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Abstract Improved crop genotypes are constantly introduced. However, information on their nutritional quality is generally limited. The present study reports the proximate composition and the concentration and relative bioavailability of minerals of improved finger millets of different genotypes. Grains of finger millet genotypes (n = 15) grown in research station during 2019 and 2020 in Ethiopia, and replicated three times in a randomized complete block design, were analysed for proximate composition, mineral concentration (iron, zinc, calcium, selenium), and antinutritional factors (phytate, tannin and oxalate). Moreover, the antinutritional factors to mineral molar ratio method was used to estimate mineral bioavailability. The result shows a significant genotypic variation in protein, fat and fibre level, ranging from 10% to 14.6%, 1.0 to 3.8%, and 1.4 to 4.6%, respectively. Similarly, different finger millets genotypes had significantly different mineral concentrations ranging from 3762 ± 332 to 5893 ± 353 mg kg−1 for Ca, 19.9 ± 1.6 to 26.2 ± 2.7 mg kg−1 for Zn, 36.3 ± 4.6 to 52.9 ± 9.1 mg kg−1 for Fe and 36.6 ± 11 to 60.9 ± 22 µg kg−1 for Se. Phytate (308–360 µg g−1), tannin (0.15–0.51 mg g−1) and oxalate (1.26–4.41 mg g−1) concentrations were also influenced by genotype. Antinutritional factors to minerals molar ratio were also significantly different by genotypes but were below the threshold for low mineral bioavailability. Genotype significantly influenced mineral and antinutritional concentrations of finger millet grains. In addition, all finger millet genotypes possess good mineral bioavailability. Especially, the high Ca concentration in finger millet, compared to in other cereals, could play a vital role to combating Ca deficiency. The result suggests the different finger millet genotypes possess good nutrient content and may contribute to the nutrition security of the local people.

IntroductionThe current study investigated the value of urine selenium (Se) concentration as a biomarker of population Se status in rural sub-Saharan Africa.MethodUrine and plasma Se concentrations were measured among children aged 6–59 months (n = 608) and women of reproductive age (WRA, n = 781) living in rural Zimbabwe (Murehwa, Shamva, and Mutasa districts) and participating in a pilot national micronutrient survey. Selenium concentrations were measured by inductively coupled plasma-mass spectrometry (ICP-MS), and urine concentrations were corrected for hydration status.ResultsThe median (Q1, Q3) urine Se concentrations were 8.4 μg/L (5.3, 13.5) and 10.5 μg/L (6.5, 15.2) in children and WRA, respectively. There was moderate evidence for a relationship between urine Se concentration and plasma Se concentration in children (p = 0.0236) and WRA (p = < 0.0001), but the relationship had poor predictive value. Using previously defined thresholds for optimal activity of iodothyronine deiodinase (IDI), there was an association between deficiency when indicated by plasma Se concentrations and urine Se concentrations among WRA, but not among children.DiscussionUrine Se concentration poorly predicted plasma Se concentration at sub-district scales in Zimbabwe, limiting its value as a biomarker of population Se status in this context. Further research is warranted at wider spatial scales to determine the value of urine Se as a biomarker when there is greater heterogeneity in Se exposure.

BackgroundZinc biofortified wheat may be a sustainable strategy to increase zinc intake in areas where fortification and dietary diversification are not feasible or are limited by household purchasing power. This convergent mixed methods study aimed to explore the farmers’ and millers’ experiences and attitudes towards the production and processing of zinc biofortified wheat in Pakistan.MethodsA telephone survey was conducted with farmers (n = 418) who were provided with Zincol-2016 biofortified wheat seed for the 2019–2020 growing season, as part of a wheat grain micronutrient mapping study across Punjab Province. The survey explored the farmers’ experiences of growing Zincol-2016 and whether they opted to grow it again in the subsequent season. Semi-structured focus group discussions were undertaken in a separate group of farmers in Khyber Pakhtunkhwa (KP) province (n = 12) who grew Zincol-2016 for the BiZiFED2 RCT. Millers were also interviewed in KP, both those who had processed Zincol-2016 for the trial (n = 12) and those who had no experience of processing biofortified wheat (n = 12). Survey data were analyzed using descriptive statistics and transcripts of focus groups were analyzed using thematic analysis.ResultsNearly half of farmers who responded to the survey (47%) re-cultivated Zincol-2016 in the following season. The drivers for Zincol-2016 re-cultivation were seed availability (100%), grain yield and growth resistance (98%), quality of the flour from the previous harvest (97%) and nutritional benefit (94.5%). Discussions with farmers suggested that the main motivators for potential scale-up of biofortified wheat were the perceived quality of the grain, wheat, and flour. Millers saw it as an opportunity to expand their business. Farmers and millers valued the health benefits of the wheat. Challenges for scale-up include the need of additional support to produce it, unfamiliarity with the biofortification process, production costs, and external threats to the supply chain.ConclusionFarmers and millers showed a strong implicit preference for Zincol-2016 over alternative varieties. Crop performance and product yield were the most cited motivators for growing Zincol-2016. Farmers and millers are willing to produce and process biofortified wheat if financial and educational support is provided.

IntroductionThere is spatial variability of selenium (Se) in soil and crops in Ethiopia. We assessed the Se content of food items, breast milk, and urine among infants in Ethiopia from two areas with contrasting Se concentrations in soils.MethodsDietary Se intakes among children (6–23 months) were evaluated using a weighed food record on two non-consecutive days. Also, spot urine samples from children and breast milk samples from their mothers were collected to determine Se concentration. Selenium concentrations in the samples were analyzed using an inductively coupled plasma mass spectrometer (ICP-MS).ResultsInjera (prepared from teff and mixtures of other cereals) with a legume-based stew were the most frequently consumed foods by the children in both areas, followed by pasta. Overall, the Se concentration (mean ± SD) of food items, breast milk (12.2 ± 3.9 μg/L vs. 3.39 ± 1.5 μg/L), and urine samples (22.5 ± 11.5 μg/L vs. 3.0 ± 1.9 μg/L) from East Amhara were significantly higher than the corresponding samples from West Amhara (p < 0.001). The total Se intakes by the study children from East Amhara and West Amhara were 30.2 [IQ 25%, 14.2; IQ 75%, 54.1] and 7.4 [IQR 25%, 4.2; IQ 75%, 10.6] μg day–1, respectively; 31.5% of children from East Amhara and 92% of children from West Amhara were at risk of inadequate Se intakes. Urinary Se excretion accounted for 53 and 39% of daily dietary Se intake in East Amhara and West Amhara, respectively. Dietary Se intake was positively correlated with urinary Se excretion in East Amhara (r = 0.56; p < 0.001) but not among samples from West Amhara (r = 0.16; p ≥ 0.05), suggesting greater physiological Se conservation in a state of deficiency.ConclusionThere is spatial variability of Se in foods, breast milk, and urine in Ethiopia, suggesting the need for implementation of targeted agronomic interventions that enhance Se concentrations in the edible portion of plant foods.

Regenerative Agriculture (RA) is used to describe nature-based agronomic approaches that aim to build soil health and crop resilience, minimize negative environmental outcomes, and improve farmer livelihoods. A benefit that is increasingly attributed to crops grown under RA practices is improved nutritional content. However, we do not know the extent to which RA influences crop nutritional quality and under what management approaches and context, can such effects be realized. A scoping review of recent literature (Web of Science, 2000–2021) was carried out to assess the evidence that RA approaches improve crop micronutrient quality. Papers included combinations of agronomic approaches that could be defined as Regenerative: “Organic Inputs” including composts and manures, cover crops, crop rotations, crop residues and biochars; “Reduced Tillage”, “Intercropping”, “Biostimulants” e.g. arbuscular mycorrhizal fungi; plant growth promoting bacteria, and “Irrigation”, typically deficit-irrigation and alternate wetting and drying. The crop types reviewed were predetermined covering common sources of food and included: Tomato (Solanum lycopersicum L.), Wheat (Triticum aestivum L.), Rice (Oryza sativa L.), Maize (Zea mays L.), Pulses (Fabaceae), Alliums (Allium spp.), and “other” crop types (30 types). This scoping review supports a potential role for RA approaches in increasing the concentrations of micronutrients in the edible portions of several crop types under specific practices, although this was context specific. For example, rice grown under increased organic inputs showed significant increases in grain zinc (Zn) concentration in 15 out of 16 studies. The vitamin C concentration of tomato fruit increased in ~50% of studies when plants were grown under increased organic inputs, and in 76% of studies when plants were grown under deficit irrigation. Overall, the magnitude and reproducibility of the effects of RA practices on most crop nutritional profiles were difficult to assess due to the diversity of RA approaches, geographical conditions, and the limited number of studies for most crops in each of these categories. Future research with appropriate designs, improved on-farm surveillance and nutritional diagnostics are needed for better understanding the potential role of RA in improving the quality of food, human nutrition, and health.

IntroductionSelenium (Se) deficiency is increasingly recognized as a public health problem in sub-Saharan Africa.MethodsThe current cross-sectional study assessed the prevalence and geospatial patterns of Se deficiency among children aged 6–59 months (n = 741) and women of 15–49 years old (n = 831) selected by simple random sampling in rural Zimbabwe (Murewa, Shamva, and Mutasa districts). Venous blood samples were collected and stored according to World Health Organization guidelines. Plasma Se concentration was determined by inductively coupled plasma-mass spectrometry.ResultsMedian, Q1, and Q3 plasma Se concentrations were 61.2, 48.7, and 73.3 μg/L for women and 40.5, 31.3, and 49.5 μg/L for children, respectively. Low plasma Se concentrations (9.41 μg/L in children and 10.20 μg/L in women) indicative of severe Se deficiency risk was observed. Overall, 94.6% of children and 69.8% of women had sub-optimal Se status defined by plasma Se concentrations of

BackgroundFood crop micronutrient concentrations can be enhanced through agronomic biofortification, with the potential to reduce micronutrient deficiencies among rural population if they have access to fertilizers. Here we reported the impact of agronomic biofortification on finger millet grain zinc (Zn) and iron (Fe) concentration.MethodsA field experiment was conducted in farmers’ fields in Ethiopia in two locations; over two seasons in one district (2019 and 2020), and over a single season (2019) in a second district. The experimental design had 15 treatment combinations comprising 3 finger millet varieties and 5 soil-applied fertilizer treatments: (T1) 20 kg ha−1 FeSO4 + 25 kg ha−1 ZnSO4 + NPKS; (T2) 25 kg ha−1 ZnSO4 + NPKS; (T3) NPKS; (T4) 30% NPKS; (T5) 20 kg ha−1 FeSO4 + NPKS. The treatments were studied at two slope positions (foot and hill), replicated four times in a randomized complete block design.ResultsGrain Zn concentration increased by 20% in response to Fe and Zn and by 18.9% due to Zn addition. Similarly, grain Fe concentration increased by 21.4% in T1 and 17.8% in T5 (Fe). Zinc fertilizer application (p

Abstract Background Dietary zinc (Zn) deficiency is widespread in sub-Saharan Africa (SSA) with adverse impacts on human health. Agronomic biofortification with Zn fertilizers and improved soil fertility management, using mineral and organic nutrient resources, has previously been shown to increase Zn concentration of staple grain crops, including maize. Here, we show the potential of different soil fertility management options on maize crops to reduce dietary Zn deficiency in Zimbabwe using secondary data from a set of surveys and field experiments. Methods An ex-ante approach was used, informed by published evidence from studies in three contrasting smallholder production systems in Zimbabwe. To estimate current Zn deficiency in Zimbabwe, data on dietary Zn supply from non-maize sources from the Global Expanded Nutrient Supply (GENuS) data set were linked to maize grain Zn composition observed under typical current soil fertility management scenarios. Results A baseline dietary Zn deficiency prevalence of 68% was estimated from a reference maize grain Zn composition value of 16.6 mg kg−1 and an estimated dietary Zn intake of 9.3 mg capita−1 day−1 from all food sources. The potential health benefits of reducing Zn deficiency using different soil fertility management scenarios were quantified within a Disability Adjusted Life Years (DALYs) framework. A scenario using optimal mineral NPK fertilizers and locally available organic nutrient resources (i.e. cattle manure and woodland leaf litter), but without additional soil Zn fertilizer applications, is estimated to increase maize grain Zn concentration to 19.3 mg kg−1. This would reduce the estimated prevalence of dietary Zn deficiency to 55%, potentially saving 2238 DALYs year−1. Universal adoption of optimal fertilizers, to include soil Zn applications and locally available organic leaf litter, is estimated to increase maize grain Zn concentration to 32.4 mg kg−1 and reduce dietary Zn deficiency to 16.7%, potentially saving 9119 DALYs year−1. Potential monetized yield gains from adopting improved soil fertility management range from 49- to 158-fold larger than the potential reduction in DALYs, if the latter are monetized using standard methods. Conclusion Farmers should be incentivized to adopt improved soil fertility management to improve both crop yield and quality.

BackgroundInadequate dietary zinc (Zn) supplies and Zn deficiency (ZnD) are prevalent in Ethiopia, where cereals are major dietary sources, yet low in bioavailable Zn. Zinc agronomic biofortification (ZAB) of staple crops through application of Zn fertilizers may contribute to alleviating ZnD. However, large-scale promotion and adoption of ZAB requires evidence of the feasibility and public health benefits. This paper aimed to quantify the potential cost-effectiveness of ZAB of staple crops for alleviating ZnD in Ethiopia.MethodsCurrent burden of ZnD among children in Ethiopia was quantified using a disability-adjusted life years (DALYs) framework. Evidence on baseline dietary Zn intake, cereal consumption, and fertilizer response ratio was compiled from existing literature and secondary data sources. Reduction in the burden of ZnD attributable to ZAB of three staple cereals (maize, teff, and wheat) via granular and foliar Zn fertilizer applications was calculated under optimistic and pessimistic scenarios. The associated costs for fertilizer, labor, and equipment were estimated in proportion to the cropping area and compared against DALYs saved and the national Gross Domestic Product capita–1.ResultsAn estimated 0.55 million DALYs are lost annually due to ZnD, mainly due to ZnD-related mortality (91%). The ZAB of staple cereals via granular Zn fertilizer could reduce the burden of ZnD by 29 and 38% under pessimistic and optimistic scenarios, respectively; the respective values for ZAB via foliar application were 32 and 40%. The ZAB of staple cereals via granular fertilizer costs US$502 and US$505 to avert each DALY lost under optimistic and pessimistic scenarios, respectively; the respective values for ZAB via foliar application were US$226 and US$ 496. Foliar Zn application in combination with existing pesticide use could reduce costs to US$260–353 for each DALY saved. Overall, ZAB of teff and wheat were found to be more cost-effective in addressing ZnD compared to maize, which is less responsive to Zn fertilizer.ConclusionZAB of staple crops via granular or foliar applications could be a cost-effective strategy to address ZnD, which can be integrated with the existing fertilizer scheme and pesticide use to minimize the associated costs.

Micronutrient deficiencies (MNDs), also known as hidden hunger, affect more than a quarter of the global population. Agronomic biofortification helps to increase the concentration of a target mineral in food crops and improve human mineral dietary intake. It is a means of providing nutrient-dense foods to a larger population, especially among rural resource-poor settings, providing that they have access to mineral fertilizers. However, the feasibility of agronomic biofortification in combating hidden hunger depends on several factors in addition to fertilizer access, including crop type, genotype, climate, soils, and soil mineral interactions. Consideration of its effectiveness in increasing human mineral intake to the daily requirements and the improvement of human health and the cost-effectiveness of the program is also important. In this paper, we review the available literature regarding the potential effectiveness and challenges of agronomic biofortification to improve crop micronutrient concentrations and reduce hidden hunger.

Abstract Background This study reports findings from formative research conducted to assess the feasibility and inform the design and implementation of the Addressing Hidden Hunger with Agronomy (AHHA) trial. The AHHA trial was a randomised, controlled trial conducted in rural Malawi, in which participants were given maize flour biofortified with selenium or control flour not biofortified with selenium for a period of 10 weeks, after which blood samples were taken to measure selenium status. Methods Formative research was conducted in villages near to the AHHA trial study site 1 year before the planned intervention. A short questionnaire with adult women (n = 50), focus group discussions with male (n groups = 3) and female (n groups = 3) community members, and in-depth key informant interviews (n = 7) were conducted to understand community practices and perceptions. Findings Meals were typically cooked and eaten at home in this community, while participants reported that maize flour would be less readily sold than maize grain – important considerations for the design of the trial. Regarding intervention delivery, we identified potential concerns around effects on fertility, links between blood sampling and witchcraft, and the potential for social stigma if community members considered participants lazy for receiving free flour. Participants reported that involvement of the Malawi government partners including health extension workers would increase trust. Interpretation Following the formative research, the AHHA trial appeared feasible. However, community sensitisation would be essential to address potential fears and concerns; effective sensitisation would support recruitment and treatment adherence, and would protect the safety and wellbeing of participants and researchers. People in positions of authority and trust including village headmen, religious leaders, health and agriculture extension workers, and community care groups should be involved in community sensitisation.

Abstract Zinc (Zn) is an essential nutrient for human health. In Ethiopia, a high prevalence of Zn deficiency has been reported. To explore demographic variation and spatial dependencies in the Zn status of the Ethiopian population, we analyzed archived serum samples (n = 3373) from the 2015 Ethiopian National Micronutrient Survey (ENMS), a cross-sectional survey of young children, school-age children, women of reproductive age (WRA) and men conducted in all 9 regions and two city administration of Ethiopia. Serum Zn concentrations, measured using inductively coupled plasma-mass spectrometry (ICPMS), were compared to thresholds based on age, sex, fasting status, and time of blood collection, after adjusting for inflammation status. Median serum Zn concentration of the population was 57.5 μg dL−1. Overall, it is estimated that 72% of the population was Zn deficient, with high prevalence in all demographic groups. Spatial statistical analysis showed that there was spatial dependence in Zn status of WRA at distances of up to 45 km. Zinc deficiency is spatially dependent over short distances. Although WRA in most areas are likely to be Zn deficient, prevalence of deficiency varies at regional scale and between rural and urban inhabitants, suggesting there is scope to explore drivers of this variation, prioritize nutritional interventions, and to design more representative surveillance programs.

The present study aimed to investigate the influence of genotypic differences on responses to zinc and iron agronomic biofortification among yields of finger millet. A field experiment was conducted over two seasons in farmers’ fields in Ethiopia (2019, 2020). The experimental design had 15 treatment combinations comprising three finger millet genotypes and the applications of different combinations of zinc and iron mineral fertilizers. Five soil-applied fertilizer treatments (20 kg h−1 FeSO4 + 25 kg h−1 ZnSO4 + NPKS, 25 kg ha−1 ZnSO4 + NPKS, 20 kg ha−1 FeSO4 + NPKS, NPKS, and 30% NPKS) at two locations (Gojjam and Arsi Negelle, Ethiopia) and using two slope positions (foot and hill) were replicated four times in a randomized complete block design. Grain yield and biomass were evaluated on a plot basis. Plant height, total and productive tiller number, finger length of the longest spike and number of fingers per main ear were measured at the maturity stage. The combined soil application of FeSO47H2O and ZnSO47H2O increased the yield of the Meba genotype by 51.6%. Additionally, ZnSO47H2O fertilizer application increased the yield of the Urji genotype by 27.6%. A yield enhancement of about 18.3% of the Diga-01 genotype was achieved due to the FeSO47H2O fertilizers’ application. The findings of the present study suggest that the influence of Zn and Fe agronomic biofortification on the yield of finger millet could be affected by genotype differences and environmental conditions.

Abstract Background Biofortification of staple food crops may be a cost-effective and sustainable approach to reducing micronutrient deficiencies in resource-poor settings with low dietary diversity. However, its success depends on uptake by the local population. This paper presents formative research conducted in a remote, rural community in North West Pakistan, prior to commencing a randomised controlled trial to test the effectiveness of consuming zinc-biofortified wheat flour for alleviating zinc deficiency. It explored local community members’ knowledge, understanding and attitudes towards biofortification and views on members of their community taking part in the trial. Methods Four focus group discussions were conducted with male and female community members (separately for cultural reasons) and four in-depth interviews were conducted with Jirga members—respected male elders. Participation was limited to households that were ineligible for the trial so that we could explore the perspectives of community members who were not influenced by the incentives of the trial. Focus group participants were selected at community events for transparency. Data collection took place at the local school and homes of Jirga members. Thematic analysis was undertaken, using a combination of deductive and inductive approaches to identify key themes. Results A total of 47 men and women participated in this study. Participants reported clear motivation to access and consume more nutritious flour, believing this would bring health benefits, particularly to women and children. Trusted members of the local community, including Jirga members and female health workers, should be involved in providing information on biofortified flour (and the trial) to increase levels of awareness and acceptance. Without their involvement, there is a risk that biofortified flour would be mistrusted. The cost of flour is the main factor affecting purchasing decisions, and biofortified flour will need to be cost-competitive to achieve widespread uptake in marginalised, rural communities. Conclusion This formative study generated rich, qualitative data from a range of community stakeholders to improve the understanding of important barriers and facilitators to the widespread acceptability and adoption of biofortified wheat. Implementation research such as this will inform future decision-making in relation to scaling up biofortified wheat in Pakistan.

Background: Selenium deficiency is widespread in the Malawi population. The selenium concentration in maize, the staple food crop of Malawi, can be increased by applying selenium-enriched fertilizers. It is unknown whether this strategy, called agronomic biofortification, is effective at alleviating selenium deficiency.Objectives: The aim of the Addressing Hidden Hunger with Agronomy (AHHA) trial was to determine whether consumption of maize flour, agronomically-biofortified with selenium, affected the serum selenium concentrations of women, and children in a rural community setting.Design: An individually-randomized, double-blind placebo-controlled trial was conducted in rural Malawi. Participants were randomly allocated in a 1:1 ratio to receive either intervention maize flour biofortified with selenium through application of selenium fertilizer, or control maize flour not biofortified with selenium. Participant households received enough flour to meet the typical consumption of all household members (330 g capita−1 day−1) for a period of 8 weeks. Baseline and endline serum selenium concentration (the primary outcome) was measured by inductively coupled plasma mass spectrometry (ICP-MS).Results: One woman of reproductive age (WRA) and one school-aged child (SAC) from each of 180 households were recruited and households were randomized to each group. The baseline demographic and socioeconomic status of participants were well-balanced between arms. No serious adverse events were reported. In the intervention arm, mean (standard deviation) serum selenium concentration increased over the intervention period from 57.6 (17.0) μg L−1 (n = 88) to 107.9 (16.4) μg L−1 (n = 88) among WRA and from 46.4 (14.8) μg L−1 (n = 86) to 97.1 (16.0) μg L−1 (n = 88) among SAC. There was no evidence of change in serum selenium concentration in the control groups.Conclusion: Consumption of maize flour biofortified through application of selenium-enriched fertilizer increased selenium status in this community providing strong proof of principle that agronomic biofortification could be an effective approach to address selenium deficiency in Malawi and similar settings.Clinical Trial Registration:http://www.isrctn.com/ISRCTN85899451, identifier: ISRCTN85899451.

A new variety of zinc biofortified wheat (Zincol-2016) was released in Pakistan in 2016. The primary aim of this study was to examine the effects of consuming Zincol-2016 wheat flour on biochemical and functional markers of zinc status in a population with widespread zinc deficiency. An individually-randomised, double-blind, placebo-controlled cross over design was used. Fifty households were recruited to participate in the study, with each household included at least one woman of reproductive age (16–49 years) who was neither pregnant nor breast feeding or currently taking nutritional supplements. All households were provided with control flour for an initial 2-week baseline period, followed by the intervention period where households were randomly allocated in a 1:1 ratio to receive biofortified flour (group A; n = 25) and control flour (group B; n = 25) for 8-weeks, then switched to the alternate flour for 8-weeks. The trial has been registered with the ISRCTN (https://www.isrctn.com), ID ISRCTN83678069. The primary outcome measure was plasma zinc concentration, and the secondary outcome measures were plasma selenium and copper concentrations, plasma copper:zinc ratio and fatty acid desaturase and elongase activity indices. Nutrient intake was assessed using 24-h dietary recall interviews. Mineral concentrations in plasma were measured using inductively coupled plasma mass spectrometry and free fatty acids and sphingolipids by mass spectrometry. Linear Mixed Model regression and General Linear Model with repeated measures were used to analyse the outcomes. Based on an average flour consumption of 224 g/day, Zincol-2016 flour provided an additional daily zinc intake of between 3.0 and 6.0 mg for white and whole grain flour, respectively. No serious adverse events were reported. This resulted in significant, increase in plasma zinc concentration after 4 weeks [mean difference 41.5 μg/L, 95% CI (6.9–76.1), p = 0.02]. This was not present after 8 weeks (p = 0.6). There were no consistent significant effects of the intervention on fatty acid desaturase and elongase activity indices. Regular consumption of Zincol-2016 flour increased the daily zinc intake of women of reproductive age by 30–60%, however this was not associated with a sustained improvement in indices of zinc status.

Abstract Background Micronutrient deficiencies including selenium (Se) are widespread in Malawi and potentially underlie a substantial disease burden, particularly among poorer and marginalised populations. Concentrations of Se in staple cereal crops can be increased through application of Se fertilisers – a process known as agronomic biofortification (agro-biofortification) – and this may contribute to alleviating deficiencies. The Addressing Hidden Hunger with Agronomy (AHHA) trial aims to establish the efficacy of this approach for improving Se status in rural Malawi. Methods A double-blind, randomised, controlled trial will be conducted in a rural community in Kasungu District, Central Region, Malawi. The hypothesis is that consumption of maize flour agro-biofortified with Se will increase serum Se concentration. We will recruit 180 women of reproductive age (WRA) (20–45 years) and 180 school-age children (SAC) (5–10 years) randomly assigned in a 1:1 ratio to receive either maize flour enriched through agro-biofortification with Se or a control flour not enriched with Se. Households will receive flour (330 g per capita per day) for 12 weeks. The primary outcome is Se concentration in serum (μg/L). Serum will be extracted from venous blood samples drawn at baseline (prior to flour distribution) and end-line. Selenium concentration will be measured by using inductively coupled plasma mass spectrometry. Discussion Findings will be communicated to policy stakeholders and participating communities and reported in peer-reviewed journals. Trial registration The Addressing Hidden Hunger with Agronomy (Malawi) trial is registered (5th March 2019; ISCRTN85899451).

Abstract Selenium (Se) is an essential human micronutrient. Deficiency of Se decreases the activity of selenoproteins and can compromise immune and thyroid function and cognitive development, and increase risks from non-communicable diseases. The prevalence of Se deficiency is unknown in many countries, especially in sub-Saharan Africa (SSA). Here we report that the risk of Se deficiency in Malawi is large among a nationally representative population of 2,761 people. For example, 62.5% and 29.6% of women of reproductive age (WRA, n = 802) had plasma Se concentrations below the thresholds for the optimal activity of the selenoproteins glutathione peroxidase 3 (GPx3;

Recent surveys have revealed substantial spatial variation in the micronutrient composition of cereals in Ethiopia, where a single national micronutrient concentration values for cereal grains are of limited use for estimating typical micronutrient intakes. We estimated the district-level dietary mineral supply of staple cereals, combining district-level cereal production and crop mineral composition data, assuming cereal consumption of 300 g capita−1 day−1 proportional to district-level production quantity of each cereal. We considered Barley (Hordeum vulgare L.), maize (Zea mays L.), sorghum (Sorghum bicolor (L.) Moench), teff (Eragrostis tef (Zuccagni) Trotter), and wheat (Triticum aestivum L.) consumption representing 93.5% of the total cereal production in the three major agrarian regions. On average, grain cereals can supply 146, 23, and 7.1 mg capita−1 day−1 of Ca, Fe, and Zn, respectively. In addition, the Se supply was 25 µg capita−1 day−1. Even at district-level, cereals differ by their mineral composition, causing a wide range of variation in their contribution to the daily dietary requirements, i.e., for an adult woman: 1–48% of Ca, 34–724% of Fe, 17–191% of Se, and 48–95% of Zn. There was considerable variability in the dietary supply of Ca, Fe, Se, and Zn from staple cereals between districts in Ethiopia.

Introduction: Selenium (Se) is an essential mineral for livestock health and productivity. In cattle, Se deficiency is associated with delayed conception, growth retardation, and increased morbidity and mortality. Methods: We conducted a survey of cattle serum (n = 224) and feed (n = 81) samples from two areas with contrasting human and cereal grain Se concentration in Ethiopia. The fodder samples include stover, straw, hay and pasture grass. Se concentration of the samples were measured using inductively coupled plasma-mass spectrometry. Results: Serum Se concentration ranged from 14.9 to 167.8 μg L-1 (median, 41.4 μg L-1). Cattle from East Amhara had significantly greater serum Se concentration compared to cattle from West Amhara (median: 68.4 μg L-1 vs 25.7 μg L-1; p < 0.001). Overall, 79.8% of cattle had Se deficiency (

We estimated dietary supplies of total and available protein and indispensable amino acids (IAAs) and predicted the risk of deficiency in Malawi using Household Consumption and Expenditure Survey data. More than half of dietary protein was derived from cereal crops, while animal products provided only 11%. The supply of IAAs followed similar patterns to that of total proteins. In general, median protein and IAA supplies were reduced by approximately 17% after accounting for digestibility, with higher losses evident among the poorest households. At population level, 20% of households were at risk of protein deficiency due to inadequate available protein supplies. Of concern was lysine supply, which was inadequate for 33% of households at the population level and for the majority of the poorest households. The adoption of quality protein maize (QPM) has the potential to reduce the risk of protein and lysine deficiency in the most vulnerable households by up to 12% and 21%, respectively.

Background: Biofortification of wheat with zinc (Zn) through breeding and agronomy can reduce Zn deficiencies and improve human health. “High-Zn” wheat varieties have been released in India and Pakistan, where wheat is consumed widely as a dietary staple. The aim of this study was to quantify the potential contribution of a “high-Zn” wheat variety (Triticum aestivum L. var. Zincol-2016) and Zn fertilizers to improving dietary Zn supply under field conditions in Pakistan.Methods: Grain Zn concentration of Zincol-2016 and local reference varieties were determined at three sites of contrasting soil Zn status: Faisalabad (Punjab Province; diethylenetriamine pentaacetate- (DTPA-)extractable Zn, 1.31 mg kg−1 soil; gross plot size 13.3 m2; n = 4; reference var. Faisalabad-2008), Islamabad (Capital Territory; 0.48 mg kg−1; 4.6 m2; n = 5; reference var. NARC-2011), and Pir Sabak (Khyber Pakhtunkhwa, KPK, Province; 0.12 mg kg−1 soil; 9.1 m2; n = 4; reference vars. Pirsabak-2015, Wadhan-2017). Eight Zn fertilizer treatment levels were tested using a randomized complete block design: control; soil (5 or 10 kg ha−1 ZnSO4.H2O; 33% Zn applied at sowing); foliar (0.79 or 1.58 kg of ZnSO4.H2O ha−1 applied as a 250 L ha−1 drench at crop booting stage); three soil × foliar combinations.Results: At the Faisalabad site, the grain Zn concentration of Zincol-2016 was greater than Faisalabad-2008, with no yield penalty. Zincol-2016 did not have larger grain Zn concentrations than reference varieties used at Islamabad or Pir Sabak sites, which both had a lower soil Zn status than the Faisalabad site. Foliar Zn fertilization increased grain Zn concentration of all varieties at all sites. There were no significant effects of soil Zn fertilizers, or variety·fertilizer interactions, on grain Zn concentration or yield.Conclusions: Environment and management affect the performance of “high-Zn” wheat varieties, and these factors needs to be evaluated at scale to assess the potential nutritional impact of Zn biofortified crops. Designing studies to detect realistic effect sizes for new varieties and crop management strategies is therefore an important consideration. The current study indicated that nine replicate plots would be needed to achieve 80% power to detect a 25% increase in grain Zn concentration.

Zinc-biofortified flour may be a cost-effective approach to improve zinc status of populations in low-resource settings. The success of biofortification programmes is subject to acceptability and uptake by consumers. This study explored community leaders’ and community members’ (n = 72) experiences and attitudes towards the flour provided during a cluster randomised controlled trial of zinc biofortified wheat in rural Pakistan (BiZiFED2). Focus group discussions (n = 12) were conducted and thematic analysis applied using an inductive, semantic, contextualist approach. Five themes were identified: (1) Contribution to food security; (2) Better sensory and baking properties than local flour; (3) Perceived health benefits; (4) Willingness to pay for the flour; and (5) Importance of trusted promoters/suppliers. Although the participants were blind to whether they had received control or biofortified flour, referred to collectively as “study flour”, the results indicated that the study flour performed well in terms of its taste and bread making qualities, with no adverse reports from participants in either arm of the BIZIFED2 RCT. Participants suggested that they would buy the biofortified wheat if this was available at a fair price due to perceived health benefits, reporting positive sensory characteristics and cooking attributes when compared to the flour available in the local markets. Overall, there was a positive reception of the programme and flour among the participants, and members of the community hoped for its continuation and expansion.

Background: Potassium (K) is an essential mineral and major intracellular electrolyte involved in the regulation of blood pressure, muscle contraction and nerve transmission in humans. Major dietary sources of K include fruits and vegetables, starchy roots and tubers, and whole grains. The aim of this study was to assess and report: (i) the sufficiency of K in national food systems globally, (ii) to quantify the contribution from food groups, and (iii) to explore spatial and temporal trends in the period of 1961–2017. Methods: Food supply and demography (1961–2017), K composition and K requirement data were combined to estimate per capita human dietary supplies of potassium (DSK), adequate intake of K (AIK) and K sufficiency ratio (KSR) at national, regional, continental and global levels. Results and Discussion: Globally, the mean ± SD. DSK (mg capita−1 d−1) increased from 2984 ± 915 in 1961 to 3796 ± 1161 in 2017. There was a wide range in DSK between geographical regions and across years, with particularly large increases in east Asia, where DSK increased from 5000 mg capita−1 day−1. Roots and tubers contributed the largest dietary source of K, providing up to 80% of DSK in most regions. At the global level, throughout the 57-year period, the population-weighted KSR was 1 based on the 2019 National Academies of Science and the 2016 European Union AIK recommendation. While KSR ≥ 1 shows sufficiency of DSK, KSR < 1 does not indicate K deficiency risk. Conclusion: Due to the absence of a Recommended Daily Allowance (RDA) for K, this study used the ratio of DSK:AIK (i.e., KSR) to assess dietary K sufficiency. Estimates of dietary K sufficiency are, therefore, highly sensitive to the AIK reference value used and this varied greatly based on different institutions and years. To quantify the risk of dietary K deficiency, bridging the data gap to establish an RDA for K should be a global research priority.

Retinol Binding Protein (RBP) is responsible for the transport of serum retinol (SR) to target tissue in the body. Since RBP is relatively easy and cheap to measure, it is widely used in national Micronutrient Surveys (MNS) as a proxy for SR to determine vitamin A status. By regressing RBP concentration against SR concentration measured in a subset of the survey population, one can define a population-specific threshold concentration of RBP that indicates vitamin A deficiency (VAD). However, the relationship between RBP and SR concentrations is affected by various factors including inflammation. This study, therefore, aimed to re-define the population-specific cut-off for VAD by examining the influence of inflammation on RBP and SR, among pre-school children (PSC) from the 2015–16 Malawi MNS. The initial association between RBP and SR concentrations was poor, and this remained the case despite applying various methods to correct for inflammation. The World Health Organization (WHO) recommends the threshold of 0.7 µmol/L to define VAD for SR concentrations. Applying this threshold to the RBP concentrations gave a VAD prevalence of 24%, which reduced to 10% after inflammation adjustments following methods developed by the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA). Further research is required to identify why SR and RBP were poorly associated in this population. Future MNS will need to account for the effect of inflammation on RBP to measure the prevalence of VAD in Malawi.

Selenium (Se) is an essential element for human health and livestock productivity. Globally, human Se status is highly variable, mainly due to the influence of soil types on the Se content of crops, suggesting the need to identify areas of deficiency to design targeted interventions. In sub-Saharan Africa, including Ethiopia, data on population Se status are largely unavailable, although previous studies indicated the potential for widespread Se deficiency. Serum Se concentration of a nationally representative sample of the Ethiopian population was determined, and these observed values were combined with a spatial statistical model to predict and map the Se status of populations across the country. The study used archived serum samples (n = 3269) from the 2015 Ethiopian National Micronutrient Survey (ENMS). The ENMS was a cross-sectional survey of young and school-age children, women and men. Serum Se concentration was measured using inductively coupled plasma mass spectrometry (ICPMS). The national median (Q1, Q3) serum Se concentration was 87.7 (56.7, 123.0) μg L−1. Serum Se concentration differed between regions, ranging from a median (Q1, Q3) of 54.6 (43.1, 66.3) µg L−1 in the Benishangul-Gumuz Region to 122.0 (105, 141) µg L−1 in the Southern Nations, Nationalities, and Peoples’ Region and the Afar Region. Overall, 35.5% of the population were Se deficient, defined as serum Se < 70 µg L−1. A geostatistical analysis showed that there was marked spatial dependence in Se status, with serum concentrations greatest among those living in North-East and Eastern Ethiopia and along the Rift Valley, while serum Se concentrations were lower among those living in North-West and Western Ethiopia. Selenium deficiency in Ethiopia is widespread, but the risk of Se deficiency is highly spatially dependent. Policies to enhance Se nutrition should target populations in North-West and Western Ethiopia.

Serum zinc concentration (SZC) is used widely to assess population-level zinc status. Its concentration decreases during inflammatory responses, which can affect the interpretation of the results. This study aimed to re-estimate the prevalence of zinc deficiency in Malawi based on the 2015–2016 Malawi Micronutrient Survey (MNS) data, by adjusting SZC measures with markers of inflammation. SZC and inflammation data from 2760 participants were analysed. Adjustments were made using: (1) The Internal Correction Factor (ICF) method which used geometric means, and (2) The Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) method, which used linear regression. Mean SZC values increased significantly when adjustments were made by either ICF or BRINDA (p < 0.001). The national prevalence of zinc deficiency decreased from 62% to 59%, after ICF adjustment, and to 52% after BRINDA adjustment. ICF and BRINDA values of SZC were highly correlated (p < 0.001, r = 0.99), but a Bland–Altman plot showed a lack of agreement between the two methods (bias of 2.07 µg/dL). There was no association between the adjusted SZC and stunting, which is a proxy indicator for zinc deficiency. Inflammation adjustment of SZC, using ICF or BRINDA, produces lower estimates of zinc deficiency prevalence, but the lack of agreement between the adjustment methods warrants further research. Furthermore, the lack of association between SZC and stunting highlights the need to explore other biomarkers and proxies of population zinc assessment. This study demonstrates the importance of considering inflammatory confounders when reporting SZC, to ensure accuracy and to support policy decision making.