Abstract
Pregnant and lactating women in rural Niger are at high risk for inadequate intakes of multiple micronutrients. Thus, 24 h dietary recalls were conducted and analyzed for dietary intakes in this population (n = 202). Using linear programming analyses, micronutrient gaps in women’s diets were identified, food-based recommendations (FBR) to improve dietary micronutrient adequacy were developed, and various supplementation strategies were modelled. Energy intakes were below estimated requirements, and, for most micronutrients, >50% of women were at risk of inadequate intakes. Linear programming analyses indicated it would be difficult to select a diet that achieved recommended dietary allowances for all but three (vitamin B6, iron and zinc) of 11 modeled micronutrients. Consumption of one additional meal per day, and adherence to the selected FBR (daily consumption of dark green leafy vegetables, fermented milk, millet, pulses, and vitamin A fortified oil), would result in a low percentage of women at risk of inadequate intakes for eight modeled micronutrients (vitamin A, riboflavin, thiamin, B6, folate, iron, zinc, and calcium). Because the promotion of realistic FBRs likely will not ensure that a low percentage of women are at risk of inadequate intakes for all modeled micronutrients, multiple micronutrient supplementation or provision of nutrient-dense foods should be prioritized.
Highlights
Maternal nutrition from the time of conception until two years post-partum, a period known as the first 1000 days, is critical for maternal and child health [1]
Usual dietary intakes of vitamin A, thiamin, riboflavin, niacin, folate and vitamin C were inadequate among >50% of pregnant and lactating women; usual dietary calcium and vitamin B12 intakes were inadequate for all women
A 2010 systematic review reporting micronutrient intake among women in resource-poor settings concluded that inadequate intakes of multiple micronutrients were common, with reported mean or median intakes in over 50% of the studies below the estimated average requirement (EAR) [3]
Summary
Maternal nutrition from the time of conception until two years post-partum, a period known as the first 1000 days, is critical for maternal and child health [1]. Undernutrition during pregnancy is a risk factor for maternal mortality and fetal growth restriction, which increases the risk of neonatal deaths and contributes to impaired post-natal linear growth and development [1]. Undernutrition during lactation adversely affects the concentrations of some macro- and micronutrients in breastmilk, which may negatively impact infant morbidity and mortality [2]. In low-income countries, it is challenging for women to meet their macro- and micronutrient requirements during pregnancy and Nutrients 2019, 11, 72; doi:10.3390/nu11010072 www.mdpi.com/journal/nutrients. In Niger, the lifetime risk of maternal death is 1 in 23 women and 11.4% of children die before reaching 5 years of age [4]. In a recent cross-sectional survey conducted among pregnant women in Zinder, Niger, 27% of pregnant women had inadequate gestational weight gain and 25%
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