Dietary Protein Inadequacy among Women of Reproductive Age from Five Low‐Income Countries

Abstract

Women in low‐income countries have low micronutrient intake adequacy, but protein adequacy has not been assessed rigorously. A 2015 report from SPRING indicated that protein intake was generally adequate in most cohorts based on the mean protein intakes being above a threshold of % energy rather than high prevalence of usual intakes above estimated average requirements (EAR) per kg body weight. Moreover, protein quality was not considered.We assessed dietary protein intake adequacy of women using existing quantitative dietary data from Bangladesh, Burkina Faso, Mozambique, Uganda, and Zambia. Food intakes were assessed by 24‐h recall, except in Bangladesh where 12‐h direct observation and weighing and 12‐h recall were used. Protein intakes were adjusted for fecal digestibility factors and amino acid scoring patterns using the Protein Digestibility Corrected Amino Acid Score (PDCAAS) method to estimate “available” protein (AP) intake. The distribution of usual intakes of AP per kg of body weight was obtained using 1–2 days of intake from each dataset, and the prevalence of inadequate intakes (PII) < EAR (0.66 g/kg, for non‐pregnant, non‐lactating, NPNL) was estimated using the National Cancer Institute usual intake model. For lactating women, the PII was estimated using 2 different EAR due to uncertainties about the age of the breastfeeding child or the protein requirement beyond 12 mo of lactation: 1) 0.66 g/kg/d and 2) 0.66 g/kg/d plus 10 g/d (additional need for 6–12 mo) divided by the average body weight of the women (0.84 – 0.89 g/kg/d).For NPNL women, the PII was: 35% in Bangladesh, 32% in Burkina Faso during lean season, 16% in Burkina Faso during post‐harvest season, 23% in Zambia, 12% in Uganda, and 1% in Mozambique. For lactating women, the PII (using lower – higher EAR) was: 30–76% in Bangladesh, 26–53% in Burkina lean season, 14–36% in Burkina Faso post‐harvest season, 14–34% in Zambia, 9–29% in Uganda, and 1–15% in Mozambique. The mean PDCAAS of the diets was lower for Burkina Faso in the lean season (62% for NPNL and 59% for lactating) than for Bangladesh (71% for NPNL and 69% for lactating), likely due the lower protein quality of the main staple in Burkina Faso (sorghum 27%) than in Bangladesh (rice 56%) and the very low intake of animal‐source foods in both countries.In summary, dietary protein inadequacy is evident in women residing in countries with diets reliant on main staples that are low in protein quality. This is of particular concern for lactating women (and likely for pregnant women in some of these settings) who have higher protein requirements.Support or Funding InformationPartially funded by the Bill & Melinda Gates Foundation grant # OPP1128015.