Precision Nutrition for Population Health
by Jackie Swift
“Malnutrition, both over- and undernutrition, is the leading risk factor for morbidity and mortality globally,” says Saurabh Mehta, Nutritional Sciences. “At the same time, nutritional status may be more amenable than other risk factors to modification at both the individual and the population level.”
Mehta is a physician with expertise in epidemiology, nutrition, and infectious disease. He focuses a major part of his public health research on nutrition and the interplay between nutrition, inflammation, and infection. “Whether you are considering cancer or an infection, nutrition and inflammation are central,” he says. “Our bodies produce and regulate, to a certain extent, the flow of nutrients and inflammatory molecules based on whether or not a disease state or threat exists. In an ideal setting, this regulation creates an environment that is hostile to the invading pathogen or the disease process.”
NutriPhone and FeverPhone: Testing Made Easy
A major focus of the Mehta group is the development of field-friendly methods to detect micronutrient status, inflammation, and infection at the point of care. Mehta and David Erickson, Mechanical and Aerospace Engineering, have developed a diagnostic platform for nutrition and infection known as NutriPhone (which assesses nutritional biomarkers) and FeverPhone (which diagnoses infections). Health-care workers can use the platform to test for nutritional deficiencies and various pathogens in a few minutes in clinical or field settings.
“When David and I started collaborating almost 10 years ago, we mapped out a shared vision for our platform,” Mehta says. “The platform needed to be low cost and to require minimal infrastructure, sample volume, and training. But it also had to be able to perform multiple functions because one of the problems in global health diagnostics is that there are hundreds of different tests designed by different companies, all with different readers that are not compatible with each other.”
With funding from the National Institutes of Health (NIH) and the National Science Foundation, Mehta and Erickson have developed their platform over the years, increasing its applications in the field. Some of the validation work is ongoing with Mehta’s collaborators in Ecuador. “Our platform is adaptable. We have made it work with many gold-standard laboratory tests,” Mehta says. “One of the current challenges is to figure out the different matrices that we can use the platform for: We can test serum, but can we test saliva? Can we test breast milk? What about urine?”
Recently the researchers were awarded a $100 thousand NIH Technology Accelerator Challenge prize for a concept to measure iron deficiency, inflammation, and malaria, at the same time, using a small amount of saliva.
Biofortified Crops for Improved Mother and Child Health
The Mehta group also focuses on developing interventions to improve the health of vulnerable populations, including pregnant women and young children, and emphasizes real-world impact. The researchers recently completed two randomized trials — one in the urban slums of Mumbai and one in southern India — evaluating the efficacy of biofortified staple crops to improve child health, nutrition, and immune function. The crops were selectively bred to have several-fold higher micronutrient content than conventional varieties.
“Our goal is to deliver 50 to 70 percent of the children’s daily requirement for key micronutrients through biofortified crops.”
In the first trial in Mumbai, researchers supplemented the diets of children 12 to 18 months old with biofortified pearl millet that contains four- to five-times higher iron and two-times higher zinc than conventional crops. For the second trial in southern India, the researchers developed a complementary feeding menu for breastfeeding women and their children. This randomized efficacy trial focused on multiple biofortified crops, including biofortified pearl millet, orange-fleshed sweet potato, and wheat.
“Our goal is to deliver 50 to 70 percent of the children’s daily requirement for key micronutrients through biofortified crops,” Mehta says. “We are looking at the impact of these crops on child growth, development, immune function, and gut microbiome.”
Sustainable Interventions, Local Involvement
These trials aim to inform sustainable interventions to improve child health and nutrition that include multiple stakeholders and prioritize local involvement, Mehta explains. The biofortified crops are grown by farmers in India, and the potential food items are evaluated for acceptability in the population before they are included as complementary foods. The researchers have also partnered with local, small-scale producers and a centralized kitchen to deliver food multiple times a day to mother-child pairs.
Ideally, Mehta says, these interventions could become part of India’s Integrated Child Development Services (ICDS) program, where qualifying families can access everything from foods to vaccines locally. This program already provides supplemental nutrition services to millions of children every day.
“If we can demonstrate that biofortified crops have an impact on children’s health, then these interventions could be scaled up to national public health programs,” Mehta explains. “If the Indian government integrates biofortified crops into the ICDS program, and acceptability and yield are high, then farmers would be more likely to grow them. This could translate to improving the health of millions of children accessing this program on a daily basis.”
Sharing Expertise with WHO
Mehta and his research team also work with colleagues at the World Health Organization (WHO) to synthesize evidence and translate it into guidelines and policy. Mehta has served as an external expert on WHO guidelines for infant feeding, emerging infections, and nutrition, and the Mehta group collaborates with colleagues at WHO to conduct systematic research reviews. Their input informed the organization’s recommendations relating to breastfeeding and potential transmission of infections, including Zika virus, Ebola virus, and SARS-CoV-2, the virus that causes COVID-19. “It’s a more downstream application to ensure that — based on the currently available best evidence — if something can be done today, it is done today,” Mehta says.