Developing micronutrient-rich snacks for pre-conception and antenatal health: the Mumbai Maternal Nutrition Project (MMNP).

Abstract

Observational and trial data suggest that poor maternal micronutrient status as a result of poor dietary quality before and during pregnancy impairs fetal growth and development. This chapter describes the development of palatable food supplements produced from locally available vegetarian foods that improve the quality of the diet of young Indian women living in Mumbai slums. A vehicle in the form of a cooked snack food that could be distributed daily was developed to provide the women with supplementary green leafy vegetables (GLVs), fruit and milk. The target nutrient content of the snack was defined based on intake data from the study population and the UK Estimated Average Requirement (EAR). The snack was analysed to measure these target nutrient levels and palatability was assessed. Several approaches were used to deliver the amount of GLVs, fruit and milk that were considered sufficient to have an impact on the women's nutritional status. A vehicle was developed that contained these micronutrient-rich foods and was palatable and acceptable to the women. Some of the target micronutrient levels were achieved using combinations of fresh GLVs, dried fruits and milk powder. Mean micronutrient levels of the final product (per serving) were: β-carotene 123 retinol equivalents; folate 68 µmg; riboflavin 0.14 mg; iron 4.9 mg; calcium 195 mg; vitamin B12 0.24 µmg. These values are between 12% and 43% of the UK EAR. To date, target vitamin C levels have not been achieved. It is possible to develop palatable, culturally acceptable and safe micronutrient-rich food supplements using a low-tech approach and locally available fresh and dehydrated ingredients.

Improving women’s diet quality preconceptionally and during gestation: effects on birth weight and prevalence of low birth weight—a randomized controlled efficacy trial in India (Mumbai Maternal Nutrition Project)

“…We considered various ways of supplying a daily, freshly prepared, safe, and palatable portion of food that contained green leafy vegetables, fruit, and milk to women who were living across an urban slum area ∼13 × 13 km. The best solution, after development and pilot testing in a different slum community (Shetanchowki, Mumbai), was snacks that resembled local street foods such as samosas and fritters, which could be filled with the key ingredients, cooked, packaged, and easily transported ( 13 ).…”

“…To test whether improving the mother's diet quality for a sustained period before and during pregnancy increases birth weight, we carried out a randomized controlled trial in low-income women in Mumbai, India. We created a snack that, when taken 3 d/wk in addition to the usual diet, increased women's average intakes of green leafy vegetables, fruit, and milk above the highest quartile in the Pune study ( 13 ) and compared it against a control snack made from vegetables of low micronutrient content. We recruited nonpregnant women who were intending to have children and planned to test the effect of starting supplementation ≥3 mo before pregnancy.…”

Obituary for Professor David Barker

“…Building collaborations between population and laboratory scientists from Toronto, Australia, New Zealand, Saudi Arabia and France has immeasurably expanded knowledge. The study of foetal origins of diabetes in India identified the importance of phenotypic variability in classical assumptions associated with chronic disease (Yajnik et al, 2003) and includes documentation of the positive effects of maternal nutritional supplementation (Shivashankaran et al, 2011). In the last years of his life he advanced knowledge on the role of the placenta at Oregon Health Sciences University (Barker & Thornburg, 2013), and he was an inspiring teacher and scientific collaborator at Emory University in the US.…”

Nutrition Security Status in India – Impediments, Remedies and Way Forward

“…Among low-income women of child-bearing age, one serving of the snack more than doubles the median intake of fruit, vegetables and milk, and provides micronutrients amounting to 12 to 43 percent of average daily requirements. Trials in rural India found that mothers with adequate intakes of similar formulations at 28 weeks' gestation delivered fewer low birth-weight babies (Shivashankaran et al, 2011).…”

“…The vast majority of India's population depends on climate-sensitive sectors like agriculture, forestry, and fishery for their livelihood. The adverse impact of climate change in the form of declining rainfall and rising temperatures, and thus, increased severity of drought and flooding, is bound to threaten food security and livelihoods in the economy (FAO, 2005).…”