Complementary Feeding Practices and Childhood Malnutrition in South Africa: The Potential of Moringa Oleifera Leaf Powder as a Fortificant: A Narrative Review.

Poor complementary feeding is a common practice in developing regions, including South Africa (SA), and is one of the main contributing factors to childhood malnutrition. This paper reviews the literature on complementary feeding practices in SA and the potential of fortifying home-prepared complementary foods with Moringa oleifera to improve their nutritional composition. Studies that investigated complementary feeding practices, indigenous crops, nutritional benefits of Moringa oleifera, and the use of MOLP as a fortificant both locally and globally were included in this review. In SA, maize meal and commercial cereal are the most commonly used complementary infant foods. The diet consumed by children from vulnerable households commonly has insufficient nutrients. Foods consumed are generally high in starch and low in other essential nutrients, including good-quality protein. Impoverished individuals consume poor-quality foods as they are unable to afford a diversified diet with food from different food groups, such as protein, fruits, and vegetables. In SA, various programs have been implemented to reduce the incidence of childhood malnutrition. However, childhood malnutrition remains on the rise. This shows a need for complementary food-based strategies that can be implemented and sustained at a household level. This can be conducted through the use of accessible indigenous crops such as Moringa oleifera. Moringa oleifera contains essential nutrients such as proteins, amino acids, vitamins, and minerals. Therefore, it could possibly be used as a home-prepared complementary food fortificant to enhance nutritional composition. Before complementary foods can be fortified with Moringa oleifera, popular home-prepared complementary foods must be identified.

Potential of pumpkin to combat vitamin A deficiency during complementary feeding in low and middle income countries: variety, provitamin A carotenoid content and retention, and dietary reference intakes.

The risk of child vitamin A deficiency (VAD) in low and middle income countries (LMICs) begins during the age range of complementary feeding (6-24 months), when children are fed complementary foods (CFs) deficient in vitamin A. However, pumpkin, a source of provitamin A carotenoids (PVACs) is widely cultivated in LMICs, but underutilized as a complementary food. Moreover, when consumed by humans, PVACs are bioconverted to retinol, the active form of vitamin A used by the body. This study evaluated the potential of pumpkin toward combating VAD by reviewing varieties of pumpkin cultivated in LMICs and their provitamin A carotenoid (PVAC) content; retention of PVACs in pumpkin during processing it as a CF; and the extent to which a CF prepared from pumpkin may meet the dietary reference intakes (DRIs) for vitamin A for children aged 6-24 months old. Pumpkin may combat VAD because the varieties cultivated have high ß-carotene content, it is a provitamin A biofortifiable food crop, and 100% retention of PVACs was observed when processed using home cooking methods. Feeding less than 50 g of cooked pumpkin per day meets 100% of the recommended dietary allowance (RDA) and adequate intake (AI) of vitamin A for children 6 to 24 months old. Consumption of pumpkin may be used to complement vitamin A supplementation, fortification, and diversification of CFs with animal source foods. For better yield of pumpkin in LMICs, nutrition sensitive agricultural programmes such as biofortification and agronomic management of pumpkin need to be promoted and supported.

Anti-Diabetic Potential of Plant-Based Pentacyclic Triterpene Derivatives: Progress Made to Improve Efficacy and Bioavailability.

Diabetes mellitus (DM) results from the inability of the pancreas to produce sufficient insulin or weakened cellular response to the insulin produced, which leads to hyperglycemia. Current treatments of DM focus on the use of oral hypoglycemic drugs such as acarbose, alpha-glucose inhibitors, sulphonylureas, thiazolidinediones, and biguanides to control blood glucose levels. However, these medications are known to have various side effects in addition to their bioavailability, efficacy, and safety concerns. These drawbacks have increased interest in the anti-diabetic potential of plant-derived bioactive compounds such as oleanolic and maslinic acids. Although their efficacy in ameliorating blood glucose levels has been reported in several studies, their bioavailability and efficacy remain of concern. The current review examines the anti-diabetic effects of oleanolic, maslinic, asiatic, ursolic, and corosolic acids and their derivatives, as well as the progress made thus far to enhance their bioavailability and efficacy. The literature for the current review was gathered from leading academic databases-including Google Scholar and PubMed-the key words listed below were used. The literature was searched as widely and comprehensively as possible without a defined range of dates.

Child acceptability of a novel provitamin A carotenoid, iron and zinc-rich complementary food blend prepared from pumpkin and common bean in Uganda: a randomised control trial.

BACKGROUND: Ugandan children are fed homemade complementary foods (CFs) which are usually deficient in vitamin A, iron and zinc. Novel homemade CFs rich in vitamin A, iron and zinc need to be developed, and assessed for their acceptability among target children. OBJECTIVE: Homemade provitamin A carotenoids (PVACs), iron and zinc-rich complementary food (CF), common bean pumpkin blend (BPB) formulated from pumpkin (Sweet cream) and common bean (Obwelu) and PVAC-rich pumpkin blend (PB) from Sweet cream were prepared by expert peer mothers. This study compared child acceptability of BPB and PB (control). METHODS: The crossover acceptability study randomly assigned Ugandan children 6 to 24 months old to either receive 100 g of BPB (n = 35) or 100 g of PB (n = 35) on day one. After a washout period of one day, children crossed over to receive either BPB (n = 35) or PB (n = 35). The amount of CF consumed, duration of consumption, and micronutrient intake were assessed. The CF was acceptable if children consumed ≥50 g (50%) of served food (100 g). A paired t-test was used to determine the mean differences within participants between BPB and PB. The level of statistical significant difference was set at a probability value of 5% (p = 0.05). RESULTS: The mean consumption of BPB and PB was 53.9 g and 54.4 g, respectively. The mean duration for consumption of BPB and PB was 20.6 and 20.3 min, respectively. There was no significant difference in the amounts consumed, and duration of consumption in BPB and PB (p > 0.05). The mean intake of vitamin A was significantly higher (p < 0.00001) in PB (152.5 µgRAE) compared to BPB (100.9 µgRAE). The mean iron intake was significantly higher in BPB (1.1 mg) (p < 0.00001) compared to PB (0.3 mg). Furthermore, zinc intake was significantly higher (p < 0.00001) in BPB (0.58 mg) compared to PB (0.13 mg). CONCLUSION: A homemade complementary food, BPB, made from locally available common bean and pumpkin is rich in PVACs, iron and zinc and is acceptable to children in the age range of complementary feeding in Uganda. TRIAL REGISTRATION: Pan African Clinical Trials Registry www.pactr.org as PACTR202002576768667 . Retrospectively registered. Date of registration: 29/January/2020.

Biofortified Crops for Combating Hidden Hunger in South Africa: Availability, Acceptability, Micronutrient Retention and Bioavailability.

In many poorer parts of the world, biofortification is a strategy that increases the concentration of target nutrients in staple food crops, mainly by genetic manipulation, to alleviate prevalent nutrient deficiencies. We reviewed the (i) prevalence of vitamin A, iron (Fe) and zinc (Zn) deficiencies; (ii) availability of vitamin A, iron and Zn biofortified crops, and their acceptability in South Africa. The incidence of vitamin A and iron deficiency among children below five years old is 43.6% and 11%, respectively, while the risk of Zn deficiency is 45.3% among children aged 1 to 9 years. Despite several strategies being implemented to address the problem, including supplementation and commercial fortification, the prevalence of micronutrient deficiencies is still high. Biofortification has resulted in the large-scale availability of ßcarotene-rich orange-fleshed sweet potatoes (OFSP), while provitamin A biofortified maize and Zn and/or iron biofortified common beans are at development stages. Agronomic biofortification is being investigated to enhance yields and concentrations of target nutrients in crops grown in agriculturally marginal environments. The consumer acceptability of OFSP and provitamin A biofortified maize were higher among children compared to adults. Accelerating the development of other biofortified staple crops to increase their availability, especially to the target population groups, is essential. Nutrition education should be integrated with community health programmes to improve the consumption of the biofortified crops, coupled with further research to develop suitable recipes/formulations for biofortified foods.

Caregiver Perceptions and Acceptability of a Provitamin A Carotenoid, Iron and Zinc Rich Complementary Food Blend Prepared from Common Bean and Pumpkin in Rural Uganda.

Ugandan children are vulnerable to vitamin A deficiency (VAD), iron deficiency (ID) and zinc deficiency (ZnD) because they are fed on complementary foods (CFs) low in vitamin A, iron and zinc. This study developed a novel provitamin A carotenoid (PVAC), iron and zinc rich common bean pumpkin blend (BPB) complementary food (CF) from locally available pumpkin and common bean in Uganda and aimed to determine its acceptance, compared to a control pumpkin blend (PB). Seventy caregivers participated in the study. The sensory attributes (taste, colour, aroma, texture and general acceptability) of BPB and PB were rated using a five-point facial hedonic scale (1 = very bad, 2 = bad, 3 = neutral, 4 = good, 5 = very good). Focus group discussions (FGDs) were conducted to assess the perceptions of caregivers about the BPB. The chi square test was used to detect the proportion difference for each sensory attribute between BPB and PB, whilst FGD data were analysed by thematic analysis. A proportion of 64% to 96% of the caregivers rated both BPB and PB as acceptable (good to very good) for all the sensory attributes. There was no significant difference in caregiver acceptability for all attributes between BPB and PB (p > 0.05). Caregivers had positive perceptions about the taste, texture, aroma and colour of the BPB. Caregivers were keen to know the specific varieties of common bean and pumpkin used to formulate the PVAC, iron and zinc rich BPB. In conclusion, BPB was acceptable to caregivers, and they were interested to know how to prepare and use it as a CF.

Consumer Perceptions and Acceptability of Traditional Dishes Prepared with Provitamin A-Biofortified Maize and Sweet Potato.

Vitamin A deficiency (VAD) is prevalent in South Africa, particularly among predominantly poor rural communities. Provitamin A (PVA)-biofortified crops could be used to address VAD; however, there are challenges of poor consumer acceptability. This study investigated the effect of replacing white maize and cream-fleshed sweet potato (CFSP) with PVA-biofortified maize and orange-fleshed sweet potato (OFSP), respectively, on consumer acceptability and perceptions of traditional dishes of rural communities in South Africa. Consumer acceptability of PVA-biofortified phutu (a crumbly maize porridge) served with either curried cabbage, chicken or bambara groundnut, separately, and boiled OFSP was evaluated by black South African adults (n = 120) using a five-point facial hedonic scale. Focus group discussions (FGDs) were conducted with 56 subjects recruited from the consumer panel to assess consumer perceptions of the food samples. The majority of the participants rated the composite dishes containing PVA-biofortified phutu as "4 = good" and the acceptability of the composite dishes varied significantly (p < 0.05). Compared to other age groups, the 50-59-year age group showed higher preference for white phutu and chicken curry, whereas the 30-39-year age group showed higher preference for PVA-biofortified phutu and chicken curry. The acceptability of OFSP and CFSP was similar. The study participants showed positive perceptions of the OFSP, as well as PVA-biofortified phutu if served with either curried chicken or cabbage. The findings suggest that PVA-biofortified maize and OFSP can replace white maize and CFSP, respectively, in selected traditional dishes of the rural communities studied to alleviate VAD.

Nutritional Properties and Consumer's Acceptance of Provitamin A-Biofortified Amahewu Combined with Bambara (Vigna Subterranea) Flour.

Amahewu is a fermented non-alcoholic cereal grain beverage, popular in Southern Africa. This study evaluates the possibility of producing an acceptable provitamin A (PVA)-biofortified maize amahewu, complemented with bambara flour, to contribute towards the alleviation of protein energy malnutrition (PEM) and vitamin A deficiency (VAD). Germinated, roasted, and raw bambara flours, were added at 30% (w/w) substitution level, separately, to either white maize or PVA-biofortified maize flour, and processed into amahewu. Wheat bran (5% w/w) was used as reference inoculum. Amahewu samples were analyzed for nutritional properties and acceptability. The protein and lysine contents of amahewu almost doubled with the inclusion of germinated bambara. Protein digestibility of amahewu samples increased by almost 45% with the inclusion of bambara. PVA-biofortified maize amahewu samples complemented with bambara were extremely liked for their color, aroma, and taste when compared with their white maize counterparts. The principal component analysis explained 96% of the variation and PVA-biofortified maize amahewu samples were differentiated from white maize amahewu samples. The taste of amahewu resulting from roasting and germination of bambara was preferred in PVA-biofortified maize amahewu, compared to white maize amahewu. We conclude that PVA-biofortified maize amahewu, complemented with germinated bambara, has the potential to contribute towards the alleviation of PEM and VAD.

Improving the Dietary Vitamin A Content of Rural Communities in South Africa by Replacing Non-Biofortified white Maize and Sweet Potato with Biofortified Maize and Sweet Potato in Traditional Dishes.

Biofortification of staple crops has a potential for addressing micronutrient deficiencies, such as vitamin A deficiency (VAD), which are prevalent in South Africa. The poor acceptability of provitamin A (PVA)-biofortified foods could be improved by combining them with other food items to produce modified traditional dishes. The nutritional composition of the dishes could also be improved by the modification. The study aimed to investigate the effect of replacing white maize and cream-fleshed sweet potato (CFSP)] with PVA-biofortified maize and orange-fleshed sweet potato (OFSP) on the nutritional composition of South African traditional dishes. The protein, fibre, total mineral (ash), lysine, and iron concentrations of the PVA maize phutu (traditional porridge) composite dishes (control), were not significantly different (P > 0.05) from those of white maize phutu composite dishes. However, the PVA concentration of PVA maize phutu composite dishes was higher than that of the white phutu composite dishes (P > 0.05). The OFSP had a significantly lower protein concentration, but a significantly higher (P > 0.05) fibre, ash, lysine, isoleucine, leucine, and PVA concentration, relative to the CFSP. The findings indicate that composite dishes in which white maize is replaced with PVA-biofortified maize, and switching over from CFSP to OFSP, would contribute to combating VAD in South Africa, and in other developing counties.

An Assessment of the Food and Nutrition Security Status of Weaned 7-12 Months Old Children in Rural and Peri-Urban Communities of Gauteng and Limpopo Provinces, South Africa.

This study assessed the food and nutrition security status of children receiving complementary food in rural and peri-urban communities. A group of 106 mothers from Lebowakgomo village and Hammanskraal Township, respectively, participated in the survey. Additionally, six focus group discussions were conducted per study area to assess the mothers' perceptions about children's food access. The Children's Food Insecurity Access Scale (CFIAS) was used to assess the food security status (access) of the children. The Individual Dietary Diversity Score (IDDS) together with the unquantified food consumption frequency survey were used as a proxy measure of the nutritional quality of the children's diets. The age and weight of the children obtained from the children's clinic health cards were used to calculate Weight-for-Age Z scores (WAZ) in order to determine the prevalence of underweight children. The findings showed that a large percentage of children were severely food-insecure, 87% and 78%, in rural and peri-urban areas, respectively. Additionally, Lebowakgomo children (23.6%) and Hammanskraal children (17.9%) were severely underweight. Overall, children's diets in both study areas was characterized by nutrient-deficient complementary foods. Cheaper foods with a longer stomach-filling effect such as white maize meal and sugar were the most commonly purchased and used. Hence, the children consumed very limited amounts of foods rich in proteins, minerals, and vitamins, which significantly increased the risk of their being malnourished.

Effects of amaranth addition on the pro-vitamin A content, and physical and antioxidant properties of extruded pro-vitamin A-biofortified maize snacks.

BACKGROUND: Pro-vitamin A-biofortified maize snacks with added leafy vegetable may have a potential as nutritious and health-promoting products, especially in addressing vitamin A deficiency, which is prevalent in developing regions. The objective of the study was to determine the effects of adding amaranth leaf powder on the physical, antioxidant properties and pro-vitamin A content of extruded pro-vitamin A-biofortified maize snacks. Extruded snacks were processed using four pro-vitamin A-biofortified maize varieties that were composited with amaranth leaf powder at 0%, 1% and 3% (w/w) substitution levels. RESULTS: At higher amaranth concentration, the expansion ratio of the snacks decreased, while their hardness increased by as much as 93%. The physical quality of the snacks may therefore need improvement. As amaranth was increased, the phenolic content and antioxidant activity of the snacks increased as well as the pro-vitamin A content. CONCLUSION: Pro-vitamin A-biofortified maize with added amaranth has a potential for use in nutritious and healthy extruded snacks. There are limited studies reporting on processing pro-vitamin A maize with complementary plant foods, which is common with white maize in southern Africa; thus the current study serves as a baseline.

Provitamin A retention and sensory acceptability of amahewu, a non-alcoholic cereal-based beverage made with provitamin A-biofortified maize.

BACKGROUND: Vitamin A deficiency is a major public health problem in sub-Saharan Africa. Amahewu is a popular southern African lactic acid fermented non-alcoholic maize-based beverage, which is deficient in vitamin A. In this study, provitamin A retention and sensory acceptability of amahewu processed using provitamin A-biofortified maize and three types of inoculums during fermentation (malted maize, wheat bran and Lactobacillus starter culture) were investigated. RESULTS: The total provitamin A content of amahewu samples, estimated as ß-carotene, ß-cryptoxanthin and α-carotene content, ranged from 3.3 to 3.8 g kg(-1) (dry weight). Provitamin A was substantially retained (79- 90% ß-carotene equivalent) in amahewu after fermentation. Amahewu samples prepared with added starter cultures had the lowest retention of provitamin A. Consumers (approx. 69%) liked provitamin A-biofortified amahewu either moderately or very much. Principal component analysis of amahewu sensory data showed that 71% of variation was due to maize types and 18% of variation could be due to the inoculum used during fermentation. Amahewu samples prepared using provitamin A-biofortified maize were slightly more liked (mean score: 7.0 ± 1.2) compared to those of white maize reference samples. The use of starter culture combined with either malted maize or wheat bran as inoculum during fermentation improved the taste and aroma of amahewu and hence its acceptability. CONCLUSION: Provitamin A is substantially retained in amahewu after fermentation. The slightly high acceptability of amahewu prepared using provitamin A-biofortified maize compared to that of white maize thus suggests that fermented product like amahewu can potentially be used to deliver provitamin A to vulnerable individuals.