance micronutrient adequacy of high-phytate maize-based diets of rural Malawian children

Published online by Cambridge University Press:  02 January 2007

Fiona Yeudall ,
Rosalind S Gibson ,
Timothy R Cullinan  and
Beatrice Mtimuni
Fiona Yeudall
Affiliation:
Department of Human Nutrition, University of Otago, Union Street, PO Box 56, Dunedin, 9015, New Zealand
Rosalind S Gibson*
Affiliation:
Department of Human Nutrition, University of Otago, Union Street, PO Box 56, Dunedin, 9015, New Zealand
Timothy R Cullinan*
Affiliation:
Department of Community Health, College of Medicine, Blantyre, University of Malawi, Lilongwe, Malawi
Beatrice Mtimuni
Affiliation:
Bunda College of Agriculture, University of Malawi, Lilongwe, Malawi
*
*Corresponding author: Email [email protected]
*Corresponding author: Email [email protected]
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Abstract

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Objective

To evaluate the efficacy of a community-based dietary intervention to reduce risk of micronutrient inadequacies in high-phytate maize-based Malawian diets.

Design

Quasi-experimental post-test design with a non-equivalent control group.

Setting

Four villages in Mangochi District, Southern Malawi.

Participants

Households with children aged 3–7 years in two intervention (n = 200) and two control (n = 81) villages participated in a 6-month intervention employing dietary diversification, changes in food selection patterns, and modifications to food processing to reduce the phytate content of maize-based diets. Baseline comparability between the groups was confirmed via assessment of sociodemographic characteristics, anthropometry, knowledge and practices, morbidity, haemoglobin and hair zinc. After 12 months, knowledge and practices and dietary intakes were assessed by interactive 24-hour recalls, one during the food plenty and a second during the food shortage season. Nutrient adequacy for the two groups was compared via dietary quality indicators and predicted prevalence of inadequate intakes using the probability approach.

Results

Intervention children had diets that were significantly more diverse and of a higher quality than those of controls. Median daily intakes of protein, calcium, zinc (total and available), haem iron, vitamin B12 and animal foods (grams; % of total energy) were higher (P<0.05) whereas phytate intakes, phytate/zinc and phytate/iron molar ratios were lower (P<0.01) in the intervention group; some spread of knowledge and practices to controls occurred.

Conclusions

Our community-based dietary strategies reduced the predicted prevalence of inadequate intakes of protein, calcium, zinc and vitamin B12, but not iron, in children from Malawian households with very limited resources.

Keywords

Dietary interventionMaizeDietsPhytateZincBioavailability
Type
Research Article
Information
Public Health Nutrition , Volume 8 , Issue 7 , October 2005 , pp. 826 - 836
Copyright
Copyright © The Authors 2005

Footnotes

†

Deceased

References

1Allen, LH, Black, AK, Backstrand, JR, Pelto, GH, Ely, RD, Molina, E, et al. An analytical approach for exploring the importance of dietary quality versus quantity in the growth of Mexican children. Food and Nutrition Bulletin 1991; 13: 95–104.CrossRefGoogle Scholar
2Neumann, CG, Harrison, GG. Onset and evolution of stunting in infants and children. Examples from the Human Nutrition Collaborative Research Support Program. Kenya and Egypt studies. European Journal of Clinical Nutrition 1994; 48: S90–102.Google ScholarPubMed
3Solomons, NW, Ruz, M, Gibson, RS. Single-nutrient interventions with zinc. American Journal of Clinical Nutrition 1999; 70: 111–3.CrossRefGoogle ScholarPubMed
4Rosado, JL, Lopez, P, Munoz, E, Martinez, H, Allen, LH. Zinc supplementation reduces morbidity, but neither zinc nor iron supplementation affects growth or body composition of Mexican preschoolers. American Journal of Clinical Nutrition 1997; 65: 13–29.CrossRefGoogle ScholarPubMed
5Gibson, RS, Hotz, C. Nutritional causes of linear growth faltering in infants during the complementary feeding period. In: Martorell, R, Haschke, F, eds. Nutrition and Growth. 47th Nestle Nutrition Workshop Series, Pediatric Program. Philadelphia, PA: Lippincott, Williams & Wilkins, 2001; 159–96.Google Scholar
6Gershoff, SN, McGandy, RB, Nondasuta, A, Tantiwongse, P. Nutrition studies in Thailand: effects of nutrient supplements, and health interventions on growth of preschool Thai village children. American Journal of Clinical Nutrition 1988; 48: 1214–8.CrossRefGoogle ScholarPubMed
7Cavan, KR, Gibson, RS, Grazioso, CF, Isalguen, AM, Ruz, M, Solomons, NW. Growth and body composition of periurban Guatemalan children in relation to zinc status: a longitudinal zinc intervention trial. American Journal of Clinical Nutrition 1993; 57: 344–52.CrossRefGoogle ScholarPubMed
8Lartey, A, Mau, A, Brown, KH, Peerson, JM, Dewey, KG. A randomized, community-based trial of the effects of improved centrally processed complementary foods on growth and micronutrient status of Ghanaian infants from 6 to 12 mo of age. American Journal of Clinical Nutrition 1999; 70: 391–404.CrossRefGoogle ScholarPubMed
9van Stuijvenberg, ME, Kvalsvig, JD, Faber, M, Kruger, M, Kenoyer, DG, Spinnler Benade, AJ. Effect of iron-, iodine-, and β-carotene-fortified biscuits on the micronutrient status of primary school children: a randomized controlled trial. American Journal of Clinical Nutrition 1999; 69: 497–503.CrossRefGoogle ScholarPubMed
10Thu, BD, Schultink, W, Dillon, D, Gross, R, Leswara, ND, Khoi, HH. Effect of daily and weekly micronutrient supplementation on micronutrient deficiencies and growth in young Vietnamese children. American Journal of Clinical Nutrition 1999; 69: 80–6.CrossRefGoogle ScholarPubMed
11Ramakrishnan, U, Martorell, R, Schroeder, DG, Flores, R. Role of intergenerational effects on linear growth. Journal of Nutrition 1999; 129: 544S–9S.CrossRefGoogle ScholarPubMed
12Gibson, RS, Hotz, C, Temple, L, Yeudall, F, Mtimuni, B, Ferguson, EL. Dietary strategies to combat deficiencies of iron, zinc, and vitamin A in developing countries: development, implementation, monitoring and evaluation. Food and Nutrition Bulletin 2000; 21: 219–31.CrossRefGoogle Scholar
13Ferguson, EL, Gibson, RS, Ounpuu, S, Sabry, J. The validity of the 24 hour recall for estimating the energy and selected nutrient intakes of a group of rural Malawian preschool children. Ecology of Food and Nutrition 1989; 23: 273–85.CrossRefGoogle Scholar
14Ferguson, EL, Gibson, RS, Opare-Obisaw, C, Ounpuu, S, Thompson, LU, Lehrfeld, J. The zinc nutriture of preschool children living in two African countries. Journal of Nutrition 1993; 123: 1487–96.CrossRefGoogle ScholarPubMed
15Ferguson, EL, Gibson, RS, Opare-Obisaw, C, Osei-Opare, F, Lamba, C, Ounpuu, S. Seasonal food consumption patterns and dietary diversity of rural preschool Ghanaian and Malawian children. Ecology of Food and Nutrition 1993; 29 219–34.CrossRefGoogle Scholar
16Ferguson, EL, Gibson, RS, Opare-Obisaw, C, Ounpuu, S, Lamba, C. Dietary strategies for improving the zinc nutriture of rural, southern Malawian and Ghanaian children. Ecology of Food and Nutrition 1995; 34: 33–47.CrossRefGoogle Scholar
17Huddle, J-M, Gibson, RS. Sub-optimal zinc status in pregnant Malawian women: its association with low intakes of poorly available zinc, frequent reproductive cycling, and malaria. American Journal of Clinical Nutrition 1998; 67: 702–9.Google Scholar
18Ferguson, EL, Gadowsky, SL, Huddle, JM, Cullinan, TR, Lehrfeld, J, Gibson, RS. An interactive 24-h recall technique for assessing the adequacy of trace mineral intakes of rural Malawian women; its advantages and limitations. European Journal of Clinical Nutrition 1995;49: 565–78.Google ScholarPubMed
19Gibson, RS, Ferguson, EL. Nutrition intervention strategies to combat zinc deficiency in developing countries. Nutrition Research Reviews 1998; 11: 115–31.CrossRefGoogle ScholarPubMed
20Gibson, RS, Yeudall, F, Drost, N, Mtimuni, B, Cullinan, T. Dietary interventions to prevent zinc deficiency. American Journal of Clinical Nutrition 1998; 68: 484S–7S.CrossRefGoogle ScholarPubMed
21National Research Council. Nutrient Adequacy: Assessment using Food Consumption Surveys. Washington, DC: National Academy Press, 1986.Google Scholar
22National Statistical Office (NSO). Malawi Demographic and Health Survey. Zomba, Malawi: NSO, 1994.Google Scholar
23Vundule, C, Mharakurwa, S. Knowledge, practices and perceptions about malaria in rural communities of Zimbabwe: relevance to malaria control. Bulletin of the World Health Organization 1996; 74(1): 55–60.Google ScholarPubMed
24Yeudall, F, Gibson, RS, Kayira, C, Umar, E. Efficacy of a multi-micronutrient dietary intervention based on haemoglobin, hair zinc concentrations, and selected functional outcomes in rural Malawian children. European Journal of Clinical Nutrition 2002; 56: 1176–85.CrossRefGoogle ScholarPubMed
25National Statistical Office (NSO)/Macro International Inc (MII). Malawi Knowledge, Attitudes and Practices in Health Survey 1996. Zomba, Malawi and Calverton, MD: NSO/MII, 1996.Google Scholar
26Drost, NM. Transforming social, gendered practices affecting malnutrition: action research in Malawi. DEd thesis, University of Toronto, Canada, 1998.Google Scholar
27Gibson, RS, Ferguson, EL. An Interactive 24-hour Recall for Assessing the Adequacy of Iron and Zinc Intakes in Developing Countries. Washington, DC: International Life Sciences Institute, 1999.Google Scholar
28Hotz, C. Assessment and improvement of complementary diets in rural Malawi, with a special focus on zinc. PhD thesis, University of Otago, New Zealand, 2000.Google Scholar
29Bunch, S, Murphy, SP. User's Guide to the Operation of the WorldFood Dietary Assessment System, Version 2.0. Berkeley, CA: Office of Technology Licensing, University of California, Berkeley, 1997.Google Scholar
30Ferguson, EL, Gibson, R, Opare-Obisaw, C, Ounpuu, S, Thompson, LU, Lehrfeld, J. The zinc, calcium, copper, manganese, nonstarch polysaccharide and phytate content of seventy-eight locally grown and prepared African foods. Journal of Food Composition and Analysis 1993; 6: 87–99.CrossRefGoogle Scholar
31Hatloy, A, Torheim, L, Oshaug, A. Food variety – a good indicator of nutritional adequacy of the diet? A case study from an urban area in Mali, West Africa. European Journal of Clinical Nutrition 1998; 52: 891–8.CrossRefGoogle Scholar
32Hotz, C, Gibson, RS. Assessment of home-based processing methods to reduce the phytate content and phytate/zinc molar ratios of white maize (Zea mays). Journal of Agricultural and Food Chemistry 2001; 49: 692–8.CrossRefGoogle ScholarPubMed
33Food and Agriculture Organization/World Health Organization (WHO)/United Nations University. Energy and Protein Requirements. WHO Technical Report Series No. 724 Geneva: WHO, 1985.Google Scholar
34Food and Agriculture Organization (FAO)/World Health Organization. Calcium Requirements. Nutrition Reports Series No. 30 Rome: FAO, 1962.Google Scholar
35Food and Agriculture Organization (FAO)/World Health Organization. Requirements of Vitamin A, Iron, Folate, and Vitamin B-12. FAO Nutrition Meetings Report Series No. 23. Rome: FAO, 1988.Google Scholar
36World Health Organization (WHO). Trace Elements in Human Nutrition and Health. Geneva: WHO, 1996.Google Scholar
37SPSS, Inc. SPSS for Windows, Version 9.0. Chicago, IL: SPSS Inc., 2000.Google Scholar
38Turnlund, JR, King, JC, Keyes, WR, Gong, B, Michel, MC. A stable isotope study of zinc absorption in young men: effects of phytate and α-cellulose. American Journal of Clinical Nutrition 1984; 40: 1071–7.CrossRefGoogle ScholarPubMed
39Goran, M, Poehlman, E, Johnson, R. Energy requirements across the life span: new findings based on measurement of total energy expenditure with doubly labeled water. Nutrition Research 1995; 15: 115–50.CrossRefGoogle Scholar
40Allen, LH, Backstrand, JR, Stanek, EJ 3rd, Pelto, GH, Chavez, A, Molina, E, et al. The interactive effects of dietary quality on the growth and attained size of young Mexican children. American Journal of Clinical Nutrition 1992; 56: 353–64.CrossRefGoogle ScholarPubMed
41Kirksey, A, Rahmanifar, A, Wachs, TD, McCabe, GP, Bassily, NS, Bishry, Z, et al. Determinants of pregnancy outcome and newborn behavior of a semirural Egyptian population. American Journal of Clinical Nutrition 1991; 54: 657–67.CrossRefGoogle ScholarPubMed
42Sigman, M, Neumann, CG, Baksh, M, Bwibo, N, McDonald, MA. Relation between nutrition and development in Kenyan toddlers. Journal of Pediatrics 1989; 115: 357–64.CrossRefGoogle ScholarPubMed
43Hansen, M, Thilsted, S, Sandstrom, B, Kongsbak, K, Larsen, T, Jensen, M, et al. Calcium absorption from small soft-boned fish. Journal of Trace Elements in Medicine and Biology 1998; 12: 148–54.CrossRefGoogle ScholarPubMed
44Hallberg, L, Hulthen, L. Prediction of dietary iron absorption: an algorithm for calculating absorption and bioavailability of dietary iron. American Journal of Clinical Nutrition 2000; 71: 1137–60.CrossRefGoogle ScholarPubMed
45Reddy, MB, Hurrell, RF, Juillerat, MA, Cook, JD. The influence of different protein sources on phytate inhibition of nonheme-iron absorption in humans. American Journal of Clinical Nutrition 1996; 63: 203–7.CrossRefGoogle ScholarPubMed
46Snedeker, S, Greger, J. Metabolism of zinc, copper and iron as affected by dietary protein, cysteine and histidine. Journal of Nutrition 1983; 119: 644–52.CrossRefGoogle Scholar
47Sandström, B, Almgren, A, Kivisto, B, Cederblad, A. Effect of protein and protein source on zinc absorption in humans. Journal of Nutrition 1989; 119: 48–53.CrossRefGoogle ScholarPubMed
48Brune, M, Rossander-Hulten, L, Hallberg, L, Gleerup, A, Sandberg, AS. Iron absorption from bread in humans: inhibiting effects of cereal fiber, phytate and inositol phosphates with different numbers of phosphate groups. Journal of Nutrition 1992; 122: 442–9.CrossRefGoogle ScholarPubMed
49Sandberg, A-S, Brune, M, Carlsson, N-G, Hallberg, L, Skoglund, E, Rossander Hulthen, L. Inositol phosphates with different numbers of phosphate groups influence iron absorption in humans. American Journal of Clinical Nutrition 1999; 70: 240–6.CrossRefGoogle ScholarPubMed
50Lönnerdal, B, Sandberg, A, Sandström, B, Lunz, C. Inhibitory effects of phytic acid and other inositol phosphates on zinc and calcium absorption in suckling rats. Journal of Nutrition 1989; 119: 211–4.CrossRefGoogle ScholarPubMed
51O'Dell, BL, de Boland, AR, Koirtyohann, SR. Distribution of phytate and nutritionally important elements among morphological components of cereal grains. Journal of Agricultural and Food Chemistry 1972; 20: 718–21.CrossRefGoogle Scholar
52de Boland, AR, Garner, GB, O'Dell, BL. Identification and properties of ‘phytate’ in cereal grains and oilseed products. Journal of Agricultural and Food Chemistry 1975; 23: 1186–9.CrossRefGoogle ScholarPubMed
53Lorri, W, Svanberg, U. Lower prevalence of diarrhea in young children using lactic acid-fermented cereal gruel. Food and Nutrition Bulletin 1993; 15: 57–63.Google Scholar
54Morris, E, Ellis, R. Effect of dietary phytate/zinc molar ratio on growth and bone zinc response of rats fed semipurified diets. Journal of Nutrition 1980; 110: 1037–45.CrossRefGoogle ScholarPubMed
55Mendoza, C, Viteri, FE, Lönnerdal, B, Young, KA, Raboy, V, Brown, KH. Effect of genetically modified, low phytic acid maize on absorption of iron from tortillas. American Journal of Clinical Nutrition 1998; 68: 1123–7.CrossRefGoogle ScholarPubMed
56Adams, C, Hambridge, M, Raboy, V, Dorsch, JA, Sian, L, Westcott, JL, et al. Zinc absorption from a low-phytic acid maize. American Journal of Clinical Nutrition 2002; 76: 556–9.CrossRefGoogle ScholarPubMed
57Bloem, MW. Monitoring process and impact indicators of food-based strategies: a Bangladesh experience Proceedings of Workshop on Prevention and Control of Micronutrient Malnutrition through Food-based Actions in the SAARC Countries. Dhaka: Bangladesh Agricultural Research Council, 1997; 98–107.Google Scholar
58Kidala, D, Greiner, T, Gebre-Medhin, M. Five-year follow-up of a food-based vitamin A intervention in Tanzania. Public Health Nutrition 2000; 3: 425–31.CrossRefGoogle ScholarPubMed
59de Pee, S, West, C. Dietary carotenoids and their role in combating vitamin A deficiency: a review of the literature. European Journal of Clinical Nutrition 1996; 50(Suppl. 3): S38–53.Google ScholarPubMed
60Murphy, S, Beaton, G, Calloway, D. Estimated mineral intakes of toddlers: predicted prevalence of inadequacy in village populations in Egypt, Kenya, and Mexico. American Journal of Clinical Nutrition 1992; 56: 565–72.CrossRefGoogle ScholarPubMed
61Calloway, D, Murphy, S, Beaton, G, Lein, D. Estimated vitamin intakes of toddlers: predicted prevalence of inadequacy in village populations in Egypt, Kenya and Mexico. American Journal of Clinical Nutrition 1993; 58: 376–84.CrossRefGoogle ScholarPubMed
62Beaton, GH, Calloway, DH, Murphy, SP. Estimated protein intakes of toddlers: predicted prevalence of inadequate intakes in village populations in Egypt, Kenya and Mexico. American Journal of Clinical Nutrition 1992; 55: 902–11.CrossRefGoogle ScholarPubMed
63Jayarajan, P, Reddy, V, Mohanram, M. Effect of dietary fat on absorption of beta carotene from green leafy vegetables in children. Indian Journal of Medical Research 1980; 71: 53–6.Google ScholarPubMed
64Erdman, JW, Bierer, TL, Gugger, ET. Absorption and transport of carotenoids. Annals of the New York Academy of Sciences 1993; 691: 76–85.CrossRefGoogle ScholarPubMed
65Jalal, F, Nesheim, MC, Agus, Z, Sanjur, D, Habicht, JP. Serum retinol concentrations in children are affected by food sources of β-carotene, fat intake, and anthelmintic drug treatment. American Journal of Clinical Nutrition 1998; 68: 623–9.CrossRefGoogle ScholarPubMed
66Takyi, EEK. Children's consumption of dark green, leafy vegetables with added fat enhances serum retinol. Journal of Nutrition 1999; 129: 1549–54.CrossRefGoogle ScholarPubMed
67Calloway, DH. Human Nutrition: Food and Micronutrient Relationships. Discussion Paper No. 1 Washington, DC: International Food Policy Research Institute, 1995.Google Scholar
68Bates, C, Evans, P, Dardenne, M, Prentice, A, Lunn, PG, Northrop-Clewes, CA, et al. A trial of zinc supplementation in young rural Gambian children. British Journal of Nutrition 1993; 69: 243–55.CrossRefGoogle ScholarPubMed
69Kikafunda, JK, Walker, AF, Allan, EF, Tumwine, JK. Effect of zinc supplementation on growth and body composition of Ugandan preschool children: a randomized, controlled, intervention trial. American Journal of Clinical Nutrition 1998; 68: 1261–6.CrossRefGoogle ScholarPubMed
70Friis, H, Ndhlovu, P, Nduluza, T. The impact of zinc supplementation on growth and body composition: a randomized controlled trial among rural Zimbabwean school children. European Journal of Clinical Nutrition 1997; 51: 38–45.CrossRefGoogle Scholar
71Rahmathullah, L, Underwood, BA, Thulasiraj, RD, Milton, RC. Diarrhea, respiratory infections, and growth are not affected by a weekly low-dose vitamin A supplement: a masked, controlled field trial in children in southern India. American Journal of Clinical Nutrition 1991; 54: 568–77.CrossRefGoogle Scholar
72Rosado, JL. Separate and joint effects of micronutrient deficiencies on linear growth. Journal of Nutrition 1999; 129: 531S–3S.CrossRefGoogle ScholarPubMed
73Bahl, R, Bhandari, N, Taneja, S, Bhan, M. The impact of vitamin A supplementation on physical growth of children is dependent on season. European Journal of Clinical Nutrition 1997; 51: 26–9.CrossRefGoogle ScholarPubMed