Protein intake adequacy among Nigerian infants, children, adolescents and women and protein quality of commonly consumed foods

Protein is important for growth, maintenance and protection of the body. Both adequacy of protein quantity and protein quality in the diet are important to guarantee obtaining all the essential amino acids. Protein-energy malnutrition is widely present in developing countries such as Nigeria and might result in stunting and wasting. Needs for protein differ depending on age and physiological status and are higher during growth, pregnancy and lactation. The present review assessed protein quantity and quality in diets of Nigerian infants, children, adolescents, and pregnant and lactating women. Literature reviews and calculations were performed to assess adequacy of Nigerian protein intake and to examine the Nigerian diet. The digestible indispensable amino acid score was used to calculate protein quality of nine Nigerian staple foods and of a mixture of foods. The Nigerian population had mostly adequate protein intake when compared with the most recent protein recommendations by the FAO (2013) and WHO/FAO/UNU (2007). An important exception was the protein intake of adolescent girls and pregnant and lactating women. Most of the assessed Nigerian plant-based staple foods were of low protein quality and predominantly lacked the amino acid lysine. The addition of animal-source foods can bridge the protein quality gap created by predominance of plant-based foods in the Nigerian diet. The methodology of this review can be applied to other low- and middle-income countries where diets are often plant-based and lack variety, which might influence protein intake adequacy.</p

Nutrients composition and sensory evaluation of white maize-based complementary food fortified with African palm weevil larvae and beetroot

Background: Cereal-based complementary foods are characterized by low protein quality contributing to high prevalence of malnutrition among children. Objective: The study evaluated the chemical composition and sensory evaluation of white maize-based complementary food fortified with African palm weevil larvae and beetroot. Methods: White maize and beetroot were obtained from the market in Abia state while African palm weevil larvae was obtained from a farm in Delta state. The white maize was processed into gruel form. The African palm weevil larvae and beetroot were processed into flour and added into the white maize in different ratios giving samples LMB (50% white maize, 40% larvae, 10% beetroot), BLM (50% white maize, 30% larvae, 20% beetroot), MLB (60% white maize, 20% larvae, 20% beetroot) and MOO (100% white maize, 0% larvae, 0% beetroot). White maize served as control. Proximate, vitamin and mineral contents of the pap were analyzed using standard methods. Sensory properties were evaluated using 9-point hedonic scale. Data was analyzed using analysis of variance. Results: The fortified samples had higher protein content: LMB (12.90g), BLM (11.43g) and MLB (10.63g) compared to the control MOO (8.51g). Energy content of the fortified samples LMB, BLM and MLB were 252.49kcal, 242.00kcal and 192.37kcal respectively higher than the MOO 102.22kcal. However, sample MOO had the most preferred sensory attributes. Conclusion: The inclusion of edible insects like the African palm weevil larvae and beetroot in complementary foods has shown prospects in combating child protein-energy malnutrition

Large scale food fortification in Nigeria: Opportunities and challenges: A position of the Nutrition Society of Nigeria

Food fortification is widely identified as a cost-effective strategy for ddressing micronutrient malnutrition&nbsp; at scale. In Nigeria, food fortification with a focus on vitamin A, iron, zinc, iodine, and other micronutrient remains a major thrust of the effort to eliminate micronutrient malnutrition. Though the step is laudable, the persisting high burden of micronutrient malnutrition suggests the need to re-think the design and implementation of the fortification programmes. This re-thinking and revision of strategy are premised on various conditions including irregular food consumption data and changing dietary patterns, poor awareness of the benefits of fortified foods, poor compliance to fortification standards, and lack of functional information system on food fortification, among others. Based on the current understanding of the nutrition and food fortification landscape in Nigeria, the Nutrition Society of Nigeria affirms that large-scale food fortification remains a cost-effective strategy to promote a healthy diet and adequate micronutrient intakes and commends the efforts of the various stakeholders especially the development partners and the government's promotion of enabling environment. However, re-thinking the implementation strategy and overhauling the fortification programme to ensure quality, transparency, and possibly digital transformation that can meet real-time data needs to guide decision-making is essential. Thus, it is necessary to ascertain the commonly consumed foods, the usually consumed portion sizes, and the current coverage of the various national micronutrient deficiencies interventions; strengthen social marketing programmes on proper handling and use of fortified foods; improve enforcement of compliance to fortifications standards; strengthen National Nutrition Information Management System to include food fortification information; explore strategies to increase the affordability of the premixes, and develop and implement a Monitoring and Evaluation framework of food fortification programmes

Effect of a Fortified Dairy-Based Drink on Micronutrient Status, Growth, and Cognitive Development of Nigerian Toddlers- A Dose-Response Study

Malnutrition results in a high prevalence of stunting, underweight, and micronutrient deficiencies. This study investigated the effect of a multi-nutrient fortified dairy-based drink on micronutrient status, growth, and cognitive development in malnourished [height-for-age z-score (HAZ) and/or weight-for-age z-score (WAZ) −3 SD] Nigerian toddlers (n = 184, 1–3 years). The product was provided in different daily amounts (200, 400, or 600 ml) for 6 months. At baseline and endline, venous blood and urine samples were collected to determine micronutrient status. Bodyweight, height, waist, and head circumference were measured, and corresponding Z-scores were calculated. The Bayley-III Screening Test was used to classify the cognitive development of the children. In a modified per-protocol (PP) population, the highest prevalence's of micronutrient deficiencies were found for vitamin A (35.5%) and selenium (17.9%). At endline, there were no significant improvements in iodine, zinc, vitamin B12, and folate status in any of the three groups. Regarding vitamin D status (25OHD), consumption of 600 and 400 ml resulted in an improved status as compared to baseline, and in a difference between the 600- and 200-ml groups. Consumption of 600 ml also increased vitamin A and selenium status as compared to baseline, but no differences were found between groups. Within the groups, WAZ, weight-for-height z-score (WHZ), and BMI-for-age z-score (BAZ) improved, but without differences between the groups. For HAZ, only the 600 ml group showed improvement within the group, but it was not different between groups. For the absolute weight, height, and head circumference only trends for differences between groups were indicated. Cognition results did not differ between the groups. Within groups, all showed a decline in the per cent of competent children for receptive language. To study the effects of a nutritional intervention on linear growth and cognition, a longer study duration might be necessary. Regarding the improvement of micronutrient status, 600 ml of fortified dairy-based drink seems most effective. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03411590?term=NCT03411590.&draw=2&rank=1, identifier: NCT03411590

Multi-Nutrient Fortified Dairy-Based Drink Reduces Anaemia without Observed Adverse Effects on Gut Microbiota in Anaemic Malnourished Nigerian Toddlers: A Randomised Dose–Response Study

Prevalence of anaemia among Nigerian toddlers is reported to be high, and may cause significant morbidity, affects brain development and function, and results in weakness and fatigue. Although, iron fortification can reduce anaemia, yet the effect on gut microbiota is unclear. This open-label randomised study in anaemic malnourished Nigerian toddlers aimed to decrease anaemia without affecting pathogenic gut bacteria using a multi-nutrient fortified dairy-based drink. The test product was provided daily in different amounts (200, 400 or 600 mL, supplying 2.24, 4.48 and 6.72 mg of elemental iron, respectively) for 6 months. Haemoglobin, ferritin, and C-reactive protein concentrations were measured to determine anaemia, iron deficiency (ID) and iron deficiency anaemia (IDA) prevalence. Faecal samples were collected to analyse gut microbiota composition. All three dosages reduced anaemia prevalence, to 47%, 27% and 18%, respectively. ID and IDA prevalence was low and did not significantly decrease over time. Regarding gut microbiota, Enterobacteriaceae decreased over time without differences between groups, whereas Bifidobacteriaceae and pathogenic E. coli were not affected. In conclusion, the multi-nutrient fortified dairy-based drink reduced anaemia in a dose-dependent way, without stimulating intestinal potential pathogenic bacteria, and thus appears to be safe and effective in treating anaemia in Nigerian toddlers

A survey among healthcare professionals from seven countries reported diverse nutritional practices of late preterm infants

Aim: To gain insight into nutritional practices and expected growth outcomes of infants born between 34 and 36 gestational weeks defined as late preterm infants (LPT). Methods: An anonymous online survey among paediatricians and neonatologists from Bangladesh, Indonesia, Mexico, Nigeria, Malaysia, Singapore and Taiwan was conducted from March until October 2020. The questionnaire consisted of 40 questions on the nutritional management and expected growth outcomes of LPT in and after-hospital care. Results: Healthcare professionals from low to high Human Development (HDI) countries (n = 322) and very high HDI countries (n = 169) participated in the survey. Human milk was the preferred feeding, resulting in an adequate growth of LPT (weight, length and occipitofrontal circumference), according to a majority of respondents (low to high HDI, 179/265, 68% vs. very high HDI, 73/143, 51%; p = 0.002). The expected growth outcome was higher after-hospital discharge. Less than half of healthcare professionals started enteral feeding during the 1st hour of life. Lactation difficulties, limited access to human milk fortifiers and donor human milk, especially among low to high HDI countries, were reported as major hurdles. Conclusion: Human milk is the first feeding choice for LPT. The diverse opinions on nutritional practices and expected growth outcomes among healthcare professionals indicate the necessity to develop general nutritional guidelines for LPT

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways