Effect of mageu consumption on systemic inflammation and nutrition in breastfeeding mothers
| dc.contributor.advisor | Happel, Anna-Ursula | |
| dc.contributor.advisor | Jaspan, Heather | |
| dc.contributor.author | Fredericks, Janine Amy | |
| dc.date.accessioned | 2026-06-25T08:18:52Z | |
| dc.date.available | 2026-06-25T08:18:52Z | |
| dc.date.issued | 2026 | |
| dc.date.updated | 2026-06-25T08:09:56Z | |
| dc.description.abstract | Optimal maternal body mass index (BMI) and nutrition are critical for postpartum health. Malnutrition and abnormal BMI are associated with a range of postpartum complications, such as lactation difficulties and cardiovascular risk. Key micronutrients, such as iron, folate, calcium and vitamin D, are essential during this period. Inflammation, measured by acute phase reactants such as C-reactive protein (CRP), ferritin and a1-acid glycoprotein (AGP), alongside inflammatory cytokines, such as interleukin (IL)-6, IL-1β, tumour necrosis factor (TNF)-a and interferon (IFN)-g, can further impact maternal health. Fermented foods containing live organisms may help regulate inflammation and support metabolic and immune function. Mageu, a traditional non-alcoholic fermented grain-based beverage, is commonly consumed in Southern Africa as a meal replacement or weaning food for infants. While traditionally fermented, live-culture Mageu has been valued for its anti-inflammatory and immune-modulatory properties, pasteurisation of commercially available Mageu eliminates most live microbes, thus reducing its probiotic potential. This study aimed to compare the effect of daily consumption of live culture Mageu (LCM), commercially pasteurised Mageu (CPM) versus no Mageu (NM) for six weeks on systemic and intestinal inflammation, nutritional markers and BMI in breastfeeding postpartum mothers, and explored relationships between these outcomes. Methods: The nutritional composition of CPM and LCM were evaluated prior to the study by external laboratories. CPM and LCM were cultured on selective media to ensure the absence of spore-forming, pathogenic Clostridium spp. and Escherichia coli (E. coli) in compliance with the South African National Standards (SANS) 1199:2011 guidelines. Total bacterial load of Mageu batches was determine by qPCR of the 16S rRNA gene. Forty-five eligible mothers were randomised 1:1:1 to NM, CPM or LCM within 10 days after delivery, and followed longitudinally over 15 weeks. After enrollment, women had a three-week washout period followed by six weeks of their randomised intervention or no Mageu. At each visit, maternal anthropometrics (height, weight) and health outcomes (including adverse events) were collected. To monitor compliance with the intervention, mothers completed daily monitoring sheets and were asked to return bottles. Maternal blood and stool were collected before starting the intervention (week 4), at completion (week 10) and 5 weeks after completion of the intervention (week 15). Maternal plasma was used to quantify systemic inflammatory markers (IL-6, IL-1b, TNF-a and IFN-g) via Luminexâ assay, intestinal inflammatory markers (lipocalin-2 and myeloperoxidase) via Enzyme-Linked Immunoassay (ELISA) and systemic micronutrients (ferritin, AGP, thyroglobulin, soluble transferrin receptor, CRP, retinol binding protein 4 (RBP4)) using a Q-Plex Human Micronutrient assay. Maternal serum was used to quantify nutritional markers (iron, serum ferritin, vitamin B12 and vitamin D) at the local National Health Laboratory Service Pathology Laboratory. Maternal stool lysates were used to quantify fecal calprotectin using ELISA. The primary analysis was to compare the change in concentration of the markers between weeks 4 and 10 and weeks 4 and 15 between randomisation arms. Secondary analyses included cross-sectional comparisons of biomarker concentrations at weeks 4, 10 and 15. The relationships between these markers with BMI, and effect of the intervention, was described using Pearson correlations, Principal Coordinate Analysis (PCoA) and heatmaps. Results: LCM had a higher nutritional content than CPM. Both CPM and LCM batches were free from E. coli and pathogenic Clostridium spp. LCM batches had a higher proportion of obligate (38.36%) and facultative anaerobe spore-formers (87.67%) and non-E. coli (79.45%) species compared to CPM (4.55%, 40.91% and 3.03%, respectively). Common microorganisms found in LCM were Clostridium beijerinckii, Clostridium manihotivorum, Bacillus spp., and Leuconostoc lactis, among others. LCM batches had a higher 16S rRNA gene copy number per μL gDNA (median 31,550 [IQR 1802-104,858]) compared to the CPM product (median 126 [IQR 8-360], p<0.0001), suggesting higher bacterial load. Self-reported and objective Mageu adherence was high, with an average of 6.62 (SD 0.14) servings per week reported for CPM and 6.64 (SD 0.22) servings per week reported for LCM users. At week 4 (prior intervention), the mean BMI was 31.75 kg/m2 (SD 6.77) and did not differ amongst randomisation arms, nor did it differ at weeks 10 (post-intervention) or 15. Generally, Mageu consumption did not impact the change of nutritional, systemic and intestinal inflammatory marker concentrations from week 4 to 10, nor from week 4 to 15. Cross-sectional analysis revealed that in NM users compared to Mageu users, ferritin was higher at week 10, and IL-6 and IFN-g concentrations tended to be higher at week 15. Further, iron concentrations increased in NM users but decreased in the CPM users from week 4 to 10. When assessing correlations between concentrations of markers between time points, concentrations of all systemic inflammatory markers, vitamin B12 and vitamin D at week 4 correlated strongly with their concentrations at weeks 10 and 15, while intestinal inflammatory marker concentrations correlated moderately between weeks 4 and 10. This suggests that individual inflammation is consistent through time postpartum and the intervention had little influence. At week 4, BMI correlated positively with RBP4 (Pearson r=0.61, p=0.0090), but not with any other markers. Iron negatively correlated with AGP (Pearson r=-0.92, p=1.47x10-7) and CRP (Pearson r=-0.78, p=0.0002). Ferritin positively correlated with IFN-g (Pearson r=0.57, p=0.0158) and TNF-a (Pearson r=0.52, p=0.0341), suggesting that ferritin levels may be reflective of inflammation rather than iron deficiency in this instance. Fecal calprotectin correlated negatively with myeloperoxidase (Pearson r=-0.50, p=0.0399) and IFN-g (Pearson r=-0.56, p=0.0184). Systemic inflammatory markers (IL-6, IL-1b, TNF-a and IFN-g) all positively and strongly correlated with each other. When nutritional and inflammatory data were integrated, no distinct clustering was observed between intervention arms, whether assessing changes from week 4 to 10 or from week 4 and 15. Discussion and conclusion: The LCM product had higher nutritional levels than commercial Mageu, suggesting that traditionally prepared Mageu products may offer superior nutritional value. LCM complied with SANS regulations as it was free from pathogens. Pasteurisation affected bacterial load. Overall, Mageu did not significantly decrease inflammation, improve nutritional status, or decrease BMI in this small cohort of postpartum women. However, we found that NM users had the highest change in concentration for some intestinal and systemic inflammatory markers over time compared to Mageu users, which might suggest that inflammation is dynamic postpartum in the absence of a nutritional intervention. More research is needed to understand the effects of locally produced live culture traditional fermented foods on inflammation and nutrition in South African mothers. Given the local context and relevance of these findings for maternal health, this should be explored in a larger cohort. | |
| dc.identifier.apacitation | Fredericks, J. A. (2026). <i>Effect of mageu consumption on systemic inflammation and nutrition in breastfeeding mothers</i>. (). University of Cape Town ,Faculty of Health Sciences ,Department of Pathology. Retrieved from http://hdl.handle.net/11427/43378 | en_ZA |
| dc.identifier.chicagocitation | Fredericks, Janine Amy. <i>"Effect of mageu consumption on systemic inflammation and nutrition in breastfeeding mothers."</i> ., University of Cape Town ,Faculty of Health Sciences ,Department of Pathology, 2026. http://hdl.handle.net/11427/43378 | en_ZA |
| dc.identifier.citation | Fredericks, J.A. 2026. Effect of mageu consumption on systemic inflammation and nutrition in breastfeeding mothers. . University of Cape Town ,Faculty of Health Sciences ,Department of Pathology. http://hdl.handle.net/11427/43378 | en_ZA |
| dc.identifier.ris | TY - Thesis / Dissertation AU - Fredericks, Janine Amy AB - Optimal maternal body mass index (BMI) and nutrition are critical for postpartum health. Malnutrition and abnormal BMI are associated with a range of postpartum complications, such as lactation difficulties and cardiovascular risk. Key micronutrients, such as iron, folate, calcium and vitamin D, are essential during this period. Inflammation, measured by acute phase reactants such as C-reactive protein (CRP), ferritin and a1-acid glycoprotein (AGP), alongside inflammatory cytokines, such as interleukin (IL)-6, IL-1β, tumour necrosis factor (TNF)-a and interferon (IFN)-g, can further impact maternal health. Fermented foods containing live organisms may help regulate inflammation and support metabolic and immune function. Mageu, a traditional non-alcoholic fermented grain-based beverage, is commonly consumed in Southern Africa as a meal replacement or weaning food for infants. While traditionally fermented, live-culture Mageu has been valued for its anti-inflammatory and immune-modulatory properties, pasteurisation of commercially available Mageu eliminates most live microbes, thus reducing its probiotic potential. This study aimed to compare the effect of daily consumption of live culture Mageu (LCM), commercially pasteurised Mageu (CPM) versus no Mageu (NM) for six weeks on systemic and intestinal inflammation, nutritional markers and BMI in breastfeeding postpartum mothers, and explored relationships between these outcomes. Methods: The nutritional composition of CPM and LCM were evaluated prior to the study by external laboratories. CPM and LCM were cultured on selective media to ensure the absence of spore-forming, pathogenic Clostridium spp. and Escherichia coli (E. coli) in compliance with the South African National Standards (SANS) 1199:2011 guidelines. Total bacterial load of Mageu batches was determine by qPCR of the 16S rRNA gene. Forty-five eligible mothers were randomised 1:1:1 to NM, CPM or LCM within 10 days after delivery, and followed longitudinally over 15 weeks. After enrollment, women had a three-week washout period followed by six weeks of their randomised intervention or no Mageu. At each visit, maternal anthropometrics (height, weight) and health outcomes (including adverse events) were collected. To monitor compliance with the intervention, mothers completed daily monitoring sheets and were asked to return bottles. Maternal blood and stool were collected before starting the intervention (week 4), at completion (week 10) and 5 weeks after completion of the intervention (week 15). Maternal plasma was used to quantify systemic inflammatory markers (IL-6, IL-1b, TNF-a and IFN-g) via Luminexâ assay, intestinal inflammatory markers (lipocalin-2 and myeloperoxidase) via Enzyme-Linked Immunoassay (ELISA) and systemic micronutrients (ferritin, AGP, thyroglobulin, soluble transferrin receptor, CRP, retinol binding protein 4 (RBP4)) using a Q-Plex Human Micronutrient assay. Maternal serum was used to quantify nutritional markers (iron, serum ferritin, vitamin B12 and vitamin D) at the local National Health Laboratory Service Pathology Laboratory. Maternal stool lysates were used to quantify fecal calprotectin using ELISA. The primary analysis was to compare the change in concentration of the markers between weeks 4 and 10 and weeks 4 and 15 between randomisation arms. Secondary analyses included cross-sectional comparisons of biomarker concentrations at weeks 4, 10 and 15. The relationships between these markers with BMI, and effect of the intervention, was described using Pearson correlations, Principal Coordinate Analysis (PCoA) and heatmaps. Results: LCM had a higher nutritional content than CPM. Both CPM and LCM batches were free from E. coli and pathogenic Clostridium spp. LCM batches had a higher proportion of obligate (38.36%) and facultative anaerobe spore-formers (87.67%) and non-E. coli (79.45%) species compared to CPM (4.55%, 40.91% and 3.03%, respectively). Common microorganisms found in LCM were Clostridium beijerinckii, Clostridium manihotivorum, Bacillus spp., and Leuconostoc lactis, among others. LCM batches had a higher 16S rRNA gene copy number per μL gDNA (median 31,550 [IQR 1802-104,858]) compared to the CPM product (median 126 [IQR 8-360], p<0.0001), suggesting higher bacterial load. Self-reported and objective Mageu adherence was high, with an average of 6.62 (SD 0.14) servings per week reported for CPM and 6.64 (SD 0.22) servings per week reported for LCM users. At week 4 (prior intervention), the mean BMI was 31.75 kg/m2 (SD 6.77) and did not differ amongst randomisation arms, nor did it differ at weeks 10 (post-intervention) or 15. Generally, Mageu consumption did not impact the change of nutritional, systemic and intestinal inflammatory marker concentrations from week 4 to 10, nor from week 4 to 15. Cross-sectional analysis revealed that in NM users compared to Mageu users, ferritin was higher at week 10, and IL-6 and IFN-g concentrations tended to be higher at week 15. Further, iron concentrations increased in NM users but decreased in the CPM users from week 4 to 10. When assessing correlations between concentrations of markers between time points, concentrations of all systemic inflammatory markers, vitamin B12 and vitamin D at week 4 correlated strongly with their concentrations at weeks 10 and 15, while intestinal inflammatory marker concentrations correlated moderately between weeks 4 and 10. This suggests that individual inflammation is consistent through time postpartum and the intervention had little influence. At week 4, BMI correlated positively with RBP4 (Pearson r=0.61, p=0.0090), but not with any other markers. Iron negatively correlated with AGP (Pearson r=-0.92, p=1.47x10-7) and CRP (Pearson r=-0.78, p=0.0002). Ferritin positively correlated with IFN-g (Pearson r=0.57, p=0.0158) and TNF-a (Pearson r=0.52, p=0.0341), suggesting that ferritin levels may be reflective of inflammation rather than iron deficiency in this instance. Fecal calprotectin correlated negatively with myeloperoxidase (Pearson r=-0.50, p=0.0399) and IFN-g (Pearson r=-0.56, p=0.0184). Systemic inflammatory markers (IL-6, IL-1b, TNF-a and IFN-g) all positively and strongly correlated with each other. When nutritional and inflammatory data were integrated, no distinct clustering was observed between intervention arms, whether assessing changes from week 4 to 10 or from week 4 and 15. Discussion and conclusion: The LCM product had higher nutritional levels than commercial Mageu, suggesting that traditionally prepared Mageu products may offer superior nutritional value. LCM complied with SANS regulations as it was free from pathogens. Pasteurisation affected bacterial load. Overall, Mageu did not significantly decrease inflammation, improve nutritional status, or decrease BMI in this small cohort of postpartum women. However, we found that NM users had the highest change in concentration for some intestinal and systemic inflammatory markers over time compared to Mageu users, which might suggest that inflammation is dynamic postpartum in the absence of a nutritional intervention. More research is needed to understand the effects of locally produced live culture traditional fermented foods on inflammation and nutrition in South African mothers. Given the local context and relevance of these findings for maternal health, this should be explored in a larger cohort. DA - 2026 DB - OpenUCT DP - University of Cape Town KW - Optimal maternal body mass index KW - Malnutrition KW - abnormal LK - https://open.uct.ac.za PB - University of Cape Town PY - 2026 T1 - Effect of mageu consumption on systemic inflammation and nutrition in breastfeeding mothers TI - Effect of mageu consumption on systemic inflammation and nutrition in breastfeeding mothers UR - http://hdl.handle.net/11427/43378 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/43378 | |
| dc.identifier.vancouvercitation | Fredericks JA. Effect of mageu consumption on systemic inflammation and nutrition in breastfeeding mothers. []. University of Cape Town ,Faculty of Health Sciences ,Department of Pathology, 2026 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/43378 | en_ZA |
| dc.language.iso | en | |
| dc.language.rfc3066 | eng | |
| dc.publisher.department | Department of Pathology | |
| dc.publisher.faculty | Faculty of Health Sciences | |
| dc.publisher.institution | University of Cape Town | |
| dc.subject | Optimal maternal body mass index | |
| dc.subject | Malnutrition | |
| dc.subject | abnormal | |
| dc.title | Effect of mageu consumption on systemic inflammation and nutrition in breastfeeding mothers | |
| dc.type | Thesis / Dissertation | |
| dc.type.qualificationlevel | Masters | |
| dc.type.qualificationlevel | MSc |