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. 2019 Jul 10;11(7):1560.
doi: 10.3390/nu11071560.

Pregnant Women in Four Low-Middle Income Countries Have a High Prevalence of Inadequate Dietary Intakes That Are Improved by Dietary Diversity

Rebecca L Lander  1 , K Michael Hambidge  1 , Jamie E Westcott  1 , Gabriela Tejeda  2 , Tshilenge S Diba  3 , Shivanand C Mastiholi  4 , Umber S Khan  5 , Ana Garcés  2 , Lester Figueroa  2 , Antoinette Tshefu  3 , Adrien Lokangaka  3 , Shivaprasad S Goudar  4 , Manjunath S Somannavar  4 , Sumera Aziz Ali  5 , Sarah Saleem  5 , Elizabeth M McClure  6 , Nancy F Krebs  7 , On Behalf Of The Women First Preconception Nutrition Trial Group
Affiliations

Pregnant Women in Four Low-Middle Income Countries Have a High Prevalence of Inadequate Dietary Intakes That Are Improved by Dietary Diversity

Rebecca L Lander et al. Nutrients. .

Abstract

Background: Up-to-date dietary data are required to understand the diverse nutritional challenges of pregnant women living in low-middle income countries (LMIC). To that end, dietary data were collected from 1st trimester pregnant women in rural areas of Guatemala, India, Pakistan, and Democratic Republic of the Congo (DRC) participating in a maternal lipid-based nutrient supplement (LNS) Randomized Controlled Trial to examine dietary diversity (DD), usual group energy and nutrient intakes, and prevalence of inadequate dietary intakes.

Methods: Two 24-h dietary recalls were conducted in ~240 pregnant women/site (total n = 966) prior to 12-week gestation. Adequate DD was assessed, i.e., ≥5 major food groups consumed within the past 24 h. Median, Q1, Q3 intakes (without LNS) of energy, macronutrients, 12 micronutrients, and phytate were examined. The "at risk" prevalence of inadequate intakes were based on international guidelines for pregnant women.

Results: Dietary patterns varied widely among sites, with adequate DD reported: 20% (Pakistan), 25% (DRC), 50% (Guatemala), and 70% (India). Significantly higher intakes of most key nutrients were observed in participants with adequate DD. More than 80% of women in all sites had inadequate intakes of folate, vitamin B12, and choline, and >80% of women in India and DRC also had inadequate intakes of calcium, thiamine, riboflavin, and vitamin B6.

Conclusions: Our data highlight the likely need for micronutrient supplementation in pregnancy, specifically multi-micronutrient interventions, and support the value of increasing DD as part of sustainable long-term nutrition programs for women of reproductive age in these poor rural settings in LMIC.

Keywords: dietary assessment; low middle income countries; nutrition; pregnant women.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Inadequate and adequate dietary diversity (DD) 1 in pregnant women in four low- and middle-income countries by site. 1 Inadequate and Adequate DD, as defined by minimum dietary diversity for women of reproductive age [12], i.e., inadequate DD: consumption of <5 major food groups (FG) in the past 24 h; adequate DD: consumption of ≥5 major FG in the past 24 h. DRC, Democratic Republic of the Congo.
Figure 2
Figure 2
Contribution of food groups to total energy intake of pregnant women in four low- and middle-income countries by site. DRC, Democratic Republic of the Congo.
Figure 3
Figure 3
Estimated prevalence of the pregnant women in four low- and middle-income countries “at risk” of inadequate intakes of key micronutrients (A) Folate, (B) Vitamin B12, (C) Calcium, (D) Vitamin A. DRC, Democratic Republic of the Congo; Vit A, vitamin A; EAR, estimated average requirement; Vit B12, Vitamin B12.
See this image and copyright information in PMC

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