Complementary Food Supplement Research Articles

Ying Yang Bao: Improving Complementary Feeding for Chinese Infants in Poor Regions.

Ying Yang Bao (YYB), a complementary food supplement, has helped to rapidly improve the nutrition status of infants and young children in poor rural regions in China. The first YYB study was performed in 2001 by the International Life Sciences Institute, the Chinese Centers for Disease Control and Prevention, and Nestlé. In 2008, the establishment of national standards for complementary food supplements stimulated implementation of about 15 nutrition intervention projects in poor rural counties in which YYB was applied to infants and young children as home fortification for complementary feeding. Data were accumulated in different studies and showed that YYB enhanced the growth of infants with respect to both anthropometry and cognition, and decreased anemia prevalence significantly in infants aged 6-24 months. The Chinese government has launched a project named Improving Children's Nutrition in Poor Rural Regions in 2012. The project has covered more than 4 million infants aged 6-24 months in 341 counties in 21 provinces in western and middle regions by the end of 2015. This nutrition intervention in early life is rather an opportunity for a better later life. The YYB program in China might present an example for developing countries aiming to improve nutrition in early life.

Effect of complementary food supplementation on breastfeeding and home diet in rural Bangladeshi children

Background: Complementary food supplements (CFSs) can enhance growth where stunting is common, but substitution for the usual diet may reduce observed benefits.Objective: We aimed to characterize dietary diversity from home foods in a CFS efficacy trial and determine whether supplementation reduced breastfeeding frequency or displaced home foods.Design: In a cluster-randomized controlled trial in rural Bangladesh, children (n = 5499) received, for 1 y starting at age 6 mo, periodic child feeding counseling for mothers (control) or counseling plus 1 of 4 CFSs fed as a daily snack. Breastfeeding status and past 24-h diet were assessed at enrollment and every 3 mo thereafter until 18 mo of age. A 7–food group dietary diversity score (DDS) was calculated from home foods only, and a DDS ≥4 constituted minimum dietary diversity (MDD).Results: Most children (97%) were breastfed through 18 mo of age, and 24-h breastfeeding frequency did not differ by supplementation group. Child dietary diversity was low; only 51% of children met the MDD by 18 mo. Rice, potatoes, and biscuits (cookies) were the most frequently consumed foods, whereas the legumes, dairy, eggs, and vitamin A–rich fruit and vegetable food groups were each consumed by <50% of children. The odds of meeting the MDD through the consumption of home foods were equal or greater in the supplemented groups compared with the control group at all ages. High socioeconomic status and any maternal education were associated with increased odds of MDD at age 18 mo, whereas child sex and household food security were not associated with MDD.Conclusions: In a setting where daily complementary food supplementation improved linear growth, there was no evidence that supplementation displaced breastfeeding or home foods, and the supplementation may have improved dietary diversity. Pathways by which supplementation with fortified foods may enhance dietary diversity, such as an improved appetite and increased body size, need elucidation. This trial was registered at clinicaltrials.gov as NCT01562379.

Assessing Program Coverage of Two Approaches to Distributing a Complementary Feeding Supplement to Infants and Young Children in Ghana

The work reported here assesses the coverage achieved by two sales-based approaches to distributing a complementary food supplement (KOKO Plus™) to infants and young children in Ghana. Delivery Model 1 was conducted in the Northern Region of Ghana and used a mixture of health extension workers (delivering behavior change communications and demand creation activities at primary healthcare centers and in the community) and petty traders recruited from among beneficiaries of a local microfinance initiative (responsible for the sale of the complementary food supplement at market stalls and house to house). Delivery Model 2 was conducted in the Eastern Region of Ghana and used a market-based approach, with the product being sold through micro-retail routes (i.e., small shops and roadside stalls) in three districts supported by behavior change communications and demand creation activities led by a local social marketing company. Both delivery models were implemented sub-nationally as 1-year pilot programs, with the aim of informing the design of a scaled-up program. A series of cross-sectional coverage surveys was implemented in each program area. Results from these surveys show that Delivery Model 1 was successful in achieving and sustaining high (i.e., 86%) effective coverage (i.e., the child had been given the product at least once in the previous 7 days) during implementation. Effective coverage fell to 62% within 3 months of the behavior change communications and demand creation activities stopping. Delivery Model 2 was successful in raising awareness of the product (i.e., 90% message coverage), but effective coverage was low (i.e., 9.4%). Future programming efforts should use the health extension / microfinance / petty trader approach in rural settings and consider adapting this approach for use in urban and peri-urban settings. Ongoing behavior change communications and demand creation activities is likely to be essential to the continued success of such programming.

Low Circulating Amino Acids and Protein Quality: An Interesting Piece in the Puzzle of Early Childhood Stunting

Low Circulating Amino Acids and Protein Quality: An Interesting Piece in the Puzzle of Early Childhood Stunting

Non‐Responsive Feeding Behaviors are Negatively Associated with Growth and Dietary Diversity at 24 months in Rural Bangladesh

This study examined the relations between maternal feeding behaviors (responsive and nonresponsive) and children's nutritional status at 24 months of age in rural Bangladesh where child undernutrition is high. Data were collected on 4846 mother‐child dyads enrolled in a complementary food supplementation trial. Anthropometry (weight, length) and child diet (24‐h recall) were collected. A context‐specific 11‐item feeding behaviors module was developed; factor analysis revealed 2 theoretically derived constructs of feeding: responsive (5 items) and forceful (6 items). Each was dichotomized to reflect low and high feeding behaviors, with approximately 2/3 of the sample reporting optimal feeding behaviors for both constructs (high responsive [70%], low forceful [66%]). In addition, a 2×2 factorial variable was created using the dichotomized constructs to produce 4 categories: 1) high responsive/low forceful; 2) high responsive/high forceful; 3) low responsive/high forceful; and 4) low responsive/low forceful. Dietary diversity score (DDS; range 0–7) was derived using the diet recall data and was used to define minimum dietary diversity (MDD; score of 4 or more). Relations were examined using multivariate linear/logistic regression models, adjusting for confounders, intervention status, and study design. Responsive feeding was positively associated with DDS and meeting MDD (β: 0.09, 95% CI: 0.01, 0.17; OR: 1.2, 95% CI: 1.03, 1.3, respectively). No significant relations were seen with growth outcomes (p&gt;0.05). Conversely, forceful feeding was negatively associated with WAZ, WLZ, and DDS (β: −0.16, 95% CI: −0.22, −0.11; β: −0.19, 95% CI: −0.25, −0.14; β: −0.12, 95% CI: −0.20, −0.03, respectively) and positively with wasting, underweight, and meeting MDD (OR: 1.38, 95% CI: 1.22, 1.56; OR: 1.55, 95% CI: 1.33, 1.81; OR: 0.82, 95% CI: 0.72, 0.94, respectively). No relationship was seen with LAZ or stunting (p&gt;0.05). Using the 2×2 factorial variable, we found that as compared to children of mothers who reported optimal feeding (combination of high responsive and low forceful behaviors), children of mothers who reported using a combination of high force and low responsivity had lower WAZ (β: −0.18, 95% CI: −0.28, −0.09), WLZ (β: −0.24, 95% CI: −0.33, −0.15), and DDS (β: −0.19, 95% CI: −0.32, −0.06), and were more likely to be wasted (OR: 1.62, 95% CI: 1.28, 2.04), underweight (OR: 1.38, 95% CI: 1.14, 1.68) and less likely to achieve MDD (OR: 0.73, 95% CI: 0.71, 0.98). In the same way, children of mothers who reported using both high force and high responsivity had lower LAZ (β: −0.07, 95% CI: −0.14, −0.004), WAZ (β: −0.16, 95% CI: −0.25, −0.09), WLZ (β: −0.16, 95% CI: −0.23, −0.10), and DDS (β: −0.12, 95% CI: −0.22, −0.01) and were more likely to be wasted (OR: 1.43, 95% CI: 1.18, 1.73), underweight (OR: 1.36, 95% CI: 1.16, 1.59) and less likely to achieve MDD (OR: 0.82, 95% CI: 0.70, 0.96). Children of mothers who reported using a combination of low force and low responsivity had lower LAZ (β: −0.08, 95% CI: −0.16, −0.01) and were less likely to meet MDD (OR: 0.84, 95% CI: 0.71, 0.98). Non‐significant relations are not presented. Findings suggest that even in the context of high undernutrition, non‐responsive feeding behaviors (especially forceful) are associated with poor growth and dietary diversity among young children. Future longitudinal research is needed to better understand causality and test the efficacy of responsive feeding interventions on the promotion of child growth and diet.Support or Funding InformationFunded by USDA, NIFA, the Johns Hopkins Center for Global Health, the Bill and Melinda Gates Foundation, and the Johns Hopkins Sight and Life Global Nutrition Research Institute.

Chronic Fatigue Syndrome (CFS) or “Systemic Immune Disorder” (SID)?

It is the opinion of the authors that the disease called chronic fatigue syndrome (CFS), or fibromyalgia, or myalgic encephalomyelitis, is primarily due to a disorder of the immune system and should rather be called “systemic immune disorder”. This disorder probably results from external factors such as inadequate stress adaptation, or a (retro)-viral infection deregulating the function of the memory T-lymphocytes in persons who are predisposed because of genetic or epigenetic alterations. Chronic inflammation with overproduction of cytokines, reactive oxygen and nitrogen species causes mitochondrial dysfunction with metabolic disturbance resulting in muscular and cerebral signs and symptoms. The reference treatment consisting of cognitive behavioural therapy (CBT) and graded exercising (GET) considers CFS to be a somatoform disease, but was proven ineffective. Causal therapy should be directed toward restoring T-cell function and is now under assessment. Organ-directed treatment aims at improving stress tolerance, at reducing inflammation and oxidative stress, and at optimizing mitochondrial function by means of nutriceutical food supplementation. Symptomatic treatment uses antidepressants, sedatives and pain killers. Experimental treatments interfere with the immune system or attempt to activate brain metabolism, and need further assessment. Adverse effects of long-term medication must be avoided. In the opinion of the authors an acceptable therapeutic result can commonly be attained by combining meditation, such as mindfulness, adaptation of lifestyle and nutrition, with complementary food supplementation using nutriceuticals and plant extracts.

Critical Dietary Habits in Early Childhood: Principles and Practice.

The adequacy of a diet is usually evaluated based on nutrient intake. As people eat foods but not nutrients, food-based dietary guidelines (FBDG) are needed. To evaluate dietary habits in infants and young children, the following stepwise approach is suggested: (1) develop country-specific FBDG to identify the potential of common nonfortified foods to ensure adequate nutrient intake and (2) examine potential 'critical' dietary patterns if main food groups are excluded, such as in vegetarian diets or if a family's precarious social status leads to food constraints. The German FBDG for infant and child nutrition demonstrate that a well-designed mixture of common foods results in an adequate supply of nutrients, except for vitamin D, iodine and iron. The following solutions are feasible to address deficiencies in these critical nutrients: routine supplementation (vitamin D), fortified complementary food consumption or supplementation for infants as well as inclusion of table salt in the family diet for children (iodine), and individual pediatric care for infants at risk (iron). In the exclusion of food groups of animal origin from vegetarian diets, several nutrients are at risk of becoming deficient if not substituted. Existing studies characterizing vegetarian children are rare. These were mainly published in the 1980s and 1990s and were biased towards a high social status. Thus, firm conclusions on today's dietary practices and health statuses of European vegetarian children cannot be drawn. A social gradient exists for food patterns and dietary quality in children, but energy intake need not necessarily be affected. Scenarios in Germany suggest that families on unemployment assistance can afford to eat a diet compliant with German FBDG only if they restrict food selection to basic food. Yet, the question of how families cope with financial constraints in everyday life remains. In conclusion, well-designed FBDG provide various opportunities to identify critical nutrients and critical food habits in early childhood and beyond.

Effect of fortified complementary food supplementation on child growth in rural Bangladesh: a cluster-randomized trial.

Background: Growth faltering in the first 2 years of life is high in South Asia where prevalence of stunting is estimated at 40–50%. Although nutrition counselling has shown modest benefits, few intervention trials of food supplementation exist showing improvements in growth and prevention of stunting.Methods: A cluster-randomized controlled trial was conducted in rural Bangladesh to test the effect of two local, ready-to-use foods (chickpea and rice-lentil based) and a fortified blended food (wheat-soy-blend++, WSB++) compared with Plumpy’doz, all with nutrition counselling vs nutrition counselling alone (control) on outcomes of linear growth (length and length-for-age z-score, LAZ), stunting (LAZ < −2), weight-for-length z-score (WLZ) and wasting (WLZ < −2) in children 6–18 months of age. Children (n = 5536) were enrolled at 6 months of age and, in the food groups, provided with one of the allocated supplements daily for a year.Results: Growth deceleration occurred from 6 to 18 months of age but deceleration in LAZ was lower (by 0.02–0.04/month) in the Plumpy’doz (P = 0.02), rice-lentil (< 0.01), and chickpea (< 0.01) groups relative to control, whereas WLZ decline was lower only in Plumpy’doz and chickpea groups. WSB++ did not impact on these outcomes. The prevalence of stunting was 44% at 18 months in the control group, but lower by 5–6% (P ≤ 0.01) in those receiving Plumpy’doz and chickpea. Mean length and LAZ at 18 months were higher by 0.27–0.30 cm and 0.07–0.10 (all P < 0.05), respectively, in all four food groups relative to the control.Conclusions: In rural Bangladesh, small amounts of daily fortified complementary foods, provided for a year in addition to nutrition counselling, modestly increased linear growth and reduced stunting at 18 months of age.

Improving complementary feeding in Ghana: reaching the vulnerable through innovative business--the case of KOKO Plus.

Reaching vulnerable populations in low-resource settings with effective business solutions is critical, given the global nature of food and nutrition security. Over a third of deaths of children under 5 years of age are directly or indirectly caused by undernutrition. The Lancet series on malnutrition (2013) estimates that over 220,000 lives of children under 5 years of age can be saved through the implementation of an infant and young child feeding and care package. A unique project being undertaken in Ghana aims to bring in two elements of innovation in infant and young child feeding. The first involves a public-private partnership (PPP) to develop and test the efficacy and effectiveness of the delivery of a low-cost complementary food supplement in Ghana called KOKO Plus™. The second involves the testing of the concepts of social entrepreneurship and social business models in the distribution and delivery of the product. This paper shares information on the ongoing activities in the testing of concepts of PPPs, social business, social marketing, and demand creation using different delivery platforms to achieve optimal nutrition in Ghanaian infants and young children in the first 2 years of life. It also focuses on outlining the concept of using PPP and base-of-the-pyramid approaches toward achieving nutrition objectives.

Preferred Delivery Method and Acceptability of Wheat-Soy Blend (WSB++) as a Daily Complementary Food Supplement in Northwest Bangladesh

Fortified blended foods (FBFs) are widely used to prevent undernutrition in early childhood in food-insecure settings. We field tested enhanced Wheat Soy Blend (WSB++)—a FBF fortified with micronutrients, milk powder, sugar, and oil—in preparation for a complementary food supplement (CFS) trial in rural northwestern Bangladesh. Formative work was conducted to determine the optimal delivery method (cooked vs. not) for this CFS, to examine mothers’ child feeding practices with and acceptance of the WSB++, and to identify potential barriers to adherence. Our results suggest WSB++ is an acceptable CFS in rural Bangladesh and the requirement for mothers to cook WSB++ at home is unlikely to be a barrier to its daily use as a CFS in this population.

Coverage of a market‐based approach to deliver a complementary food supplement to infants and children in three districts in Eastern Ghana: use of the simple spatial survey method (S3M) (255.5)

The current project aims to deliver a complementary food supplement (Koko Plus) to infants and young children in three districts in Eastern Ghana. We completed a spatially representative survey, using the Simple Spatial Survey Method (S3M) design, two months into the project with the aim of assessing coverage and barriers to coverage early in the program cycle. The S3M approach allowed for fine scale geographical coverage maps and wide-area population-level estimates to be produced. The data presented here are from an S3M sample with d = 8km (i.e. no person lived more than 8 km from a sampling point). A variable geometry sample design was used. This allowed a mixed urban, peri-urban, and rural sample to be taken with a spatial resolution that matched population density. The sample was taken from m = 58 PSUs spread over three administrative districts. The data reported are for n = 971 mother / child pairs in the sample (n = 671 in the 6 - 24 month target group for consumption of the supplement). Overall 64% (95% CI, 58 - 71%), 23% (95% CI, 19 - 27%), and 15% (95% CI, 12% - 19%) of the target group had ever heard of the supplement, ever used the supplement, and used the supplement at least once in the week prior to the survey respectively. These indicators are mapped in Figure 1. The two main reasons for non-consumption in the target group were caregivers' lack of awareness of the product (61%), and perceived lack of need for the product (14%). These results were reported back to the program within two weeks of survey completion to provide a quick feedback loop to guide programming efforts. Grant Funding Source: Study sponsor: USAID

Formative study on the acceptance of Wheat Soy Blend Plus Plus (WSB++) as a daily complementary food supplement (CFS) in rural Bangladesh

During a preparatory phase of a CFS feeding trial in rural NW Bangladesh, we field tested WSB++, an enhanced fortified blended food, using formative research methods to examine its acceptance by mothers and children and potential barriers to its use. Mothers (n = 44) living in the (JiVitA) study area with a child aged 6 to 18 months received pre‐cooked or uncooked WSB++ for 10 to 12 days. Acceptability and amount of WSB++ consumed were assessed through observation, interview and focus group discussion. Mothers liked feeding the WSB++ and found it as easy or easier to prepare as traditional complementary foods, but many added sugar or other spices to “improve the flavor”. Compliance (child consumed &gt;;75% of the daily portion) was highest (100%) among mothers who cooked WSB++ at home with daily field worker visits, compared to those who prepared WSB++ without worker visits (63%) or who received pre‐cooked WSB++ (55%). Child illness was the main reason given for lower intake. Mothers reported reduced consumption of other complementary foods during WSB++ distribution compared to before, especially when the CFS was offered at usual mealtimes. Although diet replacement is a potential challenge for effective CFS use, mothers’ willingness to cook and feed WSB++, especially with some encouragement, suggests it is an acceptable CFS to use in rural Bangladesh.Grant Funding Source: USDA (FANEP, NIFA), USA; WFP, Italy; DSM, Switzerland

Beneficial effect of food supplementation with the nutriceutical Improve® for the treatment of infertile couple

To assess the possible benefit of food supplementation with the nutriceutical Improve® for the treatment of the infertile couple. The treatment of diseases causing male or female infertility should be completed by the prescription of a judiciously formulated composite nutriceutical (Improve® Nutriphyt Inc, Oostkamp, Belgium) which counteracts the pathogenic mechanisms involved in sperm and oocyte dysfunction, enhances cellular energy production, corrects oxidation-induced damage to the cell membrane and to DNA, and repairs mitochondrial insufficiency. The efficiency of this nutraceutical was tested in controlled trials and in assisted reproduction, including 1 888 infertile couples. Complementary food supplementation with the nutriceutical Improve® plus linseed oil improved the quantity and functional quality of spermatozoa, significantly increasing their fertilizing potential. This supplement with added fish oil enhanced female fertility with higher probablity of natural conception and ongoing pregnancy using techniques of assisted reproduction. Complementary food supplementation with the nutriceutical Improve® has significant beneficial effects for the treatment of the infertile couple and reduces the cost per delivery.

Comparing the effectiveness of infertility treatments by numbers needed to treat (NNT)

To compare the clinical efficiency of different modes of treatment of infertile couples and to estimate the possible benefit of nutraceutical food supplementation (NFS), the numbers needed to treat (NNT) was calculated in 4143 infertile couples based on controlled trials in recent literature and personal data. The NNT expresses the number of individuals who need to be treated to obtain one complementary pregnancy. In female infertility, the NNT of mild or moderate endometriosis was 8.4, and in anti-estrogens treatment of anovulation, it was 5.9. In tamoxifen treatment of idiopathic oligozoospermia, NNT was 3.9, and in antioxidant supplementation, it was 7.8. Treatment of varicocele yielded NNT of 6.3 and 6.8 after 1year in multi- or single-centre trials, respectively, and NFS lowered the NNT after 3months to 2.6. Adding NFS to the male partner increased the ongoing pregnancy rate by IVF with NNT of 8.3, and adding NFS to both partners reduced the NNT to 4.0. Although these results were obtained in heterogeneous trials and populations, it is suggested that the NNT should be useful for comparing the effectiveness of different modes of treatment of the infertile couple, and that complementary nutraceutical food supplementation may be beneficial.

Implementation of a programme to market a complementary food supplement (Ying Yang Bao) and impacts on anaemia and feeding practices in Shanxi, China

In China, a full fat soy powder mixed with multiple micronutrient powders (Ying Yang Bao (YYB)) was developed, and the efficacy of YYB was shown in controlling anaemia and improving child growth and development. However, prior to 2008, there was no sustainable way to provide YYB to vulnerable populations, except through free distribution by the government. This study was to test the concept of public-private partnership (PPP) to deliver YYB and to evaluate the effectiveness of marketing YYB through PPP. Programme activities included development of a complementary food supplement (CFS) national standard, product concept test, product development and marketing, behavior change communication, monitoring and evaluation. Baseline and end-line surveys were used to evaluate product awareness, purchasing and the impacts of the project on anaemia and feeding practices. A Chinese CFS standard was approved. Caregivers and their 6- to-24-month-old children participated in the baseline (n=226) and the end-line survey (n=221). A concept test at the baseline survey showed that 78% of caregivers were willing to buy YYB at 0.1 USD. After developing the product and implementing the intervention for 8 months, 59.6% of surveyed caregivers purchased YYB. While not significant, the prevalence of anaemia was marginally lower at the end line (28.8%) than at the baseline (36.2%). For those purchasing YYB, the risk of anaemia was significantly reduced by 87% of odds (P<0.009). The end-line survey found that feeding practices had improved significantly following the intervention. An enabling policy and regulatory environment in which CFSs are defined and parameters for appropriate marketing are identified as a prerequisite for marketing YYB or other nutritious CFS. Public and private advocacy and marketing could successfully increase awareness of YYB and access and use through market channels. The YYB project may be effective for reducing anaemia and improving feeding practices.

The Potential of Encapsulated Iron Compounds in Food Fortification: A Review

Iron (Fe) encapsulation has the potential to help overcome several major challenges in Fe fortification of foods. It may decrease unwanted sensory changes in fortified products and reduce interactions of Fe with food components that lower Fe bioavailability. However, the effect of encapsulation per se on Fe bioavailability is a concern. Rat studies comparing encapsulated ferrous sulfate, ferric ammonium citrate, and ferrous fumarate to non-encapsulated compounds indicate that a ratio of capsule:substrate of > or = 60:40 may decrease the relative bioavailability (RBV) of the Fe by approximately 20%. At a ratio of capsule:substrate of < or = 50:50, the RBV of encapsulated ferrous sulfate appears to be similar to ferrous sulfate. Even minor changes in capsule composition may influence Fe bioavailability. Encapsulated ferrous fumarate given with ascorbic acid as a complementary food supplement and encapsulated ferrous sulfate fortified into salt have been shown to be efficacious in anemic children. For salt fortification, further refinements in Fe capsule design are needed to increase resistance to moisture and abrasion, while maintaining bioavailability. Studies evaluating the potential efficacy of encapsulated Fe in staple cereals (wheat and maize flours) are needed. A potential barrier to use of encapsulated forms of Fe in staple food fortification is the relatively low melting point of the capsules, which may cause unwanted sensory changes during food preparation. Research and development efforts to improve the quality of coatings and their resistance to high temperatures are ongoing. Process costs for encapsulation can be high, and unless they can be reduced, may limit applications. Further research is needed to determine which encapsulation technologies are most effective in ensuring iron bioavailability from encapsulated compounds.

The role of food supplements in the treatment of the infertile man

Recently, concerns have been raised about the presumptive increased risk of serious undesirable side effects in children born after IVF and intracytoplasmic sperm injection (ICSI). These treatments must, therefore, be reserved as the ultimate option after evidence-based and cause-directed treatment of the male patient with deficient semen has been exhausted. The present authors found that sperm quality and function improved with the intake of complementary food supplementation using a combination of zinc and folic acid, or the antioxidant astaxanthin (Astacarox®), or an energy-providing combination containing (actyl)-carnitine (Proxeed®). Also, double blind trials showed that the latter two substances increase spontaneous or intrauterine insemination- (IUI-) assisted conception rates. Extracts of Pinus maritima bark (Pycnogenol®), which inhibits the cyclo-oxygenase enzyme, reducing prostaglandin production and inflammatory reaction, and extracts of the Peruvian plant Lepidium meyenii were shown to improve sperm morphology and concentration, respectively, in uncontrolled trials. Linseed (flaxseed) oil contains alfa-linolenic acid and lignans. The former corrects the deficient intake of omega-3 essential fatty acids, which is correlated with impaired sperm motility among subfertile men. Lignans are precursors of enterolacton, which inhibits aromatase and reduces the ratio of 16-OH over 2-OH oestrogen metabolites. The resulting reduction in oestrogen load may favourably influence Sertoli cell function.