PROCOMIDA, a Food-Assisted Maternal and Child Health and Nutrition Program, Contributes to Postpartum Weight Retention in Guatemala: A Cluster-Randomized Controlled Intervention Trial

Jef L Leroy, Deanna K Olney, Marie T Ruel, Jef L Leroy, Deanna K Olney, Marie T Ruel

Abstract

Background: Food-assisted maternal and child health and nutrition (FA-MCHN) programs are widely used to reduce household food insecurity and maternal and child undernutrition in low- and middle-income countries. These programs, however, may unintentionally lead to excessive energy intake and unhealthy weight gain, especially in food-secure populations.

Objective: We evaluated the impact of an FA-MCHN program implemented in Guatemala on maternal weight from pregnancy to 24 mo postpartum. The program was earlier shown to reduce stunting.

Methods: We used a longitudinal, cluster-randomized controlled trial with arms varying in family ration size [full (FFR), reduced (RFR), none (NFR)] and individual maternal ration type [corn-soy blend (CSB), lipid-based nutrient supplement (LNS), micronutrient powder (MNP)]: A: FFR + CSB; B: RFR + CSB; C: NFR + CSB; D: FFR + LNS; E: FFR + MNP; F: control. Weight was measured during pregnancy and at 1, 4, 6, 9, 12, 18, and 24 mo postpartum. We used linear mixed models controlling for pregnancy weight with random cluster and mother effects. Data on 3535 women were analyzed.

Results: Significant (P < 0.05) or marginally significant (P < 0.10) effects of 0.50-0.65 kg were found at all time points (except 9 mo) in arm A. Similar-sized effects were found in arms B (1, 4, 6, and 12 mo) and C (1 and 12 mo). Marginally significant effects (0.51-0.66 kg) were found in arm D (1, 6, 9, and 12 mo); in arm E, marginally significant effects (0.48-0.75 kg) were found from 6 to 24 mo.

Conclusions: The effect on maternal postpartum weight is of concern because of the high existing prevalence of overweight. Programs need to include "double-duty" objectives and actions, to ensure that addressing child undernutrition does not exacerbate the problem of unhealthy weight gain. This trial was registered at clinicaltrials.gov as NCT01072279.

Keywords: Guatemala; food aid; obesity; overweight; pregnancy; stunting; weight.

Copyright © American Society for Nutrition 2019.

Figures

FIGURE 1
FIGURE 1
Trial profile. *Meets the eligibility criteria for the analyses presented in this article. CC, Convergence Center; CSB, corn–soy blend; FFR, full family ration; LNS, lipid-based nutrient supplement; MNP, micronutrient powder; NFR, no family ration; RFR, reduced family ration.
FIGURE 2
FIGURE 2
Mean unadjusted weight by wave and treatment arm of women from Alta Verapaz, Guatemala enrolled in the evaluation study of the PROCOMIDA program. Weight data from a total of 26,376 observations were included. Solid lines are intervention arms and the dashed line is the control arm. The darkness of the line and marker reflects the size of the family ration (darker shades indicating a larger ration) and the marker type shows the type of individual ration (circle: CSB; triangle: LNS; square: MNP). CSB, corn–soy blend; FFR, full family ration; LNS, lipid-based nutrient supplement; MNP, micronutrient powder; NFR, no family ration; RFR, reduced family ration.
FIGURE 3
FIGURE 3
Impact of PROCOMIDA in Alta Verapaz, Guatemala on women's weight using linear mixed models with random effects for health convergence center (the unit of randomization) and mother. Values shown are wave- and arm-specific impact estimates and 95% CIs. (A) Impact estimates using all nonmissing observations (a total of 22,555 observations). (B) Impact estimates using imputed data (a total of 24,014 observations). The darkness of the line and marker reflects the size of the family ration (darker shades indicating a larger ration) and the marker type shows the type of individual ration (circle: CSB; triangle: LNS; square: MNP). CSB, corn–soy blend; FFR, full family ration; LNS, lipid-based nutrient supplement; MNP, micronutrient powder; NFR, no family ration; RFR, reduced family ration.

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Source: PubMed

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