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1 EFFECT OF MANNA HEALTH MIX SUPPLEMENTATION ON ANTHROPOMETRIC PARAMETERS AND HEMATOLOGICAL PROFILE OF ANEMIC ADOLESCENT GIRLS Suganya N. * and Dr. D. Estherlydia** *M.Sc Student, ** Assistant Professor, Food Chemistry and Food Processing, Department of Chemistry, Loyola College, Chennai ABSTRACT In India prevalence of anemia among adolescent girls is 90 percent. It is imperative to combat Iron deficiency anemia by supplementing plant based or non-haem food sources with the mutual supplementation of whole cereals, pulses and nuts. Thus the present study aims to assess the effect of supplementation of Manna Health Mix on the Anthropometric and Hematological Parameters of 24 anemic adolescent girls. Supplement consists of 15gm of manna health mix made into 200 ml porridge with 60 ml of milk and 15 g of palm jaggery. The supplement was administered during the tea time at 4pm for all the participants for a period of 45 days. Test of significance was used to assess the impact of supplementation. Results of the present study indicate that the supplementation of Manna Health Mix exerted positive effects on the anthropometric parameters and hematological parameters in adolescent girls. The supplementation of 15 g of Manna Health Mix with palm jaggery for a period of 45 days with a balanced diet will significantly increase hemoglobin levels and regularize MCV, MCH values in anemic adolescent girls. INTRODUCTION The prevalence of Anemia is unreasonably high in developing countries like India due to poverty, inadequate diet, certain diseases and poor access to health services. The world s adolescent population estimated to stand more than 1 billion, yet adolescence remained a largely neglected, difficult to measure and hard to react population in which the needs of adolescent girls, in particular are often ignored. In India prevalence of anemia among adolescent girls is 90 percent (Shilpa et al., 2012). Iron deficiency anemia constitutes the major anemia during adolescent period. Girls are more likely to be a victim due to various reasons. Accelerated

2 development, hormonal changes, malnutrition and starting of menstrual periods in girls are major causes in this period (Lal and Pankaj, 2007). To combat the pervasive problem of anemia, initiation of iron supplementation is one of the most important nutritional interventions for adolescent girls. Developing low cost recipes which are locally available and nutritionally rich in all nutrients and focused nutritional education using available resources and correcting current dietary habits in a vulnerable group of young women may result in dietary changes that can ultimately improve iron intake (Amani and Soflaei, 2006). It is imperative to combat Iron deficiency anemia by supplementing plant based or non-haem food sources with the mutual supplementation of whole cereals, pulses and nuts. Thus the present study aims to assess the effect of supplementation of Manna Health Mix on the Anthropometric and Hematological Parameters of anemic adolescent girls. OBJECTIVES 1. To assess the effect of Manna Health Mix on the Anthropometric parameters like body weight, height and body mass index. 2. To determine the effect of Manna Health Mix on the hematological parameters like hemoglobin, serum iron and total binding capacity of iron MATERIALS AND METHODS A pre-test, post-test design, with test group on supplementation and control group without supplementation was used for the experimental study. A purposive sampling method was used to select 24 adolescent girls with Iron deficiency anemia. The experimental study was carried out for a period of 45 days. Formulation of the supplement Supplement consists of 15gm of manna health mix made into 200 ml porridge with 60 ml of milk and 15 g of palm jaggery. Administration of the supplement The supplement was administered during the tea time at 4pm for all the participants for a period of 45 days.

3 Composition of the supplement Panacea Journal of Health Sciences Cereals- 82 percent (Ragi, millet, maize, jowar, wheat, barley) Pulses - 12 percent (Fried gram, green gram) Nuts 2 percent (Ground nut, cashew nut and badam) Sago 3 percent Cardamom 1 percent Milk - 60 ml Palm jaggery 15 g Anthropometric measurements like body weight, height and Body Mass Index. Five ml of blood was drawn randomly and was given to Lancet laboratory, Chennai for analysis and hematological profile of the participants was assessed before and after the supplementation period. At the end of the study, nutrition education program was conducted to maximize knowledge and to create awareness on the importance of nutrition. Statistical analysis SPSS version was used to conduct the statistical analyses. Frequency tables were generated for the descriptive data. Test of significance was used to assess the impact of supplementation. The type I error rate was a P value of <0.05 was considered statistically significant for all statistical tests conducted. RESULTS AND DISCUSSION Demographic Profile of the participants About 29.2 percent of the participants belong to the age group of 15 and 19 years. Majority (66.7%) belong to the nuclear family. A study by the World Health Organization found that the prevalence of anemia in women aged years worldwide was 30.2% (WHO, 2005). Food and nutrition surveys (Nutrition Division, 2006) found the prevalence of anemia (hemoglobin less than 120 g/l) in women aged years to be 17.2%, whereas in the southern it area was

4 up to 21%. Socioeconomic status is also associated with a higher prevalence of anemia in many other studies. Nutritional Composition of the Supplement Health Mix Manna Health Mix is a good source of protein and iron, and a rich source of Calcium. Table 1 Composition of the supplement compared with the Recommended Dietary Allowance Nutrients Manna Milk with Jaggery Composition of health mix (60 ml +15g) Supplement* (15 g) RDA** % RDA Energy (Kcal) Carbohydrate (g) Protein (g) Fat (g) Fibre (g) Calcium (mg) Iron (mg) Phosphorus (mg) Potassium (mg) Magnesium (mg) Sodium (mg) *Supplement contains 15gm of Manna Health mix with 60 ml of milk and 15 g of sugar made into 200 ml porridge. **RDA Recommended Dietary Allowance for adolescent girls- ICMR(1989) Effect of Supplementation on Anthropometric Parameters Anthropometric measurements such as body weight, height and body mass index of girls were assessed before and after supplementation. Comparison of mean anthropometric parameters of the experimental and control group on two periods of evaluation is presented in table 2.

5 Groups Panacea Journal of Health Sciences Table 2 Comparison of Mean Anthropometric Parameters of the Experimental Group on Variable Two Periods of Evaluation N Before the Supplementation Day 1 After the Supplementation Day 46 Mean SD Mean SD Experimental Body Weight (kg) Height(cm) BMI (Kg/m 2 ) Control Body Weight (kg) Groups Height(cm) BMI (Kg/m 2 ) Variable Test of Significance Percent Change Day 1 Vs. Day 46 Mean Difference ± SD t value p value Experimental Body weight (kg) ± ** Height (cm) ± BMI (Kg/m 2 ) ± ** Control Body weight (kg) ± NS Height (cm) ± NS BMI (Kg/m 2 ) ± NS ** Significant at p <0.001, NS Not Significant Supplementation of Manna Health Mix showed a significant 2.2 percent (0.92 ± 0.9 kg) increment in mean body weight of girls in the experimental group (41.0 ± 5.43 to ± 5.68 kg) at the end of the supplementation period (p<0.005). After the supplementation period of 45

6 days girls showed increase in their weight which could be due to protein and micro nutrients present in the supplement. Sivakumar,(2006) indicated that supplementation of micronutrients in the food form resulted in significant improvement in the height, weight, lowering of morbidity among underweight children.. Supplementation of Manna Health Mix showed no significant change in mean height of girls at the end of the supplementation period. Supplementation of Manna Health Mix showed a significant 2.2 percent (0.39 ± 0.39 kg/m 2 ) Increment in mean Body Mass Index of girls in the experimental group (18.00 ± 1.86 to ± 1.9 kg/m 2 ) at the end of the supplementation period (p<0.006). Wheat germ being the major component of the food supplement is not only rich in nutrients namely iron, zinc and B-complex vitamins but also contains a considerable amount of protein (17.4 g) and the overall protein content of the food supplement was 19.6 g/100 g. Since adequate protein is essential during growth when new tissue proteins are being synthesized (ICMR, 1989), this also could have attributed to the better growth performance of the adolescents. There is no significant change in the anthropometric parameters of the control group after study period. Effect of Supplementation on Hematological Parameters Comparison of mean hematological parameters of the on two periods of evaluation between experimental and control group is presented in table 3.

7 Table 3 Comparison of Mean Hematological parameters of the on two periods of evaluation Experimental Group Control Group Variable between Experimental and Control group Reference Range Day 1 Day 46 Mean SD Mean SD Hemoglobin (g/dl) MCV (fl) MCH (pg) MCHC % IRON(µg/dl) TIBC (µg/dl) Hemoglobin (g/dl) MCV (fl) MCH (pg) MCHC % IRON(µg/dl) TIBC (µg/dl)

8 Test of Significance (Experimental Group) Day 1 Vs Day 31 Variable (mg/dl) Mean SD Percent increment or t p Difference Difference reduction value Value Experimental Group Hemoglobin % Increase ** (gm/dl) MCV (fl) % Increase ** MCH (pg) % Increase ** MCHC % % Increase NS IRON(µg/dl) % Increase NS TIBC (µgm/dl) % Increase NS Control Group Hemoglobin % Reduction NS (gm/dl) MCV (fl) % Increase NS MCH (pg) % Increase NS MCHC % % Reduction NS IRON(µg/dl) % Reduction NS TIBC (µgm/dl) % Reduction NS **- Significant at P <0.01; NS Not Significant; Mean hemoglobin levels of the adolescents have increased after the supplementation. Supplementation of Manna Health Mix showed a significant 4.75 percent (0.5 ±0.6 mmhg) increase in mean hemoglobin levels (10.5 ± 0.79 to ± 1.19 mmhg) at the end of the supplementation period (p<0.013). Control group showed a 1.96 percent reduction in the

9 hemoglobin levels but this change was not significant. Mean MCV levels of the adolescents have increased after the supplementation. Supplementation of Manna Health Mix showed a significant 9.02 percent (6.58 ±5.53 mmhg) increase in mean hemoglobin levels (75.1 ± 3.35 to ± 4.7 mmhg) at the end of the supplementation period (p<0.002). Control group also showed a 2.69 percent increase in the MCV levels but this change was not significant Mean MCHC levels of the adolescents have increased after the supplementation. Supplementation of Manna Health Mix showed a significant percent (2.3 ±1.53 mmhg) increase in mean hemoglobin levels (22.82 ± 1.35 to ± 2.29 mmhg) at the end of the supplementation period (p<0.000). Control group also showed a 0.93 percent increase in the MCH levels but this change was not significant. Mean MCHC %, Iron and TIBC of the experimental and the control group had no significant change in the end of the supplement and study period respectively. In the present study, the supplement has 82 percent of cereals which includes ragi, millet, maize, jowar, wheat, barley, sago and cardamom, 12 percent of pulses which includes fried gram, green gram and 2 percent of nuts which includes ground nut, cashew nut and badam with an addition of 60 ml of milk and 15g of palm jaggery. Iron bioavailability refers to the proportion of iron that is taken up and transferred into the body by the intestinal mucosa and is used systemically. It is affected by the chemical form of iron. Heme iron is absorbed more efficiently from the diet than non-heme iron. A number of dietary components have been shown to increase or reduce non-heme iron absorption from single test meals. The main enhancers of non-heme iron absorption are meat, and ascorbic acid found in fruit and vegetables. The main inhibitors of non-heme iron absorption are calcium, phytates in cereals and legumes, and phenolic compounds found in tea, coffee, and other beverages (Geissler and Singh, 2011). Michaelsen et al., (2007) demonstrated in their study that absorption of non-heme iron can be enhanced or inhibited by various dietary components and thus depends on the meal composition. The absorption of heme iron is much higher than the absorption of non heme iron:

10 about 25 percent for heme iron and less than 10 percent for non heme iron. Dietary compounds that influence the absorption of non-heme iron include whole grain cereals and maize where the active substance involved is phytate. CONCLUSION Manna Health Mix is an energy dense ready-to-use food which contains cereals, pulses and nuts. Manna Health Mix was made into porridge with milk to increase its sensory and nutritional properties. Results of the present study indicate that the supplementation of Manna Health Mix exerted positive effects on the anthropometric parameters and hematological parameters in adolescent girls. The supplementation of 15 g of Manna Health Mix with palm jaggery for a period of 45 days with a balanced diet will significantly increase hemoglobin levels and regularize MCV, MCH values in anemic adolescent girls. This will help reduce the incidence of Iron deficiency anemia in adolescent girls. REFERENCES 1. Amani R, Soflaei M. Nutrition education alone improves dietary practices but not hematologic indices of adolescent girls in Iran. Food Nutr Bull Sep;27(3): Geissler C and Singh M. Iron, Meat and Health, Nutrients. (2011) March; 3(3): ICMR. Nutrient Requirements and Recommended Dietary Allowances for India. NIN, Hyderabad(1989); pp Lal S, Pankaj A. Editors. Textbook of Community Medicine (Preventive and Social Medicine).1st Ed. New Delhi: CBS Publishers and Distributors; 2007; Michaelsen KF, Jorgensen MH. Dietary fat content and energy density during infancy and childhood; The effect on energy intake and growth. Eur J Clin Nutr 2007;49: Nutrition Division, Ministry of Health, Thailand.(2006).Food and nutrition surveys 5th 2003.Bangkok: Ministry of Health, Thailand.

11 7. Shilpa S. Biradar, Somashekar P. Biradar, A.C. Alatagi, A.S. Wantamutte, P.R. Malur. Prevalence of Anaemia among Adolescent Girls: A One Year Cross-Sectional Study. Journal Of Clinical And Diagnostic Research [Serial Online] 2012 May [Cited: 2013 Jul 6 ]; 6: Sivakumar B, Madhavan NK, Srecramula D, Suryanarayana P, Ravinder P, Shatrugna V Effect of micronutrient supplementation on health and immune status of school children. J. Nutr.,(2006); 22 : World Health Organization.(2005).Worldwide prevalence of anemia Geneva: WHO Global Database on Anaemia