Directory UMM :Data Elmu:jurnal:N:Nutrition And Food Science:Vol30.Issue3.2000:

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cereal/legume/fruit-based multimixes in

weaning in developing

countries

Paul Amuna

Francis Zotor

Sam Sumar and

Yvonne Tswelelo Chinyanga

Weaning is the process of expanding the diet of the infant to include foods and drinks other than mother's or formula milk, to enable them to meet the extra nutritional needs for rapid growth and development (DOH, 1994). The UK Department of Health (DOH, 1994) recommends that this process should begin between four to six months of age. Current UNICEF and WHO recommendations are that the process should actually begin at six months following exclusive breastfeeding (unless otherwise medically contra-indicated), since no special benefits have been detected in infants whose complementary feeding began at four to five months compared to those who were started at six months (WHO, 1998; UNICEF, 1999).

The weaning period is seen universally as a crucial period of the development of the infant and mistakes made or poor practices at this stage may influence later adult health (Barker, 1990). The weaning process is influenced by many factors, not least, socio-economic status, cultural and religious beliefs and practices. The timing of weaning is probably as important as the choice of weaning foods, the methods of preparation, and how weanlings are fed. Poverty, by limiting people's access to weaning foods, also affects the choice of what to feed infants and children. A number of studies have concluded that:

those least able to purchase a healthy diet due to financial constraints are those most likely to be disadvantaged with regard to access to healthy micronutrient-dense food (Smith and Brunner, 1997).

Hunger is also known not just to be a manifestation of poverty, but also to actually perpetuate it and, indeed, is the root cause of food insecurity (FAO, 1996a).

Whereas the problems associated with the weaning process are universal, affecting human weanlings both in industrialized (Wharton, 1997) and developing countries, this paper specifically addresses the issue with respect to developing countries. Food supplies available for direct human consumption have traditionally been gathered from food balance-sheets (FBS) despite their inherent flaws. Dietary energy supply (DES) per capita (i.e. simply the daily amount of food available for human

The authors

Paul Amuna(p.amuna@gre.ac.uk) is Consultant Nutritionist and Senior Lecturer, Department of Chemical and Life Sciences, The University of Greenwich, London, UK.

Francis Zotoris Researcher in Human Nutrition, Department of Chemical and Life Science, The University of Greenwich, London, UK.

Sam Sumaris Professor and Head, Centre for Food, Nutrition and Public Health, The University of Westminster, London, UK.

Yvonne Tswelelo Chinyangais a Nutritionist, Family Health Division, Ministry of Health, Botswana.

Keywords

Weaning, Nutrition, Emergency feeding programmes

Abstract

The weaning period is a crucial stage in the growth and development of the infant and child. The timing of weaning, the choice of foods, their methods of preparation, and how weanlings are fed, all affect the outcome. The commercial preparation of weaning foods and the fortification of some traditional foods are seen by some as the most sustainable and cost-effective means of alleviating micronutrient deficiencies among infants and children. This may be true in industrialized countries, but the same cannot necessarily be said of poor, developing countries. Demonstrates that, even in poor communities, it is possible to combine scant food resources in a cost-effective way to formulate multimixes which would meet energy, protein and micronutrient needs, without fortification. Proposes that such approaches can be used in community nutrition education programmes to help reduce childhood malnutrition and in emergency feeding programmes.

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consumption) has subsequently been derived for countries from such national

data. The DES has become the principal variable used by the FAO to generate estimates of the incidence of undernutrition (FAO, 1996b). Despite strong links between the DES of a country and the incidence of malnutrition, it is also true that even in industrialized countries with average DES in the region of 3,340kcals per capita/day (FAO, 1996c), there continue to be reported incidences of micronutrient undernutrition, particularly iron deficiency in weanlings (Wharton, 1997). Reasons for these include poverty and poor weaning practices. In the last decade, there has been renewed interest in food fortification largely because it is generally recognised as being the most effective way to eliminate dietary

micronutrient deficiencies. It is also thought to be socially acceptable, requiring neither a change in food habits nor a change in the characteristics of the food. Furthermore, it is argued, fortification can be introduced quickly, is relatively easy to monitor, legally enforceable and the benefits are readily visible. It is also thought to be the cheapest form of intervention for a government and is sustainable (Nestle, 1993). To date, however, few fortification programmes have undergone extensive monitoring and evaluation (Nestle, 1993; Latham, 1997).

Finding suitable food vehicles and the right fortificant compounds in developing countries remains a great challenge. Cultural

acceptability may also serve as a hindrance to food fortification. Expense and sustainability are also debatable issues.

It is therefore our objective to demonstrate that even in countries where DES may be low, there need not be a very high incidence of undernutrition if sound community nutrition education policies are properly implemented and monitored. We will also attempt to demonstrate that, while there is a clear need for food fortification with certain key nutrients, more sustainable, culturally-acceptable and effective alternatives to mass fortification programmes are still possible. The latter goal can be attained if communities are taught to combine traditional cereals, legumes, fruits and, where appropriate and affordable, animal products in the form of traditional nutrient multimixes for feeding infants and children.

Sources and distribution of food groups

Figure 1 shows a summary of the world-wide distribution of all major food groups (FAO, 1996c). Cereals, grains and legumes are fairly evenly distributed worldwide, providing about 50 per cent of dietary energy supply (DES). The highest consumption of these foods is in South Asia (contributing approximately 64 per cent of DES). These also contribute about 62 per cent of DES in the least developed countries (LDCs). In sub-Saharan Africa (SSA), cereals, grains and legumes contribute about 46 per cent of DES, with roots and tubers (15.6 per cent)

contributing the other bulk of carbohydrate sources. In South Asia (SA), sugars alone contribute about 10 per cent of DES whereas tubers, pulses, nuts, fruits and vegetables together contribute just about 15 per cent of dietary supplies. In contrast, the consumption of vegetables, fruits, pulses and vegetable oils and fats are fairly evenly distributed in SSA and the rest of the world. In the LDCs, the distribution of food groups 1-10 (Figure 1) is fairly even, despite the rather low quantities of these, giving an average DES of 2,060kcals per capita. Animal products such as fish, meats, eggs, milk and animal fats/oils are also in short supply in the LDCs.

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Formulation of nutrient multimixes

Bearing in mind the nature of food

distribution world-wide, the formulation of any weaning foods using locally-available raw materials has to take into account the following:

(1) Which cereals, legumes, grains, roots and tubers form the major staples and carbohydrate sources.

(2) Which potentially energy-dense food groups are locally available that will also help provide reasonable amounts of key micronutrients.

(3) Which vegetables, fruits, pulses and nuts are available locally and how accessible and affordable these are. Availability should take into account those growing wild, family-farm sources and purchases. Seasonal variations in availability, prices and freshness are also important

considerations.

(4) Sources of vegetable oils, dairy products, eggs and other animal products, their seasonality accessibility and affordability. (5) The techniques of food processing,

storage and distribution; household cooking methods and food distribution within the household.

(6) Socio-cultural and religious factors governing food choice, processing and food habits with specific reference to infant feeding practices.

(7) The appearance, texture, taste,

digestibility and appropriateness of the product for weanlings.

(8) Food quality and safety issues.

Taking these key factors into account, and considering the average daily energy requirements for infants and children aged 3-24 months (see Table I) (Cameron and Hofvander, 1983; DOH, 1994), four

examples of multimixes designed by our team

(Amunaet al., unpublished) have been presented in Table II. Further proximate analysis of these multimixes show standard deviations between theoretical and

experimental values for carbohydrate, protein, fat, fibre, moisture and ash contents ranging between 0.01-3.84 (unpublished data), thus indicating the importance of due care in food processing to ensure good recovery of nutrients. The analysis of the micronutrient mineral contents of such multimixes can be carried out using flame photometry, atomic absorption

spectrophotometry or inductively coupled plasma atomic emission spectrometry (ICP-AES) or mass spectrometry (ICP-MS).

Nutrient composition of multimixes

The four multimixes (A, B, C and D) have been developed to meet the energy and micronutrient needs of 4-6, 6-9, 9-12 and 12-24-month-old human weanlings,

respectively. Standard food quality and safety procedures were followed during both the formulation and preparation of each

multimix. As shown in Table II, the bulk of the components of all four multimixes is plant-based, utilizing foods commonly available and consumed in most developing countries especially in Sub-Saharan Africa. Table III shows the nutrient composition per 100g serving of each multimix.

A close look at multimix A (4-6 months) shows that, for a weanling at this age, one serving will provide about 35 per cent of their daily energy requirements and a protein intake of nearly 62 per cent. The vitamin A content is also good. The calcium content is, however, low, but adequate levels of this mineral and most other micronutrients would normally be provided by the lactating mother in breast-fed infants.

Similarly, multimixes B, C and D will provide at least 30 per cent of the weanling's daily energy requirement. The protein and micronutrient contents are also, overall, very good except for niacin (19.7 per cent and 24.6 per cent in multimixes B and C, respectively), very low folate (8 per cent) in multimix B and vitamin B12 which is limiting in multimix D. The iron contents of all multimixes are very good. This is further complemented by good vitamin C levels. These multimixes can be further enriched by the addition of sugar, fats/

Table IAverage energy intakes for infants and young children

Age group

12-24 11.0 105 1,150

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oils, salt and, where appropriate, eggs and dairy products. This would improve their palatability and aid acceptability.

Factors influencing levels of nutrients in

foods

A number of factors will influence the levels and availability of nutrients in traditional multimixes, including:

. methods of processing;

. the length and methods of storage;

. food preparation techniques;

. the season of the year;

. exposure to heat, air and light; and

. interactions between inhibitors

(anti-nutrients) and promoters in the mix.

High fibre contents of multimixes may inhibit iron absorption and reduce the digestibility of proteins in foods (Latham, 1997). The multimixes formulated contain fibre levels

not exceeding 2.66g (Table III). These multimixes are plant-based and plant proteins often contain much smaller amounts of one or more essential amino acids, particularly threonine, tryptophan and the sulphur-containing amino acid methionine. The advantage of using these multimixes is that they tend to complement each other in terms of providing limiting amino acids. This has formed the basis for the formulation of the high-quality-protein food mixtures containing 70 per cent maize and 30 per cent common beans (FAO, 1997). Indeed, most evidence appears to show that, although cereals are limited in certain amino acids, if consumed in sufficient quantities to meet total protein and energy needs, they contain enough proteins to meet the needs of weanlings and schoolchildren. The four multimixes presented here not only are energy-dense, but also provide adequate amounts of protein.

Table IIShowing macronutrient nutrient composition of examples of multimixes developed for four different groups of human weanlings

Weight Energy Protein Fat Carbohydrate Fibre Othera Contribution of energy (per cent) Ingredients (g) (kcal) (g) (g) (g) (g) (g) Protein Fat Carbohydrate Multimix A: for age 4-6 months

Sorghum flour, decoated 10.00 35.72 1.00 0.28 7.30 0.21 1.42 4.92 3.10 35.93

Pumpkin (cooked, mashed) 8.00 1.87 0.07 0.01 0.39 0.14 7.96 0.32 0.07 1.92

Melon seeds (agushie) 4.00 15.21 1.00 0.37 1.97 0.27 0.48 4.92 4.10 9.70

Spinach (fresh, cooked) 5.00 1.46 0.15 0.01 0.19 0.12 0.00 0.73 0.14 0.92

Vegetable oil (sunflower) 3.00 27.00 0.00 3.00 0.00 0.00 0.00 0.00 33.23 0.00

Total 30.00 81.26 2.22 3.67 9.85 0.74 9.86 10.89 40.64 48.47

Multimix B: for age 6-9 months

Millet flour 20.00 77.28 2.00 0.80 15.52 0.44 0.10 6.34 5.71 49.21

Egg (poached) 10.00 15.31 1.21 1.11 0.12 0.00 0.04 3.84 7.92 0.38

Melon seeds (agushie) 5.80 33.57 1.45 2.85 0.53 0.39 0.57 4.60 20.33 1.68

Total 31.00 126.16 4.66 4.76 16.17 0.83 0.96 14.78 33.96 51.27

Multimix C: for age 9-12 months

Rice, white (cooked, regular) 15.00 15.86 0.30 0.02 3.62 0.05 0.15 0.81 0.12 9.76

Blackeye beans (roasted, flour) 15.00 49.43 3.30 0.23 8.55 0.66 1.95 8.90 1.37 23.06

Vegetable oil (sunflower) 2.50 22.50 0.00 2.50 0.00 0.00 0.00 0.00 15.47 0.00

Lactogen 10.00 46.34 2.20 1.90 5.10 0.00 0.40 5.93 11.53 14.17

Eggs (hen) 10.00 14.20 1.20 1.00 0.10 0.00 0.02 3.24 6.07 0.27

Total 52.50 148.33 7.00 5.65 17.37 0.96 4.11 18.48 34.26 47.26

Multimix D: for age 12-24 months

Sorghum flour 50.00 178.60 5.00 1.40 36.50 1.05 0.03 5.87 3.70 42.87

Groundnut (roasted, paste) 15.00 86.68 3.46 6.76 3.00 0.43 1.37 4.06 17.86 3.52

Spinach (fresh, cooked) 20.00 5.83 0.594 0.05 0.75 0.49 0.00 0.70 0.14 0.88

Lactogen 15.00 69.45 3.30 2.85 7.65 0.00 1.20 3.88 7.53 8.99

Total 100.00 340.56 12.35 11.05 47.90 1.97 2.40 14.51 29.23 56.26

Note:aMinerals, ash, etc.

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Table IIIA comparison of the nutritional values of 100g servings of the developed multimixes with reference nutrient intakes (RNIs) for human weanlings

Nutrient

Multimix A (4-6 months)

Multimix B (6-9 months)

Multimix C (9-12 months)

Multimix D (12-24 months) Energy

kcal 270.0 403.70 282.50 340.56

RNI value 700 779 940 1,150

Percentage of RNI 35.57 51.82 30.05 29.61

Carbohydrate

g 32.83 51.74 33.09 47.90

RNI value a a a a

Percentage of RNI N/A N/A N/A N/A

Protein

g 7.40 14.91 13.33 12.35

RNI value 12 19 20 20

Total fat

g 12.23 15.23 10.76 11.05

RNI value a a a a

Fibre

g 2.47 2.66 2.00 2.00

RNI value a a a a

Iron

mg 5.37 6.62 3.18 6.28

RNI value a ₇ ₇ ₁₀

Percentage of RNI N/A 94.57 45.43 62.80

Calcium

mg 44.60 231.20 122.00 106.30

RNI value a 500-600 500-600 400-500

Thiamine

mg 0.12 0.224 0.632 0.317

RNI value a 0.3 0.4 0.5

Riboflavin

mg 0.096 0.221 0.183 0.173

RNI value a _0.5 _0.6 _0.7

Vitamin A

mg 186.6 176.3 114.3 219.00

RNI value 300 300 300 250

Vitamin C

mg 8.50 7.58 7.90 11.75

RNI value 20 20 20 20

Niacin

mg 1.44 1.104 1.62 4.62

RNI value a 5.6 6.6 7.6

Vitamin B12

mg 0.00 0.123 0.32 0.00

RNI value a _0.3 _0.3 _0.9

Folate

mg 38.5 4.80 57.1 55.3

RNI value a 60 60 60

Note: aData unavailable or unreliable (for age group 4-6 months, breast milk of a well-nourished mother provides these nutrients in adequate amounts)

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Cooking has the advantage of killing bacteria, improving taste and making food more edible and digestible. Certain vitamins, particularly B vitamins, vitamin C and vitamin A, may, however, be lost during cooking especially in open fires and over long periods of time in utensils which are open to the air. Drying can also lead to losses of vitamin C and folate. Germination and fermentation have traditionally been used in many developing countries in processing foods. These methods have been known to improve legume

digestibility and to increase vitamin contents of certain foods, e.g. beans. Drying, especially of cereals and fish, helps storage and hence shelf life of these foods. Poor storage and/or preservation techniques often lead to the formation of moulds, e.g.Aspergilus flavusin groundnuts which produce aflatoxins harmful to humans.

In this paper, an attempt has been made to demonstrate that it is possible to formulate

weaning foods which meet the energy and nutrient needs of human weanlings, using limited available resources in developing countries. The methods used to arrive at these formulations are traditional, relatively cheap, transferable and, in our view, sustainable. Table IV gives a summary of food sources of key micronutrients. These can be used as a guide by nutrition education workers in developing countries to help families and communities make better use of their produce. Such public education programmes will help communities improve the nutrient densities of weaning foods whilst, at the same time, meeting the micronutrient needs of children at no major extra cost. We believe that these formulations will also have a place in feeding children (and indeed adults) as part of nutrition rehabilitation programmes and during famine and other humanitarian emergencies.

Table IVMicronutrient sources suitable for developing weaning multimixes

Nutrient Major food source Moderate food source Minor food source Calcium Dried whole milk, DSM, cowpeas, dried

fish

Baobab leaves, millet finger, amaranth leaves, okra leaves, cassava leaves, pumpkin leaves

Baobab fruit, soybeans, kidney beans, mung beans, dried salted fish, chick peas, evaporated milk, dried eggs

Thiamine Dry cowpeas, mature soybeans,

groundnuts, pigeon peas, dried sunflower seeds

Beef liver, DSM (enriched), baobab (ripe, raw), cashew nuts, fresh lentils, chick peas (whole)

Millet finger, whole grain, cassava leaves, wheat flour, sorghum flour

Niacin Groundnuts (dried), beef liver, baker's yeast

Sorghum, sunflower seeds, beef/goat (moderate fat), beef kidney, chicken, dried fish

Baobab leaves, white maize, maize meal, sorghum, lentils, rice, millet, pigeon peas, soybeans, avacado (raw), baobab (ripe)

Vitamin A Fish liver oil, red palm oil, beef liver, mutton, ghee, cow's milk (powder), carrots (raw), fish liver oil, mango (ripe), sweet potato/cassava leaves

Hen's eggs, chicken, yellow maize meal, plantain (ripe), sweet potato (yellow), cowpea leaves, pumpkin (raw), pumpkin leaves

Cowpeas (young pods), tomato, avacado, orange, papaya, water melon

Iron Millet finger (flour), cowpea leaves, millet bullrush (flour)

Cashew nuts, millet finger (grain), millet bullrush (grain), sorghum (whole grain), sorghum (flour)

Yellow maize, chickpeas (seeds), bambara nuts (dry), melon seeds (fresh), beef liver, sunflower seeds, amaranth leaves, baobab (ripe), dried fish

Riboflavin Okra leaves (raw), beef kidney, beef liver, DSM, cow's milk powder

Cashew nuts, amaranth leaves, cassava leaves, cowpea leaves, hen's eggs, goat, dried fish

Dried beans, chickpeas, cowpeas (dried), lentils (dried), pigeon peas, groundnuts, melon seeds, pumpkin seeds, sunflower seeds, bean sprouts, sweet potato leaves, avacado

Vitamin B12 Beef liver Beef heart, beef kidney Beef, hen's eggs, pork

Folate Chickpeas, cowpeas, soybeans, beef liver Wheat (parboiled/flour), sweet potato, pigeon peas, groundnuts, cowpea leaves

Plantain (ripe), potato, amaranth leaves, cassava (fresh), rice (parboiled/lightly-milled)

Vitamin C Cassava leaves (raw), baobab (ripe), guava

amaranth/baobab leaves, cauliflower, cowpea/okra leaves, pumpkin/sweet potato leaves, orange/tangerine, grapefruit, lemon/lime, mango, papaya

Cassava (fresh), plantain (ripe), potato (raw), sweet potato, lentils (dried), tomato (raw), pineapple

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