Should we provide edible insects in children's diets?

PURPOSE OF REVIEW: Diets low in animal-source foods or solely consisting of plant-based foods, hardly meet nutrition needs of children, exposing them to inadequate intake of essential nutrients. Thus, including edible insects in children's diets is relevant for meeting nutritional requirements, other potential health benefits, and building more sustainable food systems. Nutrition and health research on insects is novel and still limited. This review covers recently published research between April 2022 and November 2023 focusing on the relevance of including insects in children's diets. RECENT FINDINGS: Insects provide protein, fat and micronutrients, and are generally nutritionally equivalent to animal-source foods. The protein and fat quality of edible insects varies depending on several factors. Insects also contain chitin which could potentially be beneficial for gut health. For insects to be considered suitable for inclusion in children's diet, they must be accepted. However, children who are unfamiliar with insects respond to them with curiosity and disgust. SUMMARY: Insect farming can enhance their availability and consumption, potentially addressing nutrition gaps. Furthermore, transitioning from occasional to regular insect consumption requires actual exposure and integration into diets of insects. To affirm the nutrition and health potential of edible insects for children, well designed human studies are essential.

Growth and micronutrient status parameters of Nigerian preterm infants consuming preterm formula or breastmilk.

BACKGROUND: Moderate-to-late preterm infants (32-34 weeks GA) have increased risk of neonatal morbidities compared to term infants, however dedicated nutritional guidelines are lacking. METHODS: Moderate-to-late preterm infants received a preterm formula (n = 17) or breastmilk (n = 24) from age 2-10 weeks in a non-randomized, open-label observational study. Anthropometric measurements were assessed bi-weekly. Blood concentrations of hemoglobin, ferritin, serum retinol, and 25-hydroxy-vitamin D (25OHD) were analyzed at age 2 and 10 weeks. RESULT: Average growth per day was 14.7 g/kg BW/day in formula-fed and 12.8 g/kg BW/day in breastmilk-fed infants but not different from each other. Length and head circumference in both groups were in line with the median reference values of the Fenton growth chart. At 10 weeks of age, hemoglobin tended to be higher in the formula-fed group (10.2 g/dL vs. 9.6 g/dL, p = 0.053). 25OHD increased in formula- and breastmilk-fed infants from 73.8 to 180.9 nmol/L and from 70.7 to 97.6 nmol/L, respectively. Serum retinol only increased in the formula-fed group (0.63 to 1.02 µmol/L, p < 0.001). CONCLUSION: Breastfeeding resulted in adequate growth in moderate-late preterm infants but was limiting in some micronutrients. The preterm formula provided adequate micronutrients, but weight gain velocity was higher than the Fenton reference value. IMPACT STATEMENT: Unfortified breastmilk resulted in adequate growth in weight, length and head circumference in Nigerian moderate to late preterm infants during an study period of 8 weeks, but status of vitamin D, vitamin A and iron needs to be monitored. The high-energy formula, developed for very preterm infants, resulted in higher growth in body weight in moderate to late preterm infants than the median of the Fenton preterm growth chart. This study supports the necessity of dedicated nutritional guidelines, and regular monitoring of growth and nutritional status of moderate to late preterm infants.

Comparison of test performance of two commonly used multiplex assays to measure micronutrient and inflammatory markers in serum: results from a survey among pregnant women in South Africa.

The combined sandwich-ELISA (s-ELISA; VitMin Lab, Germany) and the Quansys Q-Plex™ Human Micronutrient Array (7-Plex) are multiplex serum assays that are used to assess population micronutrient status in low-income countries. We aimed to compare the agreement of five analytes, α-1-acid glycoprotein (AGP), C-reactive protein (CRP), ferritin, retinol-binding protein 4 (RBP4) and soluble transferrin receptor (sTfR) as measured by the 7-Plex and the s-ELISA. Serum samples were collected between March 2016 and December 2017. Pregnant women (n 249) were recruited at primary healthcare clinics in Johannesburg, and serum samples were collected between March 2016 and December 2017. Agreement between continuous measurements was assessed by Bland-Altman plots and concordance measures. Agreement in classifications of deficiency or inflammation was assessed by Cohen's kappa. Strong correlations (r > 0·80) were observed between the 7-Plex and s-ELISA for CRP and ferritin. Except for CRP, the 7-Plex assay gave consistently higher measurements than the s-ELISA. With the exception of CRP (Lin's ρ = 0·92), there was poor agreement between the two assays, with Lin's ρ < 0·90. Discrepancies of test results difference between methods increased as the serum concentrations rose. Cohen's kappa for all the five analytes was < 0·81 and ranged from slight agreement (vitamin A deficiency) to substantial (inflammation and Fe deficiency) agreement. The 7-Plex 1.0 is a research and or surveillance tool with potential for use in low-resource laboratories but cannot be used interchangeably with the s-ELISA. Further optimising and validation is required to establish its interchangeability with other validated methods.

The potential of biofortification technologies for wheat and rice to fill the nutritional Zn intake gap in China.

BACKGROUND: Zinc (Zn) deficiency in humans is of worldwide concern. The objective of this study was to investigate the Zn intake gap in Chinese adults and identify the potential role of biofortification technologies for wheat and rice, including crop nutrient management and breeding, in filling the gap. RESULTS: We use data from the China Health and Nutrition Survey in 2011 to identify food consumption patterns and dietary Zn intake of 4512 adults to define and quantify the Zn intake gap in the population. The dietary Zn intake gap of surveyed adults ranged from -0.8 to 6.53 mg day-1 across nine provinces and differences were associated with differences in food consumption patterns. Both dietary Zn intake and Zn gap for males were higher than for females. The potential of changes in five management strategies (improved nitrogen fertilization, improved phosphorus fertilization, foliar Zn fertilization, improved water management and growing varieties reaching the grain Zn breeding target) was analyzed. Breeding and foliar Zn fertilization were shown to be the two most effective management strategies that could increase dietary intake by 1.29 to 5 mg Zn day-1 dependent on sex and province. CONCLUSION: This study shows that the Zn gap varied across regions in China, with some large enough to warrant interventions. Wheat and rice as two major Zn sources could be targeted without a direct need for dietary diversification. By promoting both biofortification breeding of wheat and rice and Zn fertilization, dietary Zn intake could be enhanced to contribute to human health improvement in China. © 2023 Society of Chemical Industry.

Use of Theoretical Subjects to Develop a Method for Assessing Equivalence of Dietary Vitamin A in a Mixed Diet.

BACKGROUND: Although the vitamin A (VA) equivalency of provitamin A carotenoids from single foods or capsules has been studied using several approaches, there is currently no reliable method to determine VA equivalency for mixed diets. OBJECTIVES: To reach the objective of identifying a method to determine the VA equivalency of provitamin A carotenoids in mixed diets, we tested a new approach using preformed VA as proxy for provitamin A. METHODS: We studied 6 theoretical subjects who were assigned physiologically plausible values for dietary VA intake, retinol kinetic parameters, plasma retinol pool size, and VA total body stores. Using features in the Simulation, Analysis and Modeling software, we specified that subjects ingested a tracer dose of stable isotope-labeled VA on day 0 followed by 0-µg supplemental VA or 200, 400, 800, 1200, 1600, and 2000 µg VA daily from day 14 to day 28; we assigned VA absorption to be 75%. For each supplement level, we simulated plasma retinol specific activity (SAp) over time and calculated the mean decrease in SAp relative to 0 µg. Group mean data were fitted to a regression equation to calculate predicted VA equivalency at each supplement level on day 28. RESULTS: For each subject, higher VA supplement loads resulted in lower SAp, with the magnitude of the decrease differing among subjects. The mean predicted amount of absorbed VA was within 25% of individual subjects' assigned amount for 4 of the 6 subjects, and the mean ratio of predicted to assigned amount of absorbed VA over all supplement loads ranged from 0.60 to 1.50, with an overall mean ratio of 1.0. CONCLUSIONS: Results for preformed VA suggest that this protocol may be useful for determining VA equivalency of provitamin A carotenoids in free-living subjects if mixed diets with known provitamin A content were substituted for the VA supplements.

Iron Bioavailability Should be Considered when Modeling Omnivorous, Vegetarian, and Vegan Diets.

BACKGROUND: To lower environmental impact of human food consumption, replacement of animal proteins with plant-based proteins is encouraged. However, the lower iron bioavailability of plant-based foods is rarely considered when designing healthy and sustainable diets by using diet modeling. The estimated absorbable iron content of vegetarian and vegan menu plans might therefore be too optimistic. OBJECTIVE: The main aim of this study was to investigate and compare the impact of various methods to estimate absorbable iron intake on the nutritional adequacy of omnivorous, vegetarian, and vegan menu plans designed for women of reproductive age. METHODS: A diet model was developed to design menu plans consisting of a selection of meals that best complied with nutritional requirements. Meals used for modeling were created based on food intake data from the National Health and Nutrition Examination Survey (NHANES). For each meal, absorbable iron concentrations were estimated by using 2 constant absorption factors (18% and 10%) and 2 diet-dependent absorption equations (Conway and Hallberg). For each absorption method and diet type, we used the diet model to design the optimal menu plan. Retrospectively, menu plans were evaluated by estimating the absorbable iron content by using the other absorption methods. RESULTS: Retrospective diet-dependent absorbable iron estimates were consistently lower than estimates based on constant absorption factors. Using diet-dependent estimates increased absorbable iron by optimizing enhancer and inhibitor concentrations. CONCLUSION: Iron bioavailability should be considered when modeling diets.

The potential contribution of house crickets to the dietary zinc content and nutrient adequacy in young Kenyan children: a linear programming analysis using Optifood.

Zn deficiency arising from inadequate dietary intake of bioavailable Zn is common in children in developing countries. Because house crickets are a rich source of Zn, their consumption could be an effective public health measure to combat Zn deficiency. This study used Optifood, a tool based on linear programming analysis, to develop food-based dietary recommendations (FBR) and predict whether dietary house crickets can improve both Zn and overall nutrient adequacy of children's diets. Two quantitative, multi-pass 24-h recalls from forty-seven children aged 2 and 3 years residing in rural Kenya were collected and used to derive model parameters, including a list of commonly consumed foods, median serving sizes and frequency of consumption. Two scenarios were modelled: (i) FBR based on local available foods and (ii) FBR based on local available foods with house crickets. Results revealed that Zn would cease to be a problem nutrient when including house crickets to children's diets (population reference intake coverage for Zn increased from 89 % to 121 % in the best-case scenario). FBR based on both scenarios could ensure nutrient adequacy for all nutrients except for fat, but energy percentage (E%) for fat was higher when house crickets were included in the diet (23 E% v. 19 E%). This manoeuvre, combined with realistic changes in dietary practices, could therefore improve dietary Zn content and ensure adequacy for twelve nutrients for Kenyan children. Further research is needed to render these theoretical recommendations, practical.

Significant variations in feeding practices and choice of guidelines for the management of late preterm infants among healthcare professionals in Nigeria.

AIM: We aimed to gain insights into current nutritional management practices of late preterm infants (34-36 weeks gestational age) in Nigeria. METHODS: Purposive sampling was employed to recruit 19 healthcare professionals (neonatologists, paediatricians, general practitioners and nurses) involved in the care and nutritional management of late preterm infants in Lagos and Ogun states, Nigeria. Data were collected using interviews, either individually or in small focus groups, between 15 August and 6 September 2022. Thematic analysis of interview transcripts was carried out to interpret the data. RESULTS: Ten distinct themes emerged across the research questions and objectives. For growth monitoring, 11, 6, 1 and 1 of our participants preferred to use the 2006 WHO growth standards, Fenton preterm growth chart, Ballard score and Intergrowth-21, respectively. Regarding the growth velocity of late preterm infants, most healthcare professionals aimed for 15 g/kg BW/day or more during hospitalisation. Breastmilk was unanimously the primary feeding option for late preterm infants. Most healthcare professionals preferred to use international guidelines over local guidelines. CONCLUSION: Our study shows that there is a wide divergence in the nutritional guidelines used in managing late preterm infants in Nigeria. Regarding growth monitoring, healthcare professionals tended to aim for a growth velocity higher than necessary for late preterm infants, which may be disadvantageous for their long-term health.

Intra-uterine exposure to lower maternal haemoglobin concentration is associated with impaired cognitive function in stunted adolescents: results from a 17-year longitudinal cohort study in Indonesia.

The long-term impact of maternal anaemia on cognitive performance remains unknown. Indonesian longitudinal cohort data of 363 paired pregnant mothers and their 10-14-year-old offspring were used to investigate the association between maternal haemoglobin (Hb) concentration and their offspring's cognitive function (assessed by Raven's Progressive Matrices test) during adolescence. The weighted anaemia prevalence was 49.3% in pregnant mothers and 22.2% in adolescents. Adolescents who were stunted, anaemic, or living in a rural area had significantly lower cognitive scores than their counterparts. Maternal Hb was not associated with adolescent cognitive function (ß: 0.14; 95%CI: -0.052-0.340). However, the effect of maternal Hb concentration on offspring's cognitive function was modified by stunting status (ß, stunted: 0.44; 95%CI: 0.05-0.82; non-stunted: 0.01; 95%CI: -0.02-0.24). This study shows adverse cognitive outcomes at adolescent age are likely multi-causal and can be partially explained by intra-uterine exposure to low maternal Hb concentrations.

Depressive symptoms among Mexican adolescent girls in relation to iron status, anaemia, body weight and pubertal status: results from a latent class analysis.

OBJECTIVE: The study examined the association between depressive symptoms and iron status, anaemia, body weight and pubertal status among Mexican adolescent girls. DESIGN: In this cross-sectional study, depressive symptoms were assessed by the 6-item Kutcher Adolescent Depression Scale, and latent class analysis (LCA) was used to identify and characterise groups of girls based on depressive symptoms. Iron status and inflammation were assessed using ferritin and soluble transferrin receptor, C-reactive protein and alpha-1-acid glycoprotein, respectively. Multiple logistic and linear regressions were applied to model class membership as a function of iron status, anaemia, body weight and pubertal status. PARTICIPANTS: We collected data from 408 girls aged 12-20 years. SETTING: Public schools in northern Mexico. RESULTS: LCA yielded three classes of depressive symptoms: 44·4 % of the adolescents were 'unlikely to be depressed', 41·5 % were 'likely to be depressed' and 14·1 % were 'highly likely to be depressed'. Our analyses demonstrated that iron-deficient girls had greater odds of being 'likely depressed' (OR 2·01, 95 % CI 1·01, 3·00) or 'highly likely depressed' (OR 2·80, 95 % CI 1·76, 3·84). Linear regression analyses revealed that lower Hb concentrations and higher body weight increased the probability of being 'likely depressed'. There was no evidence that depressive symptoms were associated with age at menarche and years since menstruation. CONCLUSIONS: This study shows that iron-deficient adolescent girls are more likely to suffer from depressive symptoms and that lower concentrations of Hb and higher body weight increased the probability of experiencing depressive symptoms.

Trend in age at menarche and its association with body weight, body mass index and non-communicable disease prevalence in Indonesia: evidence from the Indonesian Family Life Survey (IFLS).

BACKGROUND: In western countries, age at menarche (AAM) is nowadays lower than a century ago, coinciding with increased Body Mass Index (BMI) and prevalence of non-communicable diseases (NCD). This study aimed to determine the time trend in AAM, and its association with BMI and NCD prevalence at later age, in Indonesia. METHODS: We used secondary data of 15,744 women aged 15-65 years from the Indonesian Family Life Survey (IFLS) conducted in the period 1993 to 2015. Multiple linear regression was applied to determine the association of AAM with BMI, and Poisson regression with robust variance for investigating the association of AAM with NCD prevalence ratios. Models were adjusted for age, and effect modification by wealth status, living area, and region was investigated. RESULTS: AAM has significantly declined from 14.4 (SD:2.1) years of age in the 1940s to 13.4 y (SD:1.5) in the 1990s. AAM was inversely associated with BMI (ß: - 0.30 kg/m2, 95%CI: - 0.37, - 0.22) and body weight (ß: - 0.67 kg, 95%CI: - 0.75, - 0.54), but was not associated with height. After adjustment for age, AAM was not associated with NCD, i.e. hypertension, type 2 diabetes mellitus, liver diseases, asthma, chronic lung diseases, cardiovascular diseases, stroke, cancer, or arthritis. Including BMI in the models did not change the results. CONCLUSIONS: From the 1940s to 1990s, AAM has declined with 1 year in Indonesia. Women with earlier AAM had higher BMI and body weight at later age, but AAM was not associated with NCD prevalence in later life in the Indonesian population. Further longitudinal research is needed to disentangle the direction of causality of the associations.

The contribution of provitamin A biofortified cassava to vitamin A intake in Nigerian pre-schoolchildren.

Biofortified yellow cassava has been developed to alleviate vitamin A deficiency. We examined the potential contribution of yellow cassava to total retinol activity equivalent (RAE) intake if replacing white by yellow cassava among pre-school Nigerian children. Dietary intake was assessed as part of a randomised controlled trial. Pre-schoolchildren (n 176) were randomly assigned to receive either white cassava (WC) or yellow cassava (YC) for 17 weeks. Dietary intake assessments were conducted during the intervention and 1 month after, when children had resumed their habitual diet. Differences in RAE intake between groups and time points were compared using a linear mixed model regression analysis. During intervention, median RAE intake was 536 µg/d in the YC group and 301 µg/d in the WC group (P < 0·0001). YC contributed approximately 40 % to total RAE intake. Of the children, 9 % in the YC group and 29 % in the WC group had RAE intake below the Estimated Average Requirement. After intervention, median RAE intake was 300 µg/d and did not differ between intervention groups (P = 0·5). The interaction effect of group and time showed a 37 % decrease in RAE intake in the YC group after the intervention (Exp(ß) = 0·63; 95 % CI 0·56, 0·72). If WC was replaced by YC after intervention, the potential contribution of YC to total RAE intake was estimated to be approximately 32 %. YC increased total RAE intake and showed a substantially lower inadequacy of intake. It is therefore recommended as a good source of provitamin A in cassava-consuming regions.

Comparing saliva and urine samples for measuring breast milk intake with the 2H oxide dose-to-mother technique among children 2-4 months old.

Saliva and urine are the two main body fluids sampled when breast milk intake is measured with the 2H oxide dose-to-mother technique. However, these two body fluids may generate different estimates of breast milk intake due to differences in isotope enrichment. Therefore, we aimed to assess how the estimated amount of breast milk intake differs when based on saliva and urine samples and to explore whether the total energy expenditure of the mothers is related to breast milk output. We used a convenience sample of thirteen pairs of mothers and babies aged 2-4 months, who were exclusively breastfed and apparently healthy. To assess breast milk intake, we administered doubly labelled water to the mothers and collected saliva samples from them, while simultaneously collecting both saliva and urine from their babies over a 14-d period. Isotope ratio MS was used to analyse the samples for 2H and 18O enrichments. Mean breast milk intake based on saliva samples was significantly higher than that based on urine samples (854·5 v. 812·8 g/d, P = 0·029). This can be attributed to slightly higher isotope enrichments in saliva and to a poorer model fit for urine samples as indicated by a higher square root of the mean square error (14·6 v. 10·4 mg/kg, P = 0·001). Maternal energy expenditure was not correlated with breast milk output. Our study suggests that saliva sampling generates slightly higher estimates of breast milk intake and is more precise as compared with urine and that maternal energy expenditure does not influence breast milk output.

Protein intake adequacy among Nigerian infants, children, adolescents and women and protein quality of commonly consumed foods.

Protein is important for growth, maintenance and protection of the body. Both adequacy of protein quantity and protein quality in the diet are important to guarantee obtaining all the essential amino acids. Protein-energy malnutrition is widely present in developing countries such as Nigeria and might result in stunting and wasting. Needs for protein differ depending on age and physiological status and are higher during growth, pregnancy and lactation. The present review assessed protein quantity and quality in diets of Nigerian infants, children, adolescents, and pregnant and lactating women. Literature reviews and calculations were performed to assess adequacy of Nigerian protein intake and to examine the Nigerian diet. The digestible indispensable amino acid score was used to calculate protein quality of nine Nigerian staple foods and of a mixture of foods. The Nigerian population had mostly adequate protein intake when compared with the most recent protein recommendations by the FAO (2013) and WHO/FAO/UNU (2007). An important exception was the protein intake of adolescent girls and pregnant and lactating women. Most of the assessed Nigerian plant-based staple foods were of low protein quality and predominantly lacked the amino acid lysine. The addition of animal-source foods can bridge the protein quality gap created by predominance of plant-based foods in the Nigerian diet. The methodology of this review can be applied to other low- and middle-income countries where diets are often plant-based and lack variety, which might influence protein intake adequacy.

Greater blood volume and Hb mass in obese women quantified by the carbon monoxide-rebreathing method affects interpretation of iron biomarkers and iron requirements.

BACKGROUND/OBJECTIVE: Iron deficiency (ID) is common in overweight and obese individuals (OW/OB) but the mechanism is uncertain. Greater blood volume (BV) in OW/OB may increase hemoglobin (Hb) mass and iron requirements, and confound iron biomarkers by hemodilution. Quantification of BV/PV changes in OW/OB is challenging and a formula to estimate BV/PV based on anthropometric indices would be valuable. In normal weight (NW) and OW/OB women, we aimed at: (1) measure BV and assess whether differences in BV affect concentrations and total circulating mass of Hb and iron biomarkers; (2) develop an algorithm describing BV in OW/OB. SUBJECTS/METHODS: In a cross-sectional study, we measured BV in NW, OW, and OB non-anemic women (n = 62) by using the carbon monoxide-rebreathing method, body composition by dual energy X-ray absorptiometry, and iron and inflammatory status. RESULTS: OW and OB women had 11 and 16% higher mean BV and PV compared to NW (P < 0.05), respectively. In OW/OB compared to NW, total circulating masses of IL-6, hepcidin, Hb, and sTfR were higher, while total mass of serum iron was lower (for all, P < 0.05). An equation including height, body mass and lean mass to estimate BV in all BMI groups (R2 = 0.76). CONCLUSION: An equation based on anthropometric indices provides a good estimate of increased BV in OW/OB women. In OW/OB women, there is an increase in Hb mass that likely increases iron requirements for erythropoiesis and circulating TfR mass. At the same time, higher hepcidin concentrations may lower serum iron mass. Both these mechanisms may increase risk for ID in OW/OB women.

Food Composition Tables in Southeast Asia: The Contribution of the SMILING Project.

Objectives Food composition data are key for many nutrition related activities in research, planning and policy. Combatting micronutrient malnutrition among women and young children using sustainable food based approaches, as aimed at in the SMILING project, requires high quality food composition data. Methods In order to develop capacity and to align procedures for establishing, updating and assessing the quality of key nutrient data in the food composition tables in Southeast Asia, a detailed roadmap was developed to identify and propose steps for this. This included a training workshop to build capacity in the field of food composition data, and alignment of procedures for selecting foods and nutrients to be included for quality assessment, and update of country specific food composition tables. The SEA partners in the SMILING project finalised a country specific food composition table (FCT) with updated compositional data on selected foods and nutrients considered key for designing nutrient dense and optimal diets for the target groups. Results Between 140 and 175 foods were selected for inclusion in the country specific FCTs. Key-nutrients were: energy, protein, total fat, carbohydrates, iron, zinc, (pro-)-vitamin A, folate, calcium, vitamin D, vitamin B1, vitamin B2, vitamin B3, vitamin B6, vitamin B12 and vitamin C. A detailed quality assessment on 13 key-foods per nutrient was performed using international guidelines. Nutrient data for specific local food items were often unavailable and data on folate, vitamin B12 and vitamin B6 contents were mostly missing. For many foods, documentation was not available, thereby complicating an in-depth quality assessment. Despite these limitations, the SMILING project offered a unique opportunity to increase awareness of the importance of high quality well documented food composition data. Conclusion for Practise The self-reported data quality demonstrated that there is considerable room for improvement of the nutrient data quality in some countries. In addition, investment in sustainable capacity development and an urgent need to produce and document high quality data on the micronutrient composition of especially local foods is required.

Insects as sources of iron and zinc in human nutrition.

Dietary deficiencies in Fe and Zn are globally widespread, causing serious health problems such as anaemia, poor pregnancy outcomes, increased risk of morbidity and mortality, stunted growth and impaired physical and cognitive development. Edible insects, of which a diversity of over 2000 species is available, are dietary components for about 2 billion individuals and are a valuable source of animal protein. In the present paper, we review the available information on Fe and Zn in edible insects and their potential as a source of these micronutrients for the rapidly growing human population. The levels of Fe and Zn present in eleven edible insect species that are mass-reared and six species that are collected from nature are similar to or higher than in other animal-based food sources. High protein levels in edible insect species are associated with high Fe and Zn levels. Fe and Zn levels are significantly positively correlated. Biochemically, Fe and Zn in insects occur predominantly in non-haem forms, bound to the proteins ferritin, transferrin and other transport and storage proteins. Knowledge gaps exist for bioavailability in the human alimentary tract, the effect of anti-nutritional factors in other dietary components such as grains on Fe and Zn absorption and the effect of food preparation methods. We conclude that edible insects present unique opportunities for improving the micronutrient status of both resource-poor and Western populations.

The potential contribution of yellow cassava to dietary nutrient adequacy of primary-school children in Eastern Kenya; the use of linear programming.

OBJECTIVE: Introduction of biofortified cassava as school lunch can increase vitamin A intake, but may increase risk of other deficiencies due to poor nutrient profile of cassava. We assessed the potential effect of introducing a yellow cassava-based school lunch combined with additional food-based recommendations (FBR) on vitamin A and overall nutrient adequacy using Optifood (linear programming tool). DESIGN: Cross-sectional study to assess dietary intakes (24 h recall) and derive model parameters (list of foods consumed, median serving sizes, food and food (sub)group frequency distributions, food cost). Three scenarios were modelled, namely daily diet including: (i) no school lunch; (ii) standard 5d school lunch with maize/beans; and (iii) 5d school lunch with yellow cassava. Each scenario and scenario 3 with additional FBR were assessed on overall nutrient adequacy using recommended nutrient intakes (RNI). SETTING: Eastern Kenya. SUBJECTS: Primary-school children (n 150) aged 7-9 years. RESULTS: Best food pattern of yellow cassava-based lunch scenario achieved 100 % RNI for six nutrients compared with no lunch (three nutrients) or standard lunch (five nutrients) scenario. FBR with yellow cassava and including small dried fish improved nutrient adequacy, but could not ensure adequate intake of fat (52 % of average requirement), riboflavin (50 % RNI), folate (59 % RNI) and vitamin A (49 % RNI). CONCLUSIONS: Introduction of yellow cassava-based school lunch complemented with FBR potentially improved vitamin A adequacy, but alternative interventions are needed to ensure dietary adequacy. Optifood is useful to assess potential contribution of a biofortified crop to nutrient adequacy and to develop additional FBR to address remaining nutrient gaps.

Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women.

Iron supplements acutely increase hepcidin, but the duration and magnitude of the increase, its dose dependence, and its effects on subsequent iron absorption have not been characterized in humans. Better understanding of these phenomena might improve oral iron dosing schedules. We investigated whether the acute iron-induced increase in hepcidin influences iron absorption of successive daily iron doses and twice-daily iron doses. We recruited 54 nonanemic young women with plasma ferritin ≤20 µg/L and conducted: (1) a dose-finding investigation with 40-, 60-, 80-, 160-, and 240-mg labeled Fe as [(57)Fe]-, [(58)Fe]-, or [(54)Fe]-FeSO4 given at 8:00 am fasting on 1 or on 2 consecutive days (study 1, n = 25; study 2, n = 16); and (2) a study giving three 60-mg Fe doses (twice-daily dosing) within 24 hours (study 3, n = 13). In studies 1 and 2, 24 hours after doses ≥60 mg, serum hepcidin was increased (P < .01) and fractional iron absorption was decreased by 35% to 45% (P < .01). With increasing dose, fractional absorption decreased (P < .001), whereas absolute absorption increased (P < .001). A sixfold increase in iron dose (40-240 mg) resulted in only a threefold increase in iron absorbed (6.7-18.1 mg). In study 3, total iron absorbed from 3 doses (2 mornings and an afternoon) was not significantly greater than that from 2 morning doses. Providing lower dosages (40-80 mg Fe) and avoiding twice-daily dosing maximize fractional absorption. The duration of the hepcidin response supports alternate day supplementation, but longer-term effects of these schedules require further investigation. These clinical trials were registered at www.ClinicalTrials.gov as #NCT01785407 and #NCT02050932.

Zinc Absorption from Milk Is Affected by Dilution but Not by Thermal Processing, and Milk Enhances Absorption of Zinc from High-Phytate Rice in Young Dutch Women.

Background: Milk has been suggested to increase zinc absorption. The effect of processing and the ability of milk to enhance zinc absorption from other foods has not been measured directly in humans.Objective: We aimed to assess zinc absorption from 1) milk undergoing various processing and preparatory steps and 2) from intrinsically labeled high-phytate rice consumed with milk or water.Methods: Two randomized crossover studies were conducted in healthy young women [age:18-25 y; body mass index (in kg/m2): 20-25]: 1) a milk study (n = 19) comparing the consumption of 800 mL full-fat ultra-high temperature (UHT) milk [heat-treated milk (HTM)], full-fat UHT milk diluted 1:1 with water [heat-treated milk and water (MW)], water, or unprocessed (raw) milk (UM), each extrinsically labeled with 67Zn, and 2) a rice study (n = 18) comparing the consumption of 90 g intrinsically 67Zn-labeled rice with 600 mL of water [rice and water (RW)] or full-fat UHT milk [rice and milk (RM)]. The fractional absorption of zinc (FAZ) was measured with the double-isotope tracer ratio method. In vitro, we assessed zinc extraction from rice blended into water, UM, or HTM with or without phytate.Results: FAZ from HTM was 25.5% (95% CI: 21.6%, 29.4%) and was not different from UM (27.8%; 95% CI: 24.2%, 31.4%). FAZ from water was higher (72.3%; 95% CI: 68.7%, 75.9%), whereas FAZ from MW was lower (19.7%; 95% CI: 17.5%, 21.9%) than HTM and UM (both P < 0.01). FAZ from RM (20.7%; 95% CI: 18.8%, 22.7%) was significantly higher than from RW (12.8%; 95% CI: 10.8%, 14.6%; P < 0.01). In vitro, HTM and UM showed several orders of magnitude higher extraction of zinc from rice with HTM than from rice with water at various phytate concentrations.Conclusions: Milk enhanced human FAZ from high-phytate rice by 62% compared with water. Diluting milk with water decreases its absorption-enhancing proprieties, whereas UHT processing does not. This trial was registered at the Dutch trial registry as NTR4267 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4267).