Browsing by Person "Biesalski, Hans-Konrad"

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Baseline assessment and effect of a supplementary community-based nutrition intervention study on the prevention/treatment of anemia among young Adivasi children in West Bengal, India
(2020) Stiller, Caroline K.; Biesalski, Hans-Konrad
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<10g/dl): child´s age<24 months, low WAZ scores, any morbidity (fever, diarrhea, or respiratory infection), low maternal Hb concentrations, lack of dietary diversification (low count of FG consumed during the previous 24 hours). The third arcticle (Chapter 6) assessed the intervention effects of the three study meals on the prevention/treatment of anemia (and undernutrition) in Adivasi children. IG1 (diversified meals only) showed significant higher Hb concentrations as compared to CG during the intervention (adjusted for age and Hb concentrations at baseline, time between assessment points, and gender). The mean Hb of IG2 or IG3, remained comparable to CG. Concluding remarks: Distressing rates of anemia and undernutrition were found among Adivasi mothers and children. To address identified drivers of anemia in Adivasi children and lower the burden of undernutrition multi-sectoral programmatic actions comprising the key pillars nutrition, agriculture and health care are recommended for timely intervention before the child reaches two years of age; accompanied by hygienic and sanitary activities, with interactive awareness trainings being in the center of actions. Lack of dietary diversification was not only found as predictor for anemia at baseline, moreover the low-dose intervention trial confirmed diversified meals only (IG1) being a successful food-based approach in significantly increasing the Hb concentration as opposed to the CG, thus is suggested as useful preventive strategy to overcome nutrition-related anemia amongst Santal Adivasi children (aside iron therapy). Study findings indicate the adding of MNP (IG3) as being beneficial for decreasing the burden of undernutrition and infectious diseases.
Entwicklung eines computergestützten Assessment-Tools zur Erfassung des Ernährungszustandes von Senioren
(2011) Ott-Renzer, Cornelia; Biesalski, Hans-Konrad
Introduction: Worldwide a demographic change of population is to be observed, thus also in Germany. Special expertise in geriatric diagnostics and therapy will gain in importance. Thereby, a special relevance comes up to determination of nutritional status by corresponding screening and assessment. Conventional assessment mostly equates to questionnaire methods. Purpose/Question: Focus was on developing a software (geroMAT-Malnutrition Assessment and Therapy for gerontologic patients) for identification Senior´s nutritional state, a kind of "management tool" for diagnostics and intervention. Methods: Investigation was open, cooperative and multi-centric, as well as clinical-experimentally invested. In three partial studies (I: Suitability of the MNA® as a reference method; II: Anthropo-metry, biochemistry, body composition; III: Food patterns and intake, not-nutritive factors) indicators of malnutrition were initially selected. In a final analysis Model I (prognosis of malnutritional risk) and accordingly Model II (prognosis of the MNA®) have been developed for their use in geroMAT. Results: Prevalence of malnutrition was (in this random sample) 5%, 44% were at risk and 51% were well nourished. Due to inhomogeneity in class range by assessment with the MNA®, modelling of a dichotomic risk variable ("RiskMal", homogeneous) occurred. All up 25 features and 12 (optional) additional items from the partial studies I-III could be generated and attached to further analysis. Model I prognosticated "RiskMal" reliably (auROC=.739). Although firstly Model II predicted MNA® well (r=0,5167), model quality could be improved even further by the well-chosen parametres of a feature subset selection for Models I and II (Í: r=0,822;II: r=0,6634). Discussion: The Models I/II reached the requirements made on developing geroMAT. According to the features, geroMAT would be multi-centric usable, simple to learn and operable, documentable and reproduceable, interprofessionally and without high expense, as well as modern. Advantages of geroMAT, compared with the MNA® lay in its detailedness and its choice of further options, its capture of documented information off the normal anamnesis process and the initiation or monitoring of individual interventions. Conclusions: Mean aim of the study, the identification of indicators and model development, was reached. Other model validation studies should follow before the final clinical practice of geroMAT.
GLUT-1 content and interaction with stomatin in red blood cells from species without vitamin C biosynthesis and their relevance for diabetes mellitus type 1
(2016) Frey, Tabea Caroline; Biesalski, Hans-Konrad
Ascorbic acid is commonly known as vitamin C. By definition, vitamins, with the exception of vitamin D, are substances which can not be synthesized, but are essential for the organism. In this light, vitamin C is special. It is hypothesized that millions of years ago some species, like primates, Guinea pigs and fruit bats, lost the ability to synthesize ascorbate from glucose due to an inactivation of an enzyme called L-gulono-g-lactone oxidase. Since then, these species have been dependent on dietary intake of this micronutrient. Ascorbate is not only the most efficient watersoluble antioxidant, but also an important cofactor in neurotransmitter or collagen biosynthesis. An inadequate intake of this vitamin leads to scurvy. In 2008, a French researcher documented that all species that lost the ability to synthesize ascorbic acid express a different facilitative glucose transporter isoform(GLUT) in their erythrocytes. The expressed GLUT-1 transports not only glucose but also dehydroascorbate which is the oxidized form of vitamin C. Was that different GLUT expression the keystone event for the evolutionary success of these species? To examine the questions regarding the evolutionary benefit of this transporter expression, the kinetics of ascorbate and dehydroascorbate transport into erythrocytes from four different species were evaluated. Further, recycling and disposal of the transported vitamin as well as a possible accumulation were observed. The results demonstrate that there are three different transport types of dehydroascorbate. One which does not transport the vitamin at all, one whose transport of dehydroascorbate competes with glucose and one which absorbs dehydroascorbate completely independent of the extracellular glucose concentration. After absorption, vitamin C is not recycled and is not disposed back into the extracellular fluid. Additionally, it is not stored in the cell until the erythrocyte undergoes apoptosis. The evolutionary benefit is found in an electron transfer across the erythrocyte membrane from intracellular ascorbate to the extracellular, oxidized form of vitamin C. In an energetic light, this recycling of extracellular vitamin C is more efficient than the de novo synthesis of the micronutrient. Therefore, the erythrocyte acts not as a reservoir for vitamin C storage, but as a reservoir for electron storage to prevent degradation and loss of dehydroascorbate in times of high oxidative stress. This electron reservoir becomes more important in diseases with high levels of oxidative stress. A metabolic disorder, which is frequently described to be accompanied by high levels of oxidative stress and lowered vitamin C levels in plasma and cells, is Diabetes mellitus. The decreased plasma concentrations do not result from a smaller dietary intake. Probably, the uptake of dehydroascorbate into erythrocytes, and, therefore, the extracellular ascorbate recycling is disordered. Investigations of the distribution of GLUT-1 in different erythrocyte membrane subdomains showed that the regulation of this transporter is altered in subjects with diabetes mellitus type 1 compared to healthy controls. In vitro, no differences in dehydroascorbate transport rate could be observed, but significantly decreased intra-erythrocyte vitamin C concentrations were detected in vivo. In conclusion, the altered regulation of GLUT-1 in the erythrocyte membrane in the case of diabetes can affect vitamin C recycling in plasma. A decreased ascorbate pool in the cells leads to a decreased recycling capacity, and, therefore, to a lower antioxidant defense outside the cell. Due to that knowledge, the recommended dietary intake of vitamin C in the case of diabetes mellitus must be reconsidered to prevent further complications.
Die kleine GTPase RagA und der potentielle Pankreastumormarker TCTP, zwei Bindungspartner des Kerntransport-Proteins RanBP3
(2006) Schleicher Lilia; Biesalski, Hans-Konrad
RanBP3 is a component of the Crm1-mediated protein export from the nucleus. It favors the binding of export substrate to the RanGTP-Crm1 complex in the nucleoplasm. Upon translocation through the nuclear pore into the cytoplasm, the export complex is dissociated by RanBP1 and RanGAP. It was the objective of this thesis to advance the understanding of RanBP3 function by identifying novel binding partners. Using Yeast-Two-Hybrid Screening, two new interactors of nuclear protein RanBP3 were found, the small GTPase RagA and the translationally controlled tumour protein (TCTP). As a minimal requirement a short C-terminal part of RagA (residues 275-313) binds to the N-terminal region of RanBP3. Full length recombinant RagA was expressed. To substantiate the two-hybrid interactions, the binding of RagA to RanBP3 was verified by in vitro binding assays using recombinant proteins. RagA competes with exportin Crm1 for binding to RanBP3. Likewise, the nucleotide exchange factor for Ran, RCC1, binds to the RanBP3-Ran complex and inhibits RagA binding. Expression of GFP-fusion proteins established the cellular localisation of RagA in living and fixed cells. It is found predominantly in and at the nucleus. A model of RagA-import and -export is suggested. Residues 100-172 in the C-terminal part of TCTP form the binding site for its interaction with RanBP3. Using Northern Blot analysis, two mRNAs of TCTP were found in all human tissues examined. The TCTP sequence was completed using an ovarian cDNA library and the TCTP was cloned and expressed. By means of quantitative PCR it was shown that TCTP belongs to the small group of very abundant mRNA molecules in the cell. The TCTP-RanBP3 interaction was verified by in vitro binding assays using recombinant proteins. A polyclonal antibody to TCTP was generated. By using a GFP-TCTP fusion protein and anti-TCTP antibody the cellular localisation of TCTP was analysed. In Cos7-cells TCTP is found in and around the nucleus. In human cell lines most of the TCTP is localised at the nuclear membrane. Using specific anti-TCTP antibody it was shown that the TCTP level is increased in pancreatic tumours. A differential diagnosis of pancreatitis and pancreas tumour is feasible. TCTP has the potential to become a pancreatic tumour marker or a prognostic factor for ductal type adenocarcinomas of the exocrine pancreas.
Mangelernährung bei Tumorpatienten unter Chemotherapie : Anwendung und Weiterentwicklung eines computergestützten Programmes zur Erfassung und Vorhersage des Ernährungsstatus onkologischer Patienten
(2012) Renger, Sebastian; Biesalski, Hans-Konrad
Malnutrition is a serious problem in the health care of cancer in- and outpatients. Especially for outpatients there is little information on their nutritional status available, because nutritional screenings are not often used, although there is plenty of them accessible. The workgroup of Professor Biesalski developed a software, called oncoMAT, to calculate the current and the prospective nutritional status of tumour patients. Patient data of cancer patients from Tübingen and Freiburg were collected and analysed to test the program. For comparison the gold standard SGA (Suvjective Global Assessment) was used. Anthropometry, BIA, blood analysis and patient questioning about adverse events were used to evaluate the nutritional status as well. Results were checked for specificity and sensitivity. The Risk-Score statements were evaluated considering different model-conditions. To calculate the prognostic score, patient- and illnessrelated parameters were proved by a variance analysis and a multiple linear regression.
Nutrition and tuberculosis in Ethiopia : the role of vitamin D2 derived from sun exposed oyster mushroom on the treatment outcomes of tuberculosis
(2019) Keflie, Tibebeselassie Seyoum; Biesalski, Hans-Konrad
Tuberculosis (TB) is an old infectious disease which causes ill-health among millions of people each year. Effective anti-TB drugs are available since 1950’s, but still the global burden of TB remains enormous. The disease is very complex and there is a need to look for supportive treatment to the standard anti-TB drugs. Cognizant of this, the present doctoral study was undertaken by giving emphasis on nutrition and TB in Ethiopia. The aim of this doctoral dissertation thesis was to deal with the nutritional situation of people with and without TB and come-up with solutions that could support the effort of combating TB. In this thesis, five papers (four published and one submitted) were included. The first paper encompassed the study of dietary and nutritional assessment. In this study, dietary inadequacy, poor nutritional quality and high risk of micro nutrient deficiencies were identified. The main dietary pattern included cereals, vegetables and legumes. About one-third of the population consumed animal source food (ASF). Malnutrition was the common problem in people with and without TB. This suggested that malnutrition may pave the way for TB. The case-control study in the second paper revealed that more than one-half of TB patients had vitamin A and zinc deficiencies. More than three-fourth of TB patients had below half of the energy fulfillment. The protein intake was above the average fulfillment, but most TB patients relied on cereal-based diets. Patients with TB used a larger proportion of proteins from oral feeding for oxidation and hence for energy production. About half of the patients were undernourished. Thus, vitamin A and zinc deficiencies along with protein-energy malnutrition need to be addressed in the management program of TB. The third paper included systematic review which explored the existence of vitamin D deficiency (VDD). Sunshine, which is very important for the synthesis of vitamin D under the skin is widely available in Africa throughout the year. Surprisingly, more than three-fourth of TB patients in Africa had VDD and vitamin D insufficiency (VDI). Statistically significant variables such as use of sun protection (lack of sun-exposure), inadequate dietary intake, low body mass index (BMI), high skin pigmentation, use of drugs (anti-retro viral and /or anti-TB), low socioeconomic status, rainy season, covering body skin with clothes, old age and co-morbidity were identified as the main predictor variables that hampered the status of vitamin D. Vitamin D can be obtained from dietary intakes apart from endogenous synthesis after sun exposure. Mushroom as such, is a potential non-animal source of vitamin D. The experimental study in the fourth paper revealed that sun-exposure significantly increased the content of vitamin D2 in oyster mushroom. Increasing the surface area for sun-exposure enhanced the production of vitamin D2. Other factors such as duration of sun-exposure and moisture content determined the production of vitamin D2. Exposing slices of oyster mushroom to direct sun for brief period provided enough vitamin D2 that could satisfy the current recommended dietary allowance (RDA) of vitamin D without any visible changes in color and texture. The study in the fifth paper was a randomized controlled trial and demonstrated for the first time the role of mushroom-derived vitamin D2 on the treatment outcomes of TB. Intervention with vitamin D2 derived from sun-exposed oyster mushrooms brought significant improvement in vitamin D status, clinical outcomes and immunological responses, but not in sputum smear and culture conversion. The intervention corrected VDD in more than one-third of TB patients. About one-third of the variability in TB score in the intervention group was accounted for by the change in the serum 25 hydroxy (OH) vitamin D level. There were also significant improvements in the serum IFN-gamma and cathelicidin LL-37 peptide levels after intervention. The balance of cytokines was skewed to TH1 responses due to high level of IFN-gamma. Thus, mushroom-derived vitamin D2 could serve as potential, safe, easily available and cost-effective adjunctive therapy for TB. Taken collectively, foods enriched with vitamin D need to be included in the national TB control program to support the first line anti-TB drugs, increase the cure rate and reduce the infectiousness of TB.
Nutritional status and its impact on outcome in patients undergoing allogeneic haematopoietic cell transplantation and an experimental trial to improve the supply of a specific micronutrient
(2012) Urbain, Paul; Biesalski, Hans-Konrad
The first two studies investigated the course of the nutritional status in patients un-dergoing allogeneic haematopoietic cell transplantation (alloHCT) and the validity of nutritional markers as independent risk factors for outcome. In line with others, we detected an overall good nutritional status before alloHCT by employing quick screening tools such as BMI and the SGA questionnaire for identifying malnutrition. However, upon closer inspection, we observed unintentional weight loss previous to alloHCT to be a frequent condition, detecting many more underweight patients using age- and gender-specific BMI classification and overall low bioelectrical impedance phase angle values at admission. Deterioration in nutritional status during the early post-transplant period was significant in the cohort. Furthermore, we identified ano-rexic patients and those with clinically-relevant aGVHD (≥°II) to have an increased risk for a decline in nutritional status during early rehabilitation. In addition, it could be demonstrated for the first time that the pretransplant phase angle (≤25th percen-tile) used as a standardised value was an independent predictor for 2-year overall survival, non-relapse mortality and progression-free survival. BMI adjusted for age and gender emerged as an independent risk factor for OS and NRM. Both of these nutritional markers performed better than numerous generally-accepted risk factors, and they were the only significant prognostic values for outcome in this cohort be-sides HLA-C compatibility, donor and remission status. In addition, these two nutri-tional markers are theoretically modifiable during the often lengthy treatment period before transplantation. Further investigation is necessary to demonstrate whether or not the phase angle can be increased by strategies that enhance muscle mass via physical training together with nutritional support, and whether it can prevent dete-rioration in nutritional status and lead to beneficial effects on outcome after alloHCT. The third study investigated the association between AOX status (α-tocopherol, ascorbic acid and ß-carotene) in buccal mucosa cells (BMC) or plasma and the risk of developing oral mucositis (OM) after conditioning chemotherapy. We observed no significant differences in baseline AOX concentrations in plasma or BMC among the different OM groups (no or mild, ulcerative and severe OM), revealing that no single AOX has predictive value for the incidence or severity of OM after conditioning chemotherapy. However, patients with an overall good plasma AOX status tended to require a shorter duration of parenteral nutrition, which is a relevant clinical and economic marker for OM treatment compared to patients with at least one plasma AOX beneath the normal range. These findings may indicate that an intact antioxidative network is more relevant than any one AOX for lowering the OM risk. Future studies should consider both the exogenous- and endogenous AOX systems. The fourth study revealed a generally low serum 25-hydroxyvitamin D [25(OH)D3] status in these patients at admission. Furthermore, their 25(OH)D3 status remained low during the early post-transplant period, showing a trend towards further deterio-ration, especially in patients with corticosteroid-treated aGVHD. In addition, we con-ducted a detailed investigation of the impact of well-known influencing factors on baseline serum 25(OH)D3 status, revealing only higher body fat mass to be an inde-pendent risk factor for reduced baseline status. In fact the most important influenc-ing factors, namely dietary factors and season, revealed no detectable impact, most probably due to inadequate oral intake, prolonged disease history, and hospitalisa-tion. In conclusion, these results provide a clear rationale for the use at least of vitamin D-containing multivitamin preparations in standard multivitamin prescrip-tions, and for the monitoring of vitamin D status at regular intervals from the date of diagnosis. The fifth study was a randomised controlled trial revealing for the first time in humans that the bioavailability of vitamin D2 from vitamin D2-enhanced button mushrooms via UV-B irradiation is effective in improving vitamin D status in young, healthy adults and not different than a vitamin D2 supplement. The vitamin D2 enhancement of mushrooms boosts their nutraceutical value by creating both an abundant and excellent source of vitamin D2 that opens up new opportunities in fighting widespread vitamin D deficiency.
Promoting dietary diversification in the ASEAN region : exposing food taboos, and exploring the nutrient profiles of underutilized, indigenous food resources
(2020) Köhler, Realm; Biesalski, Hans-Konrad
The Association of Southeast Asian Nations (ASEAN) is composed of Brunei Darussalam, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Vietnam. The ASEAN region is ailing from moderate to serious incidence of malnutrition. Among the member countries, Brunei Darussalam has the highest prevalence of child obesity (17.8%), while Malaysia has the highest prevalence of adult obesity (15.6%). Indonesia has the highest percentage of young children suffering from wasting at 13.5%. Lao PDR has the highest percentage of the undernourished in the population (16.5%), at the same time, having the highest percentage of stunted children under five years of age (43.85%). It also has the highest HHI score with 38.7, which corresponds to having a severe case of micronutrient deficiencies, and the highest death rates for both children under five years of age (63 deaths per 1,000 live births) and mothers (197 deaths per 100,000 live births). To fight malnutrition, nutrition-specific interventions address the immediate determinants of nutrition of specific vulnerable groups – young children, pregnant and lactating women, and others. Dietary diversification is an example of a nutrition-specific intervention. This dissertation was conducted to turn the spotlight towards the ASEAN region, its triple burden of malnutrition, and to dietary diversification as a sustainable way to lighten the load. It tackled one of the stumbling blocks to the acceptance of dietary diversification – food taboos, and one of the stepping stones towards its successful implementation – nutrient profiling of underutilized, indigenous resources in the region. This dissertation postulated that plant- and animal-based food taboos adhered to by pregnant, post-partum, and lactating Southeast Asian women can hinder dietary diversification in the most vulnerable and crucial moment of the first 1,000 days of life. The two review papers generated were the first to consolidate and showcase researches on food taboos covering the region. They highlighted the need for culture-sensitive health interventions to address maternal and child health problems that could lead to the attainment of the sustainable development goals of reducing the maternal and under-five mortality ratios and empowering women in Southeast Asia, as well as the priority health goals of the ASEAN. The underutilized, indigenous resources in the ASEAN region have the potential to be valuable components of a diversified diet. To prove this statement and to further promote dietary diversification, the dissertation tackled the nutrient profiling of the edible insects – Bombay locust (Patanga succincta), scarab beetle (Holotrichia sp.), house cricket (Acheta domesticus), and mulberry silkworm (Bombyx mori) from Thailand, and the sago grub (Rhynchophorus bilineatus) from Indonesia. For the pigmented rice varieties, the Camoros (red), Tinta (purple) and Malinao black rice from the Philippines were analyzed, while a review of pigmented rice varieties from Thailand was also conducted. The results of the analysis showed, and based on the Codex Alimentarius on food labelling, that the edible insects are “high in” protein and can be “sources of” or “high in” minerals. Also, data showed that the pigmented rice varieties from the Philippines and the pigmented Thai rice varieties have higher mineral and vitamin contents in comparison with white Jasmine rice. The findings in this dissertation have shown that edible insects and pigmented rice varieties can be added to diversify and improve the nutritional quality of people’s diets and to fight malnutrition from the household level. The novel research into indigenous food resources contributes to the advancement of knowledge in the field of entomology and biodiversity conservation, and of course, in food science and nutrition. Most importantly, the dissertation’s contribution to the promotion of dietary diversification in the hope of attaining improved human health and nutrition will benefit the whole ASEAN region.
Ready-to-Use Food (RUF) from composite flour of local commodities in Banten Province, Indonesia for prevention and rehabilitation of malnutrition in children under five
(2021) Fetriyuna, Fetriyuna; Biesalski, Hans-Konrad
Indonesia faces a serious problem of malnutrition especially stunting and underweight caused by micronutrient deficiencies. The high prevalence of undernutrition was also found in Banten Province, Java Island, the most populated island in Indonesia. The Indonesian Demographic and Health Survey (DHS) in 2012 reported that of about 24.5 million children under five years of old, approximately 37% and 12% of them were stunted and wasted. Furthermore, based on the Basic Health Survey (Riskesdas) in 2013 and 2018, the prevalence of stunting in children under five years old was 37.2 % and 30.8%, while the proportion of underweight children was 19.6% and 17.7%. The undernourished children have an increased mortality rate, risk of illness and infections, cognitive shortages, delayed development, and poor school performance. Ready-to-use food (RUF) is a kind of food easily consumed without much preparation and can be made using various techniques for targeted consumers. RUF can be produced using locally available food resources, which may be affordable for most people suffering from undernutrition. To improve and accomplish the nutrient content of RUF to meet the standard for rehabilitation food for malnutrition, the combination of various food resources might enhance the nutritional composition. This nutritious formulation must have the following attributes: good nutritional quality in macro and micronutrient content, highly palatable taste, consistency, and texture suitable for feeding to children, no additional processing required prior to feeding, product stability, long shelf life, and readily available ingredients. This research was divided into three main objectives. The first objective was a baseline assessment of the nutritional condition of the target group of children below five years old. The second section was RUF biscuit product development. The third objective was to investigate the nutritional outcomes of the field study in Banten Indonesia, particularly in WHZ and weight after the RUF provision and weight gain of the children and acceptability. The RUF biscuit was made from the composite flour of local food resources available in Banten province Indonesia which are still underutilized. The result of nutrition content analysis in local food resources showed that the foods have a high nutritional composition as a source of macronutrients and micronutrients (vitamins and minerals). Due to poor handling of post-harvest and processing into the intermediate product (flour), some vitamins were lost during the process. Based on the baseline assessment in 2017, of the 105 children, 4.8% and 11.4% of them were wasted and overweight-obese, while 40% and 23.8% of the children were stunted and underweight. Based on the mid-upper-arm circumference, 16.1% of children were categorized as the risk of chronic energy deficiency (CED). In addition, it was found that most of the children have insufficient intake of protein, Vitamin A, Iron, and Zinc. Twelve recipes developed using the combination of local food resources showed the macronutrient composition that met the requirement for the treatment of Moderate Acute Malnutrition (MAM) children, but not for micronutrient (vitamin and minerals). Five recipes (recipes 3, 4, 7, 11, and 12) were selected based on nutritional composition and sensory evaluation. The selected recipes were continued to further research of acceptability study in Banten, Indonesia. Before the acceptability study in the field, the micronutrient composition of the recipes chosen was improved according to the MAM treatment recommendation. It fortified the RUF with micronutrient premix. The micronutrient stability test was performed to analyze the loss due to baking. Around 15-28% of the vitamins (A, B1, B2, and E) were lost after baking, which was slightly lower than the other published articles, perhaps due to the short process of baking (15 minutes). Furthermore, the micronutrient sources were from the vitamin-mineral premix with higher stability than that from foods. Minerals content was stable during the baking process. Before the acceptability study started, five fortified cookie recipes were tested to select two for the acceptance and intervention pilot study. Most of the children in the acceptance study reported that they accepted and liked the RUF cookies. The consumption of RUF biscuits for two weeks led to an improvement in the nutritional status: Reduction of severe wasting (WHZ) from 5.7% to 4.3% and of severe underweight (WAZ) from 8.6% to 4.3%. There was no difference in terms of stunting (HAZ). Thus, it has been shown that the developed RUF biscuits have the potential to reduce malnutrition in the under 5-year-olds in the target area.
Unterstützung eines Gewichtsreduktionsprogramms durch Coenzym Q10 und Alpha-Liponsäure in micellierter wasserlöslicher Formulierung
(2013) Franz, Karen; Biesalski, Hans-Konrad
Overweight and obesity affects about half of the adult population in Germany and increase the risk for a series of subsequent diseases. A promising approach to treat obesity is to regulate the food intake ? and thus body weight ? in the hypothalamus. Adenosine monophosphate-activated protein kinase (AMPK) plays a central role in this mechanism. Consequently, suppression of the hypothalamic AMPK is an imaginable mechanism to improve repletion and limit the food intake. Alpha lipoic acid (ALA) inhibits the hypothalamic AMPK and therefore delays the onset of hunger. By increasing the muscular AMPK, ALA promotes the energy expenditure. In the respiratory chain Coenzyme Q10 is directly involved in the electron transport and the transformation of energy. Therefore, the combination of ALA and Coenzyme Q10 is an interesting approach. In the context of the randomized double blind intervention study the effect of daily intake of 90 mg of Coenzyme Q10 und 100 mg alpha lipoic acid in comparison to a placebo was investigated. In total 22 overweight adults per group (BMI 27 to 33 kg/m2) with no severe pre-existing diseases participated in the study. Over the course of 12 weeks the participants received regular nutritional counseling with the goal to reduce weight. Body weight, body composition using Bioelectric Impedance Analysis (BIA), and circumference of waist and hip were measured regularly. Prospective assessment of the food intake using 3-day protocols accompanied the measurements. Concurrently, the level of repletion was documented using a visual analog scale. Participants of both groups reduced their calorie intake during the time of the study. In the first part of the study this resulted an average weight reduction of 2.7±3.7 kg in the verum group and of 1.2±3.3 kg in the placebo group. The weight reduction in the verum group reached statistical significance compared to the placebo group (p<0.05). For the participants of verum group, the ratio of fasting insulin level and fasting blood glucose level (HOMA-index) improved as well. In the verum group, the HOMA-index in the first part improved from 2.4±1.2 (µU*dl)/(mg/ml) to 1.5±1.0 (µU*dl)/(mg/ml) with statistical significance (p=0,012). No significant improvement of the HOMA-index was found in the placebo group (from 3.0±1.3 (µU*dl)/(mg/ml) to 2.5±1.2 (µU*dl)/(mg/ml)). In the second part of the study the participants of the verum group reduced their body weight for 2.1±3.5 kg and for 3.9±3.2 kg in the placebo group. The difference between the two groups didn?t reach statistical significance. The HOMA-Index of the verum group was reduced from 3.0±1.6 (µU*dl)/(mg/ml) to 2.2±1.5 (µU*dl)/(mg/ml) without statistical significance. No changes were found in the placebo group (from 2.1±1.2 (µU*dl)/(mg/ml) to 2.3±1.0 (µU*dl)/(mg/ml). Further studies must deal with the improvement of the hepatic insulin resistance (HOMA Index) and the weight reduction (first part of this study) with the combination of Q10 and ALA.