BackgroundNumerous preclinical studies on improving iron bioavailability to address iron deficiency anemia have been published; however, no preclinical systematic reviews with pairwise meta-analyses have been conducted. Therefore, it is essential to systematically review, summarize, and evaluate the evidence regarding the effects of iron fortificants in animal studies.MethodsThe initial articles were identified in four scientific databases (PubMed, Web of Science Core Collection, Scopus, and EBSCO) on 10 January 2026. The final included articles were collected after the initial articles were scanned and sorted. The data were extracted for pairwise meta-analysis. Hemoglobin (Hb) was the primary outcome.ResultsA total of 23 studies were included in this systematic review. Data from 13 rat experiments, including 56 comparisons, were analyzed using pairwise meta-analysis. The results of the meta-analysis showed that the overall effects of sodium iron ethylenediaminetetraacetate (NaFeEDTA) and ferrous fumarate on Hb were equivalent to those of ferrous sulfate (FeSO4). Ferric pyrophosphate (FePP) and ferric orthophosphate (FePO4) were inferior to FeSO4.ConclusionThe meta-analysis results suggest that both NaFeEDTA and ferrous fumarate are effective in improving Hb concentration.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/recorddashboard, CRD420261280933.

Platforms are now becoming available to allow for incorporating interactive elements into open educational resources (OERs), but little has been published about their use and effectiveness. Students enrolled in online and on-campus sections of an intermediate human nutrition course at a public Midwestern University in the United States used an OER that was adapted to an online platform, where it included embedded videos and summative assessments (interactive educational resource). Data were collected from the learning management system, course performance, resource platform and a survey. Student course grades were positively correlated with use of the interactive educational resource and percentage of questions correctly answered. Overall survey response rate was 84/109 (77.1%). Student respondents reported higher use of the interactive educational resource and preferred it over a static PDF or hard copy. Students were most motivated to utilise the interactive educational resource by the opportunity to earn extra credit followed by desire to earn a good grade. Student respondents reported that they were satisfied with their experiences using the interactive educational resource, and with a high likelihood, would recommend future students to use it. While these findings are limited to one semester at one university, they support future research efforts into the efficacy of interactive educational resources and OER-enabled pedagogy.

Background: Previously we found that extruded corn-soy blend (CSB) and sorghum-soy blend (SSB) fortified blended foods (FBFs) containing whey protein concentrate (WPC) were equally nutritious food aid products. WPC provides high-quality protein; however, it is the most expensive ingredient in these FBFs. Objectives: The primary objective of this study was to determine if soy protein can serve as an alternative to WPC and the secondary objective was to evaluate different sucrose amounts in the FBFs. Methods: Nine extruded FBFs were formulated: 1 CSB and 1 SSB, both containing 9.5% WPC and 15% sucrose, served as comparison FBFs. Three additional CSB and 4 SSB FBFs were formulated containing no WPC, but with increased soy flour to meet protein requirements and varying sucrose concentrations. The sucrose content ranged from 0% to 10% for the CSBs and 0% to 15% for the SSBs. Male weanling Sprague Dawley rats were individually housed and divided into 10 diet groups (n = 9-10) which consumed either AIN-93G or a dry FBF for 28 d. At study conclusion, blood, livers, and body composition data were collected. Results were analyzed using 1-factor ANOVA with Tukey's test. Results: Outcomes were not significantly different between the SSB groups, with the exception of significantly higher protein efficiency for the WPC-containing group. Among the CSB groups, caloric and protein efficiencies were significantly higher for the WPC-containing CSB group. There were no significant differences in hemoglobin or hepatic iron concentrations between FBF groups, but hepatic iron concentrations were significantly higher in all FBF groups than in the AIN-93G group. Groups consuming diets with <= 10% sucrose had significantly higher bone mineral density than groups consuming diets with 15% sucrose. Conclusions: These results suggest that extruded SSB, but not necessarily CSB, FBFs with soy protein and 5%-10% added sucrose are efficacious and cost-effective alternatives to WPC-containing FBFs.

BACKGROUND:Acute phytic acid intake has been found to decrease iron bioavailability; however, repeated phytic acid consumption leads to iron absorption adaptation. Salivary proline-rich proteins (PRPs) have been shown to inhibit iron chelation to tannins and may mediate similar iron absorption adaptation with phytic acid intake. OBJECTIVES:The objectives of this study were to determine whether salivary proteins bind to phytic acid in vitro, and to explore a proof of concept in a pilot study that examined the impact of 4-wk, daily phytic acid supplementation on individuals' iron status, bioavailability, and salivary PRP concentrations. METHODS:High-performance liquid chromatography (HPLC) and matrix-assisted laser desorption/ionization-time of flight were used to characterize in vitro salivary protein-phytic acid interactions. Nonanemic women (n = 7) consumed 350 mg phytic acid supplements 3 times daily for 4 wk, and meal challenges were employed to determine iron bioavailability, iron status, and salivary protein concentrations before and after supplementation periods. Enzyme-linked immunosorbent assay (ELISA) analysis of purified protein fractions and participant saliva identified proteins bound to phytic acid. RESULTS:In vitro salivary protein-phytic acid interaction identified cystatin SN, a non-proline rich salivary protein, as the specific bound protein to phytic acid. Iron bioavailability (P = 0.32), hemoglobin (P = 0.72), and serum ferritin (P = 0.08) concentrations were not reduced from week 0 to week 4 after phytic acid supplementation. Basic PRPs and cystatin SN concentrations were positively correlated with iron bioavailability at week 4. CONCLUSIONS:Overall, results suggest that phytic acid binds to the non-PRP cystatin SN and that salivary protein production may improve iron bioavailability with phytic acid consumption.

The use of alternative grains in foods is becoming common to address several concerns and trends such as nutrition, allergies, non-GMO, and sustainability. Sorghum is one such cereal crop that is increasingly being explored in applications targeting consumers who suffer from celiac disease (intolerance to wheat gluten). Another advantage of sorghum is its completely genetically modified organism (or GMO) free nature that can allow it to be used in foods designed for humanitarian aid in countries with GMO restrictions. This chapter focuses on two applications of sorghum in extruded foods, one commercial and related to gluten-free pasta, and the other non-commercial and related to non-GMO fortified blended foods used in government-sponsored aid programs. Pasta products such as spaghetti and macaroni are usually made from wheat (semolina). Gluten proteins in wheat have the unique property of forming an extensible, elastic, and cohesive mass when mixed with water, which imparts good strength, integrity of cooked product, and low cooking losses in pasta. Sorghum lacks this property and is inferior to wheat because it does not contain gluten-like proteins. Production of quality non-wheat pasta, using ingredients such as sorghum flour, is a challenge. This chapter describes a pilot-scale twin screw extrusion study on processing and evaluation of sorghum-based pre-cooked pasta in combination with rice. The sorghum-rice pasta was better in cooking quality as compared to its semolina counterpart, with the former having lower cooking loss (3.2-4.0% versus 10.1%), comparable or higher water uptake (111.1-130.1% versus 115.4%), and also considerably firmer cooked texture (246.0-375.9 g-f versus 117.5 g-f). In the second application of sorghum, processing of fortified blended foods (FBFs) for food aid applications using pilot-scale single screw extrusion was studied in comparison with corn-based FBFs, along with their quality and physicochemical characteristics. The sorghum-based FBFs were of superior quality with higher Bostwick flow (14.0- 20.0 cm/min) as compared with corn-based FBFs (6.5- 9.5 cm/min). Rapid viscoanlayzer (RVA) data was used to explain these differences and understand the interactions between various FBF components.

According to recent studies, food insecurity affects from 34%-59% of college students. This will continue to be an issue as tuition increases and more low-income and first-generation students enter universities and colleges. Nearly 52% of college students live at, or near, the poverty level, compared to a national poverty rate of 14.5%. This leaves many undergraduate and graduate students with challenging decisions around meeting their basic housing, nutritional, and educational expenses. To assess food insecurity at Kansas State University (KSU), a random sample of undergraduate and graduate students was surveyed. Findings include a high rate of food insecurity (44.3%) among respondents. This measure was calculated by summing the affirmative responses to the USDA short-form food security questions in the survey. This means that during a 7-month period during the 2016 to 2017 academic year, 44.3% of respondents experienced at least two of the following: 1) didn't have enough food to last and didn't have money to buy more, 2) couldn't afford to eat balanced meals, 3) cut the size of or skipped meals, 4) ate less than they felt they should because they didn't have enough money, or, 5) were hungry and didn't eat. This finding is consistent with other studies that report food insecurity rates between 34% and 59% at U.S. universities and community colleges. Fifty-seven percent of respondents were generally aware that food insecurity is a significant problem on college campuses. A majority of respondents (63%) reported that they knew students besides themselves who, currently or sometime during the academic year, had problems with food insecurity or hunger. Yet food assistance (e.g., food pantries) and SNAP are seldom used and responses regarding the use of an on-campus food pantry were mixed. Despite this mixed response, over 2,000 students had used the campus food pantry within the one-year period between opening in 2017 to 2018 (Bishop 2018).

Background: Sorghum-Soy Blend (SSB) and Sorghum-Cowpea Blend (SCB) fortified blended food aid porridge products were developed as alternatives to Corn-Soy Blend Plus (CSB+) and Super Cereal Plus (SC+), the most widely used fortified blended food aid products. However, the cost and nutrient cost-effectiveness of these products procured from different geographical areas have not been determined. Objective: The objective of this study is to determine the nutrient cost-effectiveness of SSB and SCB compared to existing fortified blended foods. Methods: Nutritional data as well as ingredient, processing, and transportation cost for SSB, SCB, and existing fortified blended foods were compiled. Using the omega value, the ratio of the fortified blended food’s Nutrient Value Score to the total cost of the fortified blended food divided by an identical ratio of a different fortified blended food or the same fortified blended food produced in a different country and the nutrient cost-effectiveness of each of the fortified blended foods procured in the United States and several African countries were determined. Results: Both CSB+ and SC+ are less expensive than SSB and SCB, but they also have lower Nutrient Value Scores of 7.7 and 8.6, respectively. However, the omega values of CSB+ and SC+ are all above 1 when compared to SSB and SCB, suggesting that the existing fortified blended foods are more nutrient cost-effective. Conclusions: Comparing the nutrient cost-effectiveness of various food aid products could provide valuable information to food aid agencies prior to making procurement decisions.

Partially funded by the USDA Foreign Agricultural Service under the Micronutrient Fortified Food Aid Products Pilot (MFFAPP) program and the Kansas Agricultural Experiment Station.

Background: Fortified blended foods (FBFs) are micronutrient-fortified food aid products containing cereals and pulses. It has been suggested to reformulate FBFs to include whey protein concentrate, use alternative commodities (e.g., sorghum and cowpea), and utilize processing methods such as extrusion to produce them. The Micronutrient Fortified Food Aid Pilot Project (MFFAPP) efficacy study was designed to test the efficacy of complementary feeding of newly formulated FBFs. Objectives: The aim of this study was to test the effectiveness of 5 newly formulated FBFs in combating iron deficiency anemia and vitamin A deficiency compared with traditionally prepared corn-soy blend plus (CSB+) and no intervention. A secondary aim was to determine the impact on underweight, stunting, wasting, and middle-upper arm circumference. Methods: A 20-wk, partially randomized cluster study was completed. Two age groups (aged 6-23 and 24-53 mo) with hemoglobin status <10.3 g/dL, and weight-for-height z scores >-3 were enrolled and assigned to diet groups. Biochemical and anthropometric measurements were collected at 0, 10, and 20 wk. Results: Both hemoglobin concentrations and anemia ORs were significantly improved in all intervention groups except for CSB+ and the no-intervention groups at week 20. Only extruded corn-soy blend 14 and the no-intervention age groups failed to significantly decrease vitamin A deficiency risk (P < 0.04). There were no consistent significant differences among groups in anthropometric outcomes. Conclusions: FBFs reformulated with sorghum, cowpea, corn, and soy significantly improved anemia and vitamin A deficiency ORs compared with week 0 and with no intervention. Although newly formulated FBFs did not significantly improve vitamin A deficiency or anemia compared with CSB+, CSB+ was the only FBF not to significantly improve these outcomes over the study duration. Our findings suggest that newly formulated sorghum- and cowpea-based FBFs are equally efficacious in improving these micronutrient outcomes. However, further FBF refinement is warranted.

Partially funded by the USDA Foreign Agricultural Service under the Micronutrient Fortified Food Aid Products Pilot (MFFAPP) program and the Kansas Agricultural Experiment Station.

Background: Fortified-blended foods (FBFs), particularly corn-soybean blend (CSB), are food aid products distributed in developing countries. The US Agency for International Development food aid quality review recommended developing extruded FBFs with the use of alternative commodities such as sorghum. Objective: The objective of the study was to determine bioavailable iron and vitamin A content from newly developed extruded corn, soybean, sorghum, and cowpea FBFs compared with the nonextruded traditional food aid FBFs, corn-soy blend 13 (CSB13) and corn-soy blend plus (CSB+). Methods: Eleven extruded FBFs-sorghum-cowpea (n = 7), sorghum-soy (n = 3), and corn-soy (n = 1)-along with 2 nonextruded FBFs-CSB13 and CSB+, and Cerelac (Nestle), a commercially available fortified infant food, were prepared. Bioavailable iron and vitamin A contents were assessed by using the in vitro digestion/Caco-2 cell model. Dry FBFs, aqueous fractions, and Caco-2 cell pellet vitamin A contents were analyzed by HPLC. Dry FBF and aqueous fraction iron contents were measured by atomic absorptiometry, and bioavailable iron was assessed by measuring Caco-2 ferritin contents via ELISA. Results: Iron and vitamin A concentrations in Cerelac and dry FBFs ranged from 8.0 to 31.8 mg/100 g and 0.3 to 1.67 mg/100 g, respectively. All of the extruded FBFs contained 4- to 7-fold significantly higher (P < 0.05) aqueous fraction iron concentrations compared with CSB13 and CSB+. However, there were no significant differences in Caco-2 cell ferritin and vitamin A concentrations between extruded FBFs, nonextruded FBFs, and or the basal salt solution negative control. Conclusion: Results support the theory that the consumption of newly developed extruded sorghum-cowpea, sorghum-soy, and corn-soy FBFs would result in iron and vitamin A concentrations comparable to traditional nonextruded CSB13 and CSB+ FBFs.

Background: Corn- and soybean-based fortified blended foods (FBFs) have been the primary food aid product provided by the United States. Sorghum and cowpea have been suggested as alternative FBF commodities because they are drought-tolerant, grown in food aid-receiving areas, and not genetically modified. Extrusion processing has also been suggested to improve the quality of these FBFs. Objectives: The aim of this study was to determine the protein quality and iron and vitamin A bioavailability of novel FBFs in broiler chickens. Methods: Whey protein concentrate (WPC)-containing FBFs corn-soy blend 14, sorghum-soy, and sorghum-cowpea (SC); a soy protein isolate (SPI)-containing SC FBF (SC+SPI); 2 reformulated, overprocessed SC FBFs (O-SC+WPC, O-SC+SPI); and a nonextruded WPC-containing SC FBF were developed. Nonextruded corn-soy blend plus (CSB+), a currently used FBF, and a gamebird starter/grower diet were used as comparison diets. In the prepared FBF study, 9 groups of 8-d-old broiler chicks (n = 10) consumed prepared FBFs for 21 d. In the dry study, 8 groups of 4-d-old broiler chicks (n = 24; control: n = 23) consumed dry FBFs for 14 d. Results were analyzed by 1-factor ANOVA with least-significant-difference test. Results: In the prepared study, novel formulated FBFs significantly increased caloric and protein efficiency and nonsignificantly increased body weight gain, despite similar food intake compared with CSB+. In the dry study, novel formulated FBFs, except for O-SC+SPI, significantly increased food intake, caloric efficiency, and protein efficiency and nonsignificantly increased body-weight gain compared with CSB+. Novel formulated FBFs nonsignificantly and significantly increased hepatic iron concentrations compared with all FBFs in the prepared and dry studies, respectively. Conclusion: Novel formulated FBFs, apart from O-SC+SPI, resulted in improved protein efficiencies and hepatic iron concentrations compared with CSB+, suggesting that they are of higher nutritional quality.

BackgroundFortified‐blended foods (FBFs) are micronutrient fortified, partially precooked blends of cereals and pulses that are the most commonly distributed micronutrient‐fortified food aid globally. Along with reformulation to improve FBF quality, it has been suggested that alternative commodities like sorghum and cowpea be considered for FBF formulation due to their drought tolerance, and local and regional availability in food aid receiving regions.ObjectivesOur primary objective was to determine whether newly formulated, extruded corn, soy, sorghum and cowpea‐based FBFs would result in equivalent or better hemoglobin and anemia outcomes compared with CSB+, the most commonly distributed FBF by the United States Agency for International Development. Secondary outcomes included evaluation of anthropometric and z‐score changes in height, weight, and mid‐upper arm circumference among groups.MethodsTwenty‐week, partially randomized cluster control trial located in the Mara region of Tanzania between February and July 2016. White sorghum cowpea (WSC‐1, WSC‐2), red sorghum‐cowpea (RSC), white sorghum‐soy (WSS), extruded corn‐soy blend (CSB14), or CSB+ were provided to 2186 children divided into two age groups (6–23 and 24–53 months) in seven clusters. A negative control received no FBF until study end. At 0, 10, and 20 weeks, health questionnaires, hemoglobin, and anthropometric measurements were collected. Anemia prevalence, height, weight, MUAC, WAZ, LAZ, and WHZ were calculated for each cluster at each time point. Differences in baseline socioeconomic factors, food intake and unadjusted outcomes were analyzed with SAS. Absolute anemia risk reduction was calculated for all FBFs and control compared to CSB+. Improvement and deterioration in HAZ and LAZ were also analyzed.ResultsNewly formulated FBFs were non‐inferior, or superior, to CSB+ in all outcome measures. At end line, there were significant absolute anemia risk reductions in all newly formulated FBFs compared to CSB+ in at least one age group; CSB14 and WSC‐1 anemia prevalence was significantly reduced in both age groups. In both groups, there were significant improvements in control, WSC‐2, and WSS consuming groups' HAZ scores from baseline to end line, and more children's HAZ scores improved than deteriorated compared to control in all FBFs groups.ConclusionResults suggest that sorghum and cowpea may be suitable alternatives to corn‐soy based FBFs. Socioeconomic and health factors will be analyzed in adjusted models for all outcomes.Support or Funding InformationUnited States Department of Agriculture (USDA) Foreign Agricultural Service under the Micronutrient Fortified Food Aid Products Pilot (MFFAPP) program, contract number #FFE‐621‐2012/033‐00.