Recent evaluations of the risk of dietary protein deficiency have indicated that protein digestibility may be a key limiting factor in the provision of indispensable amino acids (IAAs), particularly ...for vulnerable populations living in challenging environments where intestinal dysfunction may exist. Since the digestion of protein occurs only in the small intestine, and the metabolic activity of colonic bacteria confounds measurements at the fecal level, there is a need to develop noninvasive protein digestibility measurements at the ileal level.
We used a dual-tracer method with stable isotopes to characterize the digestibility of uniformly labeled 13C-spirulina protein as a standard protein, in comparison to a mixture of 2H-labeled crystalline amino acids, and then demonstrated the use of this standard protein to measure the digestibility of selected legumes (chick pea and mung bean) through the use of proteins that were intrinsically labeled with 2H.
The digestibility of uniformly labeled 13C-spirulina was first measured in 6 healthy volunteers (3 males and 3 females) by feeding it along with a standard mixture of 2H-labeled amino acids, in a dual-tracer, plateau-fed test meal approach. Next, intrinsically labeled legume protein digestibility was studied with a similar dual-tracer approach, with uniformly labeled 13C-spirulina as the standard, when processed differently before consumption.
The average digestibility of IAA in spirulina protein was 85.2%. The average IAA digestibility of intrinsically 2H-labeled chick pea and mung bean protein was 56.6% and 57.7%, respectively. Dehulling of mung bean before ingestion increased the average IAA digestibility by 9.9% in comparison to whole mung bean digestibility.
An innovative, minimally invasive “dual-stable-isotope” method was developed to measure protein digestibility, in which the ingestion of an intrinsically 2H-labeled test protein along with a 13C-labeled standard protein of known digestibility allows for an accurate measure of digestion and absorption of the intrinsically labeled protein. This minimally invasive method is critical to redefining protein quality and will aid in revisiting human protein requirements in different settings and in vulnerable populations. This trial was registered at Clinical Trials Registry—India as CTRI/2017/11/010468.
Abstract
While studies on ambient fine particulate matter (PM
2.5
) exposure effect on child health are available, the differential effects, if any, of exposure to PM
2.5
species are unexplored in ...lower and middle-income countries. Using multiple logistic regression, we showed that for every 10 μg m
−3
increase in PM
2.5
exposure, anaemia, acute respiratory infection, and low birth weight prevalence increase by 10% (95% uncertainty interval, UI: 9–11), 11% (8–13), and 5% (4–6), respectively, among children in India. NO
3
-
, elemental carbon, and NH
4
+
were more associated with the three health outcomes than other PM
2.5
species. We found that the total PM
2.5
mass as a surrogate marker for air pollution exposure could substantially underestimate the true composite impact of different components of PM
2.5
. Our findings provide key indigenous evidence to prioritize control strategies for reducing exposure to more toxic species for greater child health benefits in India.
In this issue, Headey and Palloni report that an increased consumption of dairy in children belonging to households with lacto-vegetarian mothers was associated with a moderately reduced risk of ...stunting in comparison with households with nonvegetarian mothers. The increase in dairy consumption was complemented by a decreased consumption of starches, presumably sourced from cereals. The replacement of cereals with dairy in increasing wealth deciles has also been observed in other national survey. A critique might be that the model examining maternal vegetarian status did not consider the child's dietary intake; some intake of nonvegetarian foods, particularly egg, was recorded in children of vegetarian mothers, although the average quantity was lower than that in the nonvegetarian category. The authors correctly point out that in India, the qualification of "nonvegetarian" (equated with meat consumption) should not be conflated with the assumption of an adequate consumption of animal source foods (ASF). The frequency of flesh food consumption in India is often very low (3) and consequently, the average daily amount eaten is low as well.
Anaemia prevalence in pregnant women of India declined from 57.9% to 50.3% from National Family Health Survey (NFHS)-3 to NFHS-4. However, over the course of that decade, the uptake of iron and folic ...acid (IFA) supplementation for 100 days of pregnancy improved by only 15%. To understand demand side risk factors of anaemia specifically related to IFA intake, an in-depth survey was conducted on pregnant women (n = 436) in 50 villages and wards of Sirohi district of Rajasthan, India. At the demand side, consistent IFA consumption in the previous trimester was inversely and strongly associated with anaemia (OR: 0.26, 95% CI: 0.12, 0.55). Reasons for inconsistent consumption included not registering to antenatal clinic, not receiving IFA tablets from the health worker and perceived lack of need. At the supply side, an analysis of IFA stock data at various levels of the health care (n = 168) providers from primary to tertiary levels showed that 14 out of 52 villages surveyed did not have access to IFA tablets. The closest availability of an IFA tablet for 16 villages, was more than 5 km away. To improve the uptake of IFA supplementation and thereby reduce iron deficiency anaemia in pregnant women, a constant supply of IFA at the village or sub-centre level, where frontline workers can promote uptake, should be ensured.
Maternal vitamin B12 supplementation to improve early neurodevelopment in infants has been proposed for some time now because vitamin B12 is a neurotropic vitamin, and infant neurodevelopment and ...growth are important dimensions for attained human capital and a healthy and successful adult life. Furthermore, there was no benefit of vitamin B12 supplementation for the more robust electrophysiological measures (event-related potentials) at age 72 months.4 In another smaller trial from rural western India, a lower dose of vitamin B12 supplementation (2 μg per day) from preconception until birth resulted in improved maternal and cord blood vitamin B12 status.5 In this trial, cognition and language domains at age 24–42 months were better in infants of mothers who received just vitamin B12 supplements, but not in infants of mothers who received the same dose of vitamin B12 and other micronutrients (eg, vitamin A, vitamin D, vitamin E, vitamin C, vitamin B1, vitamin B2, vitamin B3, vitamin B6, zinc, copper, selenium, and iodine).5 These confusing findings could be related to the small numbers of mothers and infants studied, but also highlight the need for serial, robust, and objective neurodevelopment outcome measurements. Adverse associations have also been reported in a human study with high plasma vitamin B12 concentrations (increased mortality risk)7 and in an animal study with high cyanocobalamin doses (greater pathogen colonisation).8 The trial had no other noteworthy weaknesses, but several strengths, despite its implementation in difficult circumstances during the global COVID-19 pandemic.
South Asian body composition is characterized by higher body fat at any given BMI. While this does not occur during fetal growth, it is important to understand if inappropriate fat accretion then ...begins in the first 2 years in Indian infants.
The fat mass (FM) and fat-free mass (FFM) of healthy term newborns was evaluated at 12 days, 3.5 months, 1 year, and 2 years, by deuterium oxide (D
O) dilution. The effect of being born small versus appropriate for gestational age (SGA vs. AGA), and accelerated early growth pattern on FM and FFM accretion was also investigated.
Newborns (262 total, 150 males) with mean birth weight of 2863 ± 418 g were enrolled. FM percentage (FM%) assessed by D
O in 144, 166, 81, and 115 infants at 12 days, 3.5 months, 1 year, and 2 years respectively, was11.6 ± 6.8, 21.1 ± 7.0, 17.9 ± 8.2 and 22.4 ± 9.5%. Boys had higher FFM at all ages, but FM% was similar in both sexes. Children born SGA had similar FM index (FMI) but a lower FFM index (FFMI) at 2 years compared with those born AGA. Infants with catch-up growth between 0 and 2 years had higher FMI at 2 years compared to those without. Infants in the present study had a lower FM% and FMI till 1 year of age in comparison to previous studies from other countries, but had an increase in adiposity between 1 and 2 years, whereas in previous studies FM% remained stable or declined between 1 and 2 years of age.
There was an upward inflection in the curve of FM% and FMI between 1 and 2 years of age in the present study, which may represent an early adiposity rebound. Further longitudinal body composition data for Indian infants as well as those of other ethnicities but with low birth weight will clarify whether early accelerated growth pattern contributes to greater accrual of fat rather than lean mass during childhood.
Recommended dietary allowances for fat and fatty acid (FA) intakes are set on global standards aimed at prevention of lifestyle diseases. Yet, the fat composition of a diet is both ethnic/region ...specific as well as income dependent. Indian diets are predominantly vegetarian and relatively low in fat. Furthermore, the main sources of fat are of plant origin rather than animal origin. This results in a diet that is relatively low in saturated FA, high in n-6 polyunsaturated fatty acids (PUFA), and very low in n-3 PUFA. Though this appears as a good dietary composition as per global standards, the undeniable increase in the incidence of obesity, diabetes and cardiovascular diseases in India begs for an explanation. In this context, the current article is aimed at reopening the debate on fat intakes in Indian diets, with a focus on a balance between fats, carbohydrates and proteins, rather than an emphasis on individual macronutrients.
Biomarkers of micronutrient status vary with inflammation, and can be corrected by a regression-based approach Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) using ...measured concentrations of inflammation biomarkers, e.g., C-reactive protein (CRP) and/or α1-acid-glycoprotein (AGP). However, this is confounded when inflammation is measured with multiple assays with variable limits of detection (LOD) and lower limits of quantification (LLOQ).
We aimed to develop a probability approach for the estimation of prevalence of micronutrient deficiency using the distribution of true serum/plasma micronutrient concentrations in the population.
Left-censoring of an inflammation biomarker due to varying values of LOD or LLOQ was addressed by estimating the distribution of the inflammation biomarker at concentrations lower than the LOD and using this for the probability estimation of prevalence of nutrient deficiency. This method was evaluated using 2 publicly available data sets for children <5 y old: BRINDA and the Indian Comprehensive National Nutrition Survey. Each data set included measures of serum ferritin (SF), vitamin A, zinc, and CRP measured using different assays with variable LLOQs.
The empirical distribution of SF after correction for CRP and AGP by the BRINDA method was comparable with the estimated probability distribution of SF, yielding similar estimates of iron deficiency prevalence when evaluated in the BRINDA data (17.4%; 95% CI: 15.2%, 19.7% compared with 16.8%; 95% CI: 13.9%, 20.0%; BRINDA compared with the probability method). The BRINDA method–adjusted iron deficiency prevalence was linearly associated with the proportion of left-censored CRP data, whereas these were not associated in the probability method. In the Indian survey data, estimates of prevalence of iron and zinc deficiency were comparable but vitamin A deficiency was lower by the probability method (17.6%; 95% CI: 16.7%, 20.2% compared with 15.7%; 95% CI: 15.2%, 16.3%; BRINDA compared with the probability method).
The proposed probability method is a robust alternate approach to the estimation of the prevalence of nutrient deficiency with left-censored inflammation biomarker data.
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