Millet-Based Diet Improves the Growth of Children: History
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Subjects: Food Science & Technology
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Joanna Kane-Potaka

Millets (defined broadly to include sorghum) are traditional staple foods, and climate smart nutritious crops, which are grown across Africa and Asia, they have not been mainstreamed globally like rice, wheat, and maize. Diversifying staples with millets can potentially provide more macro and micro nutrients, compared to the mainstream staples that are also often refined. However, there had been little known scientific evidence to prove millets’ efficacy on growth. 

  • infant growth
  • adolescent growth
  • millets

1. Introduction

Undernutrition, especially stunting, underweight, and wasting, is a major global crisis. It is estimated that there are currently 149 million children under five years who are affected by stunting, and 45 million children under five years who are affected by wasting [1]. Undernutrition puts children at greater risk of susceptibility to infections, increases the frequency and severity of such infections, and delays recovery. Approximately, 45% of global deaths among children under five are linked to undernutrition [2], which is particularly common in low- and middle-income countries. It is noteworthy, over a half of the stunted children under five years live in Asia, and more than one-third in Africa, while more than two-thirds of the wasted children live in Asia and more than one-quarter in Africa (UNICEF/WHO/World bank, 2019).
After birth, the first 1000 days of life are a critical stage and a window of opportunities for healthy growth, including physical, social, emotional, and cognitive development [3]. Similarly, the adolescent stage is another important growth period in the human life cycle. Although several other factors affect growth (e.g., infection), diet is a major factor which cannot be neglected. Nutrient deficient diets hinder children’s short and long-term physical, mental, and emotional development, affecting not only individual development but also economic and social development of the country. India’s latest National Family Health Survey indicates stagnation in most indicators related to the nutritional status of children including underweight, wasting, stunting and iron deficiency anaemia [4].
Child malnutrition is considered as a sensitive indicator of the overall levels of food insecurity and hunger. The Sustainable Development Goal 2 (SDG 2) aims to eliminate hunger and all forms of malnutrition by 2030. Diversified diet, especially staples, are needed to address the global challenge of hidden hunger. More than 70% of the energy intake comes from the Big 3: rice-, wheat-, and maize-based foods in developing countries of Africa and Asia [5][6]. The traditional crops, such as millets, are rich in nutrients including protein, iron, and zinc. Finger millets are particularly rich in calcium (having three times the amount as milk) along with other nutrients that are generally lacking in other staples, such as milled rice, refined wheat, and maize [7].
Many nutrients are essential during the growth and development stages, especially for linear skeletal growth. These include adequate supply of energy, amino acids, and bone forming minerals such as calcium, phosphorus, magnesium, and zinc and other ions and vitamins, such as vitamin C, D, and K required for collagen formation and bone metabolism and/or phosphate homeostasis [8].
Given the high nutrient content of millets, understanding their role in child growth would be instrumental in achieving sustainable nutritional security. Millets secure the sixth position in global production of cereal grains and remain a staple food in many rural marginalized regions of the world [9]. With rich sources of many vital nutrients, they have promising potential to combat nutrient deficiencies in third world countries. In addition, millets are recognized as smart foods [10] as they are “good for you” (nutritious and healthy), “good for the planet” (e.g., can survive with less water and other inputs and have a low carbon footprint), and “good for the farmer” (e.g., survive in high temperatures and resilient). However, their beneficial effects are often neglected, especially their impact on growth, as reported in scientific studies decades ago [11].

2. Millet-Based Diet Improve the Growth of Children

Nutrient requirements vary by age. During adolescence, typically the weight doubles and height increases 20% in healthy individuals [12]. During this time all the essential nutrients are required, especially protein, calcium, iron, and vitamins, to support bone accretion and to enhance the growth. Protein, especially branched chain amino acid leucine and sulphur containing amino acids, is a key nutrient required to support the development of muscle mass, and therefore, are especially important during adolescence [12]. Calcium always remains as a priority nutrient for bone growth especially during the tremendous growth periods of infancy (first twelve months) and adolescents (13 to 18 years).

Finger millets have a threefold higher concentration of calcium than milk, and calcium retention is higher for finger millet than for any other staple [13]. Moreover, millets contain more methionine, sulphur amino acids, compared to milled rice and refined wheat [7].
In the regular diets, there was a significant positive effect of replacing rice with millet on height, weight, MUAC, and chest circumference in various age groups (infant, pre-school, school going, and adolescents). These positive effects of millets are attributed to the naturally high content of growth promoting nutrients (especially sulphur amino acids, total protein, and calcium in case of finger millets), given that the rest of the diet was similar between the two groups.
Table 1 has information [14][15] on food provided in the interventions with preschool and school-going children, showing the composition of the diets based on diversified and enhanced rice and diversified and enhanced finger millet, compared to regular rice-based diets. It is noted that the enhanced diets based on finger millet had higher quantities of each food group: with 45% more finger millet, 270% more pulse, 59% more dairy products, 140% more green leafy vegetables, and 64% more fruits. On the other hand, the enhanced rice-based diets had higher quantities of each food group: 35% more rice, 327% more pulse, 59% more dairy products, 194% more green leafy vegetables, and 70% more fruits, compared to the regular rice-based diets. This likely explains the reason for the significant growth observed in the groups fed with the enhanced finger millet and enhanced rice-based diets, compared to the controlled regular rice-based diet group. On the other hand, there was no significant difference between the enhanced finger millet and enhanced rice diets in terms of consumption quantity per day, i.e., they were similar diets, with the main exception being a substitution of rice with millet. There was no significant difference between enhanced finger millet and enhanced rice-based diets in any of their growth parameters except chest circumference, which received a slight increase in growth (2%) in the enhanced finger millet-consuming group.
Table 1. Quantity of food items fed per day to groups consuming enhanced finger millet, enhanced rice and regular rice diets.
Food Items (g/day) Enhanced Finger Millet Based Diet Enhanced Rice Based Diet Control Diet (Regular Rice Based Diet)
  Mean ± SD Mean ± SD Mean ± SD
Millet/rice (g) 245 ± 20.4 228.3 ± 26.3 168.7 ± 26.2
Pulses (g) 100 ± 8.6 115.3 ± 5.0 27.0 ± 11.2
Milk & milk products (g) 54.2 ± 6.7 54.0 ± 9.6 34.0 ± 6.4
Roots and tubers (g) 96.7 ± 25.7 113 ± 37.2 57.2 ± 9.3
Green leafy vegetables (g) 39.2 ± 6.1 47.6 ± 4.9 16.2 ± 4.7
Oils and fats (g) 8.5 ± 1.7 8.6 ± 2.3 6.5 ± 1.0
Sugar (g) 10 ± 0.0 10.6 ± 1.2 6.5 ± 1.7
Nuts (g) 51.9 ± 2.1 53.0 ± 5.6 -
Fruits (g) 8.7 ± 0.5 9 ± 0.0 5.3 ± 0.5

This shows, that when the diet is enhanced, diverse, and nutritious, there is only minimal extra growth achieved from consumption of millet-based diets compared with rice-based diet. This is a reasonable result given that the control diet contains a diverse range and adequate quantities of nutritious foods. However, when the base diet was not enhanced and had lower nutritional value, substituting rice with millet had a large and significant impact on additional growth [6][16][17]. This provides evidence that including millets as the staple in malnourished communities can significantly improve the health and hence growth of the people.

3. Future Research Recommendations

All major growth promoters should be measured in future studies. Methionine is an essential sulphur containing amino acid and a major growth promoter. Apart from methionine, total protein, calcium, and zinc are essential as growth promoters, which were also not measured. Growth impacts of the different types of cooking/processing of the millets should be analysed to inform more detailed recommendations for dietary design. Only one study was designed to analyse the impacts of millet-based diets on children’s growth during adolescence, the third critical stage of rapid growth and bone mineralization in human life, which calls for further studies. 9. Except two studies, all other studies were conducted in the 1980s by one research team, suggesting that new studies should be undertaken to corroborate the results.

Policy Recommendations

The developmental, economic, social, and medical impacts of the global burden of malnutrition are serious and lasting for individuals, their families, communities, and countries [18]. Hence, nutritional interventions should be one of the priority areas for policy-makers, especially where the burden is high.
These studies provide evidence that millet-based diets can be effective in improving height and weight where regular rice-based diets are currently consumed. At the same time, these studies were not aimed at making changes in dietary patterns. Policy recommendations include: 1. Nutrition intervention programs developed to diversify staples using millets. 2. School feeding programs, and mother and child programs, incorporate millet-based meals designed for different age groups, using with culturally sensitive and tasty recipes. 3. Complement these interventions with awareness and marketing campaigns to change the image of millets and create interest. Implementation of these recommendations should be studied in regards to the impact and lessons learnt from the approaches.

4. Conclusions

Millets are a basket of a wide range of nutrients and have been scientifically shown to contribute to serving many of the significant nutrition and health needs globally [19][20][21][13], not only by tackling child undernutrition, but also by managing type 2 diabetes [19], lowering total cholesterol levels, obesity [20], and iron deficiency anaemia [21]. To bring this solution to reality, awareness about the nutritional value is needed to drive demand and investments in millets along the value chain, from fork to farm.

This entry is adapted from the peer-reviewed paper 10.3390/nu14010225

References

  1. WHO. Fact Sheets-Malnutrition–WHO. 2021. Available online: https://www.who.int›Newsroom›Factsheets›Detail (accessed on 1 July 2021).
  2. WHO. Fact Sheets. 2018. Available online: https://www.who.int›Newsroom›Factsheets›Detail (accessed on 1 July 2021).
  3. Pem, D. Factors affecting early childhood growth and development: Golden 1000 days. Adv. Pract. Nur. 2015, 1.
  4. NHFS-5. Ministry of Health and Family Welfare. National Health Family Survey 5 (2015–2020). 2020. Available online: http://www.rchiips.org/nfhs/pdf/NFHS5/India.pdf (accessed on 3 July 2021).
  5. Awika, J.M. Major cereal grains production and use around the world. In Implications to Food Processing and Health Promotion, Advances in Cereal Science; Awika, J.M., Piironen, V., Bean, S., Eds.; American Chemical Society: Washington, DC, USA, 2011; pp. 1–13.
  6. Anitha, S.; Kane-Potaka, J.; Tsusaka, T.W.; Tripathi, D.; Upadhyay, S.; Kavishwar, A.; Jalagam, A.; Sharma, N.; Nedumaran, S. Acceptance and Impact of Millet-Based Mid-Day Meal on the Nutritional Status of Adolescent School Going Children in a Peri Urban Region of Karnataka State in India. Nutrients 2019, 11, 2077.
  7. Longvah, T.; Ananthan, R.; Bhaskarachary, K.; Venkaiah, K. Indian Food Composition Table, National Institute of Nutrition; Indian Council of Medical Research: Hyderabad, India, 2017; pp. 1–578.
  8. Prentice, A.; Schoenmakers, I.; Laskey, M.A.; De Bono, S.; Ginty, F.; Goldberg, G.R. Symposium on ‘Nutrition and health in children and adolescents’ Session 1: Nutrition in growth and development: Nutrition and bone growth and development. Proc. Nutr. Soc. 2006, 65, 348–360.
  9. Kumar, A.; Tomer, V.; Kaur, A.; Kumar, V.; Gupta, K. Millets: A solution to agrarian and nutritional challenges. Agric. Food Secur. 2018, 7, 31.
  10. Poole, N.; Kane-Potaka, J. The smart food triple bottom line—Starting with diversifying staples. (Including summary of latest. smart food studies at ICRISAT). Agric. Dev. J. 2020, 41, 21–23. Available online: http://www.Ag4Dev41_Winter_2020_WEB.pdf(taa.org.uk) (accessed on 3 March 2021).
  11. Devdas, R.P.; Chandrasekhar, U.; Bhooma, N. Nutritional outcomes of a rural diet supplemented with low cost locally available foods—II. Impact on nursing mothers. Indian J. Nutr. Diet. 1983, 20, 71–78.
  12. Corkins, M.R.; Daniels, S.R.; De Ferranti, S.D.; Golden, N.H.; Kim, J.H.; Magge, S.N.; Schwarzenberg, S.R. Nutrition in children and adolescents. Med. Clin. N. Am. 2016, 100, 1217–1235.
  13. Anitha, S.; Ian Givens, D.; Botha, R.; Kane-Potaka, J.; Binti Sulaiman, N.L.; Tsusaka, T.W.; Subramaniam, K.; Rajendran, A.; Parasannanavar, D.J.; Bhandari, R.K. Calcium from finger millet—A systematic review and meta-analysis on calcium retention, and in-vitro bioavailability. Sustainability 2021, 13, 8677.
  14. Devdas, R.P.; Chandrasekhar, U.; Bhooma, N. Nutritional outcomes of a rural diet supplemented with low cost locally available foods—IV. Impact on children studied from birth to pre-school age. Indian J. Nutr. Dietet. 1984, 21, 115–123.
  15. Devdas, R.P.; Chandrasekhar, U.; Bhooma, N. Nutritional outcomes of a rural diet supplemented with low cost locally available foods—V. Impact on pre-schoolers followed over a period of four and a half years. Indian J. Nutr. Dietet. 1984, 21, 153–164.
  16. Durairaj, M.; Gurumurthy, G.; Nachimuthu, V.; Muniappan, K.; Balasubramanian, S. Dehulled small millets: The promising nutricereals for improving the nutrition of children. Matern. Child Nutr. 2019, 15 (Suppl. 3), e12791.
  17. Rajendra Prasad, M.P.; Benhur, D.; Kommi, K.; Madhari, R.; Vishnuvardhan Rao, M.; Patil, J.V. Impact of sorghum supplementation on growth and micronutrient status of school going children in southern India—A randomized trial. Indian J. Pediatr. 2015, 83, 9–14.
  18. Sen, A.K. Development as Freedom; Oxford University Press: New York, NY, USA, 1999.
  19. Anitha, S.; Kane-Potaka, J.; Tsusaka, T.W.; Botha, R.; Rajendran, A.; Givens, D.I.; Parasannanavar, D.J.; Subramaniam, K.; Kanaka, P.; Mani, V.; et al. A systematic review and meta-analysis of the potential of millets and sorghum for managing and preventing diabetes mellitus. Front. Nutr. 2021.
  20. Anitha, S.; Botha, R.; Kane-Potaka, J.; Givens, D.I.; Rajendran, A.; Tsusaka, T.W.; Bhandari, R. Can millet consumption help to manage hyperlipidaemia and obesity—A systematic review and meta-analysis. Front. Nutr. 2021, 8, 700778.
  21. Anitha, S.; Kane-Potaka, J.; Botha, R.; Givens, D.I.; Binti Sulaiman, N.L.; Upadhyay, S.; Longvah, T.; Rajendran, A.; Tsusaka, T.W.; Subramaniam, K.; et al. Millets can have a major impact on improving iron status, haemoglobin level and in reducing iron deficiency anaemia—A systematic review and meta-analysis. Front. Nutr. 2021.
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