Abstract
Vitamin D deficiency is common during pregnancy in Bangladesh. We aimed to examine availability and intake of foods with naturally occurring or added vitamin D in pregnant women in an urban, low income setting. We examined baseline data from an ongoing, 5‐arm, randomized controlled trial of vitamin D supplementation enrolling pregnant women at 17 to 24 weeks gestation in in Dhaka, Bangladesh (n=319; “MDIG” Trial goal n=1300, ClinicalTrials.gov: NCT01924013). A focused, semi‐quantitative food frequency questionnaire was used to estimate dietary intake of foods containing vitamin D and potentially fortified with vitamin D in the past month. Further, local food markets were visited to document the availability of vitamin D fortified foods. Median (IQR) fish intake was 2.6 (1.3, 4.6) times per week, with only 5% of women reporting no fish intake (Table 1). Fresh milk was commonly consumed (21% drank once per day) but powdered milk was not (80% never consumed). In market analysis, the only locally available, packaged foods labeled as vitamin D fortified were powdered milk and ice cream. Fresh milk, cheese, yogurt, breakfast cereals, and crackers were not vitamin D fortified. Powdered milk was widely available; we identified 13 different powdered milk products (Table 2). All were vitamin D fortified, yet only 3 products indicated 100 IU or more per serving (approximate amount in one serving of milk in the US). Promoting use of powdered milk and fortifying fresh milk should be explored as practical ways to improve vitamin D intake in pregnant women in BangladeshSupportGates Foundation (OPP1066764) and NIH BIRCWH award (K12HD055882). Table 1. Prevalence of food intake in pregnant women for foods with naturally occurring or added vitamin D, Dhaka, Bangladesh, 2014 (n=319). No. of pregnant women self‐reporting intake over past month Never < once per week Once per week 2‐6 times per week Once per day > once per day Food n (%) Milk, fresh1 60 (18.8) 83 (26.0) 19 (6.0) 88 (27.6) 68 (21.3) 1 (0.3) Powdered milk1 254 (79.6) 19 (6.0) 10 (3.1) 15 (4.7) 17 (5.3) 4 (1.3) Yogurt1 159 (49.8) 138 (43.3) 16 (5.0) 6 (1.9) 0 (0) 0 (0) Ice cream 104 (32.6) 144 (45.1) 27 (8.5) 39 (12.2) 4 (1.3) 1 (0.3) Cheese 293 (91.9) 23 (7.2) 2 (0.6) 1 (0.3) 0 (0) 0 (0) Egg 29 (9.0) 61 (19.1) 36 (11.3) 128 (40.1) 62 (19.4) 3 (0.9) Poultry 51 (16.0) 121 (37.9) 62 (19.4) 82 (25.7) 2 (0.6) 1 (0.3) Beef/Mutton/Pork 56 (17.6) 122 (38.2) 57 (17.9) 81 (25.4) 3 (0.9) 0 (0) Organ meats 183 (57.4) 114 (35.7) 13 (4.1) 7 (2.2) 2 (0.6) 0 (0) Fish (fresh or dried) 17 (5.3) 45 (14.1) 76 (23.8) 133 (41.7) 25 (7.8) 23 (7.2) 1 Trace amount of vitamin D naturally occurring per the Food Composition Table for Bangladesh, 1st Edition, University of Dhaka, June 2013. Table 2. Vitamin D content and cost of powdered milk products in Dhaka, Bangladesh, 2014.1 Milk Brand Name Package Weight Cost per 25 g serving1,2 Vitamin D content per 25 g serving Cost per 100 IU vitamin D1 Horlicks3 200 g 0.33 USD 46 IU 0.70 USD Complan Growth3 200 g 0.49 USD 38 IU 1.30 USD Fresh 250 g 0.21 USD 200 IU 0.10 USD NIDO Fortified3 350 g 0.28 USD 58 IU 0.48 USD Mark's 400 g 0.26 USD “enriched” ‐‐ Dano 400 g 0.24 USD 100 IU 0.25 USD Anchor 400 g 0.23 USD 38 IU 0.61 USD Junior Horlicks3 400 g 0.32 USD 42 IU 0.75 USD Shape Up 400 g 0.28 USD 100 IU 0.29 USD Women's Horlicks3 400 g 0.34 USD 28 IU 1.21 USD Horlicks3 450 g 0.40 USD 46 IU 0.86 USD Diploma 500 g 0.22 USD 50 IU 0.44 USD Diploma 1000 g 0.22 USD 50 IU 0.44 USD 1 Conversion rate: 77.3 Taka (currency of Bangladesh) = 1 USD (US Dollar). 2 For comparison, fresh liquid milk (515 g package) was 16 Taka per serving and was not fortified with vitamin D. 3 Malted milk products.
Published Version
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