We considered various ways of supplying a daily, freshly prepared, safe, and palatable portion of food that contained green leafy vegetables, fruit, and milk to women who were living across an urban slum area ∼13 × 13 km. The best solution, after development and pilot testing in a different slum community (Shetanchowki, Mumbai), was snacks that resembled local street foods such as samosas and fritters, which could be filled with the key ingredients, cooked, packaged, and easily transported (13 ).
Treatment snacks contained fresh and dried green leafy vegetables, milk, and dried fruit (Table 1). Green leafy vegetables included spinach, colocasia, amaranth, fenugreek, coriander, shepu, spring onion stalk, and curry leaves. Initially, we used dried green leafy vegetables with the rationale being to provide more micronutrients per unit volume of green leafy vegetables. These vegetables were commercially produced, air-dried at room temperature, and supplied as powders or flakes. However, as the trial progressed, we increased the proportion of fresh leaves purchased from local markets, which improved the palatability without major changes in the nutrient content (Table 2). Dried fruits included figs, dates, raisins, mango, apple, gooseberry, and guava. Milk was included as commercially bought full-fat milk powder. Control snacks were made from low-micronutrient vegetables such as potato, tapioca, and onion, which were purchased from local markets. To avoid monotony for the women, we created 70 treatment and 40 control recipes from these foods of which 8–14 were in use at any time (see Supplemental Table 1 under “Supplemental data” in the online issue). Snacks were made fresh each day in a dedicated study kitchen at the CSSC. Both treatment and control snacks had similar added spices, bindings, and covering ingredients (wheat, rice, or chickpea flour and semolina) and (except for one recipe in each allocation group) were cooked by deep frying in sunflower oil.
We aimed to improve diet quality rather than specific nutrient intakes by raising intakes of green leafy vegetables, fruit, and milk. On average, treatment snacks contained 10–23% of the WHO/FAO recommended Reference Nutrient Intakes for β-carotene, riboflavin, folate, vitamin B-12, calcium, and iron (Table 2) (15 ). Snacks were tested approximately every 6 mo for micronutrient contents (Eclipse Ltd), and microbiological contamination (coliforms and aflatoxin; Intertek Testing Services) with consistently negative results.
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