Does consumption of pearl millet cause goiter? A systematic review of existing evidence.

Millets (defined here to also include sorghum) have been consumed in Asian and African countries for centuries, and have in recent years become increasingly popular in Western countries, especially because of their proven health and environmental benefits. Nevertheless, some concerns have been raised that their consumption can interfere with thyroid function and cause goiter. This systematic review aimed to investigate the link between millet consumption and goiter. We found nine papers that were relevant to this topic and included them in this review. Among nine papers eight were on pearl millet and one was on fonio millet. The findings of the review indicate that published literature on the association of pearl millet and increased goiter prevalence are not compelling and strong enough to assert that pearl millet consumed as part of a balanced diet can lead to goiter in the general population. To ensure appropriate factual messaging about millets, we need more scientific research to conclusively state whether millet consumption mediates goitrogenic effects.

Does millet consumption contribute to raising blood hemoglobin levels compared to regular refined staples?: a systematic review and meta-analysis.

Millets are recognized for their health and nutritional values, and the United Nations declared 2023 the International Year of Millets. Among the several health and nutritional benefits of millets, their impact on hemoglobin concentration is important since anemia is a major public health issue in many countries. To investigate the effect of millet (including sorghum) consumption on hemoglobin concentration in the blood, a systematic review and meta-analysis were conducted. Thirteen published studies featuring randomized control trials involving 590 individuals in the intervention group and 549 control individuals were eligible for the meta-analysis. The difference-in-differences analysis revealed highly significant (p < 0.01) positive effects of millet consumption on hemoglobin concentration, with an effect size of +0.68 standardized mean difference units. The change in hemoglobin concentration observed in the intervention group was +13.6%, which is statistically significant (p < 0.0005), compared to that in the control group, which was +4.8% and not statistically significant (p = 0.1362). In four studies, the consumption of millets in the intervention group demonstrated a change from mild anemia to normal status among children, whereas there was no change in the control group. The findings provide evidence that the consumption of millets can improve blood hemoglobin concentration, likely resulting from increased iron intake. Further research is needed involving the assessment of iron content and bioavailability to better understand the effect variation among millet types and the mechanisms involved.

Can Feeding a Millet-Based Diet Improve the Growth of Children?-A Systematic Review and Meta-Analysis.

Undernutrition, such as stunting and underweight, is a major public health concern, which requires multi-sectoral attention. Diet plays a key role in growth and should optimally supply all required nutrients to support the growth. While millets (defined broadly to include sorghum) are traditional foods, and climate smart nutritious crops, which are grown across Africa and Asia, they have not been mainstreamed like rice, wheat, and maize. Diversifying staples with millets can potentially provide more macro and micro nutrients, compared to the mainstream crops. However, there is little known scientific evidence to prove millets' efficacy on growth. Therefore, a systematic review and meta-analysis was conducted to collate evidence of the benefits of millets in improving the growth of children. Eight eligible randomized feeding trials were included in the meta-analysis. Results from the randomized effect model showed a significant effect (p < 0.05) of millet-based diets on mean height (+28.2%) (n = 8), weight (n = 9) (+26%), mid upper arm circumference (n = 5) (+39%) and chest circumference (n = 5) (+37%) in comparison to regular rice-based diets over for the period of 3 months to 4.5 years, which was based on largely substituting rice with millets. When an enhanced and diverse diet was served, replacing rice with millet had only minimal growth improvement on chest circumference (p < 0.05). The quality assessment using GRADE shows that the evidence used for this systematic review and meta-analysis had moderate quality, based on eight scoring criteria. These results demonstrate the value of adding millet as the staple for undernourished communities. Further understanding of the efficacy of millets on growth in a wider range of diets is important to develop appropriate dietary programs and improve the nutritional status of various age groups across Africa and Asia.

Measuring and Influencing Behavior Change in Dietary Intake: Integrated Photovoice Approach in Nutrition Interventions in Eastern Kenya.

A study conducted in two wards of Tharaka Nithi subcounty in Kenya documented the impact of using photovoice as a learning tool to build awareness about diets in order to influence behavior change, as well as a method to measure dietary intake. After a year's nutrition awareness drive using Smart Food branding, in the intervention area, a total of 60 participants from intervention and control areas were identified for the photovoice exercise. The analysis showed household and women's dietary diversity scores to be higher in the intervention group by 35% and 45%, respectively. An estimate of nutrient intake revealed a higher intake of calories, protein, calcium, iron and zinc ranging from 70% to 205% in the intervention group. Qualitative feedback on the photovoice approach reflected increased nutrition awareness and behavior change. Results showed the efficacy of the approach in evaluating diets while simultaneously improving participants' realization of what they were consuming using images captured and a one-on-one discussion with nutritionists. The improvement in dietary diversity scores reflected the effectiveness of this creative participatory and branded approach in imparting a strong message on and enthusiasm for learning about nutrition, resulting in behavior change.

Millets Can Have a Major Impact on Improving Iron Status, Hemoglobin Level, and in Reducing Iron Deficiency Anemia-A Systematic Review and Meta-Analysis.

The prevalence of iron deficiency anemia is highest among low and middle-income countries. Millets, including sorghum, are a traditional staple in many of these countries and are known to be rich in iron. However, a wide variation in the iron composition of millets has been reported, which needs to be understood in consonance with its bioavailability and roles in reducing anemia. This systematic review and meta-analysis were carried out to analyze the scientific evidence on the bioavailability of iron in different types of millets, processing, and the impact of millet-based food on iron status and anemia. The results indicated that iron levels in the millets used to study iron bioavailability (both in vivo and in vitro) and efficacy varied with the type and variety from 2 mg/100 g to 8 mg/100 g. However, not all the efficacy studies indicated the iron levels in the millets. There were 30 research studies, including 22 human interventions and 8 in vitro studies, included in the meta-analysis which all discussed various outcomes such as hemoglobin level, serum ferritin level, and absorbed iron. The studies included finger millet, pearl millet, teff and sorghum, or a mixture of millets. The results of 19 studies conducted on anaemic individuals showed that there was a significant (p < 0.01) increase in hemoglobin levels by 13.2% following regular consumption (21 days to 4.5 years) of millets either as a meal or drink compared with regular diets where there was only 2.7% increase. Seven studies on adolescents showed increases in hemoglobin levels from 10.8 ± 1.4 (moderate anemia) to 12.2 ± 1.5 g/dl (normal). Two studies conducted on humans demonstrated that consumption of a pearl millet-based meal significantly increased the bioavailable iron (p < 0.01), with the percentage of bioavailability being 7.5 ± 1.6, and provided bioavailable iron of 1 ± 0.4 mg. Four studies conducted on humans showed significant increases in ferritin level (p < 0.05) up to 54.7%. Eight in-vitro studies showed that traditional processing methods such as fermentation and germination can improve bioavailable iron significantly (p < 0.01) by 3.4 and 2.2 times and contributed to 143 and 95% of the physiological requirement of women, respectively. Overall, this study showed that millets can reduce iron deficiency anemia.

Can Millet Consumption Help Manage Hyperlipidemia and Obesity?: A Systematic Review and Meta-Analysis.

Many health benefits of millets (defined broadly to also include sorghum) have been advocated, including their roles in managing and preventing diabetes; however, the effects of millets on hyperlipidemia (high lipid levels) have been underrecognized. A systematic review and meta-analysis were conducted to collate available evidence of the impacts of millets consumption on lipid profile, namely total cholesterol (TC), triacylglycerol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very-low-density lipoprotein cholesterol (VLDL-C). The results from 19 studies showed that the consumption of millets for periods as short as 21 days to 4 months reduced levels of TC, triacylglycerol, LDL-C, and VLDL-C (p<0.01) by 8.0, 9.5, 10 and 9.0%, respectively. Four studies demonstrated that millets consumption brought TC and triacylglycerol levels to the normal levels (<200 and <150 mg/dl, respectively). Furthermore, upon consumption of millet-based meals, there was a 6.0% increase in the HDL-C 4.0 and 5.0% reduction in systolic and diastolic blood pressure, and 7.0% reduction in body mass index (BMI). This evidence, leads us to conclude that consumption of millets reduces hyperlipidemia and hence hypertension, and raises the levels of HDL-C (good cholesterol), which can be beneficial for managing the associated risk of developing hypertension and atherosclerotic cardiovascular diseases in future. Systematic Review Registration: The protocol of this systematic review has been registered in the online registration platform called "research registry" with the unique identification number "reviewregistry1123."

A Systematic Review and Meta-Analysis of the Potential of Millets for Managing and Reducing the Risk of Developing Diabetes Mellitus.

Millets (including sorghum) are known to be highly nutritious besides having a low carbon footprint and the ability to survive in high temperatures with minimal water. Millets are widely recognised as having a low Glycaemic Index (GI) helping to manage diabetes. This systematic review and meta-analyzes across the different types of millets and different forms of processing/cooking collated all evidences. Of the 65 studies that were collected globally, 39 studies with 111 observations were used to analyze GI outcomes and 56 studies were used to analyze fasting, post-prandial glucose level, insulin index and HbA1c outcomes in a meta-analysis. It is evident from the descriptive statistics that the mean GI of millets is 52.7 ± 10.3, which is about 36% lower than in typical staples of milled rice (71.7 ± 14.4) and refined wheat (74.2 ± 14.9). The descriptive, meta and regression analyses revealed that Job's tears, fonio, foxtail, barnyard, and teff were the millets with low mean GI (<55) that are more effective (35-79%) in reducing dietary GI than the control samples. Millets with intermediate GI (55-69) are pearl millet, finger millet, kodo millet, little millet, and sorghum which have a 13-35% lower GI than the control with high GI (>69). A meta-analysis also showed that all millets had significantly (p < 0.01) lower GI than white rice, refined wheat, standard glucose or white wheat bread except little millet which had inconsistent data. Long term millet consumption lowered fasting and post-prandial blood glucose levels significantly (p < 0.01) by 12 and 15%, respectively, in diabetic subjects. There was a significant reduction in HbA1c level (from 6.65 ± 0.4 to 5.67 ± 0.4%) among pre-diabetic individuals (p < 0.01) who consumed millets for a long period. Minimally processed millets were 30% more effective in lowering GI of a meal compared to milled rice and refined wheat. In conclusion, millets can be beneficial in managing and reducing the risk of developing diabetes and could therefore be used to design appropriate meals for diabetic and pre-diabetic subjects as well as for non-diabetic people for a preventive approach.

Changing Perception through a Participatory Approach by Involving Adolescent School Children in Evaluating Smart Food Dishes in School Feeding Programs - Real-Time Experience from Central and Northern Tanzania.

The study aimed to test the prospects for, and acceptance of, pigeonpea and finger millet-based dishes in a school feeding program for 2822 adolescents' in Central Tanzania. The focus was on incorporating nutritious and resilient crops like finger millet and pigeonpea through a participatory approach involving series of theoretical and practical training sessions, for the period of 6 months on the nutritional quality and sensory characteristics of these two unexplored foods in Tanzania. Sharing knowledge on the nutritional value of these crops and involving students in the acceptance study changed their negative perception of finger millet and pigeonpea by 79.5% and 70.3%, respectively. Fifteen months after the study period, schools were still continued feeding the dishes and more than 95% of the students wanted to eat the finger millet and pigeonpea dishes at school. Around 84.2% of the students wanted to include pigeonpea 2-7 times a week and 79.6% of the students wanted to include finger millet on all 7 days in school meal. The study proved that it is possible to change food perceptions and bring about behavior change by sharing knowledge on their benefits and by engaging the consumers through a participatory and culturally appropriate approach.

How the Smart Food Concept Can Lead to the Transformation of Food Systems and Combat Malnutrition: Different Approaches in Africa, Globally, and a Case Study from Myanmar with Lessons Learnt for Creating Behavior Change in Diets.

Some of the biggest global issues are poor diets, environmental concerns, and poverty. To tackle malnutrition, fast-growing lifestyle diseases such as diabetes, environmental concerns like climate change, land and water scarcity, and poverty, we need to incorporate dietary and on-farm diversity. These issues should be treated in unison, but also with more holistic solutions. Mainstreaming "traditional" Smart Foods back as staples across Africa and Asia is part of the "Smart Food" approach. Smart Foods are food items that fulfill the criteria of being good for you, the planet, and the farmer. Sorghum and millet were selected as the first Smart Foods and a participatory fun-filled approach was adopted to create awareness, to develop culturally acceptable products, and to bring about behavior change to improve adoption, dietary diversity, and nutritional status. Smart Food piloted these activities in Myanmar to understand its potential on the consumer market. Smart Food was promoted in different countries through social media competitions in Mali, cooking shows in Kenya and India, recipe development by popular chefs in Paris and London, as well as school feeding programs in Tanzania and India, and an international millet festival in Niger. As a case study in Myanmar, we compared two approaches to introduce Smart Food - one which directly introduces new products and one which takes a culturally sensitive participatory and inclusive approach. The later approach resulted in the development of 27 recipes, in contrast with the former approach, which accepted only 3 of the 13 products tested. The 27 products developed locally exhibited superior nutrient values compared to usual rice porridge. The Smart Food initiative is demonstrating the potential to make a difference in society and for the environment, thus contributing to a major impact on leading global issues such as dietary diversity, improved nutritional status, and adapting to climate change.

Potential for smart food products in rural Myanmar: use of millets and pigeonpea to fill the nutrition gap.

BACKGROUND: The present study examined the potential for 'Smart Food' with respect to contributing to the Sustainable Development Goal 2 of ending malnutrition by 2030, using a small-scale capacity building case study in Oe Be Village, Myingyan district, Mandalay region, Myanmar. Within the study site, refined white rice is the major staple, followed by vegetables and animal source food in inadequate quantities. The protein intake in this particular dry zone community meets only 50% of the daily requirement and even less for those children aged less than 23 months. Therefore, to determine the acceptance and opportunity for legumes and millets which are produced locally, nutritious formulations were introduced for various age groups. In addition, a sensory evaluation of the recipes was conducted to test the acceptance of the nutritious products. RESULTS: Two weeks of the inclusion of millets and pigeonpea in the diets of children aged 6-23 months had a positive impact on wasting, stunting and underweight (P = 0.002, 0.014 and 0.023, respectively). Moreover, the acceptability of these new food products by the children was found to be high. These results indicate an unexplored opportunity for specific millets rich in iron, zinc and calcium, as well as for pigeonpea rich in protein, if prepared in a culturally acceptable way. CONCLUSION: The impact and acceptability of this small scale and short-term intervention indicate the potential for Smart Food products in filling the nutrition gap arising from the traditional food consumption habits in the dry zones of Myanmar. © 2019 Society of Chemical Industry.

Acceptance and Impact of Millet-Based Mid-Day Meal on the Nutritional Status of Adolescent School Going Children in a Peri Urban Region of Karnataka State in India.

The study assessed the potential for use of millets in mid-day school meal programs for better nutritional outcomes of children in a peri-urban region of Karnataka, India, where children conventionally consumed a fortified rice-based mid-day meal. For a three-month period, millet-based mid-day meals were fed to 1500 adolescent children at two schools, of which 136 were studied as the intervention group and were compared with 107 other children in two other schools that did not receive the intervention. The intervention design was equivalent to the parallel group, two-arm, superiority trial with a 1:1 allocation ratio. The end line allocation ratio was 1.27:1 due to attrition. It was found that there was statistically significant improvement in stunting (p = 0.000) and the body mass index (p = 0.003) in the intervention group and not in the control group (p = 0.351 and p = 0.511, respectively). The sensory evaluation revealed that all the millet-based menu items had high acceptability, with the highest scores for the following three items: finger millet idli, a steam cooked fermented savory cake; little and pearl millet bisi belle bath, a millet-lentil hot meal; and upma, a pearl and little millet-vegetable meal. These results suggest significant potential for millets to replace or supplement rice in school feeding programs for improved nutritional outcomes of children.