Background Inadequate complementary feeding practices in low- and middle-income countries, pose a challenge in meeting nutrient requirements for optimal child growth. The Indian Government's Supplementary Nutrition Programme (SNP) addresses this through take-home-ration (THR). However, previous situational analysis from two rural districts of Karnataka, revealed deficits in nutrient intake and poor THR utilisation. Objective To bridge the observed gap in SNP-beneficiaries (aged 6–12 months), a modified-THR with adequate fat and protein quality was formulated and tested for acceptability. Methods Two formulations: milk-predominant and legume-predominant, were developed using local ingredients and solver-based linear programming approach. Each variant included four flavours: base, cardamom, banana and apple. The modified-THR was optimised for energy (∼200 kcal), protein-quality (Digestible indispensable amino-acid score >80%), milk-to-legume ratio, protein-to-energy ratio (<0.15) and cost (<8 INR). In Phase-1, 30 mothers rated the variants using 5-point Hedonic-Smiley-Scale, shortlisting two flavours per variant. In Phase-2, another set of 35 mother-infant dyads per variant tested the shortlisted flavours. The formulation (70 g cooked/serving) was deemed acceptable if >60% was consumed within 15 minutes. Results In Phase-1, mothers preferred milk-base, milk-banana, legume-apple and legume-banana. In Phase-2, milk-base had highest median consumption (98.6%) with 87% of infants showing acceptability. Conclusions The modified-THR with added milk and legume met the predefined nutrient target for the observed macronutrient gap and was acceptable among mother-infant dyads.
In recent years, the use of relative metrics like the height-for-age z-score (HAZ) has been demonstrated to yield higher estimates of catch-up growth prevalence compared to absolute measures among children in impoverished settings. The use of height-for-age difference (HAD) may be a complementary tool to estimate rates of catch-up growth. We used data from the Indonesian Family Life Survey waves 4 and 5 to measure changes in linear growth among children aged 2–4 years up to 8–11 years old. Children's height at baseline and follow-up was calculated using HAZ and HAD and catch-up growth measured using change in HAZ and HAD between baseline and follow-up. Absolute magnitude of catch-up growth using HAD was measured and compared to HAZ. The association between catch-up growth and cognitive ability using change in HAZ and HAD was measured with linear regression. Nearly two times more children experienced an increase in HAZ compared to an increase in HAD. The prevalence of stunting among the children dropped from 38.3% to 23.8% at follow-up, mean height deficit increased by 2.11 cm. Only 10% of children recovered 80% or more of their baseline height deficit by follow-up. Both change in HAZ and HAD were associated with cognitive score at follow-up. This study shows that absolute improvements in height deficit have been achieved in Indonesian children; however, the majority continues to increase their height deficit despite increasing HAZ scores.
Background Micronutrient fortification of staple foods, including rice, has emerged as a significant policy priority due to its potential to address micronutrient deficiencies. Objective This systematic review aims to comprehensively synthesize existing evidence on the impact of micronutrient-fortified rice. The prime focus is on iron-related biomarkers, specifically haemoglobin, serum ferritin, and anaemia prevalence, to inform future policy decisions and interventions. Methods A systematic literature review was conducted to identify studies using 3 databases: PubMed, Cochrane Library, and Google Scholar (1990-). A meta-analysis was conducted to assess the impact of rice fortification on haemoglobin concentration, serum ferritin levels, and anaemia prevalence, followed by sensitivity and subgroup analyses using Stata SE 17.0. The study has been registered on PROSPERO (CRD42024495114). Results 30 studies were deemed eligible for inclusion in the systematic review. The intervention resulted in a moderate increase in haemoglobin levels ( θ = 0.630[0.3510.909]) and a statistically significant reduction in odds of anaemia ( θ = −0.835[−1.515, −0.155]). While the overall effect on serum ferritin levels was not significant, a subsequent meta-analysis of only randomized controlled trials (RCTs) using weighted mean difference (WMD) showed a significant positive effect. Regression analysis demonstrated a significant negative relationship ( t = −7.85) between baseline haemoglobin levels and the net change post-intervention. The majority of included studies involved iron either alone or in combination with other micronutrients. Conclusions Rice fortification, when implemented with attention to dose, fortificant choice, and local context, may offer cost-effective solutions to address micronutrient deficiencies. However, impacts vary across settings, requiring optimization through understanding modifiers.
BackgroundEdible residues from Hindu offerings (lungsuran) may enter mixed waste streams despite retaining nutritional value. Although food rescue research has focused on household leftovers and supply-chain loss, less is known about how culturally governed norms and changing ritual economies shape post-ritual handling of edible offerings.ObjectiveTo examine how socio-religious norms, authority structures, and changing ritual economies shape lungsuran handling in urban Bali and identify culturally legitimate pathways for nutrition-sensitive recovery.MethodsWe conducted a qualitative study in Denpasar, Indonesia, from September to November 2025 using 20 in-depth interviews with key informants, 4 focus group discussions involving 40 participants, and structured observations across 8 household and temple ritual settings. Data were transcribed, coded, and analyzed thematically.ResultsParticipants described lungsuran as edible and blessed, yet discard occurred in both household and temple settings, especially after large or frequent ceremonies. Post-ritual handling was shaped by four interrelated mechanisms: ritual-temporal suitability, authority and ownership, social permission and hierarchy, and marketization with devotional abundance. Reuse was more likely when decision rights were clear, social permission was explicit, and sorting occurred within an acceptable safety window. In pooled temple settings, ownership ambiguity, reluctance to be seen taking food, and reliance on purchased offerings increased discard. Across settings, time, labor, containers, storage, and transport affected recovery.ConclusionsLungsuran is not ordinary leftover food but a culturally governed edible flow. Nutrition-sensitive recovery is more likely when it aligns with ritual timing, clarifies authority, reduces social hesitation, and integrates food safety into community governance.
Dietary vitamin A inadequacy remains a serious public health problem, especially among young children. Food and condiment fortification programs and policies are in place in many countries to address this issue, but degradation of the vitamin A added via fortification can reduce the quantity of vitamin A reaching consumers. We modeled the impacts of vitamin A degradation on program effectiveness and cost-effectiveness in fortified wheat flour, sugar, and (hypothetical) bouillon cubes in Nigeria. We used secondary data to estimate the prevalence of vitamin A inadequacy among young children (6-59 months), and the programs' modeled contributions to reducing vitamin A inadequacy at selected levels of vitamin A degradation. The Lives Saved Tool was used to estimate child-lives saved. Program costs were estimated using activity-based models. Vitamin A degradation had a large negative impact on program effectiveness. Over the 0% to 80% vitamin A degradation range, accounting for other existing programs, fortification of sugar (7.5 mg/kg), wheat flour (2 mg/kg), and bouillon cubes (96 mg/kg) would reduce inadequacies among children by 2.9 to 0.7 percentage points, 3.9 to 0.7 percentage points, and 20.6 to 9.6 percentage points, respectively. Over the same vitamin A degradation range, average annual child-lives saved ranged from 3984 to 769 (sugar), 3036 to 739 (wheat flour), and 15 301 to 7153 (bouillon cubes); estimated cost/child-life saved ranged from US$ 550 to US$ 2848 (sugar), US$ 1039 to US$ 4271 (wheat flour), and US$ 944 to US$ 2018 (bouillon cubes). Vitamin A fortificant selection, technological innovations in vitamin A fortificants, and/or changes in premix and fortified food handling and storage could reduce degradation; these options could increase program costs, but merit consideration.
