Can a Micronutrient Powder Help Amazonian Children Avoid Deficiency?
Reading various blogs, one would expect that the bounties of the Amazon rainforest – guava, manioc and armadillo – are enough to provide all the nutrition that children need. Eating foods that are foraged is apparently the secret to good health. Top Amazonian superfoods include acai berries, raw cacao, passionfruit and sacha inchi seeds. Amazonian tribes are also reported to have the most diverse gut microbiota, with its purported health benefits. So it may be surprising to learn that indigenous populations in South America are actually at a greater nutritional risk than national populations. For example, Coimbra and co-workers show that indigenous populations in Brazil, who live almost exclusively in the Amazon, have higher rates of anemia, stunting and other health and nutritional disparities compared to the rest of the country. Areas where reliance on hunting and gathering is greatest appear to be at most risk.
The authors of a recent publication, Oliveira et al, looked at whether it was possible to reduce nutritional deficiencies by using a micronutrient powder added to foods just prior to consumption as part of a national program, ENFAC, that aims to improve complementary feeding practices in Brazil. . This approach is call in-home fortification as it occurs in the household where the foods will be eaten, rather than other fortification methods that are done at the food supplier’s level. The study was performed in infants and toddlers receiving routine pediatric care in Rio Branco, the main Brazilian city in the Amazon. The investigators selected a control group of children aged 11-14 months in which measurements were taken, and an intervention group aged 6-8 months. This unusual construction was undertaken due to ethical restrictions in blood sampling in babies. The intervention group (193 babies) received 60 sachets (2 months’ supply) containing daily amounts of 15 vitamins and minerals, and health care workers trained infant care providers to add one sachet to their food just prior to consumption. A blood sample was taken from the intervention group infants when they reached one year of age, and this was compared to a baseline sample taken for the control group (128 toddlers).
Compliance was not very good during the study: only 29% consumed all sachets, and 70% of caregivers reported that the child consumed at least half the sachets. The sachets were added to mashed vegetables with eggs, meat or rice, or beans and fruits, or porridge. The most common reason for not using the powder was that the child would not eat the food. Despite low compliance, the intervention group infants had a significantly improved nutritional profile: iron deficiency, vitamin A deficiency, and combined vitamin B12 and iron deficiency were less common, and blood concentrations of vitamin E and beta-carotene were higher. Intervention group infants had lower reported coughing and wheezing. Iron deficiency was 72% in the control group and 25% in the intervention group at the end of the trial, for example.
This study was considered to be a “pragmatic trial” as the investigators were unable to take a baseline sample for infants in the intervention group, and had to make do with a proxy baseline sample via the control group. There were some concerns that the higher beta-carotene concentrations reflected greater intakes of fruits and vegetables in the intervention group, and that it was not the micronutrient powder per se but an improved diet that lead to nutritional improvements. On the other hand, the increase in vitamin E was likely due to the supplement, and fruits and vegetables generally do not provide a good source of iron, therefore the decreases in iron deficiency anemia may also be due to the supplement.
Infants and toddlers growing up in the Amazon are at increased nutritional risk. The prevalence of chronic undernutrition and anemia is high, exposing children to potentially lifelong poorer health and reduced work capacity. In-home fortification shows potential as a means to improve micronutrient intakes and nutritional status.
Oliveira, C. S., et al. (2016). "Multiple micronutrients in powder delivered through primary health care reduce iron and vitamin A deficiencies in young Amazonian children." Public Health Nutrition FirstView: 1-9. http://dx.doi.org/10.1017/S1368980016001294
Coimbra, C. E., Santos, R. V., Welch, J. R., Cardoso, A. M., de Souza, M. C., Garnelo, L., … Horta, B. L. (2013). The First National Survey of Indigenous People’s Health and Nutrition in Brazil: rationale, methodology, and overview of results. BMC Public Health, 13, 52. http://doi.org/10.1186/1471-2458-13-52
Paley, Matthieu. We are what we eat: Foraging in the Amazon rainforest. National Geographic Proof. October 15, 2014. http://proof.nationalgeographic.com/2014/10/15/we-are-what-we-eat-foraging-in-the-amazon-rainforest/