1
|
Ramakrishnan U, Wimalasena ST, Young MF, Khuong LQ, Tran LM, Hoffman DJ, Martorell R, Nguyen PH. Preconception Micronutrient Supplementation Affects Maternal BMI and Body Composition Postpartum: A Randomized Controlled Trial in Vietnam. J Nutr 2024; 154:1440-1448. [PMID: 38417549 DOI: 10.1016/j.tjnut.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Although there is growing evidence on the role of preconception nutrition for birth outcomes, limited evidence exists for its effects on maternal health. OBJECTIVES This study evaluates the impact of preconception micronutrient supplementation on maternal BMI (kg/m2) and body composition at 6 to 7 y postpartum (PP). METHODS We followed females who participated in a randomized controlled trial of preconception supplementation in Vietnam and delivered live offspring (n = 1599). Females received weekly supplements containing either 2800 μg folic acid (FA) only, 60 mg iron and 2800 μg FA (IFA), or multiple micronutrients (MMs) (15 micronutrients including IFA) from baseline until conception followed by daily prenatal IFA supplements until delivery. Height, weight, mid-upper arm circumference, triceps skinfold, and waist-hip circumference were measured at recruitment and at 1, 2, and 6 to 7 y PP. Body fat was assessed using bioelectric impedance at 6 to 7 y PP (n = 867). Group comparisons were made using analysis of variance or chi-square tests and general linear models for adjusted models. RESULTS At 6 to 7 y PP, we found significant differences (P < 0.05) by treatment group for mean percent fat (MM: 29.2%; IFA: 27.6%; FA: 27.8%), absolute fat mass (MM: 15.1 kg; IFA: 14.0 kg; FA: 14.3 kg), and prevalence of underweight based on BMI < 18.5 (MM: 5.8%; IFA: 10.3%; FA: 14.3%). Mean BMI and triceps skinfold thickness were higher in the MM group, but these differences were not statistically significant; the differences in absolute fat mass were also attenuated after controlling for body weight. No differences were observed for fat-free mass, prevalence of overweight (BMI >23), or other anthropometric measurements. CONCLUSIONS Preconception MM supplementation was associated with lower prevalence of underweight and higher percent fat when compared with IFA and/or FA only. Preconception micronutrient interventions may have long-term effects on maternal health and merit further examination. This trial was registered at clinicaltrials.gov as NCT01665378.
Collapse
Affiliation(s)
- Usha Ramakrishnan
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States; Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta GA, United States.
| | - Sonia Tandon Wimalasena
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta GA, United States
| | - Melissa F Young
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States; Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta GA, United States
| | | | - Lan M Tran
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta GA, United States
| | - Daniel J Hoffman
- Department of Nutritional Sciences, Program in International Nutrition, New Jersey Institute for Food, Nutrition, and Health, Center for Childhood Nutrition Research, Rutgers, the State University of New Jersey, New Brunswick, NJ, United States
| | - Reynaldo Martorell
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States; Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta GA, United States
| | - Phuong H Nguyen
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam; Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States
| |
Collapse
|
2
|
Islam MH, Nayan MM, Jubayer A, Amin MR. A review of the dietary diversity and micronutrient adequacy among the women of reproductive age in low- and middle-income countries. Food Sci Nutr 2024; 12:1367-1379. [PMID: 38455218 PMCID: PMC10916566 DOI: 10.1002/fsn3.3855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 03/09/2024] Open
Abstract
The dietary quality of women of reproductive age (WRA) is particularly important during preconception, conception, and pregnancy for themselves and their offspring. Poorly diversified diets resulting in inadequate micronutrient consumption may have adverse effects on their health. This narrative review summarizes the findings of studies reporting on dietary diversity and micronutrient intake by WRA in low- and middle-income countries (LMICs). Studies on WRA aged 15-49 years in LMICs, with a sample size of more than 150, report dietary diversity and multiple micronutrient intake based on 24-h dietary recall/food weighed record/food frequency questionnaire, and published between January 2011 and June 2021 were included. The results were compared to the Food and Agriculture Organization (FAO) recommended cut-off for dietary diversity and the Indian Council of Medical Research (ICMR) recommended age- and sex-specific estimated average requirements (EARs) for micronutrient intake. This review includes 35 articles, of which 21 focused on dietary diversity and 14 on micronutrient intake. The results showed that WRA in LMICs had inadequate dietary diversity, with mean food group consumption of only 3.0-4.84, and around 42.3%-90% of women consumed inadequately diversified diets (<5 food groups). Additionally, most studies found that WRA did not consume adequate amounts of essential micronutrients, particularly calcium, iron, zinc, vitamin A, thiamin, riboflavin, folate, and vitamin B12. However, the intake of vitamin C, niacin, and vitamin B6 was above the required levels. In conclusion, this review highlights the common inadequacy of dietary diversity and multiple micronutrient intake among WRA in most LMICs. Effective measures involving improving dietary diversity, food fortification with micronutrients, and supplementation programs could help improve the dietary quality and intake of optimal micronutrients by women in LMICs.
Collapse
Affiliation(s)
- Md. Hafizul Islam
- Institute of Nutrition and Food Science, University of DhakaDhakaBangladesh
| | - Md. Moniruzzaman Nayan
- Institute of Nutrition and Food Science, University of DhakaDhakaBangladesh
- Inspira Advisory and Consulting LimitedDhakaBangladesh
| | - Ahmed Jubayer
- Institute of Nutrition and Food Science, University of DhakaDhakaBangladesh
- Bangladesh Institute of Social Research (BISR) TrustDhakaBangladesh
| | - Md. Ruhul Amin
- Institute of Nutrition and Food Science, University of DhakaDhakaBangladesh
| |
Collapse
|
3
|
Pastori G, Brouwer ID, Siemonsma M, Verhoef H, Huong LT, Le Xuan TT, Mai TT, Samuel FO, Shittu OF, Eyinla TE, Even B, Hernandez R, Lundy M, de Brauw A, Wertheim-Heck S, Ambler K, Meldrum G, De Filippo A, Talsma EF. Fruit and Vegetable Intake of Females Before, During, and After Introduction of 3 Bundled Food System Interventions in Urban Vietnam and Nigeria. Curr Dev Nutr 2024; 8:102050. [PMID: 38156343 PMCID: PMC10751831 DOI: 10.1016/j.cdnut.2023.102050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 10/31/2023] [Accepted: 11/23/2023] [Indexed: 12/30/2023] Open
Abstract
Background Low fruit and vegetable (FV) intake in low- and middle-income countries, which is associated with noncommunicable diseases and micronutrient deficiencies, requires food system interventions addressing FV accessibility, affordability, and acceptability. Periodic FV intake monitoring during interventions informs progress toward achieving increased intakes and contributes to understanding the effectiveness of these interventions. Objectives This study evaluates the trend in FV intake before, during, and after implementation of a set of nutrition-sensitive food system interventions addressing accessibility, affordability, and acceptability to increase FV consumption over a 1-y period in Vietnamese and Nigerian low-income urban and periurban females. Methods We used the Diet Quality Questionnaire to assess FV food group consumption among 600 Vietnamese (Hanoi) and 610 Nigerian (Ibadan) females before, during, and after the interventions (Vietnam: July 2020-September 2021; Nigeria: November 2020-December 2021). A FV score was compared between exposure groups with (mixed) count modeling. The trend in consumption of individual FV groups was analyzed with mixed logistic regression. Results The FV score was stable over time, and a small increase was observed after the intervention period especially in Nigeria and in urban Vietnam. A decrease in the total score was observed in periurban Vietnam. Fluctuations were detected in the probability of consumption of individual FV groups over time especially within the fruit groups, probably due to seasonal availability. The degree of exposure could not explain differences in FV intake. Conclusions We found a marginal increase in the proportion of females consuming FV during the interventions in both countries. The FV score appeared to be a simple, quick, and easy-to-use indicator for monitoring diversity, variety, and consumption.
Collapse
Affiliation(s)
- Giulia Pastori
- Department of Global Nutrition, Division of Human Nutrition and Health, Wageningen University and Research, the Netherlands
| | - Inge D Brouwer
- Department of Global Nutrition, Division of Human Nutrition and Health, Wageningen University and Research, the Netherlands
- International Food Policy Research Institute, United States
| | - Meike Siemonsma
- Department of Global Nutrition, Division of Human Nutrition and Health, Wageningen University and Research, the Netherlands
| | - Hans Verhoef
- Department of Global Nutrition, Division of Human Nutrition and Health, Wageningen University and Research, the Netherlands
| | - Le Thi Huong
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Vietnam
| | - Thi Thanh Le Xuan
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Vietnam
| | | | - Folake O Samuel
- Department of Human Nutrition and Dietetics, University of Ibadan, Nigeria
| | - Oluyemisi F Shittu
- Department of Human Nutrition and Dietetics, University of Ibadan, Nigeria
| | | | - Brice Even
- The Alliance of Bioversity International and the International Center for Tropical Agriculture, Vietnam and Colombia
| | - Ricardo Hernandez
- The Alliance of Bioversity International and the International Center for Tropical Agriculture, Vietnam and Colombia
| | - Mark Lundy
- The Alliance of Bioversity International and the International Center for Tropical Agriculture, Vietnam and Colombia
| | - Alan de Brauw
- International Food Policy Research Institute, United States
| | - Sigrid Wertheim-Heck
- Department of Global Nutrition, Division of Human Nutrition and Health, Wageningen University and Research, the Netherlands
| | - Kate Ambler
- International Food Policy Research Institute, United States
| | - Gennifer Meldrum
- The Alliance of Bioversity International and the International Center for Tropical Agriculture, Vietnam and Colombia
| | - Amanda De Filippo
- The Alliance of Bioversity International and the International Center for Tropical Agriculture, Vietnam and Colombia
| | - Elise F Talsma
- Department of Global Nutrition, Division of Human Nutrition and Health, Wageningen University and Research, the Netherlands
| |
Collapse
|
4
|
Tran LM, Nguyen PH, Hoang NT, Truong DTT, Tran THT, Bui DN, Hoa HTH, Hua DT, Bergeron G. Dietary intake and occupational status among female youths of Thai Nguyen, Vietnam. Ann N Y Acad Sci 2023; 1527:75-83. [PMID: 37501649 DOI: 10.1111/nyas.15044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Adolescence is a sensitive transition time that affects rights, roles, and responsibilities in food choice, yet limited evidence exists on dietary intakes during this critical period. This study assessed the food consumption pattern and the adequacy of energy, macronutrient, and micronutrient intakes among female youth belonging to three occupational groups in Vietnam. Dietary intakes were measured for 1001 participants aged 16-22 years using INDDEX24's 24-h recall method. Multivariate regression analyses were conducted to examine differences in diet outcomes among the three occupational groups. Dietary diversity was similar across groups but workers, compared to high school and college students, consumed less baked/grain-based sweets and fast foods, and more soft drinks, other sweets, and processed meat. Two-thirds of the sample showed energy intake lower than the estimated energy requirement, while a substantial percentage had insufficient or excessive intake of carbohydrate and fat. The mean probability of adequacy of nutrient intakes was low (0.33) and not different across all three occupational groups except for folate, which favored workers. Our study provides novel evidence supporting the development and implementation of interventions to achieve national targets, with emphasis on female youths who undergo special transitions in education, occupation, and lifestyle.
Collapse
Affiliation(s)
- Lan Mai Tran
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA
| | - Phuong Hong Nguyen
- International Food Policy Research Institute, Washington, DC, USA
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | | | | | | | - Diep Ngoc Bui
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | - Hanh Thi Hong Hoa
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | - Diem Thi Hua
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | | |
Collapse
|
5
|
Gie SM, Nguyen PH, Bergeron G, Tran LM, Hoang NT, Knight F. Locally relevant food-based recommendations could increase iron and calcium intake for adolescent girls in Vietnam. Ann N Y Acad Sci 2023; 1527:97-106. [PMID: 37414089 DOI: 10.1111/nyas.15036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Unhealthy eating habits are common among adolescents in Vietnam, where transitioning food environments increasingly offer energy-dense micronutrient-poor foods. Successful behavior change approaches must be feasible and acceptable, promoting local foods that are available, accessible, and preferred. Yet, few studies have investigated the potential of food-based approaches for adolescents. We used linear programming to identify problem nutrients, local nutrient sources, and realistic food-based recommendations (FBRs) to improve nutrient intake among girls 16-22 years in Thai Nguyen, Vietnam. We then identified a reduced set of FBRs to prioritize the most critical micronutrient gaps. Calcium and iron targets could not be met in any realistic diet modeling scenario. The best set of FBRs included seven recommendations which could meet intake targets for 9 of 11 modeled micronutrients. The best reduced set of three FBRs targeting iron and calcium only-although more feasible for behavior change-was less effective at improving intake of these nutrients since fewer foods were recommended. Given the difficulty of meeting calcium and iron targets using local foods within acceptable dietary patterns, additional interventions, such as supplementation, staple food fortification, or increasing the availability of affordable calcium- and iron-rich foods, may be necessary to promote dietary adequacy for adolescent girls.
Collapse
Affiliation(s)
| | - Phuong Hong Nguyen
- International Food Policy Research Institute, Washington, DC, USA
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen City, Vietnam
| | | | | | | | - Frances Knight
- Nutrition Division, United Nations World Food Programme, Rome, Italy
- London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
6
|
Kushi EN, Belachew T, Tamiru D. The impacts of okra consumption on the nutritional status of pregnant women, west Ethiopia. Food Sci Nutr 2023; 11:5554-5564. [PMID: 37701227 PMCID: PMC10494605 DOI: 10.1002/fsn3.3512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 09/14/2023] Open
Abstract
Food-insecurity and poor-quality diets remain a challenge for pregnant women. Consumption of okra has a great impact on improving the nutritional status of pregnant women. Okra plays a critical role in the prevention of malnutrition among pregnant women living in resource-limited settings. The evidence is scarce on the impacts of okra on mid-upper arm circumference (MUAC) measurement of pregnant women. A community-based cross-sectional study was employed among randomly selected 224 pregnant women from June 1 to July 30, 2020. An interviewer-administered questionnaire was used. The MUAC was measured by using an adult MUAC measuring tape. Data were entered into Epi-data version 3.1 and exported to SPSS version 25 for analysis by linear regression. The statistical significance of variables was declared at a p-value of .05, and unstandardized beta (β) coefficients along with a 95% confidence interval were computed. The proportion of pregnant women with low MUAC (≤22 cm) was 42.4%. In the multivariable linear regression model, hemoglobin concentration (β = 0.346, [95% CI: 0.153, 0.539], p = .001), food insecurity (β = -0.887, (95% CI: -1.441, -0.334), p = .002), daily consumption of okra (β = 1.269, [95% CI: 0.583, 1.956], p ≤ .001), and women working in NGO (β = 0.443, [95% CI: 0.256, 0.630], p ≤ .001) were significant variables. The prevalence of malnutrition among pregnant women (MUAC ≤ 22 cm) was 42.4%. Therefore, behavioral change communication interventions to promote okra consumption on regular basis were recommended.
Collapse
Affiliation(s)
| | - Tefera Belachew
- Departments of Nutrition and DieteticsJimma UniversityJimmaEthiopia
| | - Dessalegn Tamiru
- Departments of Nutrition and DieteticsJimma UniversityJimmaEthiopia
| |
Collapse
|
7
|
Nguyen SD, Biesbroek S, Le TD, Feskens EJM, Brouwer ID, Talsma EF. Environmental impact and nutrient adequacy of derived dietary patterns in Vietnam. Front Nutr 2023; 10:986241. [PMID: 37485385 PMCID: PMC10358330 DOI: 10.3389/fnut.2023.986241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
Rationale and objective Improving diet quality while decreasing environmental impacts is an important challenge for a healthy and sustainable food system. Therefore, this study aims to analyze the most common dietary patterns per female household member and explore the diet quality and environmental impacts of these patterns. Methodology The nationally representative General Nutrition Survey of 2009-2010 (n = 8,225 households) was used to derive dietary patterns using principal component analysis (PCA) based on 18 food groups as input variables. Quintiles of the highest adherence (Q5) and lowest adherence (Q1) were generated based on the factor score of each dietary pattern. Nutrient adequacy and dietary diversity scores (DDS) were calculated to measure diet quality, and greenhouse gas emission (GHGE) and blue water use (BWU) were selected as environmental impact indicators. Results Using PCA, three distinct dietary patterns were identified: an Omnivorous, Traditional, and Pescatarian pattern. Compared to the Traditional pattern, the Omnivorous and Pescatarian patterns (Q5s) were associated with a higher nutrient adequacy, with mean probability of adequacy of 0.51 in both patterns, compared to 0.45 in the Traditional pattern. However, environmental impacts in terms of GHGE and BWU per 2,000 kcal were considerably higher in the Omnivorous pattern (6.14 kg CO2-eq. and 0.15 m3/kg) compared to all other pattern's Q5s. The GHGE was lowest in the Traditional pattern (4.18 kg CO2-eq.) and the Pescatarian pattern has the lowest BWU (0.12 m3/kg). Conclusion Despite that diet quality was slightly better in all three patterns compared to the average diet of the total population, environmental impact was also higher. Therefore, future research is needed to develop a more optimal diet that considers both diet quality and environmental impact to explore the trade-offs between diet quality and environmental impact.
Collapse
Affiliation(s)
- Son D. Nguyen
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
- National Institute of Nutrition, Ministry of Health, Hanoi, Vietnam
| | - Sander Biesbroek
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Tuyen D. Le
- National Institute of Nutrition, Ministry of Health, Hanoi, Vietnam
| | - Edith J. M. Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Inge D. Brouwer
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
- International Food Policy Research Institute, Washington DC, United States
| | - Elise F. Talsma
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| |
Collapse
|
8
|
Amjad M, Akbar M. The Association between Fruit and Vegetable Intake and Socioeconomic Factors in the Households of Pakistan Using Quantile Regression Model. SOCIAL WORK IN PUBLIC HEALTH 2023; 38:248-258. [PMID: 36242534 DOI: 10.1080/19371918.2022.2134249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The purpose of this study was to examine the impact of socioeconomic factors on fruit and vegetable consumption in the households of Pakistan. Secondary data were used from a national-level survey, i.e. "Household Integrated Income and Consumption Survey" (HIICS) 2015-2016 published by the Pakistan Bureau of Statistics. A total of 11,187 households were included in the final analysis. Quantile regression models were applied to investigate the association between socioeconomic factors and the consumption of fruit and vegetable. More than half of the households in the sample did not meet the World Health Organization's (WHO) recommended criteria for fruit and vegetable consumption, which is 400 g/day/capita. According to the quantile regression model, household income is an important factor in increasing fruit and vegetable intake because an increase in income leads to a greater likelihood of spending on healthy and nutritious foods. The increased consumption of fruit and vegetable was caused by the household head's high education, which created multiple resources to increase income. Households in two provinces, i.e. Khyber Pakhtunkhwa and Baluchistan, have a greater impact on fruit and vegetable consumption than other provinces due to natural resource availability. Household size and dependency ratio hurt the consumption of fruit and vegetable because women and children are not able to do work. These results are very useful because a better understanding of the socioeconomic characteristics associated with fruit and vegetable intake could improve the effectiveness of policies aimed at increasing fruit and vegetable consumption and reducing the risk of chronic diseases.
Collapse
Affiliation(s)
- Muhammad Amjad
- Department of Mathematics and Statistics, International Islamic University, Islamabad, Pakistan
| | - Muhammad Akbar
- Department of Mathematics and Statistics, International Islamic University, Islamabad, Pakistan
| |
Collapse
|
9
|
Puwanant M, Boonrusmee S, Jaruratanasirikul S, Chimrung K, Sriplung H. Dietary diversity and micronutrient adequacy among women of reproductive age: a cross-sectional study in Southern Thailand. BMC Nutr 2022; 8:127. [PMCID: PMC9641308 DOI: 10.1186/s40795-022-00619-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Adequate nutritional intake of both macronutrients and micronutrients is essential for maintaining good health throughout life, particularly for women of reproductive age (WRA). The Minimum Dietary Diversity for WRA (MDD-W), or the sum of dietary diversity, is recommended as a simple indicator to identify at-risk WRA populations. However, there are no studies on the MDD-W among WRA in Thailand.
Objectives
To determine food group diversity, MDD-W, and micronutrient intake of WRA in Southern Thailand.
Participants
From December 2020 to November 2021, 120 healthy, young WRA (average age 33.2 ± 4.5 years) were enrolled.
Methods
A 24-h food record was used to quantitatively and qualitatively assess the food consumed. Dietary diversity was classified into ten food groups. The macronutrients and 15 micronutrients were calculated using the software program INMUCAL, which is the standard program for calculating nutrients in Thai food. The calculated intake of each micronutrient was transformed to the probability of adequacy (PA).
Results
The most common foods consumed were rice, followed by meat, eggs, fruits, and vegetables. Fewer than 40% of the participants consumed beans, dairy products, vitamin A-rich fruits and vegetables, dark green vegetables, and pulses. The average MDD-W score was 5 (range 2–8). The mean caloric intake (1,865 cal/day) was adequate for non-lactating WRA but was approximately 300 kcal/day lower than the recommendation for lactating WRA. Most WRA consumed lower amounts of micronutrients than those recommended. The mean PA (MPA) of the 15 micronutrients was 0.33 (range 0.0–0.9).
Conclusions
Non-pregnant WRA in Songkhla consumed adequate macronutrients but inadequate micronutrients. A nutritional education program regarding the importance of micronutrients should be provided to the public, with special attention to WRA.
Collapse
|
10
|
Amjad M, Akbar M, Ullah H. A copula-based approach for creating an index of micronutrient intakes at household level in Pakistan. ECONOMICS AND HUMAN BIOLOGY 2022; 46:101148. [PMID: 35691137 DOI: 10.1016/j.ehb.2022.101148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/24/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
Deficiency of micronutrients is considered as the basic cause of health issues. There are a large number of micronutrients to be considered for good health, which are analyzed separately. However, such analyses involve practical as well as methodological complications and it requires construction of an index representing malnutrition of micronutrients. This study proposes copula methodology to categorize malnutrition of micronutrients at household level by combining the dependence structure of various correlated variables. Data of eleven micronutrients are extracted from HIICS- 2015-16 published by Pakistan -Bureau of Statistics. Seven out of the eleven variables are highly correlated, which are considered to construct the index. These include calcium, iron, iodine, zinc, riboflavin, thiamine and phosphorus intakes per capita at household level. Normal probability distribution is found as the best fit to the sample data of all variables. Gaussian copula function is used to derive multivariate probability distribution by combining univariate marginal probability distribution of each micronutrient. The Multivariate distribution of Gaussian copula model is used to calculate cumulative probabilities, which provide a base to categorize households' malnutrition w.r.t. micronutrients. The results show that 60% households lie in very low or low category of micronutrient intakes, 20% of households fall into medium category while 20% fall into high or very high category of micronutrient consumption. The proposed methodology might be helpful to combine other micronutrients as well as a variety of correlated variables in many other fields having a survey data.
Collapse
Affiliation(s)
- Muhammad Amjad
- Department of Mathematics and Statistics, International Islamic University, Islamabad, Pakistan.
| | - Muhammad Akbar
- Department of Mathematics and Statistics, International Islamic University, Islamabad, Pakistan.
| | - Hamd Ullah
- Department of Mathematics and Statistics, International Islamic University, Islamabad, Pakistan.
| |
Collapse
|
11
|
Amjad M, Akbar M. Decomposition of Socioeconomic Changes in the Consumption of Micronutrients in Pakistan between 2006 and 2016. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2022; 67:133-149. [PMID: 35593158 DOI: 10.1080/19485565.2022.2072269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This study is conducted to decompose inequality in four important micronutrient intakes, i.e. calcium, iodine, iron, and zinc due to socioeconomic factors during 2006-2016. For this purpose, data were taken from national-level surveys, i.e. HIES-2006 and HIICS-2016. We applied a recently proposed decomposition method based on copula function to decompose between year changes in the consumption of micronutrients into structure and composition effect. The results show that average calcium and iron intakes increased by 518.54 (mg) and 0.962 (mg), respectively, while average iodine and zinc intakes decreased by 2.009 (mg) and 3.411 (mg), respectively, during the decade. Estimates of structure effect show that calcium, iodine, and iron consumption increased on average, i.e. 525.316 (mg), 14.615 (mg), and 2.15 (mg), respectively, while zinc intake decreased by 2.735 (mg). The composition effect is negative for all the four micronutrients, implying that consumption of calcium, iodine, iron, and zinc decreased as 6.7766 (mg), 16.624 (mg), 1.189 (mg), and 0.677 (mg), respectively. The main factors of this change are household income, urbanization, provinces, and household size. The policymakers need to know the importance of socioeconomic factors to improve hidden hunger in terms of micronutrient intakes.
Collapse
Affiliation(s)
- Muhammad Amjad
- Department of Mathematics and Statistics, International Islamic University, Islamabad, Pakistan
| | - Muhammad Akbar
- Department of Mathematics and Statistics, International Islamic University, Islamabad, Pakistan
| |
Collapse
|
12
|
Roy D, Zulfiqar F, Tsusaka TW, Datta A. Household food insecurity and dietary diversity of women of reproductive age among smallholder farming households in northwest Bangladesh. Ecol Food Nutr 2022; 61:460-483. [PMID: 35023791 DOI: 10.1080/03670244.2021.2024176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Despite Bangladesh's remarkable progress in agricultural production over the past few decades, household food and nutrition insecurity persist, especially in rural areas. The nutrition security and dietary diversity are even more critical for women of reproductive age among smallholders. This study examined household food insecurity and dietary diversity of women of reproductive age in the rural areas of northwest Bangladesh. Using cross-sectional data collected from 252 smallholder households, we measured household food insecurity and dietary diversity of women of reproductive age by the Household Food Insecurity Access Scale and the Minimum Dietary Diversity for Women, respectively. Determinants of household food insecurity were examined, and associations between household food insecurity and low dietary diversity were determined. The majority of the households were mildly insecure (51.2%) followed by moderately insecure (27.4%). The households felt anxiety of food insecurity for more than six months a year (Food Security Index = 2.10 out of 4.00). The mean food group consumed by women was 4.63 indicating low dietary diversity and dominance of diets by grains and dark green leafy vegetables. The findings also indicate a significant and positive association between household food insecurity and low dietary diversity of women. Education of household heads, household size, access to information sources, access to credit support, and perceived impacts of climate change on crop production were identified as determinants of household food insecurity. The study recommends that appropriate interventions be formulated to improve the food and nutrition security in the study areas.
Collapse
Affiliation(s)
- Debashis Roy
- Agricultural Systems and Engineering, Department of Food, Agriculture and Bioresources, School of Environment, Resources and Development, Asian Institute of Technology, Klong Luang, Thailand.,Department of Agricultural Extension Education, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Farhad Zulfiqar
- Agribusiness Management, Department of Food, Agriculture and Bioresources, School of Environment, Resources and Development, Asian Institute of Technology, Klong Luang, Thailand
| | - Takuji W Tsusaka
- Natural Resources Management, Department of Development and Sustainability, School of Environment, Resources and Development, Asian Institute of Technology, Klong Luang, Thailand
| | - Avishek Datta
- Agricultural Systems and Engineering, Department of Food, Agriculture and Bioresources, School of Environment, Resources and Development, Asian Institute of Technology, Klong Luang, Thailand
| |
Collapse
|
13
|
Nguyen VQ, Lam PV, Goto A, Nguyen TVT, Vuong TNT, Nguyen TM, Nguyen MH, Truong ATT, Tran TPT, Vo CD. Prevalence and Correlates of Zinc Deficiency Among Vietnamese Women of Reproductive Age in Ho Chi Minh City: A Single Hospital-Based Survey. Front Glob Womens Health 2021; 2:733191. [PMID: 34927136 PMCID: PMC8678106 DOI: 10.3389/fgwh.2021.733191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/01/2021] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives: Zinc is a micronutrient that plays an important role in metabolism, cell growth regulation, and differentiation. Vietnam has many population groups living in poverty. The daily food of Vietnamese people is mainly rice, which contains very little zinc. This cross-sectional study was conducted to determine the prevalence of, and factors related to, zinc deficiency in women of reproductive age. Methods and Study Design: The sample population was non-pregnant women of reproductive age (18–49 years old) who visited Nguyen Tri Phuong Hospital Gynecological Outpatient Clinic. The subjects were interviewed and data on background characteristics, anthropometric measurements, and blood tests (serum zinc concentration, complete blood count, albumin, and ferritin) were collected. Results: The prevalence of zinc deficiency, as defined by the International Zinc Nutrition Consultative Group (IZiNCG), was 85% [61/72; 95% confidence interval (CI) = 74–91%], and the prevalence of severe zinc deficiency was 37% (27/72; 95% CI = 26–50%). There were significant associations of albumin concentration, marital status, and past pregnancy history with severe zinc deficiency. Conclusions: More than three-fourths of Vietnamese women of reproductive age had zinc deficiency at our study site in Ho Chi Minh City. This health issue requires greater attention in order to swiftly promote preventive actions, and further surveillance to confirm our study findings.
Collapse
Affiliation(s)
- Vinh Quang Nguyen
- Department of Obstetrics and Gynecology, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
| | - Phong Van Lam
- Department of Nutrition and Dietetics, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
| | - Aya Goto
- Center for Integrated Science and Humanities, Fukushima Medical University, Fukushima, Japan
| | - Tu Van T Nguyen
- Department of Obstetrics and Gynecology, Tan Tao University, Ho Chi Minh City, Vietnam
| | - Thanh Nhan T Vuong
- Department of Nutrition and Dietetics, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
| | - Tien Minh Nguyen
- Department of Obstetrics and Gynecology, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
| | - Minh Ha Nguyen
- Department of Laboratory, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
| | - Anh Tuyet T Truong
- Department of Obstetrics and Gynecology, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
| | - Truc Phuong T Tran
- Department of Obstetrics and Gynecology, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
| | - Chien Duc Vo
- Department of Internal Medicine, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
| |
Collapse
|
14
|
Baxter JAB, Wasan Y, Islam M, Cousens S, Soofi SB, Ahmed I, Sellen DW, Bhutta ZA. Dietary diversity and social determinants of nutrition among late adolescent girls in rural Pakistan. MATERNAL AND CHILD NUTRITION 2021; 18:e13265. [PMID: 34467621 PMCID: PMC8710090 DOI: 10.1111/mcn.13265] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 11/29/2022]
Abstract
The conditions in which adolescent girls mature shape their health, development and nutrition. Nutrient requirements increase to support growth during adolescence, but gaps between consumption and requirements exist in low- and middle-income countries. We aimed to identify and quantify the relationship between dietary intake and diverse social determinants of nutrition (SDN) among a subset of adolescent girls 15-18.9 years (n = 390) enrolled within the Matiari emPowerment and Preconception Supplementation (MaPPS) Trial. The primary outcome, dietary diversity score (DDS), was derived by applying the Minimum Dietary Diversity for Women 10-item scale to 24-h dietary recall data collected three times per participant. To examine the associations between the SDN-related explanatory variables and DDS, we generated a hierarchical, causal model using mixed effects linear regression to account for the cluster-randomized trial design. Using all data, diets lacked diversity (DDS mean ± SD: 3.35 ± 1.03 [range: 1-7; n = 1170]), and the minimum cut-off for dietary diversity was infrequently achieved (13.5%; 95% CI: 11.6-15.6%). Consumption of starches was reported in all recalls, but micronutrient-rich food consumption was less common. Of the SDN considered, wealth quintile had the strongest association with DDS (P < 0.0001). The diets of the sampled Pakistani adolescent girls were insufficient to meet micronutrient requirements. Poverty was the most important predictor of a diet lacking in diversity, indicating limited purchasing power or access to nutritious foods. Dietary diversification and nutrition education strategies alone are unlikely to lead to improved diets without steps to tackle this barrier, for example, through fortification of staple foods and provision of supplements.
Collapse
Affiliation(s)
- Jo-Anna B Baxter
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Yaqub Wasan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Islam
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Simon Cousens
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sajid B Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Imran Ahmed
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Daniel W Sellen
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Anthropology, University of Toronto, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Chong MFF, Bui CT, Jaisamrarn U, Pacquing-Songco D, Shaw SW, Tam CT, Bardosono S. A landscape of micronutrient status in women through the reproductive years: Insights from seven regions in Asia. ACTA ACUST UNITED AC 2021; 16:1745506520973110. [PMID: 33243091 PMCID: PMC7705789 DOI: 10.1177/1745506520973110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Optimal micronutrient status is critical to the health of women, particularly during their reproductive years. A woman’s health and nutritional status during the preconception stage thus has significant implications for pregnancy outcomes and her offspring’s health later in life. In this review, we evaluated micronutrient intakes and status (iron, folate, and vitamin B12) of women in their reproductive years and during pregnancy, along with associated health consequences and dietary causes, across seven regions in Asia, namely, Hong Kong, Indonesia, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. A structured literature search, targeting peer-reviewed publication databases, as well as data from international and national sources in the public domain, was conducted. Our review of the nutritional landscape demonstrates that micronutrient deficiency–related conditions, especially anemia and its associated health consequences, are common among Asian women of reproductive age, yet the dietary causes are poorly studied. Inadequate or borderline dietary intake of micronutrients and low consumption of micronutrient supplements were evident, despite existing recommendations, food fortification, and supplementation strategies. Evaluation of current programs through nutrition monitoring and improvement of supplementation strategies, such as supplementing with multiple micronutrients, alongside food-based programs, will help better support the health of women through their reproductive years.
Collapse
Affiliation(s)
| | - Chi Thuong Bui
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Debby Pacquing-Songco
- University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Steven W Shaw
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei.,College of Medicine, Chang Gung University, Taoyuan City
| | - Ching Ting Tam
- Gleneagles Hong Kong Hospital, Wong Chuk Hang, Hong Kong
| | - Saptawati Bardosono
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| |
Collapse
|
16
|
Is Food Insecurity Associated With Iron Deficiency Anemia and Vitamin D Deficiency Among Women of Reproductive Age? TOP CLIN NUTR 2020. [DOI: 10.1097/tin.0000000000000218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
17
|
Nga HT, Quyen PN, Chaffee BW, Diep Anh NT, Ngu T, King JC. Effect of a nutrient-rich, food-based supplement given to rural Vietnamese mothers prior to and/or during pregnancy on birth outcomes: A randomized controlled trial. PLoS One 2020; 15:e0232197. [PMID: 32469870 PMCID: PMC7259625 DOI: 10.1371/journal.pone.0232197] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 04/08/2020] [Indexed: 12/31/2022] Open
Abstract
Obtaining a nutrient-rich diet during pregnancy is a challenge for pregnant women living in low-income countries. This randomized, controlled trial was designed to determine if a freshly prepared food supplement from local animal-source foods and dark-green leafy vegetables given prior to and/or during pregnancy improved birth outcomes in rural Vietnamese women. Primiparous women, 18 to 30 years of age, who participated in the study were assigned to one of three groups: PC-T women received the supplement from pre-conception to term, MG-T women received the supplement from mid-gestation to term, and the RPC women received routine prenatal care. Supplement intake was observed and quantified. Infant anthropometry was measured at birth and/or within seven days of delivery. The effect of the intervention on maternal and birth outcomes was determined using linear regression modeling. Of the 460 women enrolled in the study, 317 women completed the study. Those not completing the study had either moved from the area, did not conceive within 12 months of study enrollment, or miscarried. The food-based supplement increased protein, iron, zinc, folate, vitamin A and B12 intakes in the PC-T and the MG-T groups. However, it failed to alter infant anthropometric measurements at birth. In the entire cohort, maternal gestational weight gain was greater in women with a low pre-pregnancy BMI (<18.5) and in women with a higher educational attainment. Working as a farmer reduced gestational weight gain but it did not affect birth weight or length. In summary, a nutrient-rich, food-based supplement given to rural Vietnamese women from pre-conception to term or mid-gestation to term did not affect maternal or infant outcomes. The low weight gains, possibly due to demanding farm work done throughout the reproductive cycle, may have obviated any effects of the low energy, nutrient-rich food supplement on birth outcomes. Trial registration : Registered Clinical Trials.gov: NCT01235767.
Collapse
Affiliation(s)
| | | | - Benjamin W. Chaffee
- University of California San Francisco, San Francisco, CA, United States of America
| | | | - Tu Ngu
- National Institute of Nutrition, Hanoi, Vietnam
| | - Janet C. King
- Children’s Hospital Oakland Research Institute, Oakland, CA, United States of America
- * E-mail:
| |
Collapse
|
18
|
Tran NT, Nguyen LT, Berde Y, Low YL, Tey SL, Huynh DTT. Maternal nutritional adequacy and gestational weight gain and their associations with birth outcomes among Vietnamese women. BMC Pregnancy Childbirth 2019; 19:468. [PMID: 31801514 PMCID: PMC6894140 DOI: 10.1186/s12884-019-2643-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 11/27/2019] [Indexed: 01/08/2023] Open
Abstract
Background During pregnancy, a mother’s nutritional needs increase to meet the added nutrient demands for fetal growth and development. An enhanced understanding of adequate nutrition and sufficient weight gain during pregnancy can guide development of policies and strategies for maternal nutrition care, actions that will ultimately promote better pregnancy outcomes. In a sample of pregnant women in Vietnam, this study characterized maternal nutrition status and gestational weight gain at a mid-pregnancy baseline, then examined the association of these variables with specific birth outcomes. Methods The study used baseline data from a randomized, controlled trial that compared pregnant Vietnamese women who received a nutritional intervention group with those who received only standard dietary counseling (control group). At baseline (26–29 weeks gestation), mothers’ dietary reports were collected, and intake of 10 macro- and micronutrients was estimated; data for baseline gestational weight gain was collected for all pregnant women enrolled into the study (n = 228). This analysis also used weights, lengths, and head circumferences at birth for infants of mothers in the control group. Results At baseline, 95% of the pregnant women had concurrent inadequacies for more than five nutrients, and nearly half had concurrent inadequacies for more than ten nutrients. Almost two-thirds of the pregnant women did not meet recommendations for gestational weight gain. We found a significant, inverse association between the number of nutrient inadequacies and gestational weight gain (overall p ≤ 0.045). After adjusting for potential confounders, gestational weight gain was positively associated with birth weight, length at birth, birth weight-for-age z-score and length-for-age z-score (all p ≤ 0.006). Conclusions Our findings raise concern over the high proportion of pregnant women in Vietnam who have multiple concurrent nutrient inadequacies and who fall short of meeting recommended gestational weight gain standards. To ensure better birth outcomes in this population, policies and strategies to improve the status of maternal nutrition are greatly needed. Trial registration The trial was retrospectively registered at clinicaltrials.gov on December 20, 2013, registration identifier: NCT02016586.
Collapse
Affiliation(s)
- Nga Thuy Tran
- Micronutrient Research and Application, National Institution of Nutrition, 48B Tang Ba Ho, Hai Ba Trung District, Ha Noi, Vietnam
| | - Lam Thi Nguyen
- Clinical Nutrition, National Institution of Nutrition, 48B Tang Ba Ho, Hai Ba Trung District, Ha Noi, Vietnam
| | - Yatin Berde
- Statistical Services, Cognizant Technologies Solution Pvt. Ltd, Hiranandani Business Park, Mumbai, 400076, India
| | - Yen Ling Low
- Abbott Nutrition Research and Development Asia-Pacific Center, 20 Biopolis Way, Unit 09-01/02 Centros Building, Singapore, 138668, Singapore
| | - Siew Ling Tey
- Abbott Nutrition Research and Development Asia-Pacific Center, 20 Biopolis Way, Unit 09-01/02 Centros Building, Singapore, 138668, Singapore
| | - Dieu Thi Thu Huynh
- Abbott Nutrition Research and Development Asia-Pacific Center, 20 Biopolis Way, Unit 09-01/02 Centros Building, Singapore, 138668, Singapore.
| |
Collapse
|
19
|
Wertheim-Heck SCO, Raneri JE. A cross-disciplinary mixed-method approach to understand how food retail environment transformations influence food choice and intake among the urban poor: Experiences from Vietnam. Appetite 2019; 142:104370. [PMID: 31310835 PMCID: PMC6739597 DOI: 10.1016/j.appet.2019.104370] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 12/21/2022]
Abstract
Nutrition insecurity among urban poor in modernizing Asian metropolises is a critical issue. It is well recognized that in urban Asia the poor are food insecure. Across Asia the food retail environment is transforming rapidly, in which supermarkets increasingly replace traditional food vending, like markets and street vendors that the urban poor depend upon. The question is, how these transformations impact the diets of the urban poor? What drives their food choice? What are their daily shopping practices and how does that affect their dietary intake? To investigate this, we developed a cross-disciplinary nutrition and social practices study with a sequential quantitative-qualitative mixed-method design. Building on empirical evidence from Hanoi, Vietnam, the study links (i) food choice and measured dietary intake, with (ii) food retail environment, through (iii) food shopping practices and preferences of 400 women of reproductive age within the context of (iv) their transformative urban lifestyles. Methods included are a retail census with GPS coordinates to map the food retail environment, a household survey, a 24-h diet recall, multi-generation household interviews and shopping trips. We demonstrate that integrated sociological and nutritional perspectives are productive in rapidly generating evidence to comprehend the complex trade-offs between food safety and nutrition in everyday food consumption practices. We describe and reflect on our theoretical mix of dietary intake and social practices research, and our holistic mixed method approach which besides combining quantitative and qualitative methods, also voices the urban poor first hand.
Collapse
Affiliation(s)
- Sigrid C O Wertheim-Heck
- Environmental Policy Group, Department of Social Sciences, Wageningen University, Hollandseweg 1, 6706 KN, Wageningen, the Netherlands; C/o Food and Healthy Living Group, Aeres University of Applied Sciences, Stadhuisstraat 18, 1315 AK, Almere, the Netherlands.
| | - Jessica E Raneri
- Healthy Diets from Sustainable Food Systems Initiative, Bioversity International, Via Dei Tre Denari, 472/a, 00054, Maccarese (Fiumicino), Italy.
| |
Collapse
|
20
|
Angeles-Agdeppa I, Sun Y, Denney L, Tanda KV, Octavio RAD, Carriquiry A, Capanzana MV. Food sources, energy and nutrient intakes of adults: 2013 Philippines National Nutrition Survey. Nutr J 2019; 18:59. [PMID: 31601200 PMCID: PMC6785859 DOI: 10.1186/s12937-019-0481-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/30/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Comprehensive assessment of dietary intakes of foods and nutrients in Filipino adults are lacking. This study evaluated energy and nutrient intakes and food sources of key nutrients consumed by Filipino adults. METHODS The participants were from the 2013 National Nutrition Survey wherein food intake of young adults aged 19-49 years (n = 12,896) and older adults aged 50 years and above (n = 7853) were collected using 24-h recalls. Usual nutrient intakes were estimated using PC-SIDE program. The Philippines Dietary Reference Intakes were used to calculate proportions of inadequate intake using Estimated Average Requirement (EAR) and Acceptable Macronutrient Distribution Ranges (AMDR). Energy adequacy was evaluated using the Institute of Medicine (IOM) equation for Estimated Energy Requirements (EER). RESULTS The nutrient intakes with the highest prevalence of inadequacy (> 50%) were: iron (97-99%), vitamin C (96-98%), calcium (95-98%), riboflavin (86-91%), folate (89-90%), thiamine (73-89%), energy (67-70%), total fat (55-67%), and vitamin A (54-56%). Refined rice, pork and breads contributed most to daily intakes of energy, protein, carbohydrates, thiamine, riboflavin, and iron. Low intake of vegetables, fruits and dairy was common in both age groups. CONCLUSIONS This study demonstrated that intakes of many nutrients were markedly inadequate among adults in the Philippines, due to the rice-dominant dietary pattern with few nutrient-dense foods. These results can be used to support the development of specific interventions to improve the shortfalls in nutrient intakes.
Collapse
Affiliation(s)
- Imelda Angeles-Agdeppa
- Department of Science and Technology, Food and Nutrition Research Institute, Bicutan, Taguig, Philippines
| | - Ye Sun
- Nestlé Research, Singapore, Singapore
| | | | - Keith V. Tanda
- Department of Science and Technology, Food and Nutrition Research Institute, Bicutan, Taguig, Philippines
| | - Royce Ann D. Octavio
- Department of Science and Technology, Food and Nutrition Research Institute, Bicutan, Taguig, Philippines
| | | | - Mario V. Capanzana
- Department of Science and Technology, Food and Nutrition Research Institute, Bicutan, Taguig, Philippines
| |
Collapse
|
21
|
Dietary micronutrient intakes among women of reproductive age in Mumbai slums. Eur J Clin Nutr 2019; 73:1536-1545. [PMID: 31148589 PMCID: PMC7051904 DOI: 10.1038/s41430-019-0429-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/21/2019] [Accepted: 03/22/2019] [Indexed: 01/04/2023]
Abstract
Objectives To (1) describe micronutrient intakes among women of reproductive age living in Mumbai slums; (2) assess the adequacy of these intakes compared with reference values; (3) identify important dietary sources of micronutrients. Subjects/methods Participants were 6426 non-pregnant women aged 16–39 years, registered in a randomised controlled trial of a food-based intervention set in the Bandra, Khar and Andheri areas of Mumbai, India. Cross-sectional quantified food frequency questionnaire (FFQ) data were collected. Vitamin (n = 9) and mineral (n = 6) intakes were calculated and analysed in relation to dietary reference values (DRVs). Important dietary sources were identified for each micronutrient. Results Median intakes of all micronutrients, except vitamin E, were below the FAO/WHO reference nutrient intake (RNI). Intakes of calcium, iron, vitamin A and folate were furthest from the RNI. For seven of the micronutrients, over half of the women had intakes below the lower reference nutrient intake (LRNI); this figure was over 75% for calcium and riboflavin. The majority of women (93%) had intakes below the EAR for 5 or more micronutrients, and 64% for 10 or more. Adolescents had lower intakes than women aged >19 years. Less than 1% of adult women and no adolescents met the EAR for all micronutrients. Animal source foods and micronutrient-rich fruit and vegetables were consumed infrequently. Conclusions These women had low intakes of multiple micronutrients, increasing their risk of insufficiency. There is a need to determine the factors causing poor intakes, to direct interventions that improve diet quality and nutritional sufficiency.
Collapse
|
22
|
Nguyen CL, Hoang DV, Nguyen PTH, Ha AVV, Chu TK, Pham NM, Lee AH, Duong DV, Binns CW. Low Dietary Intakes of Essential Nutrients during Pregnancy in Vietnam. Nutrients 2018; 10:nu10081025. [PMID: 30082626 PMCID: PMC6116189 DOI: 10.3390/nu10081025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 01/05/2023] Open
Abstract
Inadequate intake of nutrients during pregnancy has been associated with poor pregnancy and infant outcomes; however, evidence remains limited in low-resource settings in Asia. This paper assessed food, macronutrient, and micronutrient intakes among 1944 Vietnamese pregnant women. Dietary information was collected via an interviewer-administered food frequency questionnaire, and nutrient intakes were estimated using the Vietnamese food composition tables. The levels of nutrient intakes were evaluated against the Vietnamese recommended nutrient intakes (RNI) for pregnancy. The diet profiles were reported as means and percentages. The average daily food intakes across socio-demographic factors were compared using ANOVA, with adjustment for multiple comparisons by the Tukey–Kramer test. Rice, fruits, and vegetables were the main food sources consumed. The mean energy intake was 2004 kcal/day with 15.9%, 31.8%, and 52.2% of energy deriving from proteins, fats, and carbohydrates, respectively. Just over half of the women did not meet the RNI for total energy intake. The intakes of essential micronutrients including folate, calcium, iron, and zinc were below the RNI, and almost all pregnant women failed to meet the recommendations for these micronutrients. The associations of maternal age, education, and pre-pregnancy body mass index with nutrient intakes varied across the nutrient subgroups. Targeted programs are needed to improve nutrient intakes in Vietnamese pregnant women.
Collapse
Affiliation(s)
- Cong Luat Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi 100000, Vietnam.
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia.
| | - Dong Van Hoang
- National Institute of Hygiene and Epidemiology, Hanoi 100000, Vietnam.
| | - Phung Thi Hoang Nguyen
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia.
- Department of Nutrition and Food, Faculty of Public Health, University of Medicine and Pharmacy, Ho Chi Minh City 700000, Vietnam.
| | - Anh Vo Van Ha
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia.
- Department of Environmental and Occupational Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 700000, Vietnam.
| | - Tan Khac Chu
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia.
- Department of Epidemiology, Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong 180000, Vietnam.
| | - Ngoc Minh Pham
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia.
- Department of Epidemiology, Faculty of Public Health, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen 250000, Vietnam.
| | - Andy H Lee
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia.
| | - Dat Van Duong
- Department of Sexual & Reproductive Health, United Nations Population Fund, Hanoi 100000, Vietnam.
| | - Colin W Binns
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia.
| |
Collapse
|
23
|
Erick M. Breast milk is conditionally perfect. Med Hypotheses 2017; 111:82-89. [PMID: 29407004 DOI: 10.1016/j.mehy.2017.12.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/24/2017] [Accepted: 12/13/2017] [Indexed: 02/08/2023]
Abstract
Breast milk is the universal preferred nutrition for the newborn human infant. New mother have been encouraged to exclusively breastfeed by health care professionals and consumer-advocacy forums for years, citing "breast milk is the perfect food". The benefits are numerous and include psychological, convenience, economical, ecological and nutritionally superior. Human milk is a composite of nutritional choices of the mother, commencing in the pre-conceptual era. Events influencing the eventual nutritional profile of breast milk for the neonate start with pre-conceptual dietary habits through pregnancy and finally to postpartum. Food choices do affect the nutritional profile of human breast milk. It is not known who coined the phrase "breast milk is the perfect food" but it is widely prevalent in the literature. While breast milk is highly nutritive, containing important immunological and growth factors, scientific investigation reveals a few short-falls. Overall, human breast milk has been found to be low in certain nutrients in developed countries: vitamin D, iodine, iron, and vitamin K. Additional nutrient deficiencies have been documented in resource-poor countries: vitamin A, vitamin B 12, zinc, and vitamin B 1/thiamin. Given these findings, isn't it more accurate to describe breast milk as "conditionally perfect"? Correcting the impression that breast milk is an inherently, automatically comprehensive enriched product would encourage women who plan to breastfeed an opportunity to concentrate on dietary improvement to optimizes nutrient benefits ultimately to the neonate. The more immediate result would improve pre-conceptual nutritional status. Here, we explore the nutritional status of groups of young women; some of whom will become pregnant and eventually produce breast milk. We will review the available literature profiling vitamin, mineral, protein and caloric content of breast milk. We highlight pre-existing situations needing correction to optimize conception and fetal development. While alternative forms of infant nutrition carry standard product labels of nutrient adequacy, this information does not apply universally to all breast milk. Infant formulas are fortified with various amounts of vitamins, minerals, supplemental protein concentrates, nucleic factors, omega 3 fatty acids and any important new nutritional finding. Infant formulas are manufactured to be consistent in composition and are monitored closely for quality. Not true for human breast milk. Any nutrient deficiency existing in pregnancy will ultimately be carried forward via lactation. It is a biological impossibility for a lactating woman to transfer nutrients via breast milk she does not have!
Collapse
Affiliation(s)
- Miriam Erick
- Department of Nutrition, Brigham and Women's Hospital, Boston, MA 02115, USA.
| |
Collapse
|
24
|
Michalski ES, Nguyen PH, Gonzalez-Casanova I, Nguyen SV, Martorell R, Tangpricha V, Ramakrishnan U. Serum 25-hydroxyvitamin D but not dietary vitamin D intake is associated with hemoglobin in women of reproductive age in rural northern Vietnam. J Clin Transl Endocrinol 2017; 8:41-48. [PMID: 29067258 PMCID: PMC5651337 DOI: 10.1016/j.jcte.2017.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/02/2017] [Accepted: 05/02/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hypovitaminosis D and anemia are both prevalent in Vietnam, and low vitamin D status may be a risk factor for anemia. This study aimed to 1) describe vitamin D intake and its determinants, and 2) examine the associations of vitamin D intake and serum 25(OH)D concentrations with hemoglobin and anemia. METHODS AND STUDY DESIGN We used data from the baseline survey of a pre-conceptual micronutrient supplementation trial in women of reproductive age (WRA) in Thai Nguyen, Vietnam (N = 4961). Vitamin D intake was estimated using a semi-quantitative food frequency questionnaire (FFQ). Multivariable regression models were used for the analyses. RESULTS Median vitamin D intake was 0.2 µg/d (8.0 IU) [IQR: 0.4]. Age, being a farmer, food insecurity, and body mass index (BMI) were inversely associated with vitamin D intake, while socioeconomic status (SES), total energy intake, and education were positively associated with vitamin D intake. Vitamin D intake was not associated with hemoglobin concentration or anemia after adjusting for age, BMI, total energy intake, transferrin receptor, C-reactive protein, α1-acid glycoprotein, SES, occupation, education, ethnicity, and food insecurity (P = 0.56 and P = 0.65 for hemoglobin and anemia, respectively). Controlling for the same covariates, 25(OH)D <50 nmol/L (vs. ≥50 nmol/L) was associated with decreased hemoglobin concentrations (β = -0.91 (SE:0.42), P = 0.03), but not with anemia (P = 0.11). CONCLUSIONS Low vitamin D status may be linked to reduced hemoglobin concentrations, but the role of diet in this association was not evident in this population of WRA in Vietnam where dietary vitamin D intake was very low.
Collapse
Key Words
- 25(OH)D, 25-hydroxyvitamin D
- AGP, α1-acid glycoprotein
- AMDR, acceptable macronutrient distribution range
- Anemia
- CRP, C-reactive protein
- Dietary intake
- EAR, estimated average requirement
- Hemoglobin
- IOM, Institute of Medicine
- IQR, interquartile range
- RBP, retinol binding protein
- SD, standard deviation
- SE, standard error
- SES, socioeconomic status
- Vietnam
- Vitamin D
- WHO, World Health Organization
- WRA, women of reproductive age
- sTfR, soluble transferrin receptor
Collapse
Affiliation(s)
- Ellen S. Michalski
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA
| | - Phuong H. Nguyen
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Viet Nam
- International Food Policy Research Institute, Washington, DC 20006, USA
| | | | - Son V. Nguyen
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Viet Nam
| | - Reynaldo Martorell
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA
- Hubert Department of Global Health, Emory University, Atlanta GA 30322, USA
| | - Vin Tangpricha
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA
- Division of Endocrinology, Metabolism & Lipids, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Usha Ramakrishnan
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA
- Hubert Department of Global Health, Emory University, Atlanta GA 30322, USA
| |
Collapse
|
25
|
Özhan O, Erdem N, Aydoğdu İ, Erkurt A, Kuku İ. Serum Zinc Levels in Iron Deficient Women: A Case-Control Study. Turk J Haematol 2017; 33:156-8. [PMID: 27211046 PMCID: PMC5100729 DOI: 10.4274/tjh.2015.0206] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Since similar symptoms and findings can be seen in the deficiencies of both iron and zinc, we aimed to evaluate the serum zinc levels of women with iron deficiency anemia (IDA). This study was conducted with women with iron deficiency and a healthy control group. When serum zinc levels were compared, they were found to be lower in the IDA group, which was statistically significant. With the help of these studies, iron and zinc treatment instead of only iron replacement may be considered in cases of iron deficiency.
Collapse
Affiliation(s)
| | - Neslihan Erdem
- Celal Bayar University Faculty of Medicine, Department of Internal Medicine, Manisa, Turkey, Phone : +90 555 729 88 22, E-mail :
| | | | | | | |
Collapse
|
26
|
Saxena V, Naithani M, Singh R. Epidemiological determinants of Folate deficiency among pregnant women of district Dehradun. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2017. [DOI: 10.1016/j.cegh.2016.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
27
|
Impact of Preconception Micronutrient Supplementation on Anemia and Iron Status during Pregnancy and Postpartum: A Randomized Controlled Trial in Rural Vietnam. PLoS One 2016; 11:e0167416. [PMID: 27918586 PMCID: PMC5137891 DOI: 10.1371/journal.pone.0167416] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/05/2016] [Indexed: 11/22/2022] Open
Abstract
Objective Preconception micronutrient interventions may be a promising approach to reduce anemia and iron deficiency during pregnancy, but currently we have limited data to inform policies. We evaluated whether providing additional pre-pregnancy weekly iron-folic acid (IFA) or multiple micronutrient (MM) supplements compared to only folic acid (FA) improves iron status and anemia during pregnancy and early postpartum. Methods We conducted a double blind randomized controlled trial in which 5011 Vietnamese women were provided with weekly supplements containing either only 2800 μg FA (control group), IFA (60 mg Fe and 2800 μg FA) or MM (15 micronutrients with similar amounts of IFA). All women who became pregnant (n = 1813) in each of the 3 groups received daily IFA (60 mg Fe and 400 μg FA) through delivery. Hematological indicators were assessed at baseline (pre-pregnancy), during pregnancy, 3 months post-partum, and in cord blood. Adjusted generalized linear models were applied to examine the impact of preconception supplementation on anemia and iron stores, using both intention to treat and per protocol analyses (women consumed supplements ≥ 26 weeks before conception). Results At baseline, 20% of women were anemic, but only 14% had low iron stores (ferritin <30 μg/L) and 3% had iron deficiency (ferritin <12 μg/L). The groups were balanced for baseline characteristics. Anemia prevalence increased during pregnancy and post-partum but was similar among intervention groups. In intention to treat analyses, prenatal ferritin was significantly higher among women receiving MM (geometric mean (μg/L) [95% CI]: 93.6 [89.3–98.2]) and IFA (91.9 [87.6–96.3]) compared to control (85.3 [81.5–89.2]). In per protocol analyses, women receiving MM or IFA had higher ferritin 3 months postpartum (MM 118.2 [109.3–127.8]), IFA 117.8 [108.7–127.7] vs control 101.5 [94.0–109.7]) and gave birth to infants with greater iron stores (MM 184.3 [176.1–192.9]), IFA 189.9 [181.6–198.3] vs control 175.1 [167.9–182.6]). Conclusion Preconception supplementation with MM or IFA resulted in modest increases in maternal and infant iron stores but did not impact anemia. Further research is needed to characterize the etiology of anemia in this population and identify effective interventions for reducing prenatal anemia. Trial Registration ClinicalTrials.Gov NCT01665378
Collapse
|
28
|
Sukumar N, Adaikalakoteswari A, Venkataraman H, Maheswaran H, Saravanan P. Vitamin B12 status in women of childbearing age in the UK and its relationship with national nutrient intake guidelines: results from two National Diet and Nutrition Surveys. BMJ Open 2016; 6:e011247. [PMID: 27519920 PMCID: PMC4985863 DOI: 10.1136/bmjopen-2016-011247] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess serum B12, folate and the associated homocysteine (Hcy) levels among women of childbearing age in the UK and examine their association with dietary intake in relation to the UK Recommended Nutrient Intakes (RNIs) for B12 and folate. DESIGN Cross-sectional study. SETTING Data from two publicly available National Diet and Nutrition Surveys (NDNS 2000/2001 and 2008/2012) were used. These were population-based surveys of randomly selected samples of adults which were carried out in their households. PARTICIPANTS Women of childbearing age (aged 19-39 years), representative of the UK population. Those who were pregnant or breastfeeding were excluded. OUTCOME MEASURES The associations between micronutrient intakes and blood levels of B12, folate and Hcy were assessed by correlation and stepwise linear regression. B12 intake was divided into quintiles and plotted against blood B12 and Hcy concentrations to determine the threshold of any associations. RESULTS 299 women from the first NDNS cohort had complete intake and biomarker data. The prevalence of serum vitamin B12 (≤150 pmol/L) and serum folate (≤10 nmol/L) deficiency and hyperhomocysteinemia (≥12 µmol/L) was 12.4%, 6.4% and 21.2%, respectively, despite seemingly adequate B12 intakes (median 3.8 μg/day, 96% consumed more than the UK RNI of 1.5 μg/day). B12 concentrations increased across all quintiles of intake with serum levels in quintiles 4 and 5 (median intake 4.9 and 7.1 μg/day, respectively) significantly higher than quintile 1. However, Hcy concentrations levelled off between quintiles 4 and 5. Comparison of micronutrient intake between the two surveys found that folate intake has reduced in the more recent cohort. CONCLUSIONS The UK RNI for B12 intake should be increased for women of childbearing age with intakes of around 5-7 μg/day likely to be associated with stable biomarker levels. B12 levels should also be measured in women preconceptionally or in early pregnancy given the high rates of deficiency.
Collapse
Affiliation(s)
- Nithya Sukumar
- Warwick Medical School, University of Warwick, Coventry, UK
- Academic Department of Diabetes and Metabolism, George Eliot Hospital, Nuneaton, UK
| | | | - Hema Venkataraman
- Warwick Medical School, University of Warwick, Coventry, UK
- Academic Department of Diabetes and Metabolism, George Eliot Hospital, Nuneaton, UK
| | | | - Ponnusamy Saravanan
- Warwick Medical School, University of Warwick, Coventry, UK
- Academic Department of Diabetes and Metabolism, George Eliot Hospital, Nuneaton, UK
| |
Collapse
|
29
|
Ramakrishnan U, Nguyen PH, Gonzalez-Casanova I, Pham H, Hao W, Nguyen H, Truong TV, Nguyen S, Harding KB, Reinhart GA, Neufeld LM, Martorell R. Neither Preconceptional Weekly Multiple Micronutrient nor Iron-Folic Acid Supplements Affect Birth Size and Gestational Age Compared with a Folic Acid Supplement Alone in Rural Vietnamese Women: A Randomized Controlled Trial. J Nutr 2016; 146:1445S-52S. [PMID: 27281806 DOI: 10.3945/jn.115.223420] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/26/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Maternal nutritional status before and during early pregnancy plays a critical role in fetal growth and development. The benefits of periconception folic acid (FA) supplementation in the prevention of neural tube defects is well recognized, but the evidence for preconception micronutrient interventions for improving pregnancy outcomes is limited. OBJECTIVE This study aimed to evaluate whether preconception supplementation with weekly iron and folic acid (IFA) or multiple micronutrients (MMs) improves birth outcomes compared with FA alone. METHODS We recruited 5011 women of reproductive age in a double-blind, randomized controlled trial in Vietnam and provided weekly supplements containing either 2800 μg FA, 60 mg Fe and 2800 μg FA (IFA), or the same amount of FA and iron plus other MMs until they conceived (n = 1813). All pregnant women received daily IFA through delivery, and were followed up for birth outcomes, including birth weight, gestational age, preterm delivery and small for gestational age (SGA). Group comparisons were done with the use of ANOVA or chi-square tests for both intention-to-treat (n = 1599) and per-protocol analyses (women consumed supplements ≥26 wk before conception; n = 824). Effect modification by baseline underweight or anemia status was tested with the use of generalized linear models. RESULTS The mean age of the women was 26 y, 30% were underweight, and <10% were nulliparous. The groups were similar for most baseline characteristics. The mean ± SD duration of the preconception intervention was 33 ± 25 wk and compliance was high (>90%). Infants born to the 3 groups of women did not differ (P ≥ 0.05) on mean ± SD birth weight (3076.8 ± 444.5 g) or gestational age (39.2 ± 2.0 wk), or prevalence of SGA (12%), low birth weight (5%) and preterm delivery (10%). There were no significant differences in women who consumed supplements ≥26 wk before conception or by baseline underweight or anemia. CONCLUSION Weekly supplementation with MMs or IFA before conception did not affect birth outcomes compared with FA in rural Vietnamese women. The trial was registered at clinicaltrials.gov as NCT01665378.
Collapse
Affiliation(s)
- Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA;
| | - Phuong H Nguyen
- International Food Policy Research Institute, Hanoi, Vietnam; Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | - Ines Gonzalez-Casanova
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Hoa Pham
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | - Wei Hao
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Hieu Nguyen
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | - Truong V Truong
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | - Son Nguyen
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | | | - Gregory A Reinhart
- The Mathile Institute for the Advancement of Human Nutrition, Dayton, OH; and
| | | | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| |
Collapse
|
30
|
Determination of trace elements in Ethiopian, Vietnamese, and Japanese women using high-resolution IC-PMS. Nutrition 2016; 31:1243-6. [PMID: 26333889 DOI: 10.1016/j.nut.2015.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/09/2015] [Accepted: 04/23/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Humans and other living organisms require small quantities of trace elements throughout life. Both insufficient and excessive intakes of trace elements can have negative consequences. However, there is little information on serum level of trace elements in different populations. This study examines serum levels of trace elements in Ethiopian, Japanese, and Vietnamese women. METHODS Random samples of healthy women who were referred for routine hospital laboratory examinations in the cities of Hanoi, Sapporo, and Gondar were invited to participate in the study. Serum levels of magnesium, zinc, copper, iron, selenium, and calcium were determined using an inductively coupled plasma mass spectrometer. Furthermore, body mass index of each study participant was determined. RESULTS The mean ± SD serum concentrations of zinc (μg/dL), copper (μg/dL), iron (μg/dL), selenium (μg/dL) and calcium (mg/dL), respectively, were 76.51 ± 39.16, 152.20 ± 55.37, 385.68 ± 217.95, 9.15 ± 4.21, and 14.18 ± 3.91 in Ethiopian women; 111.49 ± 52.92, 105.86 ± 26.02, 155.09 ± 94.83, 14.11 ± 3.41, and 11.66 ± 2.51 in Vietnamese women; and 60.69 ± 9.76, 107 ± 156, 268 ± 128, 8.33 ± 3.65, and 11.18 ± 0.68 in Japanese participants. Ethiopian women had significantly higher level of serum calcium than Vietnamese and Japanese women (both P < 0.05). Although the mean calcium concentration in Vietnamese women was higher than in women from Japan, the difference was not statistically significant (P > 0.05). Furthermore, compared with Japanese women, Ethiopian women had significantly high iron and copper concentrations (P < 0.05). Serum selenium and zinc levels were higher in Vietnamese than Ethiopian women. CONCLUSION The study revealed a remarkable difference in serum concentrations of trace elements in women from different countries, implying differences in trace elements in the food or soil.
Collapse
|
31
|
The relative influence of maternal nutritional status before and during pregnancy on birth outcomes in Vietnam. Eur J Obstet Gynecol Reprod Biol 2015; 194:223-7. [PMID: 26454228 DOI: 10.1016/j.ejogrb.2015.09.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/01/2015] [Accepted: 09/17/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to: (1) examine the role of multiple measures of prepregnancy nutritional status (weight, height, body composition) on birth outcomes (low birth weight (LBW), small for gestational age (SGA), preterm, birth weight, birth length, infant head circumference and mid-upper arm circumference (MUAC)); (2) assess relative influence of maternal nutritional status before and during (gestational weight gain) pregnancy on birth outcomes. STUDY DESIGN We used prospective data on maternal body size and composition collected from women who participated in a randomized controlled trial evaluating the impact of preconceptional micronutrient supplements (PRECONCEPT) on birth outcomes in Thai Nguyen province, Vietnam (n=1436). Anthropometric measurements were obtained before conception through delivery by trained health workers. The relationship between prepregnancy nutritional status indicators, gestational weight gain (GWG) and birth outcomes were examined using generalized linear models, adjusting for potential confounding factors. RESULTS Maternal prepregnancy weight (PPW) was the strongest anthropometric indicator predicting infant birth size. A 1 standard deviation (SD) increase in PPW (5.4kg) was associated with a 283g (95%CI: 279-286) increase in birthweight. A similar and independent association was observed with birthweight for an increase of 1 SD in gestational weight gain (4kg) (250g; 95% CI: 245-255). Women with a PPW <43kg or who gained <8kg during their pregnancy were more likely to give birth to a SGA (OR 2.9: 95%CI 1.9-4.5, OR 3.3: 95%CI 2.2-5.1) or LBW infant (OR 3.1: 95%CI 1.5-6.2, OR 3.4: 95%CI 1.6-7.2), respectively. CONCLUSIONS These findings indicate that clinical care and programs aimed at improving birth outcomes will have the greatest impact if they address maternal nutrition both before and during pregnancy. Women with a PPW <43kg or a GWG <8kg are at greatest risk for poor birth outcomes in this setting. Preconception counseling and clinical care to obtain a healthy weight prior to pregnancy along with routine obstetric care on gestational weight gain is critical to improve birth outcomes. TRIAL REGISTRATION NCT01665378 (https://clinicaltrials.gov/show/NCT01665378).
Collapse
|
32
|
Dang S, Yan H, Zeng L, Wang Q, Li Q, Xiao S, Fan X. The status of vitamin B12 and folate among Chinese women: a population-based cross-sectional study in northwest China. PLoS One 2014; 9:e112586. [PMID: 25390898 PMCID: PMC4229226 DOI: 10.1371/journal.pone.0112586] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 10/08/2014] [Indexed: 01/08/2023] Open
Abstract
Objective To assess the status of the vitamin B12 and folate of Chinese women living in northwest China. Methods A population-based cross-sectional study was conducted in 2008 among Chinese women aged 10–49 years living in Shaanxi province of northwest China. A stratified multistage random sampling method was adopted to obtain a sample of 1170 women. The women were interviewed for collection of their background information and their plasma vitamin B12 and folate were measured with the immunoassay method. The status of both vitamins was evaluated and the prevalence of deficiency was estimated. Results The median value of the women was 214.5 pg/mL for vitamin B12 and 4.6 ng/mL for folate. The urban women had a significantly higher vitamin B12 (254.1 vs. 195.9 pg/mL) but lower folate (4.4 vs. 4.7 ng/mL) than rural women. Total prevalence of deficiency was 45.5% (95% CI: 42.6%∼48.4%) for vitamin B12 and 14.7% (95% CI: 12.6%∼16.8%) for folate. About 36% of women presented vitamin B12 deficiency alone, 5.2% belonged to folate deficiency alone and 9.5% was combined deficiency in both vitamins. More than 25% of the women were in marginal vitamin B12 status (200–299 pg/mL) and 60% in marginal status of folate (3–6 ng/mL). About 75.2% of rural women with folate deficiency were deficient in vitamin B12 and 46% for urban women. Quantile regression model found decreasing coefficient of folate status across 73 different quantiles of vitamin B12, which indicated that the women with folate deficiency had lower vitamin B12 significantly compared with those with no deficiency. Conclusions The deficiency of vitamin B12 and folate is still prevalent among the Chinese women in northwest China. Vitamin B12 deficiency could be more serious and the improvement of poor vitamin B12 status should be invoked when practicing the supplementation of folate against the neural tube defects in northwest China.
Collapse
Affiliation(s)
- Shaonong Dang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Hong Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
- * E-mail:
| | - Lingxia Zeng
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Quanli Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Qiang Li
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Shengbin Xiao
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Xiaojing Fan
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| |
Collapse
|