Malnutrition classification of children based on Z scores [20].
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 179 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 252 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
\n'}],latestNews:[{slug:"stanford-university-identifies-top-2-scientists-over-1-000-are-intechopen-authors-and-editors-20210122",title:"Stanford University Identifies Top 2% Scientists, Over 1,000 are IntechOpen Authors and Editors"},{slug:"intechopen-authors-included-in-the-highly-cited-researchers-list-for-2020-20210121",title:"IntechOpen Authors Included in the Highly Cited Researchers List for 2020"},{slug:"intechopen-maintains-position-as-the-world-s-largest-oa-book-publisher-20201218",title:"IntechOpen Maintains Position as the World’s Largest OA Book Publisher"},{slug:"all-intechopen-books-available-on-perlego-20201215",title:"All IntechOpen Books Available on Perlego"},{slug:"oiv-awards-recognizes-intechopen-s-editors-20201127",title:"OIV Awards Recognizes IntechOpen's Editors"},{slug:"intechopen-joins-crossref-s-initiative-for-open-abstracts-i4oa-to-boost-the-discovery-of-research-20201005",title:"IntechOpen joins Crossref's Initiative for Open Abstracts (I4OA) to Boost the Discovery of Research"},{slug:"intechopen-hits-milestone-5-000-open-access-books-published-20200908",title:"IntechOpen hits milestone: 5,000 Open Access books published!"},{slug:"intechopen-books-hosted-on-the-mathworks-book-program-20200819",title:"IntechOpen Books Hosted on the MathWorks Book Program"}]},book:{item:{type:"book",id:"8290",leadTitle:null,fullTitle:"Pharmacognosy - Medicinal Plants",title:"Pharmacognosy",subtitle:"Medicinal Plants",reviewType:"peer-reviewed",abstract:"Pharmacognosy is a term derived from the Greek words for drug (pharmakon) and knowledge (gnosis). 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Majority of food emulsions are constituted with polysaccharide and protein combinations. They are the essential ingredients of any food colloid formulation mainly due to their ability to change product shelf life by varying food texture (Schmidt & Smith, 1992; Schorsch, Jones & Norton 1999). Their interaction in the formulation thus finds many applications particularly in new food formulation development. Due to complex formation and creation of nano or micro structures (aggregation and gelation behavior) they generally change the rheological properties of food colloids which may affect the food product texture and colloidal stability (Benichou, 2002; McClements, 2005, 2006, 2007; Dickinson, 2003). Polysaccharide and protein interactions in solution and interfaces have been studied by several groups (Dickinson, 2003, 2008; Bos &Van Vliet 2001; Carrera & Rodríguez Patino 2005; Krägel, Derkatch, & Miller, 2008; Koupantis, & Kiosseoglou, 2009; Mackie, 2009). However, despite the vast advancement made in the recent past, polysaccharide and protein interactions in food hydrocolloids continue to be one of the most challenging topics to understand.
Proteins, being surface active can play major role in the formation and stabilization of emulsions in the presence of polysaccharide, while interacting through electrostatic or hydrophobic-hydrophobic interactions. On the other hand, polysaccharides being hydrophilic in nature generally remain in aqueous phase thus help in controlling the aqueous phase rheology like thickening, gelling and acting as stabilizing agents. The formation and deformation of polysaccharide-protein complexes and their solubility depend on various factors like charge and nature of biopolymers, pH, ionic strength and temperature of the medium and even the presence of surfactant of the medium (Ghosh & Bandyopadhyay, 2011). If pH of the medium is reduced below isoelctric point (pI) of the protein present then net positive charge of the protein will become prominent which will interact with negatively charged polysaccharide to form stable electrostatic complex. Similarly, if solution pH increased more than protein pI, the net negative charge of protein will tend to form complex with positively charged polysaccharides (Xia & Dubin, 1994; Dickinson, 2008; Turgeon, Schmitt & Sanchez, 2007). Generally, chances of weaker complex formation is more when solution pH is almost equal to protein pI, because at that pH range surface charge of protein becomes nearly zero. However, at very high concentration, similarly charged biopolymers repel each other and the net repulsion make the system unstable (separate as two distinct phases) which is known as thermodynamic incompatibility. Incompatibility in the system occurs at pH higher than the protein pI and at higher ionic strength (Grinberg & Tolstoguzov, 1997). Thus by varying pH and ionic strength of the medium one can achieve a control on the polysaccharide-protein interactions.
Polysaccharides and proteins both contribute to the structural and textural properties of food by changing rheology of food emulsions through their gelling networking system (Dickinson, 1992). Non-covalent interactions between polysaccharide and protein in any emulsion formulation play a major role to change the interfacial behavior and stability of the food colloids. The driving force for these non-covalent interactions is electrostatic interactions, hydrophobic interactions, H-bonding and Van der Waals interactions. Recent literatures also focus on how protein and polysaccharide molecules can be linked together by covalent bond. At pH close to protein pI this Maillard-type conjugates were used to improve the colloidal stability and interfacial structure of proteins in certain conditions (Jiménez-Castańo, Villamiel, & López-Fandiňo, 2007; Benichou, Aserin, Lutz & Garti, 2007)). Recent developments in the field describe interfacial physico-chemical properties of polysaccharide-protein mixed systems (Rodríguez Patino & Pilosof 2011). In this chapter, we would like to focus more on polysaccharide and protein non-covalent interaction studies and their effect towards food colloids stability.
Polysaccharide and protein complex formation is mainly driven by various non-covalent interactions, like electrostatic, H-bonding, hydrophobic, and steric interactions (Kruif et al 2001). Protein carries +ve or –ve zeta potential based on the pH of the medium (+ve at pH lower than pI and vice-versa). This +ve or –ve electrical charge on the protein chain point towards the presence of different amino acids in the protein molecules and their mode of ionization at different pH ranges (Fig. 1). Carboxylate polysaccharides get deprotonated (become anionic) at a pH range higher than its pKa (Fig. 1). This electrical charge on the back bone of protein or polysaccharide chain is responsible for electrostatic attraction or repulsion between them. Again, presence of -COOH group on the polysaccharide and -NH3, -COOH groups on the protein chain are the sources of hydrogen bonding between these two bio-polymers. Extent of both of this hydrogen bonding and electrostatic interaction depends on the solution parameters such as pH, ionic strength, temperature etc. Except these ionic patches on the bio-polymers, few non-polar segments are also present on the bio-polymers, which are responsible for the hydrophobic staking with each other. Even though solution parameters are important factors to control the different mode of interactions between protein and polysaccharide, type of proteins/polysaccharides, molecular weight, charge density, and hydrophobicity of the bio-polymers are also play significant role towards the extent of complexation between two bio-polymers at a fixed condition.
Variation of charge density on the polysaccharide and protein chain at various pH ranges.
In general, interactions between proteins and polysaccharides are quite explored where large numbers of report have been published based on the interactions between oppositely charged “protein-polysaccharide” systems (Dmitrochenko et al 1989; Bengoechea et al 2011, Stone & Nickerson 2012). Although electrostatic attraction is the main driving force for the complexation between protein and polysaccharide, but it is also reported that hydrogen bonding and hydrophobic interaction plays a secondary role for stability of the “protein-polysaccharide” aggregates (McClements, 2006). The extent of hydrogen bonding and hydrophobic interaction also depends on temperature (Weinbreck et al, 2004). In 2009 Nickerson and co-workers(Liu, Low, & Nickerson, 2009) have reported that pea protein and gum acacia complex stabilize at low temperature due to increase in hydrogen bonding interactions and destabilize at high temperature due to decline in hydrogen bonding interactions. Temperature also plays an important role to decide the protein conformations (folded or unfolded). In 2007, Pal (Mitra, Sinha & Pal, 2007) and coworkers have reported that human serum albumin unfolds at higher temperature and undergoes in reversible refolding conformations upon cooling (below 600 c). Unfolded conformations of protein expose more reactive sites (amino acids) to the solvent phase, thus more chances of interactions (or binding) with polysaccharide. Binding of anionic polysaccharides (pH~pKa) to the cationic proteins (at pH<pI) result both soluble and insoluble complexes (Magnusson & Nilsson, 2011). Initial binding of polysaccharides (anionic) to the proteins (cationic) cause charge neutralizations, which lead to the formation of insoluble “protein-polysaccharide” aggregates (Schmitt et al, 1998). Further binding of anionic polysaccharides to those neutral aggregates make it effectively anionic, which leads to formation of soluble complexes. But binding of anionic polysaccharides with anionic proteins (pH>pI) are also known and governed by the interactions between anionic reactive sites of polysaccharide and small cationic reactive sites of protein (Fig. 2). Binding of anionic polysaccharides to the cationic side of proteins (at pH>pI) result in formation of anionic “protein-polysaccharide” aggregates, thus soluble complexes. Therefore, concentration of polysaccharides and pH play an important role towards the solubility of “protein-polysaccharide” aggregates.
Two bio-polymers can exist either in a single phase systems or in a phase separated systems depending on the nature of bio-polymers, their concentration, and solution conditions. When two bio-polymers carry opposite charge, then either they agglomerates to form soluble complexes (single phase) or insoluble precipitates (2-phase system). On the other hand, when two non-interacting bio-polymers mixed together, either they exist in a single phase system (where two separate entities distributes uniformly throughout the medium) or exist as two distinct phases (each phases comprise different bio-polymer). Therefore, in the protein-polysaccharide system, phase separation occurs through two different mechanisms which are associative phase separation and segregative phase separation (Tolstoguzov, 2006). Associative phase separation is the aggregation between two oppositely charged bio-polymers (electrostatic attraction driven), leads to the phase separation, where one phase is enriched with two different bio-polymers (coacervation or precipitation) (Fig. 3). Segregative phase separation occurs either due to strong electrostatic repulsion (between two similarly charged bio-polymers) or because of very high steric exclusion (between two neutral bio-polymers). In this case, at low concentration, two biopolymers can co-exist in a single phase whereas at higher concentration, it starts phase separation. (Fig. 3).
Interaction between polysaccharide and protein at various pH.
Schematic representation of the possible mode of interaction between polysaccharides and proteins.
Polysaccharide-protein complexes exhibit a wide range of interesting properties, such as surface activity to stabilize air-water or oil-water interfaces, viscosifying, and gelling properties etc. Viscosifying and gelling ability of polysaccharide-protein complexes help to obtain gel-like processed food products without any thermal treatment in the process. The interfacial properties of these complexes help to impart stability into the emulsion food products. Also, protein–polysaccharide complexes are able to encapsulate several active ingredients; hence they act as delivery systems for many bioactives or sensitive molecules in food formulations. These complexes are also known to vary bulk/interfacial structures, textures and shelf-life stability of the food colloids. In the following section we will discuss this polysaccharide-protein interaction in light of their functional properties.
Viscosity and gelling are the rheological property which depends on the molecular characteristics of the biopolymers, such as their molecular weight, shape, chain flexibility. Other factors are the concentration, interaction between the biopolymers and water, as well as solution parameters like: pH, ionic strength and presence of other components/ligands etc. Interactions between polysaccharide and protein have been proven to widen the functional properties of each individual biopolymer. Rheological properties of polysaccharide-protein complex lead to new rheological behaviors different from each individual biopolymer.
Association of two bio-polymers is expected to increase the bulk viscosity of the system as entities of larger sizes are formed. The rheological behavior of several protein–polysaccharide mixed systems have been studied and ranged from viscous to viscoelastic properties showing elastic behavior is reported. The hydrated polysaccharide-protein complexes increase viscosity and rheology of the system found to be depends on the nature and structure of polysaccharides. Viscous property of gum acacia-protein coacervates attributes to the globular conformation of the polysaccharide, whereas the same protein with linear pectin results in gel-like system. Beside the nature of the individual bio-polymer solution property and concentration of bio-polymers are also known to affect the rheology of the system (Dickinson, 2011). For example, it was found that pH played a major role in the viscosity of the coacervate phase. A maximum viscosity was obtained at pH 4.0, where concentration of whey protein and gum arabic in the coacervate phase was maximum and extent of electrostatic attraction was highest. This suggests that the electrostatic interactions between whey protein and gum arabic were responsible for the highly viscous behavior of the coacervates. Whereas, the same composition of whey protein and gum arabic at pH above protein pI (i.e. comparatively lower electrostatic interactions) showed more elastic nature than viscous. Ionic strength and protein/polysaccharide ratio is also known to play an important role towards the rheology of polysaccharide-protein systems. For example, optimal salt concentrations (0.21 M NaCl) favor the coacervation of β-lactoglobulin with pectin at higher concentration and produce much stronger gel strength. For better gelling property, it is necessary to control the parameters which required to form coacervate, because strong associative interaction decrease the solubility of complexes and hence lower the hydration capacity of the complex, which leads to decrease in the viscosity (Schmitt & Turgeon, 2011; Kruif, et al 2004).
Viscoelastic properties of polysaccharide-protein complexes also play an important role towards the foam stability in variety of food products. In case of air-water system foam can be define as the air entrapment by a thin liquid film (water), where this liquid film is stabilized by some surface active molecules. Stability of the foam increases with the increase in the stability of the interfacial liquid film, because lower stability of this interfacial liquid film can lead to the diffusion of air entrapped inside the foam. Viscosity of this liquid film is another parameter by which one can control the diffusion rate of air entrapped inside the foam. Therefore, higher stability and viscosity of the interfacial liquid film leads to lower diffusion of air entrapped inside the foam and increase the foam stability. Schmitt and co-workers have studied the air-water interfacial property of β-lactoglobulin-acacia gum complexes at pH 4.2 [Schmitt et al 2005]. The group has reported that although surface activity of the complex is similar with the pure protein, but complex forms much stronger viscoelastic interfacial film with thickness of about 250 Å. As a result, gas permeability of thin-film stabilized by the complexes was significantly reduced (0.021 cm s -1) compared to pure β-lactoglobulin (0.521 cm s-1). This phenomenon suggests that stability of foam (stabilized by protein-polysaccharide complex) is higher compared to the foam stabilized by protein alone.
The likely explanation of the higher foam stability and different interfacial properties of coacervate is that protein-polysccharide complexes are able to re-organize at the interface by coalescence, forming interfacial microgel. These findings were applied for the ice cream formulation for improved air bubble stability (Schmitt C, Kolodziejczyk E. 2010). Similarly, gelatin has been replaced by whey protein isolate-gum acacia complexes to improve the bubble stability in chilled dairy products (Schmitt C, Kolodziejczyk E. 2010). In case of stabilization by complexes, variation in ratio of biopolymers could be used to control the size of the complexes, hence their surface activity. In addition to that, viscoelastic properties of the air-water interfacial film is possible to tune by either adsorbing two biopolymers simultaneously or by the sequential adsorption of protein followed by polysaccharide. As for example, β-lactoglobulin-pectin complexes are known to stabilize the air-water interface. In this case, thickness of the film obtained from the sequential adsorption of protein and polysaccharide was higher (450 Å) than the adsorption of complexes (250 Å) (Ganzelves et al 2008).
In contrary to air-water foam stability, use of polysaccharide-protein complexes for the stabilization of oil-water emulsion (Martínez et al 2007) has received much more attention. Use of these polysaccharide-protein hydrocolloids as an emulsion stabilizer will be discussed in the next section.
Emulsion is a uniform dispersion of liquid droplets within a continuous matrix of a second immiscible liquid, stabilized by surface active molecules. These stabilizers are termed as emulsifier. In the context of the present topic, we will limit our discussion to the role of bio-polymers as emulsifier. Generally, emulsifier has the amphiphilic character to adsorb onto the interface of liquid droplets, which can prevent the phase separation of two immiscible liquids. For a fixed emulsifier, stability of the emulsion depends on few factors, such as rate of adsorption of the emulsifier, concentration of emulsifier, etc. At low concentration of emulsifiers, emulsion system fails to retain its initial droplet size. This destabilization can take place through different mechanisms. In case of poor coverage of the interface by liquid droplets, they can coalesce with each other to form a bigger droplet (Fig. 4). Few examples are also reported, where polymer adsorbed onto the interface of liquid droplets thus bridge between two such liquid droplets and initiates bridging flocculation. Interestingly, emulsions at high emulsifier concentration produces stable oil droplets due to better coverage of the interfaces of the liquid droplets ( Liu & Zhao, 2011).
Emulsion is possible to achieve by using many surface active agents, such as small surfactant molecules, bio-polymers (proteins or polysaccharides, hydrocolloids (protein-polysaccharide complexes), and inorganic particles. Stability of those emulsion systems mainly governs by the two important factors. First, repulsive force between two closely approaching liquid droplets; second, Ostwald ripening, which involves disappearing of smaller droplets in expense of the formation of larger one. Higher degree of repulsion between the two neighboring droplets results in maximum stability due to least chances of coalescence. Repulsive force between the two liquid droplets govern by the inter droplet distance, i.e. thickness of the thin liquid film between two closely approaching droplets. Thickness of this liquid film depends on the space occupied by the adsorbed molecules (emulsifier) at interface of the droplets. Emulsion generally get stabilized by different emulsifiers present in the formulations such as surfactants, proteins, or hydro-colloids (protein-polysaccharide complexes) and the relative thickness of the liquid film between two closely spaced droplets lies in the order of hydrocolloids (5-10 nm) > proteins (1-5 nm) > surfactants (0.5-1 nm) (Fig. 5). Therefore, stability of the emulsion droplets expected to be higher when they are stabilized by protein-polysaccharide complex compared to the same stabilized by protein or surfactant molecules. In addition to the thickness of the liquid film between two closely spaced droplets, rate of desorption of the emulsifiers from the interface is another important factor. Adsorption of emulsifier molecules (like surfactants, proteins etc.) at the liquid interface is highly reversible. Desorption of the emulsifiers from the liquid interface governs the instability of the system. According to this fact, emulsion stabilized by particles (size ranges from 10 nm to several μm) is likely to have indefinite stability, because of the maximum thickness of thin liquid film in between two closely spaced droplets and maximum desorption energy of the particles from the liquid interface. Despite of this theoretical consideration, experimental evidence by Tcholakova et al. does not support this hypothesis that particle stabilized emulsion are more stable compared to surfactant or protein or hydrocolloids stabilized emulsion (Tcholakova et al. 2008).
Schematic representation of mode of stabilization and destabilization of oil droplets in an oil-water emulsion.
Schematic representation of the relative thickness of the thin liquid film between two closely spaced droplets, stabilized by A) surfactant, B) protein, and C) protein-polysaccharide hydrocolloids.
Another factor guides the emulsion instability is Ostwald ripening, which is disappearance of small size droplets at the expense of the larger droplets formation. Driving force for the Ostwald ripening is the difference in the chemical potential of the smaller and larger droplets. Mass transfer takes place between the droplets by diffusion process. Therefore, Ostwald ripening process requires the solubility of the dispersed phase into the continuous phase to initiate the diffusion process. Type of the emulsifier also plays an important role towards the Ostwald ripening process. Emulsion stabilized by the water soluble surfactant molecules has lower interfacial tension, which reduces the thermodynamic driving force of Ostwald ripening. Adsorption of the surfactant molecules at the droplet interface is a reversible phenomenon. Reversible desorption and adsorption of the surfactant molecules from the interface of the liquid droplet increases the rate of mass transfer between the dispersed droplets, hence increase the Ostwald ripening. The chances of desorption of emulsifier is less in case of the emulsions stabilized by protein molecule because it provides a thicker layer (elastic layer) around the droplets and greater surface coverage of the interfacial area. These factors reduce the ripening process in the protein stabilized emulsion. Ostwald ripening process is possible to avoid completely, only if emulsion is stabilized by insoluble particles (due to very high desorption energy) or thickness of the elastic layer around the dispersed droplets is equal to the droplet radius (Kabalnov, 2001). For this reason particulate emulsions are able to prevent the ripening process completely. Whereas hydrocolloid (protein-polysaccharide complexes) mostly behaves like a soft polymer, more resembles with the protein structures compared to solid particles, which cannot completely avoid the ripening process.
Protein–polysaccharide complex stabilized emulsions are possible to obtain by using two alternative ways. One of them involves addition of charged polysaccharide solution to a primary emulsion which is already stabilized by the protein as single emulsifier, to produce emulsion droplets having a protein–polysaccharide ‘bilayer’ surface coating (Fig. 6B). Another method involves addition of an aqueous solution containing the protein–polysaccharide complexes as an emulsifying agent following homogenization (Fig. 6A). For convenience, the first method is termed as ‘bilayer emulsions’ and second one is termed as ‘mixed emulsions’. The bilayer approach is also commonly known as ‘layer-by-layer’ approach. Recently, it has attracted significant importance because of its use in nano-encapsulation and protection of emulsions against severe environmental stresses. The major problem lies in ‘layer-by-layer’ approach, where emulsion droplet tends to flocculate. Flocculation during the ‘layer-by-layer’ adsorption takes place because of two different mechanisms: a) bridging flocculation, b) depletion flocculation. Bridging flocculation takes place at low polysaccharide concentration when droplet collisions occur faster than the rate of polysaccharide saturation of the protein-coated droplet surfaces. Depletion flocculation occurs at higher polysaccharide concentration when unadsorbed polysaccharide exceeds a critical value. For this reason it is convenient to make emulsions with protein and polysaccharide present together before homogenization compared to ‘layer-by-layer’ approach. Recently direct comparison between the two techniques has been demonstrated experimentally, which shows that the more convenient mixed emulsion approach leads to better stability behavior than the bi-layer approach(Camino et al 2011).
Schematic illustration of two alternative approach of preparing oil-water emulsion using protein-polysaccharide complexes as an emulsifier. A) Mixed emulsions, both protein and polysaccharide present together during emulsification. B) Bilayer emulsion, polysaccharide added to emulsion prior stabilized by protein.
Generally, encapsulation includes all aspects of protection or stabilization of active molecules (flavors and bio-actives) against several external drastic conditions (such as heat, redox potential, shear, temperature, light, oxygen, moisture, etc.). Controlled release facilitates the delivery of the encapsulated material to the targeted place with the optimal kinetics. Conditions for the encapsulation of active molecules depends on the sensitivity (thermal and redox stability) and nature (solubility in oil and water) of the active components but release can be controlled by mechanical process, pH variations (acidic conditions in the stomach, neutral in the intestine) or enzymatic actions etc. As for example, Peniche et al. has shown the encapsulation of shark liver oil (rich in poly unsaturated fatty acids) using chitosan-alginate system to mask the unpleasant taste of oil. These capsules disrupts by enzymes, like lipase or pancreatine. Initially it was resistant to the acid environment of the stomach, but after 4 hour in the intestinal pH (pH 7.4), the capsule walls weakened and delivers the active molecules.
Another important application of this aspect is the encapsulation of flavor molecules. Recently, Yeo et al. has shown that gelatin–acacia gum coacervate can encapsulate flavors which can be released during cooking in baked goods (Yeo et al. 2005). Weinbreck et al. (Weinbreck et al. 2004) has shown that Whey protein–acacia gum coacervates can encapsulate lemon and orange flavors and their release under mechanical action like chewing. Encapsulation was one of the first applications of gum arabic-gelatin coacervates (Bungenberg de Jong and Kruyt, 1929). Viscous coacervate was made at a temperature higher than the gel point of gelatin and during cooling, interfacial rigidity increases which lead to a stable gelled shell around the microcapsule. This rigid shell disrupts after consumption, gelatin melts easily in the mouth and therefore releases the encapsulated actives. In addition to gelatin-acacia gum, several other protein-polysaccharide systems have been evolved (whey proteins, plant proteins, pectin, and xanthan gum) to broaden the encapsulation techniques. Beside these polysaccharide-protein combinations, process parameter for encapsulation (pH, ionic strength, macromolecular ratio, and drying/homogenization procedure) also plays an important role to modulate the physical properties (thickness, swelling rate, etc.) of the coacervate layer in the microcapsules (Savary et al 2010). Use of cross-linking agents can further harden the coacervate layer after formation of the microcapsules. As for example, use of trans-glutaminase can introduce covalent linkages between carboxyl group of a glutamine and amino group of lysine in the protein molecules. Alternatively, formaldehydes and glutaraldehydes have also been studied although they are non-food grade reagents. Recently, tannic acid, plant phenolics, citral molecules and glycerin have been studied as food grade alternatives (McClements, 2010).
Contrary to the encapsulation through coacervation, the bi-layer emulsion technique (formed by successive adsorption of biopolymers at the interface) is another way to study the microcapsule properties. Recently, McClements group has described that bi-layer approach of encapsulation has a better control of the interface structure, charge, thickness and permeability with improved stability and controlled release of actives. Group has reviewed this research area and discussed multilayer emulsions in light of bioavailability control and release of actives to the specific site of action depending on layer composition and properties (McClements, 2011). Sagis et al. has used high molecular weight pectins and pre-heated whey proteins (denaturation of protein) for the encapsulation through multilayer approach. (Sagis et al 2011).
Basic understanding of supramolecular chemistry which span among origin and nature of the various non-covalent molecular interactions between polysaccharides and proteins can be widely used to create various desirable nano and macro structures which are quite significant in food colloids/formulations. Food product texture modulation and colloidal stability can be achieved by controlling protein-polysaccharide interactions. Modulation of this interaction by varying medium conditions like pH, ionic strength etc. one can create many possibilities towards rheological properties of food colloids which may affect the emulsion stability. Protein-polysaccharide interactions are well characterized in various pH conditions. Although, the interaction depends on type and nature of biopolymers, no structure-activity correlation has been established until now. Moving forward, there is a huge demand to establish a correlation between biopolymer structures and interaction efficiency. The creative manipulation of polysaccharide-protein interactions can open up a completely new dimension in health and nutrition platform. Food particle travels from mouth to gut in various pH environments (for example pH decreases when it moves from mouth saliva to stomach and increases when partially digested food particle passes from stomach to small intestine), thus one can design a smart polysaccharide-protein complex system which can encapsulate or slow down and trigger or release of nutrients in various stages of digestion process depending on the pH of the system and any particular health demand. Such kind of pH sensitive system design and product development which works in vivo is a real challenge for the food scientists. Unfortunately, general understanding of protein-polysaccharide interactions, their bulk and interfacial properties toward emulsion stability is not completely understood and requires more systematic investigation in future to unveil its full potential.
Malnutrition is a universal public health problem in both children and adults globally [1]. It is not only a public health concern but it is an impediment to global poverty eradication, productivity and economic growth. By eliminating malnutrition, it is estimated that 32% of the global disease burden would be removed [2]. As a widespread serious problem affecting children in developing countries, progress towards tackling the different forms of malnutrition remains relatively slow [3]. Malnutrition occurs due to an imbalance in the body, whereby the nutrients required by the body and the amount used by the body do not balance [1]. There are several forms of malnutrition and these include two broad categories namely undernutrition and over nutrition. Undernutrition manifests as wasting or low weight for height (acute malnutrition), stunting or low height for age (chronic malnutrition), underweight or low weight for age, and mineral and vitamin deficiencies or excessiveness. Over nutrition includes overweight, obesity and diet-related non-communicable diseases (NCDs) such as diabetes mellitus, heart disease, some forms of cancer and stroke [1]. Malnutrition is an important global issue currently, as it affects all people despite the geography, socio-economic status, sex and gender, overlapping households, communities and countries. Anyone can experience malnutrition but the most vulnerable groups affected are children, adolescents, women, as well as people who are immune-compromised, or facing the challenges of poverty [3].
\nAccording to the World Health Organization (WHO), 462 million adults are underweight, while 1.9 billion adults are overweight and/or obese. In children under 5 years of age, 155 million are stunted, 52 million are wasted, 17 million are severely wasted and 41 million are overweight and/or obese [1]. The manifestation of malnutrition is multifold, but the paths to addressing prevention are key and include exclusive breastfeeding for the first 2 years of life, diverse and nutritious foods during childhood, healthy environments, access to basic services such as water, hygiene, health and sanitation, as well as pregnant and lactating women having proper maternal nutrition before, during and after the respective phases (levels and trends) [3].
\nIt is vital that malnutrition is addressed in children as malnutrition manifestations and symptoms begin to appear in the first 2 years of life [4]. Coinciding with the mental development and growth periods in children, protein energy malnutrition (PEM) is said to be a problem at ages 6 months to 2 years. Thus, this age period is considered a window period during which it is essential to prevent and/or manage acute and chronic malnutrition manifestations [4, 5, 6]. Child and maternal malnutrition together have contributed to 3.5 million annual deaths. Furthermore, children less than 5 years of age have a disease burden of 35% [7]. In 2008, 8.8 million global deaths in children less than 5 years old were due to underweight, of which 93% occurred in Africa and Asia. Approximately one in every seven children faces mortality before their fifth birthday in sub Saharan Africa (SSA) due to malnutrition [8].
\nYoung malnourished children are affected by compromised immune systems by succumbing to infectious diseases and are prone to cognitive development delays, damaging long term psychological and intellectual development effects, as well as mental and physical development that is compromised due to stunting [7, 9, 10, 11]. A malnutrition cycle exists in populations experiencing chronic undernutrition and in this cycle, the nutritional requirements are not met in pregnant women. Thus, infants born to these mothers are of low birth weight, are unable to reach their full growth potential and may therefore be stunted, susceptible to infections, illness, and mortality early in life. The cycle is aggravated when low birth weight females grow into malnourished children and adults, and are therefore more likely to give birth to infants of low birth weight as well [9]. Malnutrition is not just a health issue but also affects the global burden of malnutrition socially, economically, developmentally and medically, affecting individuals, their families and communities with serious and long lasting consequences [1].
\nStudies in Sudan, Ethiopia, Bangladesh, and Haiti have indicated that the causes of malnutrition are multi-faceted, with both environmental and dietary factors contributing to malnutrition risk in young children [12]. Diet and disease have been identified as primary immediate determinants; with household food security, access to health facilities, healthy environment, and childcare practices influenced by socio-economic conditions [13]. Mother’s antenatal visit and body mass index were also identified as risk factors for malnutrition [14]. In children under 3 years of age some of the main factors included poor nutrition, feeding practices, education and occupation of parent/caregiver, residence, household income, nutrition knowledge of mother [15]. These studies have suggested that nutrition education for the mother is important, as it is a resource that mothers can utilize for better care of their children. It can also provide the necessary skills required for childcare, improvement of her feeding practices, enable her to make choices and have preference of health facilities available, increase her nutritional needs awareness, and give her the chance of changing her beliefs regarding medicine and disease [16]. Some of the nutritional interventions that have had some success in addressing malnutrition include exclusive breastfeeding for the first 6 months of life, vitamin A supplementation, deworming, zinc treatment and rehydration salts for diarrhea, food fortification, and folic acid/iron for lactating and pregnant women, improvement of access to piped water and hygiene [17]. These interventions have positively influenced the development, growth and survival of children [18]. Malnutrition is not a uniform condition and therefore groups and areas that experience high risk of malnutrition must be identified and targeted interventions available to assist [17].
\nTo determine both over and undernutrition, assessment of the nutritional status is important. This identifies those individuals who are vulnerable and at risk, and how to guide a response [19]. In determining the nutritional status of a child, it must be referenced in comparison to a healthy child [20]. Most of the anthropometric indices are used with reference tables such as that of the National Center for Health Statistics (NCHS) and the currently widely recommended and used 2006 WHO child growth standards [21]. In expressing anthropometric indices relative to a reference population, the measurements are developed using the median and standard deviations of the reference populations, which are known as Z scores [22, 23, 24]. The Z score classification system interprets weight for age (W/A), weight for height (W/H) and height for age (H/A). Z scores describe a child’s mid upper arm circumference (MUAC)/weight/height in comparison to the median and the mid upper arm circumference (MUAC)/weight/height of the child relative to the reference population [25]. The anthropometric value is expressed by the two score system as “a number of standard deviations or Z scores below or above the reference mean or median value” [26]. Thus, the Z score is calculated as follows:
\nAs previously mentioned malnutrition consists of both over and undernutrition (Table 1).
\nUndernutrition does not only affect the health of individuals but impacts greatly on the growth of the economy and productivity, as well as the eradication of poverty. To support their growth and development, infants and young children have increased nutritional needs and therefore are most affected by undernutrition [27, 28]. Prolonged malnourished status in children can lead to the development of motor function and physical growth delays, lack of social skills, and low infection resistance, thus making them susceptible to common ailments and infections [28, 29]. Additionally, due to frequent infection, susceptible children become engaged in a negative cycle whereby infections lead to growth delays and their learning abilities are hindered, and infections in malnourished children may lead to childhood mortality [30].
\nUndernutrition is subdivided into two categories that include micronutrient malnutrition and growth failure. To differentiate between acute or chronic malnutrition, the nutritional status of an individual is assessed by using anthropometry [27]. According to Zere and McIntyre [31], anthropometry is advantageous over biochemical evaluation, as it is less invasive and cost effective; hence, in addressing child survival nutritional status anthropometry is one of the favored predictors [32]. To assess the growth status of children the most common indices used in anthropometry include low weight for height or wasting, stunting or low height for age, underweight or a low weight for age and waist/arm circumference.
\nIn PEM the condition is characterized by the individual being susceptible to infection due to long-term consumption of protein and energy that is insufficient to meet the body’s needs. While the body may first attempt to utilize the nutrients to meet the energy demands, if there is insufficient intake of energy then the consumed protein is used to meet the energy demands and does not address the functions of the protein in the body, hence leading to PEM. While PEM requires the measuring of growth parameters such as height and weight as it is not immediately obvious, in severe PEM children present with marasmus and kwashiorkor [33, 34]. Marasmus is characterized by a lack of protein and energy in the diet, while an inadequate intake of protein causes kwashiorkor. Marasmus or severe wasting (below −3SD) presents with a MUAC less than 115 mm in children under age five. Children with marasmus present with an “old man” appearance and are very thin [33]. In kwashiorkor, a child does not necessarily appear as undernourished but there is the presence of oedema. The children present with hair that is discolored and skin that is shiny and very tight. The weight for height is greater than or equal to −2SD. In marasmic-kwashiorkor bilateral oedema is present, with a weight for height less than −2SD [33, 34, 35].
\nA common presentation of PEM in children is underweight. Underweight is seen as children having a weight for age with a Z score of −2SD, with severe underweight at −3SD [36, 37]. Since proteins and/or energy are insufficient in a diet, there is weight loss or failure to gain weight. This can be accompanied by a decline in linear height [38]. While the children may present with normal body proportions such as weight to height ratios, they will be undersized and underweight [39]. Through regular monitoring of growth indices such as height and weight, underweight can be identified at an early stage [26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39]. In 2013, 99 million children less than 5 years of age were underweight. Of this figure, one third of the children were from Africa and two-thirds present in Asia. An estimated 14.6% of newborns were with low birth weight in 2015, and approximately nine out of 10 of the newborns were from low and middle income countries (LMICs). Approximately 45% of deaths in LMICs in children under age five is due to underweight. In adolescent girls the underweight prevalence increased from 5.5% in 2000 to 5.7% in 2016 [40].
\nStunting is a major public health concern that begins in intrauterine life although children are only classified as stunted at approximately age 2 years. The detrimental effects of stunting include intrauterine growth retardation, as well as inadequate nutrition required for growth and development of children [41]. High frequency of infection and decreased disease resistance such as diarrhea and pneumonia are influenced by stunting. Childhood stunting may also lead to increased mortality, poor recovery from disease and is also an obesity risk factor in adulthood [41, 42]. Stunting causes growth impairment during childhood that is associated with increased cardio-metabolic disease and obesity risk and cognitive development delay in adulthood [43]. This creates both short and long term effects that indicate the importance of stunting being identified and monitored in early life [42].
\nIn children the initial 1000 days of life are an important window period for intervention implementation and tracking for the improvement of child growth and development [7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44]. Often stunting is correlated with poor socio-economic status, as well as environmental conditions surveys in South Africa (SA) have identified an increased stunting prevalence in black people compared to their Indian or white counterparts [31]. Some surveys looked at a wider age range of children (0–14 years) and higher stunting prevalence was found in children living informal settlements within urban and rural areas [36, 37, 38, 39, 40, 41, 42, 43, 44, 45].
\nIn stunting or low height for age the Z score is below 2 standard deviations [21]. It is prevalent usually in infants and children younger than 5 years [36], who are susceptible to infection and have an insufficient intake of nutrients over the long term. Low height for age is seen as the failure of an individual to reach full linear growth and if stunting occurs before age two then irreversible poor cognitive and motor developments may occur [41]. Severe stunting is indicated by a height for age that is lesser than the median by 85% to represent a standard deviation of −3SD [46]. In 2013 in children under 5 years of age, 161 million were identified as stunted globally. The trend of global decrease were evident from the period 2000–2013, during which figures declined from 199 million to 161 million (33–25%). However, one third of stunted children were still found in Africa [47]. During 2000–2018 the number and proportion of stunted children under age five rose by 6.5 million in Central and Western Africa and by 1.4 million in Southern and Eastern Africa. Thus, the stunting burden continues to escalate in Africa, creating serious human capital development complications [40].
\nIn the last five decades overweight and obesity appears to be reaching epidemic levels in both developing and developed countries [48, 49]. Eclipsing infectious disease and under-nutrition as a significant mortality and ill-health contributor, overweight and obesity have presented as the most prevalent global nutritional problem over the last two decades. Globally an estimated 1 billion adults are overweight, with 300 million of them being obese [49]. An estimated 155 million obese children contribute to this epidemic [50]. Obese children tend to become obese adults. Obesity-related health problems occur in early years of life and progress into adulthood [51]. Several chronic disease conditions in later life are associated with childhood obesity. These chronic diseases include diabetes, stroke, high blood pressure, cancers and heart disease [52]. Despite the increased prevalence of overweight and obesity in children, research evaluating treatment in these age groups is minimal. Middle-income countries such as South Africa (SA), Brazil and China have increased overweight and obesity rates across all age groups and economic levels [49]. However, over the last few years overweight has increased in every continent. It has been postulated that the number of overweight children under age five will rise from over 40 million to approximately 43 million by 2025 [53]. As of 2018, approximately half of the overweight under five children were in Asia, with a quarter in Africa. Between 2000 and 2018 in Africa, the number of overweight under five children rose by just under 44%. In children and adolescents aged 5–19 years old, the proportion of overweight in 2000 rose from one in 10 (10.3%) to just under one in five (18.4%) in 2016 [40].
\nSome developing countries such as SA are currently facing a nutrition transition with the dual burden of over and undernutrition. This nutrition transition is the replacement of traditional home cooked balanced diet meals by energy-dense foods, as well as sedentary lifestyles due to technology and urbanization. A review study highlighted the dual burden in SA in children aged 0–20 years. The prevalence of wasting and stunting was higher in younger male children and predominant in rural areas, whereas overweight/obesity prevalence was highest in females and children in urban settings. It is important for tracking of over and undernutrition in children at a district level that can also be used to prioritize, monitor and evaluate government policies regarding malnutrition [54]. More recent years have seen the double burden of malnutrition being accompanied by a triple burden of malnutrition, affecting families, communities and countries. In countries such as India and Egypt, the problem is increasing and therefore highlights the urgent need to consider child malnutrition in the greater familial and household contexts [40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55]. A study in Ghana addressed the concurrent occurrence of obesity and stunting in children aged under 5 years, providing data for the first time on such an occurrence. The study reported a stunting prevalence of 27.5%, overweight prevalence of 2.4% and an overall concurrent stunting and overweight prevalence of 1.2% [56]. A study in South Africa, with children aged 6–12 years old, reported that 9.1% were stunted, while 14.9% were overweight/obese [57]. This highlights the need for urgent targeted interventions in children to address this double burden to prevent these malnutrition issues as they transition into adulthood.
\nIn wasting or low weight for height the Z score is below 2 standard deviations [21]. Wasting is reflective of a body mass that is low in comparison to the age and may be due to disease or starvation. Weight loss and retardation of growth occur due to inadequate intake of food and long term it leads to wasting and becomes more severe with emaciation [58]. A child falls behind another child who is growing actively when his/her own growth is affected acutely [38], and the body height and weight become less than ideal for the age of the child [59]. Severe wasting occurs when the weight for height is less than the median by 70% to represent a standard deviation of −3SD [46]. According to the national Department of Health (DoH) height measurements in all children should be conducted at least every 3 months [60]. In measuring overall growth to compare growth standards, both height and weight measurements are essential. Globally, in 2013, in children less than 5 years of age, 51 million were wasted and 17 million severely wasted. Global wasting prevalence in 2013 approximated 8%, of which 3% accounted for severe wasting. A postulated third of wasted children were present in Africa and an estimate of the children severely wasted in Africa followed the same trend [61]. As of 2018–2019 52 million children are wasted, with an estimated 16.6 suffering from severe wasting in 2018 [62]. Children left untreated with severe acute malnutrition (SAM) are at least 12 times more likely to die than healthy children [63]. South Asia is the global wasting epicenter as 15.2% of children under five are wasted. Together with other hotspots such as Oceania, Southeast Asia and SSA, improvements regarding wasting are minimal [64] (Table 2).
\n\nClassification | \nZ score values | \n
---|---|
Adequately nourished | \n−2 < Z-score < +1 | \n
Moderately malnourished | \n−3 < Z-score < −2 | \n
Severely malnourished | \nZ-score < −3 | \n
Malnutrition classification of children based on Z scores [20].
Country | \nYear of last survey | \nWasting | \nOverweight | \nStunting | \nUnderweight | \n
---|---|---|---|---|---|
Angola | \n2015–2016 | \n4.9 | \n3.4 | \n37.6 | \n19.0 | \n
Benin | \n2017–2018 | \n5.0 | \n1.9 | \n32.2 | \n16.8 | \n
Botswana | \n2007–2008 | \n7.2 | \n11.2 | \n31.4 | \n11.2 | \n
Burkina Faso | \n2017 | \n8.6 | \n1.7 | \n21.1 | \n16.2 | \n
Burundi | \n2016–2017 | \n5.1 | \n1.4 | \n55.9 | \n29.3 | \n
Cabo Verde | \n1994 | \n6.9 | \n— | \n21.4 | \n11.8 | \n
Cameroon | \n2014 | \n5.2 | \n6.7 | \n31.7 | \n14.8 | \n
Central African Republic | \n2012 | \n7.6 | \n1.9 | \n39.6 | \n24.6 | \n
Chad | \n2014–2015 | \n13.3 | \n2.8 | \n39.8 | \n29.4 | \n
Comoros | \n2012 | \n11.3 | \n10.6 | \n31.1 | \n16.9 | \n
The Congo | \n2014–2015 | \n8.2 | \n5.9 | \n21.2 | \n12.3 | \n
Cote d’Ivoire | \n2016 | \n6.1 | \n1.5 | \n21.6 | \n12.8 | \n
Democratic Republic of Congo | \n2013–2014 | \n8.1 | \n4.4 | \n42.7 | \n23.4 | \n
Djibouti | \n2012 | \n21.6 | \n8.1 | \n33.5 | \n29.9 | \n
Equatorial Guinea | \n2011 | \n3.1 | \n9.7 | \n26.2 | \n5.6 | \n
Eritrea | \n2010 | \n15.3 | \n2.0 | \n52.0 | \n39.4 | \n
Eswatini (former Swaziland) | \n2014 | \n2.0 | \n9.0 | \n25.5 | \n5.8 | \n
Ethiopia | \n2016 | \n10.0 | \n2.9 | \n38.4 | \n23.6 | \n
Gabon | \n2012 | \n3.4 | \n7.7 | \n17.0 | \n6.4 | \n
The Gambia | \n2013 | \n11.0 | \n3.2 | \n24.6 | \n16.5 | \n
Ghana | \n2014 | \n4.7 | \n2.6 | \n18.8 | \n11.2 | \n
Guinea | \n2016 | \n8.1 | \n4.0 | \n32.4 | \n18.3 | \n
Guinea—Bissau | \n2014 | \n6.0 | \n2.3 | \n27.6 | \n17.0 | \n
Kenya | \n2014 | \n4.2 | \n4.1 | \n26.2 | \n11.2 | \n
Lesotho | \n2014 | \n2.8 | \n7.5 | \n33.4 | \n10.5 | \n
Liberia | \n2013 | \n5.6 | \n3.2 | \n32.1 | \n15.3 | \n
Madagascar | \n2012–2013 | \n7.9 | \n1.1 | \n48.9 | \n32.9 | \n
Malawi | \n2015–2016 | \n2.8 | \n4.6 | \n37.4 | \n11.8 | \n
Mali | \n2015 | \n13.5 | \n1.9 | \n30.4 | \n25.0 | \n
Mauritania | \n2015 | \n14.8 | \n1.3 | \n27.9 | \n24.9 | \n
Mauritius | \n1995 | \n15.7 | \n6.5 | \n13.6 | \n13.0 | \n
Mozambique | \n2011 | \n6.1 | \n7.8 | \n42.9 | \n15.6 | \n
Namibia | \n2013 | \n7.1 | \n4.0 | \n22.7 | \n13.2 | \n
Niger | \n2016 | \n10.1 | \n1.1 | \n40.6 | \n31.4 | \n
Nigeria | \n2016–2017 | \n10.8 | \n1.5 | \n43.6 | \n31.5 | \n
Rwanda | \n2014–2015 | \n2.3 | \n7.9 | \n38.2 | \n9.6 | \n
Sao Tome and Principe | \n2014 | \n4.0 | \n2.4 | \n17.2 | \n8.8 | \n
Senegal | \n2017 | \n9.0 | \n0.9 | \n16.5 | \n14.4 | \n
Seychelles | \n2012 | \n4.3 | \n10.2 | \n7.9 | \n3.6 | \n
Sierra Leone | \n2013 | \n9.5 | \n8.8 | \n37.8 | \n18.2 | \n
Somalia | \n2009 | \n15.0 | \n3.0 | \n25.3 | \n23.0 | \n
South Africa | \n2016 | \n2.5 | \n13.3 | \n27.4 | \n5.9 | \n
South Sudan | \n2010 | \n24.3 | \n5.8 | \n31.3 | \n29.1 | \n
Togo | \n2013–2014 | \n6.6 | \n2.0 | \n27.6 | \n16.1 | \n
Uganda | \n2016 | \n3.5 | \n3.7 | \n28.9 | \n10.4 | \n
United Republic of Tanzania | \n2015–16 | \n4.5 | \n3.7 | \n34.5 | \n13.7 | \n
Zambia | \n2013–14 | \n6.2 | \n6.2 | \n40.0 | \n14.9 | \n
Zimbabwe | \n2015 | \n3.3 | \n5.6 | \n27.1 | \n8.5 | \n
Joint malnutrition country estimates of anthropometric indicators in children aged 0–59 months [65].
As a developing or middle-income country, SA is still undergoing major transitions socially, economically and in the population’s health. The country is currently facing a quadruple disease burden, with non-communicable diseases linked to diet and lifestyle; the burden of Human Immunodeficiency Virus/Acquired immunodeficiency syndrome (HIV/AIDS); infectious diseases and poverty linked to under nutrition; and deaths due to injuries [66]. As a developing country SA is in a nutrition transition where both over and undernutrition coexist [67]. The first 2 years of life are a vulnerable time frame as it is during this period that malnutrition begins. According to Faber and Wenhold [68], chronic malnutrition or stunting is more prevalent in children in SA compared to wasting. Since the post-apartheid era in 1994, SA has faced great challenges in addressing the nutritional status of infants, young children and adults [69]. However, large-scale nationwide surveys were conducted to trace the progress, failures and successes in addressing malnutrition. In 1994 the South African Vitamin A Consultative Group (SAVACG) conducted a national survey on the nutritional status of children aged 6–71 months [70]. Anthropometric results revealed that approximately 10% or 660,000 children were underweight, with one in every four children (1.5 million) affected by stunting. Severe wasting was only recorded in 0.4% of children. KwaZulu-Natal (KZN), Eastern Cape and Northern Province revealed the greatest prevalence of malnutrition [70]. In 1999 the National Food Consumption Survey (NFCS) was conducted in children aged 1–9 years [71], collecting a larger set of data in comparison to the SAVACG survey. The NFCS reported 10% underweight in children, with 20% affected by stunting and 17.1% as overweight and/or obese. The NFCS secondary analysis, focusing on children aged 1–5 years, reported underweight at 6.8%, stunting at 20.1%, overweight at 20.6% and obesity at 9.5% [69]. In 2005, the National Food Consumption Survey-Fortification Baseline (NFCS-FB) reported that of children aged 1–9 years old, 20% were affected by stunting, 9.3% were underweight, wasting was found in 4.5%, and 14% were overweight or obese [72]. The South African National Health and Nutrition Examination Survey (SANHANES) conducted in 2012 reported that in children aged 0–14 years stunting prevalence was 15.4%, with 3.8% having severe stunting. Wasting was reported at 2.9%, with severe wasting at 0.8%. Underweight was reported at 5.8%, with severe underweight at 1.1%. Regarding over nutrition, SANHANES identified 18.1% of children as overweight and 4.6% as obese [36]. The prevalence of overweight and obesity was significantly greater in females (25% and 40.1%) compared to males (19.6% and 11.6%) respectively. Underweight was significantly higher in males (13.1%) in comparison to females (4.0%) [36]. Thus, it is evident that SA is facing the malnutrition epidemic at a young age and context-specific and targeted interventions are required to prevent child malnutrition before it progresses into adulthood.
\nDuring 2012–2013, WHO member states recognized the seriousness of malnutrition and its effect on global health [3]. Thus, at the United Nation’s General Assembly in 2016, the United Nations Decade of Action on Nutrition 2016–2025 was announced. This set a time frame for all forms of malnutrition to be addressed and for diet-related and nutrition targets to be met by 2025. This also set the time frame for the Sustainable Development Goals (SGDs) to be achieved before 2030, particularly SDG 2 that aims to improve nutrition, achieve food security and end hunger, as well as SDG 3 that aims to ensure healthy living and promote well-being for all [1]. To tackle the malnutrition epidemic food fortification is important to ensure that children with good weight do not risk becoming overweight or obese [73]. All malnutrition indicators must be included in interventions, and more importantly treated together rather than stand-alone issues [74]. As part of the health system strengthening and with the goal of combatting malnutrition, existing policies on child malnutrition must be evaluated. The coexistence of stunting and overweight/obesity remains a challenge in LMICs that requires multi-sectoral action. During infancy and early childhood optimal nutrition is vital to ensure that, development and rapid growth demands are met. In the efforts to tackle the nutrition disparities, the first 1000 days of life are an important window period, presenting the opportunity to prevent both stunting and overweight/obesity [75]. Interventions must be inclusive of both linear growth and appropriate weight, beginning in early life and preferably during this important window period. To further tackle the double and triple burdens of malnutrition, early screening and identification of at risk children, including those already with malnutrition, is essential at healthcare facilities [76]. Thus, a more holistic, context-specific approach is required, whereby interventions not only take into consideration the risk factors, but also consider the inclusion of nutritionists and educating mothers on self and childcare regarding nutrition [77]. Furthermore, child malnutrition research and interventions must be up-scaled from community level to provincial and national levels so that it informs policy on the intervention strategies that can address the burden of child malnutrition. This is vital as children left untreated transition into malnourished adulthood, increasing the healthcare costs and needs, weakening the healthcare systems, and perpetuating the vicious malnutrition cycle.
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\\n"}]'},components:[{type:"htmlEditorComponent",content:'Copyright is the term used to describe the rights related to the publication and distribution of original Works. Most importantly from a publisher's perspective, copyright governs how Authors, publishers and the general public can use, publish, and distribute publications.
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