Prenatal dietary diversity may influence underweight in infants in a Ugandan birth-cohort

Isabel Madzorera, Shibani Ghosh, Molin Wang, Wafaie Fawzi, Sheila Isanaka, Ellen Hertzmark, Grace Namirembe, Bernard Bashaasha, Edgar Agaba, Florence Turyashemererwa, Patrick Webb, Christopher Duggan, Isabel Madzorera, Shibani Ghosh, Molin Wang, Wafaie Fawzi, Sheila Isanaka, Ellen Hertzmark, Grace Namirembe, Bernard Bashaasha, Edgar Agaba, Florence Turyashemererwa, Patrick Webb, Christopher Duggan

Abstract

Growth faltering in early childhood is prevalent in many low resource countries. Poor maternal dietary diversity during pregnancy has been linked with increased risk of fetal growth failure and adverse birth outcomes but may also influence subsequent infant growth. Our aim is to assess the role of prenatal maternal dietary diversity in infant growth in rural Uganda. Data from 3291 women and infant pairs enrolled in a birth cohort from 2014 to 2016 were analysed (NCT04233944). Maternal diets were assessed using dietary recall in the second or third trimesters of pregnancy. Maternal dietary diversity scores (DDS) were calculated using the FAO Minimum Dietary Diversity for Women (MDD-W). Cox regression models were used to evaluate associations of the DDS with the incidence of underweight, stunting and wasting in infants from 3 to 12 months, adjusting for confounding factors. The median DDS for women was low, at 3.0 (interquartile range 3.0-4.0), relative to the threshold of consuming five or more food groups daily. Infants of women in highest quartile of DDS (diverse diets) were less likely to be underweight (adjusted hazard ratio: 0.70, 95% confidence interval: 0.61, 0.80) compared with infants of women in Quartile 1 (p for trend <0.001) in models controlling for maternal factors. There was no significant association between DDS and stunting or wasting. Our findings suggest a relationship between higher maternal dietary diversity and lower risk of underweight in infancy. These findings suggest that programmes to improve infant growth could additionally consider strengthening prenatal dietary diversity to improve child outcomes globally.

Keywords: MDD-W; Uganda; infant growth; maternal dietary diversity; prenatal; stunting; underweight; wasting.

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

© 2021 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Consumption of food groups in the previous 24 h by pregnant women in the Uganda birth cohort

References

    1. Addo, O. Y. , Stein, A. D. , Fall, C. H. , Gigante, D. P. , Guntupalli, A. M. , Horta, B. L. , … Consortium on Health Orientated Research in Transitional Societies, G . (2013). Maternal height and child growth patterns. The Journal of Pediatrics, 163(2), 549–554. 10.1016/j.jpeds.2013.02.002
    1. Adu‐Afarwuah, S. , Lartey, A. , & Dewey, K. G. (2017). Meeting nutritional needs in the first 1000 days: A place for small‐quantity lipid‐based nutrient supplements. Annals of the New York Academy of Sciences, 1392(1), 18–29. 10.1111/nyas.13328
    1. Alderman, H. , & Headey, D. (2018). The timing of growth faltering has important implications for observational analyses of the underlying determinants of nutrition outcomes. PLoS ONE, 13(4), e0195904–e0195904. 10.1371/journal.pone.0195904
    1. Ali, Z. , Saaka, M. , Adams, A.‐G. , Kamwininaang, S. K. , & Abizari, A.‐R. (2017). The effect of maternal and child factors on stunting, wasting and underweight among preschool children in Northern Ghana. BMC Nutrition, 3(1), 31. 10.1186/s40795-017-0154-2
    1. Allen, L. H. (2012). B vitamins in breast milk: relative importance of maternal status and intake, and effects on infant status and function. Advances in Nutrition, 3(3), 362–369. 10.3945/an.111.001172
    1. Amugsi, D. A. , Mittelmark, M. B. , & Oduro, A. (2015). Association between maternal and child dietary diversity: An analysis of the Ghana demographic and health survey. PLoS ONE, 10(8), e0136748–e0136748. 10.1371/journal.pone.0136748
    1. Arimond, M. , Wiesmann, D. , Becquey, E. , Carriquiry, A. , Daniels, M. C. , Deitchler, M. , … Torheim, L. E. (2010). Simple food group diversity indicators predict micronutrient adequacy of women's diets in 5 diverse, resource‐poor settings. The Journal of Nutrition, 140(11), 2059S–2069S. 10.3945/jn.110.123414
    1. Aryastami, N. K. , Shankar, A. , Kusumawardani, N. , Besral, B. , Jahari, A. B. , & Achadi, E. (2017). Low birth weight was the most dominant predictor associated with stunting among children aged 12–23 months in Indonesia. BMC Nutrition, 3(1), 16. 10.1186/s40795-017-0130-x
    1. Black, R. E. , Victora, C. G. , Walker, S. P. , Bhutta, Z. A. , Christian, P. , de Onis, M. , … Uauy, R. (2013). Maternal and child undernutrition and overweight in low‐income and middle‐income countries. The Lancet, 382(9890), 427–451. 10.1016/S0140-6736(13)60937-X
    1. Briend, A. , Khara, T. , & Dolan, C. (2015). Wasting and stunting‐‐Similarities and differences: Policy and programmatic implications. Food and Nutrition Bulletin, 36(1 Suppl), S15–S23. 10.1177/15648265150361s103
    1. Christian, P. , Lee, S. E. , Donahue Angel, M. , Adair, L. S. , Arifeen, S. E. , Ashorn, P. , … Hu, G. (2013). Risk of childhood undernutrition related to small‐for‐gestational age and preterm birth in low‐ and middle‐income countries. International Journal of Epidemiology, 42(5), 1340–1355. 10.1093/ije/dyt109
    1. Dal Pont, A. , Ferraroni, M. , Bravi, F. , Decarli, A. , Agostoni, C. , & Wiens, F. (2016). Impact of maternal nutrition on breast‐milk composition: A systematic review. The American Journal of Clinical Nutrition, 104(3), 646–662. 10.3945/ajcn.115.120881
    1. Dewey, K. G. (2016). Reducing stunting by improving maternal, infant and young child nutrition in regions such as South Asia: Evidence, challenges and opportunities. Maternal & Child Nutrition, 12(S1), 27–38. 10.1111/mcn.12282
    1. Dorea, J. G. (2002). Selenium and breast‐feeding. British Journal of Nutrition, 88(5), 443–461. 10.1079/BJN2002692
    1. Feed the Future Innovation Lab for Nutrition . (2018). Semi Annual report Year 6: Tufts University. Tisch Library.
    1. Food and Agriculture Organization . (2016). Minimum dietary diversity for women: A guide to measurement. Retrieved from Feed the Future. (2018). Retrieved from Innovation Lab for Nutrition
    1. Fink, G. , Peet, E. , Danaei, G. , Andrews, K. , McCoy, D. C. , Sudfeld, C. R. , … Fawzi, W. W. (2016). Schooling and wage income losses due to early‐childhood growth faltering in developing countries: National, regional, and global estimates. The American Journal of Clinical Nutrition, 104(1), 104–112. 10.3945/ajcn.115.123968
    1. Gewa, C. A. , & Yandell, N. (2012). Undernutrition among Kenyan children: Contribution of child, maternal and household factors. Public Health Nutrition, 15(6), 1029–1038. 10.1017/s136898001100245x
    1. Greenland, S. , & Pearce, N. (2015). Statistical foundations for model‐based adjustments. Annual Review of Public Health, 36, 89–108. 10.1146/annurev-publhealth-031914-122559
    1. Gresham, E. , Byles, J. E. , Bisquera, A. , & Hure, A. J. (2014). Effects of dietary interventions on neonatal and infant outcomes: A systematic review and meta‐analysis. The American Journal of Clinical Nutrition, 100(5), 1298–1321. 10.3945/ajcn.113.080655
    1. Groenwold, R. H. H. , White, I. R. , Donders, A. R. T. , Carpenter, J. R. , Altman, D. G. , & Moons, K. G. M. (2012). Missing covariate data in clinical research: When and when not to use the missing‐indicator method for analysis. CMAJ, 184(11), 1265–1269. 10.1503/cmaj.110977
    1. Huang, M. , Sudfeld, C. , Ismail, A. , Vuai, S. , Ntwenya, J. , Mwanyika‐Sando, M. , & Fawzi, W. (2018). Maternal dietary diversity and growth of children under 24 months of age in rural Dodoma, Tanzania. Food and Nutrition Bulletin, 39(2), 219–230. 10.1177/0379572118761682
    1. Iannotti, L. L. , Zavaleta, N. , León, Z. , Shankar, A. H. , & Caulfield, L. E. (2008). Maternal zinc supplementation and growth in Peruvian infants. The American Journal of Clinical Nutrition, 88(1), 154–160. 10.1093/ajcn/88.1.154
    1. Innis, S. M. (2014). Impact of maternal diet on human milk composition and neurological development of infants. The American Journal of Clinical Nutrition, 99(3), 734S–741S. 10.3945/ajcn.113.072595
    1. K Poon, A. , Yeung, E. , Boghossian, N. , S Albert, P. , & Zhang, C. (2013). Maternal dietary patterns during third trimester in association with birthweight characteristics and early infant growth (vol. 2013).
    1. Madzorera, I., Isanaka, S., Wang, M., Msamanga, G. I., Urassa, W., Hertzmark, E., ⋯ Fawzi, W. W. (2020). Maternal dietary diversity and dietary quality scores in relation to adverse birth outcomes in Tanzanian women. The American Journal of Clinical Nutrition, 112(3), 695–706. 10.1093/ajcn/nqaa172
    1. Martin, C. L. , Siega‐Riz, A. M. , Sotres‐Alvarez, D. , Robinson, W. R. , Daniels, J. L. , Perrin, E. M. , & Stuebe, A. M. (2016). Maternal dietary patterns during pregnancy are associated with child growth in the first 3 years of life. The Journal of Nutrition, 146(11), 2281–2288. 10.3945/jn.116.234336
    1. Martin‐Prével, Y. , Allemand, P. , Wiesmann, D. , Arimond, M. , Ballard, T. , Deitchler, M. , Dop, M.C. , Kennedy, G. , Lee, W.T. & Mousi, M. (2015). Moving forward on choosing a standard operational indicator of women's dietary diversity. Retrieved from Rome:
    1. Merialdi, M. , Caulfield, L. , Zavaleta, N. , Figueroa, A. , Costigan, K. , Dominici, F. , & Dipietro, J. (2004). Randomized controlled trial of prenatal zinc supplementation and fetal bone growth. The American Journal of Clinical Nutrition, 79, 826–830. 10.1093/ajcn/79.5.826
    1. Multicentre Growth Reference Study Group, W. H. O., & de Onis, M . (2006). WHO child growth standards based on length/height, weight and age. Acta Paediatrica, 95(Supplement 450), 76–85. 10.1080/08035320500495548
    1. Myatt, M. , Khara, T. , Schoenbuchner, S. , Pietzsch, S. , Dolan, C. , Lelijveld, N. , & Briend, A. (2018). Children who are both wasted and stunted are also underweight and have a high risk of death: A descriptive epidemiology of multiple anthropometric deficits using data from 51 countries. Archives of Public Health, 76(1), 28. 10.1186/s13690-018-0277-1
    1. Negash, C. , Whiting, S. J. , Henry, C. J. , Belachew, T. , & Hailemariam, T. G. (2015). Association between maternal and child nutritional status in Hula, rural Southern Ethiopia: A cross sectional study. PLoS ONE, 10(11), e0142301–e0142301. 10.1371/journal.pone.0142301
    1. Nguyen, P. H. , Avula, R. , Ruel, M. T. , Saha, K. K. , Ali, D. , Tran, L. M. , … Rawat, R. (2013). Maternal and child dietary diversity are associated in Bangladesh, Vietnam, and Ethiopia. The Journal of Nutrition, 143(7), 1176–1183. 10.3945/jn.112.172247
    1. Okubo, H. , Miyake, Y. , Sasaki, S. , Tanaka, K. , Murakami, K. , Hirota, Y. , … Ohya, Y. (2012). Maternal dietary patterns in pregnancy and fetal growth in Japan: The Osaka maternal and child health study. The British Journal of Nutrition, 107(10), 1526–1533. 10.1017/s0007114511004636
    1. Olofin, I. , McDonald, C. M. , Ezzati, M. , Flaxman, S. , Black, R. E. , Fawzi, W. W. , … Danaei, G. (2013). Associations of suboptimal growth with all‐cause and cause‐specific mortality in children under five years: A pooled analysis of ten prospective studies. PLoS ONE, 8(5), e64636. 10.1371/journal.pone.0064636
    1. Perumal, N. , Al Mahmud, A. , Baqui, A. H. , & Roth, D. E. (2017). Prenatal vitamin D supplementation and infant vitamin D status in Bangladesh. Public Health Nutrition, 20(10), 1865–1873. 10.1017/s1368980015003092
    1. Prentice, P. M. , Schoemaker, M. H. , Vervoort, J. , Hettinga, K. , Lambers, T. T. , Van Tol, E. A. , … Koulman, A. (2019). Human milk short‐chain fatty acid composition is associated with adiposity outcomes in infants. The Journal of Nutrition, 149(5), 716–722. 10.1093/jn/nxy320
    1. Quansah, D. Y. , & Boateng, D. (2020). Maternal dietary diversity and pattern during pregnancy is associated with low infant birth weight in the Cape Coast metropolitan hospital, Ghana: A hospital based cross‐sectional study. Heliyon, 6(5), e03923. 10.1016/j.heliyon.2020.e03923
    1. Rahman, M. S. , Howlader, T. , Masud, M. S. , & Rahman, M. L. (2016). Association of low‐birth weight with malnutrition in children under five years in Bangladesh: Do mother's education, socio‐economic status, and birth interval matter? PLoS ONE, 11(6), e0157814–e0157814. 10.1371/journal.pone.0157814
    1. Roth, D. E. , Krishna, A. , Leung, M. , Shi, J. , Bassani, D. G. , & Barros, A. J. D. (2017). Early childhood linear growth faltering in low‐income and middle‐income countries as a whole‐population condition: Analysis of 179 demographic and health surveys from 64 countries (1993‐2015). The Lancet Global Health, 5(12), e1249–e1257. 10.1016/S2214-109X(17)30418-7
    1. Roth, D. E. , Morris, S. K. , Zlotkin, S. , Gernand, A. D. , Ahmed, T. , Shanta, S. S. , … Al Mahmud, A. (2018). Vitamin D supplementation in pregnancy and lactation and infant growth. New England Journal of Medicine, 379(6), 535–546. 10.1056/NEJMoa1800927
    1. Saaka, M. (2012). Maternal dietary diversity and infant outcome of pregnant women in Northern Ghana. Int. J. Child Health Nutr.. 10.6000/1929-4247.2012.01.02.6
    1. Saaka, M. , & Galaa, S. Z. (2016). Relationships between wasting and stunting and their concurrent occurrence in Ghanaian preschool children. Journal of Nutrition and Metabolism, 2016, 4654920. 10.1155/2016/4654920, 1, 11
    1. Schoenbuchner, S. M. , Dolan, C. , Mwangome, M. , Hall, A. , Richard, S. A. , Wells, J. C. , … Moore, S. E. (2019). The relationship between wasting and stunting: A retrospective cohort analysis of longitudinal data in Gambian children from 1976 to 2016. The American Journal of Clinical Nutrition, 110(2), 498–507. 10.1093/ajcn/nqy326
    1. Shi, J. , Korsiak, J. , & Roth, D. E. (2018). New approach for the identification of implausible values and outliers in longitudinal childhood anthropometric data. Annals of Epidemiology, 28(3), 204–211.e203. 10.1016/j.annepidem.2018.01.007
    1. Smith, T. , Smith, B. , & Ryan, M. A. (2003). Survival analysis using Cox proportional hazards modeling for single and multiple event time data. Retrieved from Cary, NC, USA: Paper presented at the Proceedings of the Twenty‐eighth Annual SAS Users Group International Conference, SAS Institute, Inc., paper.
    1. Stewart, C. P. , Iannotti, L. , Dewey, K. G. , Michaelsen, K. F. , & Onyango, A. W. (2013). Contextualising complementary feeding in a broader framework for stunting prevention. Maternal & Child Nutrition, 9(Suppl 2), 27–45. 10.1111/mcn.12088
    1. Subramanian, S. V. , Ackerson, L. K. , Davey Smith, G. , & John, N. A. (2009). Association of maternal height with child mortality, anthropometric failure, and anemia in India. JAMA, 301(16), 1691–1701. 10.1001/jama.2009.548
    1. Uganda Bureau of Statistics, U., & Icf . (2018). Uganda demographic and health survey 2016. Retrieved from Kampala, Uganda.
    1. United Nations Children's Fund (UNICEF), W. H. O., International Bank for Reconstruction and Development/The World Bank . (2019). Levels and trends in child malnutrition: Key findings of the 2019 edition of the joint child malnutrition estimates. Retrieved from Geneva: World Health Organization.
    1. Victora, C. G. , de Onis, M. , Hallal, P. C. , Blossner, M. , & Shrimpton, R. (2010). Worldwide timing of growth faltering: Revisiting implications for interventions. Pediatrics, 125(3), e473–e480. 10.1542/peds.2009-1519
    1. Villamor, E. , Saathoff, E. , Bosch, R. J. , Hertzmark, E. , Baylin, A. , Manji, K. , … Fawzi, W. W. (2005). Vitamin supplementation of HIV‐infected women improves postnatal child growth. The American Journal of Clinical Nutrition, 81(4), 880–888. 10.1093/ajcn/81.4.880
    1. WHO Child Growth Standards SAS igrowup package . (2006). In.
    1. Yakoob, Y. M. , & Lo, W. C. (2017). Nutrition (micronutrients) in child growth and development: A systematic review on current evidence, recommendations and opportunities for further research. Journal of Developmental & Behavioral Pediatrics, 38(8), 665–679. 10.1097/DBP.0000000000000482
    1. Yang, S. , & Hutcheon, J. A. (2016). Identifying outliers and implausible values in growth trajectory data. Annals of Epidemiology, 26(1), 77–80.e802. 10.1016/j.annepidem.2015.10.002
    1. Zerfu, T. A. , Umeta, M. , & Baye, K. (2016). Dietary diversity during pregnancy is associated with reduced risk of maternal anemia, preterm delivery, and low birth weight in a prospective cohort study in rural Ethiopia. The American Journal of Clinical Nutrition, 103(6), 1482–1488. 10.3945/ajcn.115.116798

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren