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Efficacy of Malunggay ( Moringa oleifera ) leaves in improving the iron and vitamins A and B status of Filipino schoolchildren

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Acta Hortic. 1158. ISHS 2017. DOI 10.17660/ActaHortic.2017.1158.33
Proc. I International Symposium on Moringa
Eds.: A.W. Ebert and M.C. Palada
293
Efficacy of Malunggay (Moringa oleifera) leaves in
improving the iron and vitamins A and B status of
Filipino schoolchildren
M.E. Seraficoa, L.A. Perlas, C.R. Magsadia, J.A. Desnacido, R.V. Viajar, E.O. Rongavilla,
G.P.AzanaandT.P.Trinidad
FoodandNutritionResearchInstitute,DepartmentofScienceandTechnology,Bicutan,TaguigCity,Philippines.
Abstract
Theprevalenceofirondeficiencyanemia(IDA)andvitaminAdeficiency(VAD)
remainatasignificantpublichealthlevelinthePhilippinesasshownbyNational
NutritionSurveysconductedbytheFNRI-DOST.Whileriboflavinandfolicacid
deficienciesamongschoolchildrencouldalsobeareasofconcern,nutritional
assessmentofthesevitaminsarelacking.Inthisstudy,Moringa oleifera,locally
knownasMalunggay,wasconsideredasapossiblesolutiontotheseproblems
becauseofitshighnutritionalcontent.Thestudywasconductedintwopublic
elementaryschoolsinMuntinlupaCitywhere121underweightchildrenaged8-10
yearsoldweredividedintocontrol(n=60)andexperimental(n=61)groups.The
controlgroupwasfedwithsnackfoods(arrozcaldo, ginataang mais,macaronisoup,
pancit cantonandpolvoron)duringrecesswhiletheexperimentalgroupwasfedwith
thesamesnackfoodswhereinthreegramsMalunggayleafpowder(MLP)wasadded.
Heightandweight,foodintakeandhemoglobin,serumferritin,vitaminA,riboflavin
andfolicacidweremeasuredbeforeandafterthe120-dayfeedingperiod.Results
showedthattheconsumptionofthesnackfoodssignificantlyincreasedthenutrient
intakesofthechildren.GreatestincreasewasrecordedforvitaminAintakeofthe
childrengiven3gMLP.EndlinevitaminAintakeexceededtherequirementfor
vitaminA.Increaseinheightandweightbetweenthegroupswerenotdifferent.
Increaseinhemoglobinlevelswasgreateramongchildrenwhoconsumedsnackfoods
withMLPwhileincreaseinserumvitaminAlevelswasobservedinbothgroups.A
significantincreaseinserumfolicacidwasrecordedintheexperimentalgroup.In
conclusion,regularconsumptionofMalunggayleavesmayhelpalleviatecertain
micronutrientdeficienciessuchasIDA,VAD andfolicaciddeficiency.
Keywords:moringa,hemoglobin,vitaminAdeficiency,folicacid,riboflavin
INTRODUCTION
IronandvitaminAdeficienciescontinuetobeproblemsindevelopingcountries(Yang
etal.,2006b).InthePhilippines,theprevalenceofironandvitamin A deficiencies
continuouslyremainat levels thatpose a publichealth concern.The7th National Nutrition
Surveyconducted by the Foodand Nutrition Research Institute-Department ofScienceand
Technology (FNRI-DOST) in 2008 showed that among 6-12 years old children, 19.8 and
11.1%wereanemicandvitaminAdeficient,respectively(Foodand Nutrition Research
Institute-DepartmentofScienceandTechnology(FNRI-DOST),2010a,b).
Ontheotherhand,thestatusofB-vitaminsofFilipinoschoolchildren has not been
assessedfor thepasttenyears.Vitamin B deficiencies maybecomeapublichealthconcern
becausefoodsrichinthesevitaminssuchasdairyproductsanddarkgreenleafyvegetables
likeromainelettuce,kale,spinach,watercressandbroccoliarerelativelyexpensive.
Governmentinvestmentshavepouredtovariousinterventionprograms designed to
addressthemalnutritionproblem.Approacheshaveincludedfortification,supplementation,
nutrition education and supplementary feeding programs utilizingnutritiousandlowcost
aE-mail: mes@fnri.dost.gov.ph
294
foods.
Recent developments in the search for finding solutions to malnutrition, have
identified food-based approaches as a sustainable complement to supplementation
programs. Findings of Yang’s group (2006) showed that Moringaoleifera is one of the
promising crops which could contribute to increased intake of micronutrients and
antioxidants. The World Health organization has likewise promotedmoringaasan
alternative to imported food supplies to treat malnutrition (Sreelatha and Padma, 2009;
Johnson,2005).
Foodbased approachesto eliminatemicronutrient deficiencies havebeenconducted
and found to be effective, both in animal and human studies. Inseveralanimalstudies,
feedingMoringaoleiferaleavestorats(NambiarandSeshadri,2001),cows(Sarwattetal.,
2004)andhens(Kakengietal.,2007)resultedinbothweightgainandimprovednutritional
status.
Most of the studies on the efficacy of Moringaoleifera on improvement of the
nutritionalandhematologicalstatusofmalnourishedhumanswereconductedinveryyoung
children.Weightgainwasrecordedwheninfantswerefedcomplementaryfoodsmixedwith
moringaseedsinBurkinaFaso(Compaoréetal.,2011)andmoringaleafpowderinUganda
(Jilcottetal.,2010). An interventionstudy using traditionalcomplementaryfood(CF)with
moringa among infants in Nigeria resulted in improved hemoglobin, serum ferritin and
serumretinol level(Nnam,2009).Ontheotherhand,increaseinhemoglobinlevelwas not
significantintheCFwithmoringaamonginfantsinBurkinaFaso(Compaoréetal.,2011).
In-vitro studies on bioavailability of micronutrients from moringa leaves were also
reported. In a recent study conducted by Trinidad et al. (2013), the bioavailability of iron
and zinc from moringa leaves was 17.1 and 70.6%, respectively. Beta-carotene and lutein
fromfreshanddriedmoringaleavesarealsohighlybioavailable(PullakhandamandFailla,
2007).
In the Philippines, Moringaoleifera, is commonly called Malunggay. Its leaves are
amongthetop30commonlyconsumedfooditemsofFilipinos(FoodandNutritionResearch
Institute-DepartmentofScienceand Technology(FNRI-DOST), 2010a, b). Among 6-12year
oldchildren,consumptionofMalunggayis15gday-1.
Efficacyof Malunggayforundernourishedchildrenhasnotbeenfullyestablisheddue
tolimitedscience-basedstudiesinhumans.Itishopedthatthisstudycan supportclinical
evidence to the various claims on the effectiveness of Malunggay, particularly on the
alleviationofmicronutrientdeficiency.
Thestudywas carried out todetermine the efficacy ofMalunggayleafpowderadded
tosnackproductsinimprovingtheironandvitaminsAandBstatusof8-10yearsold
schoolchildren.Specifically,thestudysoughttocomparethechangesin weight and height,
hemoglobin, serum ferritin, serum retinol, serum folic acid concentrations and riboflavin
statusamongthestudyparticipants.
MATERIALSANDMETHODS
Studysettinganddesign
ThestudywasconductedinMuntinlupaCityinthesouthernmostpartoftheNational
Capital Region. Two public elementary schools with similar socio-economic and
environmental characteristics werepurposely selected as study sites. Children with below
normalbodymassindex(BMI)wereconsideredasparticipantsofthestudy.Atotalsample
sizeof121childrenwasconvenientlyallocatedintoexperimental(60studentsfromSchool
1)andcontrol(61studentsfromSchool2)groups.
Theexperimentalgroupwasfedsnackproductswith3gofMLP,while the control
group was fed with snack products without MLP.  Nutrient composition of the snack foods
werecomputedfromthePhilippineFoodCompositionTables(FNRI-DOST,1997). Feeding
lastedfor120days.Baselineandend-linedatacollectionwasconductedforbothgroups.
The study protocol was reviewed and approved by the Food and Nutrition Research
InstituteInstitutionalEthicsandReviewCommittee(FIERC).Informed,writtenconsentwas
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obtained from the children’s parents after the purpose and procedures of the study were
explained.
Moringaleaves
MoringaleafpowderwaspurchasedfromJapan-PhilippinesMalunggayEcoFarm,Inc.
(JPM)locatedintheProvinceofLaguna.NutrientcontentofMLP was determined by the
FoodAnalyticalServiceLaboratoryofFNRI.
Dataandbloodcollectionandanalyticalmethods
Parentsofstudychildrenwereinterviewedface-to-faceusingapre-testedstructured
questionnaire.Atbaseline,generalprofileofthechildrenaswellashealthandnutritiondata
wascollected.Selecteddemographicandsocio-economicdatawerealso obtained. Intakeof
vitaminsandmineralsupplementsonemonthpriortodatacollection andtwoweeks prior
tobloodextractionwasrecorded.Allchildrenparticipantsweredewormedbeforethestart
ofthefeedingtrial.
Weight of children was measured at baseline and end-line using a calibrated 160-kg
capacitybeambalance weighing scale.Heightwasmeasuredusingamicrotoisepostedflat
againstawall.
A two-day non-consecutive 24-h food recall was collected at baseline and end-line.
Studychildrenortheirparent/caregiverswereinterviewedontheirfoodintakeforthepast
24h.
Bloodsampleswerecollectedfromallstudychildrenatbaselineandafter120daysof
the intervention study. About 5 mL blood by venipuncture was extracted from each child
withapproximately2mLtransferredinatubewithananticoagulant.Remainingbloodwas
allowed to set and serum was separated within 2 h after collection. Serum and
anticoagulatedbloodwerethenkeptina-80°Cfreezeruntilanalyzed.
Hemoglobinwasdeterminedonsite using thecyanmethemoglobinmethod(Zwartet
al., 1996), ferritin using an immunoradiometric assay procedure(DPC)andvitaminAvia
HPLC method (Furr et al., 1992). For riboflavin status, erythrocyte glutathione reductase
activityinbloodwasdetermined,whileserumfolicacidwasdetermined using a
radioimmunoassaymethod(DPC).
Statisticalanalysis
Alldataweretransformedtonumericalcodesguidedbyacodingmanualpreparedfor
thestudy.TheStatisticalPackageforSocialSciencesversion9.0was usedforencodingand
statistical analysis. Parametrictests such as t-test and paired t -testwere used to compare
means among normally distributed variables. Chi-square test wasusedtocompare
proportionsbetweengroups.
RESULTS
Energyandnutrientcontentofsnackproducts
Theenergyandnutrientcontentofthefivedifferentsnackfoodsutilizedinthefeeding
interventionispresentedinTable1.The3gMLPcontainsabout11.5kcal,0.8gprotein,37.7
mgcalcium,0.4mgiron,225.9µgvitaminA,and2.1mgvitaminC.Amongthesnackfoods,
polvorongavethehighestnutrientsperserving.Ontheotherhand,arrozcaldohadtheleast
amountofnutrientsperserving.Meatwasnotaddedtothedevelopedsnackfoodstoavoid
confoundingwiththenutrientsfromthemeat.Flavorenhancerswereaddedinstead.
Characteristicsofstudychildren
There were slightlymore females (53.3 and 54.1% for the experimental and control
groups,respectively)than males in bothstudy groups. Childreninthe experimentalgroup
weresignificantlyolder(9.8±0.5years)comparedwiththecontrolgroup(9.1±0.8years).
Lessthanhalf(40.0%fortheexperimentaland44.3%forthecontrol  group) ofth e
childreninbothstudygroupsgotsickinthepasttwoweeksatbaseline,whereasatend-line
296
alowerpercentageforbothgroupswerenoted(datanotshown).
Table1.NutrientcontentofsnacksfoodsandMalunggayleafpowderperserving.
Snack products
Energy and nutrient content
Energy
(kcal)
CHO
(g)
Pro
(g)
Fe
(mg)
Vit. A
(µg)
B2
(mg)
Vit.C
(mg)
Arrozcaldo (210 g)219.640.4 5.1 1.5 0.8 0.10.0
Ginataang mais (210 g)421.571.4 6.4 1.8 6.8 0.10.0
Pancit canton (210 g)342.643.6 8.8 2.5 154.8 0.14.6
Macaroni soup (240 g)262.445.1 9.6 2.4 35.8 0.20.0
Polvoron (60 g)625.477.3 13.7 3.0 192.3 0.52.8
Malunggay leaves powder (3 g)11.51.51 0.8 0.4 225.91No data2.1
1Converted from ß-carotene.
Anthropometricstatus
Baselinemeanweightofchildrenwassimilarforbothgroups(20.45±1.73 and
20.17±2.37kgfortheexperimentalandcontrolgroup,respectively)aspresentedinTable2.
Mean weights for both groups increased significantly (p<0.001), with the control group
havingslightlyhigherincrease.Themeanchangeinweightacross periods between study
groupswasnotsignificant.
Table2.Meanweightandheight(±SD)ofchildrenbystudygroupandperiod.
Variables
Study Group
p-value1 Experimental Control
n=60 n=61
Weight (kg)
Baseline20.45±1.73 20.17±2.37 0.468
End-line21.89±2.18 22.00±2.94 0.813
Difference+1.44 +1.82
p-value20.001 0.001
Height (cm)
Baseline124.68±4.78 123.64±6.69 0.325
End-line126.51±5.01 126.14±6.95 0.742
Difference+1.82 +2.51
p-value0.001 0.001
1Using independent sample t-test.
2Using paired-sample t-test.
Thebaselinemeanheightofstudychildrenintheexperimentalgroup (124.68±4.78
cm)wasnotdifferentwiththatofchildreninthecontrolgroup(123.64±6.69cm).Similarly,
atend-linetheirmeanheightswerenotsignificantlydifferentfromeachother(126.51±5.01
vs.126.14±6.95cm).Themeanchangeinheightbetweenstudygroupswasnotsignificantly
different,whilethemeanchangeinheightfrombaselinetoend-linewithinstudygroupswas
significantlydifferent(p<.001).
ThemeanBMI-for-agez-scoreofchildrenintheexperimentalandcontrolgroupswere
both significantly different across periods but differences were not significant between
groups.
Biochemicalindices
Table 3 showsmean hemoglobin,ferritin,serumretinol,folicacidandEGR-ACofthe
study children. Atthe start of the feeding trial, hemoglobin levels of the experimentaland
controlgroupswerestatisticallythesame(p=0.854).Attheendofthefeedingperiod,mean
297
hemoglobinlevelsof theexperimental group increasedby 0.3 gdL-1(p=0.015) andthatof
thecontrolgroupincreasedby0.2gdL
-1(p=0.025). Both had significant increases in
hemoglobinlevelswiththeexperimentalgrouphavingaslightlyhigherincrease.
Table3. Mean concentration (±SD) of hemoglobin, ferritin, serum retinol, folic acid and
EGR-ACbystudygroupandperiod.
Biochemical parameter
Study group
p-value1Experimental Control
n=60 n=61
Hemoglobin (g dL-1)
Baseline12.5±0.10 12.5±0.13 0.854
End-line12.8±0.11 12.7±0.11 0.540
p-value20.015 0.025
Ferritin (ng mL-1)
Baseline53.9±6.11 47.8±3.5 0.386
Endline39.4±3.7 39.4±3.7 0.998
p-value0.010 0.033
Serum rerinol (µg dL-1)
Baseline34.0±0.89 32.9 ± 0.88 0.375
End-line34.8±0.90 34.6 ± 0.85 0.897
p-value0.438 0.036
Riboflavin
Baseline1.03±0.015 1.03 ± 0.021 0.932
End-line1.01±0.016 1.03 ± 0.018 0.487
p-value0.384 0.931
Serum folic acid (ng mL-1)
Baseine
End-line
p-value
8.6±0.32
9.2±0.29
0.047
9.1±0.30
9.4±0.35
0.328
0.241
0.593
1Using Chi-square test.
2Using Independent sample t-test.
Serum ferritin levelsfor both groups were similar at the start of the trial and at the
endof thestudy. Surprisingly, serum ferritinlevelsdecreased significantlyfor both groups
(p=0.01fortheexperimentalgroupandp=0.033forthecontrolgroup).
Table3alsoshowsresultsforretinol,riboflavinandfolatestatusofthechildrenbefore
andafterfeeding.Atthestartandendofthefeedingtrial,boththeexperimentalandcontrol
groupshadadequatevitaminAlevels.TherewasanincreaseinvitaminAconcentrationin
bothgroups.Unexpectedly, however,theincrease in vitaminAconcentration of thecontrol
groupwassignificantlyhigher(p=0.036).Althoughthestudywaslimitedtotheanalysisofa
fewnutrients,otherstudiessuggestthatdriedmoringaleavescontain a relatively high
vitamin E content (Moyo et al., 2006; Sá nchez-Machado et al., 2006; Yang et al., 2006a)
whichcouldhavehadnegativeinteractionwiththebeta-carotenepresent.
There was no change in the riboflavin status of both groups of participants. On the
otherhand,serumfolicacidhadincreasedsignificantly(p=0.042) at the end of the feeding
trialfortheexperimentalgroup.Althoughserumfolicacidalso increased for the control
group,thechangewasnotsignificant.
Energyandnutrientintakeofstudychildren
Meanone-dayenergyandnutrientintakesofthechildrenweredeterminedbeforeand
after the intervention. Table 4 presents the intake of the children during the intervention
period. The control group had higher mean one-day energy intake (1235.13±297.54 kcal)
comparedtotheexperimentalgroup(1131.83±360.58kcal),meeting64.3and74.3%ofthe
298
energy requirement, respectively. There was no change in energy intake from baseline to
end-line for both groups, but end-line energy intake was significantly higher among the
participants in the control group (p=0.016). A similar trend was observed for the other
nutrients,withthecontrolgrouphavinghigherintakescomparedtotheexperimentalgroup.
However,thedifferencesbetweenthetwogroupswerenotsignificant.
Table4. Mean one-day energy and nutrient intake (±SD) of childrenbystudygroupand
period.
Energy and nutrients
Study Group
p-value1 Experimental Control
n=60 n=61
Energy (kcal day-1)
Baseline1131.83±360.58 (64.3) 1235.13±297.54 (74.3)0.088
End-line1510.57±392.46 (85.9) 1684.34±438.87 (101.8)0.023
p-value20.0000.000
Protein (g day-1)
Baseline32.22±12.32 (69.6) 35.34±9.00 (79.8)0.115
End-line42.36±11.94 (91.7) 46.58±13.74 (105.6)0.074
p-value0.0000.000
Iron (mg day-1)
Baseline6.52±2.80 (50.8) 6.99±2.70 (58.5)0.348
End-line8.85±2.21 (70.1) 9.11±2.83 (77.4)0.582
p-value0.0000.000
Vitamin A (µg day-1)
Baseline236.11±150.96 (59.0) 279.82±198.58 (70.0)0.716
End-line515.04±105.00 (128.8) 284.66±124.00 (71.2)0.000
p-value0.0000.869
Vitamin C (mg day-1)
Baseline12.38±15.31 (30.8) 13.16±14.23 (35.5)0.772
End-line14.06±11.41 (36.0) 17.55±34.98 (48.0)0.462
p-value0.0000.000
1Using independent sample t-test.
2Using paired-sample t-test.
DISCUSSION
Moringaolefeira is said to beo ne of theworld’s most useful plants. Almost all ofits
parts–leaves,fruitsandrootshavebeenusedforavarietyoffoodandmedicinalpurposes
(bar.gov.ph).It is anexcellentsourceof nutrition anda natural energybooster. It isloaded
withnutrientsandvitaminsandaminoacids.LocallyknownasMalunggay,itsleavesarerich
inproteinandother nutrients, which canbeused bydoctors, nutritionists andcommunity
healthworkerstotreatundernutritionandavarietyofillnesses(ThurberandFahey,2009).
Malunggayisknowntobeveryrichinseveralmacronutrients,micronutrients and
antioxidants(ThurberandFahey,2009;Oduroetal.,2008)andthusisoneofthepromising
crops that could help alleviate micronutrient deficiencies. To date, there are very few
documentedstudiesonthis.Thus,thepresentstudyaimedtodeterminetheefficacyofMLP
inimprovingtheiron,andvitaminsAandBstatusofFilipinochildren.
Popularsnackfoodssuchasarrozcaldo,ginataangmais,pancitcanton,macaronisoup
andpolvoronwerechosenforthefeedingtrial.Acceptabilitytestswereconductedbeforethe
actualfeedingtrial,however,theamountofMLPaddedwaslimitedbecauseoftheverydark
coloritimpartedtothesnackfoods.Aswell,tasteoffoodwithmorethan3gMLPwasbitter
and unacceptable even for adults. This is lower than the 5-7 g of dried M.oleiferaleaf
powderaddedtodailysaltysnacksof1-5yearoldchildreninIndia(Nambiaret.al.,2003).
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Nutrientintakeof thechildreninthecontrolgroupatend-linewashigherwhen only
householdfoodandsnackfoodswereconsidered,butthedifferencewasreducedwhenMLP
wasadded.Highestreductionswererecordedforprotein,energy, calcium, vitamin A and
vitamin C intakes. It is widely reported that Malunggayisaveryrichsourceofnutrients.
NutrientsfromtheMLPconsumedbythestudychildrenmaynothaveprovidedtherequired
amountforittoresultinasignificantincreaseinnutrientintakeamongthechildrengiven3
gMLPdailybutresultedinincreaseinheightandweightofthechildren.
InBurkinaFaso,acomplementaryfood(CF)madewithMoringaoleifera seeds, was
testedandcomparedtotheexistingCFinthearea(Compaoréetal.,2011).Thestudywas
conducted among severely malnourished, 6-36 months old infants. Feeding lasted till
childrenwereeligibleforthehome-basedtherapystudywhencomplicationswereresolved
andtheir appetitereturned.Durationof recoverywasabout45daysforthegroupgivenCF
withmoringacomparedtoabout100daysforthegroupgiventheexistingCF.Weightgain
washigher in thosegivenCFwith moringa. However, increase in hemoglobinlevelwasnot
significantintheCFwithmoringa.
The additional nutrients provided by 3 g MLP resulted in minimal changes in the
biochemicalparametersstudied.Asignificantincreaseinhemoglobinwasrecordedforboth
groups.Three grams of MLPprovided0.4 mg Fed-1(Table1),whichunfortunatelywas not
enough to meet the requirement for iron. Moreover, the bioavailability of iron coul d have
beeninhibitedbythepresenceofphytateandfiberinMLP.Ithasbeenshownthataslittleas
2mgphytatecanreduceironabsorptionby18%(Hallbergetal.,1989).Thebioavailability
ofironinMLPwasreportedtobe17.1%(Trinidadetal.,2013).
WehavenotfoundanystudyonefficacyofMLPamong8-10yearoldchildren.Afour-
week intervention study using the maize traditional CF with moringa, among infants 6-12
months, conducted in Nigeria, resulted in an increase in hemoglobin, serum ferritin and
serumretinollevel(Nnam,2009).Likewise,meanhemoglobinlevelsincreasedsignificantly
ina3-monthefficacytrialamongmoderatelyanemiclactatingwomeninSenegal (Idohou-
Dossouet al.,2011). Thesewomen received100 gof MLPeach weekwhichismuchmore
thanwhatwegavetothechildreninthisstudy.Wegave3gday-1 or 21 g week-1. Serum
ferritinlevelsremainedunchangedattheendoftheintervention, which is similar to
findingsofourstudy.Meanferritinlevelsofthechildreninourstudywerenormal.
Malunggayisveryrichinβ-carotenewhicheventuallyconvertstovitamin A. Beta-
carotene and lutein from fresh and dried Malunggay leaves are also highly bioavailable
(PullakhandamandFailla,2007).IncreaseinvitaminAintakeintheexperimentalgroupwas
highlysignificantasaresultofthe3gMLP.Theend-linemean vitamin A intake of the
experimentalgrouphasincreasedtoalevelhigherthanthatoftherequirementforvitamin
Aforthisagegroup.However,thisamountdidnotresultinan increase in serum retinol
levelsofthechildren.Meanserumretinollevelsofthechildrenwerenormalatthestartof
theintervention.Studieshaveshownthatinterventionandsupplementationtrialsaremore
effectiveinthosewithlowmicronutrientlevels.
Asignificant increase inserum folic acidwasrecordedamong the childrengiven3 g
MLP day-1.Thisisanindicatorofrecentintakeofthenutrient.Amonggreen, leafy
vegetables, Malunggay leaves contain the highest dietary folate equivalents amounting to
370 µg 100 g-1 (Food and Nutrition Research Institute-Department of Science and
Technology (FNRI-DOST), 2010a, b). These could have been the drivertoincreasethe
concentrationofserumfolateamongthechildrenintheexperimentalgroup.
CONCLUSIONS
Thefollowingconclusionscanbedrawnfromthestudy:
- Increase inmean hemoglobin levelwas greater forchildren givensnack foodswith
three grams of Malunggay leaf powder compared to those given only snack foods.
However,bothgroupshadasignificantincreaseinhemoglobinlevel.
-ChildrengivensnackfoodswiththreegramsMLPachievedmorethan100%oftheir
dailyvitaminArequirement.
- Improved serum folic acid concentration could be attributed to the high folate
300
content of MLP. Significant increase in serum folic acid level was observed among
childrengivensnackfoodswithMLPbutnotinthecontrolgroup.
ACKNOWLEDGEMENTS
The authors would like to express their deepest gratitude to the following: the
PhilippineCouncil forHealthResearchandDevelopmentforfunding thestudy,DepEdNCR,
parents and student participants. In addition, thank you is extendedtothestaffof
Nutritional Biochemistry Section, Ms. Marites Alibayan, Ms. Joselita Rosario Ulanday, Ms.
AsuncionTorres,Ms.AdorieSabenecio,Ms.EvaRebato,Ms.Ma.Estrella Valle, Ms. Dovie
Domiquel,andMr.HerbertPatalenwhohelpedpreparethesnackfoodsandassistedinfield
data collection; Mr. Carl Vincent Cabanilla for retinol analysis;Mr.JeffreydeLeon,Mr.
EldridgeFerrerandMs.AileenJoyRamosforthestatisticalanalyses.
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... Serafico et al. 58 realizaron una intervención con niños de una escuela pública y el mismo estatus socioeconómico, divididos en dos grupos. Un primer grupo que actuó como control, ingirió diferentes tipos de snacks y el segundo ingirió los mismos snacks a los que se le añadieron 3 g de polvo de hojas de moringa durante 120 días. ...
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57 Moringa oleifera Lam. (Moringaceae): evaluación nutricional y clínica en modelos animales y correspondencia con investigaciones en humanos Moringa oleifera Lam. (Moringaceae): nutritional and clinical evaluation in animal models and correspondence with human research Resumen Moringa oleifera es una especie vegetal que pertenece a la familia Moringaceae. Durante cientos de años, poblaciones de diferentes países han considerado que posee propiedades medicinales y nutritivas. Recientemente se le ha prestado atención en países tropicales y subtropicales de Europa del Este, América Latina, el Caribe y Asia, y se ha ganado un lugar en la industria de suplementos, ingredientes funcionales y en la fortificación de alimentos. El objetivo de este trabajo fue relacionar los hallazgos bioquímicos y fisiológicos determinados en modelos experimentales animales y los que se han logrado demostrar en humanos en los mismos aspectos, mediante el empleo de M. oleifera; con un llamado de atención a aquellas similitudes y diferencias entre el modelo animal y el prototipo humano. Los efectos beneficiosos de M. oleifera vinculados al tratamiento de la diabetes mellitus, dislipidemias y anemia se han asociado en gran medida al contenido y variedad de sustancias antioxidantes que posee y que complementan su valor en nutrientes. Esta revisión enfatiza en la necesidad de desarrollar experimentos controlados en humanos para estudiar el papel de los principios activos de M. oleifera en nutrición y clínica para establecer las formas idóneas de suministrar la planta y dosis óptimas que permitan lograr los efectos deseados, de manera que resulte aceptable al paladar y sea una solución sostenible en el tratamiento de estas enfermedades. Abstract Moringa oleifera is a plant species that belongs to the Moringaceae family. For hundreds of years, populations of different countries have considered that it has medicinal and nutritional properties. It has recently received attention in tropical and subtropical countries in Eastern Europe, Latin America, the Caribbean, and Asia, and has earned a place in the supplement, functional ingredient, and food fortification industry. The objective of this work was to relate the biochemical and physiological findings determined in experimental animal models and those that have been demonstrated in humans in the same aspects, through the use of M. oleifera; with a call for attention to those similarities and differences between the animal model and the human prototype. The beneficial effects of M. oleifera linked to the treatment of diabetes mellitus, dyslipidemias and anemia have been largely associated with the content and variety of antioxidant substances that it possesses and that complement its value in nutrients. This review emphasizes the need to develop controlled experiments in humans to study the role of the active principles of M. oleifera in nutrition and clinic to establish the ideal ways to supply the plant and optimal doses that allow to achieve the desired effects, so that is acceptable to the palate and is a sustainable solution in the treatment of these diseases.
... Nutrient fortification in food through supplementation of moringa leaves powder in bread increased the nutrient content like calcium, magnesium and beta-carotene (27) . School children that consumed moringa-snack foods fortified with 3g of moringa exhibited increased hemoglobin (an indicator for reduced anemia), vitamin A and folic acid levels (28) . Some information has been published on the nutritional profile of moringa leaves, flowers, and pods from different varieties and locations (11,(29)(30)(31) . ...
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Background/Objectives: Moringa (Moringa oleifera) is a multi-purpose tree with valuable nutritional density found in the leaves and pods. Both seasonal and year-round cultivars are available and consumed in Bangladesh. This study evaluated the qualitative and quantitative morphological characteristics and nutritional content in leaves and pods of moringa cultivars from two major ecological locations in Bangladesh. Methodology: The selected local varieties used were seasonal production (SP: V1) and year-round production (YP: V2) cultivars from the two ecological regions Chapai Nawabganj (L1) and Pabna (L2). Findings: Flowering and fruiting occurred once per year in seasonal cultivar (SP) and three times per year in year-round cultivar (YP). Flowers are zygomorphic; and tripinnate and pinnately compound leaves in both cultivars. The average yield of pods over two years of production for V1 was 45-62 kg/year/plant and 27-38 kg/plant/year for V2. Leaves contained more than two times higher protein (29-36%) compared to pods (11-15%). Similarly, nutrients including calcium and iron were significantly higher in leaves (2314-3487 ppm and 276-418 ppm, respectively) than pods (2017-2032 ppm and 61-68 ppm, respectively). There were no significant differences in potassium content of both cultivars in both location, but pod contained more than four times higher phosphorus (1.5- 1.7%) than leaves (0.34-0.38%). The highest amounts of magnesium (1768-1861 ppm) and sodium (496-535 ppm) were found in pods. Applications: Cultivar and plant part (e.g leaves) can be considered when promoting and utilizing moringa micronutrient for nutritional security. It demands for policies and development actions for production and intensification of moringa in dry parts of the country. Keywords: Moringa; cultivars; leaves; pods; morphology; nutritional security
... Nutrient fortification in food through supplementation of moringa leaves powder in bread increased the nutrient content like calcium, magnesium and beta-carotene (27) . School children that consumed moringa-snack foods fortified with 3g of moringa exhibited increased hemoglobin (an indicator for reduced anemia), vitamin A and folic acid levels (28) . Some information has been published on the nutritional profile of moringa leaves, flowers, and pods from different varieties and locations (11,(29)(30)(31) . ...
... Indigenous nutrient-rich plant sources like Moringa oleifera are increasingly discussed as potential sustainable solution to combat malnutrition in children [88], [89], [90], [91], [92], [93], [94], [95], [96], [97], [98], [99], [100], [101], [102]. Descriptive studies (intra-group comparisons) comment positively on MLP application as preventive or treatment approach however bear distinct limitations: ...
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Background and objectives: Malnutrition associated with anemia remains a leading cause of morbidity and mortality among Adivasi children in India. The present trial aimed to test three possible ways of designing improved supplementary meals and to define their role in decreasing rates of anemia, thus increasing hemoglobin (Hb) concentrations as primary health objective: diversified meals only (intervention group 1 (IG 1)), with the addition of locally producible Amaranthus tricolor/Moringa oleifera leaf powders (ALP/MLP) in the ratio 2:1 (IG2) or with an adjusted amount of commercially produced micronutrient powder TopNutri (IG3). Methods: Cluster-randomization of 21 villages resulted in the inclusion of n=293 children aged 6-39 months after baseline assessment. The trial duration was 18 months, beginning in February 2015 (baseline assessment), with application of study meals three times a week at community level. Anthropometric, Hb (HemoCue201+) and morbidity data were collected in a total of four assessment points. At baseline a socio-economic questionnaire was performed. Results: Adjusted for age and Hb concentrations at baseline, time between assessment points, and gender; IG1 showed significant higher Hb concentrations as compared to the control group (CG) throughout the intervention period. The Hb of the remaining intervention groups IG2 or IG3, remained comparable to the CG at all assessment points. The effect on growth indices was less consistent, however most positive tendencies related to nutrition status (stunting, underweight, wasting) and morbidity reduction were attributable to IG3, indicating the beneficial role of a holistic nutrient composition in addressing undernutrition and infectious diseases. Conclusion: This low-dose intervention trial proofed the feeding of diversified diets alone (IG1) to be sufficient to significantly increase Hb concentrations of study children. On the way of achieving diversified diets for Santal children the promotion of kitchen garden programs combined with interactive awareness trainings may be a key measure. Trial registration: the trial was retrospectively registered at the German Clinical Trials Register on the 1 st July 2019 (DRKS00017388). URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017388
... Moringa is the cheapest source of nutrients, proteins, enzymes and other essential vitamins i.e. A, C and E (Serafico et al., 2017) that's why it helps in reduction of malnutrition in famine areas. Moringa is grown as a multipurpose tree and is used for water purification and as a softening agent, for livestock feed, extraction of various enzymes, as insecticidal for other plants, antiviral potential for human herpesvirus-4, plant growth promoter agent, as oil seed crop and vegetables (Salango and Urbano, 2013;Brilhante et al., 2017). ...
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This study was carried out to estimate the optimum conditions for moringa seed to maintain its quality during storage. Appropriate moisture contents and suitable temperature at the time of storage and reliable packaging materials may help to lower thresholds of respiration and extend the seed longevity in storage. Seeds of moringa were stored at 8, 10 and 12% seed moisture contents (SMC) in hermetic (super) and traditional (cloth) bags for six months. Highest germination (70%) and vigor were found in hermetically sealed super bag at 8% SMC after storage. Highest electrical conductivity of seed leachates and melonaldehyde contents for seed stored at 10 and 12% SMC at 10 and 25 °C in cloth bags depicted maximum deterioration and lowest values for these traits were found in super bags at 8% SMC. Oil and protein contents of seed were comparatively higher at 8 and 10% SMC at 10 °C. Seed stored in hermetically sealed super bags retained higher oil and protein contents as compared to cloth bags. Ageing induced deterioration at high seed SMC and temperature was associated with membrane damages and lipid peroxidation in seed. In conclusion, it is recommended that moringa seeds must be stored in hermetically sealed super bag at 8% SMC for preservation of seed quality. Under humid environment, seed storage in cloth bag should not be practiced as it increases equilibrium seed moisture contents, which promotes seed deterioration.
... The World Health Organization recommended that feeding moderately malnourished children green leafy vegetables containing iron and provitamin A is a valuable ingredient in their diet and recommended further assessment of moringa leaves value for children with moderate malnutrition (5). In May 2017, a study concluded that regular consumption of Moringa oleifera leaves by schoolchildren might help to improve certain micronutrient deficiencies such as iron deficiency anemia, vitamin A , and folic acid deficiencies as well (6). Fever is a very common complaint in children and it is a condition characterized by rising in the core temperature above 38ºC rectally. ...
... The World Health Organization recommended that feeding moderately malnourished children green leafy vegetables containing iron and provitamin A is a valuable ingredient in their diet and recommended further assessment of moringa leaves value for children with moderate malnutrition (5). In May 2017, a study concluded that regular consumption of Moringa oleifera leaves by schoolchildren might help to improve certain micronutrient deficiencies such as iron deficiency anemia, vitamin A , and folic acid deficiencies as well (6). Fever is a very common complaint in children and it is a condition characterized by rising in the core temperature above 38ºC rectally. ...
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Full-text available
Background: Fever is a very common complaint in children, about 20% of childhood fevers have no apparent cause and the risk is greatest among infants and children younger than 36 months. Physical examination and patient history do not always identify the cause. Moringa oleifera is a desert tree found in the Middle East to India and it could provide health benefits to humans by protection against oxidative stress. It also showed an antipyretic effect compared to paracetamol in an experimental animal. Objective: This study aimed to investigate the antipyretic effect of Moringa oleifera in a case of toddler presented with pyrexia. Subjects: An 18-month-old girl was feverish for four days with loss of appetite. There were no symptoms of upper or lowers respiratory infection or otitis media or gastrointestinal disease. Results: The temperature returned to normal after an hour of sweating when the girl drank 40 ml of warm water extract of five grams of Moringa leaves boiled for twenty minutes. Conclusions: Moringa oleifera can be a safe and natural alternative to other well-known antipyretics for treating toddlers having fever who could not tolerate certain antipyretic medications due to some its side effects and to avoid the unnecessary use of antipyretics that in case it is not efficient alone it will be combined with other medications such as antibiotics.
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Background: India´s Adivasi scheduled tribe population is disproportionately affected by anemia and undernutrition. On the avenue to sustainably promote child health locally available resources have to be maxed out. Subsequently, designed recipes may find entrance and modify dietary routines on household level, through interactive home-based cooking trainings, community awareness and homestead food production. Study design: From February 2015 onwards, the cluster-randomized controlled feeding trial was conducted in 21 tribal villages Birbhum District, West Bengal. The intervention lasted for 18 months and embraced four assessment points (t0, t6, t12, t18) including medical checkup, measurement of Hb concentrations (HemoCue Hb201+) as well as anthropometric indices. A semi-structured household (HH) survey was part of the baseline assessment. The research comprises one control group (CG) and three intervention groups (diversified meals only (IG1), with the addition of locally producible Amaranthus tricolor/Moringa oleifera leaf powders (ALP/MLP) in the ratio 2:1 (IG2), or with an adjusted amount of commercially produced micronutrient powder (MNP) TopNutri (IG3)). Supplementary meals were provided three times a week during an on-the-spot community feeding program. 293 children (6-39 months) were valid for the pre-/post intervention effect analysis. Objectives: To assess the overall burden of anemia and undernutrition and to investigate nutrition-sensitive and nutrition-specific factors determining the maternal and child nutritional status at baseline, moreover to identify independent drivers of anemia in Adivasi children (Article I and II). To design improved recipes and to evaluate their effect in a supplementary feeding intervention on the primary outcome variable hemoglobin (Hb), and the secondary outcome variables stunting (HAZ), underweight (WAZ), and wasting (WHZ) (Article III). The first article (Chapter 4) provides data on the maternal nutritional status and child feeding practices, and describes socio-demographic characteristics, family planning methods, use of antenatal care services and birth, childcare, mother-child dyad analysis. Moderate/severe forms of anemia and underweight were prevalent in every second mother. Child feeding practices and child caring were found to be suboptimal. Infants (6 to 11 months) were particularly vulnerable with merely every fourth child fulfilling the minimum acceptable diet (2 to 3 meals per day and  4 food groups (FG) per day). On HH level the serving of animal-sourced foods, legumes, vegetables and fruits has to be scaled up. The second article (Chapter 5) assessed the prevalence of anemia and undernutrition among Santal Adivasi children, determined independent predictors of moderate/severe anemia, and depicted agricultural assets, livelihood, aspects of food security and hygiene, morbidity rates, health seeking behavior. Binary Logistic regression assessed five independent predictors of moderate/severe anemia in children (Hb
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Purpose Moringa ( Moringa oleifera ) is a highly nutritious, fast-growing crop that has emerged in Western markets as a “superfood” and as a “smart crop” for income generation potential among small-scale farmers. As such, moringa has been widely promoted by agricultural development practitioners in low-income countries and by emerging businesses aimed at achieving nutritional and social impact. However, the intrinsic nutritional and agronomic strengths of moringa are not enough to warrant its widespread promotion without first evaluating its economic potential to farmers. Design/methodology/approach A Land Use System (LUS) analysis modeling tool was employed to test the economic performance of two sets of moringa production practices in Kenya. Data were collected during in-depth interviews and field visits with farmers in Meru that supply a local market, and in Shimba Hills that supply an organic export market. Findings Results suggest that current production practices over an 12-years assessment period generate a Net Present Value (NPV) of US$8,049 [ha-1] in Meru and a negative NPV of US$697 [ha-1] in Shimba Hills; with average daily returns to family labor of these two production systems of roughly 1.6 times and 0.13 times the prevailing local wage rate, respectively. These differences were attributed to a higher farmgate prices and greater yields in Meru. The analysis tool was then used to predict the effects of changes in farming practices, e.g. if farmers in Meru switched to intensive bed cultivation NPV is estimated to increase by ∼650%. Research limitations/implications This study demonstrates the importance of examining the economic performance of agricultural production systems intended to increase the benefits to small-scale farmers. Originality/value Our study is the first to assess moringa's economic performance within two production systems in Kenya – a local farmers' cooperative in Meru, and a group of farmers contracted by an export company.
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A randomized study was conducted to test the efficacy of Moringa powder on iron status and weight gain in women. In an open-labelled randomized trial, 82 moderately anaemic, lactating women, aged 26.7� 6.5 years, received a weekly dose of either 100g of Moringa powder(Moringa group) or 120 mg iron sulphate with 0.5 mg folicacid (Control group). Data from 64 women (33 from Moringa group and 31 from Control group) were analyzed. Baseline parameters, socio-economic, anthropometry, haematology, plasma ferritin, and acute phase proteins were comparable in both groups. Low plasma ferritin (< 12 �g/l) indicating iron deficiency was found in 13 and 14 women from the Moringa and Control groups, respectively. After 3 months oftreatment, mean haemoglobin concentrations significantly increased in both groups (p<0.001) but iron stores were unchanged in the Moringa group while they significantly increased in the Control group indicating that consumption of Moringa leaves failed to restore iron stores in anaemic subjects. A slight improvement was observed in the prevalence of anaemia in both groups but anaemia still persisted due to other reasons than iron deficiency anaemia. None of the groups gained weightduring the 3 months. However, the average weight lost was less important in the Moringa group (-0.8 � 2.1 kg) compared to the control group (-1.2� 2.3 kg) but the difference was not significant (p=0.45).The amount of digestible protein in the powder could suggest that the consumption of Moringa was beneficial to the rural women by preventing weight loss during the rainy season. Micronutrient status improvement of vulnerable people in developing countries like Senegal shouldcombine diet-based strategies through production and consumption of animal derived food, vegetable, fruits and food fortification program. However, Moringa Oleifera is one example of local food that can be used in nutritional intervention program, but its use needs additional rigorous clinical trials to confirm its nutritional benefits.
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Moringa (Moringa oleifera Lam. moringaceae) is a highly valued plant that is mostly cultivated in the tropics and subtropics. It is used for food, medication and industrial purposes. The objective of the study was to assess the nutritional value of Moringa leaves of the South African ecotype. Proximate and Van Soest methods were used to determine the nutritional value of Moringa leaves. The dried leaves had crude protein levels of 30.3% and 19 amino acids. The dried leaves had the following mineral contents: calcium (3.65%), phoshorus (0.3%), magnesium (0.5%), potassium (1.5%), sodium (0.164%), sulphur (0.63%), zinc (13.03 mg/kg), copper (8.25%), manganese (86.8 mg/kg), iron (490 mg/kg) and selenium (363 mg/kg). 17 fatty acids were observed with α-Linolenic acid (44.57%) having the highest value followed by heneicosanoic (14.41%), g-linolenic (0.20%) palmiteic (0.17%) and capric acid (0.07%). Vitamin E had the highest concentration of 77 mg/100 g than beta-carotene, which had 18.5 mg/100 g in the dried leaves. The fiber content was neutral detergent fibre (NDF) (11.4%), acid detergent fibre (ADF) (8.49%), acid detergent lignin (ADL) (1.8%) and (acid detergent cellulose (ADC) (4.01%). The condensed tannins had a value of 3.2%, while total polyphenols were 2.02%. The values of amino acids, fatty acids, minerals and vitamin profiles reflect a desirable nutritional balance.
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Levels of some nutrients in Moringa oleifera leaves as well as seven varieties of sweet potato (Ipomoea batatas) leaves were determined using standard analytical methods. Crude protein ranged from 16.78 -25.39%; crude fibre from 9.75 -12.14%; crude fat from 0.38 -1.91%; ash content from 8.71 -11.60%; moisture content (fwb) ranged from 80.16 -88.20%; carbohydrate values from 53.29 -59.01%; and calorific values ranged from 1344.00 – 1399.00 kJ/g (316.66-329.76 cal/g) for the sweet potato leaves. For M. oleifera leaves, crude protein was 27.51%, crude fibre was 19.25%, crude fat was 2.23%, ash content was 7.13%, moisture content was 76.53%, carbohydrate content was 43.88%, and the calorific value was 1296.00 kJ/g (305.62 cal/g). Elemental analysis of the leaves in mg/100g dry matter (DM) indicates the sweet potato leaves contained appreciable levels of calcium (1310.52-1402.27) and iron (9.62-23.02). Calcium and iron content of M. oleifera also in mg/100 g (DM) were 2,009.00 and 28.29, respectively. These results reveal that the leaves contain an appreciable amount of nutrients and can be included in diets to supplement our daily nutrient needs.
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Two experiments were carried out to evaluate the nutritive value of Moringa oleifera leaf meal (MOLM). In experiment 1, the effect of substituting Moringa oleifera for cottonseed cake (CSC) on milk yield and composition of cross bred cows fed napier grass (Pennisetum purpureum) as basal diet was determined. In experiment 2, dry matter degradability (DMD) of MOLM and CSC in the rumen was determined using a nylon bag technique. Other components of supplementary rations were maize bran and minerals. Dietary treatments used in this experiment were 0.0, 0.55, 1.11 and 1.65 kg DM/day of MOLMas substitute for CSC levels of 1.23, 0.82, 0.41 and 0.00 kg DM. Four individually confined lactating dairy cows with body weights averaging 347 ± 22 kg were allocated to four dietary treatments in a balanced 4 x 4 Latin Square Design. When CSC was substituted with MOLM milk yield was significantly increased. There were no effects of substituting CSC with MOLM on total solids, fat, milk protein and ash contents of the milk. MOLM had higher DMD (820 g/kgDM) than CSC (697 g/kg DM). DM degradability of MOLM was higher than CSC. It is concluded that up to 1.65 kg DM of MOLM could substitute for 1.23 CSC in dairy cow diets without affecting the milk yield. For best performance a combination of the two with lower levels of MOLM gave higher milk yield than either protein source fed alone.
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An experiment was carried out to investigate the effect of substituting Moringa oleifera leaf meal (MOLM) for sunflower seed meal (SSM) as a protein source of egg strain commercial chickens. The effects of substitution on feed intake (FI), dry matter intake (DMI), egg weight (EWT), Laying percentage (LP), egg mass production (EMP), and feed conversion ratio (KG FEED/KG EGGS) were investigated. Four dietary treatments based on MOLM and SSM as plant protein sources were formulated such that MOLM reciprocally replaced SSM at levels of 20, 15, 10 and 0% giving the dietary treatments containing 0, 5, 10 and 20% MOLM levels for MOLM-0, MOLM-10, MOLM-15 and MOLM-20 respectively. A total of 96 twenty-one weeks of age pullets were allocated to the dietary treatments in a randomised design. Each treatment consisted of three replicates and eight birds per replicate. The EWT was significantly highest in MOLM-0 and lowest in MOLM-10. LP showed a significant progressive decreasing trend as MOLM proportion increased in the diet. Further, EMP showed a significant progressive decrease at 10 and 20% MOLM levels. DMI and DFI significantly increased progressively at 10 and 20% MOLM levels. Also, Kg feed/Kg eggs (g feed intake/g egg mass) were significantly highest in birds fed 20% MOLM levels. The results, therefore, suggest that MOLM could completely replace SSC up to 20% without any detrimental effect in laying chickens. However, for better efficiency 10% inclusion level is optimal and an addition of MOLM above 10% high energy based feeds are required for better utilization.
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A strong food-based approach is critical to alleviate nutritional deficiencies in the tropics. Our survey of over 120 species of Asian indigenous vegetables for nutrient contents, antioxidant activities (AOA), and indigenous knowledge of their medicinal uses indicated that Moringa oleifera was among the most promising species. We conducted additional studies to evaluate four Moringa species for AOA, antioxidant contents and nutritional quality, and to investigate M. oleifera's AOA and iron as affected by freezing, boiling, and in vitro digestion. We concluded that the four Moringa species are high in AOA, antioxidant and nutrient contents, low in oxalate content. Boiling in water enhanced aqueous AOA, and the AOA was maintained after simulated digestion. Cooking Moringa increased available iron and raised total available iron of mixtures with mungbean. Moringa, an easily grown perennial, have tremendous potential to improve diets and health.
The study examined the effect of pulverised Moringa oleifera leaf added to maize traditional complementary food (MTCF) on the iron status of infants 6-12 months in Nigeria. Fourty infants were used for the four-week intervention study. The haemoglobin (Hb), serum ferritin (SF) and serum retinol (SR) levels of the infants were determined at baseline and at the end of the study. The infants were randomly assigned to test group (TG) and control group (CG) (n = 20). Infants in the TG received MTCF with Moringa oleifera leaf while the CG had only MTCF. For the TG, the mean Hb increased from 10.65 to 12.98 g dl<sup align="right">−1</sup>. The proportion of the infants with SF levels below 12 μg l<sup align="right">−1</sup> fell from 90% to 5% and those with SR levels below 20 μg dl<sup align="right">−1</sup> fell from 85% to 15%. There were no significant changes in the mean Hb, SF and SR levels of infants in the CG.
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Moringa oleifera, an edible tree found worldwide in the dry tropics, is increasingly being used for nutritional supplementation. Its nutrient-dense leaves are high in protein quality, leading to its widespread use by doctors, healers, nutritionists and community leaders, to treat under-nutrition and a variety of illnesses. Despite the fact that no rigorous clinical trial has tested its efficacy for treating under-nutrition, the adoption of M. oleifera continues to increase. The "Diffusion of innovations theory" describes well, the evidence for growth and adoption of dietary M. oleifera leaves, and it highlights the need for a scientific consensus on the nutritional benefits.
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In this paper we describe the development, implementation, evaluation, and subsequent improvements of a supplemental feeding program that provides community-based care to underweight children in a rural East African setting, using a locally-sourced and produced ready-to-use food (RUF). Production teams were trained to grind soybeans and groundnuts (peanuts), which were then mixed with moringa oleifera leaf powder to form an energy-dense supplemental food, designed for use as an RUF. Eligible children (based on low weight-for-age or mid-upper-arm circumference < 12 cm) received RUF of approximately 682 kcal per day for five weeks. Weekly growth monitoring and caregiver education were provided by trained health center staff and community volunteers. The program was evaluated by examining RUF nutrient composition, weight gain velocity, and qualitative data from key-informant interviews and home feeding observations. Locally-produced RUF had similar energy density but higher protein content than commercial RUTF (ready-to-use therapeutic food). Mean weight gain of children was 2.5 g/kg/day (range 0.9-6.0). Feeding observations revealed that caregivers were diluting the RUF fed to children. Production team members desired increased financial compensation for their work but were enthusiastic about the program as helpful to malnourished children. Locally-produced RUF is a promising strategy for community-based care of moderately malnourished children. Through the production team's entrepreneurship, a small business was formed, whereby financial incentives encouraged continued RUF production. Future efforts are needed to educate caregivers on correct RUF use and improve commercial viability in local markets.
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The dose-dependent inhibitory effect of sodium phytate on iron absorption was studied in man by serving wheat rolls containing no phytates and rolls to which various amounts (seven dose levels between 2 and 250 mg expressed as phytate phosphorus) were added just before serving. Fe in the two kinds of rolls was labeled with two radioisotopes of Fe (55Fe, 59Fe) and the rolls were served on alternate days. The inhibition of Fe absorption was strongly related to the amount of phytate added; 2 mg inhibited absorption by 18%, (p less than 0.001), 25 mg by 64% (p less than 0.001), and 250 mg by 82% (p less than 0.001). The addition of ascorbic acid significantly counteracted the inhibition whereas the corresponding effect of meat was less well defined and only seen at the highest phytate level. The marked inhibition of Fe absorption by phytates and the significant counteracting effect of ascorbic acid have wide nutritional implications.