Projected health effects of realistic dietary changes to address freshwater constraints in India : a modelling study

Acknowledgements This study forms part of the Sustainable and Healthy Diets in India project supported by the Wellcome Trust's Our Planet, Our Health programme (grant number 103932). LA's PhD is funded by the Leverhulme Centre for Integrative Research on Agriculture and Health. SA is supported by a Wellcome Trust Capacity Strengthening Strategic Award-Extension phase (grant number WT084754/Z/08/A). We would like to thank Zaid Chalabi (London School of Hygiene & Tropical Medicine) for providing valuable guidance on the modelling methods.Peer reviewedPublisher PD

Limited Supply of Protein and Lysine Is Prevalent among the Poorest Households in Malawi and Exacerbated by Low Protein Quality

We estimated dietary supplies of total and available protein and indispensable amino acids (IAAs) and predicted the risk of deficiency in Malawi using Household Consumption and Expenditure Survey data. More than half of dietary protein was derived from cereal crops, while animal products provided only 11%. The supply of IAAs followed similar patterns to that of total proteins. In general, median protein and IAA supplies were reduced by approximately 17% after accounting for digestibility, with higher losses evident among the poorest households. At population level, 20% of households were at risk of protein deficiency due to inadequate available protein supplies. Of concern was lysine supply, which was inadequate for 33% of households at the population level and for the majority of the poorest households. The adoption of quality protein maize (QPM) has the potential to reduce the risk of protein and lysine deficiency in the most vulnerable households by up to 12% and 21%, respectively

Effectiveness of Agronomic Biofortification Strategy in Fighting against Hidden Hunger

Micronutrient deficiencies (MNDs), also known as hidden hunger, affect more than a quarter of the global population. Agronomic biofortification helps to increase the concentration of a target mineral in food crops and improve human mineral dietary intake. It is a means of providing nutrient-dense foods to a larger population, especially among rural resource-poor settings, providing that they have access to mineral fertilizers. However, the feasibility of agronomic biofortification in combating hidden hunger depends on several factors in addition to fertilizer access, including crop type, genotype, climate, soils, and soil mineral interactions. Consideration of its effectiveness in increasing human mineral intake to the daily requirements and the improvement of human health and the cost-effectiveness of the program is also important. In this paper, we review the available literature regarding the potential effectiveness and challenges of agronomic biofortification to improve crop micronutrient concentrations and reduce hidden hunger

Site-specific factors influence the field performance of a Zn-biofortified wheat variety

Background: Biofortification of wheat with zinc (Zn) through breeding and agronomy can reduce Zn deficiencies and improve human health. ‘High-Zn’ wheat varieties have been released in India and Pakistan, where wheat is consumed widely as a dietary staple. The aim of this study was to quantify the potential contribution of a ‘high-Zn’ wheat variety (Triticum aestivum L. var. Zincol-2016) and Zn fertilisers to improving dietary Zn supply under field conditions in Pakistan. Methods: Grain Zn concentration of Zincol-2016 and local reference varieties were determined at three sites of contrasting soil Zn status: Faisalabad (Punjab Province; diethylenetriamine pentaacetate- (DTPA-)extractable Zn, 1.31 mg kg-1 soil; gross plot size 13.3 m2; n=4; reference var. Faisalabad-2008), Islamabad (Capital Territory; 0.48 mg kg-1; 4.6 m2; n=5; reference var. NARC-2011), and Pir Sabak (Khyber Pakhtunkhwa, KPK, Province; 0.12 mg kg-1 soil; 9.1 m2; n=4; reference vars. Pirsabak-2015, Wadhan-2017). Eight Zn fertiliser treatment levels were tested using a randomised complete block design: control; soil (5 or 10 kg ha-1 ZnSO4.H2O; 33% Zn applied at sowing); foliar (0.79 or 1.58 kg of ZnSO4.H2O ha-1 applied as a 250 L ha-1 drench at crop booting stage); three soil foliar combinations. Results: At the Faisalabad site, the grain Zn concentration of Zincol-2016 was greater than Faisalabad-2008, with no yield penalty. Zincol-2016 did not have larger grain Zn concentrations than reference varieties used at Islamabad or Pir Sabak sites, which both had a lower soil Zn status than the Faisalabad site. Foliar Zn fertilisation increased grain Zn concentration of all varieties at all sites. There were no significant effects of soil Zn fertilisers, or variety·fertiliser interactions, on grain Zn concentration or yield. Conclusions: Environment and management affect the performance of ‘high-Zn’ wheat varieties, and these factors needs to be evaluated at scale to assess the potential nutritional impact of Zn biofortified crops. Designing studies to detect realistic effect sizes for new varieties and crop management strategies is therefore an important consideration. The current study indicated that nine replicate plots would be needed to achieve 80% power to detect a 25% increase in grain Zn concentration

A pilot survey of selenium status and its geospatial variation among children and women in three rural districts of Zimbabwe

IntroductionSelenium (Se) deficiency is increasingly recognized as a public health problem in sub-Saharan Africa.MethodsThe current cross-sectional study assessed the prevalence and geospatial patterns of Se deficiency among children aged 6–59 months (n = 741) and women of 15–49 years old (n = 831) selected by simple random sampling in rural Zimbabwe (Murewa, Shamva, and Mutasa districts). Venous blood samples were collected and stored according to World Health Organization guidelines. Plasma Se concentration was determined by inductively coupled plasma-mass spectrometry.ResultsMedian, Q1, and Q3 plasma Se concentrations were 61.2, 48.7, and 73.3 μg/L for women and 40.5, 31.3, and 49.5 μg/L for children, respectively. Low plasma Se concentrations (9.41 μg/L in children and 10.20 μg/L in women) indicative of severe Se deficiency risk was observed. Overall, 94.6% of children and 69.8% of women had sub-optimal Se status defined by plasma Se concentrations of <64.8 μg/L and <70 μg/L, respectively.DiscussionHigh and widespread Se deficiency among women and children in the three districts is of public health concern and might be prevalent in other rural districts in Zimbabwe. Geostatistical analysis by conditional kriging showed a high risk of Se deficiency and that the Se status in women and children in Murewa, Shamva, and Mutasa districts was driven by short-range variations of up to ⁓12 km. Selenium status was homogenous within each district. However, there was substantial inter-district variation, indicative of marked spatial patterns if the sampling area is scaled up. A nationwide survey that explores the extent and spatial distribution of Se deficiency is warranted

Community Perceptions of Zinc Biofortified Flour during an Intervention Study in Pakistan

Zinc-biofortified flour may be a cost-effective approach to improve zinc status of populations in low-resource settings. The success of biofortification programmes is subject to acceptability and uptake by consumers. This study explored community leaders’ and community members’ (n = 72) experiences and attitudes towards the flour provided during a cluster randomised controlled trial of zinc biofortified wheat in rural Pakistan (BiZiFED2). Focus group discussions (n = 12) were conducted and thematic analysis applied using an inductive, semantic, contextualist approach. Five themes were identified: (1) Contribution to food security; (2) Better sensory and baking properties than local flour; (3) Perceived health benefits; (4) Willingness to pay for the flour; and (5) Importance of trusted promoters/suppliers. Although the participants were blind to whether they had received control or biofortified flour, referred to collectively as “study flour”, the results indicated that the study flour performed well in terms of its taste and bread making qualities, with no adverse reports from participants in either arm of the BIZIFED2 RCT. Participants suggested that they would buy the biofortified wheat if this was available at a fair price due to perceived health benefits, reporting positive sensory characteristics and cooking attributes when compared to the flour available in the local markets. Overall, there was a positive reception of the programme and flour among the participants, and members of the community hoped for its continuation and expansion

Good soil management can reduce dietary zinc deficiency in Zimbabwe

Dietary zinc (Zn) deficiency is widespread in sub-Saharan Africa (SSA) with adverse impacts on human health. Agronomic biofortification with Zn fertilizers and improved soil fertility management, using mineral and organic nutrient resources, has previously been shown to increase Zn concentration of staple grain crops, including maize. Here, we show the potential of different soil fertility management options on maize crops to reduce dietary Zn deficiency in Zimbabwe using secondary data from a set of survey and field experiments. An ex-ante approach was used, informed by published evidence from studies in three contrasting smallholder production systems in Zimbabwe. To estimate current Zn deficiency in Zimbabwe, data on dietary Zn supply from non-maize sources from the Global Expanded Nutrient Supply (GENuS) data set were linked to maize grain Zn composition observed under typical current soil fertility management scenarios. A baseline dietary Zn deficiency prevalence of 68% was estimated from a reference maize grain Zn composition value of 16.6 mg kg-1 and an estimated dietary Zn intake of 9.3 mg capita-1 day-1 from all food sources. The potential health benefits of reducing Zn deficiency using different soil fertility management scenarios were quantified within a Disability Adjusted Life Years (DALYs) framework. A scenario using optimal mineral NPK fertilizers and locally available organic nutrient resources (i.e. cattle manure and leaf litter), but without additional soil Zn fertilizer applications, is estimated to increase maize grain Zn concentration to 19.3 mg kg-1. This would reduce the estimated prevalence of dietary Zn deficiency to 55%, potentially saving 2,238 DALYs year-1. Universal adoption of optimal fertilizers, to include soil Zn applications and locally available organic leaf litter, is estimated to increase maize grain Zn concentration to 32.4 mg kg-1 and reduce dietary Zn deficiency to 16.7%, potentially saving 9,119 DALYs year-1. Potential monetized yield gains from adopting improved soil fertility management range from 49-to 158-fold larger than the potential reduction in DALYs, if the latter are monetized using standard methods. Farmers should be incentivized to adopt improved soil fertility management to improve both crop yield and quality

Differences in the nutritional quality of improved finger millet genotypes in Ethiopia

Improved crop genotypes are constantly introduced. However, information on their nutritional quality is generally limited. The present study reports the proximate composition and the concentration and relative bioavailability of minerals of improved finger millets of different genotypes. Grains of finger millet genotypes (n = 15) grown in research station during 2019 and 2020 in Ethiopia, and replicated three times in a randomized complete block design, were analysed for proximate composition, mineral concentration (iron, zinc, calcium, selenium), and antinutritional factors (phytate, tannin and oxalate). Moreover, the antinutritional factors to mineral molar ratio method was used to estimate mineral bioavailability. The result shows a significant genotypic variation in protein, fat and fibre level, ranging from 10% to 14.6%, 1.0 to 3.8%, and 1.4 to 4.6%, respectively. Similarly, different finger millets genotypes had significantly different mineral concentrations ranging from 3762 ± 332 to 5893 ± 353mgkg−1 for Ca, 19.9 ± 1.6 to 26.2 ± 2.7mgkg−1 for Zn, 36.3 ± 4.6 to 52.9 ± 9.1mgkg−1 for Fe and 36.6 ± 11 to 60.9 ± 22µgkg−1 for Se. Phytate (308–360µgg−1), tannin (0.15–0.51mgg−1) and oxalate (1.26–4.41mgg−1) concentrations were also influenced by genotype. Antinutritional factors to minerals molar ratio were also significantly different by genotypes but were below the threshold for low mineral bioavailability. Genotype significantly influenced mineral and antinutritional concentrations of finger millet grains. In addition, all finger millet genotypes possess good mineral bioavailability. Especially, the high Ca concentration in finger millet, compared to in other cereals, could play a vital role to combating Ca deficiency. The result suggests the different finger millet genotypes possess good nutrient content and may contribute to the nutrition security of the local people

Examining the effectiveness of consuming flour made from agronomically biofortified wheat (Zincol-2016/NR-421) for improving Zn status in women in a low resource setting Pakistan: Study protocol for a randomised, double blind, controlled cross over trial (BiZiFED)

Introduction: Dietary zinc (Zn) deficiency is a global problem, particularly in low and middle-income countries where access to rich, animal-source foods of Zn is limited due to poverty. In Pakistan, Zn deficiency affects over 40% of the adult female population, resulting in sub-optimal immune status and increased likelihood of complications during pregnancy. Methods and analysis: We are conducting a double blind, randomised controlled feeding study with crossover design, in a low resource setting in Pakistan. Households were provided with flour milled from genetically and agronomically biofortified grain (Zincol-2016/NR-421) or control grain (Galaxy-2013. Fifty households were recruited. Each household included a female aged 16-49 years who is neither pregnant nor breastfeeding, and not currently consuming nutritional supplements. These women were the primary study participants. All households were provided with control flour for an initial 2-week baseline period, followed by an 8-week intervention period where 25 households receive biofortified flour (Group A) and 25 households receive control flour (Group B). After this eight-week period, Group A and B crossed over, receiving control and biofortified flour respectively for eight weeks. Tissue (blood, hair and nails) have been collected from the women at five time points: baseline, mid and end of period 1, mid and end of period 2. Ethics and dissemination: Ethical approval was granted from the lead University (reference number: STEMH 697 FR) and the collaborating institution in Pakistan. The final study methods (including any modifications) will be published in peer reviewed journals, alongside the study outcomes on completion of the data analysis. In addition, findings will be disseminated to the scientific community via conference presentations and abstracts and communicated to the study participants through the village elders at an appropriate community forum

Impact of zinc and iron agronomic biofortification on grain mineral concentration of finger millet varieties as affected by location and slope

Background: Food crop micronutrient concentrations can be enhanced through agronomic biofortification, with the potential to reduce micronutrient deficiencies among rural population if they have access to fertilizers. Here we reported the impact of agronomic biofortification on finger millet grain zinc (Zn) and iron (Fe) concentration. Methods: A field experiment was conducted in farmers’ fields in Ethiopia in two locations; over two seasons in one district (2019 and 2020), and over a single season (2019) in a second district. The experimental design had 15 treatment combinations comprising 3 finger millet varieties and 5 soil-applied fertilizer treatments: (T1) 20 kg ha−1 FeSO4 + 25 kg ha−1 ZnSO4 + NPKS; (T2) 25 kg ha−1 ZnSO4 + NPKS; (T3) NPKS; (T4) 30% NPKS; (T5) 20 kg ha−1 FeSO4 + NPKS. The treatments were studied at two slope positions (foot and hill), replicated four times in a randomized complete block design. Results: Grain Zn concentration increased by 20% in response to Fe and Zn and by 18.9% due to Zn addition. Similarly, grain Fe concentration increased by 21.4% in T1 and 17.8% in T5 (Fe). Zinc fertilizer application (p < 0.001), finger millet variety (p < 0.001), and an interaction of Fe and Zn had significant effect on grain Zn concentration. Iron fertilizer (p < 0.001) and interactive effect of Fe fertilizer and finger millet variety (p < 0.01) had significant effects on grain Fe concentration. Location but not slope position was a source of variation for both grain Zn and Fe concentrations. Conclusion: Soil application of Zn and Fe could be a viable strategy to enhance grain Zn and Fe concentration to finger millet grain. If increased grain Zn and Fe is bioavailable, it could help to combat micronutrient deficiencies