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

Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
Maternal and Infant Health Center, INCAP (Institute of Nutrition for Central America and Panama), Guatemala City 01011, Guatemala
Kinshasa School of Public Health, Kinshasa BP8502, Democratic Republic of the Congo
Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research’s Jawaharlal Nehru Medical College, Belagavi, Karnataka 590010, India
Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan
RTI International, Durham, NC 27709, USA
Author to whom correspondence should be addressed.
Nutrients 2019, 11(7), 1560;
Received: 22 May 2019 / Revised: 3 July 2019 / Accepted: 4 July 2019 / Published: 10 July 2019
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
PDF [793 KB, uploaded 18 July 2019]
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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. View Full-Text
Keywords: dietary assessment; nutrition; pregnant women; low middle income countries dietary assessment; nutrition; pregnant women; low middle income countries

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Lander, R.L.; Hambidge, K.M.; Westcott, J.E.; Tejeda, G.; Diba, T.S.; Mastiholi, S.C.; Khan, U.S.; Garcés, A.; Figueroa, L.; Tshefu, A.; Lokangaka, A.; Goudar, S.S.; Somannavar, M.S.; Ali, S.A.; Saleem, S.; McClure, E.M.; Krebs, N.F.; on behalf of the Women First Preconception Nutrition Trial Group. Pregnant Women in Four Low-Middle Income Countries Have a High Prevalence of Inadequate Dietary Intakes That Are Improved by Dietary Diversity. Nutrients 2019, 11, 1560.

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