Locally processed roasted-maize-based weaning foods fortified with legumes: factors affecting their availability and competitiveness in accra, ghana

Tom Brown (roasted-maize porridge) is one of the traditional weaning foods in Ghana. As an effort by the Ministry of Health to enhance the nutrient content of this lownutrient- density weaning food, a product called weanimix, which is Tom Brown fortified with legumes (cowpeas or soybeans and groundnuts), was introduced more than two decades ago. Cowpeas are an indigenous African legume, popularly used by Ghanaians for various traditional dishes. While soybeans are not traditionally used, they can easily be incorporated into local diets. Commercial weanimix-type products in ready-to-cook flour form are currently available mainly at supermarkets, which target higher-income consumers. This paper examined: (1) the competitiveness between cowpeas and soybeans as an ingredient in weanimix; and (2) constraints to making weanimix more widely available to lower-income families. Local food processors, weaning mothers, commercial custom millers, and retailers were interviewed for both qualitative and quantitative data. Secondary price data were collected from different sources including the Ministry of Food and Agriculture. Descriptive analysis was carried out to address non-price factors of the issues, andenterprise budgeting and sensitivity analyses were conducted to address price factors. The study found that the higher price of cowpeas, compared to soybeans, is a minor factor in local processors’ choice between cowpeas and soybeans. Rather, the current overwhelmingly popular use of soybeans in the weanimix-type products among the respondents was attributed to non-price factors such as the perception that soybeans are more nutritious. A main reason for the lack of availability of weanimix for mothers from lower-income families appeared to be low awareness of the product among consumers. The results of sensitivity analysis showed that typical differences in prices currently observed between weanimix-type products and Tom Brown seems to be larger than the difference in the cost of production between these products. It was also shown that the level of processing and retail margins greatly affect the retail prices of weanimix. Weanimix could be made more available to lower-income consumers if local companies expanded their outlet for the product from supermarkets to small shops or if grain and flour-type product vendors in the local markets (who currently prepare and sell Tom Brown) produced and sold weanimix. However, actions would need to be taken to help assure consumers of the quality of the product sold through market vendors.Key words: weaning food, cowpeas, soybeans, Ghan

Life course socioeconomic position and body composition in adulthood: a systematic review and narrative synthesis

INTRODUCTION: Multiple systematic reviews have investigated the relation between socioeconomic position (SEP) and body mass index (BMI) throughout the life course. However, BMI does not capture quantity and distribution of fat and muscle, which are better indicators of obesity than BMI, and have been independently linked to adverse health outcomes. Less is known about the relation between SEP and body composition, and the literature has not been reviewed. We therefore systematically reviewed the literature on the association between life course SEP and body composition in adulthood. METHODS: A protocol was registered on PROSPERO (CRD42019119937), and the review followed PRISMA guidelines. An electronic search of three databases (MEDLINE, Embase Classic + Embase and SPORTDiscus) was conducted. Original studies in the English language were included that examine the association between any recognised measure of SEP at any age and body composition (fat mass, fat-free mass, ratio and distribution) in adulthood, measured using a direct technique, i.e., not an anthropometric measure. A narrative synthesis was conducted. RESULTS: A total of 47 papers were included in the final review, none were from low-income countries (LICs). Greater advantage in childhood and adulthood was associated with lower fat levels in high-income countries (HICs). Associations in the opposite direction were found exclusively in middle-income countries (MICs). No studies in MICs reported associations for childhood SEP. For measures of lean mass, the majority of papers reported no association, or greater advantage in adulthood associated with higher lean mass, with little variation between HICs and MICs. Associations in HICs are more often observed in women than men. CONCLUSION: The results indicate that fat measures follow similar patterns to those seen for BMI, and that women in HICs are more likely to experience inequalities in both fat and lean measures. Further research in LICs and MICs is needed

Socioeconomic position and body composition in childhood in high- and middle-income countries: a systematic review and narrative synthesis

BACKGROUND: The relation between socioeconomic position (SEP) and obesity measured by body mass index (BMI), a measure of weight for height, has been extensively reviewed in children, showing consistent associations between disadvantaged SEP and higher BMI in high-income countries (HICs) and lower BMI in middle-income countries (MICs). Fat mass (FM), a more accurate measure of adiposity, and fat-free mass (FFM) are not captured by BMI, but have been shown to track from childhood to adulthood, and be important for cardiovascular health and functional outcomes in later life. It is not clear whether body composition is associated with SEP. We systematically reviewed the association between SEP and body composition in childhood. METHODS: A systematic review was carried out following PRISMA guidelines. The protocol was pre-registered with PROSPERO (CRD42019119937). Original studies in the English language, which examined the association between SEP and body composition in childhood, were included. An electronic search of three databases was conducted. Two independent reviewers carried out screening, data extraction and quality assessment. Due to heterogeneity in results, a narrative synthesis was conducted. Heterogeneity in findings according to SEP, sex, body composition measure and country income level was investigated. RESULTS: 50 papers were included, the majority from HICs. No papers were from low-income countries. Disadvantage in childhood was associated with greater FM and lower FFM in HICs, but with lower FM and lower FFM in MICs. When measures of FFM indexed to height were used there was no evidence of associations with SEP. In HICs, more studies reported associations between disadvantaged SEP and higher FM among girls comparative to boys. CONCLUSIONS: Inequalities in FM are evident in HICs and, in the opposite direction, in MICs and follow similar trends to inequalities for BMI. Inequalities in height are likely important in understanding inequalities in FFM

Effect of Mycophenolate Mofetil on Plasma Bioelements in Renal Transplant Recipients

The proper concentrations of plasma bioelements may favorably reduce the incidence of metabolic disorders, which often occur during immunosuppressive therapy. Mycophenolate mofetil (MMF) is currently one of the most frequently administered immunosuppressive agents; however, MMF treatment is often related to gastrointestinal side effects. The aim of this study was thus to verify whether the MMF treatment itself, or its metabolite pharmacokinetics, has an effect on the concentrations of plasma bioelements. To determine this, the effect of MMF on the levels of both major (sodium [Na], potassium [K], calcium [Ca], magnesium [Mg]), and trace (iron [Fe], zinc [Zn], copper [Cu]) plasma bioelements in 61 renal transplant recipients was assessed in comparison to a control group (n = 45). The pharmacokinetic parameters of mycophenolic acid were determined by the high-performance liquid chromatography method. All patients filled out a 24-h diet history questionnaire. The results showed high plasma concentrations of Fe and low plasma concentrations of Mg and Zn as compared with diagnostic norms. The patients treated with MMF had significantly lower plasma Na (P < 0.001) and significantly higher plasma Zn (P = 0.030) and Cu concentrations (P < 0.001). In conclusion, MMF treatment was found to affect plasma Fe, Zn, and Cu levels by increasing their concentrations while decreasing the plasma Na concentration. Mg and Zn deficiencies, as well as excessive Fe levels, are frequently observed irrespective of the immunosuppressive regimen applied, which suggests that monitoring of these bioelements may be favorable

Comparison of the influence of cyclosporine and tacrolimus on the pharmacokinetics of prednisolone in adult male kidney transplant recipients

Cyclosporine has been observed to precipitate cushingoid features in kidney transplant recipients already on prednisolone. Some pharmacokinetic studies have demonstrated increased prednisolone exposure in patients on cyclosporine therapy compared with azathioprine, whereas other studies have found no difference. The objective of this study was to determine whether cyclosporine impacts on prednisolone exposure as compared with tacrolimus