No abstract

Previously, we have found that subclinical breast inflammation, as indicated by raised breastmilk concentrations of sodium and the inflammatory cytokine, interleukin-8 (IL-8), was highly prevalent in Bangladesh and associated with poor infant growth. In order to investigate further the prevalence of subclinical breast inflammation and to assess the impact of dietary intervention, we studied rural Tanzanian women taking part in a study of dietary sunflower or red palm oil supplementation during late pregnancy and lactation. We measured breastmilk concentrations of IL-8, the anti-inflammatory cytokine, transforming growth factor-beta2 (TGF-beta) and the ratio of sodium to potassium. We also estimated systemic inflammation by plasma concentrations of the acute phase proteins, alpha1-acid glycoprotein and C-reactive protein. There were highly significant intercorrelations among milk Na/K ratio and concentrations of IL-8 and TGF-beta, the last only after treatment with bile salts which also improved TGF-beta recovery in the enzyme-linked immunosorbent assay (ELISA). Plasma acute phase protein concentrations tended to correlate with milk Na/K ratio and IL-8, suggesting that subclinical breast inflammation was related to systemic inflammation. Dietary supplementation with vitamin E-rich sunflower oil but not provitamin A-containing red palm oil decreased milk Na/K, IL-8 and TGF-beta at 3 months postpartum; however, the effect was significant only for Na/K ratio. The results suggest that milk Na/K ratio, IL-8, and TGF-beta all measure the same phenomenon of subclinical breast inflammation but that Na/K ratio, having the lowest assay variability, is the most useful. Subclinical breast inflammation may result in part from systemic inflammation and may be improved by increased dietary intake of vitamin E-rich sunflower oil.

Although vegetables and fruits are readily available and consumed in most areas of Tanzania, vitamin A deficiency is still prevalent. The objective of the present study was to measure the in vitro accessibility (available for absorption) of alpha-carotene and beta-carotene in vegetable relishes prepared with or without oil. Derived results were used to calculate the contribution of vegetable relish to recommended daily intake of retinol. Five sundried green leafy vegetables from Tanzania were cooked without oil, with sunflower oil or with red palm oil. The total amount and in vitro accessibility of alpha-carotene and beta-carotene from a portion (100 g) of vegetable relish was determined. The in vitro method used simulated the digestion process in the gastrointestinal tract. Carotenoids released after digestion were quantified using high-performance liquid chromatography. The total amount of beta-carotene varied between 1211 and 3659 microg/100 g among the five vegetable sources studied. From green leaves cooked without oil, 8-29% of the beta-carotene content became accessible after in vitro digestion and 39-94% from leaves cooked with sunflower oil or red palm oil. Adding red palm oil instead of sunflower oil resulted in about twice as much accessible beta-carotene, due to the high accessibility of its beta-carotene content. The red palm oil contributed also a considerable amount of alpha-carotene. The results showed that by eating vegetable relishes with added oil daily, it should be possible to provide the recommended intake level of vitamin A.

Continual course correction during implementation of nutrition programmes is critical to address factors that might limit coverage and potential for impact. Programme improvement requires rigorous scientific inquiry to identify and address implementation pathways and the factors that affect them. Under the auspices of “The Micronutrient Powders Consultation: Lessons Learned for Operational Guidance,” 3 working groups were formed to summarize experiences and lessons across countries regarding micronutrient powder (MNP) interventions for young children. This paper focuses on how MNP interventions undertook key elements of programme improvement, specifically, the use of programme theory, monitoring, process evaluation, and supportive supervision. Methods included a review of published and grey literature, interviews with key informants, and deliberations throughout the consultation process. We found that although much has been written and published about the use of monitoring and process evaluation to inform MNP interventions at small scale, there has been little formal documentation of lessons for the transition from pilot to scaled implementation. Supervision processes and experiences are not documented, and to our knowledge, there is no evidence of whether they have been effective to improve implementation. Improving the efficiency and effectiveness of interventions requires identification of critical indicators for detecting implementation challenges and drivers of impact, integration with existing programmes and systems, strengthened technical capacity, and financing for implementation of effective monitoring systems. Our understanding of programme improvement for MNP interventions is still incomplete, especially outside of the pilot stage, and we propose a set of implementation research questions that require further investigation.