Innovative products using amrutham nutrimix and its popularization among young mothers

Under nutrition in children is a widespread health problem in our country. ICDS that addresses the problem of malnutrition has been unsuccessful even after three decades of implementation. Amrutham nutrimix a nutritious supplementary food given for malnourished children is not utilized due to monotony in its preparation. Hence an attempt was made to formulate nutritious amrutham based recipes. Twenty common recipes including sweet dishes and savories were prepared. Acceptability of all the developed products was assessed by a taste panel. Iron and protein content was analysed for the 6 most accepted products. All the formulated products were affordable and ranged from 50p (murukku) to Rs.3/-(sweet balls) per 100g. The recipes were displayed and popularized among young mothers as they are the prime caregivers of young toddlers and are willing to change food behavior for the welfare of their children. Recipes and its health benefits were discussed with the participants. The education program was very effective in imparting nutrition knowledge as there was significance in the pre and post test scores. Hence, amrutham nutrimix can be an affordable and acceptable nutritional substitute to WHO recommended ready to use therapeutic food (RUTF) for Severe Acute Malnutrition (SAM) especially when used in diverse forms as suggested in the current study.


Introduction
Hunger is a global measure of food deprivation, while malnutrition is the physiological outcome of hunger.According to the National Family Health Survey 3 conducted in [2005][2006], 48% of the children under 5 years were chronically malnourished (indicating long term food deprivation) and 43% underweight.In the state of Kerala in India, one-quarter of the children under age five were stunted, 16% wasted and 23 % were underweight (NFHS-3, 2008).The recent global hunger index also seems unpromising as India ranks 55 among 76 countries and the situation is described to be 'serious' (Grebmer et al, 2014).Malnutrition, influenced by economic (rising food prices), social (food taboos), environmental (poor sanitation/ hygiene) and individual (inadequate food intake) factors is an important concern in children under 6 years.Providing special nutrition support can prevent causing irreversible damages that affect their future potential.The ICDS (Integrated Child Development Services) is a flagship welfare program of the Government of India that focuses primarily on early childhood development.In an effort to bridge the gap between the recommended calorie allowance and the average calorie intake of children, nutritional supplements and some food based nutrimixes are distributed to low income families.Currently, about 916 lakh people are receiving nutritional supplement through the ICDS (http://wcd.nic.in/icds.htm).
Locally produced foods are culturally acceptable and have been successful in managing malnutrition in India for many decades (Prasad et al 2009).This was also supported by Dube et al, (2009) who compared the acceptability and energy intake of ready to use therapeutic foods (RUTF) and a cereal pulse based home preparation and reported that the home preparation had better acceptability.
Amrutham is one such supplement that is nutritious, ready to cook and distributed free of cost as a take home ration through anganwadi centres.The supplement consisting of wheat (45%), soyabean (6%), bengalgram (10%), groundnut (10%) and jaggery (25%) (http://www.ruralhealthgoa2012.org) is often prepared as porridges.However this is unappealing to children due to monotony in taste and unattractive appearance.It is not properly consumed, often wasted and used as poultry feed.
Making innovative preparations with amrutham nutrimix could pave way for its better use in future to overcome the problem of malnutrition.Hence the use of locally prepared health mixes like amrutham nutrimix as supplementary food will be an affordable, long-term solution to tackle the problem of undernutrition when compared to the WHO's (World Health Organization) RUTF that are both unaffordable and suited only for short-term use.
Hence an effort was made in this study to formulate nutritious amrutham based recipes and popularize it among young mothers to ensure its efficient use in children.

Preparations using amrutham nutrimix
In the present study, 20 common preparations were chosen.In all preparations, the multigrain amrutham powder was added as a substitute instead of the usually used single grain flours.The recipes were chosen based on the participants' familiarity with the recipes and availability of ingredients (Recipes available as supplementary file).
Amruth Kheer -A dessert made with coconut milk and nutrimix 2.
Ela Ada -Nutrimix spread on banana leaf with a filling of coconut and jaggery 5.
Kumbilappam -A mix of amrutham powder, coconut and jaggery wrapped in fresh bay leaf and steamed 6.
Murrukku -A south Indian savory crunchy wheels made with nutrimix and cumin and sesame seeds 7.
Upma -A mild flavoured tiffin cooked as a thick porridge using nutrimix and mild seasonings 9.
Halwa -Jaggery based sweet Indian dessert 10.Steam Cake -Colourful stacks of powdery nutrimix interlaced with layers of coconut and vegetables 11.Sweet Pidi -Nutrimix balls on thick sugar sweetened porridge 12. Onion Vada -Doughnut shaped deep fried snack with nutrimix and onion 13.Vattayappam -Fermented and steamed dish made with coconut and sugar 14.Idiappam -Nutrimix based steamed noodles topped with fresh coconuts 15.Sweet balls -Sweet balls with nutrimix, coconut and jaggery 16.Pakkavada-Crispy fried ribbons made with nutrimix 17.Idli -A staple fermented South Indian breakfast with nutrimix 18. Mixture -A savory made with extruded nutrimix and fried groundnuts 19.Chocolate shake -A nutrimix based chocolate flavoured milkshake 20.Special Cake-Nutrimix based cake baked with raisins

Selection of panel members
All preparations were standardized in the laboratory.The standardized recipes were subjected to sensory evaluation by panel members that included young mothers.Though the products were intended for young children, they are not capable of scientific evaluation of the products.Hence, their mothers who are the primary care givers and are aware of the likes and dislikes of their children were chosen as panel members.The study was conducted in a semi urban anganwadi centre located in Kottayam District, Kerala, India.Among the 22 young mothers whose children attended the anganwadi centre, 10 were selected as panel members on the basis of their ability to differentiate between samples identified using the triangle test 1 .Willingness of the subjects to participate in the taste panel was obtained.The mothers were in the age of 21 -35 yrs and all belonged to the low socio economic strata.

Sensory evaluation
A well designed score card was used to score all the products.The panel members were asked to evaluate the products on a five point scale for attributes like appearance, colour, texture, flavor and taste.The total scores of the products were calculated and the best six were identified by ANOVA.

Chemical analysis and Nutrient calculation of the selected preparations
Nutritive value of the products for calories, protein, fat, carbohydrate, -carotene, iron and calcium was computed using ICMR values (Gopalan et al, 2002).The protein and iron content of the best six products alone were analyzed using standard colorimetric procedures.Nutrient content of the nutrimix was taken from the nutritional information provided in the label.The cost of the products was also calculated to know its affordability.

Popularization of the products through nutrition education
Mothers are always willing to change food behaviors for the welfare of their children.Hence the selected recipes were popularized among young mothers whose children attended the anganwadi centre.Nutrition education program was conducted to provide awareness about amrutham nutrimix as an important supplementary feed.All the dishes were displayed and method of preparation was explained to them in order to encourage its use in different preparations.Pre and post tests were done using a questionnaire that helped to assess their knowledge regarding supplementary feeds, amrutham nutrimix and its benefits.The impact of the education program was statistically analyzed by t-test.

Organoleptic qualities of the developed products
When the quality of food product is assessed by means of human sensory organs, the evaluation is said to be sensory or organoleptic.Sensory quality is a combination of different senses of perception coming into play in choosing and eating a food.Appearance, flavor and mouth feel decide the acceptance of the food (Srilakshmi, 2012).
Table I shows the results of sensory evaluation of the developed products.

Nutrient content of the selected recipes
The nutrient content of all the products is presented in Table 2.
Products like cake, pidi, vattayappam, kinnathappam kozhukatta were the most calorie dense and provided more than 400 Kcals/100g.Murukku, pakkavada and sweet idli had the highest protein content of 35g/100g.The inclusion of coconut milk to amruth kheer made the product rich in fat (22g/100g) followed by halwa (12g) and pidi (11g).The calcium and iron content in sweet pidi was 320mg and 8.45mg/100g.Steam cake that included green leafy vegetables, carrots and beetroot had very high β-carotene content (970µg/100g).All the developed products contained nutrients that made an appreciable contribution to the daily recommended allowance of preschoolers.

Cost of the products
Almost all the products were prepared using low cost locally available ingredients which are affordable.Cost was calculated based on the prices of raw materials.The cost of the dishes ranges from 50 paise to Rs. 3 per 100 gm.Sweet balls was the most expensive (Rs.3) and idli, murukku, mixture and pakkavada (50 paise) were the least expensive dishes.Figure 1 and 2 shows the cost of the products.

Popularization, nutrition education and its impact
Through the program, mothers were made aware about nutritional needs of children, occurrence and symptoms of malnutrition, need for supplementary foods to tackle malnutrition, amrutham nutrimix and its significance.The products prepared were displayed and popularized during the nutrition education session.A recipe book indicating the proportion of ingredients, method of preparation, yield and serving size was provided to all the participants.The pre and post test scores (Table 3) revealed that the awareness programme conducted was very effective in improving knowledge of the participants about amrutham nutrimix and its nutritional significance in children.

Conclusion
Supplementary feeding activities need to be better targeted towards those who need it most and help parents utilize the services effectively to improve their children's health and nutrition.Amrutham nutrimix, a highly nutritious supplement can help a long way in the treatment and prevention of undernutrition if utilized properly.This study shows that the mix can be incorporated or made into a variety of dishes rather than give it as just porridge.These products, being rich in calories and protein can also be used as a supplementary food for undernourished children.Participation of local self help groups or Kudumbasree units in the preparation and supply of these value added products as ready to eat (RTE) foods can minimize wastage and ensure better utilization by the beneficiaries.Such an arrangement can also empower women as an income generation activity.
Roast amrutham powder and sieve it.Dissolve sugar in luke warm water and allow the yeast to rise.Make smooth batter with amrutham powder, yeast and sugar.Keep it aside for 4 hours or till it ferments into double its volume.Grind coconut, cumin seed and cardamom together.Mix with the fermented batter and salt.Pour the batter in to greased moulds and steam cook till done.

Method
To the Amrutham powder, add ground coconut, cumin powder and mix well to make a dough.Take half of the dough and roll in to small balls.Add more hot water to the rest of the dough and cook till it reaches thick liquid consistency.Add the small balls to the liquid and cook for 5 minutes.Serve hot

Note:
The recipes contained in this supplementary material are to be followed exactly as written.The publisher is not responsible for your specific health or allergy needs that may require medical supervision.The publisher is not responsible for any adverse reactions to the recipes contained in this supplementary material.

Figure 1 :
Figure 1: Costs of various prepared sweet dishes

Table 1 :
Mean scores of sensory evaluation

Table 2 :
Nutrient content of selected preparations

Table 3 :
Impact of nutrition education program MethodRoast amrutham powder and sieve it.Powder cumin seed and cardamom together and mix with amrutham powder.Add sugar, salt and coconut milk and make a thick batter.Pour the batter into greased moulds and steam cook till done.MethodMix all ingredients with water and make thick dough.Roll the bay leaf like a cone and fill it with the dough.Steam cook till done.MethodKnead amrutham powder with other ingredients and make smooth thick dough.Heat oil in a pan.Fill the dough in a murukku press and squeeze the dough in round pattern over a greased plate.Drop it gently into hot oil.Deep fry till light brown and place it on tissue.MethodMake a very smooth paste with Amrutham powder.Add salt and yeast.Leave it overnight for fermentation.Grease idli plates and pour batter.Steam cook till done.MethodMix sautéd onion, salt and curry leaves to the Amrutham powder.Make it into thick dough with water.Place some dough on wet plantain leaf.Flatten with hand and make a hole in the centre.Slide the vada into hot oil.Fry till golden brown.Serve hot.MethodDry roast amrutham powder in a thick bottomed pan.Add water and cook till done.Add milk and sugar and boil for 5 mins.Fry nuts and raisins in ghee and add to the kheer.Sprinkle cardamom powder and mix well.Serve hot.MethodBlend all ingredients together in a mixer and serve chilled.MethodBeat butter and sugar together till fluffy.Whisk the eggs.Fold the amrutham powder with egg and butter mix.Pour in a greased vessel and steam for 45 minutes.MethodMix milk and amrutham powder without any lumps and boil with constant stirring.When the mixture thickens, add carrot puree and sugar and mix well.Add ghee and keep stirring till mixture leaves the sides of the pan.Garnish with fried nuts and raisins.
Method:Heat oil in a pan.Add mustard seeds and sauté ginger, chilly, onion, carrot, beans and curry leaves.Pour half cup water to it and add salt.When water boils, sprinkle the fried Amrutham powder.Stir well to prevent lumps.Add coconut.Cover with the lid and cook it for few minutes.Garnish with coriander leaves.