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.

Can cereal-legume intercrop systems contribute to household nutrition in semi-arid environments: A systematic review and meta-analysis.

Introduction: Intercropping cereals with legumes can intensify rainfed cereal monocropping for improved household food and nutritional security. However, there is scant literature confirming the associated nutritional benefits. Methodology: A systematic review and meta-analysis of nutritional water productivity (NWP) and nutrient contribution (NC) of selected cereal-legume intercrop systems was conducted through literature searches in Scopus, Web of Science and ScienceDirect databases. After the assessment, only nine articles written in English that were field experiments comprising grain cereal and legume intercrop systems were retained. Using the R statistical software (version 3.6.0), paired t-tests were used to determine if differences existed between the intercrop system and the corresponding cereal monocrop for yield (Y), water productivity (WP), NC, and NWP. Results: The intercropped cereal or legume yield was 10 to 35% lower than that for the corresponding monocrop system. In most instances, intercropping cereals with legumes improved NY, NWP, and NC due to their added nutrients. Substantial improvements were observed for calcium (Ca), where NY, NWP, and NC improved by 658, 82, and 256%, respectively. Discussion: Results showed that cereal-legume intercrop systems could improve nutrient yield in water-limited environments. Promoting cereal- legume intercrops that feature nutrient-dense legume component crops could contribute toward addressing the SDGs of Zero Hunger (SDG 3), Good Health and Well-3 (SDG 2) and Responsible consumption and production (SDG 12).

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.

Assessment of the Nutritional Status of Four Selected Rural Communities in KwaZulu-Natal, South Africa.

Under- and over-nutrition co-exist as the double burden of malnutrition that poses a public health concern in countries of the developing regions, including South Africa (SA). Vulnerable groups such as pregnant women and children under five years are the most affected by malnutrition, especially in rural areas. Major contributing factors of malnutrition include food and nutrition insecurity, poverty, and unhealthy lifestyles. The current study aimed to assess the nutritional status, using selected anthropometric indices and dietary intake methods (repeated 24 h recall and food frequency), of four rural communities in KwaZulu-Natal (SA). Purposive sampling generated a sample of 50 households each in three rural areas: Swayimane, Tugela Ferry, and Umbumbulu and 21 households at Fountain Hill Estate. The Estimated Average Requirement cut-point method was used to assess the prevalence of inadequate nutrient intake. Stunting (30.8%; n = 12) and overweight (15.4%; n = 6) were prevalent in children under five years, whilst obesity was highly prevalent among adult females (39.1%; n = 81), especially those aged 16-35 years. There was a high intake of carbohydrates and a low intake of fibre and micronutrients, including vitamin A, thus, confirming the need for a food-based approach to address malnutrition and micronutrient deficiencies, particularly vitamin A deficiency.

The Effect of Moringa oleifera Leaf Powder on the Physical Quality, Nutritional Composition and Consumer Acceptability of White and Brown Breads.

Fortifying popular, relatively affordable, but nutrient-limited staple foods, such as bread, with Moringa oleifera leaf powder (MOLP), could contribute significantly to addressing under nutrition, especially protein and mineral deficiencies, which are particularly prevalent among a large proportion of populations in sub-Saharan African countries. The current study aimed to determine the effect of MOLP on the physical quality, nutritional composition and consumer acceptability of white and brown breads. The texture, colour and nutritional composition of white and brown bread samples substituted with 5% and 10% (w/w) MOLPs were analysed using standard methods and compared with the control (0% MOLP). A consumer panel evaluated the acceptability of the bread samples using a nine-point hedonic scale. Bread samples became darker as the concentration of MOLP was increased, whilst nutrient levels increased. The overall consumer acceptability of the bread samples decreased with increasing concentrations of MOLP. However, brown bread samples were significantly more acceptable compared with corresponding white bread samples (p < 0.05). Under the experiment conditions of the current study, it seems that the bread containing 5% MOLP can be used to contribute significantly to addressing malnutrition, with respect to protein deficiency.

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.

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.

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.

Mainstreaming Underutilized Indigenous and Traditional Crops into Food Systems: A South African Perspective.

Business as usual or transformative change? While the global agro-industrial food system is credited with increasing food production, availability and accessibility, it is also credited with giving birth to 'new' challenges such as malnutrition, biodiversity loss, and environmental degradation. We reviewed the potential of underutilized indigenous and traditional crops to bring about a transformative change to South Africa's food system. South Africa has a dichotomous food system, characterized by a distinct, dominant agro-industrial, and, alternative, informal food system. This dichotomous food system has inadvertently undermined the development of smallholder producers. While the dominant agro-industrial food system has led to improvements in food supply, it has also resulted in significant trade-offs with agro-biodiversity, dietary diversity, environmental sustainability, and socio-economic stability, especially amongst the rural poor. This challenges South Africa's ability to deliver on sustainable and healthy food systems under environmental change. The review proposes a transdisciplinary approach to mainstreaming underutilized indigenous and traditional crops into the food system, which offers real opportunities for developing a sustainable and healthy food system, while, at the same time, achieving societal goals such as employment creation, wellbeing, and environmental sustainability. This process can be initiated by researchers translating existing evidence for informing policy-makers. Similarly, policy-makers need to acknowledge the divergence in the existing policies, and bring about policy convergence in pursuit of a food system which includes smallholder famers, and where underutilized indigenous and traditional crops are mainstreamed into the South African food system.

Food and Nutrition Insecurity in Selected Rural Communities of KwaZulu-Natal, South Africa-Linking Human Nutrition and Agriculture.

Lack of access to nutritious and balanced diets remains a major impediment to the health and well-being of people living in rural areas. The study utilizes a qualitative systematic approach to conduct an environmental scan and review of scientific literature of studies conducted in South Africa, specifically KwaZulu-Natal (KZN). Availability and access to nutritious, diverse and balanced diets were identified as key constraints for achieving food and nutrition security as well as for human health and well-being. This has led to both under- and over-nutrition, with the former, in particular stunting, affecting children under 5 years. A high incidence of over-nutrition, both overweight and obesity, was observed among black African females. In South Africa, poor people rely mostly on social grants and cannot afford a balanced diet. Under these circumstances, agriculture could be used to increase availability and access to diverse and nutritious foods for the attainment of a balanced diet. The wider use of traditional vegetable crops and pulses could improve availability and access to healthy and locally available alternatives. The promotion of household and community food gardens, and the use of nutrient dense crops with low levels of water use, i.e., high nutritional water productivity, offers prospects for addressing malnutrition in poor rural areas.