HarvestPlus Nutrition

Transcription

1 HarvestPlus Nutrition Introduction and update Erick Boy Hyderabad (September 8, 2014) HarvestPlus c/o IFPRI 2033 K Street, NW Washington, DC USA Tel: Fax: HarvestPlus@cgiar.org

2 Presentation Outline HarvestPlus Nutrition Research Goals Process Target levels for iron, zinc and provitamin A Achievements in phases I & II Ongoing and future research: phase III

3 Q: can you put enough nutrient in the crop to improve nutrition? Photo: Harriet Nsubuga

4 Research Goals: discover, develop, prove the concept, monitor & evaluate Development Validating minimum target levels Average daily food consumption Nutrient retention in food Bioavailability Evaluation Monitoring & Evaluation Efficacy (randomized controlled) trials Effectiveness DEPLOYMENT Source: Food & Nutrition Bulletin 28 (2), S271-79

5 Nutrition research to date Dietary intake & nutritional status Nutrient retention Absorption/ bioavailability Efficacy Effectiveness Sweet Potato Maize Cassava * Beans Pearl millet Rice * Wheat (2)*

6 TDRC, ZAMBIA

7 Original nutrient baseline and target levels by crop (µg/g) % EAR for Iron % EAR for Zinc % EAR for Vitamin A Beans Iron Pearl millet iron Rice zinc Wheat zinc Cassava BC Maize BC Baseline Increment

8 Current nutrient targets for women of child bearing age (NP, NL) high consumption population Assumption Average daily consumption (g) Pro Vitamin A Carotenoids (BC) Cassava (as flour) Iron Beans (boiled) Zinc Rice (polished) Bangladesh 800 g 200g 400g % retention 20% 90% 90% % absorbed 17% 5% 20% Estimated Average Requirement (absorbed µg/d) Additional % EAR 81% 30% 34% Total %EAR 81% 71% 80%

9 Nutrient target for women of child bearing age (NP, NL) Haiti? Parameters Average daily consumption (g) Cassava Flour (Pro Vitamin A Carotenoids) Boiled beans (Iron) Polished Rice (Zinc) 200 g 100g 200g % retention 30% 90% 90% % absorbed 17% 5% 20% Estimated Average Requirement (absorbed µg/d) Additional% EAR 30% 14% 17% Total %EAR 30% 29% 40%

10 Efficacy Trials: gold standard for evidence on causality Effectiveness trials: measuring impact under real life conditions

11 Put simply: Efficacy trials controlled conditions Study candidates screened to exclude confounders (other diseases, behaviors, etc) Subjects selected by age, gender, etc. are randomly assigned to experimental vs control treatments Treatments ( biofortified vs conventional food) are masked: same appearance, taste, color, amount, etc. Final result (outcomes) measured before and >1 times thereafter Analysis: since all other factors are equal, any differences

12 Nutrition: Maize Studies on approx. 1,500 children between four and eight years of age found that: Beta-carotene from the orange maize is absorbed by the body. Regular orange maize consumption improved or maintained vitamin A nutrition, despite high burden of malaria, infection, and other stresses in rural villages. Regular orange maize consumption improved children s vision in the dark or dim light. Note: These are preliminary sensitive unpublished results that are intended for this donor presentation only. They may not be shared publically in any form, until verified and published in a peer reviewed journal.

13 Cassava: serum retinol and β-carotene concentrations after intervention White cassava 1 White cassava 2 Yellow cassava 3 (N=113) 1 (N=113) 2 (N=111) 3 Serum retinol (µmol/l) (0.16) a 0.82 (0.18) b 0.82 (0.19) b Serum retinol, adj (µmol/l) (0.17) a 0.83 (0.18) b 0.83 (0.18) ab* Serum β-carotene (µmol/l) 0.16 (0.10) a 0.41 (0.21) b 0.97 (0.46) c Missing data for serum retinol, 1 n=11; 2 n=8; and 3 n=6; Missing data for β-carotene, 2 n=1; 3 n=1; 4 Means (SD), all such values; 5 Adjusted for inflammation according to Engle-Stone et al. (2013); Statistical significance testing was done by ANCOVA with baseline concentration as a co-variate. Differences in characters indicate statistical significance with P<0.05; * Group 3 vs. group 1: P=0.062.

14 Effect of intervention on serum retinol (µmol/l) according to VAD status White cassava 1 White cassava 2 Yellow cassava No VAD (n=258) VAD (n=79)

15 Conclusion Yellow cassava can significantly improve vitamin A status of school children; Children with vitamin A deficiency show a slightly better response than non-vad children; Effect of the high prevalence of adverse BCMO1 genotype needs further investigation in Africa; Data on immune function, gut integrity and dark adaptation still pending

16 Orange Sweet Potato Vitamin A-rich orange sweet potato (OSP) was released to 24,000 households in Mozambique and Uganda from Findings from the project have shown high rates of adoption and consumption, resulting in increased vitamin A intakes among women and children Distribution of OSP has been scaledup in Uganda by HarvestPlus to reach 225,000 households by 2016 Photo: HarvestPlus

17 Impact on vitamin A intakes

18 Vitamin A summary β-carotene from maize, cassava & OFSP is highly bioavailable (βc:retinol ratios 3:1, 5:1 & 12:1, respectively); Results of maize efficacy trials on ~1500 preschoolers in Zambia show that: β-carotene is efficiently absorbed Regular consumption maintained vitamin A stores and dark adaptation despite high burden of malaria & other stresses in rural villages Kenya efficacy trial proves cassava is efficacious in improving serum retinol among school children (Wageningen Agric. U. doctoral thesis). OFSP effectiveness trials demonstrated high rates of adoption, increased vit. A intake among women and children, & improved vit. A status in children (Uganda)

19 Nutrition: Pearl Millet Iron-deficient Indian children under the age of three who ate traditionally-prepared porridges and flat bread made from ironrich pearl millet flour absorbed substantially more iron than from ordinary pearl millet flour, enough to meet their physiological requirements. Zinc was similarly absorbed in sufficient amounts meet the children s full daily zinc needs. The Journal of Nutrition. First published ahead of print August 7, 2013

20 Nutrition: Pearl Millet Marginally iron-deficient Beninese women who ate a traditionally prepared iron-rich pearl millet paste were found to absorb twice the amount of iron than paste made from ordinary pearl millet. Less than 160 grams of iron-rich pearl millet flour daily is enough to provide Beninese women aged with more than 70 percent of their daily iron needs. The Journal of Nutrition. First published ahead of print August 7, 2013

21 Nutrition: Pearl Millet Efficacy studies show that at 6 months, the intervention resolved 65% of iron deficiency in children, and was associated with a two-fold increase in the likelihood of resolving iron deficiency. Note: These are preliminary sensitive unpublished results that are intended for this donor presentation only. They may not be shared publically in any form, until verified and published in a peer reviewed journal.

22 Meta-analysis of the Impact of Iron Bio-fortification Interventions on Iron Status Julia L. Finkelstein, Saurabh Mehta, Jere D. Haas Division of Nutritional Sciences Cornell University, Ithaca, New York Divisions of Nutrition and Infectious Diseases St. John s Research Institute, Bangalore, India

23 Continuous Outcomes: Ferritin Studies Diff. in Means S.E. p-value Pearl Millet Rice Beans Summary Significantly increased ferritin concentrations

24 Iron biofortification meta-analysis conclusions Iron fortification interventions increased hemoglobin, serum ferritin, and total body iron, and resolved iron deficiency Findings provide support for iron bio-fortified interventions, with increased potential to benefit among iron deficient individuals A comprehensive approach to prevent anemia and iron deficiency, including the use of larger samples and appropriate dosing in research studies, and targeted preventive interventions are needed to reduce the burden of iron deficiency in resource-limited settings

25 Iron crops summary Bioavailability limited by phytate in beans and pearl millet Improvement in iron status with beans (Rwanda), rice (Philippines) and pearl millet (India) efficacy trials Wheat and rice iron concentrations cannot be increased sufficiently through conventional plant breeding

26 Zinc summary slide US-Institute of Medicine & IZiNCG physiological zinc requirements should be revised and reconciled; Biofortified pearl millet consumption results in significant amounts of zinc absorbed by children (meeting the entire daily estimated average requirement); Biofortified wheat provides nearly 70% more absorbed Zn than control wheat for women, irrespective of the extraction rate. Two efficacy trials underway in India (women and children under 5 yrs)

27 Phase III Nutrition proposal HarvestPlus c/o IFPRI 2033 K Street, NW Washington, DC USA Tel: Fax: HarvestPlus@cgiar.org

28 NUTRITION STRATEGIC PLAN OUTLINE: Objectives: 1. Consolidate evidence base on existing biofortified crops in different age/gender target groups 2. Better understand the potential of biofortification for improving nutrition during the first 1,000 days: Women s nutritional status going into pregnancy and during lactation: single and multiple biofortified crops through pregnancy and lactation. Health, nutritional status and survival in infancy - Biofortified products in culturally appropriate weaning foods: formulation, proximate and MN analysis, shelf life, etc. 3. Retention and shelf life of processed foods manufactured with biofortified crops for rural and marginal urban markets

29 Approach Assess bioavailability of iron, zinc and provitamin A carotenoids in new crops & multiple crop combinations (interactions in whole meals) Assess nutritional efficacy and health impact of crop and nutrient combinations during 1000 days window of development (conception to year 2 of life) (food basket) Characterize secondary staple crops (lentils, banana, etc.) Food composition and consumer acceptability of processed products from biofortified crops (formulation, proximate composition, retention, sensory testing, shelf life and storage effects)

30 MANAGEMENT, STAFF, NATIONAL COALITION, FINANCIAL RESOURCES, INFRASTRUCTURE, OTHER MATEIAL CONTRIBUTIONS FROM PARTNERS INPUTS ACTIVITIES OUTPUTS OUTCOMES Policies, production, delivery, quality & behavior change communication POLICIES, legislation & regulations PROUCTION & SUPPLY procurement & training strategies DELIVERY SYSTEMS EXTERNAL & INTERNAL QUALITY SYSTEMS BEHAVIOR CHANGE COMMUNICATION Availability of intervention in country Providers knowledgeab le & motivated inform & solve constrains with target populations Importation, production & distribution meet quality standards & specifications Access & Coverage Coverage Access Knowledge & Appropriate use Target popn. uses interv. appropriately Impact on intake, status, and function in Target population Improved intake & diminishe d loss of vitamins & minerals Decreased Mortality & morbidity Improved Nutritional Status Improved development, performance & productivity Other Interventions Achieved Millennium Development Goals