NEW YORK, New York — A consequence of poverty, malnutrition affects many children across India and its dire effects continue to exacerbate the cycle of poverty. In an interview with The Borgen Project, Dr. Saurabh Mehta and Dr. Samantha Huey explained the impact of biofortified crops on maternal and child malnutrition in India.
In December 2020, the fifth National Family Health Survey, a large-scale survey that collects information on population health and nutrition across India, released data on malnutrition rates across the country. The survey also referred to as NFHS-5, found that, in 2019 and 2020, more than 40% of children in the Karimganj district of Assam and the Dang district of Gujarat faced acute undernourishment. In 2015 and 2016, 36.5% of children between 6-59 months old in Assam, a state in eastern India, suffered from anemia. From 2019 to 2020, 39.4% of children of the same age group in Kerala, another Indian state, faced the same health issue.
Iron deficiency is the most common cause of anemia and it can stem from a lack of proper nutrition. The Comprehensive National Nutrition Survey (2016–18) found that deficiencies in vitamins B9 and B12 contribute to high rates of anemia among children in India. Anemia can lead to cognitive disturbances in children, making it more difficult for them to pay attention in school and succeed in an education that could provide a route out of poverty. Needless to say, child malnutrition in India is a significant health issue requiring innovative solutions.
Biofortification is an agricultural process that poses a solution to micronutrient malnutrition. Biofortification improves the nutritional quality of food crops through methods such as plant breeding, biotechnology and agricultural development.
Researchers are currently working to determine the efficacy of biofortification in preventing child malnutrition in India. One scientist engaging in this work is Dr. Saurabh Mehta, the Janet and Gorden Lankton Professor of Public Health and Nutrition at Cornell University. Mehta is the principal investigator on two randomized controlled trials to investigate the impact of biofortified crops on maternal and child nutrition in India.
The first trial examined children ages 12-18 months in the urban slums of Mumbai. The researchers used one biofortified crop to deliver higher doses of iron to the children. In the second trial, the team investigated the impact of multiple biofortified crops on the nutrition of mother and child dyads, or pairs, in a rural area of South India. The children formed part of the 6-24 month age group and the mothers engaged in breastfeeding. The researchers combined biofortified crops into meals to deliver higher doses of iron, vitamin A and zinc to address child malnutrition in India.
Before serving biofortified crops to these populations, Mehta and his team first had to assess whether the target group of children faced any kind of nutritional deficiency and, if so, determine the inadequacies in their diets. This information allowed the researchers to determine whether dietary intervention would help solve these micronutrient deficiencies.
The results of the team’s preliminary research were consistent with those reported in the NFHS-5. “We found that, yes, iron deficiency and anemia was a big issue in this population,” Mehta said in an interview with The Borgen Project. “The diets were not adequately delivering enough iron.”
To coordinate the study, Dr. Samantha Huey, a postdoctoral associate working in Mehta’s research group, spent two years in Mumbai. There, she managed multiple steps of the project, overseeing data collection, training of local staff and study development.
Working in Mumbai allowed Huey to see both the impact of child malnutrition and the ability of her project to combat this issue, firsthand. She recalled working with an infant with rickets, a disease that vitamin D deficiency causes, which leads to soft bones and bowed legs.
“Being from the U.S., I think most people today studying nutrition only see this in textbooks or read about it, but never see an up-close and personal case,” Huey told The Borgen Project. “Along with the high prevalence of iron deficiency and anemia from our preliminary studies, [it]really painted the picture of the problem and how our intervention could help.”
One major crop the project utilized was pearl millet, an ancient grain crop. The team chose pearl millet partly due to its health benefits — “Pearl millet has a favorable glycemic index profile… so [it’s] supposed to be less diabetogenic,” Mehta said — and because researchers can easily manipulate its nutrient content without genetically modifying the plant, which is illegal in India.
“Pearl millet has properties that enable us to deliver excellent nutrients in the crop at an affordable enough price,” Mehta explained, “and with enough bioavailability that can enable enough absorption when consumed in reasonable amounts.”
Bioavailability refers to the proportion of a nutrient that the body can absorb and utilize. When pearl millet supplies nutrients to the body, the body can easily absorb and use them, so that the people consuming the millet can acquire nutrients in sufficient amounts.
Pearl millet is less widely consumed in India than crops such as wheat and rice, so the researchers conducted a study to determine whether the target group of children would be open to eating these crops. While in Mumbai, Huey oversaw recipe development for the study, which involved replacing grains in traditional meals with pearl millet.
“Because the trial was taking place among young children who were just about to be, or currently starting to be, weaned from breast milk, we had to develop culturally appropriate but also really tasty, complimentary food,” Huey said. The researchers served two to three meals a day to the children, six days a week, for nine months. Overall, researchers served about 35 different meals over the course of the study.
Mehta and Huey hope that the results from the trials, which will be published in the near future, will help inform nutrition policy. One of the main reasons for their involvement in the project was the Integrated Child Development Services Scheme, a program that delivers supplemental rations to “children up to the age of 6 years, pregnant and lactating mothers and women 16–44 years of age.”
“In most places, this supplemental ration is based on wheat and rice,” Mehta said. “If we find convincing enough evidence, can we then convince the government to replace some part of that wheat and rice with a biofortified pearl millet piece?”
Although biofortification offers a promising solution to micronutrient malnutrition, it is not the only method of mitigating this issue. Other solutions include taking supplements and including a more diverse array of foods in one’s diet.
“Biofortification is one of the complementary strategies. I wouldn’t say that it’s a silver bullet or that this is a magical solution,” Mehta said. Still, biofortification is a useful process that will likely continue to gain popularity in the years to come, aiding in the fight against global poverty, especially as more scientists publish related research. “Many people in nutrition and global health are excited about biofortification,” Huey says. “It’s a really promising and sustainable potential strategy to mitigate micronutrient deficiencies.”
– Aimée Eicher