Change of weight in women of reproductive age before and after nutritional intervention
In this study, nutritional status will be assessed through anthropometry. Body weight will be collected in kg using a standard weighing machine, and determined at the time of EGD, at the end of the intervention (day 90) and at study completion (day 180).
Height of women of reproductive age before and after nutritional intervention
In this study, nutritional status will be assessed through anthropometry. Height will be collected in centimeters using stadiometer. Anthropometry will be collected at the time of EGD, at the end of the intervention (day 90) and at study completion (day 180).
Change in BMI of women of reproductive age before and after nutritional intervention
In this study, nutritional status will be assessed through anthropometry. Body weight in kilogram and height in cm will be determined at the time of EGD, at the end of the intervention (day 90) and at study completion (day 180). Their BMI will be calculated based on their weight and height taken at different intervals. BMI will be reported in kg/m^2.
Change in body composition of total fat and fat-free mass of women of reproductive age before and after nutritional intervention
Bioelectric Impedance Analysis (BIA) will be used to measure total fat and fat-free mass before, during and after the intervention. BIA is a method of assessing the body composition by measuring the body fat in relation to lean body mass. It is an integral part of a health and nutrition assessment. BIA will be used to measure total fat and fat free mass before and after intervention with each of the three arms. 30 low-BMI women (18-30 years) provided with MDCF-2/RUSF intervention, with an age-matched cohort of 30 healthy (normal-BMI) women who undergo EGD and subsequent serial fecal and plasma sampling (without nutritional intervention) serving as a control group will be selected for this analysis. Data will be collected on days 1, 90 and 180 and the unit of measurement is in percentage of fat.
Validated plasma biomarker (sCD14)
Blood will be collected at baseline (at the time of EGD), and days 30, 90 and 180 (study completion), to determine changes in the representation of plasma biomarkers of EED as a function of treatment. Plasma sCD14 will be measured by ELISA method and it serves as a marker for Systemic inflammation
Validated plasma biomarker (CRP)
Blood will be collected at baseline (at the time of EGD), and days 30, 90 and 180 (study completion), to determine changes in the representation of plasma biomarkers of EED as a function of treatment. Plasma c-reactive protein (CRP) will be measured by ELISA method.
Validated plasma biomarker (AGP)
Blood will be collected at baseline (at the time of EGD), and days 30, 90 and 180 (study completion), to determine changes in the representation of plasma biomarkers of EED as a function of treatment. alpha-1-acid glycoprotein (AGP) will serve as a marker for Systemic inflammation and it will be measured by ELISA method.
Hormonal regulators of appetite and satiety (Leptin)
Blood will be collected at baseline (at the time of EGD), and days 30, 90 and 180 (study completion), to determine changes in the representation of plasma biomarkers of EED as a function of treatment. Leptin will serve as a marker for Hormonal regulators of appetite and satiety and it will be measured by ELISA method from plasma.
Hormonal regulators of appetite and satiety (Ghrelin)
Blood will be collected at baseline (at the time of EGD), and days 30, 90 and 180 (study completion), to determine changes in the representation of plasma biomarkers of EED as a function of treatment. Ghrelin will serve as a marker for Hormonal regulators of appetite and it will be measured by ELISA method from Plasma.
Hormonal regulators of appetite and satiety (IGF-1)
Blood will be collected at baseline (at the time of EGD), and days 30, 90 and 180 (study completion), to determine changes in the representation of plasma biomarkers of EED as a function of treatment. Insulin-like growth factor 1 (IGF-1) will serve as a marker for Hormonal regulators of appetite and satiety and it will be measured from plasma using ELISA method.
Hormonal regulators of appetite and satiety (Glucagon-like peptide-2 (GLP-2))
Blood will be collected at baseline (at the time of EGD), and days 30, 90 and 180 (study completion), to determine changes in the representation of plasma biomarkers of EED as a function of treatment. Glucagon-like peptide-2 (GLP-2)will serve as a marker for Hormonal regulators of appetite and satiety and it will be measured from plasma using ELISA method.
Micronutrients level in plasma (Ferritin)
Blood will be collected at baseline (at the time of EGD), and days 30, 90 and 180 (study completion), to determine changes in the representation of plasma biomarkers of EED as a function of treatment. Ferritin will serve as a marker for micronutrient level in the blood and it will be measured by ELISA method from Plasma.
Micronutrients level in plasma (Zinc)
Blood will be collected at baseline (at the time of EGD), and days 30, 90 and 180 (study completion), to determine changes in the representation of plasma biomarkers of EED as a function of treatment. Zinc will serve as a marker for micronutrient level in the blood and the plasma zinc will be measured by atomic absorption spectrometry method.
Validated fecal biomarkers of health status including mediators of growth, systemic inflammation, gut inflammation/enteropathogenic burden) (stool PH)
Fecal samples will be collected at the time of EGD and subsequently, every 30 days for analysis of the effects of intervention on the microbiota-microbiome. Stool pH will be measured on freshly collected stool samples by portable stool pH meter from Hanna instruments, USA.
Validated fecal biomarkers of health status including mediators of growth, systemic inflammation, gut inflammation/enteropathogenic burden) (Myeloperoxidase)
Fecal samples will be collected at the time of EGD and subsequently, every 30 days for analysis of the effects of intervention on the microbiota-microbiome. Myeloperoxidase will be measured from fecal samples using ELISA method.
Validated fecal biomarkers of health status including mediators of growth, systemic inflammation, gut inflammation/enteropathogenic burden (neopterin)
Fecal samples will be collected at the time of EGD and subsequently, every 30 days for analysis of the effects of intervention on the microbiota-microbiome. Neopterin will be measured from fecal sample using ELISA method
Validated fecal biomarkers of health status including mediators of growth, systemic inflammation, gut inflammation/enteropathogenic burden (calprotectin)
Fecal samples will be collected at the time of EGD and subsequently, every 30 days for analysis of the effects of intervention on the microbiota-microbiome. Calprotectin will be measured from fecal sample using ELISA method.
Validated fecal biomarkers of health status including mediators of growth, systemic inflammation, gut inflammation/enteropathogenic burden (Dual oxidase 2 (DUOX2)
Fecal samples will be collected at the time of EGD and subsequently, every 30 days for analysis of the effects of intervention on the microbiota-microbiome. Fecal DUOX2 will be measured by ELISA method.
Validated fecal biomarkers of health status including mediators of growth, systemic inflammation, gut inflammation/enteropathogenic burden (Oxidation-Reduction Potential (Redox potential))
Fecal samples will be collected at the time of EGD and subsequently, every 30 days for analysis of the effects of intervention on the microbiota-microbiome. Redox potential will be measured in millivolt (mV)
Validated fecal biomarkers of health status including mediators of growth, systemic inflammation, gut inflammation/enteropathogenic burden Lipocalin 2 (Lcn2)
Fecal samples will be collected at the time of EGD and subsequently, every 30 days for analysis of the effects of intervention on the microbiota-microbiome. Lipocalin 2 (Lcn2) will be measured by ELISA method using fecal sample.
Pregnancy-related change in weight
Pregnant women will be enrolled and followed up over a period of 9 months. Enrolment will be done before 2nd trimester. Low-BMI pregnant will be provided with daily supplementation of supplemental food (MDCF-2/RUSF) and normal-BMI women will be followed without any intervention. For the low-BMI pregnant women, antenatal care (ANC) services from nearby healthcare facility will be ensured by study staff. Trained Health Workers (HWs) will visit the homes of all enrolled pregnant women once a month. During the follow up, the investigators will collect anthropometry data from each participant every four-weekly. The unit of data collection for pregnant women is kg. Relevant laboratory investigation that will be done among pregnant women will follow previously described methods.