Can the supplementary consumption of baobab (Adansonia digitata L.) fruit pulp improve the hemoglobin levels and iron status of schoolchildren in Kenya? Findings of a randomized controlled intervention trial

Esther Charlotte Evang,Tsige-Yohannes Habte,Michael Bernhardt Krawinkel,Willis Omondi Owino

doi:10.1007/s00394-020-02447-2

Esther Charlotte Evang, Tsige-Yohannes Habte + Show 2 more

Open Access

https://doi.org/10.1007/s00394-020-02447-2

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Abstract

PurposeIn the rural Kenyan diet, the bioavailability of iron is low and predisposes the population to iron deficiency. Fruit pulp of the indigenous baobab tree contains significant amounts of vitamin C, which enhances non-heme iron bioavailability. We studied the impact of baobab fruit pulp (BFP) consumption on the hemoglobin (Hb) and iron status of Kenyan schoolchildren.MethodsThe single-blind randomized controlled intervention trial was implemented daily among apparently healthy schoolchildren aged 6–12 years with hemoglobin level < 12.2 g/dl. For 12 weeks, children in the intervention group (n = 29) received a drink with BFP, while the control group (n = 29) received an isoenergy drink without BFP. At baseline and endline, blood samples were taken.ResultsThe development of hemoglobin, ferritin (FER) and soluble transferrin receptor (sTfR) did not differ significantly between the intervention and control groups. However, in the intervention group, Hb levels improved slightly (2.2%), while they decreased slightly (1.2%) in the control group. Levels of geometric means of sTfR remained almost unchanged (0.7%) in the intervention group and slightly worsened (2.7%) in the control group. In both the groups, geometric mean of FER levels decreased, yet to a smaller extent in the intervention (17.3%) than in the control (26.0%) group.ConclusionEven though no significant effects of BFP could be detected in this study, the identification of products such as BFP remains pertinent to help improve non-heme iron absorption in the most vulnerable populations.

Highlights

In sub-Saharan Africa, anemia is widespread and associated with increased morbidity and mortality [1, 2], and impaired cognitive and behavioral development in children [3]
To include the required number of children, a cut-off for low Hb levels was set at 12.15 g/dl, i.e., 6% above the normal cut-off at 11.5 g/dl used in Kenyan schoolchildren otherwise
The diet was high in phytate and phenolic compounds, similar to the diet in the Baobab Nutrition Intervention Study, a higher vitamin C intakes predicted a lower risk of anemia [21]

Summary

Introduction

In sub-Saharan Africa, anemia is widespread and associated with increased morbidity and mortality [1, 2], and impaired cognitive and behavioral development in children [3]. Other drivers of anemia are parasitic infections (Plasmodium falciparum, helminths and schistosomiasis) [4] and hemoglobin disorders [7, 8]. The latest representative data in Kenyan children aged 6 months to 12 years show an anemia prevalence of 25% [9], which is classified as moderate public health problem [10]. A study on schistosomiasis and soil-transmitted helminths in Kenyan schoolchildren reported 61% with anemia [11]. Other studies representing regional differences reported prevalence of iron deficiency of 33%, 15% and 6.3% [5, 13, 14] and tissue iron deficiency from 20.3 to 70.4% [13]

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