Efficacy of a community-based dietary intervention to enhance micronutrient adequacy of high-phytate maize-based diets of rural Malawian children.
OBJECTIVE
To evaluate the efficacy of a community-based dietary intervention to reduce risk of micronutrient inadequacies in high-phytate maize-based Malawian diets.


METHODS
Quasi-experimental post-test design with a non-equivalent control group.


METHODS
Four villages in Mangochi District, Southern Malawi.


METHODS
Households with children aged 3-7 years in two intervention (n = 200) and two control (n = 81) villages participated in a 6-month intervention employing dietary diversification, changes in food selection patterns, and modifications to food processing to reduce the phytate content of maize-based diets. Baseline comparability between the groups was confirmed via assessment of sociodemographic characteristics, anthropometry, knowledge and practices, morbidity, haemoglobin and hair zinc. After 12 months, knowledge and practices and dietary intakes were assessed by interactive 24-hour recalls, one during the food plenty and a second during the food shortage season. Nutrient adequacy for the two groups was compared via dietary quality indicators and predicted prevalence of inadequate intakes using the probability approach.


RESULTS
Intervention children had diets that were significantly more diverse and of a higher quality than those of controls. Median daily intakes of protein, calcium, zinc (total and available), haem iron, vitamin B12 and animal foods (grams; % of total energy) were higher (P < 0.05) whereas phytate intakes, phytate/zinc and phytate/iron molar ratios were lower (P < 0.01) in the intervention group; some spread of knowledge and practices to controls occurred.


CONCLUSIONS
Our community-based dietary strategies reduced the predicted prevalence of inadequate intakes of protein, calcium, zinc and vitamin B12, but not iron, in children from Malawian households with very limited resources.
Yeudall
Fiona
F
Department of Human Nutrition, University of Otago, PO Box 56, Dunedin 9015, New Zealand.
Gibson
Rosalind S
RS
Cullinan
Timothy R
TR
Mtimuni
Beatrice
B
D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000379:methods*; D004032:Diet / Q000592:standards; D005260:Female; D006801:Humans; D008295:Malawi; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage* / Q000378:metabolism; D009747:Nutritional Physiological Phenomena; D009751:Nutritional Requirements; D009753:Nutritive Value; D010043:Outcome and Process Assessment, Health Care; D010833:Phytic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D011203:Poverty; D012424:Rural Population; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D003313:Zea mays
D018977:Micronutrients; D010833:Phytic Acid