1/22/2013 Study on Nutritional Status and Food Pattern of Pre-Pregnant, Pregnant and Lactating Mothers in Bogor, West Java Siti Madanijah, Dodik Briawan, Rimbawan, Zulaikhah, Nuri Andarwulan, Lilis Nuraida & Jacques Bindels Southeast Asian Food & Agricultural Science & Technology (SEAFAST) Center, Bogor Agricultural University PB) OUTLI LINE NE Background Objectives Output Methods Results Conclusion 1
1/22/2013 BACKGROUND The malnutrition problems in Indonesia occur at the every stage of the life cycle DOUBLE BURDEN NUTRITION PROBLEMS Source : Harian Kompas, 2006 2
1/22/2013 BACKGROUND BACKGROUND 3
1/22/2013 OBJECTIVES To obtain data on nutritional status in the pre-pregnant (at child-bearing age), pregnant and lactating mothers; To obtain data on food pattern in the pre-pregnant (at child-bearing age), pregnant and lactating mothers To define recommendation of additional nutrients required by pre-pregnant (at child-bearing age), pregnant and lactating mothers OUTPUTS Information on the prevalence and the severity of nutritional status in pre-pregnant (at child-bearing age), pregnant and lactating mothers Information on food preferences and food pattern including snack foods in pre-pregnant (at child-bearing age), pregnant and lactating mothers Recommendations of additional nutrients required by pre-pregnant (at child-bearing age), pregnant and lactating mothers 4
1/22/2013 METHODS Location : Bogor area Methods of data collection 3 groups: ◦ SURVEY - pre pregnant (at child- 2x24 hours Food bearing age) women Recall - pregnant women FFQ - lactating mother ◦ BLOOD ANALYSIS Number of respondent : 200/group; total 600 Criteria of subject: - at quintile 2, 3 and 4 based on HH expenditure; Design for Selection of respondents Population 1 st screening : meet the inclusion criteria for each group Yes Interview using Respondent Stop screening form candidate (1) No 2 nd screening : meet 2 nd , 3 rd and 4 th Quintile BOGOR CITY **) (Rp/cap/month) Q Range Mean Respondent Q 5 622,421 - 6,676,869 1,158,923 STOP candidate (2) No Q 4 432,210 – 618,983 517,468 Q 3 332,781 – 430,137 378,730 Yes Q 2 253,875 – 330,787 295,701 Q 1 127,869 – 247,698 213,570 Interview using Blood Analysis Questionnaire ** SUSENAS 2009 5
1/22/2013 Inclusion Criteria for each group Inclusion criteria for pregnant Inclusion criteria for pre-pregnant women: women (child-bearing age) : - healthy - healthy - age : 20-40 years - married (age 20-40 years) - at second trimester of pregnancy - preparing for pregnancy (>3-6 mo) Inclusion criteria for lactating mother: - healthy - age : 20-40 years - breastfeeding (age of their babies 50- 180 days) Respondent of the study Group Quintile Total Pre-pregnant Pregnant Lactating women mothers women Q2 66 68 69 204 Q3 65 67 72 204 Q4 69 68 79 216 Total 200 203 220 623 6
1/22/2013 Sub samples for Blood Analysis Group/ Pre- Pregnant Lactating Total Quintile pregnant Q2 15 15 15 45 Q3 15 15 15 45 Q4 15 15 15 45 Total 45 45 45 135 Data Analysis Food Consumption The Indonesian Food Composition Table (2007 and 2008), ASEAN Food Composition Table (2000), Nutrisurvey, The Composition of Foods, Wfood Composition (FAO) were used to calculate the nutrients intake. The nutrients adequacy was assessed by comparing the actual nutrients intake with the Indonesian RDA’s (ID -RDA) / Angka Kecukupan Gizi (WKNPG, 2004) Nutrients CBA (=PP) Pregnant Lactating Energy (kcal/day) 1800-1900 2100-2200 2350-2450 50 67 67 Protein (g/day) 26 35 32 Iron (mg/day) 800 950 950 Calcium (mg/day) 500 800 800 Vitamin A (RE/day) 75 85 100 Vitamin C (mg/day) 400 600 500 Folate (µg/day) 9.3-9.8 13.5-14.0 13.9-14.4 Zinc (mg/day) 7
1/22/2013 Data Analysis for Food Consumption Cut-off point for nutrients intake Nutrients Category and cut off Source Energy and protein intake Clear deficit (<70% RDA) Ministry of Moderate-mild deficit (70-90% RDA Health, RI (1996) Sufficient (>90% RDA) Vitamin and mineral intake Estimated Average Requirement: 77% RDA Gibson (2005) (Fe, Ca, Vitamin A, Vitamin C, Deficient (< 77% RDA) Folate, Zinc) Sufficient (≥77 % RDA) Blood samples : +15 ml/respondent Types of Blood Sample Analysis (135 respondent, 45 respondent/group) Pre- No Analysis Pregnant Lactating Method pregnant Peroxidation/Colorimetry 1. Hb v v v Chemiluminescent 2. Ferritin serum v v v Immunoassay (CMIA) 3. Zn v v v AAS 4. Se v v v AAS 5 Vitamin A v v v HPLC Chemiluminescent 6 Folic acid v - - Immunoassay (CMIA) 8
1/22/2013 Data Analysis for Blood Biomarker Cut-off point for blood biomarker Blood biomarker Category and cut-off Hemoglobin Pre-pregnant women and lactating mothers Deficiency (< 12 g/dL) Pregnant women Deficiency (< 11 g/dL) Ferritin Pre-pregnant women and lactating mothers Deficiency (<15 µg/L) Pregnant women Deficiency (<12 µg/L) Folate (pre-pregnant women) Deficiency (<6.7 ng/ml) Selenium Deficiency (< 0.75 µmol/L) Zinc Deficiency (<65 µmol/L) Vitamin A (All group) Deficiency (<20 µg/dL) RESUL SULTS TS 9
1/22/2013 Nutritional Status A. BMI based Nutrition status CBA / PP (n=200) Lactating (n=220) Underweight (< 18.5) 28 (14%) 20 (9.1%) Normal (18.5 – 24.9) 110 (55%) 113 (51.4%) Overweight (25.0 – 29.9) 45 (22.5%) 69 (31.4%) Obese (≥ 30.0) 17 (8.5%) 16 (8.2%) Mean ± SD 23.2 ± 4.7 22.5 ± 3.2 B. MUAC based Nutrition status CBA /PP (n=200) Pregnant (n=203) Lactating (n=220) CEM (< 23.5 cm) 25 (12.5%) 38 (18.7%) 32 (14.5%) Normal (≥ 23.5 cm) 175 (87.5) 165 (81.3%) 188 (85.5%) Mean ± SD 27.4 ± 3.8 26.1 ± 3.7 26.7 ± 3.3 Food Consumption (g/cap/day) No Food Category CBA / PP Pregnant Lactating 1 Cereals and cereal products 511.1 495 567.0 2 7.8 5 6.7 Meat and meat products 3 37.3 30 34.4 Poultry and poultry products 4 23 23 23.4 Fish and fish products 5 20.1 21 30.1 Egg and egg products 6 64.6 182 56.2 Milk and dairy products 7 67.7 82 100.0 Legume and legume products 8 138.8 160 234.3 Vegetables and veg. products 9 29.1 59 26.8 Fruit and fruit products 10 1133.7 1197 1292.3 Beverages 11 75.6 101 88.5 Snack foods TOTAL 2108.7 2352.4 2459.6 10
1/22/2013 Energy gy and prot otein in intake e during pre-pregn egnancy pregn gnan ancy and lactation ion Energy intake (kcal/day) Protein intake (g/day) 70 (ID-RDA: 50, 67 , 67 g/d) 60 50 40 Protein 30 20 10 0 pre pregn pregnancy lactation Energy intake was below Indonesia RDA’s (77.6 %, 76.2% and 73.9%, respectively) Protein intake was below Indonesia RDA (93.2%, 72.1% and 86%, respectively) Energy gy and prot otein in intake e during pregnan ancy y according ding to SEL Energy intake (kcal/day) Protein intake (g/day) (ID-RDA (AKG): 67 g/d) 70 (ID-RDA (AKG): 2100-2200 kcal/d) 60 50 40 Protein 30 20 10 0 Q2 Q3 Q4 “wealth quintiles” “wealth quintiles” Energy and protein intake of total group were below Indonesia RDA’s (75.7% and 72.1%, respectively) 11
1/22/2013 Protein Quality Intake of animal protein sources and vegetable protein Protein intake (g/day ) 70 milk+dairy egg fish meat+poultry vegetable 60 50 40 30 20 10 0 quintile 2 quintile 3 quintile 4 Next to the low absolute protein intake in Q2, the poor protein quality (only 31.3% animal protein) increases the level of concern ! Average erage %ID-RD RDA A and percen entag tage e of nutrient ient defic icienci iencies es CBA / PP Pregnant Lactating Nutrients %ID-RDA % def %ID-RDA % def %ID-RDA % def Energy 77.4 45.0 75.7 39.7 73.8 45.9 Protein 93.3 27.0 72.1 57.6 86.4 34.1 Iron 94.7 63.0 59.7 84.7 94.5 68.2 Calcium 69.7 68.0 79.8 55.7 75.5 60.5 Vitamin A 89.1 62.5 72.1 66.5 73.2 65.9 Vitamin C 37.1 88.0 45.5 84.7 49.5 76.8 Folate 40.7 90.0 33.8 98.0 45.5 90.9 Zinc 127.6 30.0 89.6 53.7 91.8 50.0 12
1/22/2013 Percentage of macronutrient deficiencies (cut off: 70% of ID-RDA, 2004) 60 57,6 50 45,0 45,9 40 39,7 CBA 34,1 Pregnant 30 Lactating 27,0 20 10 0 Energy Protein Percentage of individual vitamin and mineral deficiencies (cut off: 77% of ID-RDA, 2004 (~EAR) 100 90,9 90,0 88,0 90 98,0 76,8 80 84,7 84,7 68,2 68,0 65,9 70 63,0 62,5 60,5 66,5 60 50 55,7 53,7 50 40 30,0 30 20 10 0 Iron Calcium Vit amin A Vitamin C Folate Zinc CBA Pregnant Lactating 13
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