Seasonality of energy expenditure during pregnancy and lactation for rural Nepali women

Total energy expenditure (TEE) was estimated for 19 nonpregnant, nonlactating (NPNL) and 24 pregnant (P) or lactating (L) women from 3601 h of minute-by-minute observation and 168 measurements of the energy cost of activities. NPNL women significantly increased subsistence activity and TEE from 9.9 MJ [1.89 x basal metabolic rate (BMR)] in the winter to 10.5 MJ (2.01 x BMR) in the monsoon season. There were differences between NPNL,P, and L women in the winter, but not in the spring or monsoon season when all individuals sustained very heavy physical activity. High TEE values resulted from spending very long hours in tasks that, although appearing physically demanding to the casual observer, were characterized by light or moderate energy cost. The study highlights the importance of seasonal constraints on women's work, which prevent P and L women from significantly curtailing physical activity during the monsoon season, and which effectively limit the scope of behavioral mechanisms for saving energy and reducing TEE.

The nutritional status of children of displaced families in Beirut

The nutritional status of children of displaced families in Greater Beirut was investigated in 1986 (a sample of 146 households) and in 1991 (137 households). Data on demographic variables, nutrient intake (calories, protein, and iron), and anthropometric measurements were collected. Iron intake was only 50-57% of the RDA for the 1-3 age group, and 35.6% and 32.0% of all children consumed < 60% of the RDA for iron in 1986 and 1991, respectively. Main sources of protein were dairy products, milk and eggs. The lower nutrient intake in 1991 compared to 1986 was negatively related to social class. Anthropometric measurements showed an increased past and recent undernutrition of the children in 1991 as compared to both the 1986 child sample and the NCHS standard child population. Severe inflation and marked increase in food prices were reflected in dietary intake and growth of the children. Food aid programmes, government subsidy of bread, and partial wage correction were possible stabilizing factors for the most destitute groups but not for the total population of displaced children.

Korean women's attitudes toward pregnancy and prenatal care

A convenience sample of 40 native-born pregnant Korean women receiving prenatal care at a U.S. military facility in a major metropolitan area in Korea completed a questionnaire about attitudes toward pregnancy and prenatal care. Responses revealed a family life characterized by positive maternal and paternal perceptions of the pregnancy and less preference for a male child than we had anticipated. Traditional beliefs in Tae Mong, a conception dream, and Tae Kyo, rituals for safe childbirth, were followed. Food taboos, including protein sources, were reported. Attitudes toward prenatal care services, care providers, and maternal health habits are described.

Biological determinants of pregnancy weight gain in a Filipino population

Patterns of pregnancy weight gain and predictors of first trimester and total weight gain were investigated in a sample of 1367 women from Cebu, Philippines, with pregnancy intervals of < 2 y. The mean total weight gain based on actual measurements of prepregnant weight was 8.4 kg. Controlling for gestational week when weight was measured, multivariate-regression models predicted higher first trimester weight gain with higher parity, lower prepregnant body mass index (BMI), and longer nonpregnant intervals. Higher total weight gain was associated with longer nonpregnant intervals, lower prepregnant BMI, taller maternal stature, and relatively high dietary energy intakes. Lactation into the third trimester of pregnancy and maternal age over 35 y had significant negative effects on total weight gain. Given the importance of maternal weight gain in predicting birth outcome, this study provides information on modifiable risk factors that should be considered when developing maternal-infant health policy and programs.

Influence of birth interval and child labour on family energy requirements and dependency ratios in two traditional subsistence economies in Africa

The consequences of different birth intervals on dietary energy requirements and dependency ratios at different stages of the family lifecycle are modelled for Gambian agriculturalists and !Kung hunter-gatherers. Energy requirements reach a peak at between 20 and 30 years after starting a family for the Gambians, and between 15 and 20 years for the !Kung. For the Gambians, shorter birth interval confers no economic advantage over the traditional birth interval of 30 months. For the !Kung, the lack of participation in subsistence activities by children gives an output:input ratio in excess of that reported in other studies, suggesting that they are in a state of chronic energy deficiency.

Prolonged lactation contributes to depletion of maternal energy reserves in Filipino women

This paper identifies determinants of women's postpartum weight and weight change in a large group of Filipino women followed for 24 mo. Longitudinal, multivariate models focused on the effects of lactation, while controlling for energy intake, energy expenditure, reproductive history and seasonality. Lactation was found to have a significant negative effect on weight of urban women. The negative effects of lactation increased with the intensity and duration of breast-feeding. Among rural women negative effects of lactation on weight were observed only after 10-14 mo. Models of net postpartum weight change (from 2 to 24 mo) among nonpregnant women confirmed an important role for lactation. The likelihood of weight loss was significantly increased by lactation of more than 12-mo duration, by greater maternal age and by low dietary energy intake. The effects of lactation on maternal energy reserves can be mitigated substantially be increasing maternal dietary energy intakes.

Reproduction and maternal nutrition in Madura, Indonesia

The prevalence and severity of chronic energy deficiency (CED) among women of reproductive age as well as its consequences on the newborn and the mother were assessed in a longitudinal study. More than 40% of the mothers had a Body Mass Index (BMI) less than 18.5 before pregnancy, a level below which CED is considered to exist. Weight gain during pregnancy was low, on average 6.6 kg. Taking the difference between 4 week postpartum weight and pre-pregnant weight as net weight gain during pregnancy, mothers with a BMI less than 18.5 before pregnancy gained weight while those with a higher BMI lost weight. This observation suggests that the partitioning of energy to the fetus and the mother depends on the energy reserves of the mother before pregnancy. The functional significance of BMI as an indicator of CED is illustrated by its relation with birth weight. Similarly, 4 week postpartum, weight and BMI were predictive for the weight changes in the mother in the first 12 months after delivery. The groups with the lowest values gained weight, while the heaviest mothers lost weight. In view of the negative effects of CED among women of reproductive age on the infant and the mother, maternal undernutrition should receive the same attention as malnutrition among preschool children.

Energetic and metabolic cost of growth in Gambian infants

The aim of the study was to measure the energy used for growth of healthy fullterm and breast-fed Gambian infants. The weight gain (WG) of 14 infants (mean age +/- SEM 17 +/- 1 d, weight 3.581 +/- 0.105 kg) was measured over a 2-week period; the energy intake (EI) from breast milk was assessed for 24 h in the middle of the study period by weighing the infant before and after each breast-feed. On the same day, sleeping energy expenditure (SEE) and respiratory quotient (RQ) were measured for 30 min on five occasions through the 24-h period. EI averaged 502 +/- 25 kJ/kg.d, and SEE 230 +/- 6 kJ/kg.d; thus, an average of 272 kJ/kg.d were available for physical activity and the energy stored for growth. The total energy spent by infants while sleeping and for periods of physical activity was calculated to be 1.7 x SEE. The mean RQ measured on five occasions averaged 0.879 +/- 0.009. SEE was correlated with WG (r = 0.747, P less than 0.005), with a slope of the regression line of 5.5 kJ/g; this value can be considered as an estimate of the energy spent for new tissue synthesis in the resting infant. The efficiency of weight gain was lower in this study (67%) than in studies conducted on fast-growing preterm infants or children recovering from malnutrition.

Lactation performance of rural Mesoamerindians

Anthropometry, body composition and dietary intake of 30 lactating Otomi Indians of Capulhuac, Mexico, were studied to identify maternal factors which potentially limit lactation and thereby infant growth. Human milk production, milk composition, and maternal dietary intake, body weight, skinfold thicknesses, and body composition were measured at 4 and 6 months postpartum. The 2H2O dose-to-mother method was used to estimate milk production and maternal total body water (TBW). Fat-free mass (FFM) was calculated as TBW/0.73. Body fat was computed as body weight minus FFM. Human milk samples were analyzed for energy, nitrogen, lactose and fat using standard analytical methods. Maternal diet was assessed by three 24-h intake recalls. Mean (SD) milk production was 885 (146) and 869 (150) g/d at 4 and 6 months, respectively. Milk concentrations of protein nitrogen (1.23 (0.17) mg/g) and lactose (66.6 (2.8) mg/g) were comparable to, but the concentrations of fat (22.2 (6.7) mg/g) and energy (0.54 (0.06) kcal/g) were lower than, values observed in economically privileged populations. Maternal height, weight, and BMI were 1.47 (0.06) m, 50.3 (6.0) kg, and 23.4 (3.1) kg/m2, respectively. Maternal TBW, FFM and body fat were 55.8 (4.6)%, 76.4 (6.3)%, and 23.6 (6.4)%, expressed as a percentage of body weight, respectively. Maternal energy and protein intakes averaged 1708 (338) kcal/d and 40 (10) g/d, respectively. Milk production was negatively correlated with maternal body fat (P = 0.006). Energy and fat concentrations in the milk of the Otomi women were positively related to their weight (P = 0.002), BMI (P = 0.05), and body fat (P = 0.004). Energy concentrations in milk were not related to rates of milk production (r = 0.24; P = 0.23). Nor was milk production or composition significantly associated with maternal dietary intake. Lactation performance of these Otomi women correlated significantly with maternal body size and composition, but not current dietary intake.

Is cow's milk suitable for the dietary supplementation of rural Gambian children? 1. Prevalence of lactose maldigestion

To define the age-related prevalence of lactose maldigestion (LM), 218 children aged 13-72 months from a rural Gambian village were studied using a lactose breath hydrogen test. There was a significant rise in LM from 21% to 76% between the 2nd and 3rd-5th years of life (p < 0.001). Only eight children had diarrhoea within 2 weeks before the test. Diarrhoea and abdominal discomfort followed in only seven children (3%). There was no difference in mean time of introduction of supplementary diet or cessation of breastfeeding between children aged 12-36 months with lactose digestion and LM. There was a greater proportion of children with normal lactose digestion than with LM in those still receiving breast milk (85% vs 15%), and a greater proportion of LM in the fully weaned group (63% vs 37%) (p < 0.001). There was no relation between weight-for-age or weight-for-height and the ability to digest lactose. The ability to digest lactose is lost in the majority of children during the 2nd year, coincident with the cessation of breastfeeding, but is not a major factor associated with growth failure thereafter.

Is cow's milk suitable for the dietary supplementation of rural Gambian children? 2. Patterns of cow's milk intake

Cow's milk has been advocated as a source of supplementary diet for children in many parts of the developing world. The frequency and forms of cow's milk intake and the factors regulating its availability and consumption by 507 children aged up to 6 years in three Gambian villages were measured. Nineteen per cent of mothers did not give cow's milk to their children. Of 413 children taking cow's milk, 41% consumed it only once a week, 32% two to four times a week, 19% once a day and 8% more than once a day. Eighty per cent of children took both fresh and sour milk. Forty-one per cent of infants up to 1 year old received cow's milk at some time. There was a decrease with age in the proportion of children taking fresh milk and a rise with age in the proportion taking sour milk alone (p < 0.001) and both forms of milk. Only 2% of children were reported to have an adverse reaction to fresh cow's milk. The main factors affecting intake were the availability of money and milk. The consumption of cow's milk in early life is common and free of adverse effects. When it is available, it should be used to supplement the diet of the weaned child.

Is human lactation a particularly efficient process?

The recommended dietary allowances of many expert committees (UK DHSS 1979, FAO/WHO/UNU 1985, USA NRC 1989) have set out the extra energy requirements necessary to support lactation on the basis of an efficiency of 80 per cent for human milk production. The metabolic efficiency of milk synthesis can be derived from the measurements of resting energy expenditure in lactating women and in a matched control group of non-pregnant non-lactating women. The results of the present study in Gambian women, as well as a review of human studies on energy expenditure during lactation performed in different countries, suggest an efficiency of human milk synthesis greater than the value currently used by expert committees. We propose that an average figure of 95 per cent would be more appropriate to calculate the energy cost of human lactation.

Assessment of knowledge and skills about growth monitoring amongst child development project officers

Knowledge and skills about growth monitoring (GM) amongst Child Development Project Officers (CDPOs) were assessed by interview technique. Majority (94%) of subjects had correct knowledge that GM helps in early detection of growth retardation while about 83% felt that a flattened growth curve indicates no weight gain. The percentages of CDPOs who were able to interpret and read correctly about what ascending descending and flattened growth curves indicate were 83, 71 and 50% respectively. There is thus a need of in-service training of CDPOs in GM activities.

Child nutrition in the pre-harvest season in Kenya

This study examines the food consumption and nutritional status of pre-school children during the period March-April, at the end of the dry season in the Kano Plain of Nyanza Province. The diet of pre-school children in this region of Kenya consists foremost of maize and milk. Food consumption was generally low with considerable deficits in energy intake and other nutrients among all age groups, although protein intake was generally at recommended levels. The heights of the children did not differ from the available national and regional figures, but the weights of the children were far below earlier figures which must be related to the prevailing lean seasons. The youngest group in the sample, aged 6-12 months, showed the largest deficit in weight status. This group appears to suffer most from the seasonal imbalance. Overall the findings indicate that the seasonal deficits in this part of Kenya are more severe than was assumed until now.

Nutrient intakes during pregnancy: observations on the influence of smoking and social class

The influence of smoking and social class on dietary intake in pregnancy was investigated in a random sample of smokers (greater than or equal to 15 cigarettes/d) and nonsmokers. A total of 206 subjects (94 smokers and 112 nonsmokers) completed a 7-d weighed dietary intake at 28 wk gestation and 178 completed a second assessment at 36 wk. Nonsmokers had higher intakes of almost all nutrients than did smokers and the nutrient density of their diet was greater. Energy intake was nonsignificantly higher in nonsmokers. Women in higher social classes had the highest nutrient intakes. Smokers were shorter than nonsmokers and tended to be of lower social class. After maternal height and social class were controlled for, smoking had a significant effect on intake of many micronutrients. Dietary intake was reduced in late pregnancy, particularly in smokers. These data suggest that smokers in all social classes have a poorer quality of diet.

Effect of protein rich diet during acute phase of dysentery

Ninety six children upto the age of five years suffering from uncomplicated acute dysentery of less than 3 days' duration were studied to find out the impact of feeding of extra-protein rich diet during their acute phase of illness. These children were randomly allocated to either control group (receiving only hospital diet) and study group (receiving hospital diet and extra milk which constituted 30% of ideal total calorie requirement of patients. Patients in the two groups were comparable on admission. Forty percent reduced food intake was observed among the children of both the groups due to severe anorexia which was reflected by no significant differences in clinical outcome, anthropometrical measurements and haematological parameters between the two groups on day 7 of hospitalisation and on day 15 after discharge.