Nutrition & Food Science Sensory attributes and acceptability of complementary foods fortified with Moringa oleifera leaf powder Laurene Boateng, Eunice Nortey, Agartha N. Ohemeng, Matilda Asante, Matilda Steiner-Asiedu, Article information: To cite this document: Laurene Boateng, Eunice Nortey, Agartha N. Ohemeng, Matilda Asante, Matilda Steiner-Asiedu, (2019) "Sensory attributes and acceptability of complementary foods fortified with Moringa oleifera leaf powder", Nutrition & Food Science, Vol. 49 Issue: 3, pp.393-406, https://doi.org/10.1108/ NFS-07-2018-0192 Permanent link to this document: https://doi.org/10.1108/NFS-07-2018-0192 Downloaded on: 27 May 2019, At: 07:48 (PT) References: this document contains references to 54 other documents. 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Downloaded by University of Ghana At 07:48 27 May 2019 (PT) The current issue and full text archive of this journal is available on Emerald Insight at: www.emeraldinsight.com/0034-6659.htm Sensory attributes and Moringaoleifera leaf acceptability of complementary powder foods fortified with Moringa oleifera leaf powder 393 Laurene Boateng Received 6 July 2018 Department of Nutrition and Dietetics, University of Ghana, Accra, Ghana Revised 30 August 2018Accepted 30 August 2018 Eunice Nortey Department of Nutrition and Dietetics, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana Agartha N. Ohemeng College of Basic and Applied Science, University of Ghana, Accra, Ghana Matilda Asante Department of Nutrition and Dietetics, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Legon, Ghana, and Matilda Steiner-Asiedu Department of Nutrition and Food Science, University of Ghana, Legon, Ghana Abstract Purpose – Inadequacies in several micronutrients in complementary foods, notably iron, zinc, calcium, vitamin A, vitamin B6 and riboflavin have been reported. Moringa oleifera leaf powder (MLP), prepared from dried moringa leaves is nutrient-rich and has been explored for the treatment of micronutrient deficiencies among children in developing countries. This increasing interest in the use ofmoringa oleifera leaves to improve complementary foods notwithstanding, the unique sensory characteristics of the leaf powder potentially holds implications for the acceptability of local diets that are fortified with it. The purpose of this paper is to investigate the levels of MLP fortification that are most acceptable for feeding infants and young children. Design/methodology/approach – The authors performed a review of the literature, with the aim of investigating the sensory attributes and acceptable levels of fortification of complementary food blends fortified with different levels of MLP. Findings – The minimum amount of MLP to be added to a complementary food blend to observe significant improvements in its nutritional value was estimated to be about 10 per cent. However, at this 10 per cent fortification level also, sensory attributes of the products begin to become less desirable. Practical implications – For the success of nutrition interventions that involve the use of MLP to improve the nutritional quality of complementary foods, there is a need to consider the acceptability of the sensory attributes of the formulated blends in the target group. Safety of MLP as an ingredient in infant foods must also be investigated. Originality/value – The authors of this paper make recommendations for the use of MLP to fortify complementary foods to ensure its success as a food fortificant in nutrition interventions. The researchers are not aware of any published study that focuses on this subject. Keywords Malnutrition, Micronutrients, Acceptability, Complementary foods, Nutrition & Food ScienceVol. 49 No. 3, 2019 Moringa oleifera leaf powder pp. 393-406© EmeraldPublishingLimited 0034-6659 Paper type Literature review DOI 10.1108/NFS-07-2018-0192 Downloaded by University of Ghana At 07:48 27 May 2019 (PT) NFS Introduction 49,3 Inadequate intake of micronutrients is recognized as an important contributor to the global burden of disease through increased rates of illness and death from infectious diseases and of disability such as mental impairment (Black, 2003). Deficiencies of vitamin A, iron, iodine and zinc among children are the most devastating in terms of impaired development and mortality (Hall et al., 2001). UNICEF (2016) reports that millions of children suffer from 394 stunted growth, cognitive delays, weakened immunity and disease as a result of micronutrient deficiencies. Vitamin A deficiency affects about one-third of children living in low- and middle-income settings, mainly in sub-Saharan Africa and South Asia and more than 40 per cent of children under five in developing countries are anaemic (UNICEF, 2016). In Ghana, the recent Demographic and Health Survey report indicated that 19 per cent of the infants and young children under five years of age in Ghana are stunted and 5 per cent are wasted, whilst 66 per cent of them have varying forms of anaemia (Ghana Statistical Service, 2015). Thus, undernutrition continues to be a challenge that needs to be addressed. In developing countries, complementary foods that are deficient in both macronutrients and micronutrients coupled with a high burden of infections during complementary feeding period (from age 6-24 months) are major underlying causes of child malnutrition (Dewey and Vitta, 2013). Inadequacies in several micronutrients in complementary foods, notably iron, zinc and calcium, vitamin A, vitamin B6 and riboflavin, have been reported (Gibson, 2011). In the rural settings of Ghana (and much of West Africa), porridge prepared from unrefined cereals such as maize, millet or sorghum is usually the first complementary food. These unrefined cereals have high levels of anti-nutrients which inhibit the absorption of micronutrients, thus resulting in malnutrition (Amagloh et al., 2012). Improving the quality of diets of infants and young children during the complementary feeding period is one of the most cost-effective strategies for improving health and reducing morbidity and mortality (Krebs and Hambidge, 2007). Two main ways to provide additional nutrients to this target group of young children (6-23month) are fortification and supplementation (de Pee and Bloem, 2009). Distribution and sustainability of supplementation programmes, however, remain an issue in poor resource settings. Thus, food-based approaches including fortification, improving dietary quality through diversification/modification and nutrition education and bio-fortification are increasingly being pursued (Gibson, 2011). Fortification can be carried out in different ways, including home fortification, where a small amount of powder or spread is added to a home-prepared meal (de Pee, 2015). Dewey and Vitta have proposed the promotion of increased intake of key nutrients from local foods, including certain indigenous foods that are currently under- utilized as complementary foods, to ensure adequate nutrient intake among infants and young children (Dewey and Vitta, 2013). Moringa oleifera, one such edible plant, has been shown to be a rich source of micronutrients that could be included in infant complementary foods. Moringa oleifera, Lam (Syn M.pterygosperma Gaertn) usually referred to in the literature as Moringa, is naturally occurring, as well as a cultivated variety of the genus Moringa belonging to family Moringaceae. Moringa oleifera is the most widely cultivated pan-tropical species of theMoringaceae family, which is native to the sub-Himalayan tracts of India, Pakistan, Bangladesh and Afghanistan, and is known by such regional names as benzolive, drumstick tree, kelor, marango, mlonge, mulangay, nébéday, saijhan and sajna (Dhakar et al., 2011). Moringa is a drought-tolerant tree that tolerates a wide range of environmental conditions (Saint Sauveur, 2001). The leaves, pods, seeds, gums, bark and flowers of moringa are reportedly used in more than 80 countries to treat mineral and vitamin deficiencies, support a healthy cardiovascular system, promote normal blood- Downloaded by University of Ghana At 07:48 27 May 2019 (PT) glucose levels, neutralize free radicals, provide excellent support of the body’s anti- Moringa flammatory mechanisms, improve anaemia and support the immune system (Mahmood oleifera leaf et al., 2010). Several reports on the nutritional qualities ofmoringa currently exist in both the scientific and the popular literature, and virtually, every part of the tree is beneficial in some powder way to both rural and urban populations (Dhakar et al., 2011). Several studies have investigated the nutrient content ofMoringa oleifera leaves in particular (Asante et al., 2014; Garba et al., 2015; Moyo et al., 2011), with impressive results with respect to its nutritional potential. Available data suggest that the leaves contain highly digestible proteins and are 395 rich in vitamin A, iron, calcium, vitamin C and other carotenoids (Dhakar et al., 2011). The leaves have also been explored for the treatment of micronutrient deficiencies among children in Malawi and Tanzania (Babu and Rajasekaran, 1991; Rweyemamu, 2006). Glover-Amengor et al. (2017) reported that the leaves of Moringa oleifera could be harvested and cheaply dried with solar dryers and milled to form a powder that could be stored for use in rural households. In some developing countries, there is currently an increasing interest in the use of Moringa oleifera leaf powder (MLP) to fortify complementary foods, and several studies have reported a marked improvement in the nutrient composition of complementary foods fortified with MLP (Steve and Babatunde, 2013; Isingoma et al., 2015; Odinakachukwu et al., 2014; Shiriki et al., 2014). This increasing interest in the use of Moringa oleifera leaves to improve complementary foods, notwithstanding the unique sensory characteristics (colour, taste and odour) of the leaf powder potentially holds implications for acceptability of local diets that incorporate the leaf powder. Food acceptance plays a crucial role in the success of nutrition interventions that seek to introduce new food commodities (Babu and Rajasekaran, 1991). For a nutrition intervention to be successful, most consumers in the target populations (in this case infants and young children) must accept and consume the food commodities in quantities sufficient to improve their nutritional health (Miller and Welch, 2013). Oyeyinka and Oyeyinka (2018) have, however, reported in their review paper which focuses onmoringa as a food fortificant that, the acceptability and sensory characteristics of foods decrease with increasing MLP supplementation. Children who are the target of complementary feeding interventions have been shown to like sweet tastes and dislike bitter tastes and tend to eat more of foods they like (Drewnowski, 1997). The above findings give an indication that, despite their improved nutritional quality, increasing levels of MLP could reduce the acceptance of MLP-fortified foods (Gebretsadikan et al., 2015) and potentially affect the success of MLP complementary feeding nutrition interventions. Thus, the authors of this paper reviewed the literature on the sensory evaluation of complementary foods fortified with MLP, with the aim of investigating the levels of fortification that are most acceptable for feeding infants and young children. Methods A search in Google Scholar was performed with keywords such as “Moringa Oleifera leaf powder”, “complementary food”, “acceptability”, “sensory evaluation” and “malnutrition”. The bibliographies of the articles on hand were used to find other references. Studies that formulated complementary food blends for infant porridges using MLP as a fortificant and further investigated the sensory profile/acceptability of the formulated foods were included in the study. The authors identified seven studies (including one study that usedMoringa stenopetala) that focused on the sensory evaluation of complementary foods that had been formulated with MLP. The details of the seven studies are summarized in Table II. Eight other studies Downloaded by University of Ghana At 07:48 27 May 2019 (PT) NFS which reported the sensory profiles of other food products like bread and cookies which 49,3 could potentially be used as complementary foods for older infants were also identified and included in the review (Table III). Nutritional potential of MLP in complementary foods Moringa oleifera has been given a lot of attention as a nutrient source and has been studied 396 more than many other plants (Witt, 2013). The leaves, fruit, flowers and immature pods of this tree are used as a highly nutritive vegetable in many countries, particularly in India, Pakistan, Philippines, HI and many parts of Africa (Mishra et al., 2012). The dried leaves in particular are concentrated sources of valuable nutrients and can be cheaply produced and stored for use in low-resource settings (Glover-Amengor et al., 2017). Dewey et al. (2009) have also reported that home fortification of complementary foods, also referred to as “point- of-use” fortification, is a promising strategy that is able to deliver the appropriate amount nutrients for children 6-24 months without making major alterations to their diet (Dewey et al., 2009). MLP is a nutritious product that can be used at home to fortify the diets of infants and young children. Virtually, all children are introduced to some kind of porridge when they start complementary feeding, often based on the local staple food. Thus, safely produced and fortified porridges can fit well with existing food consumption practices and enable feeding of an adequately nutritious meal to children (de Pee and Bloem, 2009). There has been a recent interest in the promotion of MLP as a nutritionally valuable ingredient in complementary foods (Isingoma et al., 2015; Odinakachukwu et al., 2014; Shiriki et al., 2014; Steve and Babatunde, 2013). Witt (2013) pooled together the findings of several studies that investigated the nutritional value of MLP and determined the contribution of 5 g of the product to diets of children aged 1-3 years, a summary of which is reported in a Table I. The study found a wide variability in the nutrient content of both the fresh and dried leaves and recommended that nutrition intervention studies that intended to include Moringa oleifera as part of supplemental feeding programs, need to analyse samples periodically throughout the program to ensure that planned nutrient targets are being met continuously (Witt, 2013). Sensory characteristics of MLP Recent studies have mainly focused on the nutritional quality of Moringa oleifera leaves, regardless of the complexity of the food matrix of recipes in which they are involved (Mawouma et al., 2017). Sensory responses to the taste, smell and texture of foods help determine food preferences and eating habits (Drewnowski, 1997). A recent study by Ramaroson et al. (2015) investigated the role of languages in consumers’ description of six samples of Moringa leaf powder sourced from five regions in Malaysia. The authors of the study required two groups of assessors (each group spoke a different language) to spontaneously generate descriptors for the appearance, taste and aroma/flavour of MLP among other sensory attributes. The descriptors for appearance generated by both groups included “green”, “yellow” and “dried leaves”. Descriptors generated for taste included “bitter”, “tasteless”, “sour”, “astringent”, “hot”, “aftertaste”, whilst descriptors generated for odour/aroma included “dry leaves”, “cassava leaves”, “raw”, “acid”, “dryfish/shrimp” and “fermented/rotten”(Ramaroson et al., 2015). This study gives an indication of generally undesirable descriptions of the sensory attributes of MLP, and these attributes are conferred onto products to which MLP is added. This review focused on seven studies that investigated the sensory profiles of complementary food blends fortified with MLP (Table II). Specifically, the sensory characteristics of flavour and colour are highlighted. Downloaded by University of Ghana At 07:48 27 May 2019 (PT) Moringa Nutrient content ofMoringa Recommended oleifera nutrient intake (%) of recommendation provided oleifera leaf 5 g (1 Tbsp) 20g (1 cup) 5 g (1 Tbsp) 20 g (1 cup) powder Moringa leaf freshMoringa 1-3-year-old Moringa leaf freshMoringa Nutrient powder leaves children powder leaves Energy 15.2 kcal, 0.064 17.3 kcal, 0.072 1,098 kcal, 4.6 1 2 (kcal, MJ) MJ MJ MJ 397 Protein (g) 1.2 1.76 13 9 14 Fibre, total dietary (g) 2.0B 1.3B 19 11 7 Ca (mg) 95 106B 700 14 15 Mg (mg) 23.65B 5.2-30.2B 80 29 6.5-38 Fe (mg) 1.625B 2.16 7(14)C 23(12)C 31(15)C Zn (mg) 0.12 0.06-0.26B 3(6)C 4(2)C 2(1)C Thiamine (mg) 0.13B 0.05B 0.5 26 9 Riboflavin (mg) 0.06-1.0B 0.15B 0.5 12-200 29 Niacin (mg) 0.41B 0.74B 6 7 12 Vitamin B6 (mg) 0.12B 0.24B 0.5 24 48 Folate (mg) 27B 41 150 18 27 Vitamin A 182B 258 300 61 86 Table I. (mg, RAE) A Contribution of Vitamin C 8.6 32.4 15 57 216 Fresh and dried (mg) moringa oleifera Vitamin E (mg) 2.8-5.6B 5 6 46-93 83 leaves to the nutrient Notes: ATable used with permission from Witt, 2013; Bfor these nutrients, the amount of data were limited needs of children or data were highly variable; Cthe value provided in parenthesis is for vegetarians aged 1-3 years Flavour of complementary foods formulated with MLP Flavour, an important component in the acceptance of foods, is a combination of the senses of taste, aroma and mouth feel (Singh-Ackbarali and Maharaj, 2014). Taste is an important influential factor in a person’s selection of a particular food. Clark cites a study that investigated infants’ reactions when they were given solutions of sweet and bitter compounds. In this study, Clark notes that, in response to tastes that were sweet, children exhibited a facial acceptance response that included large eyes and a retraction of the mouth, in such a manner as to resemble a smile (Clark, 1998). Bitter tastes, however, elicited an entirely different response with infants tightly shutting their eyelids, gaping at the mouth and suddenly turning their heads, indicative of dislike for the taste of the test food (Clark, 1998). Clark concluded from these findings that, from an early age, human behaviour towards foods seems to be strongly influenced by the effects of taste and flavour (Clark, 1998). In six of the seven studies presented in Table II, the mean scores for taste were inversely related to the moringa levels in the porridges (Abioye and Aka, 2015; Gebretsadikan et al., 2015; Olaitan et al., 2014; Olorode et al., 2013; Ukey et al., 2014; Ntila et al., 2018). Olorode et al. (2013) attributed this trend to the “leafy taste” of MLP, Gebretsadikan et al. (2015) attributed it to the “herbal flavor” of MLP, whilst Ntila et al. (2018) attributed it to the “bitter taste” of porridges to whichMLP had been added. Colour of complementary foods formulated with MLP Extensive research has confirmed the importance of colour in taste recognition and intensity, flavour detection and recognition and in food preference and food acceptability (Imram, 1999). Colour is a strong indicator of the acceptability of a product because a small Downloaded by University of Ghana At 07:48 27 May 2019 (PT) NFS 49,3 398 Table II. Summary of sensory evaluation studies of complementary food blends fortified with MLP Downloaded by University of Ghana At 07:48 27 May 2019 (PT) Ingredients and Fortification level Fortification level Authors’ description of MLP for overall least for overall most recommendation of Country/ complementary foods to Description of Use of control fortification acceptable MLP acceptable MLP acceptable MLP No. Authors Year which MLP was added sensory panel (0%MLP) range (%) formulation (%) formulation (%) fortification levels (%) 1 Nigeria/ 2015 Fermented maize flour, Trained panel of Yes 10-15 15 10 10 Abioye and used to make a porridge 10 university Aka called “Ogi” students 2 Nigeria/ 2013 Fermented maize flour, Panel of 50 Yes 5-25 25 5 10 Olorode et al. used to make a porridge university staff called “Ogi” and students 3 Nigeria/ 2014 Millet flour, used to make Semi-trained Yes 2.5-10 10 2.5 Not reported Olaitan a porridge panel of 14 mothers 4 India/ Ukey 2014 Soybean flour and barley Not reported Yes 5-15 15 5 5 flour used to make a weaning food 5 * Ethiopia/ 2015 Orange flesh sweet potato Untrained panel No 5-10 10 5 5-8 Gebretsadik- and soybean flour of 50 town an composite, used to make residents porridge 6 Ghana/ 2 Porridges made from Semi-trained No 10-15 10 15 15 Boateng cereal–legume blends panel of 36 infant et al. and caregiver dyad 7 South 2018 Porridges made from Panel of 120 Yes 1-3 1 3 1 Africa/ Ntila maize meal caregivers of et al. children aged 7- 12 months Notes: *This study usedMoringa stenopetala for fortifying the complementary food blend. w/w – weight by weight improvement in colour rating can result in a big difference in the acceptability of the product Moringa (Gebretsadikan et al., 2015). oleifera leaf In the studies presented (Table II), the deep green colour of the porridges resulting from the addition ofmoringa leaf powder was reported to be one of the underlying reasons for the powder decrease in acceptability of the formulated foods, as the levels of MLP increased. Olorode et al. (2013) reported that the green colour is contrary to the normal white or yellow colour of maize “Ogi”, whilst Gebretsadikan et al. (2015) reported that an increase in the proportion of moringa led to poor acceptability due to the amplification of unfamiliar green colour of the 399 porridge. Overall acceptability of complementary foods formulated with MLP As with the other sensory attributes, the overall acceptance was inversely related to MLP levels in the porridges in majority of the summarized studies. TheMLP fortification levels of the complementary foods ranged from 1 to 25 per cent. The most acceptable levels of fortification ranged from 1 to 15 per cent, with three out of the five studies reporting 5 per cent fortification level as the most acceptable. The least acceptable fortification levels ranged from 3 to 25 per cent. The authors recommended a fortification level of between 1 and 15 per cent for the formulation of an acceptable product. Each of the studies (with the exception of the study by Boateng et al., 2017) used a control porridge which had 0 per cent MLP. The sensory characteristics of MLP-fortified porridges differed markedly from the controls as fortification of MLP increased. The summarized studies (Table II) appear to give an early indication that the minimum amount of MLP to be added to a product to observe significant improvements in its nutritional value is about 10 per cent. However, at this 10 per cent fortification level also, the sensory attributes of the products begin to become less desirable. Acceptability of other foods fortified with MLP Baked snack foods such as bread and cookies are widely consumed in every part of the world and have become an attractive target for feeding and nutrition improvement programmes among low-income groups and disaster-relief agencies (Mouminah, 2015). Table III summarizes the results of sensory evaluation studies that involved the fortification of these products with MLP. Similar trends were observed for these foods as with the complementary food blends. An exception was the study by Premi and Sharma (2014) in which fortified cookies with MLP at 0, 10, 20 and 30 per cent were subjected to organoleptic evaluation. The cookies fortified with 20 per cent MLP were found to be most acceptable in terms of appearance, taste, texture and overall acceptability even when compared to all the other formulations, including the control. This finding was inconsistent with the other reported studies (Table III). In spite of the inverse relationship between MLP fortification levels and sensory attributes of the food products, all the studies presented (Dachana et al., 2010; El-Gammal et al., 2016; Kar et al., 2013; Manaois et al., 2013; Mouminah, 2015; Odinakachukwu et al., 2014; Premi and Sharma, 2014), with the exception of the study, recommended the inclusion of MLP at various levels in formulating the food products, because of the nutritional benefits. Sengev et al. (2013), however, concluded that, despite the high nutrient content of Moringa oleifera powder, it is not a good substitute for wheat in bread production due to the reduction in its physical characteristics and sensory attributes. The way forward The use of uncommon crops like the leaves of Moringa oleifera for complementary food fortification would have an impact on their sensory attributes and may be difficult to accept Downloaded by University of Ghana At 07:48 27 May 2019 (PT) NFS 49,3 400 Table III. Summary of sensory evaluation studies of other food items fortified with MLP Downloaded by University of Ghana At 07:48 27 May 2019 (PT) Ingredients and description of Fortification level Fortification level Authors’ complementary MLP for overall least for overall most recommendation of Country/ foods to which Description of Use of Control fortification acceptable MLP acceptable MLP acceptable MLP No. Authors Year MLP was added sensory panel (0%MLP) range (%) formulation (%) formulation (%) fortification levels (%) 1 Egypt/ El- 2016 Wheat flour, Panel of 15 Yes 5-20 20 5 5-10 Gamal used to bake pan university staff bread members 2 Nigeria/ 2013 Wheat flour, Not reported Yes 1-5 5 1 Not reported Sengev used to bake bread 3 India/ 2010 Wheat flour, Trained panel Yes 5-15 15 5 10 Dachana used to bake of 16 baking et al. cookies technologists 4 India/ 2013 Wheat flour used Panel of 20 Yes *5 – one – – 5 Kar et al. to bake biscuits university staff fortification members level only 5 Saudi 2015 Wheat flour, Panel of 10 Yes 5-15 15 5 10 Arabia/ used to bake judges Mouminah cookies 6 India/ 2014 Wheat flour, Trained panel Yes 10-30 10 20 20 Premi used to bake of 10 judges cookies 7 Pakistan/ 2013 Whey-based Trained panel Yes 1-5 5 1 and 2 4 Nadeem drink of 10 judges 8 Philippines/ 2013 Rice flour used to 36 grade-six Yes 1-5 5 1-2 1-2 Manaois make rice pupils 11-12 et al. crackers years 30 staff of a rice company in the short term because of the tendency to adopt specific crops for porridge processing by Moringa any given community (Gebretsadikan et al., 2015). The findings of this review indicate that, oleifera leaf despite the high nutrient content of MLP, it may not be successful in improving the nutritional status of infants in low-resource populations, if the new foods are not accepted by powder the target consumers. The authors thus make a number recommendations for consideration in the use of MLP to fortify complementary foods:  The need for acceptability trials: Acceptability of complementary food blends 401 fortified with MLP will need to be investigated with extensive acceptability trials that include a component where mothers are required to feed the formulated products to their children under home conditions for extended periods. Wardle et al. (2003) have reported that repeated exposure to the taste of unfamiliar foods is a promising strategy for promoting liking of previously rejected foods in children. Considering the uniqueness of the sensory attributes of MLP complementary food blends, one-time sensory or organoleptic evaluations may not be enough to determine the acceptability of the fortified foods.  In this review, it can be observed that, although the formulated complementary foods were intended for infants and young children, majority of the panels that took part in the sensory evaluation were adults. Furthermore, only three of the seven studies reported (Olaitan et al., 2014; Boateng et al., 2017 and Ntila et al., 2018) used panels of mothers and infant caregivers, (the most appropriate population to determine the acceptability of complementary food), for the sensory evaluation. The study by Boateng et al. (2017), which is the only study that included infants on the sensory panel, concluded that MLP used either as part of a formulated cereal– legume blend or as a supplement which was added to infants’ usual diets were well accepted by infants and their caregivers in the population studied (Boateng et al., 2017). More rigorously designed acceptability trials involving mother–infant pairs and lasting for extended periods are urgently needed to help ascertain the minimum levels of incorporation of MLP that will be both acceptable and nutritionally beneficial to the target population.  Exploring the use of alternative forms of the formulated foods such as fermented products; a study by Isingoma et al. (2015) aimed to improve the nutritional value and safety of finger millet porridges using Moringa oleifera, Cucurbita maxima and lactic acid fermentation. Two types of porridge products were produced (one type fermented and the other unfermented) and subjected to sensory analysis. The results of the study indicated that majority of the mothers preferred the flavour of fermented porridges to non-fermented porridges. Mothers also showed higher preference in taste, colour and acceptability of fermented Moringa oleifera- and Cucurbita maxima-fortified finger millet porridges than the non-fermented ones. It will be beneficial to ascertain this finding by conducting further studies, as this may be an alternative way of improving the acceptability of moringa-fortified porridges. The effect of fermentation on the nutritional quality of the MLP-fortified foods must also be investigated.  Exploring the incorporation of MLP in other types of foods aside porridges; the authors of this review recommend that, to extend the nutritional benefits of MLP, the use of other dishes in which the leaf powder can be added in substantial quantities without adversely affecting the sensory attributes should be explored. Glover-Amengor et al. reported that, in a rural community in Ghana, Moringa Downloaded by University of Ghana At 07:48 27 May 2019 (PT) NFS oleifera leaves are eaten mostly in stews and soups (Glover-Amengor et al., 2017). 49,3 These and other yet-to-be-explored food alternatives fortified with MLP may be more acceptable to infants and young children than complementary food blends.  Incorporation of dietary components that will enhance the sensory attributes of the MLP-fortified complementary food blends is another option that can be explored; the study in Ethiopia (Table 2) that aimed to develop nutritionally enriched and 402 palatable complementary food products for Ethiopian mothers from orange flesh sweet potato (OFSP), soybean and moringa leaf powder blends found that, in general, the fortified porridges processed from high OFSP and/or soybean proportions with less moringa received the highest overall acceptability products (Gebretsadikan et al., 2015). In this review also, the overall acceptance was inversely related to the moringa levels in the porridges. However, the researchers reported that the acceptability of moringa-fortified food products could increase with OFSP supplementation because of its sweet nature that has a masking effect on the undesirable taste and odour of the MLP-fortified products (Gebretsadikan et al., 2015).  Using other parts of theMoringa oleifera plant. A study in Nigeria that explored the use of Moringa oleifera flower powder in the fortification of complementary foods showed that the proximate composition and organoleptic properties of cereal such as maize, millet and others could be enhanced through the addition of flour made from the flowers ofMoringa oleifera (Arise et al., 2014). In this study, the ratings for the taste and flavour increased with increasing level of inclusion ofMoringa oleifera flower powder (Arise et al., 2014), contrary to what is observed for the MLP-fortified foods. These findings indicate that the flower powder could be used instead of the leaf powder to fortify complementary food blends.  Safety of MLP as an ingredient in complementary foods: A number of studies have investigated the safety and toxicological aspects relating to the use of moringa leaves as a source of nutrients. The findings of an animal study by Villarruel-Lopez et al. (2018) revealed no lethal dose and no significant differences in genotoxicity parameters at the tested doses. Another animal study by Moodley (2017) indicated that oral administration of MLP up to 2,000 mg/kg body weight showed no changes in clinical signs or gross pathology and that the LD50 was greater than 2,000 mg/ kg. Owusu-Ansah et al. (2011) estimated hazard indices from the mineral composition of moringa leaves. Their findings indicated that there was no toxicity potential associated with the use of moringa leaves; however, the researchers recommended strict adherence to nutritionists’ recommended dosage to avoid risk of overdosing of metallic minerals (Owusu-Ansah et al., 2011). This recommendation is especially useful when considering the use of moringa leaves as an ingredient in fortifying foods of infants whose bodies are at crucial stages of development. A study by Olawoye et al. (2018) also revealed that there was a pharmacokinetic interaction between amodiaquine, a popular drug for the treatment of malaria, and MLP when given together or following a long period of ingestion of MLP (Olawoye et al., 2018). This finding is particularly important, as it indicates that the presence of MLP may alter the amount of amodiaquine absorbed, thus resulting in either sub- therapeutic or toxic serum levels (Olawoye et al., 2018). Given that MLP is being considered for use in infant and young child populations in low-resource settings where malaria is likely to be endemic, there is a high possibility of simultaneous administration of MLP with anti-malarials with little known ramifications, if infants Downloaded by University of Ghana At 07:48 27 May 2019 (PT) are fed with complementary foods fortified with MLP. There is a need for further Moringa investigation on the safety and toxicological aspects of the use of MLP, particularly oleifera leaf as an ingredient to fortify foods of infants in low-resource settings. powder Conclusion There is no doubt that the addition of the nutrient-rich MLP to complementary foods in sufficient quantities will significantly improve their nutritional value. Despite the high 403 nutrient content of MLP, it may not be successful in improving the nutritional status of infants in low-resource populations if the target consumers do not accept the new foods. Formulating complementary foods fortified with MLP to meet the nutritional needs of infant and young children in low-resource settings, however, is only one of many factors that could lead to improved infant and young child nutrition. Consumer acceptability of the fortified foods is key in the entire fortification process. To ensure success, nutrition interventions that involve the incorporation of indigenous foods like MLP to improve nutritional quality of complementary foods should necessarily consider the acceptability of the sensory attributes of the formulated blends in the target group. Well-designed acceptability trials, involving mother–infant pairs and lasting for extended periods, are urgently needed to help ascertain the minimum levels of incorporation of MLP that will be both acceptable and nutritionally beneficial to the target population. Safety and toxicological studies are also needed. References Abioye, V.F. and Aka, M.O. 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