Non-lactating Women Research Articles

Study of Efficacy and Safety of Injection Depot Medroxy Progesterone Acetate In Lactating and Non-lactating Women

Subject: This was a prospective study of efficacy and safety of injection depot medroxy progesterone acetate (DMPA) in lactating and non-lactating women. Abstract: The population of India is growing rapidly. The socio-economic problem of overpopulation is too well known. The use of safe and effective contraception is the need of the hour in India. Contraceptive advice is a vital component of good community health. Aims and Objective: The present study aims to study the establish safety and effectiveness of injection DMPA as a contraceptive method, acceptance, and continuation rate of injection DMPA in lactating mothers who had received first dose at postpartum period and non-lactating women and study the side effect of injection DMPA. Methods: A prospective study was conducted, at J K Lone mother and Child Hospital, Government Medical College Kota, Rajasthan, between April 2019 and April 2020. One hundred women were given injection DMPA 150 mg intramuscularly taken as study group and 100 women not using hormonal contraception were taken as controls group. They were followed at every 3 months. The comparison between the two groups was done using student t-test Chi-square test for calculation of p value. Results: The study was conducted to evaluate that women who were used DMPA mean age were 25.35 years. Overall accepted rate is 20%. No effect of literacy on acceptance rate. Significant menstrual irregularity found which was most common reason for attrition. Failure rate was zero among DMPA user. No significant effect on BP, blood sugar, and weight gain. No adverse effect on lactation. Conclusion: The study concludes that DMPA is a very effective contraceptive. Women accept it very easily without much degree of motivation. However, side effect decreases compliance.

Prevalence of Anemia Among Women of Reproductive Age in Rural Haryana, India

ObjectivesAnemia is a public health problem in women of reproductive age in many low- and medium-income countries including India. Maternal anemia can cause low birth weight, impaired fetal growth, and preterm birth. We assessed the baseline prevalence of anemia, iron deficiency (ID), iron deficiency anemia (IDA), and inflammation using c-reactive protein (CRP) among non-pregnant, non-lactating women of reproductive age living in the Ambala District, Haryana, India prior to the start of a wheat flour fortification program. MethodsWe conducted a multistage cluster probability household and biomarker survey and analyzed venous blood samples from non-pregnant, non-lactating women aged 18–49 years residing in rural areas of two subdistricts in the Ambala District. Factors of interest were: anemia, hemoglobin < 12.0 g/dL; ID, serum ferritin < 15μg/L; IDA, presence of both anemia and iron deficiency; inflammation, CRP > 5 mg/L. We used the BRINDA regression adjustment for ferritin to account for inflammation. Prevalence and 95% confidence intervals (CI) for anemia, ID, IDA, and CRP were estimated. ResultsAmong 775 non-pregnant, non-lactating women of reproductive age, 54.3% (95% CI; 50.7, 58.0) had anemia, 86.9% (95% CI; 84.3, 89.2) were iron deficient, and 15.1% (95% CI; 12.5, 18.1) had inflammation. Among those with anemia, 58.2% (95 CI; 54.3, 62.0) had iron deficiency anemia. ConclusionsAnemia, iron deficiency, and iron deficiency anemia among non-pregnant, non-lactating women of reproductive age in Haryana are significant public health concerns. The findings from the survey helped quantify the burden of inadequate iron intake and informed the Haryana government’s prevention strategy aimed at reducing micronutrient deficiencies through a wheat flour fortification program. Funding SourcesCenters for Disease Control and Prevention.

Food Security and Dietary Intake in Pregnant Women from Urban Low Income Group

In the 1970s poverty leading to low dietary intake prior to and during pregnancy was the major factor responsible for maternal under-nutrition and low birth weight. Over the last four decades there has been reduction in poverty and household food insecurity; concurrently there has been a steep decline in physical activity and some decline in energy intake. As a result of all these changes currently both under-nutrition and over-nutrition are major public health problems in women. A study was undertaken to assess food security status of the family and dietary intake of pregnant women from urban low income families using 24 hour dietary recall. Dietary intakes of pregnant women were compared with intakes of Non-Pregnant Non-Lactating women (NPNL) from the same family. Dietary intakes of both NPNL and pregnant women were compared with Estimated Average Requirement (EAR). Computation of energy intake/CU/day from the diet survey showed that these families were food secure. Both in NPNL and in pregnant women, intakes of cereal and roots and tubers were adequate; pulse, leafy vegetables and other vegetables and milk consumption was below EAR; fat consumption was above EAR. Mean energy intake was higher than EAR in NPNL women. There was a small increase in energy intake during pregnancy and intakes met EAR in pregnant women. Dietary intake of iron was below EAR in pregnant women. In urban sedentary women from food secure families, a small but sustained higher than EAR energy intake over years appears to contribute to progressive increase in over-nutrition with increasing age.

English

BACKGROUND Breast engorgement is swollen, painful breasts with overfilling of breast milk. It is normally due to an imbalance between supplying &amp; sucking of milk from the breast. In lactating mothers, this condition is common during the puerperal period. If breast engorgement is not cured, it will cause mastitis. The incidence rate of mastitis in India is 2 - 5 % in lactating &amp; 1 % in non-lactating women. Signs of breast engorgement are the inflamed and oedematous mammary gland &amp; the shiny &amp; diffusely red skin of breast. The female may have pyrexia &amp; that usually reduces over a period of 24 hours. The nipples could stretch, be tight &amp; flat which makes it difficult for the baby to suck milk from the breast. METHODS Research approach was interventional evaluatory approach. Research design was pre-experimental post-test design. The study was conducted in AVBR hospital Sawangi Meghe, Wardha district. Sample consisted of post-natal mothers. Sampling technique was a non-probability purposive sampling technique. Sample size was of 40. Tool used was a structured questionnaire including socio-demographic &amp; breast engorgement assessment scale. RESULTS All postnatal mothers had normal breast engorgement score at day 1, at day 2; 92.5 % of the postnatal mothers had normal and 7.5 % had mild engorgement at day 3; 77.5 % of postnatal mothers had normal, 15 % had mild and 7.5 % had moderate engorgement; and at day 4, 7.5 % had mild and 7.5 % had moderate engorgement. By using the chi-square test statistically, no significant difference was found in breast engorgement score at day 1 and at day 2 (א2 = 3.11, p = 0.07), and a significant difference was found between day 1 and day 3 (א2-value = 10.14, p = 0.006) and between day 1 and day 4 (א2-value = 11.43, p = 0.003). CONCLUSIONS This study reveals that there was no significant difference on the first and second day but on the 3rd and 4th day, significant difference was there. After lactational counseling, breast engorgement score was reduced. Lactational counseling is important for the prevention of breast engorgement. KEY WORDS Evaluate, Effectiveness, Breast Engorgement, Lactational Counselling, Postnatal Mother

Sexual function, mental health, and quality of life under strain of COVID-19 pandemic in Iranian pregnant and lactating women: a comparative cross-sectional study

BackgroundThe impact of COVID-19 pandemic on mental health of pregnant and lactating women is unclear. This study aimed to assess the impact of COVID-19 on psychological health, sexual function, and quality of life (QoL) in Iranian pregnant and lactating women and compare the results with non-pregnant/non-lactating women.MethodThis comparative cross-sectional study was carried out on pregnant and lactating women, with non-pregnant/non-lactating women from May to Jun 2020. Patients were asked to complete three questionnaires: Hospital Anxiety and Depression Scale (HADS), Female Sexual Function Index (FSFI), and Short-Form Health Survey (SF-12). One-way ANOVA was used to reveal the statistical differences between the three groups.ResultThe mean age of patients was 20.81 ± 5.92 years old. The mean (SD) score of HADS in pregnant, lactating and non-pregnant / non-lactating women were 12.11 (6.72), 11.98 (8.44) and 9.38 (6.2) respectively, and the results showed that the scores in pregnant, lactating women were higher than non-pregnant / non-lactating women (P < 0.001). Also the mean (SD) score of QOL and FSFI was 68.29 (9.47), 74.18 (12.65), 79.03 (10.48) and 22.71 (8.16), 22.72 (8.16), 26.19 (3.93) in three groups and the scores in pregnant, lactating women were lower than non-pregnant/non-lactating women (P < 0.001).ConclusionThe COVID-19 epidemic increases the risk of depression, anxiety, FSD, and lowers QoL in pregnant and lactating women, with the general population. This suggests the urgent need for psychological intervention in the maternal population during the epidemic.

Management of breast infections in primary care

Breast infections are a common presentation globally. Symptoms can range from mild discomfort and erythema of the skin to systemic sepsis and abscess formation with associated long-term physical and psychological morbidity. Although more common in the puerperium, non-lactating women, in particular, those between the ages of 18 and 50 years can be affected by the condition. Prompt recognition and treatment in primary care can reduce the incidence of abscess formation. Delayed or inappropriate treatment can lead to chronic infection with associated tissue destruction. In a minority of cases an inflammatory mass and skin changes can be a presenting feature of breast cancer.

Prevalence of Chronic Energy Deficiency and Associated Factors among Non-pregnant and Non-lactating Rural Women (18-49 Ages) in Mirab-Badwacho District, Hadiya Zone, Southern Ethiopia

Background: Non-pregnant and non-lactating women are the most vulnerable and neglected segments in most society. However, the non-pregnant and non-lactating women are the best window of opportunity to implement strategies, to correct maternal and child death and improve good pregnancy outcomes especially in Ethiopia. The aim of this study was to assess the prevalence of chronic energy deficiency and associated factors among rural women (18-49 ages) in Mirab-Badwacho district, Hadiya zone, Southern Ethiopia.Methods: A community based cross sectional study was employed. Multi-stage sampling technique was used to select 634 study participants. Data were collected by structured questionnaire by trained data collectors. Descriptive statistics was done and the association between the dependent and independent variables was measured using OR at 95% confidence interval. Results: The overall prevalence of chronic energy deficiency among non-lactating and non-pregnant women was 35.2% (95% CI: 31.5%, 38.9%). Age of the respondents (AOR=1.91, 95% CI: 1.06, 3.46), family size (AOR= 1.61, 95% CI: 1.14, 2.27), meal frequency per day in the past 24 hours (AOR=3.18, 95% CI: 1.26, 8.05), drinking treated water (AOR=1.82, 95% CI: 1.11, 3.08), and past history of illness (AOR=1.60, 95% CI: 1.13, 2.26) were statistical significantly associated with women’s chronic energy deficiency.Conclusion: Chronic energy deficiency was found to be high in the study area. Therefore, sustained health and nutrition education should be recommended to the communities on health care practices, proper water treatments, feeding practices and dietary diversifications in order to improve health and nutrition outcomes of non-pregnant and non-lactating women.

Nutritional status of vitamin B_(12) and its influence factors in Chinese lactating women in 2013

To examine the vitamin B_(12) status of lactating women in China and to analyze the factors affecting the level of serum vitamin B_(12) in these subjects. Participants were from the Chinese National Nutrition and Health Surveillance in 2013. By multi-stage stratified cluster randomly sampling method, 10 331 lactating women were selected from 55 counties of 30 provinces in China. Questionnaire was conducted to collect the basic information of lactating women and the dietary intake of them in the past one month was collected by food frequency questionnaire. A total of 20% of the total number of lactating women(a total of 1976) were randomly selected to analyze serum vitamin B_(12) by electro-chemiluminescence immunoassay method. Serum vitamin B_(12) deficiency was defined as a serum vitamin B_(12) level&lt;200 pg/mL. The distribution of serum vitamin B_(12 )was lognormal, a generalized linear model was used to analyze the factors affecting the serum vitamin B_(12) level after logarithm transformation of it. The median of serum vitamin B_(12)(P25, P75) in lactating women was 469. 0(349. 0, 633. 5)pg/mL, the prevalence of vitaminB_(12) deficiency was 2. 7%(53/1976)and marginal deficiency rate was 12. 8%. With the increase of the education level of the lactating women the rate of vitamin B_(12) deficiency decreased gradually. The rate of vitamin B_(12 )deficiency of the lactating women presented regional differences and varied significantly among different regionals, education levels and the mothers who were breastfeeding or not. The value of serum vitamin B_(12 )was analyzed by generalized linear regression model showed that the levels of serum vitamin B_(12) in general rural counties and medium-sized or small cities were 1. 07 and 1. 13 times higher than those in poor rural areas, respectively. The serum vitamin B_(12) level of non-lactating women was 1. 08 times higher than that of lactating women. The serum vitamin B_(12 )level of the lactating women with junior high school level or below was significantly lower than that of the lactating women with college education and university education level, 88. 3% and 85. 0% of the lactating women with college education and university education, respectively. Serum vitamin B_(12) levels were positively correlated with intake of livestock meat, fish and seafood. The status of vitamin B_(12) in lactating women in China is good. Our findings suggest that some regionals, education levels, breastfeeding or not and livestock meat, fish meat and seafood supplement may be associated with serum vitamin B_(12 )in lactating women.

Breast Milk–Derived Retinol Is a Potential Surrogate for Serum in the 13C-Retinol Isotope Dilution Test in Zambian Lactating Women with Vitamin A Deficient and Adequate Status

BackgroundVitamin A (VA) deficiency (VAD) affects ∼19 million pregnant women worldwide. The extent of VAD in Zambian women of reproductive age is unknown owing to lack of survey inclusion or the use of static serum retinol concentrations, a low-sensitivity biomarker. ObjectivesThis cross-sectional study employed isotopic techniques to determine VA status with serum and milk among women aged 18–49 y (n = 197) either lactating with infants aged 0–24 mo or nonlactating with or without infants. MethodsAssistants were trained and piloted data collection. Demographic data, anthropometry, and relevant histories were obtained including malaria and anemia. For retinol isotope dilution (RID), baseline fasting blood and casual breast milk samples were collected before administration of 2.0 μmol 13C2-retinyl acetate and 24-h dietary recalls. On day 14, blood (n = 144) and milk (n = 66) were collected. Prevalence of total liver VA reserves (TLR) ≤0.10 μmol/g was defined as VAD with comparison to the DRI assumption of 0.07 μmol/g as minimally acceptable for North Americans. ResultsWhen a 20% adjustment for dose lost to milk was made in the RID equation for lactation, mean total body VA stores (TBS) for lactating women were 25% lower than for nonlactating women (P < 0.01), which was not the case without adjustment (P = 0.3). Mean ± SD TLR for all women were 0.15 ± 0.11 μmol/g liver. Using retinol purified from breast milk instead of serum for RID analysis yielded similar TBS and TLR, which were highly correlated between methods (P < 0.0001). Serum retinol ≤0.70 μmol/L had 0% sensitivity using either VAD liver cutoff and milk retinol ≤1.0 μmol/L had 42% sensitivity for VAD at 0.10 μmol/g. ConclusionsDetermining accurate VA status among women of reproductive age, especially lactating women, forms a basis for extrapolation to the general population and informing policy development and program implementation.

Multiple Micronutrients, Lutein, and Docosahexaenoic Acid Supplementation during Lactation: A Randomized Controlled Trial.

Breastfed infants require an adequate supply of critical nutrients for growth, tissue functions, and health. Recommended intakes for several nutrients are considerably higher in lactating than non-lactating women but are not always met with habitual diets. We report a randomized, double-blind clinical trial in 70 healthy lactating women in Germany evaluating the effects of supplementation with multiple micronutrients, lutein, and docosahexaenoic acid (DHA) compared to placebo on maternal nutrient status and milk composition. The primary endpoint was the effect on the change of human milk DHA content (as a proportion of total milk fatty acids) during 12 weeks of supplementation. Maternal blood and milk biomarkers were measured as secondary endpoints. Supplementation increased maternal milk DHA by 30% compared to a decline in the placebo group. Supplementation also increased maternal blood DHA (17%), eicosapentaenoic acid (4%), 25-OH-vitamin D (24%), vitamin B12 (12%), lutein (4%), and beta carotene (49%), while homocysteine decreased. No significant difference in the number of adverse events was observed between supplementation and placebo groups. In conclusion, multi-micronutrient supplementation was safe and increased maternal blood and milk concentrations of selected nutrients in healthy women.

The Microbiota of the Human Mammary Ecosystem.

Human milk contains a dynamic and complex site-specific microbiome, which is not assembled in an aleatory way, formed by organized microbial consortia and networks. Presence of some genera, such as Staphylococcus, Streptococcus, Corynebacterium, Cutibacterium (formerly known as Propionibacterium), Lactobacillus, Lactococcus and Bifidobacterium, has been detected by both culture-dependent and culture-independent approaches. DNA from some gut-associated strict anaerobes has also been repeatedly found and some studies have revealed the presence of cells and/or nucleic acids from viruses, archaea, fungi and protozoa in human milk. Colostrum and milk microbes are transmitted to the infant and, therefore, they are among the first colonizers of the human gut. Still, the significance of human milk microbes in infant gut colonization remains an open question. Clinical studies trying to elucidate the question are confounded by the profound impact of non-microbial human milk components to intestinal microecology. Modifications in the microbiota of human milk may have biological consequences for infant colonization, metabolism, immune and neuroendocrine development, and for mammary health. However, the factors driving differences in the composition of the human milk microbiome remain poorly known. In addition to colostrum and milk, breast tissue in lactating and non-lactating women may also contain a microbiota, with implications in the pathogenesis of breast cancer and in some of the adverse outcomes associated with breast implants. This and other open issues, such as the origin of the human milk microbiome, and the current limitations and future prospects are addressed in this review.

Overweight and obesity among urban women with iron deficiency anaemia in Bangladesh.

In this study, we aimed to determine the prevalence and factors associated with overweight and obesity among nonpregnant and nonlactating (NPNL) women of reproductive age with iron deficiency anaemia (IDA) in urban Bangladesh. We obtained data from the baseline assessment of a randomized control trial conducted among 525 women of reproductive age (18–49 years) with IDA (Hb < 12 gdl−1 and serum ferritin <30 μg L−1). The study was carried out in Mirpur, Dhaka, Bangladesh, between December 2017 and January 2019. We collected information on women's socio‐demographic characteristics and anthropometry. Body mass index (BMI) was calculated using the following formula: weight in kilograms per height in square metres. BMI ≥ 25–29.9 kg m−2 was considered as overweight, whereas BMI ≥ 30 kg m−2 as obese. A multivariable logistic regression model was used to ascertain the risk factors of overweight and obesity. The prevalence of overweight and obesity was 29.9% (95% CI: 26.0–34.0) and 13.1% (95% CI: 10.4–16.3), respectively. The combined prevalence of overweight and obesity was 43.0% (95% CI: 38.7–47.4). The multivariable analysis showed married women (aOR: 4.4; CI: 1.8–11.1), women aged 30–49 years (aOR: 7.6; CI: 2.4–24.1), unemployed women (aOR 1.5; CI: 1.0–2.4) and women from the wealthier households (aOR 3.9; CI: 2.3–6.8) had the highest risk of being overweight and obese compared with their counterparts. Both age and household wealth statuses showed dose–response relationships. Combination of overweight and obesity with IDA poses a particular challenge for public health interventions. The policymakers should consider what new interventions and policy initiatives are needed to address this combination of overweight and obesity with IDA.

Assessing statistical similarity in dietary intakes of women of reproductive age in Bangladesh.

Women of reproductive age (WRA) need adequate nutrient intakes to sustain a healthy pregnancy, support fetal growth, and breastfeed after childbirth. However, data on women's dietary intake in low‐ and middle‐income countries (LMICs) are limited, and assessment of differences between dietary intakes of pregnant or lactating women compared with that of nonpregnant, nonlactating (NPNL) women is untested. Using single, multiple‐pass 24‐h dietary recall data from a sample of WRA residing in rural Bangladesh, we examined women's dietary intakes for energy, protein, calcium, iron, vitamin A, and dietary diversity for three groups: NPNL (n = 2,903), pregnant (n = 197), and lactating women (n = 944). We used equivalence testing to examine similarity in adjusted intakes for pregnant versus NPNL women and lactating versus NPNL women with a predetermined equivalence threshold based on recommendations specific for each reproductive stage. On average, both pregnant and lactating women had insufficient intakes for all dietary measures. Although statistically significant differences were observed between pregnant and NPNL women for energy intake and dietary diversity and between lactating and NPNL women for energy and protein intake, the magnitudes of these differences were too small to reject equivalence. Statistical similarity was also evident in all micronutrients and dietary diversity for both two‐group comparisons. Understanding statistical differences and similarities between dietary measures of women in distinct reproductive stages has important implications for the relevance, appropriateness, and evaluation of maternal diet‐enhancing interventions in LMICs, especially during pregnancy and lactation, when demand for macronutrients and micronutrients is elevated.

Effect of Lactation on Nutritional Status in Urban Women from Low Middle Income Families

In India breast feeding is universal. Studies carried out in the 1980s have shown that in women from low income families, lactation during the first six months was associated with weight loss. Over time there has been substantial reduction in under-nutrition across all groups including lactating women and over-nutrition has emerged as a public health problem. A study was taken up to assess the impact of universal and prolonged lactation on nutritional status and adiposity in 2240 women from urban low middle income group; 83.5% were 18-29 years of age and 16.5% were 30 years or older. As lactating women had to meet the energy cost of milk production, they weighed less and had lower mean BMI, MUAC, HC and WC as compared to non-lactating women. Prevalence of under-nutrition was higher and over-nutrition was lower in lactating women as compared to non-lactating women. In this community, prevalence of under-nutrition was low and lactation was not associated with persistent deterioration in nutritional status in either of the age groups; identifying lactating women who are under-nourished, providing them with nutrition education and take home rations continuously and monitoring their improvement may result in steep reduction in under-nutrition rates. Prevalence of over-nutrition in lactating women especially in ≥ 30 year age group was high; over-nutrition rates increased with waning lactation. Nutrition and health education on importance of increasing physical activity and interventions to promote discretionary physical activity are urgently required to halt the rise in over-nutrition and risk of non-communicable diseases in these women.

Validity assessment of self-reported weight and its correction process among Mexican adult women of reproductive age.

ObjectiveWe aimed to evaluate the agreement between self-reported weight (SRW) and measured weight (MW) in adult women of reproductive age, identify characteristics associated with the difference between SRW and MW (DW), and develop a correction procedure for SRW.MethodsWe used data from 3,452 non-pregnant or non-lactating adult women who participated in the Mexican Family Life Survey. Standardized personnel asked women about their weight before measuring weight and height. We conducted a Bland-Altman analysis for agreement and adjusted linear regression models for sociodemographic characteristics.ResultsMean DW was -0.59±3.21 kg. Difference varied according to Body Mass Index (BMI) and region of residence (p< 0.05). Correction model for log-MW, included the log-SRW, age group (18–34 and 35–49 years), interaction term (age × SRW), log-height, Southern region, and living with a partner. Based on self-reported weight, we observed an overestimation of underweight/normal weight prevalence and an underestimation of overweight or obesity prevalence.ConclusionSRW has limitations to be considered as an alternative to MW among women of reproductive age with specific characteristics. Our proposed correction equation may decrease SRW imprecision improving the estimation of overweight and obesity. We suggest that studies consider and adjust the possible bias associated with weight misreporting on health outcomes.

Risk of Breast Cancer in Women with Mastitis: A Retrospective Population-Based Cohort Study.

Background and objectives: Breast cancer is a common cancer in women and has been the fourth leading cause of death in Taiwanese women. Risk factors for breast cancer include family history of breast cancer, genetic factors, and not breastfeeding. Several studies have reported an association between repeated inflammation at a young age, especially among lactating women, and cancer; however, the number of studies about the association of mastitis and breast cancer in nonlactating women is still limited. Therefore, the aim of this study was to determine the relationship between mastitis in women aged ≥40 years and breast cancer. Materials and Methods: This was a retrospective cohort study design. The data source was the Longitudinal Health Insurance Database 2010 (LHID 2010), comprising data collected by Taiwan’s National Health Insurance program. Cases of newly diagnosed mastitis in women aged ≥40 years (ICD-9-CM code = 611.0) were selected from the years 2010 to 2012. Women not diagnosed with mastitis were selected as the control group, and their data for the years 2009 to 2013 were obtained through the database. In addition, the non-mastitis group was matched 1:10 by age. Results: A total of 8634 participants were selected from the LHID 2010, which included 734 cases with mastitis and 7900 cases without mastitis. After adjustment for age, hypertension, hyperlipidemia, diabetes, hypothyroidism, and autoimmune diseases, the Cox proportional hazard model showed that patients with mastitis had a higher risk of breast cancer (aHR = 3.71, 95% CI = 1.9–7.02) compared with the non-mastitis group. The Kaplan–Meier curve also showed that women with mastitis had a higher risk of developing breast cancer. Conclusions: This study confirmed that women with mastitis have a higher risk of developing breast cancer. Therefore, women aged ≥40 years could reduce breast cancer risk by taking precautions to prevent mammary gland infection and mastitis.

1332-P: Lactation Improves Glucose Homeostasis by Enhancing ß-Cell Mass and Function through Serotonin Production

Parous women who did not lactate have increased risk of diabetes compared to nulliparous women, but this risk is normalized by lactating for &amp;gt;3 months. However, the mechanism of the beneficial effects of lactation has not been elucidated. Therefore, we compared metabolic phenotypes including β cell characteristics in lactating and non-lactating humans and mice. For the human study, we recruited gestational diabetes and gestational impaired glucose tolerance women, and performed 75 g oral glucose tolerance test at postpartum 2 months and annually thereafter. Both lactating and non-lactating women showed normal glucose tolerance after 2 months of lactation. However, after a mean 3.6 years from delivery, lactated women maintained similar glucose tolerance whereas glucose tolerance deteriorated over time in non-lactated women. The Disposition index was improved in previously lactated women, suggesting improved β cell function after several years of delivery. For the mouse study, nine-week-old female C57BL/6J mice were mated to give birth and pups were either left (Lactating) or removed (Non-lactating) from the cage at the day of delivery. At 3 weeks after delivery, lactating mice had improved glucose tolerance and increased β cell mass compared to non-lactating mice. Lactating mice maintained high serum prolactin levels, which induced serotonin production in β cell via PRLR-STAT5-TPH1 cascade. Serotonin facilitated β cell proliferation and enhanced β cell function in lactating mice. Amelioration of glucose tolerance and β cell function were maintained for several months after the cessation of lactation in mice. These beneficial effects of lactation, however, were diminished in β cell-specific Tph1 knockout mice. We demonstrated a novel mechanism of 5-HT derivatives acting as a direct anti-oxidant to enhance β cell survival upon oxidative stress. In conclusion, serotonin contributes to the beneficial metabolic effects of lactation by enhancing β cell mass and function. Disclosure J. Moon: None. H. Kim: None. H. Jang: Speaker’s Bureau; Self; Daiichi Sankyo, Handok, Pfizer Inc., Takeda Pharmaceutical Company Limited. H. Kim: None. Funding National Research Foundation of Korea (2017H1A2A1042095, 2013H1A8A1003985, 2018R1A6A3A01012333, 2015M3A9B3028218, 2018R1A2A3074646)

Household Coverage with Adequately Iodized Salt and Iodine Status of Nonpregnant and Pregnant Women in Uzbekistan.

Background: Globally, iodine deficiency has been drastically reduced since the introduction of salt iodization programs; nonetheless, many populations remain at-risk for iodine deficiency. This study aimed to assess the iodine status among women of reproductive age in Uzbekistan and to identify factors associated with iodine deficiency, including the availability of adequately iodized salt at the household level.Methods: A cross-sectional household survey was conducted to produce region-specific estimates of the household coverage with adequately iodized salt and iodine status among women for each of the 14 regions in Uzbekistan. Other information, such as socioeconomic status, lactation and pregnancy, residence, age, and consumption of iodine supplements, was also collected.Results: Overall, 36% of 3413 households had adequately iodized salt (iodine concentration >15 ppm [parts per million (mg I/kg salt)]), 20% had inadequately iodized salt (5–14 ppm), and 44% had salt without detectable iodine (<5 ppm). Adequate iodization was found in 33.2% of the 2626 salt samples taken from retail packages labeled as “iodized,” 36.5% of the 96 samples taken from retail packages without mention of iodization, and 50.5% of the 674 samples without the original packaging (p < 0.001). The median urinary iodine concentration (UIC) of 140.9 μg/L (95% confidence interval [CI 132.4–150.7]) in nonpregnant nonlactating women indicated adequate iodine status, while for nonpregnant lactating and pregnant women, the median UIC of 112.9 μg/L [CI 99.3–128.4] and 117.3 μg/L [CI 101.8–139.9], respectively, indicated borderline adequacy. Significant differences in UIC (p < 0.001) were found between nonpregnant nonlactating women living in households with adequately iodized salt (UIC 208.9 μg/L), inadequately iodized salt (UIC 139.1 μg/L), and noniodized salt (UIC 89.9 μg/L).Conclusions: Coverage with adequately iodized salt is low in Uzbekistan, and women in households with poorly iodized salt have substantially worse iodine status; claims on packaging about salt iodization do not reflect salt iodine content. This highlights the importance and effectiveness of salt iodization and the need to strengthen this program in Uzbekistan.

Waist Circumference Complementing Body Mass Index Measures Assessed as Disease Risk Indicators in Adult Women; A Comparison Study in the Dominican, Honduras and El Salvador

Abstract Objectives To determine differences in nutritional status to guide the culturally specific education interventions. Methods Pilot training occurred in each country using consistent equipment and measurement protocols. The IRB approved protocol for pretesting and educational interventions was conducted daily for a month at each location. Descriptive statistics and Pearson 2-tailed correlations were performed. Results Subjects, all non-pregnant, non-lactating women (n = 126 DR, n = 101 ES, n = 132 HN), ranged in age from 18 to 78 yrs with 30% in their 30’s; mean ages 32.9 DR, ES 37.0, HN 42.8 (all differed, P ≤ 0.05). Most reported their ethnicity as Hispanic/Latino-Americano. At pre-testing, subjects (%) with normal BMI distributions = DR 5.6, ES 18.8, HN 15.9; obese/overweight = DR 88.8, ES 75.3, HN 62.9 (all differed, P ≤ 0.05). Mean (SD) for WC (in) = DR 38.3 ± 5.6, ES 37.4 ± 5.1, HN 36.3 ± 5.7; waist: height ratios in HN 14% lower than mean measures for DR and ES. BMI and WC were closely correlated (r = 0.70, P ≤ 0.01). Self-reported data on physical activity, weekly household income, health insurance and level of education provided insight on factors contributing to nutritional status. Conclusions BMI and WC measures were convenient, noninvasive, inexpensive and available for comparative assessments. Pre-testing data indicate subjects, the majority in their 20’s and 30’s in all three countries, had BMI and waist measures higher than recommended indicating greater risk for disease. Physical activity and socioeconomic factors highlight disparities, particularly the lack of health insurance. Our findings support the need for country specific educational interventions in future research protocols to support weight management programs. This study highlights the valuable uniqueness of the VCOM international service area clinic model. Funding Sources VCOM REAP Program FY19.

Validation of a New Instrument for Assessing Diet Quality and Its Association with Undernutrition and Non-Communicable Diseases for Women in Reproductive Age in India

Abstract Objectives India has been undergoing a rapid nutrition transition, resulting in the co-existence of undernutrition and nutrition-related non-communicable diseases (NCD). There is a need to develop and validate a diet quality assessment tool to assess risks for the double burden of disease. Methods We included 2915 non-pregnant and non-lactating women (15–49 years) from two Indian cohorts: The Andhra Pradesh Children and Parent Study and the Indian Migration Study. Using dietary data collected from FFQs, we developed a novel diet metric, the Global Diet Quality Score (GDQS). We categorized foods into 25 groups based on similarity of nutrient intake and intake patterns. Each category was assigned a positive or negative score based on prior evidence on their associations with undernutrition and NCD. Scores were calculated from the frequency and intake amounts for each category with higher scores corresponding to better diet quality (maximum total points of 49). We evaluated associations between the GDQS (overall, positive submetric, and negative submetric) and overall nutrient adequacy (&amp;gt;6/12 nutrients intake being adequate), individual micro and macronutrients, BMI, hemoglobin, systolic and diastolic blood pressure (SBP and DBP), high density lipoprotein (HDL), and total cholesterol (TC). Results The mean (SD) of the GDQS was 24 (4) points. In energy-adjusted models, positive associations were found between the overall GDQS and intakes of calcium, fiber, folate, iron, MUFA, protein, PUFA, SFA, total fat, and zinc in energy-adjusted models (r = 0.15–0.33, P &amp;lt; 0.001). Adjusted for age, GDQS was positively associated with overall nutrient adequacy. Quintile analyses showed that GDQS was positively associated with the odds of being overweight, obese and high SBP. Lower intake of foods in the GDQS negative submetric was associated with lower odds of having BMI ≥ 30 kg/m2 (OR = 0.66 (95% CI: 0.56–0.77), TC ≥200 mg/dL (0.87 (0.78–0.97), and DBP ≥ 80 mmHg (0.82 (0.74–0.92). Conclusions Among Indian women, the overall GDQS was positively associated with overall nutrient adequacy. Both the overall and negative submetric were associated with several NCD risk markers. Future studies should validate these metrics against incident diabetes and cardiovascular disease. Funding Sources Intake - Center for Dietary Assessment at FHI Solutions.