Enhancing household soybean processing and utilization in the Eastern Province of Zambia, a concurrent triangulation study design.

The purpose of this study was to establish best ways of improving household soybean processing and utilization in selected districts in the Eastern Province of Zambia. This was a concurrent triangulation study design, nested with a cross sectional survey and barrier analysis. Up to 1,237 households and 42 key informants participated in the quantitative and qualitative studies respectively. Quantitative data was analysed using Stata MP 15 software (StataCorp, College Station, TX, USA). NVIVO QSR10 software (QSRInt, Melbourne Australia) was used to organize qualitative data which was later analysed thematically. In this study whole soybean processing and utilization in eastern province was at 48%. However, accessibility to soybean for household consumption throughout the year was negligible (0.29%). Based on the food systems an interplay of factors influenced soybean processing and utilization. In the food environment, a ready-made Textured Soya Protein mainly imported [1,030/1237(83%)] and a milled whole soybean-maize blend AOR 816.37; 95%CI 110.83 to 6013.31 were preferred. Reports of labour intensity, hard to cook properties, coarse milling and beany flavour with associated anti-nutrients negatively influenced whole soybean utilization. In the enabling environment, soybean production AOR 4.47; 95%CI 2.82 to 7.08 increased the chances of utilization. Lack of inputs, poor access to affordable credit and lack of ingredients were deleterious to utilization. Low coverage of existing projects and poor access to technologies were other adverse factors. Among the Socioeconomic factors, a higher social hierarchy shown by owning a bed AOR 1.75; 95%CI 1.22 to 2.49, belonging to the Chewa community AOR 1.16; 95%CI 1.08 to 0 1.25, gender of household head particularly male AOR 1.94; 95%CI 1.21 to 3.13, off farm income and livestock ownership were supportive to soybean utilization. Unfavourable factors were; belonging to any of the districts under study AOR 0.76; 95%CI 0.58 to 0.98, lack of knowledge (55.65%), low involvement of the male folks AOR 0.47; 95%CI 0.30 to 0.73 and belonging to a female headed household AOR 1.94; 95%CI 1.21 to 3.13. Age, time and household size constraints as well as unreliable soybean output markets, lack of land, poor soils in some wards and poor soybean value chain governance were other negative factors. Immediately in the food environment there is need to boost milling of whole soybean while strengthening cooking demonstrations, correct processing, incorporation of soybean in the local dishes and conducting acceptability tests. In the enabling environment, there should be access to inputs, affordable credit facilities and subsidized mineral fertilisers. Post-harvest storage, collective action with full scale community involvement and ownership should be heightened. Socioeconomic approaches should target promotion of soybean processing and utilization among all ethnic groups, participation of male folks and female headed households as well as advocating for increased nutrition sensitive social protection. In the medium or long term, capacity building, market development, import substitution agreements, creation of new products, development of cottage industries, information exchange and inter district trade as well as more public-private partnerships and more local private sector players should be bolstered. Lastly farm diversification should be supported

Comparison of an interactive 24-h recall and weighed food record for measuring energy and nutrient intakes from complementary foods among 9-10-month-old Malawian infants consuming lipid-based nutrient supplements.

Fortifying complementary foods with lipid-based nutrient supplements (LNS) may improve energy and nutrient intakes of infants at risk for undernutrition. We aimed to determine the relative validity of an interactive 24-h recall (i-24-HR) for assessing the impact of an LNS intervention on dietary intakes of energy and nutrients among rural Malawian 9-10-month-old infants (n 132) participating in the International Lipid-Based Nutrient Supplements Dose (iLiNS-DOSE) trial. Dietary data were collected for the same day via i-24-HR and weighed food records. Inter-method agreements were estimated overall and by intervention group, using Bland-Altman plots and paired t tests; measurement error models (differential error); and percentage of food omissions and intrusions were estimated. Overall, inter-method differences in mean intakes of energy and most nutrients were not significant. When stratified by group, recalled energy intakes were under-estimated (-368 kJ; P=0·01) in the control but not in the intervention group (-42 kJ; P=0·6). This differential reporting error was related to an over-estimation of recalled LNS (8·1 v. 4·5 g; P30 % eating occasions) omissions were milk/fish/eggs, starchy roots/vegetables and sweetened snacks. Common intrusions were milk/yogurt. Starchy staples and LNS were recalled when consumed (>85 %) (i.e. matched). These results emphasise the importance of considering differential error when interpreting dietary results in LNS trials

The impact of climate change on food systems, diet quality, nutrition, and health outcomes: A narrative review

Many consequences of climate change undermine the stability of global food systems, decreasing food security and diet quality, and exposing vulnerable populations to multiple forms of malnutrition. The emergence of pandemics such as Covid-19 exacerbate the situation and make interactions even more complex. Climate change impacts food systems at different levels, including changes in soil fertility and crop yield, composition, and bioavailability of nutrients in foods, pest resistance, and risk of malnutrition. Sustainable and resilient food systems, coupled with climate-smart agriculture, are needed to ensure sustainable diets that are adequately diverse, nutritious, and better aligned with contextual ecosystem functions and environmental conservation. Robust tools and indicators are urgently needed to measure the reciprocal food systems-climate change interaction, that is further complicated by pandemics, and how it impacts human health

Impact of small quantity lipid-based nutrient supplements on infant and young child feeding practices at 18 months of age: results from four randomized controlled trials in Africa.

Optimal infant and young child feeding (IYCF) practices can help ensure nutrient adequacy and support healthy growth and development. Small-quantity lipid-based nutrient supplements (SQ-LNS) have been proposed to help fill nutrient gaps, but little is known about the impact of provision of SQ-LNS on breastfeeding or complementary feeding practices. In the context of four coordinated randomized controlled nutrient supplementation trials in diverse sites in Africa, we compared IYCF practices at infant age 18 months (after 9-12 months of supplementation) between those receiving and not receiving SQ-LNS. Practices were assessed by caregiver recall. Continued breastfeeding ranged from 74% (Ghana site) to 97% (Burkina Faso site) and did not differ between groups in any site; prevalence of frequent breastfeeding also did not differ. In two sites (Burkina Faso and Malawi), infants receiving SQ-LNS were more likely to meet the World Health Organization recommendations for frequency of feeding (percentage point differences of 12-14%, P < 0.0001 and P = 0.005, respectively; the remaining two sites did not have data for this indicator). Most indicators of infant dietary diversity did not differ between groups in any site, but in the same two sites where frequency of feeding differed, infants receiving SQ-LNS were less likely to have low frequency of consumption of animal-source foods in the previous week (percentage point differences of 9-19% for lowest tertile, P = .02 and P = 0.04, respectively). We conclude that provision of SQ-LNS did not negatively impact self-reported IYCF practices and may have positively impacted frequency of feeding

Lipid-Based Nutrient Supplements During Pregnancy and Lactation Did Not Affect Human Milk Oligosaccharides and Bioactive Proteins in a Randomized Trial.

BACKGROUND: Human milk oligosaccharides (HMOs) and bioactive proteins are beneficial to infant health. Recent evidence suggests that maternal nutrition may affect the amount of HMOs and proteins in breast milk; however, the effect of nutrient supplementation on HMOs and bioactive proteins has not yet been well studied. OBJECTIVE: We aimed to determine whether lipid-based nutrient supplements (LNSs) affect milk bioactive protein and HMO concentrations at 6 mo postpartum in women in rural Malawi. These are secondary outcomes of a previously published randomized controlled trial. METHODS: Women were randomly assigned to consume either an iron and folic acid capsule (IFA) daily from ≤20 wk gestation until delivery, followed by placebo daily from delivery to 6 mo postpartum, or a multiple micronutrient (MMN) capsule or LNS daily from ≤20 wk gestation to 6 mo postpartum. Breast milk concentrations of total HMOs, sialylated HMOs, fucosylated HMOs, lactoferrin, lactalbumin, lysozymes, antitrypsin, immunoglobulin A, and osteopontin were analyzed at 6 mo postpartum (n = 647). Between-group differences in concentrations and in proportions of women classified as having low concentrations were tested. RESULTS: HMO and bioactive protein concentrations did not differ between groups (P > 0.10 for all comparisons). At 6 mo postpartum, the proportions of women with low HMOs or bioactive proteins were not different between groups except for osteopontin. A lower proportion of women in the IFA group had low osteopontin compared with the LNS group after adjusting for covariates (OR: 0.5; 95% CI: 0.3, 0.9; P = 0.016). CONCLUSION: The study findings do not support the hypothesis that supplementation with an LNS or MMN capsule during pregnancy and postpartum would increase HMO or bioactive milk proteins at 6 mo postpartum among Malawian women. This trial was registered at clinicaltrials.gov as NCT01239693

Lipid-Based Nutrient Supplements Increase Energy and Macronutrient Intakes from Complementary Food among Malawian Infants.

BACKGROUND: Low intakes of good-quality complementary foods (CFs) contribute to undernutrition and consequently negatively affect health, growth, and development. Lipid-based nutrient supplements (LNSs) are designed to ensure dietary adequacy in micronutrients and essential fatty acids and to provide some energy and high-quality protein. In populations in which acute energy deficiency is rare, the dose-dependent effect of LNSs on CF intakes is unknown. OBJECTIVE: The objective of this study was to evaluate the difference in energy and macronutrient intakes from CF between a control (no supplement) group and 3 groups that received 10, 20, or 40 g LNS/d. METHODS: We collected repeated interactive 24-h dietary recalls from caregivers of rural Malawian 9- to 10-mo-old infants (n = 748) to estimate dietary intakes (LNS and all non-breast-milk foods) of energy and macronutrients and their dietary patterns. All infants were participating in a 12-mo randomized controlled trial to investigate the efficacy of various doses of LNS for preventing undernutrition. RESULTS: Dietary energy intakes were significantly higher among infants in the LNS intervention groups than in the control group (396, 406, and 388 kcal/d in the 10-, 20-, and 40-g LNS/d groups, respectively, compared with 345 kcal/d; each pairwise P < 0.05), but no significant differences were found in energy intakes between groups who were administered the different LNS doses (10 g LNS/d compared with 20 g LNS/d: P = 0.72; 10 g LNS/d compared with 40 g LNS/d: P ≥ 0.67; 20 g LNS/d compared with 40 g LNS/d: P = 0.94). Intakes of protein and fat were significantly higher in the LNS intervention groups than in the control group. No significant intergroup differences were found in median intakes of energy from non-LNS CFs (357, 347, and 296 kcal/d in the 10-, 20-, and 40-g LNS/d groups, respectively, compared with 345 kcal/d in the control group; P = 0.11). CONCLUSION: LNSs in doses of 10-40 g/d increase intakes of energy and macronutrients among 9- to 10-mo-old Malawian infants, without displacing locally available CFs. This trial was registered at clinicaltrials.gov as NCT00945698

Lisäravinnon vaikutus lasten saaman rintamaidon määrään ja yhteydet kasvuun ja kehitykseen Malawissa

Lisäravinnon vaikutus lasten saaman rintamaidon määrään ja yhteydet kasvuun ja kehitykseen Malawissa Maailmanlaajuisesti lyhytkasvuisten lasten osuus on vähentynyt ja on nyt 27 prosenttia. Malawissa ei ole tapahtunut merkittävää edistymistä vaan 37 prosenttia alle viisivuotiaista lapsista on ikäänsä nähden lyhytkasvuisia. Eräs lyhytkasvuisuutta lisäävä tekijä Malawissa on se, että rintaruokinta ja lisäruokinta eivät tue lasten kasvua parhaalla mahdollisella tavalla. Kuitenkin puuttuu tutkimustietoa siitä, kuinka alle 6 kuukauden ikäisen lapsen saaman rintamaidon määrä vaikuttaa kasvuun ja kehykseen myöhemmällä iällä. Tällä tutkimuksella oli neljä tavoitetta. Kaksi ensimmäistä liittyy SQ-LNS (small-quantity lipid-based nutrient supplement) – lisäravinnon antamiseen. Selvitin lisäravinnon vaikutusta lapsen saaman rintamaidon ja lapsen saaman energian ja ravinteiden määrään. Kolmas tavoite oli selvittää muita tekijöitä, jotka vaikuttavat lapsen saaman rintamaidon määrään ja neljäs tavoite käsitteli sitä, miten rintamaidon määrä on yhteydessä 9-18 kuukauden ikäisten lasten kasvuun ja kehitykseen. Mittasimme lapsen saaman rintamaidon määrää äidin juoman raskasvety-liuoksen perusteella ja ravinnon määrää 24-tunnin raportoinnilla (24 hour dietary recall method). Lapsen kehityksen arvioimiseen sovellettin kahta vakiintunutta tutkimusmenetelmää (Kilifi Developmental Inventory ja MacArthur-Bates Communicative Development Inventory). Tutkimus toteutettiin Mangochin läänissä, Malawissa, eteläisessä Afrikassa. Rintamaidon määrä 9-10 kuukauden ikäisillä lapsilla ei ollut tilastollisesti merkitsevästi erilainen lisäravintoa saaneilla ja verrokeilla. Sen sijaan SQ-LNS lisäravintoa saaneiden lasten energian, proteiinin ja rasvojen saanti oli tilastollisesti merkitsevästi suurempaa kuin verrokkiryhmän lasten. Emme kuitenkaan havainneet eroja lasten muista ruuista saaman energian ja ravinteiden osuudessa, joten tutkimuksessa annettu lisäravinto ei vähentänyt lasten ruokkimista paikallisesti valmistetuilla ruuilla. Lapsen paino ja äidin pituus, ikä ja koulutuksen määrä ennustivat lapsen saaman rintamaidon määrää. Arvioitaessa rintamaidon määrän ja kasvun ja kehityksen yhteyttä usean selittäjän regressiolla, 9-10 kuukauden ikäisen lapsen saama rintamaidon määrä ei ollut tilastollisesti merkitsevästi yhteydessä kasvuun 12 ja 18 kuukauden välissä tai kehitykseen 18 kuukauden iässä. Rintamaidon määrä oli kuitenkin yhteydessä lapsen pituuteen (length for age z score) 12 kuukauden iässä. Johtopäätöksenä totean, että SQ-LNS-lisäravinteen lisääminen lapsen ruokavalion ei vähentänyt lapsen saamaan rintamaidon määrää 9-10 kuukauden iässä tai korvannut tämän ikäisille lapsille tarjottavia muita ruokia. Lasten saama rintamaidon määrä ei myöskään ollut yhteydessä heidän kasvuunsa tai kehitykseensä varhaislapsuudessa. Lapsen saaman rintamaidon pääasiallisia ennustavia tekijöitä olivat hänen oma painonsa sekä äidin pituus, ikä ja koulutus. Tuloksiin perustuen mahdollisimman hyvän rintaruokinnan tukeminen ja edistäminen pitäisi pitää osana terveysvalistusta ja samalla kun parannetaan lasten lisäruokintaa SQ-LNS-tyyppisiä tuotteita käyttäen.Intake of breast milk among 9–10 months old infants (n=359) was not significantly different between those supplemented with SQ-LNS at a dose ranging from 10 to 40g/d and infants in the control group who did not receive SQ-LNS. The overall mean (SD) and the mean (SD) daily breast milk intake of infants in the control arm was 752.0 (244) and 730.6 (226) g respectively. The differences (95% CIs) in mean intake of infants provided with 10, 20, or 40 g SQ-LNS/d, compared with controls, were +62 (-218, +143), +30 (-240, +99), and +2 (-268, +72) g/d, respectively. Children in the SQ-LNS intervention groups had significantly higher dietary energy, protein and fat intakes than those in the control group. However, no significant differences were observed in median intakes of energy from non-SQLNS complementary foods implying that SQ-LNSs increased intakes of energy and macronutrients without displacing locally available complementary foods. To study the predictors of breast milk intake, path analysis was performed prior to conducting regression analysis, in order to establish potential causal relationships between variables. The regression analysis demonstrated that infant breast milk intake was significantly predicted by infant weight, and the following maternal factors, height, age and education. An increase in body weight of an infant by 1kg was associated with an increase in breast milk intake of 68g per day. On the other hand, an additional year spent in school by the mother was associated with a reduction in breast milk intake by about 11g per day. An increase in maternal age by a year was associated with a reduction in amount of breast milk intake by 6.5 grams, while an additional centimeter of maternal height was associated with an increase in breast milk intake by almost 7 grams. The association between breast milk amount and growth and development was assessed using both univariate and multiple regression analyses. In multiple regression, breast milk intake (g/d) at 9–10 months was not associated with either growth between 12 and 18 months or development at 18 months, but was positively associated with attained length for age-z score at 12 months. In conclusion supplementation of complementary foods with SQ-LNS did not result in reduction in breast milk intake at 9–10 months of age and displacement of complementary foods among rural Malawian infants. Amount of breast milk intake during later infancy was not associated with growth and development in early childhood. Infant weight, maternal height, age and education were the main predictors of breast milk intake among Malawian infants