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Research Project: Pediatric Clinical Nutrition

Location: Children's Nutrition Research Center

Title: Protein-quality evaluation of complementary foods in Indian children

item SHIVAKUMAR, NIRUPAMA - St John'S National Academy Of Health Sciences
item KASHYAP, SINDHU - St John'S National Academy Of Health Sciences
item KISHORE, SATVIK - St John'S National Academy Of Health Sciences
item THOMAS, TINKU - St John'S National Academy Of Health Sciences
item VARKEY, ANEESIA - St John'S National Academy Of Health Sciences
item DEVI, SARITA - St John'S National Academy Of Health Sciences
item PRESTON, THOMAS - University Of Glasgow
item JAHOOR, FAROOK - Children'S Nutrition Research Center (CNRC)
item SHESHSHAYEE, M - University Of Agricultural Sciences
item KURPAD, ANURA - St John'S National Academy Of Health Sciences

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/31/2018
Publication Date: 3/28/2019
Citation: Shivakumar, N., Kashyap, S., Kishore, S., Thomas, T., Varkey, A., Devi, S., Preston, T., Jahoor, F., Sheshshayee, M.S., Kurpad, A.V. 2019. Protein-quality evaluation of complementary foods in Indian children. American Journal of Clinical Nutrition. 109(5):1319-1327.

Interpretive Summary: Young children grow very fast from 6 months to 24 months of their life. In addition to breast milk from their mothers they need other types of nutritious foods that supply all the ingredients needed to support this fast growth. These foods are called complementary foods. They have to be a mixture of different food items that will provide enough vitamins, minerals, energy and protein needed for fast growth in these young children. Unfortunately, in most poor countries more than 90% of children do not get such a well-balanced diet so they do not grow as fast as they should. This causes them to become underweight and shorter in length, a condition called stunting. Protein is one of the main ingredient needed for growth in children. Most of the complementary foods that is fed to young children in poor countries either do not have enough protein or have protein that is of poor quality. A food protein is of poor quality if it does not contain 20 compounds called amino acids which are needed for growth or if it is not properly digested by the child. It is believed that most food proteins from animals such as milk and eggs are of very high quality but the proteins from plants such as cereals and beans are not of very high quality because they do not have adequate amounts of all 20 amino acids and are poorly digested by young children. However, in the past there was no way of knowing how well a protein was digested because there was no method to measure it. We developed such a method and used it for the first time to measure how well the protein from four different foods, rice, finger millet, mung bean, and hen egg, commonly used to feed young children in India, were digested. We found that only 65% of protein from mung bean, 68% from finger millet and 78% from rice was digested compared to 87% for egg. That is the quality of egg protein was very high compared to the three proteins from plants. We also found that most children who were stunted were eating foods that only contained the plant proteins. We calculated that the quality of the plant proteins can be vastly improved if egg or milk was added. Finally, we recommend that to prevent stunting in children in poor countries, egg or milk should be added to complementary foods that consist only of cereal or beans.

Technical Abstract: The types of food in complementary feeding of infants and young children are important for growth and development. Food protein quality, as measured by the Digestible Indispensable Amino Acid Score (DIAAS), requires the determination of true ileal digestibility of indispensable amino acids (IAAs) in children. First, the aim of this study was to measure the true ileal IAA digestibility of four (rice, finger millet, mung bean, and hen egg) commonly consumed complementary foods in children aged <2 y using the dual-isotope tracer method. Second, we calculated the DIAAS of complementary feeding diets and their relation to stunting in a representative Indian rural population. Rice, finger millet, and mung bean were intrinsically labeled with deuterium oxide (2H2O), whereas egg was labeled through oral dosing of hens with a uniformly 2H-labeled amino acid mixture. True ileal IAA digestibility was determined by the dual-isotope tracer technique. The DIAAS of complementary food protein was calculated in children aged 1–3 y from a nationally representative survey to evaluate its relation with stunting. True ileal IAA digestibility was lowest in mung bean (65.2% +/- 7.1%), followed by finger millet (68.4 % +/- 5.3%) and rice (78.5% +/- 3.5%), and was highest for egg (87.4% +/- 4.0%). There was a significant inverse correlation of complementary food DIAAS with stunting in survey data (r=-0.66, P=0.044). The addition of egg or milk to nationally representative complementary diets theoretically improved the DIAAS from 80 to 100. The true ileal IAA digestibility of four foods commonly consumed in complementary diets showed that the DIAAS was associated with stunting and reinforces the importance of including animal source food (ASF) in diets to improve growth.