Nutrient intakes of pregnant and lactating women in Indonesia and Malaysia: Systematic review and meta-analysis

Anemia in Breastfeeding Women and Its Impact on Offspring's Health in Indonesia: A Narrative Review

Anemia in breastfeeding women is a neglected global health issue with significant implications for maternal and child health. Despite its widespread occurrence and adverse effects, this problem remains largely unknown and overlooked on the global health agenda. Despite efforts to improve health access coverage and provide iron and folic acid supplementation, anemia persists. This underscores the need for a comprehensive approach to address the problem. Urgent action must be taken to prioritize education and awareness campaigns, ensure access to nutritious food, and enhance healthcare services. Education programs should focus on promoting iron-rich diets, dispelling cultural myths, and providing practical guidance. Improving healthcare services requires increasing availability, ensuring a consistent supply of iron supplements, and providing adequate training for healthcare providers. A successful implementation relies on a strong collaboration between the government, healthcare providers, and community. It is crucial that we acknowledge that high coverage alone is insufficient for solving the issue, emphasizing the importance of targeted interventions and a strategic implementation. By adopting a comprehensive approach and addressing the underlying causes of anemia, Indonesia can make significant progress in reducing its prevalence and improving the overall health of its population, particularly among breastfeeding women.

Association between Iron-Folic Acid Supplementation during Pregnancy and Maternal and Infant Anemia in West Java, Indonesia: A Mixed-Method Prospective Cohort Study

The Indonesian government has provided iron-folic acid (IFA) supplementation in response to maternal pregnancy iron-deficiency anemia. However, community-based cohorts on IFA's effects on maternal and infant anemia are limited. A mixed-method study design with a primary longitudinal cohort was used to observe the association between IFA and anemia in mothers and infants. Iron-folic acid supplementation was observed throughout pregnancy. Anemia status was based on a single hemoglobin assessment using HemoCue Hb 201 + in the second or third trimester of pregnancy for the mother and at birth for the infant. Qualitative data were collected via in-depth interviews (IDIs) and a forum group discussion (FGD). Iron-folic acid supplementation with > 180 tablets throughout pregnancy was associated with lower pregnancy anemia (adjusted relative risk [aRR] = 0.25, 95% CI: 0.092-0.664, P = 0.006) after adjusting for potential confounding variables. Supplementation with IFA was not associated with infant anemia (RR = 1.033, 95% CI: 0.70-1.54, P = 0.873 for 90-180 tablets and RR = 1.07, 95% CI 0.70-1.63, P = 0.774 for > 180 tablets). The IDIs and FGD suggested that IFA and multivitamin content knowledge, IFA consumption monitoring, and paternal involvement were important in IFA supplementation and effectiveness in reducing anemia. Iron-folic acid supplementation was associated with reduced maternal but not infant anemia. Because maternal anemia is associated with infant anemia, an anemia monitoring program for women in early pregnancy is vital in addressing infant health. Paternal involvement was also identified as a major factor in maternal and child health.

Maternal macronutrient and energy intake during pregnancy: a systematic review and meta-analysis

BACKGROUND

Nutritional status during pregnancy can have a significant impact on infant and maternal health outcomes. To maintain maternal homeostasis and support fetal growth, adequate macronutrient and energy intake during pregnancy is essential. Therefore, this study sought to systematically review and meta-analyze macronutrient and energy intakes during pregnancy.

METHODS

A systematic review and meta-analysis was carried out based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The required data were collected from four databases including: Web of Sciences, ProQuest, Scopus, and PubMed, from 1 January 1980 to 30 May 2023, by using a combination of search terms (dietary pattern" OR "diet quality" OR "food habits" OR "nutrition surveys" OR "diet surveys" OR "food-frequency questionnaire" OR "diet record" OR "dietary recall") AND ( "pregnancy" OR "reproduction" OR "maternal health" OR "neonatal outcomes") among interventional and observational studies. Excel and STATA version 11 were used for data analysis.

RESULTS

Among 7081 published articles, 54 studies were included in the review. Most of the 33 (61%) studies were cohort studies and a total of 135,566 pregnant women were included. The overall average of energy, carbohydrate, fat, and protein intake was 2036.10 kcal/day, 262.17 gr/day, 74.17 gr/day, and 78.21 gr/day, respectively. Also, energy intake during pregnancy was higher in American (2228.31 kcal/day, CI95%: 2135.06-2325.63) and Eastern Mediterranean regions (2226.70 kcal/day, CI95%: 2077.23-2386.92) than other regions (P < 0.001). Energy intake was higher in the third trimester than others (2115.64 kcal/day, CI95%: 1974.15-2267.27). Furthermore, based on the findings, there was a significant difference between energy intake in different World Health Organization (WHO) regions (P < 0.05).

CONCLUSIONS

According to the results of meta-analysis, the average total energy was below than average total energy required during pregnancy. More efforts are needed to encourage women to adopt healthy eating habits during pregnancy to support healthy fetal and infant development.

Changing trend of neonatal Ca/P/Mg status in a Chinese population

Background

Calcium (Ca), phosphorus (P), and magnesium (Mg) are essential elements for keeping the body homeostasis. We aimed to investigate the changing trend of serum levels of Ca/P/Mg in neonates.

Methods

We enrolled 82 premature newborns, 173 neonatal sepsis, 50 neonatal hypoglycemia, 254 neonatal jaundice, 43 neonatal haemolytic disease, and 59 healthy controls in our retrospective study. Serum levels of Ca/P/Mg were collected and expressed in quarters. We analysed the association between neonatal disorders and Ca/P/Mg levels (fourth quarter vs. first quarter) using binary logistic regression analysis. Smooth curve analysis was performed to analyze the non-linear association between birthweight/procalcitonin (PCT) and Ca/P levels. Threshold effect analysis was also performed to yield the turning point of birthweight/PCT in their associations with Ca/P levels.

Results

Binary logistic regression analyses showed that neonatal haemolytic disease, hypoglycemia, sepsis, jaundice, and prematurity were all significantly associated with the fourth quarter of Ca level (P<10-4; P<10-4; P<10-4; P=0.001; and P<10-4, respectively). Neonatal hypoglycemia and prematurity were significantly associated with the fourth quarter of P level (P=0.004; and P=0.003, respectively). Neonatal haemolytic disease, hypoglycemia, sepsis, jaundice and prematurity were not associated with Mg level. Birthweight was significantly associated with Ca level before and after the turning point of 3,220 grams. PCT was significantly associated with Ca level before and after the turning point of 16.8 µg/L. Birthweight was significantly associated with P level before the turning point of 2,990 gram. PCT was significantly associated with P level before the turning points of 3.5 and 34.21 µg/L.

Conclusions

Neonatal disorders demonstrated a decreasing trend of serum Ca/P level. A significantly non-linear association was observed between birthweight/PCT and serum Ca/P levels.

Breakfast Consumption and Quality of Macro- and Micronutrient Intake in Indonesia: A Study from the Indonesian Food Barometer

Breakfast is an important meal that has been shown to have a positive effect on health. The current study aimed to assess the patterns of breakfast consumption among adult Indonesians and to estimate the contribution of breakfast to their nutrient intake and dietary quality. The study used 24-h recall data from the 2018 Indonesian Food Barometer study to assess breakfast intake among 1333 adults aged 18 and above from six provinces in Indonesia. Diet quality was measured using the Nutrient Rich Food index (NRF) 9.3, and the nutritional profile of breakfast was compared across tertiles of NRF 9.3. In total, 5.2% of adults in Indonesia skipped breakfast. Breakfast contributed 26% to daily energy intakes and 22-28% to intakes of all reported nutrients, except for total sugar (12%), vitamin C (8%) and vitamin D (7%). With respect to daily requirements, breakfast contributed approximately 20% to energy, protein, fat and sodium requirements, 26% to saturated fat but <15% to the requirements for most micronutrients and only 5% for fiber. Among breakfast consumers, a higher NRF score was associated with higher daily intakes of protein, dietary fiber and micronutrients and lower intakes of sodium from breakfast. This study suggests that a balanced breakfast in Indonesia should aim to lower fat and saturated fat intake while increasing fiber, potassium, calcium and vitamin C and D intake. These findings could inform the development of nutrient-based guidelines for breakfast consumption in Indonesia.