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

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

Are millets more effective in managing hyperlipidaemia and obesity than major cereal staples? A systematic review and meta-analysis

Millets are important staples across developing countries in Asia and Africa. A previous systematic review and meta-analysis showed that eating millets significantly controlled hyperlipidaemia and obesity by focusing on a comparison of pre- and post-intervention measurements. This study further provides meta-analysis of the effects of the consumption of millets on hyperlipidaemia and obesity by analysing millets against other staple grains using the difference-in-differences method, where the effects were computed on the Standardised Mean Difference scale. Thus, only studies that included a control group as well as the baseline were included. The results from twelve eligible studies on blood lipid profile show significant (p < 0.05) favourable effects of consuming millets compared to other staples (rice, wheat, and quinoa). Specifically, the effects on total cholesterol, triacylglycerol, and very low-density lipoprotein cholesterol levels were −0.44, −0.29, and −0.41, respectively (p < 0.05), while the effect on the high-density lipoprotein cholesterol level was +0.59 (p < 0.05). In addition, the effects on low-density lipoprotein cholesterol and the body mass index were −0.60 and −0.29, respectively, with p = 0.06 each. While this study strengthens the evidence that the consumption of millets contributes to reducing the risks of hyperlipidaemia, and therefore cardiovascular diseases, more detailed and rigorous studies are recommended

Can millet consumption help manage hyperlipidemia and obesity?: a systematic review and meta-analysis

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

Impact of regular consumption of millets on fasting and post-prandial blood glucose level: a systematic review and meta-analysis

Millets have a low Glycemic Index and are thus expected to help reduce concentration of Fasting and Post-Prandial Blood Sugar (FBS and PPBS) and glycated hemoglobin (HbA1c), which can potentially help the management of type 2 diabetes. This study conducts a systematic review and meta-analysis of the effects of millets consumption on FBS, PPBS, and HbA1c levels in comparison to major staple diets using the difference-in-differences (DID) method, where the effect size was computed on the Standardized Mean Difference scale. Among twelve eligible articles, ten were used in the meta-analysis to assess the effects on FBS levels, while five were used to assess the effects on PPBS levels. The results show significant effects on FBS (p <  0.01) and PPBS (p <  0.05) levels with the effect size of −0.71 and −0.42, respectively. There were 11.8% (p =  0.001) and 15.1% (p =  0.012) reductions in FBS and PPBS level respectively observed in the millet consuming group whereas the comparator group did not have significant reductions in either indicator. On the other hand, the effects on HbA1c levels were insignificant, presumably due to the small sample size where only two studies were undertaken over 90 days, which warrants further research. The findings corroborate the evidence that millets can contribute to managing FBS and PPBS levels better than major staple diets, implying that millets consumption helps reduce the risk of type 2 diabete

Calcium from finger millet—a systematic review and meta-analysis on calcium retention, bone resorption, and in vitro bioavailability

Calcium deficiency during child growth leads to osteoporosis in later stages of life. Finger millet is one of the calcium dense foods, with three times the level of calcium than milk, and the only cereal that contains high calcium content which is consistent across different varieties (364 � 58 mg/100 g). Thus, finger millet has potential for addressing calcium deficiency naturally. This study aimed to determine the retention and impact of finger millet calcium on bone turnover through a systematic review and meta-analysis. Three human studies were eligible for systematic review. Of these, only two were eligible for meta-analysis to assess the retention of calcium in children of 9 to 12 years. One study on bone turnover markers was not used in the meta-analysis as at least two studies are required to conduct meta-analysis. Due to the lack of complete data only four studies were eligible for meta-analysis to assess the in vitro bioavailability of calcium from unprocessed and a range of different types of processed finger millet. The result shows that there was significant retention (p < 0.05) of 23.4 � 2.9% calcium from finger-millet-based diet which could help bone accretion during child growth if finger-millet-based diet is consumed. The bone turnover marker study shows that the resorption of calcium reduced by 28% and 47% among peri and post-menopausal women respectively after feeding the nutria mixed grain ball. However, there is no significant change in bone formation marker. Depending on the type of processing, calcium bioavailability either increased or decreased. One in vitro study showed that calcium bioavailability from finger millet was 28.6% when boiled, whereas three studies on processing show that certain processing can double the calcium bioavailability to 61.4%. Irrespective of the type of processing, finger millets contribute to high calcium retention and extremely high bioavailable calcium and could be useful for healthy growth and in dealing with complications related to calcium deficiency

A systematic review and meta-analysis of the potential of millets for managing and reducing the risk of developing diabetes mellitus

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

Millets can have a major impact on improving iron status, hemoglobin level, and in reducing iron deficiency anemia– a systematic review and meta-analysis

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

Can feeding a millet-based diet improve the growth of children?—A systematic review and meta-analysis

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

Early and extended erythropoietin monotherapy after hypoxic ischaemic encephalopathy:a multicentre double-blind pilot randomised controlled trial

Objective: To examine the feasibility of early and extended erythropoietin monotherapy after hypoxic ischaemic encephalopathy (HIE). Design: Double-blind pilot randomised controlled trial.Setting: Eight neonatal units in South Asia. Patients: Neonates (≥36 weeks) with moderate or severe HIE admitted between 31 December 2022 and 3 May 2023. Interventions: Erythropoietin (500 U/kg daily) or to the placebo (sham injections using a screen) within 6 hours of birth and continued for 9 days. MRI at 2 weeks of age. Main outcomes and measures: Feasibility of randomisation, drug administration and assessment of brain injury using MRI. Results: Of the 154 neonates screened, 56 were eligible; 6 declined consent and 50 were recruited; 43 (86%) were inborn. Mean (SD) age at first dose was 4.4 (1.2) hours in erythropoietin and 4.1 (1.0) hours in placebo. Overall mortality at hospital discharge occurred in 5 (19%) vs 11 (46%) (p=0.06), and 3 (13%) vs 9 (40.9%) (p=0.04) among those with moderate encephalopathy in the erythropoietin and placebo groups. Moderate or severe injury to basal ganglia, white matter and cortex occurred in 5 (25%) vs 5 (38.5%); 14 (70%) vs 11 (85%); and 6 (30%) vs 2 (15.4%) in the erythropoietin and placebo group, respectively. Sinus venous thrombosis was seen in two (10%) neonates in the erythropoietin group and none in the control group. Conclusions: Brain injury and mortality after moderate or severe HIE are high in South Asia. Evaluation of erythropoietin monotherapy using MRI to examine treatment effects is feasible in these settings. Trial registration number: NCT05395195