Pregnant Women in Four Low-Middle Income Countries Have a High Prevalence of Inadequate Dietary Intakes That Are Improved by Dietary Diversity

Rebecca L Lander, K Michael Hambidge, Jamie E Westcott, Gabriela Tejeda, Tshilenge S Diba, Shivanand C Mastiholi, Umber S Khan, Ana Garcés, Lester Figueroa, Antoinette Tshefu, Adrien Lokangaka, Shivaprasad S Goudar, Manjunath S Somannavar, Sumera Aziz Ali, Sarah Saleem, Elizabeth M McClure, Nancy F Krebs, On Behalf Of The Women First Preconception Nutrition Trial Group, Rebecca L Lander, K Michael Hambidge, Jamie E Westcott, Gabriela Tejeda, Tshilenge S Diba, Shivanand C Mastiholi, Umber S Khan, Ana Garcés, Lester Figueroa, Antoinette Tshefu, Adrien Lokangaka, Shivaprasad S Goudar, Manjunath S Somannavar, Sumera Aziz Ali, Sarah Saleem, Elizabeth M McClure, Nancy F Krebs, On Behalf Of The Women First Preconception Nutrition Trial Group

Abstract

Background: Up-to-date dietary data are required to understand the diverse nutritional challenges of pregnant women living in low-middle income countries (LMIC). To that end, dietary data were collected from 1st trimester pregnant women in rural areas of Guatemala, India, Pakistan, and Democratic Republic of the Congo (DRC) participating in a maternal lipid-based nutrient supplement (LNS) Randomized Controlled Trial to examine dietary diversity (DD), usual group energy and nutrient intakes, and prevalence of inadequate dietary intakes.

Methods: Two 24-h dietary recalls were conducted in ~240 pregnant women/site (total n = 966) prior to 12-week gestation. Adequate DD was assessed, i.e., ≥5 major food groups consumed within the past 24 h. Median, Q1, Q3 intakes (without LNS) of energy, macronutrients, 12 micronutrients, and phytate were examined. The "at risk" prevalence of inadequate intakes were based on international guidelines for pregnant women.

Results: Dietary patterns varied widely among sites, with adequate DD reported: 20% (Pakistan), 25% (DRC), 50% (Guatemala), and 70% (India). Significantly higher intakes of most key nutrients were observed in participants with adequate DD. More than 80% of women in all sites had inadequate intakes of folate, vitamin B12, and choline, and >80% of women in India and DRC also had inadequate intakes of calcium, thiamine, riboflavin, and vitamin B6.

Conclusions: Our data highlight the likely need for micronutrient supplementation in pregnancy, specifically multi-micronutrient interventions, and support the value of increasing DD as part of sustainable long-term nutrition programs for women of reproductive age in these poor rural settings in LMIC.

Keywords: dietary assessment; low middle income countries; nutrition; pregnant women.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Inadequate and adequate dietary diversity (DD) 1 in pregnant women in four low- and middle-income countries by site. 1 Inadequate and Adequate DD, as defined by minimum dietary diversity for women of reproductive age [12], i.e., inadequate DD: consumption of <5 major food groups (FG) in the past 24 h; adequate DD: consumption of ≥5 major FG in the past 24 h. DRC, Democratic Republic of the Congo.
Figure 2
Figure 2
Contribution of food groups to total energy intake of pregnant women in four low- and middle-income countries by site. DRC, Democratic Republic of the Congo.
Figure 3
Figure 3
Estimated prevalence of the pregnant women in four low- and middle-income countries “at risk” of inadequate intakes of key micronutrients (A) Folate, (B) Vitamin B12, (C) Calcium, (D) Vitamin A. DRC, Democratic Republic of the Congo; Vit A, vitamin A; EAR, estimated average requirement; Vit B12, Vitamin B12.

References

    1. Wu G., Imhoff-Kunsch B., Girard A.W. Biological mechanisms for nutritional regulation of maternal health and fetal development. Paediatr. Perinat. Epidemiol. 2012;26:4–26. doi: 10.1111/j.1365-3016.2012.01291.x.
    1. Torheim L.E., Ferguson E.L., Penrose K., Arimond M. Women in resource-poor settings are at risk of inadequate intakes of multiple micronutrients. J. Nutr. 2010;140:2051s–2058s. doi: 10.3945/jn.110.123463.
    1. Dominguez-Salas P., Moore S.E., Cole D., da Costa K.A., Cox S.E., Dyer R.A., Fulford A.J., Innis S.M., Waterland R.A., Zeisel S.H., et al. DNA methylation potential: Dietary intake and blood concentrations of one-carbon metabolites and cofactors in rural African women. Am. J. Clin. Nutr. 2013;97:1217–1227. doi: 10.3945/ajcn.112.048462.
    1. Ramakrishnan U., Grant F., Goldenberg T., Zongrone A., Martorell R. Effect of women’s nutrition before and during early pregnancy on maternal and infant outcomes: A systematic review. Paediatr. Perinat. Epidemiol. 2012;26:285–301. doi: 10.1111/j.1365-3016.2012.01281.x.
    1. Nyaradi A., Li J., Hickling S., Foster J., Oddy W.H. The role of nutrition in children’s neurocognitive development, from pregnancy through childhood. Front. Hum. Neurosci. 2013;7:97. doi: 10.3389/fnhum.2013.00097.
    1. Prendergast A.J., Humphrey J.H. The stunting syndrome in developing countries. Paediatr. Int. Child Health. 2014;34:250–265. doi: 10.1179/2046905514Y.0000000158.
    1. Adu-Afarwuah S., Lartey A., Okronipa H., Ashorn P., Ashorn U., Zeilani M., Arimond M., Vosti S.A., Dewey K.G. Maternal Supplementation with Small-Quantity Lipid-Based Nutrient Supplements Compared with Multiple Micronutrients, but Not with Iron and Folic Acid, Reduces the Prevalence of Low Gestational Weight Gain in Semi-Urban Ghana: A Randomized Controlled Trial. J. Nutr. 2017;147:697–705. doi: 10.3945/jn.116.242909.
    1. Hambidge K.M., Westcott J.E., Garces A., Figueroa L., Goudar S., Dhaded S.M., Pasha O., Ali S., Tshefu A., Lokangaka A., et al. A multi-country randomized controlled trial of comprehensive maternal nutrition supplementation initiated prior to conception: The Women First trial. Am. J. Clin. Nutr. 2019;109:457–469. doi: 10.1093/ajcn/nqy228.
    1. Christian P., Mullany L.C., Hurley K.M., Katz J., Black R.E. Nutrition and maternal, neonatal, and child health. Semin. Perinatol. 2015;39:361–372. doi: 10.1053/j.semperi.2015.06.009.
    1. Althabe F., Moore J.L., Gibbons L., Berrueta M., Goudar S.S., Chomba E., Derman R.J., Patel A., Saleem S., Pasha O., et al. Adverse maternal and perinatal outcomes in adolescent pregnancies: The Global Network’s Maternal Newborn Health Registry study. Reprod. Health. 2015;12:S8. doi: 10.1186/1742-4755-12-S2-S8.
    1. Gibson R.S., Ferguson E.L. An Interactive 24-Hour Recall for Assessing the Adequacy of Iron and Zinc Intakes in Developing Countries. LSI Press; Washington, DC, USA: 1999.
    1. Food and Agricultural Organization of the United Nations . Minimum Dietary Diversity for Women: A Guide for Measurement. FAO; Rome, Italy: 2016.
    1. Hambidge K.M., Krebs N.F., Westcott J.E., Garces A., Goudar S.S., Kodkany B.S., Pasha O., Tshefu A., Bose C.L., Figueroa L., et al. Preconception maternal nutrition: A multi-site randomized controlled trial. BMC Pregnancy Child. 2014;14:111. doi: 10.1186/1471-2393-14-111.
    1. Koso-Thomas M., McClure E.M. The Global Network for Women’s and Children’s Health Research: A model of capacity-building research. Semin. Fetal Neonatal. Med. 2015;20:293–299. doi: 10.1016/j.siny.2015.04.004.
    1. Lander R.L., Hambidge K.M., Krebs N.F., Westcott J.E., Garces A., Figueroa L., Tejeda G., Lokangaka A., Diba T.S., Somannavar M.S., et al. Repeat 24-hour recalls and locally developed food composition databases: A feasible method to estimate dietary adequacy in a multi-site preconception maternal nutrition RCT. Food Nutr. Res. 2017;61:1311185. doi: 10.1080/16546628.2017.1311185.
    1. United States Department of Agriculture . USDA National Nutrient Database for Standard Reference, Release 28. Agricultural Research Service; Beltsville, MD, USA: 2010.
    1. Stadlmayr B., Charrondiere U.R., Enujiugha V., Bayili R.G., Fagbohoun E.G., Samb B., Addy P., Barikmo I., Ouattara F., Oshuag A. West African Food Composition Table. FAO of the United Nations; Rome, Italy: 2012.
    1. Bunch S., Murhpy S.P. Users Guide to the Operation of the Worldfood Dietary Assessment System, Version 2.0. Office of Technology Licensing, University of California, Berkeley; Berkeley, CA, USA: 1997.
    1. Shaheen N., Rahim A., Mohiduzzaman M., Banu C., Bari L., Tukun A., Mannan M., Bhattacharjee L., Stadlmayr B. Food composition table for Bangladesh. Final Res. Results. 2013;3:187–209.
    1. Institute of Nutrition of Central America and Panama (INCAP) Table of Food Composition of Central America. INCAP/Pan-American Health Organization; Guatemala City, Guatemala: 2007.
    1. Food and Agriculture Organization/International Network of Food Data Systems (FAO/INFOODS) FAO/INFOODS Guidelines for Food Matching, Version 12. Food and Agriculture Organization Rome; Rome, Italy: 2012.
    1. Bognár A. Tables on Weight Yield of Food and Retention Factors of Food Constituents for the Calculation of Nutrient Composition of Cooked Foods (Dishes) BFE; Karlsruhe, Germany: 2002.
    1. Rahim A. Food and Foodways of Bangladesh: A Note on Recipe Composition and Eating Principle. Institute of Nutrition and Food Science, University of Dhaka; Dhaka, Bangladesh: 2013.
    1. Institute of Medicine . The Essential Guide to Nutrient Requirements. National Academies Press; Washington, DC, USA: 2006. Dietary Reference Intakes.
    1. Gibson R.S. Principles of Nutritional Assessment. 2nd ed. Oxford University Press; New York, NY, USA: 2005.
    1. Institute of Medicine . Dietary Reference Intakes: Applications in Dietary Assessment. National Academies Press; Washington, DC, USA: 2000.
    1. Lee S.E., Talegawkar S.A., Merialdi M., Caulfield L.E. Dietary intakes of women during pregnancy in low-and middle-income countries. Public Health Nutr. 2013;16:1340–1353. doi: 10.1017/S1368980012004417.
    1. Yang Z., Huffman S.L. Nutrition in pregnancy and early childhood and associations with obesity in developing countries. Matern. Child Nutr. 2013;9:105–119. doi: 10.1111/mcn.12010.
    1. Yajnik C.S. Transmission of obesity-adiposity and related disorders from the mother to the baby. Ann. Nutr. Metab. 2014;64:8–17. doi: 10.1159/000362608.
    1. Baig-Ansari N., Badruddin S.H., Karmaliani R., Harris H., Jehan I., Pasha O., Moss N., McClure E.M., Goldenberg R.L. Anemia prevalence and risk factors in pregnant women in an urban area of Pakistan. Food Nutr. Bull. 2008;29:132–139. doi: 10.1177/156482650802900207.
    1. Samuel T.M., Thomas T., Finkelstein J., Bosch R., Rajendran R., Virtanen S.M., Srinivasan K., Kurpad A.V., Duggan C. Correlates of anaemia in pregnant urban South Indian women: A possible role of dietary intake of nutrients that inhibit iron absorption. Public Health Nutr. 2013;16:316–324. doi: 10.1017/S136898001200119X.
    1. Arsenault J.E., Yakes E.A., Islam M.M., Hossain M.B., Ahmed T., Hotz C., Lewis B., Rahman A.S., Jamil K.M., Brown K.H. Very low adequacy of micronutrient intakes by young children and women in rural Bangladesh is primarily explained by low food intake and limited diversity. J. Nutr. 2013;143:197–203. doi: 10.3945/jn.112.169524.
    1. Coffey D. Prepregnancy body mass and weight gain during pregnancy in India and sub-Saharan Africa. Proc. Natl. Acad. Sci. USA. 2015;112:3302–3307. doi: 10.1073/pnas.1416964112.
    1. Thankachan P., Muthayya S., Walczyk T., Kurpad A.V., Hurrell R.F. An analysis of the etiology of anemia and iron deficiency in young women of low socioeconomic status in Bangalore, India. Food Nutr. Bull. 2007;28:328–336. doi: 10.1177/156482650702800309.
    1. Bloch M., Althabe F., Onyamboko M., Kaseba-Sata C., Castilla E.E., Freire S., Garcés A.L., Parida S., Goudar S.S., Kadir M.M., et al. Tobacco use and secondhand smoke exposure during pregnancy: An investigative survey of women in 9 developing nations. Am. J. Public Health. 2008;98:1833–1840. doi: 10.2105/AJPH.2007.117887.
    1. Gupta P.C., Subramoney S. Smokeless tobacco use, birth weight, and gestational age: Population based, prospective cohort study of 1217 women in Mumbai, India. BMJ. 2004;328:1538. doi: 10.1136/bmj.38113.687882.EB.
    1. Ashfaq M., Channa M.A., Malik M.A., Khan D. Morphological changes in human placenta of wet snuff users. J. Ayub Med. Coll. Abbottabad JAMC. 2008;20:110–113.
    1. Willis D.N., Popovech M.A., Gany F., Hoffman C., Blum J.L., Zelikoff J.T. Toxicity of gutkha, a smokeless tobacco product gone global: Is there more to the toxicity than nicotine? Int. J. Environ. Res. Public Health. 2014;11:919–933. doi: 10.3390/ijerph110100919.
    1. Hambidge K.M., Krebs N.F., Garces A., Westcott J.E., Figueroa L., Goudar S.S., Dhaded S., Pasha O., Aziz Ali S., Tshefu A., et al. Anthropometric indices for non-pregnant women of childbearing age differ widely among four low-middle income populations. BMC Public Health. 2017;18:45. doi: 10.1186/s12889-017-4509-z.
    1. Termote C., Bwama Meyi M., Dhed’a Djailo B., Huybregts L., Lachat C., Kolsteren P., Van Damme P. A biodiverse rich environment does not contribute to a better diet: A case study from DR Congo. PLoS ONE. 2012;7:e30533. doi: 10.1371/journal.pone.0030533.
    1. Jaacks L.M., Slining M.M., Popkin B.M. Recent underweight and overweight trends by rural-urban residence among women in low-and middle-income countries. J. Nutr. 2015;145:352–357. doi: 10.3945/jn.114.203562.
    1. Bielderman I., Vossenaar M., Melse-Boonstra A., Solomons N.W. The potential double-burden of vitamin A malnutrition: Under-and overconsumption of fortified table sugar in the Guatemalan highlands. Eur. J. Clin. Nutr. 2016;70:947–953. doi: 10.1038/ejcn.2016.36.
    1. De Graaf C. Why liquid energy results in overconsumption. Proc. Nutr. Soc. 2011;70:162–170. doi: 10.1017/S0029665111000012.
    1. Popkin B.M. Contemporary nutritional transition: Determinants of diet and its impact on body composition. Proc. Nutr. Soc. 2011;70:82–91. doi: 10.1017/S0029665110003903.
    1. Singh G.M., Micha R., Khatibzadeh S., Shi P., Lim S., Andrews K.G., Engell R.E., Ezzati M., Mozaffarian D. Global, Regional, and National Consumption of Sugar-Sweetened Beverages, Fruit Juices, and Milk: A Systematic Assessment of Beverage Intake in 187 Countries. PLoS ONE. 2015;10:e0124845. doi: 10.1371/journal.pone.0124845.
    1. Levin B.E. Metabolic imprinting: Critical impact of the perinatal environment on the regulation of energy homeostasis. Philos. Trans. R. Soc. Lond B Biol. Sci. 2006;361:1107–1121. doi: 10.1098/rstb.2006.1851.
    1. Hacker A.N., Fung E.B., King J.C. Role of calcium during pregnancy: Maternal and fetal needs. Nutr. Rev. 2012;70:397–409. doi: 10.1111/j.1753-4887.2012.00491.x.
    1. Hambidge K.M., Miller L.V., Mazariegos M., Westcott J., Solomons N.W., Raboy V., Kemp J.F., Das A., Goco N., Hartwell T., et al. Upregulation of zinc absorption matches increases in physiologic requirements for zinc in women consuming high-or moderate-phytate diets during late pregnancy and early lactation. J. Nutr. 2017 doi: 10.3945/jn.116.245902.
    1. Hambidge K.M., Krebs N.F. Strategies for optimizing maternal nutrition to promote infant development. Reprod. Health. 2018;15:87. doi: 10.1186/s12978-018-0534-3.
    1. Arimond M., Wiesmann D., Becquey E., Carriquiry A., Daniels M.C., Deitchler M., Fanou-Fogny N., Joseph M.L., Kennedy G., Martin-Prevel Y., et al. Simple food group diversity indicators predict micronutrient adequacy of women’s diets in 5 diverse, resource-poor settings. J. Nutr. 2010;140:2059S–2069S. doi: 10.3945/jn.110.123414.
    1. Martin-Prével Y., Allemand P., Wiesmann D., Arimond M., Ballard T., Deitchler M., Dop M.C., Kennedy G., Lee W.T., Moursi M. Moving Forward on Choosing a Standard Operational Indicator of Women’s Dietary Diversity. [(accessed on 13 April 2019)]; Available online: .
    1. Iannotti L.L., Lutter C.K., Waters W.F., Gallegos Riofrio C.A., Malo C., Reinhart G., Palacios A., Karp C., Chapnick M., Cox K., et al. Eggs early in complementary feeding increase choline pathway biomarkers and DHA: A randomized controlled trial in Ecuador. Am. J. Clin. Nutr. 2017;106:1482–1489. doi: 10.3945/ajcn.117.160515.
    1. Rao S., Joshi S., Bhide P., Puranik B., Asawari K. Dietary diversification for prevention of anaemia among women of childbearing age from rural India. Public Health Nutr. 2014;17:939–947. doi: 10.1017/S1368980013001006.
    1. Food and Agriculture Organization/International Network of Food Data Systems (FAO/INFOODS) FAO/INFOODS Food Composition Database For Biodiversity. Food and Agriculture Organization Rome; Rome, Italy: 2013.
    1. Savy M., Martin-Prevel Y., Traissac P., Eymard-Duvernay S., Delpeuch F. Dietary diversity scores and nutritional status of women change during the seasonal food shortage in rural Burkina Faso. J. Nutr. 2006;136:2625–2632. doi: 10.1093/jn/136.10.2625.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa