Abstract P603: Diet Quality Scores Measured With Standard and Modified Component Weights Are Associated With Mortality Risk in the Multiethnic Cohort

Introduction: The Dietary Patterns Methods Project reported higher scores of four selected dietary indices were all inversely associated with mortality risk. Diet quality components are generally weighted equally but previous meta-analyses and NHANES analyses suggest some may be more integral for mortality risk reduction. Thus, we examined if modified weight (vs. standard) Healthy Eating Index (HEI)-2015 scores were differently associated with all-cause and cardiovascular (CVD) mortality risks.

Hypothesis: High modified weight (vs. standard) HEI-2015 scores will be associated with stronger mortality risk reduction.

Methods: Data from adults (n=156,863) enrolled in the Multiethnic Cohort (MEC) Study recruited between 1993-96 from Hawaii and California with vital status and dietary data were analyzed. Baseline diet quality was assessed with the HEI-2015 using a food frequency questionnaire. Standard component weights of 5 or 10 points on 9 adequacy and 4 moderation components were reweighted creating two modified HEI scores, the Key Facets HEI with equally weighted fruits, vegetables, whole grains, and plant proteins and the Machine Learning (ML)-weighted HEI, calculated using weights reflecting relative component contributions to mortality risk from a prior analysis of NHANES III adults using LASSO models. All 3 HEI scores were assigned to deciles; sex-stratified, adjusted Cox models evaluated associations of HEI deciles with all-cause and CVD mortality risk.

Results: Participants represented 5 ethnic groups (24% White, 16% African American, 23% Latino, 29% Japanese American, and 7% Native Hawaiian), and 55.3% were women. The mean age was 59.1 years, mean BMI was 26.4 kg/m 2 , and 27.3% were college graduates. For men and women, high scores (≥90th, vs. <10th percentile) on all HEIs were significantly associated (p<0.05) with 10% to 24% reduced all-cause and CVD mortality risks.

Conclusions: Similar mortality risk reductions were observed for standard and modified weight diet quality scores in this sample.

Association Between Oyster Consumption and Hemoglobin Concentrations Among Ghanaian Women

Objectives

Oysters are a rich source of iron and consumption may reduce the risk of anemia. In 2017, a community in Ghana implemented an annual closed season of oyster harvesting between November–March, designed to benefit the sustainability of oyster harvesting. Our objectives were to determine the effect of the open and closed season on oyster consumption and anemia.

Methods

In a 6-month, longitudinal pilot study, we enrolled women in the Bortianor/Tsokomey area in Ghana and included 96 who regularly consume oysters during the open season and 40 who do not. Data were collected at two time points: 1) March 2020 (end of closed season) and 2) August 2020 (5 months into the open season). We collected the amount and frequency of oyster consumption using a 30-day food frequency questionnaire. We analyzed hemoglobin (Hb) concentrations using a Hemocue Analyzer 201. We used paired t-tests to analyze the difference in Hb concentrations and McNemar's test for anemia (Hb &lt; 12.0 g/dL) between seasons and used independent t-tests between groups.

Results

At enrollment, mean ± SD age was 34 ± 8 y and BMI was 26 ± 5 kg/m2. Among women who ate oysters during the open season, Hb did not differ by season (closed season mean ± SD: 10.4 ± 2.6, open season: 9.8 ± 2.8, p = 0.06) and the prevalence of anemia was 74% in the closed season and 72% in the open season (p = 0.81). For women who did not eat oysters during the open season, Hb did not differ by season (closed season Hb mean ± SD: 9.6 ± 2.2, open season Hb: 9.9 ± 2.3, p = 0.15) and the prevalence of anemia in the closed season was 84%, and 78% in the open season (p = 0.35). During the open season, mean ± SD oyster consumption among women who ate oysters was 1726 ± 1685 grams, or 470 oysters per month. There was no difference between groups in Hb and anemia prevalence during the closed (Hb: p = 0.17, anemia: p = 0.16) or open (Hb: p = 0.15, anemia: p = 0.49) season.

Conclusions

The prevalence of anemia was high during both seasons in both groups of women. Implementing a closed season on oyster harvesting was not related to a higher prevalence of anemia among women that eat oysters. Further research into the causes of anemia among this population is needed and programmatic action to address the high prevalence of anemia in women of reproductive age is warranted in this area.

Funding Sources

University of Rhode Island start-up grant, awarded to Dr. Brietta M. Oaks.

Is Intuitive Eating a Mediator Between Stress and Adiposity in Midlife Women?

Objectives

Stress increases appetite for highly palatable foods and can affect decision-making. Thus, higher stress may interfere with the ability to eat intuitively and result in calorie intake that exceeds physiological needs, contributing to increased adiposity. To our knowledge this relationship has not been explored. Our objective was to examine the association between perceived stress and adiposity in midlife women and test whether intuitive eating (IE) mediates this relationship.

Methods

Data from a cross-sectional study of midlife women, 40–64 years of age (n = 113), conducted April 2017 to July 2019 was analyzed. Participants completed two in-person visits and self-reported questionnaires, including the Perceived Stress Scale and the Intuitive Eating Scale. Adiposity was assessed by dual energy x-ray absorptiometry. We examined the following subscales of the Intuitive Eating Scale as possible mediators: 1) unconditional permission to eat, 2) eating for physical rather than emotional reasons, and 3) reliance on internal hunger and satiety cues. We used structural equation modeling and bootstrap confidence intervals to examine mediation of intuitive eating through perceived stress and adiposity.

Results

The direct path from perceived stress to adiposity was not significant (Β = 0.07, p = .51) and indirect effects through the intuitive eating subscales were not significant. Higher perceived stress was associated with both lower reliance on internal hunger and satiety cues (Β = −0.02, p = .04) and lower eating for physical reasons (Β = −0.04, p = .003), and lower reliance on internal hunger and satiety cues was associated with higher adiposity (Β = −5.49, p &lt; .01). Eating for physical reasons was not associated with adiposity (Β = −1.38, p = .12) and unconditional permission to eat was not associated with perceived stress (Β = −0.006, p = .59) or adiposity (Β = 0.55, p = .63).

Conclusions

Though mediation was not present, lower reliance on hunger and satiety cues was independently associated with higher perceived stress and higher adiposity in this sample of midlife women. Given the association between higher perceived stress and lower intuitive eating, future research is warranted to examine possible physiological reasons explaining this relationship.

Funding Sources

Supported by funds from the College of Health Sciences at the University of Rhode Island.

International Lipid-Based Nutrient Supplements (iLiNS) DYAD-Ghana Follow-Up Study: Effects on Social-Emotional Problems at Age 9–10 Years

Objectives

We aimed to investigate the effect of pre- and post-natal small-quantity lipid-based nutrient supplements (SQ-LNS) on child social-emotional problems at age 9–10 years in the context of children's home environments. As previously found in the 5-year follow-up study of the same trial, we expected that SQ-LNS would reduce social-emotional problems and that greater effects of SQ-LNS would be found among children from more disadvantaged home environments.

Methods

The International Lipid-Based Nutrient Supplements (iLiNS) DYAD-Ghana trial was a randomized controlled trial conducted in 2009–2014. 1320 pregnant women ≤ 20 weeks gestation were randomly assigned to receive daily (1) iron and folic acid (IFA) during pregnancy and placebo during 6 mo postpartum, (2) multiple (18) micronutrients (MMN) during pregnancy and 6 mo postpartum, or (3) SQ-LNS (20 g/d) for pregnant women during pregnancy and 6 mo postpartum and SQ-LNS for children from 6 to 18 mo of age. In 2021, we assessed child social-emotional problems at age 9–10 years by caregiver, child, and/or teacher report using the Strengths and Difficulties Questionnaire (SDQ), Brief Problem Monitor, Early Adolescent Temperament Questionnaire, Mood and Feelings Questionnaire, Screen for Child Anxiety Related Emotional Disorders, and Children's Emotion Management Scales.

Results

We re-enrolled and assessed outcomes in 966 children, 79.4% of the 1217 children eligible for re-enrollment (excluding those known not survived). At age 9–10 years, a very small percentage (<2%) of children had social-emotional difficulties scores in the abnormal range on the caregiver-reported SDQ, in contrast to the high prevalence previously found at age 5 years in the same cohort (25%). No significant differences were found between SQ-LNS and control groups. Early childhood home environment score did not modify the effect of SQ-LNS on any score.

Conclusions

Effects of pre- and post-natal SQ-LNS on social-emotional development previously found at age 5 y were not sustained to age 9–10 y in this cohort. This may have been due to the low prevalence of social-emotional problems at 10 y of age, such that there was little potential to benefit from early nutritional intervention at this age in this outcome domain.

Funding Sources

National Institutes of Health, Bill & Melinda Gates Foundation.

Fishery Management Practices and Oyster Consumption Among Oyster-Harvesting Communities in Ghana

Objectives

Sustainable management of fisheries is important for improving nutrition and food security. In 2017, an oyster harvesters’ association in Ghana began implementing a 5-month (Nov-Apr) closed season to improve oyster yields of the Densu estuary. It is unknown how much oysters contribute to the diet of women during the open season and whether there is a substantial reduction in oyster consumption during the closed season This study aimed to examine oyster consumption during the open and closed seasons and the perception of the closed season.

Methods

We recruited women (n = 137) residing in 4 major communities located near the Densu estuary in the Ga-South Municipality of Ghana. We collected data on oyster harvesting and consumption using a survey and a 30-day food frequency questionnaire during the closed (March 2020) and open (August 2020) seasons. The amount of oysters consumed was determined by converting reported portion sizes to grams using average wet weights of oysters purchased in the study area. We used McNemar's test for paired samples to compare differences in the proportion of women who consumed oysters, and Wilcoxon signed-rank test to compare differences in the amount of oysters consumed.

Results

A majority (63%) of the women were oyster harvesters. Significantly higher proportion of women consumed oysters in the 30 days preceding the interview during the open compared to the closed season (57% vs 13%, p < 0.0001). Among those who consumed oysters, the mean ± SD oysters (wet weight) consumed at a sitting was 218.4 ± 114.7 g, equivalent to 60 oysters, and did not differ between the open (211.6 ± 119.9 g) and closed ((242.8 ± 92.6 g) seasons (P = 0.73). The majority of women were aware of the closed season (87%) and viewed it positively (85%).

Conclusions

The majority of women in these communities consume oysters during the open season, and are in support of the closed season. Considering that a smaller percentage of women consumed oysters during the closed season, additional research is warranted to further examine the aggregate impacts of oyster management in Ghana on nutrition and household food insecurity, considering both consumption and income impacts.

Funding Sources

University of Rhode Island.

Associations of Maternal and Child Fatty Acid Status With Child Growth and Development Outcomes in Ghana

Objectives

Maintaining adequate fatty acid intake during pregnancy and lactation is necessary to support fetal and infant growth. Low maternal intake may lead to decreased transfer of fatty acids to the fetus. Our objective was to examine associations of individual fatty acid status at three different time points with child growth and development outcomes at 18 months.

Methods

A cohort of 1,320 women were enrolled in the International Lipid-Based Nutrient Supplements Dyad Ghana trial (iLiNS-DYAD-G). Fatty acids were measured in maternal plasma at 36 weeks gestation (n = 130), maternal breast milk six months postpartum (n = 303), and child plasma at 18 months (n = 369) and quantified as weight percentage of total identified fatty acids of the sample (% weight). We examined correlations between time points (maternal, breastmilk, and child) for five indicators of fatty acid status: % weight of four individual fatty acids (alpha-linolenic acid, ALA; linolenic acid, LA; docosahexaenoic acid, DHA; arachidonic acid, AA) and the n6: n3 ratio (ratio of LA & AA to ALA, DHA & EPA). We then examined whether each fatty acid indicator was associated with child growth (head circumference for age, length for age, weight for length z-scores) or developmental outcomes (motor, language, and social-emotional scores) at 18 months. Adjusted regressions included child sex, food insecurity scores, socioeconomic status, intervention group, and years of maternal education.

Results

Maternal plasma and breast milk were positively correlated for % weight AA, LA, and n6: n3 ratio. Maternal and child plasma were positively correlated for % weight DHA and n6: n3 ratio. Breast milk and child plasma fatty acids were positively correlated for % weight AA, ALA, DHA, and n6: n3 ratio. Associations of fatty acid status indicators with child growth and developmental outcomes were not significant after correcting for multiple comparisons.

Conclusions

Although maternal fatty acid status was associated with breastmilk and child fatty acid status, maternal and child fatty acid status was not generally associated with child growth and development at 18 months of age in this sample of mother-child dyads in Ghana.

Funding Sources

Bill & Melinda Gates Foundation; National Institute of Child Health and Human Development & Fogarty International Center R01HD099811.

Maternal and Child Supplementation With Small-Quantity Lipid-Based Nutrient Supplements Increases Child HDL Cholesterol Efflux Capacity

Objectives

The purpose of this secondary outcome analysis is to investigate whether small-quantity lipid-based nutrient supplements (SQ-LNS) alters lipid, protein or glycan composition, or the cholesterol efflux capacity (CEC), of high-density lipoprotein (HDL) particles in children in the International Lipid-Based Nutrient Supplements (iLiNS) DYAD trial in Ghana.

Methods

Plasma samples were obtained from a subcohort of 80 children at 18 months of age from the iLiNS-DYAD-Ghana trial. Mothers were randomized to either iron and folic acid (IFA) in pregnancy and 200 mg/d calcium for 6 months postpartum or SQ-LNS (pregnancy and 6 months postpartum). Children in the SQ-LNS group received SQ-LNS from 6 to 18 months while children in the IFA group did not receive supplements. HDL was isolated from plasma by sequential ultracentrifugation followed by size-exclusion chromatography. Assay of cholesterol efflux was performed in vitro, and glycoproteomic and lipidomic composition were analyzed by mass spectrometry. The primary analysis was a comparison of the effects of intervention groups on HDL lipidome, proteome, and CEC. In the exploratory analysis, we compared the enrichment of glycopeptides in measured HDL-associated proteins between groups.

Results

Mean (±SD) HDL CEC was higher among children in the SQ-LNS vs. IFA group (20.9 ± 4.1% vs. 19.4 ± 3.3%; one-tailed p = 0.038). We found no differences in HDL lipidomic or proteomic composition between groups.

Conclusions

Prenatal and postnatal SQ-LNS may improve the CEC of child HDL particles. These improvements may have a potential impact on child health outcomes.

Funding Sources

Supported by Bill & Melinda Gates Foundation grant to the University of California, Davis.

Intraindividual double burden of overweight and micronutrient deficiencies or anemia among preschool children

BACKGROUND

Child overweight prevalence is increasing globally, but micronutrient deficiencies persist.

OBJECTIVES

We aimed to 1) describe the prevalence and distribution of intraindividual double burden of malnutrition (DBM), defined as coexistence of overweight or obesity (OWOB) and either micronutrient deficiencies or anemia, among preschool children; 2) assess the independence of DBM components, e.g., whether the prevalence of DBM is greater than what would be expected by chance; and 3) identify predictors of intraindividual DBM, to guide intervention targeting.

METHODS

We analyzed data from 24 population-based surveys from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia project (separately by survey; n = 226 to n = 7166). We defined intraindividual DBM as coexisting OWOB and ≥1 micronutrient deficiency [e.g., Micronutrient Deficiency Index (MDI) > 0; DBM-MDI] or anemia (DBM-Anemia). We assessed independence of DBM components with the Rao-Scott chi-square test and examined predictors of DBM and its components with logistic regression.

RESULTS

DBM prevalence ranged from 0% to 9.7% (median: 2.5%, DBM-MDI; 1.4%, DBM-Anemia), reflecting a lower prevalence of OWOB (range: 0%-19.5%) than of micronutrient deficiencies and anemia, which exceeded 20% in most surveys. OWOB was generally not significantly associated with micronutrient deficiencies or anemia. In more than half of surveys, children 6-23 mo of age, compared with ≥24 mo, had greater adjusted odds of DBM-Anemia, anemia, and micronutrient deficiencies. Child sex and household socioeconomic status, urban location, and caregiver education did not consistently predict DBM or its components.

CONCLUSIONS

Intraindividual DBM among preschool children was low but might increase as child OWOB increases. The analysis does not support the hypothesis that DBM components cluster within individuals, suggesting that population-level DBM may be addressed by programs to reduce DBM components without targeting individuals with DBM.

Micronutrient and Metal Content of Dried Oysters in Ghana

Objectives

Oysters are potentially a good nutrition source but have the risk of being contaminated with toxic environmental metals. Micronutrient and metal levels in oysters in Ghana are currently unknown. Our objectives were to determine the micronutrient status and metal content of oysters in Ghana.

Methods

A total of 10 dried oysters originating near the Densu River in Ghana were analyzed in bulk by inductively coupled plasma-mass spectrometry for 12 micronutrients and 5 metals, including iron (Fe), zinc (Zn), cadmium (Cd) and lead (Pb).

Results

Micronutrient content (mean ± SD) of the oysters included Fe (40 ± 11 mg/100 g), Zn (158 ± 61 mg/100 g), Mg (531 ± 65 mg/100 g), Ca (203 ± 87 mg/100 g), P (881 ± 189 mg/100 g), K (255 ± 51 mg/100 g), Mn (5 ± 2 mg/100 g), Cr (0.28 ± 0.05 mg/100 g), Co (9 ± 3 mg/100 g), Ni (0.17 ± 0.04 mg/100 g), Cu (7 ± 2 mg/100 g) and Se (0.23 ± 0.03 mg/100 g). The metal content of the oysters included Cd (96 ± 26 µg/100 g), Pb (59 ± 11 µg/100 g), V (108 ± 32 µg/100 g), and As (446 ± 67 µg/100 g).

Conclusions

Dried oysters from Ghana are an excellent source of iron and zinc. These oysters were also contaminated with cadmium and lead. Our data supports that cadmium and lead levels may be a health concern for people in Ghana who consume dried oysters. This research supports further sampling on dried oysters in Ghana.

Funding Sources

University of Rhode Island start-up grant, awarded to Dr. Brietta M. Oaks.

Prenatal Vitamin Use in Rhode Island According to Women, Infants, and Children (WIC) Participation

Objectives

To examine prenatal vitamin (PNV) use between Women, Infants, and Children (WIC) and non-WIC pregnant women and explore food security and sociodemographic characteristics associated with each group.

Methods

A cross-sectional study was conducted among a convenience sample of Rhode Island pregnant women 18 years of age or older. Women were recruited from WIC offices, OB-GYN offices, and pregnant women known to the research team. All women that participated in the study completed an anonymous 21-question survey in-person or online that asked about PNV use, sociodemographic characteristics, and food security. We conducted t -testsand chi-square tests in this data analysis using SPSS. T-tests were used for continuous variables and chi-square was used for categorical variables.

Results

Out of 96 pregnant women, 61% were WIC participants. WIC participants were more likely to be Hispanic (47% vs 16%, P = 0.00), identify as a race other than white (35% vs 8%, P = 0.02), and were less likely to have a bachelor's degree (7% vs 59%, P &lt; 0.001). WIC participants had a higher prevalence of food security than non-WIC participants (56% vs 27%, P = 0.01). There was no significant difference in PNV use between WIC and non-WIC participants (P = 0.91), with 92% of women from both groups consuming PNVs during pregnancy. However, WIC participants were more likely to obtain PNVs through a prescription than non-WIC participants (53% vs 24%, P = 0.003).

Conclusions

This study indicates that there is high use of prenatal vitamins in both WIC and non-WIC participants, which is contrary to previous published studies on prenatal vitamin use among low-income women. In addition, we found that WIC participants are obtaining prescription prenatal vitamins more than non-WIC women. This is worth further attention as the composition of prescription and non-prescription prenatal vitamins differ.

Funding Sources

University of Rhode Island startup grant.

Feasibility of Using Tablet-Based Cognitive Assessments in a Large Randomized Trial in Ghana

Objectives

We aimed to assess: 1) the feasibility of using three tablet-based tasks to measure the cognitive outcomes of a nutrition trial in Ghana, specifically the Paired Associate Learning (PAL), Serial Reaction Time (SRT), and Simon tasks from the Rapid Assessment of Cognitive and Emotional Regulation (RACER); 2) whether learning effects in the three tasks show expected patterns compared to published data; and 3) the sensitivity of the RACER scores to two nutritional indicators: length-for-age z-score (LAZ) and hemoglobin concentration (Hb).

Methods

966 children aged 4–6 years participated in the International Lipid-Based Nutrient Supplements trial preschool follow-up study in Ghana. Field staff measured anthropometry, child Hb, and administered the RACER tasks at a project office visit. We used repeated-measures regression controlling for pre-specified covariates to assess learning effects and Pearson's correlations to assess the sensitivity of RACER scores to the two nutrition indicators.

Results

The success rate for completing the PAL, Simon and SRT tasks was 99.0%, 99.3%, and 93.5% respectively. As expected, on the PAL task, children were more accurate in the delayed recall trials than in the training trials, demonstrating declarative learning. On the Simon task, children showed the expected pattern of inhibitory control by responding faster and closer to the target position in same-side trials than opposite-side trials. They also demonstrated procedural learning by responding faster in the ordered block than the random block in the SRT task. The correlations between RACER scores and the two nutrition indicators (LAZ and Hb) were not significant.

Conclusions

Tablet-based assessments can be used to evaluate the outcomes of large nutrition trials in low-resource settings with high success rate. The results showed expected patterns compared to results from children in high-income countries. Although we did not find expected correlations with nutrition indicators typically associated with cognitive development, future analysis will further explore these associations.

Funding Sources

Bill & Melinda Gates Foundation, the Society for Research in Child Development, and USDA NIFA Hatch Project.

Maternal Hemoglobin Concentrations Across Pregnancy and Maternal and Child Health: A Systematic Review and Meta-analysis (P11-033-19)

Objectives

Maternal anemia is a well-recognized global health problem; however, there remain questions on specific hemoglobin thresholds that predict health risk or protection for mother and child. Our objective was to conduct a systematic review and meta-analysis to examine the associations of maternal hemoglobin concentrations with a range of maternal and infant health outcomes, accounting for timing of measurement (preconception, first, second and third trimesters), etiology of anemia and cut-off category.

Methods

Our search strategy identified 7,677 articles. Screening and article selection was conducted using Covidence systematic review software to organize search results from PubMed and Cochrane Review. The systematic review included 272 studies and the meta-analysis included 102 studies.

Results

Low maternal hemoglobin (< 110 g/L) was associated with poor birth outcomes (low birth weight, OR (95%CI): 1.43 (1.31-1.55); preterm birth, 1.35 (1.25-1.46); small-for-gestational age, 1.08 (1.00-1.18); stillbirth, 1.43 (1.05-1.95); perinatal mortality, 1.73 (1.32-2.26); and neonatal mortality, 1.49 (1.19-1.87); and adverse maternal outcomes (post-partum hemorrhage, 2.17 (1.51-3.10); preeclampsia, 1.84 (1.31-2.59); and blood-transfusion, 6.57 (3.59-12.00). High maternal hemoglobin (> 130 g/L) was associated with increased odds of small-for-gestational age, 1.22 (1.08-1.37); stillbirth, 1.88 (1.21-2.91); preeclampsia, 1.48 (1.10-2.01); and gestational diabetes, 2.02 (1.63-2.50). Relationships varied by timing of measurement and cut-off category; limited data were available on anemia etiology. There were insufficient data for other maternal outcomes and long-term child health outcomes.

Conclusions

Current data are insufficient for determining if revisions to current hemoglobin cut-offs are required. Pooled high-quality individual-level data analyses as well as prospective cohort studies that measure hemoglobin throughout pregnancy would be valuable to inform the re-evaluation of hemoglobin cut-offs.

Funding Sources

This work was commissioned and financially supported by the Evidence and Programme Guidance Unit, Department of Nutrition for Health and Development of the World Health Organization (WHO), Geneva, Switzerland.

The Double Burden of Malnutrition: A Systematic Review of Operational Definitions (P22-006-19)

Objectives

The double burden of malnutrition (DBM) has received increased attention in research and policy arenas, with wide variation in how DBM is defined. We aimed to systematically identify current operational definitions for DBM (e.g., the coexistence of overnutrition and undernutrition) used in research and evaluate their frequency of use and implications for nutrition surveillance and programs.

Methods

We conducted a structured search for peer-reviewed articles published up to July 2017, using terms describing overnutrition (e.g., overweight, obesity) and undernutrition (e.g., stunting, anemia) in PubMed and Scopus. Additional references were added through snowball searches and online searches for gray literature. We included studies that reported DBM prevalence, including those with primary or secondary data analyses (see Figure 1). Screening of abstracts and full texts for inclusion was conducted in duplicate, with discrepancies resolved by discussion and consensus. Information extracted included the level of DBM assessment (population, household, or individual), measures of overnutrition and undernutrition (BMI, waist circumference, micronutrient status, etc.), and stated definitions of DBM.

Results

We identified 1920 titles and abstracts for screening through the structured search, and added an additional 66 papers and reports. Of these, 500 full-texts were reviewed and 239 were eligible for data extraction. Frequently-occurring DBM definitions included the coexistence of: 1) overweight/obesity and underweight within a population (e.g., entire country or region); 2) adult overweight/obesity and child stunting within a population or household; and 3) overweight/obesity and anemia or iron deficiency within an individual. DBM was most frequently measured at the population level, followed by the individual and household levels.

Conclusions

The most common operational definitions of DBM relied on population-level analyses of anthropometric indicators, with many studies leveraging existing data, such as national health surveys. Further research exploring DBM definitions in relation to key health outcomes and country priorities may help select indicators that best inform public health program and policy development.

Funding Sources

This work was supported by the USDA National Institute of Food and Agriculture Hatch Project.

Supporting Tables, Images and/or Graphs

Maternal Blood Pressure in Relation to Birth Outcomes and Consumption of a Lipid-Based Nutrient Supplement (P11-001-19)

Objectives

It is unknown whether prenatal lipid-based nutrient supplements (LNS) affect blood pressure. The cutoffs to define high blood pressure have recently changed and little research has examined the association between the newly proposed blood pressure cutoffs and birth outcomes. Our objectives were to assess 1) the impact of LNS on maternal blood pressure; and 2) the association between blood pressure and birth outcomes.

Methods

In total, 1320 pregnant women ≤ 20 wk gestation in Ghana were randomized to receive daily either: 1) iron and folic acid (IFA), 2) multiple micronutrients (MMN), or 3) LNS. Blood pressure was measured at enrollment and 36 wk gestation. Gestational age was determined by ultrasound and newborn anthropometry included weight, length, and head circumference. The effect of LNS on maternal blood pressure was analyzed using ANOVA and associations between maternal blood pressure and birth outcomes were examined by linear and logistic regressions.

Results

Mean (± SD) systolic and diastolic blood pressure (SBP and DBP) at 36 wk gestation were 110 ± 11 and 63 ± 8 mmHg, respectively, and did not differ by supplementation group (P > 0.05). At enrollment, higher DBP was associated with lower birth weight and shorter pregnancy duration; 6.6% of women had high SBP (≥ 130 mmHg) and 3.6% had high DBP (≥ 80 mmHg), and women with high DBP had greater odds of low birth weight (adjusted OR = 2.99 (95% CI = 1.04, 8.62)) and preterm birth (3.99 (1.46, 10.86)) but there were no significant associations with SBP. At 36 wk, higher SBP was associated with a lower birth weight, birth length, newborn head circumference, and a shorter pregnancy duration and higher DBP was associated with a lower birth weight and length; 4.3% of women had high SBP and 2.4% had high DBP and women with high DBP had greater odds of low birth weight (4.14 (1.26, 13.62)) but high SBP (≥ 130 mmHg) was not associated with any birth outcomes.

Conclusions

Daily LNS during pregnancy did not have a significant effect on maternal blood pressure compared with IFA or MMN in this setting. Both higher SBP and higher DBP were associated with a shorter pregnancy duration and birth size; however, only high DBP was associated with adverse birth outcomes. It is unclear whether the new cutoff for high SBP is useful for identifying pregnancies at risk for adverse birth outcomes.

Funding Sources

Funded through a grant from the Bill & Melinda Gates Foundation to the University of California, Davis.

Path analyses of risk factors for linear growth faltering in four prospective cohorts of young children in Ghana, Malawi and Burkina Faso

Stunting prevalence is an indicator of a country’s progress towards United Nations’ Sustainable Development Goal 2, which is to end hunger and achieve improved nutrition. Accelerating progress towards reducing stunting requires a deeper understanding of the factors that contribute to linear growth faltering. We conducted path analyses of factors associated with 18-month length-for-age z-score (LAZ) in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements Project in Ghana (n=1039), Malawi (n=684 and 1504) and Burkina Faso (n=2619). In two cohorts, women were enrolled during pregnancy. In two other cohorts, infants were enrolled at 6 or 9 months. We examined the association of 42 indicators of environmental, maternal, caregiving and child factors with 18-month LAZ. Using structural equation modelling, we examined direct and indirect associations through hypothesised mediators in each cohort. Out of 42 indicators, 2 were associated with 18-month LAZ in three or four cohorts: maternal height and body mass index (BMI). Six factors were associated with 18-month LAZ in two cohorts: length for gestational age z-score (LGAZ) at birth, pregnancy duration, improved household water, child dietary diversity, diarrhoea incidence and 6-month or 9-month haemoglobin concentration. Direct associations were more prevalent than indirect associations, but 30%–62% of the associations of maternal height and BMI with 18-month LAZ were mediated by LGAZ at birth. Factors that were not associated with LAZ were maternal iron status, illness and inflammation during pregnancy, maternal stress and depression, exclusive breast feeding during 6 months post partum, feeding frequency and child fever, malaria and acute respiratory infections. These findings may help in identifying interventions to accelerate progress towards reducing stunting; however, much of the variance in linear growth status remained unaccounted for by these 42 individual-level factors, suggesting that community-level changes may be needed to achieve substantial progress.