Brazilian pregnant and lactating women do not change their food intake to meet nutritional goals

Iodine Intake and its Interindividual Variability in Brazilian Pregnant Women: EMDI Brazil Study

Data on pregnant women's iodine intake are limited in Brazil. The aim of the study was to evaluate the contribution of foods, food groups, and food subgroups to the Brazilian pregnant women's iodine intake, and identify which food items explain the interindividual variability of their intake. A cross-sectional study with food consumption data of 2247 pregnant women from 24-h recalls was developed. Food items were classified according to the FAO/WHO GIFT classification, and their contribution to iodine intake and interindividual variability was assessed by the proportion of means method and linear regression, respectively. The mean usual iodine intake was 163.1 mcg (95% CI: 162.9-163.2). The food groups "spices and condiments," "cereals and their products," and "milk and milk products"; and the food subgroups "herbs and spices," "wheat and wheat-based products," "milk: fresh and processed," "dough-based sweets," and "eggs: fresh and processed" contributed to at least 80% of the iodine intake. Of these, only the food subgroups "milk," "dough-based sweets," and "eggs" did not explain the higher proportion (> 80%) of the interindividual variability. The contribution of "salt," "white French bread," "fluid whole milk," and "rice" to the iodine intake and its interindividual variability is highlighted. This study confirms the importance of "salt" as a dietary source of iodine and that few food groups and subgroups explained the difference in the iodine intake among pregnant women. Despite that, Brazilian staple foods, such as "rice," "beans," "eggs," "milk," and "bread" were identified as important for iodine intake and could be included in nutritional guidelines targeted to Brazilian pregnant women.

Micronutrient inadequacy among lactating mothers in rural areas of North Mecha District, Amhara Region, Ethiopia

Background

Lactating mothers are frequently at risk for nutritional deficiencies due to the physiological requirements of lactation. Throughout the world, a significant number of lactating mothers have micronutrient intake inadequacy. Evidence on micronutrient intake during lactation is limited in rural Ethiopia. Therefore, this study aimed to determine micronutrient intake inadequacy and associated factors among lactating mothers.

Methods and materials

A community-based cross-sectional study was conducted from February 1 to 18, 2023, among lactating mothers in rural areas of the North Mecha District of Amhara Region, Northwest Ethiopia. A multistage sampling technique was used to select 449 study participants. An interviewer-administered questionnaire was employed to collect dietary intake data by using a single multiphasic interactive 24-h dietary recall. The NutriSurvey 2007 software and Ethiopia, Tanzania and Kenya food composition tables were used to calculate nutrient values for the selected 12 micronutrients. For the remainder of the analysis, SPSS version 25 was employed. The Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR) were calculated by dividing all NAR values by the number of micronutrients computed to evaluate the nutrient intakes. A logistic regression analysis was conducted to determine the factors contributing to the overall micronutrient intake inadequacy, and statistical significance was determined at a p value <0.05.

Result

A total of 430 lactating mothers participated in the study, with a 96% response rate and a mean age of 29.46 ± 5.55 years. The overall prevalence of micronutrient intake inadequacy was 72.3% (95% CI: 67.9, 76.5). The odds of micronutrient intake inadequacy were 2.5 times higher among lactating mothers aged 18-25 years old as compared to mothers in the age group ≥36 years old (AOR = 2.52, 95% CI: 1.09, 5.83). Mothers with the educational status of unable to read and write and primary school incomplete were 3.5 (AOR = 3.49, 95% CI: 1.24, 9.83) and 3.6 (AOR = 3.56, 95% CI: 1.06, 11.99) times more likely to have micronutrient intake inadequacy than mothers with secondary school completed or above educational status, respectively. Mothers whose partner's occupation was other than farming were 3.3 times more likely to have micronutrient intake inadequacy as compared to mothers whose partners were engaged in farming (AOR = 3.32, 95% CI: 1.08, 10.27). Lactating mothers who were from food-insecure households were 83% more likely to have high micronutrient intake inadequacy as compared to lactating mothers from food-secure households (AOR = 1.83, 95% CI: 1.04, 3.23). Lactating mothers with nutrition-related unfavorable attitudes were 77% more likely to have inadequate intake of micronutrients compared to lactating mothers with favorable attitudes (AOR = 1.77, 95% CI: 1.07, 2.93).

Conclusion

The prevalence of micronutrient intake inadequacy among lactating mothers was high. Age of the mothers, educational status of the mothers, occupation of the partner, household food security, and nutrition-related attitude were significantly associated with micronutrient intake inadequacy. Community driven nutrition education and interventions are needed to address the high micronutrient intake inadequacy among lactating mothers in rural Ethiopia.

Nutritional Status of Breastfeeding Mothers and Impact of Diet and Dietary Supplementation: A Narrative Review

Adequate nutrition during breastfeeding is crucial for ensuring the good health of mothers and babies. Despite the high energy and nutrient demands of breastfeeding, lactating women are often vulnerable from a nutritional perspective. The nutritional focus during breastfeeding tends to be on the newborn, often neglecting the mother's diet. Therefore, in the present narrative review, nutrient intakes were compared with the dietary reference values (DRVs) proposed by the European Food Safety Authority (EFSA) as well as by the World Health Organization/Food and Agriculture Organization (WHO/FAO). In the diets of lactating mothers, dietary inadequacies were observed in the intake of some vitamins, such as folic acid, vitamin B12, vitamin A, and vitamin D, and in the intake of certain minerals like calcium, iron, and iodine; polyunsaturated omega-3 fatty acid deficiencies, primarily in eicosapentaenoic acid and docosahexaenoic acid, were also observed. On the other hand, the debate on the necessity of supplementation during lactation continues; the need for nutritional supplementation during lactation depends on many factors, such us mothers' eating habits. There seems to be a positive association between nutritional supplementation of the lactating mother and the concentration of certain nutrients in human milk. The present narrative review provides an update on the nutritional status (fatty acids and micronutrients) of breastfeeding mothers and the impact of diet and dietary supplementation on human milk composition.

The Impact of Linoleic Acid on Infant Health in the Absence or Presence of DHA in Infant Formulas

Both linoleic acid (LA) and α-linolenic acid (ALA) are essential dietary fatty acids, and a balanced dietary supply of these is of the utmost importance for health. In many countries across the globe, the LA level and LA/ALA ratio in breast milk (BM) are high. For infant formula (IF), the maximum LA level set by authorities (e.g., Codex or China) is 1400 mg LA/100 kcal ≈ 28% of total fatty acid (FA) ≈ 12.6% of energy. The aims of this study are: (1) to provide an overview of polyunsaturated fatty acid (PUFA) levels in BM across the world, and (2) to determine the health impact of different LA levels and LA/ALA ratios in IF by reviewing the published literature in the context of the current regulatory framework. The lipid composition of BM from mothers living in 31 different countries was determined based on a literature review. This review also includes data from infant studies (intervention/cohort) on nutritional needs regarding LA and ALA, safety, and biological effects. The impact of various LA/ALA ratios in IF on DHA status was assessed within the context of the current worldwide regulatory framework including China and the EU. Country averages of LA and ALA in BM range from 8.5-26.9% FA and 0.3-2.65% FA, respectively. The average BM LA level across the world, including mainland China, is below the maximum 28% FA, and no toxicological or long-term safety data are available on LA levels > 28% FA. Although recommended IF LA/ALA ratios range from 5:1 to 15:1, ratios closer to 5:1 seem to promote a higher endogenous synthesis of DHA. However, even those infants fed IF with more optimal LA/ALA ratios do not reach the DHA levels observed in breastfed infants, and the levels of DHA present are not sufficient to have positive effects on vision. Current evidence suggests that there is no benefit to going beyond the maximum LA level of 28% FA in IF. To achieve the DHA levels found in BM, the addition of DHA to IF is necessary, which is in line with regulations in China and the EU. Virtually all intervention studies investigating LA levels and safety were conducted in Western countries in the absence of added DHA. Therefore, well-designed intervention trials in infants across the globe are required to obtain clarity about optimal and safe levels of LA and LA/ALA ratios in IF.

Dietary intake and socio-economic predictors of inadequate energy and nutrient intake among women of childbearing age in Karamoja sub-region of Uganda

BACKGROUND

Karamoja sub-region is the most food insecure part of Eastern Africa. The poor status of food security in the sub-region is reflected in the high rate of undernutrition among women of childbearing age (WCBA) and children under 5 years (CUFY). The sub-region is unique in Uganda in terms of cultural diversity, agro-ecology and rainfall pattern and agricultural practices. However, the influence of these unique characteristics on dietary intake of WCBA in the sub-region is less understood. Therefore, this study examined dietary intake and socio-economic predictors of inadequate energy and nutrient intake among WCBA in Karamoja sub-region.

METHODS

A longitudinal study design was used involving 755 WCBA in the harvesting season where 635 were followed-up in the planting season. Data were collected using 24-h recall, dietary diversity and socio-economic and demographic questionnaires.

RESULTS

Intake of energy and nutrients were generally significantly higher (p < 0.05) during the planting season than in the harvesting season. Irrespective of the district, physiological status and season, household consumption of plant-based foods was far higher than intake of animal-based foods dominated by starchy stables (76-100%), dark green leafy vegetables (70-100%) and legumes, nuts and seeds (22-97%) depending on the district. Majority of the respondents had two meals (breakfast: 65-100%; supper: 90-100%) with up to 45% of WCBA who consumed alcohol across meal times. .Overall on average, 57.7, 66.6, 78.5, 60.3, 67.7 and 93.7% of WCBA did not meet the recommended daily allowance (RDA) for energy, protein, calcium, iron, zinc and folic acid, respectively. Binary logistic regression revealed that inadequate intake of energy and nutrients significantly increased (p < 0.05) with the status of being lactating/breastfeeding and was influenced by age of WCBA, number of women married, education level and occupation of the household head depending on season.

CONCLUSIONS

This study demonstrated that dietary intake of WCBA in Karamoja sub-region was inadequate. Age of WCBA, number of women married, education level and occupation of the household head and spouse and being a lactating/breastfeeding mother were the key socio-economic and demographic factors that influenced inadequate intake of energy and nutrients among WCBA.

Micronutrient intake inadequacy and its associated factors among lactating women in Bahir Dar city, Northwest Ethiopia, 2021

Background

Inadequate intake of micronutrients in lactating women was prevalent worldwide. In particular, to our knowledge, there has been little report concerning Ethiopian lactating women regarding their micronutrient intake. Our objective was to assess micronutrient intake inadequacy and its associated factors among lactating women in Bahir Dar city, Northwest Ethiopia, 2021.

Methods

Community-based cross-sectional study was conducted from February 15 to March 05, 2021. Four hundred thirteen respondents were selected through systematic random sampling. Data were collected by interviewer-administered semi-structured questionnaire and a single multiphasic 24 hours dietary recall was used to assess dietary assessment. Data entry and analysis were carried out using EpiData and SPSS respectively. The ESHA food processor, Ethiopian food composition table, and world food composition table have used the calculation of nutrient values of the selected micronutrient. The nutrient intakes were assessed by Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR). Multivariable binary logistic regression analysis was done to identify the factors of overall micronutrient intake inadequacy.

Result

The overall prevalence of micronutrient intake inadequacy across 12 nutrients was 39.9% [95% CI (34.9, 45.0)]. The inadequate intake of vitamin A was 98.2%. Similarly, the inadequate intake of B vitamins ranges from 13.4% to 68.5%. The insufficient intakes of calcium, iron, and zinc were 70.9%, 0%, and 4.7%, respectively. Around 36 and 91.6% of the respondents had inadequate intake of selenium and sodium, respectively. On multivariable logistic regression analysis; Being divorced was 2.7 times more likely to have overall micronutrient intake inadequacy than being married [AOR = 2.71, 95% CI (1.01, 7.33)]. The odds of overall micronutrient intake inadequacy were 2.6 higher in merchants than in housewives [AOR = 2.63, 95% CI (1.40, 4.93)]. Lactating women who had poor nutritional knowledge were 2.7 times more likely to have overall micronutrient intake inadequacy than those who had good nutritional knowledge [AOR = 2.71, 95% CI (1.47, 4.99)].

Conclusion and recommendation

Overall, the micronutrient intake in lactating women was lower than the recommended levels. Therefore; educating lactating women about appropriate dietary intake is essential.

Predictors of 25-hydroxyvitamin D concentrations during pregnancy: A longitudinal analysis in the Brazilian Amazon

OBJECTIVES

To determine predictors of 25-hydroxyvitamin D₃ (25(OH)D₃) concentrations (25^th, 50^th, and 75^th percentiles) in the third trimester of pregnancy.

SUBJECTS/METHODS

Data on sociodemographic, obstetric, lifestyle and pregnancy characteristics, including serum 25(OH)D₃ and retinol, were collected among 448 pregnant women who participated in the Maternal and Child Health and Nutrition in Acre, Brazil (MINA-Brazil Study) in Cruzeiro do Sul, Brazilian Amazon (latitude 7°S). Simultaneous-quantile regression was fitted to prospectively assess predictors at the 25^th, 50^th and 75^th percentiles of 25(OH)D₃ concentrations.

RESULTS

In the third trimester, 25(OH)D₃ <50 nmol/L was observed in 26% of pregnant women. Exposure to the Amazonian dry season during follow-up and vitamin D status ≥75 nmol/L in the second trimester of pregnancy were positively associated with 25(OH)D₃ concentrations in the third trimester. Pregnant women who were the main providers of family income presented lower 25(OH)D₃ concentrations (50^th and 75^th percentiles: -15 nmol/L, 95%CI -24; -3, p = 0.02, and -22 nmol/L, 95%CI -36; -7, p = 0.004, respectively), as well as those with sustained vitamin A insufficiency (25^th and 50^th percentiles: -27 nmol/L, 95%CI -40; -15, p < 0.001, and -17 nmol/L, 95%CI -33; -1, p = 0.04, respectively). Sun protection practices had a smaller negative impact on 25(OH)D₃, restricted to participants whose concentrations were at the 25^th percentile of the distribution.

CONCLUSIONS

Seasonality and vitamin A status were important predictors of 25(OH)D₃ concentrations in the third trimester. Adequate exposure to sunlight and dietary sources of vitamin A within safe intake levels may help ensuring a good nutritional status of vitamin D during pregnancy.

Chinese Breast Milk Fat Composition and Its Associated Dietary Factors: A Pilot Study on Lactating Mothers in Beijing

Regional differences were found in breast milk composition. This study intended to profile the composition of fatty acid (FA) and triacylglycerol (TAG) in Chinese breast milk and to explore its association with maternal diet. Breast milk samples and data of 52 lactating women at 60–90 days postpartum were collected. The FA composition was measured using gas chromatography–flame ionization detection (GC-FID), and the TAG profile was detected by an ultra-performance liquid chromatography system, coupled with accurate-mass quadrupole time-of-flight mass spectrometer. A semi-quantitative food intake frequency questionnaire and a one-time 24-h dietary recall were used to evaluate the previous month's and the short-term dietary intake, including dietary patterns, food groups, and nutrients. Oleic–palmitic–linoleic (OPL) is the most predominant TAG within the Chinese human milk, followed by oleic–palmitic–oleic (OPO), with an average OPL-to-OPO ratio of 1.35. Linoleic acid (LA) and oleic acid (OA) accounted for 23.9 and 32.0% of the total FAs, respectively. Among the food groups consumed during the preceding month, LA content was positively associated with the consumption of soybeans and soybean products (r = 0.311, p = 0.030), whereas a negative correlation was identified with seafood consumption (r = −0.302, p = 0.030). Negative correlations were found between the OA content and the consumption of soybeans and soybean products (r = −0.363, p = 0.009), livestock and poultry meat (r = −0.375, p = 0.006), nuts (r = −0.305, p = 0.028), as well as cooking oil (r = −0.445, p = 0.001). No significant associations were identified between the LA and OA contents and the dietary patterns. This study confirmed a high OPL level in Chinese breast milk and revealed associations of FAs with maternal dietary intake.

Analysis of dietary patterns and nutritional adequacy in lactating women: a multicentre European cohort (ATLAS study)

Eating habits of lactating women can influence the nutrient composition of human milk, which in turn influences nutrient intake of breastfed infants. The aim of the present study was to identify food patterns and nutritional adequacy among lactating women in Europe. Data from a multicentre European longitudinal cohort (ATLAS study) were analysed to identify dietary patterns using cluster analysis. Dietary information from 180 lactating women was obtained using 3-d food diaries over the first 4 months of lactation. Four dietary patterns were identified: 'vege-oils', 'fish-poultry', 'confectionery-salads' and 'mixed dishes'. Nutrition adequacy was not significantly different between clusters, but the 'vege-oils' cluster tended to yield the highest nutrition adequacy measured by Mean Adequacy Ratio. Compared with European dietary reference values (DRVs) for lactating women, women in all clusters had inadequate intakes of energy, pantothenic acid, folate, vitamin C, vitamin A, vitamin D, zinc, iodine, potassium and linoleic acid. Adequate intake for fibre and α-linolenic acid was only achieved in the 'vege-oils' cluster. Overall, fat intake was above DRVs. The present study showed that various dietary patterns do not adequately supply all nutrients, indicating a need to promote overall healthy dietary habits for European lactating women.

Effect of ultra-processed foods consumption on glycemic control and gestational weight gain in pregnant with pregestational diabetes mellitus using carbohydrate counting

AIMS

The aims were to evaluate the consumption of ultra-processed foods by pregnant women with pre-existing diabetes mellitus (DM) using the carbohydrate counting method, in addition to investigating the association with total gestational weight gain and glycemic control.

METHODS

A cohort study of adult Brazilian pregnant women with pre-existing DM. Dietary intake was evaluated adopting the NOVA classification to identify the reported consumption of ultra-processed foods. Weight was measured at all consultations and laboratory tests were evaluated at each gestational trimester. Multivariate linear regression was used in the analysis.

RESULTS

Pregnant women (n = 42) presented mean total gestational weight gain of 12.02 ± 4.8 kg, 65.8% of them with inadequate weight gain. Daily consumption of ultra-processed foods was 272.37 ± 170.55 kcal. The increase of every 1 kcal in the calorie intake from ultra-processed foods in the third trimester increased glycated hemoglobin by 0.007% (β = 0.007, p = 0.025), raised 1-h postprandial glucose by 0.14 mg/dL (β = 0.143, p = 0.011), and added 0.11 kg to total gestational weight gain (β = 0.11, p = 0.006).

CONCLUSION

Ultra-processed food consumption influenced glycemic control and total gestational weight gain in pregnant women with DM.

Maternal macro- and micronutrient intake six months after hypertensive versus normotensive pregnancy: is poor diet quality contributing to future cardiometabolic disease risk?

BACKGROUND

Hypertensive pregnancy is associated with increased long-term cardiometabolic disease risk. Assessing dietary intake patterns after hypertensive (HP) versus normotensive pregnancy (NP) may provide insights into the mechanism of this risk.

METHODS

This study was a prospective sub-study of the P4 (Postpartum, Physiology, Psychology and Paediatrics) cohort. Women were studied six months after NP versus HP (preeclampsia or gestational hypertension). Dietary energy, macronutrient and micronutrient intake were measured using a three-day food diary (FoodWorks™) and assessed against Australian and New Zealand Nutrient Reference Values to determine nutritional adequacy. Comparisons between breastfeeding and non-breastfeeding women were assessed, and linear regression modelling (using hypertensive status, breastfeeding status, and demographic/pregnancy variables) performed to assess predictors of energy intake.

RESULTS

Seventy-four women (60 NP, 14 HP) were included. HP women had higher mean body mass index (p = 0.02) and lower breastfeeding rates (29% HP versus 83% NP, p < 0.001) compared to NP women. Twenty-four-hour energy intake and total fat intake were 17% and 20% lower after HP respectively. Nutrient deficiencies were prevalent across all participants, however more HP women had inadequate magnesium, calcium and phosphorus intake. Breastfeeding women had significantly increased energy (17%), carbohydrate (15%) and total fat intake (21%), and increased vitamin A, vitamin E, riboflavin, magnesium and iron intake compared to non-breastfeeding women. HP and breastfeeding status were independent predictors of energy intake.

CONCLUSIONS

HP women had lower micronutrient intake and greater prevalence of nutritional inadequacy compared to NP women, reflecting poorer diet quality and potentially contributing to future increased cardiometabolic disease risk.

Changes in Dietary Intake in Pregnant Women from Periconception to Pregnancy in the Japan Environment and Children's Study: A Nationwide Japanese Birth Cohort Study

BACKGROUND

Nutritional requirements increase during pregnancy. However, relatively few studies have examined longitudinal changes in dietary intake from periconception to pregnancy. Here, we investigated changes in the intake of food and nutrients, and compliance with dietary reference intakes (DRIs) in pregnant women.

METHODS

The Japan Environment and Children's Study, a nationwide multicenter prospective cohort study, included 30,373 pregnant women who answered a validated food frequency questionnaire repeatedly to assess changes in dietary intake in periconception and pregnancy. Energy-adjusted intakes of food groups and nutrients were described using the density method. The percentage of women not meeting DRIs was calculated.

RESULTS

Of all foods groups examined, intake of food significantly increased from periconception to pregnancy for dairy products (mean difference 23.5 g/1000 kcal, 95% confidence interval [CI] 22.0-25.0 g/1000 kcal), confectionaries (2.0 g/1000 kcal, 1.8-2.2 g/1000 kcal), and soft drinks (1.3 g/1000 kcal, 0.3-2.3 g/1000 kcal). Of all nutrients examined, intake was significantly increased for calcium (mean difference 27 mg/1000 kcal, 95% CI 25-29 mg/1000 kcal), vitamin A (15 μgRE/1000 kcal, 13-18 g/1000 kcal), and saturated fat (0.4% energy, 0.4-0.4% energy). The percentage of women not meeting DRIs increased for vitamin B group, vitamin C, saturated fat and salt.

CONCLUSION

We found that energy-adjusted intakes of calcium, vitamin A, and saturated fat increased from periconception to pregnancy, while intake of other nutrients did not increase. The percentage of women not meeting DRIs increased for water-soluble vitamins, saturated fat, and salt.

Gestational weight gain, nutritional status and blood pressure in pregnant women

OBJECTIVE

To evaluate whether weekly gestational weight gain is associated with anemia, vitamin A insufficiency, and blood pressure levels in the third trimester of pregnancy.

METHODS

A prospective study with 457 pregnant women attending primary care in Cruzeiro do Sul, Acre. The weekly gestational weight gain rate measured between the second and third trimesters was classified as insufficient, adequate, and excessive according to the recommendations of the Institute of Medicine 2009. The outcomes at the beginning of the third gestational trimester were: anemia (Hb < 110 g/L), vitamin A insufficiency (serum retinol<1.05 μmol/L) and blood pressure levels (continuous values, in mmHg). Age-adjusted prevalence ratios, schooling, and use of vitamin and mineral supplements were calculated in Poisson regression models with robust variance.

RESULTS

A total of 18.6% of pregnant women had insufficient weekly weight gain, and 59.1% had excessive weight gain. The frequencies of anemia, vitamin A insufficiency and hypertension (systolic blood pressure ≥ 140 mmHg or diastolic ≥ 90 mmHg) were 17.5%, 13.4%, and 0.6%, respectively. The prevalence ratios for anemia among pregnant women with insufficient and excessive weight gain were 0.41 (95%CI 0.18-0.93) and 1.00 (95%CI 0.63-1.59), respectively, when compared to pregnant women with adequate weight gain. For vitamin A insufficiency, the adjusted prevalence ratio was significantly higher among pregnant women with insufficient weight gain (2.85, 95%CI 1.55-5.24) and no difference for excessive weight gain (1.53, 95%CI 0.84-2.74) when compared to pregnant women with adequate weight gain. Pregnant women with excessive weight gain had higher mean systolic blood pressure (111.10; 95%CI 109.9-112.2) when compared to pregnant women with insufficient weight gain (107.50; 95%CI 105.4-109.6) and adequate (106.20; 95%CI 104.3-108.20).

CONCLUSIONS

Insufficient weekly gestational weight gain was associated with the risk of vitamin A insufficiency. Excessive weight gain, in turn, was associated with higher blood pressure values at the beginning of the third gestational trimester.

The validity of resting energy expenditure predictive equations in adults with central obesity: A sub-sample of the RaNCD cohort study

BACKGROUND

There are different equations for estimating Resting Energy Expenditure (REE). However, these equations were mainly developed based on populations of western countries.

AIM

The present study was conducted to determine the validity of REE predictive equations in adults with central obesity.

METHODS

This study was conducted with 129 adults with central obesity aged 35-65 years, a sub-sample from a large cohort study (Western Iran), Kurdish population. REE was measured by indirect calorimetry (IC) and REE predictive equations. Data were analysed using Pearson correlation, paired t-test, concordance correlation coefficient (CCC), mean squared deviation (MSD), level of agreement (LOA) and Bland-Altman plot.

RESULTS

All REE predictive equations had low CCC and high LOA. Although there was no statistically significant difference in the REE measured with IC and the REE predicted with the Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU), FAO/WHO/UNU (Height), Muller and revised Harris-Benedict equations (P = 0.874, 0.113, 0.619, 0.143 and P = 0.121), other equations had statistically significant differences with IC (P<0.001). In addition, the highest correlation was found between the IC (r = 0.682). The least difference was related to the FAO/WHO/UNU equation, with an agreement limit of -507.96 to 500.79 Kcal/day, with a 95% confidence interval.

CONCLUSIONS

The results of this study showed that the FAO/WHO/UNU, Muller, revised Harris-Benedict equations and Mifflin St Jeor equations are relatively acceptable for estimating REE. However, these prediction equations are not good at predicting REE; more precise equations are needed to apply for different ethnic groups.

Global inequities in dietary calcium intake during pregnancy: a systematic review and meta-analysis

BACKGROUND

Evidence shows that adequate calcium intake during pregnancy reduces the risk of hypertensive disorders of pregnancy. In most low- and middle-income countries (LMICs) the daily calcium intake is well below recommendations. Mapping calcium intake during pregnancy worldwide and identifying populations with low calcium intake will provide the evidence base for more targeted actions to improve calcium intake.

OBJECTIVE

To assess dietary calcium intake during pregnancy worldwide.

SEARCH STRATEGY

MEDLINE and EMBASE (from July 2004 to November 2017).

SELECTION CRITERIA

Cross-sectional, cohort, and intervention studies reporting calcium intake during pregnancy.

DATA COLLECTION AND ANALYSIS

Five reviewers working in pairs independently performed screening, extraction, and quality assessment. We reported summary measures of calcium intake and calculated the weighted arithmetic mean for high-income countries (HICs) and LMICs independently, and for geographic regions, among studies reporting country of recruitment, mean intake, and total number of participants. When available, inadequate intakes were reported.

MAIN RESULTS

From 1880 citations 105 works met the inclusion criteria, providing data for 73 958 women in 37 countries. The mean calcium intake was 948.3 mg/day (95% CI 872.1-1024.4 mg/day) for HICs and 647.6 mg/day (95% CI 568.7-726.5 mg/day) for LMICs. Calcium intakes below 800 mg/day were reported in five (29%) countries from HICs and in 14 (82%) countries from LMICs.

CONCLUSION

These results are consistent with a lack of improvement in calcium dietary intake during pregnancy and confirm the gap between HICs and LMICs, with alarmingly low intakes recorded for pregnant women in LMICs. From the public health perspective, in the absence of specific local data, calcium supplementation of pregnant women in these countries should be universal.

TWEETABLE ABSTRACT

Despite dietary recommendations, women in LMICs face pregnancy with diets low in calcium.

Predictors of vitamin A status among pregnant women in Western Brazilian Amazon

Determining the predictors of serum retinol at mid-pregnancy is relevant for planning interventions aimed at improving vitamin A status of pregnant women and their offspring. This prospective study assessed predictors of serum retinol at the beginning of the third trimester of pregnancy. We enrolled 442 pregnant women living in the urban area of Cruzeiro do Sul, Western Brazilian Amazon. Demographic, socio-economic, environmental and clinical characteristics as well as obstetric history, anthropometric, dietary and biochemical data, including serum retinol, were gathered between 16 and 20 gestational weeks. Serum retinol also measured at the beginning of the third trimester of pregnancy (approximately 28 gestational weeks) was the outcome of interest. Multiple linear regression models were used to evaluate associations with the outcome. Overall, the following variables explained serum retinol at the beginning of the third trimester of pregnancy in the adjusted model (R 2 = 11·1 %): seasonality (winter season - November to April; β=0·134; 95 % CI 0·063, 0·206), weekly consumption of Amazonian fruits (β=0·087; 95 % CI 0·012, 0·162) and retinol concentrations between 16 and 20 gestational weeks (β=0·045; 95 % CI 0·016, 0·074) were positively associated, whereas having a smoker in the house was negatively associated (β=-0·087; 95 % CI: -0·166, -0·009). Consumption of pro-vitamin A-rich fruits by pregnant women should be encouraged. Passive smoking may play a role in decreasing vitamin A status as a proxy of smoking exposure during pregnancy.

Translation of nutrient recommendations into personalized optimal diets for Chinese urban lactating women by linear programming models

Background

Lactating women need to consume a high-quality diet to replete nutrient stores depleted during pregnancy and to ensure sufficient nutrition for breastfeeding. However, several studies reported suboptimal dietary quality and nutrient intake of lactating mothers in China. The objectives of this study was to apply dietary modeling method to develop individualized optimal diets, which meet the nutrient requirements for lactating women in urban China.

Methods

Data were collected from a sample of 576 lactating women from 0 to 240 days postpartum during the Maternal Infant Nutrition Growth study conducted between 2011 and 2012 in three cities including Beijing, Guangzhou, and Suzhou. Dietary intake data were collected with an interviewer-administered 24-h survey. Linear programming was applied to develop dietary plans that meet recommendations for lactation women in the China Dietary Reference Intakes 2013 and the Chinese Dietary Guideline 2016, while with least deviation from the observed dietary intake.

Results

Through dietary modeling, individual optimal diets were developed for 576 lactating women. The optimal diets met all the food and nutrient intake constraints set in the linear programming models. The large difference between observed and optimized diets suggests that the nutrient needs of lactating mothers in China may only be met after substantial dietary changes. In addition, the analysis showed that it was difficult to meet the recommended intake for six nutrients: vitamin A, vitamin B1, vitamin B6, calcium, selenium, and dietary fiber. Moreover, four clusters in the optimized diets were identified by K-means cluster analysis. The four clusters confirmed that the optimal diets developed by linear programming could characterize the variety in dietary habits by geographical regions and duration of lactation.

Conclusion

Linear programming could help translate nutrient recommendations into personal diet advices for a sample of urban lactating mothers from China. The study showed that dietary modeling is helpful to support healthy eating of lactation women by translating dietary guidelines into personalized meal plans.

Trial registration

The Maternal Infant Nutrition Growth study was registered in ClinicalTrials.gov with identifier NCT01971671. Registration date October 29, 2013.

Development of a Diet Quality Index Adapted for Pregnant Women

OBJECTIVE:

To develop a Diet Quality Index Adapted for Pregnant Women (IQDAG) and to evaluate its relation with the characteristics of women treated at the Brazilian Unified Health System.

METHODS:

The data on food intake come from a cross-sectional study carried out with 785 adult pregnant women in the city of Ribeirão Preto, state of São Paulo, Brazil, between 2011 and 2012. The index was based on the recommendations of the Brazilian Ministry of Health, previous national dietary indexes, and the new Dietary Guidelines for the Brazilian Population. We used the ANOVA, Kruskal-Wallis, and chi-square tests to describe the quality of the diet according to the characteristics of the mother.

RESULTS:

The IQDAG has nine components, and it is represented by three food groups (in servings/1,000 kcal), five nutrients, and a moderator component. A high proportion of pregnant women reached the maximum score for the components of legumes and vegetables. However, few women reached the maximum score for consumption of fresh fruits, fiber, omega-3, calcium, folate, iron, and ultra-processed foods. We verified a better quality of diet among older and eutrophic pregnant women who reported practicing more physical activity and taking dietary supplements. We also observed the highest index score among women with higher intake of carbohydrates, proteins, vitamins C, E, and A, and minerals calcium, folate, and iron, as well as among those with lower intake of total fats and saturated fats.

CONCLUSIONS:

This dietary index is unprecedented in incorporating the recommendation of the new Dietary Guidelines for the Brazilian Population regarding the moderation of the consumption of ultra-processed foods. It was useful in evaluating the quality of the diet of pregnant women and we verified a higher score among older and eutrophic women who reported a healthy lifestyle. Strategies are needed to promote a higher consumption of fresh fruits, foods high in fiber, omega-3, calcium, folate, iron, and minimally processed foods in pregnant women.

Vitamin A intake of Brazilian mothers and retinol concentrations in maternal blood, human milk, and the umbilical cord

Objectives To analyse intake of vitamin A (VA) and retinol concentrations in maternal blood, breast milk (BM), and the umbilical cord (UC) of newborns, and to determine the associations among these variables. Methods We performed a cross-sectional, epidemiological study of 180 mother-newborn dyads. Maternal and UC blood samples and BM were collected. VA intake by the mother over 30 days was assessed using a questionnaire. Results Mean retinol concentrations in maternal serum, the UC, and BM were 0.65 ± 0.27, 0.36 ± 0.18, and 2.95 ± 2.70 µmol/L, respectively. Retinol concentrations <0.70 µmol/L were found in 57.2% of maternal blood samples and in 94.9% of UC samples. A total of 27.9% of BM samples showed retinol concentrations <1.05 µmol/L. Mean VA intake by the mothers was 1041.33 ± 1187.86 µg retinol activity equivalents/day and was inadequate (<550 µg retinol activity equivalents/day) in 44.7%. Conclusions High proportions of insufficient retinol concentrations were observed in the UC, maternal blood, and BM. A high percentage of pregnant women had inadequate VA intake. Mothers with insufficient serum retinol concentrations had newborns with lower retinol concentrations in the UC. Higher retinol concentrations were observed in maternal blood and the UC with a higher VA intake.

Vitamin B-6 Status in Unsupplemented Pregnant Women Is Associated Positively with Serum Docosahexaenoic Acid and Inversely with the n-6-to-n-3 Fatty Acid Ratio

BACKGROUND

Vitamin B-6-deficient diets decrease plasma docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and arachidonic acid (AA) concentrations in healthy adults. These fatty acids (FAs) are important for fetal neurodevelopment, but the relation between vitamin B-6 status and circulating polyunsaturated FAs (PUFAs) during pregnancy is unknown.

OBJECTIVE

We sought to assess the relation between plasma pyridoxal 5' phosphate (PLP; the active form of vitamin B-6) and serum DHA, EPA, AA, linoleic acid, eicosadienoic, and α-linolenic acid concentrations during pregnancy.

METHODS

A prospective cohort study in 186 healthy pregnant Brazilian women (aged 20-40 y) who were not using supplements was conducted in Rio de Janeiro, Brazil. Participants were enrolled in the first trimester of pregnancy (5-13 gestational weeks) and were followed up twice between 20-26 and 30-36 wk of gestation. Longitudinal linear mixed-effects regression models were used to evaluate the associations between 1) first-trimester PLP and PUFA concentrations across pregnancy and 2) ΔPLP (i.e., difference between third- and first-trimester plasma PLP concentrations) and PUFA concentrations across pregnancy. Models were adjusted for gestational week, first-trimester body mass index, smoking habit, and dietary intakes of vitamin B-6, fish, total fat, and PUFAs.

RESULTS

Plasma PLP concentrations (median, IQR) substantially declined during pregnancy from 35.8 nmol/L (28.6-44.3 nmol/L) in the first trimester to 21.0 nmol/L (15.8-26.3 nmol/L) in the second trimester, and 16.8 nmol/L (12.9-20.3 nmol/L) in the third trimester (both P < 0.0001). Changes in plasma PLP concentrations across trimesters were positively associated with serum DHA concentrations (β = 0.252, P = 0.012) and inversely associated with serum n-6-to-n-3 (ω-6-to-ω-3) FA ratio (β = -0.010; P = 0.015), after adjustments for confounders.

CONCLUSIONS

Maternal vitamin B-6 status during pregnancy was positively associated with the circulating concentration of DHA and inversely associated with n-6:n-3 FAs in Brazilian women who were not taking vitamin supplements. Further study is required to determine the impact of poor vitamin B-6 status on fetal neurodevelopment.

[High prevalence of inadequate calcium and vitamin D dietary intake in two cohorts of pregnant women]

This study aimed to identify the prevalence of inadequate calcium and vitamin D dietary intake and related factors in two cohorts of pregnant women according to trimester of pregnancy. Two 24-hour dietary recall tests were taken in each trimester, one pertaining to weekends. Variables significantly correlated with intake of these nutrients were included in a multivariate linear regression model, adjusted for energy. Prevalence of inadequate intake was estimated according to the National Cancer Institute method (United States). In cohort A, inadequate vitamin D did not differ between trimesters; in B there was a reduction: from 99.7% in the first trimester to 97.1% in the third. In cohorts A and B, inadequate calcium intake exceeded 70%, falling slightly from the first (89.2% and 81.4%) to the second (79.7% and 69.1%) and third trimesters (82.7% and 72.6%). There was no correlation between maternal variables and the intake of these micronutrients. In conclusion, intake of vitamin D and calcium is seriously inadequate and distributed homogeneously among pregnant women in the primary healthcare network.

A systematic review and metaanalysis of energy intake and weight gain in pregnancy

BACKGROUND

Gestational weight gain within the recommended range produces optimal pregnancy outcomes, yet many women exceed the guidelines. Official recommendations to increase energy intake by ∼ 1000 kJ/day in pregnancy may be excessive.

OBJECTIVE

To determine by metaanalysis of relevant studies whether greater increments in energy intake from early to late pregnancy corresponded to greater or excessive gestational weight gain.

DATA SOURCES

We systematically searched electronic databases for observational and intervention studies published from 1990 to the present. The databases included Ovid Medline, Cochrane Library, Excerpta Medica DataBASE (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Science Direct. In addition we hand-searched reference lists of all identified articles.

STUDY ELIGIBILITY CRITERIA

Studies were included if they reported gestational weight gain and energy intake in early and late gestation in women of any age with a singleton pregnancy. Search also encompassed journals emerging from both developed and developing countries.

STUDY APPRAISAL AND SYNTHESIS METHODS

Studies were individually assessed for quality based on the Quality Criteria Checklist obtained from the Evidence Analysis Manual: Steps in the academy evidence analysis process. Publication bias was plotted by the use of a funnel plot with standard mean difference against standard error. Identified studies were meta-analyzed and stratified by body mass index, study design, dietary methodology, and country status (developed/developing) by the use of a random-effects model.

RESULTS

Of 2487 articles screened, 18 studies met inclusion criteria. On average, women gained 12.0 (2.8) kg (standardized mean difference = 1.306, P < .0005) yet reported only a small increment in energy intake that did not reach statistical significance (∼475 kJ/day, standard mean difference = 0.266, P = .016). Irrespective of baseline body mass index, study design, dietary methodology, or country status, changes in energy intake were not significantly correlated to the amount of gestational weight gain (r = 0.321, P = .11).

CONCLUSION

Despite rapid physiologic weight gain, women report little or no change in energy intake during pregnancy. Current recommendations to increase energy intake by ∼ 1000 kJ/day may, therefore, encourage excessive weight gain and adverse pregnancy outcomes.