Both encouraging feeding style and high energy density may increase energy intakes from fermented millet gruels eaten by infants and toddlers in Ouagadougou.

Traditional fermented millet gruel is frequently eaten by children in Burkina Faso as a complementary food or for breakfast. The effects of gruel energy density and feeding style on intakes (amounts and energy) were assessed in children in Ouagadougou. Twenty-three young children (11 infants and 12 toddlers) were given two meals of gruel per day for two periods of 11 consecutive days, first, the traditional fermented gruel (TFG), and second, an improved high energy density fermented gruel (IFG). On the first 10 days of each period, the children were fed as usual, while on the 11th day, the mothers were asked to use encouraging feeding. Intakes of TFG and IFG were also measured once a day for nine days in 25 preschoolers (2-5 years-old). After adjustment for the subject effect, IFG intakes did not significantly differ from TFG intakes in the groups of infants and toddlers, meaning there was a significant increase in energy intakes, which almost doubled. Encouraging feeding increased TFG intakes in both age groups, but IFG intakes only increased in toddlers, whose energy intake tripled compared to that from TFG with the usual feeding style. In preschoolers, mean IFG intakes were lower than TFG intakes and there were no increase in mean energy intakes. Improving fermented gruel and training the mothers to encourage their young children during feeding are two possible strategies to improve food intakes, and hence to better satisfy the children's nutritional needs.

A six-month intervention with two different types of micronutrient-fortified complementary foods had distinct short- and long-term effects on linear and ponderal growth of Vietnamese infants.

Traditional complementary foods (CF) with a low nutrient density have been implicated in growth faltering, stunting, and other adverse outcomes in children. The efficacy of 2 types of locally produced, micronutrient-fortified CF to prevent stunting of infants living in rural Vietnam was evaluated. In a village-randomized controlled study, 426 infants, 5 mo of age, received for 6 mo a fortified CF, either as an instant flour (FF) or a food complement (FC) in village canteens, or traditional CF at home (C). After 6 mo of intervention, weight, length, length-for-age Z-score (LAZ) and weight-for-age Z-score were greater in the 2 intervention groups compared with the C group, with an estimated effect of +0.22 LAZ for the FF group and +0.21 LAZ for the FC group. At the last follow-up, 18 mo after the intervention, there was no significant difference in height-for-age Z-score (HAZ) between the groups, even though the HAZ in the FF group was 0.17 greater than that in the C group (P = 0.18). In contrast, the weight-for-height Z-score and BMI Z-score, indices of ponderal growth, were greater in the FF group (-0.49 and -0.26, respectively) than in the FC group (-0.73 and -0.49, respectively), with Z-scores in the C group intermediate and not significantly different from the others. This study shows that regular provision of locally produced CF fortified with micronutrients partly stopped growth faltering in Vietnamese infants, with differential effects on long-term length and ponderal growth. Providing only micronutrients instead of a complete array of nutrients might result in only short-term length growth benefits.

Complementary foods fortified with micronutrients prevent iron deficiency and anemia in Vietnamese infants.

To investigate whether an intervention including micronutrient-fortified complementary foods can improve iron status, we conducted a randomized controlled trial in 5-mo-old Vietnamese infants (n = 246). Villages (n = 29) were randomly divided into those receiving instant flour (FF) or a food complement (FC) both fortified with micronutrients or nothing [control (C)]. FF and FC infants received daily for 6 mo at least 2 meals of fortified complementary foods. Micronutrient status was assessed by measurement of hemoglobin (Hb) and plasma ferritin (PF), transferrin receptor, zinc, and retinol. Final Hb (mean ± SD) was higher in the FF (112.5 ± 8.0 g/L) and FC (114.0 ± 7.0 g/L) groups compared with C (109.0 ± 8.0 g/L; P = 0.006). PF (geometric mean [95% CI]) was also higher in FF (19.8 µg/L [17.5-22.3]) and FC (20.8 µg/L [18.3-23.6]) compared with C (11.1 µg/L [9.8-12.5]; P < 0.0001). Anemia prevalence decreased more in the FC group (-43.6%) compared with C (-10.3%; P = 0.006). The change in prevalence of PF < 12 µg/L was different in the FF (-16.4%) and FC (-6.7%) groups compared with C (+30.4%; P < 0.01). Endpoint prevalence of iron deficiency (ID) and ID anemia (IDA) were lower in the FF (13.4 and 6.7%, respectively) and FC (15.2 and 3.8%) groups compared with C (57.5 and 37.5%) (P < 0.0001). Retinol and zinc concentrations did not differ among groups, but endpoint prevalence of zinc deficiency was lower in FF infants (36.1%) than in C infants (52.9%; P = 0.04). Micronutrient-fortified complementary foods significantly improved iron status and decreased the prevalence of anemia, ID, and IDA in Vietnamese infants and can be an important tool to reduce ID in infancy in developing countries.

Effect of extrusion cooking and amylase addition to gruels to increase energy density and nutrient intakes by Vietnamese infants.

Extrusion cooking and amylase addition are two processing methods used for the preparation of high energy dense (ED) gruels of suitable consistency. A quantitative study of energy and nutrient intakes of 67 infants aged 6 to 10 months in rural areas in Vietnam was carried out to compare the effects of these processes used alone or in combination. Twice a day, for a period of four days each, infants successively ate four gruels prepared from different flours based on a blend of rice, sesame and soybean: an instant flour obtained by extrusion cooking (gruel A), a ready-to-cook flour obtained by extrusion cooking plus alpha-amylase addition (gruel B), a flour produced by milling crude rice, sesame and roasted soybean plus alpha-amylase addition (gruel C) and without amylase (control gruel D). Gruels A, B and C had a high ED of respectively 94, 122 and 124 kcal/100 g while the control gruel D had a low ED (59 kcal/100 g). The intakes of the four gruels were inversely linked to their ED. However, despite the fact that gruels B and C had similar ED, larger intakes were obtained with gruel B, which was attributed to better acceptability. The average energy intakes of high ED gruels A, B and C, respectively 112, 134 and 117 kcal/meal, were significantly higher than that of gruel D (81 kcal/meal). Of the three processing methods, the one combining extrusion cooking and amylase addition gave the best results in terms of gruel acceptability and energy intake.

Marketing complementary foods and supplements in Burkina Faso, Madagascar, and Vietnam: lessons learned from the Nutridev program.

BACKGROUND: Sustainable approaches to improving infant and young child feeding are needed. The Nutridev program worked in Vietnam, Madagascar, and Burkina Faso to test different strategies to improve complementary feeding using fortified products sold to families. OBJECTIVE: To review the experiences of programs producing and marketing fortified complementary foods and to report on the feasibility of local production and marketing of fortified complementary foods to increase usage of high-quality foods among children of low-income families in a self-sustaining manner. METHODS: Project documents, surveys of mothers, and production and sales reports were reviewed. RESULTS: Nutridev experience in Vietnam, Madagascar, and Burkina Faso demonstrates that it is possible to produce affordable, high-quality complementary foods and supplements locally in developing countries. Strategies to make products readily available to the targeted population and to convince this population to consume them yielded mixed results, varying greatly based on the strategy utilized and the context in which it was implemented. CONCLUSIONS: In several contexts, the optimal approach appears to be strengthening the existing food distribution network to sell complementary foods and supplements, with the implementation of a temporary promotion and nutrition education network in partnership with local authorities (e.g., health services) to increase awareness among families about the fortified complementary food product and optimal feeding practices. In urban areas, where the density of the population is high, design and implementation of specific networks very close to consumers seems to be a good way to combine economic sustainability and good consumption levels.

Recipes and nutritional value of dishes prepared from green-leafy vegetables in an urban district of Antananarivo (Madagascar).

The recipes of 50 multi-ingredient dishes consumed by the population in an urban district were noted down. The nutritional value was determined as well as the cook value of the dishes in order to evaluate the severity of the thermal treatment. The recipes were simple and involved steps such as boiling, mixing, and cutting. Fibre contents were rather low except when the leaf stems were included. All the dishes had very high beta-carotene content (15.8-25.0 mg/100 g dry matter) and retinol activity equivalent (RAE) (1.3-2.3 mg RAE/100 g dry matter) because of the high proportion of fresh leafy vegetables (from 41.2% to 58.8% of the total dry matter of the ingredients). When meat was added to the preparation, the micronutrient content (iron, zinc, and retinol) was not increased significantly. In three dishes, a positive correlation was found between the thermal treatment severity and the 13-cis-beta-carotene amount.

Effect of the consumption of high energy dense and fortified gruels on energy and nutrient intakes of 6-10-month-old Vietnamese infants.

The aim of this study was to test the ability of two new products, an instant infant flour and a food supplement containing amylases, to increase energy and micronutrient intakes of infants older than 6 months. Three groups of 48 infants were randomly constituted. Infants in groups 1 and 2 consumed at least twice a day gruel made either from the instant flour or from the food supplement. Infants from the control group received complementary foods prepared in the usual way. Each infant was surveyed during a whole day in order to measure feeding frequencies and characteristics as well as amounts of the different types of complementary foods consumed. Foods consumed by infants in the two experimental groups differed considerably in energy, micronutrient density and in consistency from the home-made complementary foods. Due to the incorporation of amylases, gruels made from the food supplement had a higher energy density, a more appropriate consistency and resulted in higher intakes per meal than gruels made from instant flour. In comparison with home-made complementary foods, both experimental products resulted in significantly higher energy and nutrient intakes. The two experimental products appeared to increase sufficiently both energy and nutrient intakes of infants to complement their breastmilk intake.

Dietary diversity is a good predictor of the micronutrient density of the diet of 6- to 23-month-old children in Madagascar.

This study was conducted in the context of a multicountry validation of indicators of diet quality and had the following objectives: 1) to determine how well dietary diversity scores (DDS) predict diet quality of children aged 6-23 mo in urban Madagascar; and 2) to assess whether the prediction was improved by changing the food groups included and by imposing a minimum amount restriction. Correlation and regression were used to describe the relationship between 4 diversity scores (2 based on 8 and 7 food groups, the latter excluding fats and oils, and 2 that imposed a 10-g minimum restriction on food groups) and the mean micronutrient density adequacy (MMDA) of the diet. MMDA, the dietary quality score used, was calculated as the mean individual micronutrient density adequacy for 9 or 10 "problem" nutrients (depending on age and breast-feeding status), each capped at 100%. We used sensitivity and specificity analysis to determine how well DDS predicted MMDA below or above selected cut-offs. All scores were positively correlated with MMDA. When the fats and oils group was omitted, correlations were 10-16% higher for breast-fed children and 19-28% higher for non-breast-fed children. Correlations were only slightly improved with the 10-g minimum. With the 7-food group score, a score of

Consumption pattern, biochemical composition and nutritional value of fermented pearl millet gruels in Burkina Faso.

Ben-kida and ben-saalga are popular pearl-millet-based fermented gruels in Burkina Faso. A survey of 318 households in Ouagadougou (Burkina Faso) showed that they are often used as complementary food for young children. Pearl millet and gruels, sampled in 48 production units, were analysed for proximate composition, factors reducing nutrient bioavailability (phytate, insoluble fibres and iron-binding phenolic compounds), alpha-galactosides, sugars, total lactic acid and d-lactic acid, zinc and iron contents. The effects of processing of pearl millet into fermented gruel are discussed. Both positive effects (e.g. a decrease in factors reducing nutrient bioavailability or alpha-galactosides) and undesirable effects (e.g. considerable lipid, protein, iron and zinc losses) were observed. Lactic acid was produced during processing and d(-)-lactate was detected in all samples. The gruels had very low energy density, even after addition of sugar, and low lipid, protein and mineral contents, well below recommendations for complementary foods.

Assessment of child feeding practices using a summary index: stability over time and association with child growth in urban Madagascar.

BACKGROUND: Previous studies investigating the association between an infant and child feeding index (ICFI) and length-for-age were based on a cross-sectional design and on the assumption that data collected with brief recalls could provide information about more enduring processes. OBJECTIVES: The objectives were to test the stability of the individual ICFI values over time and to investigate how they relate to length-for-age z score (LAZ) and weight-for-length z score (WLZ) at the end of the study. DESIGN: This prospective cohort study included 363 children aged 6-17 mo who were visited 3 times over 6 mo. A cross-sectional ICFI (CS-ICFI) was constructed for each visit by using data on feeding practices and data from quantitative 24-h recalls. A longitudinal ICFI (L-ICFI) was constructed with use of the 3 CS-ICFIs. The stability of the CS-ICFI was assessed by using the variance of the repeatability coefficient (s(2)r). RESULTS: Stability of the CS-ICFI was shown by the value of 0.704 (95% CI: 0.625, 0.805) of the s(2)r, which differed significantly from 1 (P < 0.0001). There was no significant association between the CS-ICFIs and LAZ or WLZ at visit 3. In contrast, when moving from low to high L-ICFI, there was a highly significant 0.5 z score difference in mean LAZ at visit 3 (P = 0.0008). The L-ICFI was not associated with WLZ. CONCLUSIONS: The ICFI constructed by using data collected with brief recalls can provide information about feeding in the long term. However, the absence of association with LAZ suggests a lack of precision that can be reduced by using an ICFI based on repeated measurements.

Improvement of the in vitro digestible iron and zinc content of okra (Hibiscus esculentus L.) sauce widely consumed in Sahelian Africa.

The effects of the formulation (okra, fish, soumbala, extract of wood ash) and cooking time of okra sauce on total iron and zinc content and on their in vitro digestibility were evaluated following a Doehlert uniform shell design with 5 factors and 33 trials. Cooking time had no significant effect on in vitro digestible iron and zinc content, whereas formulation did. Each ingredient had a specific effect. Extract of wood ash, which is a source of soluble and digestible iron and zinc, is a good way of increasing the digestible mineral content of the dish. Okra, the main ingredient in this sauce, has a negative effect and should be added in moderate quantities (< 37.7% of the DM of the sauce). An optimization using the desirability function allows us to identify the optimal recipe that enabled the quantity of digestible iron to be doubled and the quantity of digestible zinc to be increased by one third. This recipe calls for a mixture of 37.7% okra, 26.3% dried fish, 18.5% soumbala, and 3.7% extract of wood ash cooked for 25 min.

Home-processing of the dishes constituting the main sources of micronutrients in the diet of preschool children in rural Burkina Faso.

The diet of 200 randomly selected 1-year-old to 5-year-old children was studied in a rural area of Burkina Faso. The mothers took part in a questionnaire survey and a 24-h dietary recall to index the type and the ingested quantities of the food consumed by the child the previous day. The average percentages of the Recommended Nutrient Intake met by the consumption of a dish component per meal did not exceed 25% for energy, iron, zinc and vitamin A. With respect to their initial composition and the quantities ingested, several dish components such as starchy-based products (millet-based-tô) or sauces (red sorrel leaves, dried okra) were good sources of micronutrients in the children's diets. Several dish components were selected and their preparation observed in six households to obtain precise details of the recipe. Several ingredients (42) and unit operations (nine) were used to prepare the local foods. Cooking in water (boiling), which was the main unit operation, did not exceed 43 min and the temperature used was under 100 degrees C. Several ingredients were subjected to two or three thermal treatments and the duration of cooking reached 56 min in groundnut sauce. The most at-risk unit operations likely to decrease the nutritional quality were cooking in water followed by draining or cooking for a long time.

Influence of the technological know-how of producers on the biochemical characteristics of red sorghum malt from small scale production units in Ouagadougou (Burkina Faso).

The process of red sorghum malt production was monitored three times in five production units (PU) selected upon their ability to produce malt flours having a high capacity to fluidify high-energy-density gruels. Raw, germinated and degermed seeds were analysed for macronutrient, soluble sugars, phytate and cyanide contents and alpha-amylase activity. Know-how differences between producers lay mainly in the duration and type of equipment used for steeping and germination. Moreover, three PUs applied a maturation step before sun-drying and one PU added ashes to steeped seeds before germination. No significant difference was detected in the proximate composition of malts from the five PUs. For all PUs, traditional malting increased the protein content and decreased the lipid and ash contents, while the fibre content was not affected. Significant increases in sugar contents and in alpha-amylase activity were observed but in variable proportions from one PU to another. The phytate content decreased significantly in all PUs. The cyanide content increased in all PUs but more drastically or less drastically according to the PU. Finally, degerming lowered the cyanide content to an acceptable level for human consumption. The between-PU variability may be due either to the nature and origin of the raw seeds or to technological know-how differences between producers. Further investigations are needed to optimize and standardize the malting process with a view to maximizing alpha-amylase and phytase activities and minimizing the variability of their biochemical characteristics.

Characterization of the consistency of gruels consumed by infants in developing countries: assessment of the Bostwick consistometer and comparison with viscosity measurements and sensory perception.

Standardized techniques are still needed to characterize the consistency of gruels for infants in developing countries. The aim of this study was to evaluate the interest of the use of the Bostwick consistometer. Bostwick flow was measured on gruels prepared with different flours, at low or high energy density (i.e. without or with amylase). The range of Bostwick flow, from 0 to 240 mm/30 sec, adequately described a wide range of gruel consistencies from completely liquid to almost solid. However, the temperature of the gruel must be carefully controlled during measurements as Bostwick flow is highly temperature dependent, especially in the case of gruels with high energy density. The relationship between Bostwick flow and apparent viscosity proved to depend on the type of gruel: at an apparent viscosity of 1 Pa.sec, gruels prepared from maize, rice, millet or multicomponent flours had different Bostwick flow values of, respectively, 20, 35, 75 and 55 mm/30 sec. Sensory analysis was then performed with a panel of mothers of infants and young children in Ouagadougou (Burkina Faso). Gruels of similar apparent viscosity and different Bostwick flow distances or of inversely similar Bostwick flow distances and different apparent viscosities were prepared by adding carob seed flour, and differentiation and ranking tests were then carried out. Both types of test revealed that mothers differentiated similar gruels having different Bostwick flow distances more easily than gruels having different apparent viscosities. It can thus be concluded that Bostwick flow, which is an empirical multi-criteria parameter, conveys the sensory perception of gruel consistency better than apparent viscosity.

Relative contribution of phytates, fibers, and tannins to low iron and zinc in vitro solubility in pearl millet (Pennisetum glaucum) flour and grain fractions.

In vitro digestions were performed on pearl millet flours with decreased phytate contents and on two dephytinized or nondephytinized pearl millet grain fractions, a decorticated fraction, and a bran fraction with low and high fiber and tannin contents, respectively. Insoluble residues of these digestions were then incubated with buffer or enzymatic solutions (xylanases and/or phytases), and the quantities of indigestible iron and zinc released by these different treatments were determined. In decorticated pearl millet grain, iron was chelated by phytates and by insoluble fibers, whereas zinc was almost exclusively chelated by phytates. In the bran of pearl millet grain, a high proportion of iron was chelated by iron-binding phenolic compounds, while the rest of iron as well as the majority of zinc were chelated in complexes between phytates and fibers. The low effect of phytase action on iron and zinc solubility of bran of pearl millet grain shows that, in the case of high fiber and tannin contents, the chelating effect of these compounds was higher than that of phytates.

Iron and zinc in vitro availability in pearl millet flours (Pennisetum glaucum) with varying phytate, tannin, and fiber contents.

Simulations of gastro-intestinal digestion, used to estimate in vitro iron and zinc availability, were performed on two kinds of samples: (i) samples with decreased phytate contents from whole pearl millet flour and (ii) nondephytinized or dephytinized samples from two pearl millet grain fractions, a decorticated fraction with low fiber and tannin contents and a bran fraction with high fiber and tannin contents. Iron and zinc in vitro availabilities of whole pearl millet flour were significantly improved by phytate degradation, even if the IP6 were not all degraded. Total dephytinization of decorticated fraction led to a marked increase in iron and zinc in vitro availabilities, but that of bran fraction had no effect on either iron or zinc in vitro availability. Even if phytates are involved in reducing in vitro iron and zinc availability in pearl millet flour, fibers and tannins play an important role by chelating a high proportion of iron and zinc in grain hulls.