Effects of Chinsaga (gynandropsis gynandra) on haematological profile and markers of iron metabolism in Kenyan breastfeeding women
Introduction: Chinsaga (Gynandropsis gynandra (L.)) is a leafy vegetable indigenous to Africa, and is an important component of the traditional diet of the people of western Kenya such as the Abagusii, who refer to it as Chinsaga. The Abagusii believed Chinsaga has powerful blood restorative properties, and is recommended for pregnant and lactating women as a hematinic and immunostimulant. Objective: This study sought to provide scientific validation for the traditional use of Gynandropsis gynandra (L.) among the Kisii community (Abagusii) in promoting maternal and child nutrition. This was done by assessing the impact of Gynandropsis gynandra (Chinsaga) consumption on the hematological profile and selected iron metabolism biomarkers among lactating women at Kenyatta National Hospital as indicators of nutritional status. The study also aimed at documenting the socioeconomic value of Chinsaga and chromatographic characterization of the plant sourced from Kilgoris and Kisii. Methodology: A cross-sectional survey was undertaken to examine the socioeconomic value and trade of Chinsaga in Kisii and Kilgoris followed by plant collection and processing to provide material for a clinical study. A sample of the processed material was subjected to chromatographic characterization using Thin Layer (TLC) and High Performance Liquid (HPLC) Chromatography. The study was reviewed and granted ethics approval by the Kenyatta National Hospital – University of Nairobi Ethics and Research Committee (KNH-UoN ERC), reference number: KNH-ERC/01/3757. A randomized triple blind controlled study was carried out at Kenyatta National Hospital Maternal Child Health Clinic 17. The study enrolled 119 women below 35 years of age, with a maximum of 4 live births and between their first and second month after delivery. The two arm study evaluated the effects of Chinsaga consumption on hematological profile and on selected markers of iron metabolism. The comparator intervention was dietary supplementation with processed kale (Brassica carinata). Participants were followed for 28 days and anthropometrics, demographics, blood and milk specimens were collected. The pre and post treatment hematological laboratory parameters tested included; ferritin, transferritin and lactoferrin as biomarkers of iron metabolism. Results: Chinsaga trade has a well structured supply chain with: producers; collectors; wholesalers; retailers and consumers in a variety of combinations. The highest demand is in urban areas. Commercial agriculture of Chinsaga has good prospects; however farm sizes are declining. The plant undergoes three stages of maturation as described by farmers: Omonyenye (germination to four weeks); Amasabore (week 4 to 8) and Ekegoko, (mature stage). The Amasabore and Ekegoko are recommended for lactating mothers. A chromatographic fingerprint of Chinsaga was developed using ethyl acetate: methanol: water (50:20:10) on thin layer chromatography (TLC) and greater resolution achieved using gradient elution on HPLC-UV with acetonitrile, propan-2-ol, water and formic acid (0.4%) in the ratios 85:35:25, adjusted to pH 2.3 as mobile phase on a C18 column. In the clinical study involving lactating mothers, Chinsaga supplementation was associated with significantly higher values of Red Blood Cell Counts (RBC) in the 2nd visit (median 4.79 Interquatile Range (IQR) 4.51 – 5.05, p=0.03) and 3rd visit (median 4.85, (IQR 4.46 – 5.18, p=0.03) compared to the control arm. Similar differences across arms were observed with changes in mean corpuscular volume; (median 27.3, IQR 25.5 – 29, p=0.03) and hemoglobin concentration (median 27.5, IQR 25.85 – 28.85, p=0.05). However there were no statistically significant differences across arms for hemotocrit, (median 39.2, IQR 33.9 – 40.3, p=0.31) and hemoglobulin (median 13.3, IQR 11.7 – 13.85, p=0.42). On stratified data analysis, the effects of Chinsaga are dependent on patient reported duration of iron intake. The effects of Chinsaga on RBC count were most prominent in patients who had taken iron supplements for at least 1 month. On bivariable generalized linear regression modeling, the other variables that were positively associated with RBC counts and with p< 0.05 were; duration of stay at the current residence, age of husband, Njahe, Ugali and Cocoa. However, on adjusting for confounding, only cocoa consumption had a statistically negative effect on RBC counts (adjusted β 6.735 ± 1.827 P=0.00). At a molecular level, there was progressive increase in transferrin gene expression during the three clinic visits. The highest mean was observed in the third visit (2.3, 95% C I (4.49 , 0.170). Conclusion and recommendations: This study confirms the cultural value of Chinsaga and its socioeconomic benefit to the community of the Kisii by providing scientific data supporting the folklore use of Chinsaga by breastfeeding mothers for blood restoration as evidenced by the improvement of the hematological profile and effects on markers of iron metabolism. Chinsaga is a viable commercial crop that should be exploited for the socioeconomic benefit of Kenyans. Studies are needed to examine the effect of Chinsaga diet on enhancing breast milk quantity. This study exposes a gap in the knowledge and the need to conduct similar studies on traditional vegetables and foods consumed by various communities in Kenya. Such action will help preserve what is known and promote the incorporation of the traditional vegetables into the diet for the benefit of mankind. In addition, this study has demonstrated feasibility and provided a model for the design and conduct similar studies.