Impact of Food Rations and Supplements on Micronutrient Status by Trimester of Pregnancy: Cross-Sectional Studies in the Maela Refugee Camp in Thailand.

Wolfgang Stuetz,Tilman Grune,Verena Carrara,François Nosten,Basi Po,Borimas Hanboonkunupakarn,Sue Lee,Kanlaya Sriprawat,Rose Mc Gready,Hans Biesalski

doi:10.3390/nu8020066

Abstract

Micronutrient fortified flour (MFF), supplementary food rations and micronutrient (MN) supplements may prevent deficiencies among pregnant women. Objectives of cross-sectional surveys in 2004 (n = 533) and 2006 (n = 515) were to assess the impact of new food rations (flour, oil) and supplements on MN status by trimester of pregnancy in the Maela refugee camp. Hemoglobin, iron status, zinc, retinol, β-carotene and tryptophan decreased, while α-/γ-tocopherol and 5-methyltetrahydrofolate (5-MTHF) increased from first to third trimester. In 2006, mean zinc and α-tocopherol for each trimester was significantly higher than in 2004. The weeks of supplemented thiamine and folic acid were positively correlated with thiamine diphosphate (TDP) and 5-MTHF, but not for ferrous sulfate as iron deficiency was observed in 38.5% of third-trimester women. Frequent consumption of fish paste and owning a garden or animal were associated with significantly higher iron status, retinol, β-carotene, and 5-MTHF. In conclusion, MFF and supplementary oil were most likely to explain improved zinc and α-tocopherol status, while thiamine and folate supplements ensured high TDP and 5-MTHF in late pregnancy. MN supplements, MN-rich staple food, small gardens, and programs to improve iron compliance are promising strategies to prevent MN deficiencies during pregnancy in vulnerable populations.

Highlights

Securing adequate maternal nutrition with essential micronutrients (MNs) poses a difficult challenge in acute and protracted refugee settings [1]
Pregnant women are routinely provided with additional food rations food rations, and MN supplements to prevent MN deficiencies [4]
Micronutrient fortified flour (MFF) as an additional food ration in the basic food basket increased estimated daily intakes, in particular for vitamin A, B-vitamins, ascorbic acid, zinc and iron, while the supplementary oil ration for pregnant women especially improved the intakes of tocopherols (Table 2)

Summary

Introduction

Securing adequate maternal nutrition with essential micronutrients (MNs) poses a difficult challenge in acute and protracted refugee settings [1]. Nutrients 2016, 8, 66 from neighboring Myanmar [2] Nutrition in this setting relies mainly on the provided food basket consisting of rice, split mung beans, fermented fish, iodized salt, soybean oil and dried chilies [3]. Pregnant women are routinely provided with additional food rations (e.g., mung beans, fish) and MN supplements (iron, folate, thiamine) to prevent MN deficiencies [4]. In July 2004, MN fortified flour (MFF) was introduced as a supplementary food ration to all inhabitants in the Maela camp [5]; in February 2005, an additional oil ration for pregnant and post-partum women was provided in the Shoklo Malaria. Pregnant women are routinely provided with additional food rations (e.g., mung beans, Blood MNs and hemoglobin concentration in pregnant women can be modulated by fish) food rations, and MN supplements (iron, folate, thiamine) to prevent MN deficiencies [4]. In July 2004, MN the provision of MN supplements, the availability of seasonal MN-rich food, and with normal fortified flour (MFF) was introduced as a supplementary food ration to all inhabitants in the Maela physiological duringoil gestation as plasma volumewomen expansion camp adaptations [5]; in Februarythat

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Discussion

Conclusion