Flores ML, Neufeld LM, González-Cossío T, Rivera J, Martorell R, Ramakrishnan U

Language: English
References: 34
Page: 190-198
PDF size: 199.79 Kb.

ABSTRACT

Objective. To compare dietary intake of women supplemented with multiple micronutrients (MM) or iron only during pregnancy. Materials and Methods. Design: Randomized, double-blind, controlled community-based trial. Setting: One semi-urban community in Central Mexico. Subjects: Pregnant women identified before week 13 of pregnancy, willing to provide informed consent. Interventions: Women were randomly assigned to receive daily supplementation with MM or iron only from recruitment until delivery. Supplements were delivered to the participants’ home and compliance observed daily. Dietary intake was assessed by repeat 24-hr recall. Data were analyzed using non-parametric tests and multiple regression analysis to determine the impact of MM supplementation on dietary intake of energy and select micronutrients. Results. During the third trimester, women in the MM group consumed more energy and iron from dietary sources than women in the iron only group. After adjustment for differences between the groups at baseline, women in the MM group consumed 111.3 kcal/day more (p‹0.05) energy. The difference in iron intake was not significant after adjusting for the increase in energy intake. Conclusions. Women consuming MM supplements during pregnancy increased energy intake from dietary sources without a concurrent increase in micronutrient density. Future studies should include measures of appetite and p hysical activity during pregnancy to determine the implications of additional energy intake for weight gain and retention.

REFERENCES

1. Picciano MF. Pregnancy and lactation. In: Ziegler-Ekhard E, Filer LJ, ed. Present knowledge in nutrition. 7th Edition, Washington, DC: ILSI Press, 1996:384-395.

2. Lenders CM, McElrath TF. Nutrition in adolescent pregnancy. Curr Opin Pediatr 2000;12:291-296.

3. Beard JL. Effectiveness and strategies of iron supplementation during pregnancy. Am J Clin Nutr 2000;71:1288S-1294S.

4. Lapido OA. Nutrition in pregnancy: mineral and vitamin supplements. Am J Clin Nutr 2000;72 Suppl 1:280S-290S.

5. Rivera DJ, Shamah LT, Villalpando HS, González de Cossío T, Hernández PB, Sepúlveda. J Nutritional status of children and women in México. Cuernavaca, México: National Institute of Public Health, 2001.

6. Barquera S, Rivera JA, Espinosa-Montero J, Safdie M, Campirano F, Monterrubio EA. Energy and nutrient consumption in Mexican women 12-49 years of age: Analysis of the National Nutrition Survey, 1999. Salud Publica Mex 2003;45 suppl 4:S530-S539

7. Anderson AS, Lean ME. Dietary intake in pregnancy. A comparison between 49 Cambridge shire women and current recommended intakes. Hum Nutr Appl Nutr 1986;40:1-8.

8. Vitolins MZ, Quandt SA, Case LD, Bell RA, Arcury TA, McDonald J. Vitamin and mineral supplement use by older rural adults. J Gerontol Biol Sci Med Sci 2000;55:M613-M617.

9. Stoltzfus RJ, Chway HM, Montresor A, Tielsch JM, Jape JK, Albonico M, et al. Low dose daily iron supplementation improves iron status and appetite but not anemia, whereas quarterly anthelminthic treatment improves growth, appetite and anemia in Zanzibari preschool children. J Nutr 2004;134:348-356.

10. McCarthy D, Weihofen D. The effect of nutritional supplements on food intake in patients undergoing radiotherapy. Oncol Nurs Forum 1999; 26:897-900.

11. Wilson CW. Appetite for vitamin C: its relationship to cellular energy potential. Int J Vitam Nutr Res Suppl 1982;23:173-185.

12. Dossa AMR, Ategbo ED, Van Raaij MA, Graaf C, Hautvast GAJ. Multivitamin-multimineral and iron supplementation did not improve appetite of young stunted and anemic Beninese children. J Nutr 2001;131: 2874-2879.

13. Ramakrishnan U, González-Cossio T, Neufeld LM, Rivera J, Martorell R. Multiple micronutrient supplementation during pregnancy does not lead to greater infant birth size than does iron-only supplementation: a randomized controlled trial in a semirural community in Mexico. Am J Clin Nutr 2003; 77: 720-725.

14. National Research Council. Recommended dietary allowance. 9th ed. Washington, DC: National Academy Press, 1980.

15. Institute of Medicine. Dietary reference intakes: applications in dietary assessment: a report of the of the Subcommittees on Interpretation and Use of Dietary Reference Levels of Nutrients, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Washington, DC: National Academy Press, 2001:81-93.

16. Institute of Medicine. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: National Academy Press, 2001:770-773.

17. Institute of Medicine Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients), Washington, DC: National Academy Press, 2002:1-10.

18. Kleinbaum DG, Kupper LL, Muller KE. Applied regression analysis and other multivariate methods. 2nd edition. Boston: PWS-Kent Publishing Company, 1988.

19. World Health Organization Obesity. Preventing and managing the global epidemic. Report of a WHO Consultation on Obesity. Geneva: WHO, 1997.

20. Rolland-Cachera MF, Cole TJ, Sempe M, Tichet J, Rossignol C, Charraud A. Body Mass Index variations; centiles from birth to 87 years. Eur J Clin Nutr 1991; 45:13-21.

21. Beaton GH, Milner J, McGuire V, Feather TE, Little JA. Source of variance in 24-hour dietary recall data: Implications for nutrition study design and interpretation. Carbohydrate source, vitamins, and minerals. Am J Clin Nutr 1983;37:986-995.

22. Conover WJ. Practical Nonparametric Statistics. New York: Wiley & Sons, 1980.

23. Willett W. Howe R, Kushi LH. Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr 1997;65:1220S-1228S.

24. Ramakrishnan U, González-Cossio T, Neufeld LM, Rivera J, Martorell R. Effect of Prenatal Multiple Micronutrient Supplements on maternal weight and skinfold changes: A Randomized double-blind clinical trial in Mexico. Food Nutr Bull 2005;26:273-280

25. King JC. Physiology of pregnancy and nutrient metabolism. Am J Clin Nutr 2000;71:Suppl 5:S1218-S1225.

26. Kant AK. Association of self-perceived body weight status with dietary reporting by US teens. Obes Res 2002;10:1259-1269.

27. Gnardellis C, Boulou C, Trichopoulou A. Magnitude, determinants and impact of under-reporting of energy intake in a cohort study in Greece. Public Health Nutr 1998;1:131-137.

28. Poppitt SD, Swann D, Black AE, Prentice AM. Assessment of selective under-reporting of food intake by both obese and non-obese women in a metabolic facility. Int J Obes Relat Metab Disord 1998;22:303-311.

29. Bergmann MM, Flagg EW, Miracle-McMahill HL, Boeing H. Energy intake and net weight in pregnant women according to body mass index (BMI) status. Int J Obes Relat Metab Disord 1997;21:1010-1015.

30. Willett W. Nature of variation in diet. In: Nutrition Epidemiology. New York: Oxford University Press, 1990:34-51.

31. Beaton GH, Approaches to analysis of dietary data: relationship between planned analyses and choice of methodology. Am J Clin Nutr 1994;59:S253-S261.

32. Nelson M Assessment of food consumption and nutrient intake. In: Nelson M, Bingham SA, eds. Design Concepts in Nutrition Epidemiology. New York: Oxford University Press, 1991:138-160.

33. Persson V, Winkvist A, Harina TNS, Creiner T, Hakimi M, Stenlund H. Variability in nutrient intakes among pregnancy women in Indonesia: implications for the design of epidemiological studies using the 24-h recall method. J Nutr 2001;131:135-330.

34. Nyambose J, Koski, KG, Tucker KL, High intra/interindividual variance ratios for energy and nutrients intakes of pregnant women in rural Malawi show that many days are required to estimate usual intake. J Nutr 2002;132:1313-1318.