Abstract

The objective of this work was to verify the ability of PASLoc porridges formulated from flours made with local food products to meet the protein-energy and micronutrient needs of moderately malnourished children as well as the international quality standards for infant foods. To do so, four (4) PASLoc porridges made from local food products were subjected to physicochemical, biochemical, and rheological analysis using standard detection methods. The results obtained for 100 g of dry matter revealed dry matter contents ranging from 19.75% to 24.83%, lipid and protein contents ranging from 19.63% to 34.46% and 11.18% to 17.29%, respectively, energy densities ranging from 79.02 to 99.32 Kcal/100 mL and viscosities ranging from 1.06 to 2.03 Pa. At the rheological level, porridges 2A and 2B have viscosities that may contribute to their acceptability by children. However, they are deficient in calcium, sodium, zinc, and vitamins A and D because they provide less than 50% of the daily requirements for this age group. The principal component analysis reveals nutritional potentialities with respect to the parameters in porridge PASLoc 2A, 2B, and 1A. This implies advantages in the management of moderate acute malnutrition in children aged 6 to 59 months.

1. Introduction

According to ¹, malnutrition is a disruption of the nutritional balance that is harmful to the body. It manifests itself in many forms, ranging from severe undernutrition to being overweight or obese. Undernutrition, which is the most widespread, remains a major public health problem in the world ². It can be the result of deficiencies in macronutrients (carbohydrates, lipids, or proteins) or micronutrients (vitamins and minerals) and can be acute or chronic. According to ³ estimates, the total number of undernourished people in 2020 was 768 million. Children are not left out because in the same year, stunting affected 22% and wasting 6.7% of children. This represents 149.2 million children and 45.4 million under 5 years of age, respectively, with nearly a quarter of them living in sub-Saharan Africa and more than half in South Asia. Actual numbers, particularly for stunting and wasting, are expected to be higher as a result of the effects of the pandemic COVID-19 ³. In Côte d'Ivoire, the results of the Multiple Indicator Cluster Survey show for the 0-59 month age group a prevalence of 6% acute malnutrition (wasting), of which 1.2% is severe, and 21.6% chronic malnutrition (stunting), with regional disparities exceeding the WHO emergency thresholds ⁴. In terms of underweight, in 2012, an estimated 14% of children were born weighing less than 2,500 grams. This estimate fell to 12.8% in 2016 ⁴.

Specialized food products (SAPs) have been developed for the reduction of undernutrition and its corollaries, which are a priority for the WHO. Indeed, specialized food products (SAPs) are nutritional products developed specifically to treat and prevent nutritional deficiencies ⁵. Most often lipid-based and rich in micronutrients, they offer a relatively long shelf life at room temperature ⁶. They are used specifically in interventions targeting populations suffering from or at risk of undernutrition, particularly children aged 6–59 months, pregnant and lactating women, and in aggravating cases such as epidemics or poor sanitation ^{5, 7}.

However, despite their intriguing nutritional contributions, these specialized foods have limitations, including: their very high sales costs (3 to 5 times the price of a normal flour); their nature as imported foods; their non-conformity with population dietary habits; their high fat content; and their nature as nutritional products rather than conventional foods ⁸. All of these problems greatly compromise the use of specialized food products and, more importantly, the supply of countries that need them.

The alternative is the formulation of traditional supplementary feeds or porridges made from simple, fermented, or fortified local cereal flours ⁹. This has the advantage of facilitating the production of locally available and less expensive supplementary feeds. In Côte d'Ivoire, the PNN offers food formulations called specialized food products based on local foods (PASLoc) in the nutritional rehabilitation centers in order to harmonize care actions, ensure the quality of services, and contribute to and pursue actions to improve the nutritional situation in Côte d'Ivoire. Do the porridges produced by these PASLoc guarantee adequate and maximum recovery of MAM? Do their nutritional and energy profiles meet the requirements of international standards? The objective of this work is therefore to systematically characterize the physicochemical, biochemical, and nutritional potential of porridges prepared from different flours formulated from local food products (PASLoc), which are intended for the care of children from 6 to 59 months suffering from moderate acute malnutrition.

2. Material and Methods

The plant material consisted of flours produced from millet (Panicum miliaceum), soybean (Glycine max), maize (Zea mays), rice (Oriza sativa), and groundnut (Arachis hypogea L) grains purchased from wholesalers at the "Forum market" in Adjame, and brown sugar and palm olein enriched with vitamin A purchased from a shopping mall in the Abidjan district. The fish meal was obtained from Clupea harengus, purchased from a fish wholesaler in the autonomous port of Abidjan (Côte d'Ivoire).

Millet, maize, rice and soybean grains were winnowed, sorted and then washed with large amounts of water to remove all foreign matter. After washing, the millet and maize grains were germinated for 72 hours at 30°C. The rice grains were dried directly in an oven at 50°C for 24 hours, while the maize and soybean grains were soaked in tap water for 18 hours and 24 hours respectively at room temperature (30°C). After soaking, the soybeans were directly dried in the oven. All the grains were then oven-dried at 50°C for 24 hours, as were the millet, rice and soybean grains. After drying, the grains were ground separately using a Moulinex electric mill. The flours obtained were sieved using a fine mesh sieve (200 µm) and then roasted on a hot plate equipped with a probe at 70°C for 30 min with constant stirring, then stored after cooling in airtight glass jars at a temperature of 28°C ± 2°C.

The groundnut paste was obtained after roasting over low heat for 40-60 min and then shelled before roasting. The roasted seeds were then ground into a paste and the paste obtained was stored in an airtight glass jar at a temperature of 28°C ± 2°C.

The fish meal was obtained after evisceration, smoking over charcoal and then drying in an oven (Venticell, France) at 50°C for 24 hours. The dried sample was then ground into meal before being stored in a sealed glass jar at 28°C ± 2°C.

Four types of PASLoc flour were formulated by mixing each type of flour previously prepared according to the proportions defined in Table 1 according the procedure described by ¹⁰.

To make the porridges from the PASLoc flour, the inputs were mixed according to the proportions defined in Table 2 and then the mixture was stirred to a homogeneous blend using a spatula. The homogeneous mixture was then brought to a boil over low heat for 3 to 5 minutes while stirring regularly with the spatula.

Moisture and dry matter contents were determined according to the method described by ¹¹, lipid content by ¹², total protein content by ¹³, energy density by ¹⁴. According to this method, the energy density of 100 mL of a porridge prepared from cereal and legume flours is equal to 4 Kcal multiplied by the dry matter content. A BROO FIELD Model DV-II + viscometer was used to determine the viscosity and the viscosity reading was taken in centipoise (CP) and subsequently converted to Pascal.second (Pa.s).

The determination of vitamins was carried out using a Shimadzu SPD 20A apparatus, according to the method of ¹⁵ with a PAD detector, a Cluzeau France brand C18 ODS column, 250 x 4.6 of isocratic mode (Acetonitrile: 55 mL); tetrahydrofuran (37 mL and water: eight (8) mL) with a mobile phase flow rate (1.5 mL) and a detection wavelength of 325 nm. A mass of one (1) g of dried boiled powder was weighed and then transferred to a 100 mL beaker containing 20 mL of methanol. The beaker was protected from light with aluminum foil. Then, the resulting solution was stirred with a bar magnet for two (2) hours 30 minutes at room temperature and then the methanol was filtered off and transferred to a 25 mL flask to form the test solutions. The standard solutions of each vitamin were immediately prepared by dilution series in methanol to constitute the control solutions.

Mineral contents (Ca, K, Mg, Na Fe and Zn) were determined by atomic absorption spectrophotometry, using the ¹⁶ digestion method. An ash sample (0.5 g) of previously dried boiled powder was dissolved in 30 mL of a mixture of perchloric acid (11.80 mol/L), nitric acid (14.44 mol/L) and sulfuric acid (18.01 mol/L). The mixture, stirred in the fume hood, was heated on a hot plate until thick white smoke appeared. After this heat treatment, the mixture was cooled to room temperature for 15 min and then 50 mL of distilled water was added. It was boiled again for 30 minutes on the same hot plate and then cooled again under the same conditions. It was then filtered on Whatman No. 4 filter paper into a 50 mL flask. The filtrate obtained was made up to the mark of the flask with distilled water. The level of each mineral was determined by atomic absorption spectrophotometer at a specific wavelength corresponding to each mineral by comparison to standard solutions. The phosphorus content was determined by the spectrophotometer method.

The analysis of variance (ANOVA) was performed with the IBM SPSS Statistics version 20.0 software to study the degree of difference between the variables. In case of significant difference between the studied parameters, the classification of means (homogeneous groups) was performed with Duncan's test. The significance level (α) is 0.05. Statistical differences with a probability value less than 0.05 were considered significant.

3. Results

The physicochemical characteristics and macronutrient content of the porridges made from local food products are reported in Table 3 and Table 4. Thus, for moisture and dry matter content, energy density, and viscosity, the statistical analysis reveals a significant difference between the physicochemical properties and macronutrient contents from one porridge to another at the threshold of P < 0.05. The different PASLoc porridges have high moisture content. They range from 75.17% to 80.24% for PASLoc 2A and PASLoc 2B porridge, respectively. This moisture content is negatively correlated with the dry matter content, which ranges from 19.75% to 24.83% for PASLoc1A and PASLoc 2A, respectively. However, these moisture and dry matter contents are below the recommended standard for infant formula. For lipid content, PASLoc 1A has the lowest content, while PASLoc 1B and 2B have the highest content. This content varies from 19.63 ± 0.2% to 34.5% for PASLoc 1A and PASLoc 1B, respectively. The lowest protein content was observed in PASLoc 1A and the highest in PASLoc 2A. The protein contents ranged from 11.18 ± 0.02% to 17.29 ± 0.02% for PASLoc 1A and PASLoc 2A, respectively. PASLoc 1B and PASLoc 2B slurries have statistically identical protein contents. These values are higher than the theoretical values of the flour. The energy density of the very high PASLoc slurries varies from 79.02 Kcal/100 mL to 99.32 Kcal/100 mL for PASLoc 1A porridge and PASLoc 2A porridge, respectively. The different slurries also show very high viscosities, varying from 1.06 Pa.s to 2.03 Pa.s for PASLoc 2B porridge and PASLoc 1A porridge, respectively. However, the Pearson test reveals a positive correlation between energy density and dry matter content, while a negative correlation is observed between viscosity and dry matter content.

The mineral content (mg/100g MS) of the different PASLoc porridges is presented in Table 5. The statistical analysis shows a significant difference (P < 0.05) in the calcium, potassium, magnesium, iron, and phosphorus contents of the different PASLoc porridges, except for the zinc content, which does not show a significant difference (P > 0.05). PASLoc porridge 2A had the highest calcium (70.06 ±0.05 mg/100g DM), potassium (709.03 ±0.05 mg/100g DM), magnesium (107.89 ±0.01 mg/100g DM) and iron (4.53 ±0.11 mg/100g DM) content compared to the other types of porridge. However, the consumption of 100 g of these porridges only covers the daily magnesium and iron requirements of children aged 6 to 59 months (Table 5). Sodium and phosphorus levels were higher in PASLoc porridge 1B than in other PASLoc porridges. Sodium levels ranged from 4.63 ±0.23 mg/100g DM to 29.36 ±0.40 mg/100g DM for PASLoc 1A and PASLoc 1B porridges, respectively, and phosphorus levels ranged from 175.50 ±0.65 mg/100g DM to 299.70 ±1.73 mg/100g DM. However, the sodium content in 100 g of porridge does not cover the standard daily requirement of this nutrient for children aged 6–59 months, whereas the phosphorus content does. The zinc content expressed in mg/100g DM does not show any significant difference in all porridges. The zinc levels of 0.90 ±0.17 mg/100g DM, 0.73 ± 0.63 mg/100g DM, 0.96 ±0.05 mg/100g DM and 0.86 ± 0.05 mg/100g DM for PASLoc porridges 1A, 1B, 2A and PASLoc 2B, respectively, are not sufficient to meet the standard zinc requirements of children aged 6–59 months.

Figure 1 and Figure 2 show the vitamin A, E, D, and B1 content of the different PASLoc porridges. The statistical analysis shows a significant difference in the vitamin content of the different PASLoc porridges. The vitamin A content is higher in PASLoc porridge 1A (17.36 ±0.32 µg/100g). However, this is very low compared to the standard level (250-300 µg/d) recommended for children aged 6–59 months. Vitamins E and D are within the standard range (5-7 mg/d for Vitamin E and 10-15 µg/d for Vitamin D) recommended for children. The content of Vitamin E is between 16.63 ±0.37 mg/100g and 30.66 ±0.75 mg/100g respectively for PASLoc porridge 1A and PASLoc porridge 2A, and that of Vitamin D is between 0.10 ±0.01 µg/100g and 0.43±0.05 µg/100g respectively for PASLoc porridge 1A and PASLoc porridge 2B. The vitamin B1 content in the different porridges was within the standard norms (0.5 mg/d) recommended in PASLoc 1A and PASLoc 2A porridges, with the exception of PASLoc 2B and PASLoc 1B porridges. For PASLoc 2B and PASLoc 2A porridges, respectively, Vitamin B1 levels ranged from 0.40 0.01 mg/100 g to 0.54 0.005 mg/100 g.

4. Discussion

The physicochemical characteristics of the PASLoc porridges developed revealed a correlation between the dry matter content, viscosity, and energy density of the porridges as shown in the correlation matrix. Indeed, the higher the dry matter content, the less viscous the porridge and the more energetically dense it is. These results are consistent with those of ¹⁸ for infant porridges prepared using germination and fermentation techniques. Indeed, these porridges presented high dry matter content and energy densities, respectively, ranging from 19.75% to 24.83% and 79.02 Kcal/100 mL to 99.32 Kcal/100 mL against a rather low viscosity ranging from 1.06 Pa.s-1 to 2.03 Pa.s-1 compared to the values obtained by ¹⁹ for porridges prepared from cassava and attiéké. These high dry matter and energy density rates as well as the low viscosity of the porridges could be justified by the use of germinated cereals for the preparation of the different porridges. Indeed, during germination, the action of natural amylases contained in the seeds causes the pre-digestion of the starchy constituents (dextrinization) and, consequently, the reduction of the bulk of the product ready to be consumed, thus increasing the nutritional density of the product. In Benin, ²⁰ applied the sprouting technique to their porridges to reduce the thick consistency of the porridges. According to studies conducted by ^{21, 22}, the incorporation of sprouted seeds leads to an increase in flow velocity associated with an increase in dry matter and energy density of the porridges. This same phenomenon was observed by ¹⁹ with the use of sprouted maize meal as a source of alpha amylases for increasing the energy density of cassava and attiéké-based weaning porridges. Also, according to ²³, to be easily acceptable to younger children, the porridge should have a viscosity of no more than 1.5 Pa.s-1. However, PASLoc 1A and 1B have a viscosity higher than this recommendation. They would therefore be less suitable for older infants but could be consumed by older children. For porridges used to supplement breast milk, ²³ recommends an energy density in excess of 60 kcal/100 mL. All PASLoc porridges meet this recommendation because they all have an energy density greater than 60 kcal/100 mL. Their consumption could therefore provide the necessary energy needed by moderately malnourished children to initiate growth and maintain good health.

In terms of lipid content, the porridge prepared from PASLoc 1A has a content lower than the minimum level recommended by the codex for complementary food preparations, i.e. at least 20%, in contrast to PASLoc 1B, 2A, and 2B, which have sufficient content. These values are, furthermore, higher than those determined by ²⁴ for yam and squash-based infant porridges. Therefore, porridges 1B, 2A, and 2B would be excellent sources of fat for the consumer. According to ²⁵, the contribution of fat to energy intake is very important in infants, and in addition to its energy role, fat is essential for brain development and function. Through the synthesis of eicosanoids (prostaglandins, thromboxanes, and leukotrienes) and docosanoids (protectin, neuroprotectin), lipids are also involved in the regulation of inflammation and immunity. In addition, they participate in the regulation of numerous genes involved in a wide range of metabolic functions. They are also essential as suppliers of fat-soluble vitamins (A, D, E, and K) ²⁶.

For the protein content, the codex standard recommends an intake of 6 to 15% for children under 3 years old. All PASLoc porridges meet this recommendation, with PASLoc porridge 2A exceeding this standard. According to ²⁷ and validated by ²⁸, the protein content of PASLoc porridges, especially PASLoc porridge 2A, would be beneficial for children suffering from moderate acute malnutrition. Its consumption could allow them to recover quickly. Indeed, proteins are essential macronutrients for the body because they are involved in the proper conduct of metabolic reactions and biological functions (establishment of muscle tissue, production of enzymes and hormones, and accelerated growth) ²⁹. Thus, the consumption of these porridges could therefore have a positive impact on the nutritional health of children with protein-energy malnutrition.

For mineral and vitamin contents, PASLoc porridges have calcium and zinc contents well below the recommended average nutritional requirements for children aged 6 months and older ¹⁷. The very high magnesium content is able to meet more than 95% of the daily requirements for infants aged 6 months and complies with the ¹⁶ directive. The level of potassium also complies with this standard because it can meet more than 50% of the daily requirements for infants aged 6 months and over and children aged 1 to 3 years. The phosphorus content is able to meet more than 100% of the daily requirement for infants aged 6 months and over; more than 80% of the daily requirement for children aged 1 to 3 years; and more than 50% of the daily requirement for children aged 4 to 6 years. For iron, the values determined are likely to meet the daily requirements of children aged 1 to 6 years. However, an in vivo study should be conducted to determine the bioavailability. These porridges would therefore be very good sources of magnesium, potassium, phosphorus, and iron and could therefore be used in the fight against malnutrition due to deficiencies in these minerals. Indeed, iron is necessary for the transport and use of oxygen as well as for various oxidation-reduction reactions, and an iron deficiency in infants and young children would be the cause of attention, memory, and learning capacity disorders for which the administration of iron has no effect. Magnesium deficiency is the cause of muscle contractions and hyperactivity in malnourished children ³⁰, and according to ¹⁷, this mineral is involved in more than three hundred enzymatic systems and in numerous metabolic pathways such as energy production and reactions involving ATP. Potassium plays a fundamental role in nerve transmission, muscle contraction, and heart function. It is also involved in insulin secretion, in carbohydrate and protein metabolism, and in acid-base balance. A potassium deficiency mainly results in heart rhythm disorders, cramps, fatigue, and polyuria. Phosphorus is an equally important mineral because it is involved in many physiological processes such as the storage and transport of energy, the regulation of the acid-base balance of the organism and cell signaling. In addition, a phosphorus deficiency would result in anorexia, anemia, muscle weakness, bone pain, rickets in children, and osteomalacia in adults ¹⁷.

Compared to the recommended daily values ¹⁷, PASLoc porridges 1B, 2A and 2B provide about 5 times more Vitamin E compared to 3 times more for PASLoc porridge 1A. For vitamin B1, they are all able to meet about 100% of daily requirements. Indeed, ³¹ reveals that the vitamin E content would contribute to the fluidification of blood in blood cells and would reduce cardiovascular diseases or cancer. As for vitamin B1, it would contribute to the production of energy in the body and would also intervene in the normal functioning of organs, the nervous system and in the formation of blood. For vitamins A and D, the level determined is well below the Dietary Reference Intake ³² although these micronutrients are of vital importance for the physical well-being of people. Vitamin A is involved in the regulation of genome expression, immune system function, and differentiation of mucosal epithelia (including the ocular epithelium) as well as the retinal epithelium in twilight vision. A deficiency in vitamin A in children would be manifested in particular by intra-uterine and post-natal growth delays as well as congenital malformations, a loss of twilight vision and a dryness of the ocular conjunctiva. Vitamin D is a fat-soluble vitamin that participates in the maintenance of calcium and phosphorus homeostasis and in the mineralization of tissues (bones, cartilage and teeth) during and after growth. The symptoms of a vitamin D deficiency would be manifested by rickets in children ¹⁷.

A principal component analysis (PCA) was performed in order to visualize the relationships that may exist between physicochemical and biochemical parameters and the different PASLoc slurries. This analysis also made it possible to explain 77.17% of the variables, of which 39.61% were correlated with axis 1 (F1) and 37.55% correlated with axis 2 (F2) (Figure 3). Following the representation of the cloud of variables and individuals in the reference frame formed by the F1 and F2 axes, it appears that the 1AB and 2AB mixtures are correlated with the F1 axis. The 2BB spray is strongly correlated to the F2 axis. An interpretation of the 1BB spray would be risky because it is too close to the center. This distribution of the slurries (PASLoc) in the factorial plane allows us to classify them into three distinct groups. The first group is made up of the 1AB and 2AB porridges, which are characterized by their protein, potassium, sodium, phosphorus, vitamin E, and energy density contents. The second group is the 2BB porridge, which is characterized by lipid content, calcium, vitamin A, vitamin D, vitamin B1, and viscosity. The 1BB porridge forms the third group and is correlated with iron, magnesium, and zinc content.

5. Conclusion

The objective of this work was to verify that the porridges from four (4) flours proposed for the rehabilitation of moderately acute malnourished children (MAM) meet the protein-energy needs, the micronutrient needs, and the international quality standards. The different analyses carried out on these porridges show that they are able to meet the protein-energy needs of children from 6 to 59 months diagnosed with moderate acute malnutrition. Moreover, porridges 2A and 2B have a viscosity that can contribute to their acceptability by children. However, they are deficient in calcium, sodium, zinc, and vitamins A and D because they provide less than 50% of the daily requirements for this age group. In order for these porridges to fully ensure their role in the growth of the child, it is imperative to proceed to their enrichment to fill the deficit in these elements.

Acknowledgments

We thank the managers of the University Félix Houphouet-Boigny for the partnership with the INSP (National Institute of Public Health) in Côte d’Ivoire, which facilitated the conduct of this study against moderate acute malnutrition. We thank also the PNN team and its partners.

Conflicts of Interest

The authors report no financial or any other conflicts of interest in this work.

Abbreviations

MAM: Moderate Acute Malnutrition

PNN: National Nutrition Program

PASLoc: Specialized Local Food Products

References