19 May 2015

Pearls, Bread and Iron: biofortified millet reduces iron deficiency in Indian schoolkids

Biofortification is one of those ideas that seems too simple to be true--good nutrition for crops is good nutrition for people.  But it also seems to face many hurdles to bring it to fruition.  For example, is it really possible to find or breed varieties of staple crops using conventional breeding methods, that are high in key micronutrients, that improve yields (or at least do not lower them), that don’t affect the appearance, texture or taste of the food, and can be afforded and consumed by micronutrient deficient populations in sufficient quantities (with their micronutrient content remaining bioavailable)--to make a difference to their micronutrient status?  I make that about 10 hurdles to overcome.  Well, for Pearl Millet in India, the race seems to have been won.  The answer to the multipart question is “yes”.

What is the evidence?  Well, a new paper in the Journal of Nutrition reports on a randomized trial of iron-fortified pearl millet in school children of 12-16 years of age in the Indian state of Maharashtra.  The trial, overseen by the highly experienced Cornell nutritionist, Jere Haas, finds that the consumption of biofortified Pearl Millet (eaten in the form of Bhakri bread) for 4 months by the 12-16 year old children resulted in them being 1.6 times as likely to be iron-replete as the children eating non-biofortified Pearl Millet.
The study has limitations.  It was done in a boarding school setting and so the school meals provided more structure than family meals.  Also 28% of the study population was anemic, which is lower than many such populations.   These factors limit the external validity of the study (i.e. how likely is it to be generalizable?).  The authors recognize these limitations and outline how future studies should deal with these issues.
Nevertheless this is a big step forward for biofortification and the HarvestPlus programme behind it. This is the first such trial to show such strong effects on iron deficiency.  With over 2 billion people deficient in one or more micronutrients, we should be looking for all potential pathways—diet diversity, supplementation, fortification, and biofortification—to perform at high levels to eliminate this hidden form of malnutrition.

Biofortication seems to be charting one clear pathway to improved nutrient status, but they are all important.  I very much hope we get many more of these biofortification efficacy (and effectiveness) studies and that as many as possible show positive impacts.  
If the pearl is the oyster’s autobiography, as the saying goes, then this study may be the midpoint of biofortification’s biography. 

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