Objective: Despite public health campaigns based on Fe and folic acid supplements, Fe-deficiency anaemia remains highly prevalent among women in India. We investigated leaf concentrate as an alternative to Fe and folic acid supplements for treating anaemia in adolescent girls. Design: Randomised controlled two-arm trial over 3 months: one group received daily Fe and folic acid (IFA; 60 mg Fe, 500 mg folic acid); the other daily leaf concentrate (LC; 5 mg Fe, 13 mg folic acid). Hb concentration, mean cell volume, serum Fe, serum ferritin and total Fe-binding capacity were measured pre-and post-intervention. Setting: Jaipur, India. Subjects: One hundred and two adolescent girls aged 14-18 years. Results: Of the 102 girls randomized to the two arms of the trial, four (3?9 %) were severely anaemic (Hb , 7 g/dl), twenty-eight (27?5 %) were moderately anaemic (Hb $ 7 g/dl, ,10 g/dl) and seventy (68?6 %) were mildly anaemic (Hb $ 10 g/dl, ,12 g/dl). In the IFA group, eleven girls (20?4 %) withdrew due to side-effects, compared with one girl (2?1 %) in the LC group (P 5 0?005). Total losses to followup were 14/54 in the IFA group and 2/48 in the LC group. At the end of the trial, none of the eighty-six remaining girls were severely anaemic, nine (10?5 %) were moderately anaemic and twenty-six (30?2 %) were mildly anaemic; fifty-one (59?3 %) had normal Hb levels ($12 g/dl). After adjustment for baseline values, LC was as effective as IFA in improving serum Fe parameters and treating anaemia. Conclusions: Leaf concentrate is an effective, and more palatable, alternative to Fe and folic acid supplements for treating anaemia in adolescent girls.
Leaf concentrate is an extremely nutritious human food, containing approximately 50% (dry weight) highquality protein, together with numerous micronutrients, principally b-carotene, vitamins B 6 , B 9 , E and K, plus iron, calcium and magnesium. Many studies have shown that those consuming it recover quickly from nutritional anaemia and have a significantly improved general state of health. Today, over 40,000 people receive a daily serving of 10g of dried lucerne leaf concentrate. The fractionation of leaves was first reported over 200 years ago and has been the subject of extensive research and application since the 1940s. The process breaks down the original leaves into three products: residual fibre, 'whey' and leaf concentrate. The whey and the fibre are effective fertilizers, substrates for fermentation and/or animal feed. Through the use of all three products, leaf fractionation can be more productive, in terms of edible protein per hectare of land, than any other known agricultural method. This chapter presents the history and nutritional qualities of leaf concentrate, provides technical details of leaf fractionation at domestic and intermediate (community/semi-industrial) scales of production, and reviews studies that provide evidence for the effectiveness of leaf concentrate in improving human nutritional status. It concludes by reviewing the factors that have hitherto hindered the widespread adoption of leaf concentrate and leaf fractionation. The authors suggest how these may be overcome, and discuss the potentially wider role of leaf concentrate in alleviating human malnutrition, including its use in a locally produced ready-to-use therapeutic food.
Leaf concentrate. Undernutrition. UN food aid policies The greatest untapped food resource on earth? Madam You recently published a letter from John Waterlow FRS on leaf concentrate, 'whose benefits for undernourished children-and adults-are potentially immense' (1). Leaf concentrate is rightly known as 'the greatest untapped food resource on earth'. With many colleagues throughout the world, I attest to its efficacy: I have seen for myself its impact particularly on child health in Africa, Asia and Latin America. The purpose of this letter is to ask why the United Nations agencies whose duty is to treat and prevent undernutrition, continue to ignore leaf concentrate. Here is the testimony of the nutritionist Sister Luci Morren, who works with impoverished communities in Nicaragua. The French charity L'Association Pour La Promotion des Extraits Foliaires en Nutrition (APEF), with whom I work, has many other testimonials, together with results from professionally supervised small field trials. Sister Luci reports that with leaf concentrate, 'appetite improves, people are less tired, more energetic, irondeficiency anaemia is resolved, skin problems subside, sometimes vision improves, coughs clear up, as do headaches and insomnia. Respiratory infections become less severe and less frequent, as do other ailments. Mothers are less fatigued in pregnancy, give birth to bigger, heavier babies, and recover more quickly after their confinement. Those who breastfeed have more milk and so are able adequately to feed until weaning, while their children gain weight normally'. My own association with leaf concentrate goes back half a century. As an engineer, in 1958 I joined the team formed by Norman Pirie FRS in the UK at the Rothamsted agriculture research centre, and for the next 14 years developed the process for extracting leaf concentrate (then known as leaf protein) as a cheap, available and effective food supplement (2). Ever since then, I have been involved in efforts to introduce and popularise leaf concentrate. For the last 15 years APEF has been distributing leaf concentrate in twenty countries within four continents. Up to now, more than 60 million 10-gram daily portions of concentrate have been extracted from alfalfa, also known as lucerne (Medicago sativa). Many other leaves that are rich in protein, carotenoids, iron, and many other micronutrients and bioactive compounds, are also excellent bases for concentrate. Just over three years ago, at a meeting in Geneva, the head of the department of Child and Adolescent
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