Effect of Traditional Complementary Porridges Enriched with Cashew Kernel (Anacardium occidental) and Vegetable Cortea (Corchorus olitorius L.) on the Nutritional Protein Profile and Inflammatory Status of Moderately Acutely Malnourished Children in Côte d’Ivoire

  

    
 
    

    
 
    
Rehabilitation porridges compared 2 to 2 
  
  

    
Biological    parameters
    
Evolution between

      D0 and D30
    
BC1– BC2
    
BC1    - BC3
    
BC1    - BC4
    
BC2    - BC3
    
BC2    - BC4
    
BC3    - BC4
  
  

    
Nutritional proteins 
    
Albumin
    
Increase 
    
BC2
    
BC3
    
BC4
    
NS
    
NS
    
NS
  
  

    
Pre albumin
    
Decrease 
    
BC1
    
NS
    
NS
    
BC3
    
BC4
    
NS
  
  

    
Transferrin
    
Increase 
    
BC2
    
BC3
    
BC4
    
NS
    
BC4
    
BC4
  
  

    
Ferritin
    
Increase 
    
BC2
    
BC3
    
BC4
    
NS
    
NS
    
NS
  
  

    
 
    
 
    
 
    
BC2***
    
BC3***
    
BC4***
    
BC3*
    
BC4**
    
BC4*
  
  

    
Inflammatory    proteins
    
Orosomucoid
    
Decline 
    
BC2
    
BC3
    
BC4
    
BC3
    
BC4
    
NS
  
  

    
C-Reactive Protein
    
Decline 
    
BC2
    
BC3
    
BC4
    
NS
    
BC4
    
BC4
  
  

    
 
    
 
    
 
    
BC2**
    
BC3**
    
BC4**
    
BC3*
    
BC4**
    
BC4*
  
  

    
 
    
PINI Index
    
Decline
    
NS
    
BC3 
    
BC4 
    
BC3 
    
BC4 
    
NS
  
  

    
 
    

    
 
    
BC2*****
    
BC3******
    
BC4******
    
BC3***
    
BC4*****
    
BC4**
  
  

    
The NS sign indicates that there    is no significant difference between the effects of the two types of porridge    according to the Wilcoxon-Mann-Whitney test at the 5% level. The letter BC    with a number indicates the type of porridge having a more significant effect    (P <0.05) for a given parameter. The letter BC with numbers and stars (*)    at the bottom of each column indicates the most effective porridge taking    into account all the nutritional parameters. The stars indicate the number of    parameters with a more significant effect. 
  

Table 2: Comparison of the effect of fortified porridge consumed by moderately acutely malnourished children on nutritional and inflammatory proteins.

Discussion

This study showed that diet had a significant influence on the variation of the nutritional and inflammatory protein profile during the nutritional rehabilitation of moderately malnourished young children [10]. Regarding nutritional proteins, on D0, serum albumin levels were close to the required minimum and those of pre-albumin below the reference value in all MAMs. This suggests early undernutrition in all children. This early malnutrition would reflect a protein-energy deficiency [17,18] due to insufficient or unbalanced food intake. After 30 days of nutritional rehabilitation, serum albumin was significantly increased in all children. This intake of albumin could be of dietary origin either directly in the form of phytonutrients (vegetable albumin, carotenoid) or under the action of micronutrients contained in the diet [9]. For transferrin, the study showed that 75% of the children (G1-BC1, G3-BC3, G4-BC4) had transferrinemia in the range of normal values at the beginning of the study, but all (100%), had serum ferritin below the reference range. This suggests a deficit of iron stores in these children which would be the consequence of iron deficiency. This negative iron balance at this stage occurs when the intestinal absorption of iron is insufficient to meet the body’s needs. This induces a mobilization of iron reserves stored in the form of ferritin. Indeed, ferric iron (fe3+) associated with ferritin in enterocytes is transported in the form of ferrous iron (Fe2+) in the plasma via an export protein, ferroportin; ferrous iron (Fe2+) is then oxidized to ferric iron (Fe3+) by hephaestin (a ferroxidase). Finally, ferric iron rebinds to blood transferrin, which transports it to different sites in the body to meet needs [17,19,21]. This drop in ferritin observed at beginning of the study in 75% of children is accompanied by an abnormally high level of orosomucoid or a1-GPA (inflammatory protein). It can be said that this early malnutrition is accompanied by inflammation in these children [9]. The appearance of the inflammatory process observed in 75% of MAM children at the beginning of the study clearly shows that malnutrition is accompanied by inflammation, as indicated by the work of Yapi [11] and Money [21]. Indeed, the inflammatory process is triggered with the secretion of interleukin 1 following a drop in serum albumin [22,23]. These results once again confirm the usefulness of blood assays for markers of nutritional and inflammatory status during the moderate phase of malnutrition. In an infectious environment, these tests make it possible to detect protein energy malnutrition at an early stage in order to prevent serious forms, the negative consequences of which on the cognitive development of children and the appearance of chronic diseases in adulthood are widely documented [24]. The inflammatory and nutritional prognostic index between 1 and 10 at the start of the study shows that the inflammatory and nutritional risks are still low [25,26]. After 30 days of nutritional rehabilitation, the study indicated a significant increase in nutritional proteins and a significant decrease in inflammatory proteins in all children except in the children in the control group where prealbumin remained below the minimum required value. This suggests that the children in the control group are still mildly malnourished but without inflammation despite porridge consumption (BC1). The disappearance of the inflammatory process observed in the children of the G₁-BC₁, G₂- BC₂ and G₃-BC₃ groups could be explained by the significant increase in albumin which, by induced effect, led to a significant drop in the proteins of the inflammation (C-reactive protein and orosomucoid). To better understand this mechanism, it is important to specify that the biosynthesis of inflammatory proteins is carried out under the action of cytokines of the inflammatory reaction (TNF a, interleukin 1 and interleukin 6) produced by phagocytic cells. These cytokines are metabolic messengers emitted by the inflammatory focus to hepatocytes [27]. At the level of activated hepatocytes, there will be an increased production of inflammatory reaction proteins, including C-reactive protein and orosomucoid, which will mobilize the body’s immune defenses. On the other hand, cytokines (IL1 and TNF a) have a negative effect on albumin synthesis [28]. In response to the inflammatory process, the clinical signs such as pain, redness, heat and swelling appear. Several studies have shown that inflammation leads to a decrease in the synthesis of nutritional proteins, in particular albumin, but an increase in the synthesis of inflammatory proteins by hepatocytes [10,29]. Indeed, other studies have shown that in a cancer patient, serum albumin remains low until the inflammation is resolved, even if nutritional support is put in place [30]. The beneficial effect of nutritional supplementation leading to an end of the inflammatory process is marked by the increase in albumin and the significant decrease in CRP and the drop in orosomucoid. The improvement in the serum level of these proteins would be due to the dietary intake of porridge with type I nutrients (iron, vitamin A, B2, B9, E) and especially type II nutrients (zinc, phosphorus, Essential Amino Acid (EAA), Essential Fatty Acid (AGE)) and antioxidant compounds [1,8]. Indeed, type II nutrients are tissue-building nutrients and are required for almost all biochemical pathways and contribute to the development of skeletal tissues [1]. As for type I nutrients, they contribute to the development of functional tissues. All these nutrients contribute to the rapid renewal of cells with a short lifespan, in particular the enterocytes of the intestine, immune and inflammatory cells. Their deficiencies can therefore lead to poor absorption and dysfunction of the immune system [1].

The study found more significant variation in inflammatory proteins in children in the G₃-BC₃ and G₄-BC₄ groups. This phenomenon can be explained by the content of these porridges in leaves of vegetable cortea(Corchorus olitorius) and cashew kernel (Anacardium Occidental). Indeed, several studies have shown that the leaves of Corchorus olitorius have anti-inflammatory, antibacterial and antifungal properties [31,32]. In traditional medicine, these leaves are used to treat gonorrhea, pain and fever [32]. Other studies have shown that the aqueous extracts of these leaves have high antioxidant properties [34] and are used to prevent anemia [35,36]. As for the cashew kernel (Anacardium Occidental), a resent study has shown that it neutralizes oxidative stress and tissue inflammation [37]. In addition, the study showed that it causes a significant increase in ferritin and transferrin in the blood within the limits of normal values with normal serum levels of inflammatory proteins (CRP and a1-GPA) in MAMs. supplemented. These results could be explained by the absorption of dietary iron in the intestine and its increasing use by the body of young MAM children in an increased phase of renewal of deficient tissues [38]. Indeed, the iron ingested in the diet comes in two forms (heme and non-heme). In the case of the study, non-heme iron in the ferric state (Fe 3+) in the duodenum is first reduced to ferrous iron (Fe 2+) at the level of the apical membrane of the enterocytes, and then is transported inside enterocytes thanks to a divalent metal transporter. Once in the enterocyte, part can be stored in ferritin and the other transported in the plasma by a ferroportin in the form of ferrous iron (Fe 2+). In the plasma, this ferrous iron is oxidized to ferric iron (Fe 2+) by hephaestin. Finally, ferric iron (Fe 2+) binds to transferrin to be transported to different sites in the body to meet needs. In case of excess iron, the synthesis of ferritin is activated to store iron and the synthesis of transferrin is inhibited. The opposite happens with iron deficiency. Senescent enterocytes are destroyed by macrophages releasing ferritin. Plasma ferritin can come from the cells of damaged cells [17,19]. In view of the foregoing, it could be said that the dietary intake of iron contained in porridge has improved the iron status of children. In addition, the levels of vitamin B2 contained in enriched porridge [8] would allow greater availability of iron stored in the form of ferritin, which would help to potentiate the immune system, the synthesis of red blood cells and to create the conditions for harmonious growth of young children. By consuming these enriched porridges, we would help to fight against anemia in Ivorian children because more than 75% are anemic with 80% of anemia of iron deficiency [4]. The significant drop in the PINI index below 1 after consumption of enriched porridge clearly shows an improvement in the nutritional status and health of MAM children. It can therefore be said that the consumption of enriched porridge improved the nutritional and inflammatory status of MAMs, thus confirming the relationship between malnutrition and the inflammatory state [39]. Another study by Youan (2018) [18] showed a significant evolution of nutritional proteins following MAM supplementation using porridge enriched with legumes and green algae (spirulina).

Concerning the effect of porridges on the biological parameters of malnutrition, the statistical results indicated that the enriched porridges had a more significant effect in the positive variation of nutritional proteins than the control porridge. Among the enriched porridges, the BC4 porridge enriched with both cashew kernels and Corchorus olitorius leaves would be the most effective according to statistical tests. Then comes the BC3 porridge. Indeed, these two porridges are the richest in micronutrients [8]. These statistical tests also indicate that the BC₄ and BC₃ porridges have a more beneficial effect in reducing inflammation at the MAM level. These results can be explained by the nutritional, anti-inflammatory and antioxidant properties acquired by the porridges following their enrichment with cashew kernels and Corchorus olitorius leaves [1,8,32,33].

Conclusion

This study showed that the enrichment of traditional porridge supplements from local ingredients such as cashew kernel (Anacardium Occidental) and dried leaves of Corchorus olitorius has a beneficial effect on the variation of nutritional proteins and inflammatory conditions, and improved iron stores in the MAM children’s bodies. This improvement in the nutritional status and the reduction in the risk of infection of young MAM children would be due to the richness of porridge in type I nutrients (Vitamin B2, B9, iron) and II (zinc, AAE, phosphorus), and probably to the antioxidant, antibacterial and anti-inflammatory properties that the porridges would have acquired following their fortification. Thus, the consumption of these enriched porridges could make it possible to fight effectively against child malnutrition in underprivileged areas and prevent iron deficiency anemia in young children.

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