Abstract
Information on micronutrient adequacy of diets of rural Indonesian lactating women is lacking, despite their high nutrient requirements. This is of concern because deficits in micronutrient intakes may compromise the health of both mothers and infants. This study aimed to assess micronutrient adequacy and dietary diversity (DD) among rural lactating women and explore relationships between micronutrient adequacy, DD, and intakes of energy and food groups consumed. We measured in-home 12-h weighed food records and 12-h recalls over three non-consecutive days from 121 exclusively breastfeeding women at 2–5 months postpartum. Next, we calculated intakes of energy and 11 micronutrients and estimated probability of adequacy (PA) for usual intakes of 11 micronutrients for each women taking into account national fortification of wheat flour with thiamin, riboflavin, folate, zinc, and iron. We assessed DD from nine food groups consumed. Energy and macronutrient balance were within recommended ranges, yet population prevalence of adequacy was less than 50% for niacin, vitamins B6 and C, and less than 60% for calcium, vitamin B12 and vitamin A, all micronutrients not targeted by the national wheat flour fortification program. In contrast, population prevalence of adequacy for the fortified micronutrients was at least 60%, with iron and zinc attaining 79% and 97%, respectively. Overall mean population prevalence of micronutrient adequacy was 57% and mean (±SD) DD score was 4.3±1.2. Mean PAs, a composite measure based on individual PAs over 11 micronutrients, were strongly correlated with energy intakes and with DD scores. In the multivariate models with maternal education and wealth index as covariates, organ meats were the most important determinant of mean PA after controlling for energy intake. In conclusion, despite wheat flour fortification, lactating mothers remained at risk of multiple micronutrient inadequacies. Increasing intakes of animal source foods including organ meats, and fruits and vegetables should be considered.
Highlights
Breastfeeding imposes additional nutrient demands on lactating mothers to cover both the energy cost of milk production and the nutrients secreted in breast milk [1,2]
We chose the prevalence of inadequate intakes of calcium because of the very low calcium intakes among lactating women highlighted by earlier research in Indonesia [13] and elsewhere in Asia [5,9] and the absence of calcium as a fortificant in the mandatory fortification of wheat flour in Indonesia
The prevalence of adequacy for each of the micronutrients not targeted by fortification was less than 50% for niacin, vitamin B6, and vitamin C, and less than 60% for calcium, vitamin B-12, and vitamin A
Summary
Breastfeeding imposes additional nutrient demands on lactating mothers to cover both the energy cost of milk production and the nutrients secreted in breast milk [1,2]. The requirements for some micronutrients are increased by 50% or more during lactation [3], making them even higher than for pregnancy [4] Notwithstanding such high nutrient requirements, information on micronutrient intakes during lactation is limited, especially from low income countries where women are especially at risk to inadequate intakes because their habitual diets are often plant-based and of poor dietary quality [5,6,7,8,9]. Such dietary inadequacies in the face of the augmented micronutrient demands of lactation may compromise the health of both the mothers and their infants. Low maternal intakes have the potential to reduce concentrations of certain micronutrients in breast milk posing risk of suboptimal micronutrient intakes and status among exclusively breastfed infants [12,14]
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