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Home Fortification of Rice with Lime: a Novel Potential Way to Reduce Calcium Deficiency in Bangladesh

Nurun Nahar Naila, MBBS, MPH
Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh

Prasenjit Mondal, MBBS, MS
Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh

Sabri Bromage, ScD, MPH
Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA

M. Munirul Islam, MBBS, PhD
Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh

M. Mamun Huda, MSc
Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh

Mohammad Sohel Shomik, MBBS, MPH
Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh

Dinesh Mondal, MBBS, MD, PhD
Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh

Wafaie Fawzi, MBBS, MPH, MS, DrPH
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; 4Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA

Tahmeed Ahmed, MBBS, PhD
Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b),Dhaka, Bangladesh; 6James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh

Abstract/ Executive Summary:

Background: In order to improve calcium status, fortified rice should have acceptable organoleptic properties of that food. Objective:We aimed to assess whether home fortification of rice with slaked lime can increase calcium content of rice and whether this fortified rice is well tolerated in a nutritionally at-riskpopulation. Methods:This experimental study measured the calcium content of rice cooked with different concentration of lime and assessed the acceptability of fortified rice among 400 women and children. Each participant received fortified rice with one of five concentrations of lime (0, 2.5, 5, 7.5 or 10 gm per 500 gm of rice), with or without additional foods (lentil soup or fried green papaya). All participants were asked to score the organoleptic qualities on a hedonic scale. Results: Analysis showed that rice calcium content increased in a dose- response manner with increased lime during cooking (76.03, 205.58, 427.55, 614.29 and 811.23 mg/kg for given lime concentrations). Acceptability of the meal was greater when additional foods were served with rice at all lime concentrations. In both groups, the 7.5M arm reported highest overall acceptability (children,6.25; women 6.10). This study found significant association between overall acceptability (different concentrations of lime mixed rice; with/without additional foods) and between groups (women vs.children) (p value=< 0.001) where-as no association was found within groups.Conclusions: Lime-fortified rice can be feasible considering the calcium uptake of rice and organo-leptic character. Further research on bio-availability can establish a solid foundation that will support design of an effective intervention to reduce calcium deficiency in this population.

Keywords: Acceptability, Ca deficiency, Lime, Rice fortification, Bangladesh

Location: International Center for Diarrheal Disease Research, Bangladesh (icddr, b) in Dhaka

Start Date:

End Date:

Program Area: Quality and Nutrition

Commodity: Rice

Objectives:

To develop basic understanding of the potential for lime fortification of rice as an effective inter venation for increasing population calcium intake in Bangladesh, this study sought to (1) measure the calcium concentration of rice that has been fortified at different concentrations of slaked lime added to the cooking water and (2) test the organoleptic acceptability of rice fortified with slaked lime among high-risk target groups of women and children.

Methodology:

Fortification and Laboratory Analysis of Rice Five hundred gram samples of milled, parboiled Miniket rice (the most commonly consumed variety in Bangladesh) were washed and cooked in 750 mL water using a Teflon-coated electric rice cooker (NOVA RC-1501, Mumbai, India) at the International Center for Diarrheal Disease Research, Bangladesh (icddr, b) in Dhaka. To each uncooked 500 g rice sample, 0, 2.5, 5.0,7.5, or 10.0 g slaked lime was added, which had been collected in a single batch from a local market in the Cox’s Bazar District.Three samples of rice at each of the 5 fortification concentrations were prepared for analysis at the Nutrition Biochemistry laboratory of icddr,b. After cooking, the rice was homogenized with the addition of a minimal recorded amount of calcium-free water. An adequate amount of each sample was analyzed using atomic absorption photometry following standard procedures. Acceptability Trial of Lime-Fortified Rice: Study Population and Recruitment: Organoleptic acceptability of lime-fortified rice was assessed in the Bauniabadh section of Mirpur, a subdistrict of Dhaka. Bauniabadh was selected because its demographic characteristics and sanitary conditions are those of typical urban slum in which calcium-rich foods are generally less accessible and because the study investigators had ongoing research activities in the area. A convenience sample of 200 women of reproductive age (15-49 years) and 200 children (7-10 years) was drawn from a list of current Bauniabadh residents. To recruit women, the research team visited eligible participants’ house-holds, explained the purpose and methods of the study, and obtained consent. Pregnant women and habitual consumers of betel leaf with slaked lime were excluded from the study. Children were recruited from 2 primary schools randomly selected among 6 located in Bauniabadh. In each school, 7- to 10-year-old students were invited at random to participate, explained the purpose and methods of the study, and consenting students were recruited. During recruitment, basic socio-demographic information was collected from participants, while height and weight were measured on the day of the acceptability trial using an stadiometer (Seca 217, Chino, California) and digital bathroom scale (GS-150; Peachtree, Norcross,Georgia) following standard procedures. Acceptability Trial of Lime-Fortified Rice: Study Arms and Randomization Participants were randomly assigned to one of10 study arms in which they consumed a specific amount (100 or 50 g for women and children, respectively) of either plain rice or mixed rice (which included a side dish of80 g lentils and 70 g fried green papaya [FGP] for the women and 40 g lentils and 35 g FGP for the children, following typical Bangladeshi recipes) fortified with 1 of 5 concentrations of lime (0, 2.5,5, 7.5, or 10 g per 500 g uncooked rice). The mixed rice arms were included to evaluate whether added ingredients could mitigate potential effects of fortification on the acceptability of rice and because plain rice is rarely consumed in Bangladesh even among the poorest communities (lentil and papaya are commonly consumed and available year-round). Food samples were pre-pared freshly on the day of the acceptability trial following the procedure described previously. An initial weighed portion was provided to participants, after which additional portions were provided to those who requested them (additional portions were not weighed). Participants were assigned to study arms by a researcher external to the study team using permuted block randomization. Aside from those fortifying the rice samples, all participants and research team members were blinded to the level of slaked lime added to each sample. Acceptability Trial of Lime-Fortified Rice: Organoleptic Testing Participants were requested not to consume any solid food up to 2 hours prior to consumption of the test rice on the day of the acceptability trial.After feeding, each participant’s leftovers of their initial portion (if any) were measured using digital cooking scales (TANITA analog cooking scale 1439, Tokyo, Japan) to calculate their consumed mass. Participants were then interviewed by trained research assistants who assessed participants’ opinion of the food’s color, flavor, and mouth feel according to a 7-point hedonic scale:“dislike extremely,” “dislike very much,”“dislike,” “neither like or dislike,” “like,” “like very much,” or “like extremely,” which were scored 1, 2, 3, 4, 5, 6, or 7 points, respectively. Each participant’s 3 sub scores were summed to produce an overall acceptability score ranging from 3 to 21. Hedonic scales are the most widely used and validated approach for measuring food acceptability. Acceptability Trial of Lime-Fortified Rice:Sample Size Calculation The sample size for the acceptability trail was calculated in STATA using a non inferiority trial on the basis of a hedonic scale score. We assumed that 99%and 90%of the participants in both non fortified and fortified groups would rate the rice sample as satisfactory (mean overall liking score >4), respectively. The non inferiority limit was considered to be 10%, which means that a statistically significant difference may not be of interest unless the difference is greater than this threshold, 10%. Considering 80%power and 5%level of significance, we required the minimum number of 18 to 20 participants in each arm. We enrolled 20 participants in each arm to increase the power of the study. In this trial, we tested acceptability in 2 groups of equal size, where one group consumed fortified rice, and the other groups were provided with rice along with lentil soup and FGP. In this study, there were 10 different groups (arms) in both children and women samples. Therefore, in total, we required and enrolled 200 children and 200 women to conduct the acceptability trial. Statistical Analysis Data were validated using logical and range checks, and descriptive statistics were tabulated. The relationship between added and analyzed calcium concentration of plain and mixed rice at different fortification levels was analyzed graphically. Mean acceptability score and sub scores across study arms were compared using one-way analysis of variance.

Source of Information: Food and Nutrition Bulletin 2019, Vol. 40(3) 357-368

Article Link (Online Journal): DOI: 10.1177/0379572119845573

Funding Source:

Budget:

Total Budget (Tk.) :

Achievement/Findings:

Our study supports the conclusion that the scale-up of lime-fortified rice in Bangladesh is feasible and potentially effective considering the intervention’s demonstrated acceptability and organoleptic character and ability to increase rice calcium concentrations. These results support further research into the bio availability, clinical effectiveness, and cost-effectiveness of this intervention in the population of Bangladesh.

Knowledge Management: Journal