Non-pregnant Non-lactating Women Research Articles

Folic Acid–Fortified Iodized Salt and Serum Folate Levels in Reproductive-Aged Women of Rural India

India has a disproportionately high prevalence of neural tube defects, including spina bifida and anencephaly (SBA), causing a high number of stillbirths, elective pregnancy terminations, and child mortality; India contributes a large proportion of the global burden of SBA. Thirty years after folic acid was shown to be effective in reducing SBA prevalence, only about one-quarter of such births are prevented globally through cereal grain fortification. To determine the association of folic acid-fortified iodized salt with serum folate concentrations among nonpregnant and nonlactating women of reproductive age. This nonrandomized controlled trial using a preintervention and postintervention design was conducted in 4 rural villages in Southern India from July 1 to November 30, 2022. All households in the villages agreed to participate in the study. Preintervention and postintervention serum folate levels were analyzed among study participants at baseline and after 4 months, respectively. Consumption of approximately 300 µg/d of folic acid using double fortified salt (folic acid plus iodine). Median serum folate concentrations were assessed at baseline and 4 months. Change in median serum folate levels between baseline and study end point as the primary outcome of the study. A total of 83 nonpregnant nonlactating women aged 20 to 44 years (mean [SD] age, 30.9 [5.1] years) were eligible for the study and provided serum samples for analysis at baseline and the end point of the intervention. The median serum folate concentration increased from 14.6 (IQR, 11.2-20.6) nmol/L at baseline to 54.4 (IQR, 43.5-54.4) nmol/L at end of study, a 3.7-fold increase from baseline to study end point. Two-tailed Wilcoxon signed rank test showed the median difference in preintervention and postintervention serum folate concentrations to be highly significant (P < .001). The participants found the salt acceptable in color and taste. Use of folic acid-fortified iodized salt was associated with increased serum folate concentrations in women of reproductive age. This novel evidence can inform public health policy to accelerate SBA prevention. ClinicalTrials.gov Identifier: NCT06174883.

The Global Diet Quality Score predicts diet quality of women of reproductive age in Addis Ababa, Ethiopia.

Improving diet quality is recognised as a double-duty action that can simultaneously address multiple forms of malnutrition. This study aimed to assess diet quality among non-pregnant non-lactating women of reproductive age (WRA) in Addis Ababa, Ethiopia. A 1-d quantitative 24 h recall was conducted among 653 non-pregnant/non-lactating women. Diet quality, assessed using the women dietary diversity score (WDDS), the Global Diet Quality Score (GDQS) and the Nova 4 classification reflecting consumption of ultra-processed foods (UPF), was compared. The proportion that meets the minimum dietary diversity for women (MDD-W) was estimated. The average MDD-W score was 2·6 (sd 0·9), with only 3 % of women meeting the MDD-W (≥ 5 food groups). Consumption of wholegrain and legumes was high, but UPF were also consumed by 9 % of the women. GDQS was positively associated with WDDS, age and skipping breakfast and was negatively associated with eating out of home and UPF consumption (P < 0·05). The multivariate regression model showed that GDQS (total) was not associated with wealth but was significantly associated with both UPF and WDDS (P < 0·001). Unlike UPF and WDDS alone, GDQS was able to predict both nutrient adequacy and unhealthy dietary practices. The diet quality of WRA in Addis Ababa is low in diversity, possibly exposing them to higher risk of nutrient inadequacy and non-communicable diseases as reflected by the low GDQS. Understanding what drives food and dietary choices in urban settings is urgently needed.

Behind the Scene of the Prevalence of Anaemia: An Extended Way of Reporting.

To develop the methods for an extended reporting of anaemia and to measure the status of the key contextual underlying factors of anaemia. Statistical appraisal of haemoglobin vs. key influencers of anaemia in Bangladesh--the intake of animal source food (ASF), concentration of iron in the drinking groundwater (GWI) and the prevalence of congenital haemoglobin disorder (CH) are conducted. The primary data of the National Micronutrient Survey 2011-12 and the British Geological Survey 2001 are analysed to assess the intake of ASF and the GWI concentration respectively. The prevalence of thalassaemia from a national survey is used to appraise the CH. ASF is evaluated relative to the 97.5th percentile intake and group-scores are assigned. Association of the GWI and haemoglobin is examined by the linear-fit and the mspline-fit and the group-scores are allocated. Group-score is allocated for prevalence of thalassaemia. Inflammation adjusted ferritin is considered to report haemoglobin. A nationwide survey in Bangladesh. Preschool children (PSC, 6-59 months), School Age Children (SAC, 6-14 years) and Non-pregnant Non-lactating Women (NPNLW, 15-49 years). The extended reporting to the prevalence of anaemia in Bangladeshi preschool children, school children and women are -- anaemia 33% [ASF: 2.08; GWI: 1.75; CH: 2], anaemia 19% [ASF: 1.98; GWI: 1.56; CH: 2], and anaemia 26% [ASF: 2.16; GWI: 1.58; CH: 2] respectively. The extended reporting of anaemia is a useful tool to understand the status of the key influencers of anaemia, to design the context-customised intervention and to monitor the intervention.

Prevalence of anemia and associated risk factors among the lactating and nonpregnant-nonlactating Tangkhul women.

Anemia is a major public health issue throughout the world. Nutritional deficiencies in terms of iron, B12 (cobalamin) and B9 (folate) are the main causes of anemia in the absence of genetic abnormalities and chronic diseases in many countries. Lactating mothers are susceptible to anemia because of maternal iron depletion during lactation as well as blood loss during childbirth. The present study examines the prevalence of anemia among the lactating (cases) and nonpregnant-nonlactating (control) married Tangkhul women of Ukhrul district. A community-based cross-sectional study was conducted among 400 individuals (lactating: 150; nonpregnant-nonlactating women: 250) from 11 villages of the Ukhrul district in Manipur. A pretested schedule, which included height, weight, and socio-demographic parameters were used. Body mass index = weight (in kg)/height (in metre2) was computed of each subject and categorized. Hemoglobin concentration was measured using Sahli's method. Statistical methods namely Chi-square (χ2) test and binary logistic regression were applied. The prevalence of anemia was higher in the lactating women (62.0%) than nonpregnant-nonlactating women (56.8%). Odds ratio (OR) of multivariate logistic regression analysis indicated that anemia was significantly associated in both cases and control with low literacy level (OR = 5.03 and 3.71), low income (OR = 2.51 and 3.56), cultivator (OR = 6.20 and 3.86), and multigravida >4 (OR = 5.25 and 2.67), respectively. Dietary practices play an important role in causing anemia. Low literacy level, low income, cultivator, and high gravidity were identified as the associated risk factors of anemia.

An alternative approach to adjust the iron status for inflammation in population: an exploratory study

Background: Iron deficiency (ID), one of the major micronutrient deficiencies globally, is challenging to measure. This is due to the dual character of ferritin which measures both the ID and concurrently affected by inflammation and infection. To address this, inflammation biomarkers—e.g., CRP (C-Reactive Protein) and AGP (Alpha-1- Acetylated Glycoprotein) are used through various standard methods to report inflammation-adjusted ID. However, there are problems with these methods and their underlying principles. An exploratory study was conducted to suggest an alternative way for inflammation adjustment with the focus on changing the inflammation-cut off point of the biomarker.&#x0D; Methods: Data of the Bangladesh National Micronutrient Survey 2011-12 were used in three population groups—preschool age children (6-59 month), school age children (6-14 years) and non-pregnant non-lactating women of reproductive age. Spearman Rank correlation was used between the iron status markers (ferritin, hemoglobin) vs. the inflammation biomarkers (CRP; AGP) at various cut-off levels of the inflammation markers, e.g., all-values, ≤ 5 mg/L, ≤1 mg/L, and ≤0.35 mg/L. ID was estimated over specified ranges of percentiles of the inflammation biomarker.&#x0D; Results: Spearman Rank correlation between CRP and ferritin showed statistically significant coefficients at various cut-offs of CRP, except at CRP≤1 mg/L in preschool children and at CRP≤0.35 mg/L in school age children. The decrease in ferritin concentration was 6.7%-11.1% across the studied populations between the inflammation-unadjusted concentration and at CRP≤1 mg/L. Generally, the prevalence of ID was higher at CRP≤1 mg/L than at CRP&gt; 1 mg/L. These findings suggested that a single inflammation biomarker, CRP with a cut-off of &gt;1 mg/L excluded the corresponding cases of inflammation-elevated ferritin, allowing for a simpler estimation of the inflammation-adjusted ID in this setting.&#x0D; Conclusion: Usage of CRP with the cut-off ≤1 mg/L is a useful, simplified and economic way to report the inflammation-adjusted ferritin-based ID in Bangladesh and similar settings with a modest infection burden. The method needs assessment in areas where the infection-burden is higher or in settings where malaria is endemic.

Performance of the Global Diet Quality Score with Nutrition and Health Outcomes in Mexico with 24-h Recall and FFQ Data

BackgroundThe Global Diet Quality Score (GDQS) is intended as a simple global diet quality metric feasible in low- and middle-income countries facing the double burden of malnutrition. ObjectiveThe aim of this study was to evaluate the performance of the GDQS with markers of nutrient adequacy and chronic disease in nonpregnant nonlactating (NPNL) Mexican women of reproductive age and to compare it with the Alternate Healthy Eating Index-2010 (AHEI-2010) and the Minimum Dietary Diversity for Women (MDD-W). MethodsWe included NPNL women aged 15 to 49 y from the Mexican National Health and Nutrition Surveys (2012 and 2016) with 24-h recall (n = 2542) or a FFQ (n = 4975) (separate samples). We evaluated the correlation of the GDQS with the energy-adjusted intake of several nutrients and evaluated its association with health parameters using covariate-adjusted linear regression models. ResultsThe GDQS was positively correlated with the intake of calcium, folate, iron, vitamin A, vitamin B-12, zinc, fiber, protein, and total fat (rho = 0.09 to 0.38, P < 0.05) and was inversely correlated with the intake of added sugar (rho = −0.37 and −0.38, P < 0.05) using both instruments, and with total fat, SFA, and MUFA only with 24-h recall data (rho = −0.06 to −0.16, P < 0.05). The GDQS was inversely associated with serum ferritin, BMI, waist circumference, and serum total and LDL cholesterol using FFQ data (P < 0.05), and was positively associated with serum folate using 24-h recall data (P < 0.05). Similar correlations and associations were observed with the MDD-W (only with micronutrients) and the AHEI-2010 (only with chronic disease-related nutrients and health markers). ConclusionsIn comparison to other diet metrics, the GDQS can capture both dimensions of nutrient adequacy and health markers related to the risk of chronic disease. The performance of the GDQS was satisfactory with either 24-h recall or FFQ.

Changes in the Global Diet Quality Score, Weight, and Waist Circumference in Mexican Women

BackgroundEvidence on concurrent changes in overall diet quality and weight and waist circumference in women of reproductive age from low- and middle-income countries is limited. ObjectiveWe examined the associations of changes in the Global Diet Quality Score (GDQS) and each GDQS food group with concurrent weight and waist circumference change in Mexican women. MethodsWe followed prospectively 8967 nonpregnant nonlactating women aged 25–49 y in the Mexican Teachers’ Cohort between 2006 and 2008. We assessed diet using an FFQ of the previous year and anthropometric measures were self-reported. Regression models were used to examine 2-y changes in the GDQS and each food group (servings/d) with weight and waist circumference changes within the same period, adjusting for demographic and lifestyle factors. ResultsCompared with those with little change in the GDQS (−2 to 2 points), women with the largest increase in the GDQS (>5 points) had less weight (β: −0.81 kg/2 y; 95% CI: −1.11, −0.51 kg/2 y) and waist circumference gain (β: −1.05 cm/2 y; 95% CI: −1.62, −0.48 cm/2 y); likewise, women with the largest decrease in the GDQS (<−5 points) had more weight (β: 0.36 kg/2 y; 95% CI: 0.06, 0.66 kg/2 y) and waist circumference gain (β: 0.71 cm/2 y; 95% CI: 0.09, 1.32 cm/2 y). Increased intake of dark green leafy vegetables, cruciferous vegetables, deep orange vegetables, citrus fruits, and fish and shellfish was associated with less weight gain. In addition, deep orange vegetables, low fat and high fat dairy, whole grains, and fish were associated with less waist circumference gain within the 2-y period. ConclusionsImprovements in diet quality over a 2-y period reflected by an increase in the GDQS and changes in consumption of specific components of the GDQS were associated with less weight and waist circumference gain in Mexican women.

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.

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.

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.

A Novel Food-Based Diet Quality Score Is Associated with Nutrient Adequacy and Reduced Anemia Among Rural Adults in Ten African Countries

Abstract Objectives We aimed to develop and evaluate an easily-tabulated metric that is sensitive to diet quality in diverse settings. In this analysis, we examined associations between a novel food-based metric – the Global Diet Quality Score (GDQS) - and diet quality using data from rural Africa. Methods The GDQS gives points for higher intake of 16 healthy food groups and lower intake of 9 unhealthy groups, based on 3 intake ranges for each group. We scored the GDQS using food frequency questionnaire (FFQ) data from 1613 men and 1710 nonpregnant nonlactating women ages 15–49 (median: 30) in 12 rural African villages participating in the Millennium Villages Project in 2006 to 2009. We evaluated associations between the GDQS and nutrient intakes calculated from the same FFQ, body mass index (BMI), mid-upper arm circumference (MUAC), hemoglobin, and an overall nutrient adequacy score ranging from 0 to 7 (1 point given for each of 7 nutrients meeting average requirements). Associations were also derived for GDQS submetrics (GDQS+ and GDQS−) computed using only healthy or unhealthy food groups, respectively, and simplified versions of the GDQS and submetrics (scored using 2 intake ranges for each food group). Results Moderate rank correlations were observed between the GDQS+ and energy-adjusted intakes of fiber (women: 0.43, men: 0.33), folate (0.40, 0.30), vitamin A (0.40, 0.34), and zinc (0.38, 0.30), exceeding correlations with the Minimum Dietary Diversity Score for Women (p for difference between metrics &amp;lt;0.05 for fiber and folate in both sexes). The simplified GDQS- correlated moderately with energy-adjusted saturated fat intake (women: 0.35, men: 0.29). Rank correlations between the GDQS+ and overall nutrient adequacy score differed notably by country (range: 0.34–0.75), but not by age or season. Adjusting for age, interview month, and household size, the GDQS and GDQS+ were associated with hemoglobin and anemia (p for difference between metrics &amp;gt;0.05): women and men in the highest GDQS+ quintile had an OR of anemia of 0.25 (95% CI 0.09, 0.68) and 0.16 (95% CI 0.04, 0.46), respectively, relative to those in the lowest. Metrics were not associated with BMI or MUAC in adjusted analyses. Conclusions The GDQS and submetrics were associated with nutrient intakes, hemoglobin, and reduced anemia in rural African adults. Funding Sources Intake - Center for Dietary Assessment at FHI Solutions.

Pregnancy-Related Bone Mineral and Microarchitecture Changes in Women Aged 30 to 45 Years.

ABSTRACTAt birth, the neonatal skeleton contains 20 to 30 g calcium (Ca). It is hypothesized maternal bone mineral may be mobilized to support fetal skeletal development, although evidence of pregnancy‐induced mineral mobilization is limited. We recruited healthy pregnant (n = 53) and non‐pregnant non‐lactating (NPNL; n = 37) women aged 30 to 45 years (mean age 35.4 ± 3.8 years) and obtained peripheral quantitative computed tomography (pQCT) and high‐resolution pQCT (HR‐pQCT) scans from the tibia and radius at 14 to 16 and 34 to 36 weeks of pregnancy, with a similar scan interval for NPNL. Multiple linear regression models were used to assess group differences in change between baseline and follow‐up; differences are expressed as standard deviation scores (SDS) ± SEM. Decreases in volumetric bone mineral density (vBMD) outcomes were found in both groups; however, pregnancy‐related decreases for pQCT total and trabecular vBMD were −0.65 ± 0.22 SDS and −0.50 ± 0.23 SDS greater (p < .05). HR‐pQCT total and cortical vBMD decreased compared with NPNL by −0.49 ± 0.24 SDS and −0.67 ± 0.23 SDS, respectively; trabecular vBMD decreased in both groups to a similar magnitude. Pregnancy‐related changes in bone microarchitecture significantly exceeded NPNL change for trabecular number (0.47 ± 0.23 SDS), trabecular separation (−0.54 ± 0.24 SDS), cortical thickness (−1.01 ± 0.21 SDS), and cortical perimeter (0.78 ± 0.23 SDS). At the proximal radius, cortical vBMD and endosteal circumference increased by 0.50 ± 0.23 SDS and 0.46 ± 0.23 SDS, respectively, compared with NPNL, whereas cortical thickness decreased −0.50 ± 0.22 SDS. Pregnancy‐related decreases in total and compartment‐specific vBMD exceed age‐related change at the distal tibia. Changes at the radius were only evident with pQCT at the cortical‐rich proximal site and suggest endosteal resorption. Although the magnitude of these pregnancy‐related changes in the appendicular skeleton are small, if they reflect global changes across the skeleton at large, they may contribute substantially to the Ca requirements of the fetus. © 2020 Crown copyright. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). This article is published with the permission of the Controller of HMSO and the Queen's Printer for Scotland.

Dual Nutrition Burden in Urban Women from Low Middle Income Families

&lt;p&gt; Currently India is experiencing dual nutrition burden. Prevalence of both under and over nutrition is reported to be higher in women as compared to men. Over nutrition rates in Delhi are among the highest in India. A mixed longitudinal study was undertaken to assess nutritional status of urban women from low middle income families. Between January 2015 and December 2017, 4155 non-pregnant non-lactating women were enrolled for this observational study. These women belonged to food secure low middle income families. They were living in highly congested urban localities in one or two room tenements and had no access to public spaces where they could go for walk or discretionary physical activities. In all women, height was measured at enrolment. Efforts were made to measure weight, mid upper arm, waist and hip circumferences once in three months. Prevalence of under nutrition (BMI &amp;lt; 18.5) in the 18-29 years age group was 12.1%, but 33.9% had BMI of ≥25. There was a progressive increase in over-nutrition, high waist and hip circumferences with increasing age; 68.4% of women aged 50 years and above were over-nourished. None of the undernourished women had waist circumference ≥ 80 cm; among the normally nourished 8.5% and in the over-nourished women 3/4th had waist circumference above 80cm. Hip circumference showed a similar trend but prevalence of ≥ 102 cm was lower. Prevalence of over nutrition, truncal and abdominal adiposity was high in women from Delhi low middle income families.&lt;/p&gt;

Subclinical Vitamin A Deficiency and Anemia among Women and Preschool Children from Northeast India.

Background:Micronutrient deficiencies such as iron, Vitamin A, and iodine are important public health problems in India.Objective:The objective of the study was to assess subclinical Vitamin A deficiency (VAD) and anemia among women and preschool children from Northeast India. Methodology: A community-based cross-sectional study was carried out by adopting systematic sampling in Phek district of Nagaland. Data were collected from women on sociodemographic particulars, and finger prick blood was collected for hemoglobin and free-flowing drop for Vitamin A estimation on Whatman no. 1 filter paper.Results:The overall prevalence of anemia was 27%, 40%, 44%, and 52% among preschool children, nonpregnant nonlactating women, lactating mothers, and pregnant women, respectively, whereas VAD was 37% among preschool children and 24%–32% among adult women. The prevalence of VAD was observed high among those living in kutcha house, illiteracy of head of households, big family size, and low per capita income.Conclusions:Anemia and VAD are important public health problems among tribal population in spite of the rich biodiversity.

DIETARY DIVERSITY AMONG WOMEN IN THE REPRODUCTIVE AGE GROUP IN URBAN FIELD PRACTICE AREA, VIMSAR, BURLA

One of the problems among Women of Reproductive Age (WRA) group has been lack of effective programs whose benefits are not reaching WRA group. Another problem is the prevalence of monotonous diet based on starchy staple food, which lacks essential micronutrients and contribute to the burden of malnutrition and micronutrient deficiency. The objectives of the study was to assess household dietary diversity and nutritional status of non-pregnant non-lactating women of reproductive age in urban field practice area in Burla as a way of comparing food security situation. It was a cross sectional study. Data were collected from urban field practice area in Burla and were analysed to assess the dietary diversity among “women of reproductive age (WRA)” group. One third (about 29%) of them was malnourished. On application of logistic regression, those aged ≥25years had better odds of having Minimum Dietary Diversity (MDD) score of 5 and above (OR=1.777). Subjects with BMI range ≥21.5 Kg/mt2 also had better odds of having MDD score of 5 and above (OR=3.371). Women of reproductive age are nutritionally more vulnerable because of pregnancy, lactation and menstruation requiring nutrient dense quality food. Monotonous diet based on starchy staple lacks essential micronutrients and contribute to the burden of malnutrition and micronutrient deficiency. Intake of diverse diet is a cost effective strategy to overcome this problem. From our survey we conclude that more than half of WRA failed to achieve MDD. Based on findings, Information Education and Communication (IEC) activities are recommended with an emphasis on locally available, low-cost nutrition diet.&#x0D; Keywords: Minimum Dietary Diversity, Women of Reproductive Age, Micronutrients

Assessing Statistical Similarity and Differences in Dietary Intakes of Women of Reproductive Age in Bangladesh (P10-058-19)

ObjectivesIn low-income countries, where maternal undernutrition is endemic, data on women’s dietary intake is lacking. Thus, the hypothesis that intakes of pregnant or lactating women is similar to that of non-pregnant, non-lactating women remains untested. We use novel quantitative approaches to evaluate whether the hypothesized similarity is statistically significant at a population level. Our study aimed to 1) compare nutrient intakes of non-pregnant, non-lactating (NPNL) women, pregnant women (PW), and lactating women (LW) to reproductive stage- specific recommendations, 2) assess whether exposure to pregnancy and lactation alters dietary intake compared to NPNL group, 3) Test whether nutrient intakes of PW and LW are statistically similar to those of NPNL women MethodsWe used 24-hour recall data from the 2011–12 Bangladesh Integrated Household survey (n = 4044) to quantify dietary intake of energy, proteins, calcium, iron, vitamin A, and women’s dietary diversity score (WDDS) for NPNL women, PW and LW. Multivariable regression models assessed the association between reproductive status and nutrient intakes. Equivalence test, that looks for proof of similarity, rather than proof of difference, assessed statistically significant similarity in nutrient intakes of PW vs. NPNL women, and LW vs. NPNL women at alpha equals 0.05 and a pre-specified equivalence margin or ‘delta’, defined as ± 60% of the additional nutrient intakes recommended for PW and LW. If the 95% CI of the difference between means lied completely within ± delta, then the null hypothesis of ‘no equivalence’ was rejected, and similarity between the two groups claimed. ResultsPW and LW had suboptimal intakes for all nutrients. Compared to NPNL group, mean energy intakes of PW and LW were greater by 100 Kcal/d and 80 Kcal/d, respectively. Mean WDDS was 3.7 ± 1 across all three groups. Significant and positive relationship was found only for lactation status and energy intake. In both group comparisons, the null of ‘no equivalence’ was rejected at alpha equals 0.05 for all nutrients. ConclusionsDietary intakes of PW and LW are similar to NPNL women in rural Bangladesh. There is a need to enhance women’s diets, especially during pregnancy and lactation when demand for macronutrients and micronutrients is elevated. Funding SourcesNone.

Assessing the Efficacy of Bovine Lactoferrin to Correct Iron Deficiency Anemia in Non-pregnant Non-lactating Women: A Randomized Controlled Trial (FS08-02-19)

Objectives1. To determine if bovine lactoferrin (bLf) is at least as effective as oral ferrous sulfate in iron deficiency anemia in non-pregnant women of reproductive age (WRA)2. To determine the optimal dose of oral bLf3. To compare the side-effects of the treatments MethodsDesign: Non-inferiority, double-blind, individually RCT in non-pregnant WRA with iron deficiency anemia (Hb <12 g/dl & serum ferritin <30 μg/L) SettingMirpur, Dhaka, Bangladesh Participants555 non-pregnant, non-lactating women of 15–49 years. InterventionsWomen were allocated individually (1:1:1) in three arms. Arm A, B and C received daily oral 200 mg bLf, 400 mg bLf and 60 mg ferrous sulfate. All received 400 μg of folic acid daily. Treatment was for 12 weeks. OutcomesSerum Hb and serum ferritin at baseline and every 30 days for 3 months. Inflammatory markers: C-reactive protein (CRP); alpha(1)-Acid glycoprotein (AGP); hepcidin, at baseline and end line. Possible adverse effects were assessed. ResultsWomen on 200 mg bLf had a decrease in Hb of 0.3 g/dl (95% CI, −0.60 to 0.00 g/dl, P = 0.05), women on 400 mg bLf arm had no change in Hb: 0.0 g/dl (95% CI, −0.32 to 0.32 g/dl, P = 1.00), and women on ferrous sulfate arm had an increase in Hb: 1.1 g/dl (95% CI, 0.83 to 1.37 g/dl, P < 0.0001).Women on 200 mg bLf had an increase in ferritin: 2.8 μg/l (95% CI, 0.38 to 5.22 μg/l, P = 0.02), women on 400 mg bLf had an increase in ferritin: 3.5 μg/l (95% CI, 0.64 to 6.36 μg/l, P = 0.02) and women on ferrous sulfate arm had an increase in ferritin: 41.1 μg/l (95% CI, 35.74 to 46.47 μg/l, P < 0.0001).There were no significant differences in AGP and CRP between arms at the base line (P = 0.38 and 0.95) and end line (P = 0.87 and 0.14). Those on ferrous sulfate had a significant increase in hepcidin concentration after 90 days (P = .000).Abdominal pain, indigestion, diarrhea and black stool were significantly higher on ferrous sulfate group. There were no differences for other side-effects across treatment arms ConclusionsFerrous sulfate has better efficacy than bLf for iron deficiency anemia in non-pregnant non-lactating women of reproductive age in urban Bangladesh. This lactoferrin product may be inactive, or there may have been inadequate dietary iron for bLF to promote its absorption. Funding SourcesSaving Lives at Birth and Medical Research Council, UK.

Coverage of and compliance to iron supplementation under the National Iron Plus Initiative among reproductive age-group women in urban Puducherry - a cross-sectional study.

Anaemia is a global health problem and an important cause of morbidity in all age groups, especially among women and children. Various programmes have been implemented to combat anaemia in India and National Iron Plus Initiative (NIPI) is the latest programme to be implemented. To ascertain the proportion of reproductive age women receiving iron supplementation under the NIPI and assess the compliance and factors hindering the implementation and compliance of the programme. A cross-sectional study was conducted among women of reproductive age (15-49 years) during November 2017. The participants were interviewed at their household using a pre-tested semi-structured questionnaire to obtain information on socio-demographic details, whether they were receiving iron supplements and compliance to the programme. Out of 302 study participants, only 138 (45.7%) were found to be receiving the supplements under the NIPI. The major source of iron supplementation was various health facilities (69.4%). Of those not receiving the tablets, 96.3% were non-pregnant non-lactating women. The proportion of study participants receiving iron supplementation through house visits by auxiliary nurse mid-wives (ANMs) was only 1.45%. Of the 138 women receiving supplementation, 85 (61%) were compliant with their medication. Compliance also tended to be higher among pregnant and lactating women. The most important reasons for non-compliance were adverse effects and forgetfulness. The presence of regular house visits by ANMs had a significant association with reception of tablets [prevalence ratio (PR)-1.43]. Pregnant women had a significant association with both reception (PR-2.19) and compliance (PR-1.8) with iron supplementation. The current NIPI programme needs to be regularly evaluated to ensure its effective implementation. Importance should be given to non-pregnant non-lactating women to increase coverage among them.

Efficacy of Dietary Supplementation in the Form of Multigrain Panjiri in Managing Anaemia among Ethnic Tribal Women of Chhattisgarh

As per the Government of India 2013 database, anaemia in India is a serious public health issue with a high prevalence of about 74 percent with haemoglobin&lt; 11gm/dl. It’s prevalent in all age groups, nearly 58 percent in pregnant women, 50 percent among non-pregnant non-lactating women, 56 percent among adolescent girls. The situation is no different in Chhattisgarh. With a tag of tribal dominated state situation needs to be addressed carefully because of socio-economic status of tribal women is comparatively low. The present study assessed the efficacy of dietary supplementation in the form of multigrain panjiri in management of anaemia among ethnic tribal anaemic women of Chhattisgarh. In the study, 100 tribal women from tribal dominated region of Chhattisgarh were selected as sample. The age range of selected subjects was 19 to 25 years. The inclusion criteria for selection of subjects was WHO classification for anaemia. Cyanmet haemoglobin method was used for estimation of haemoglobin. Two groups were created with equal number of subjects in both the groups. The experimental group received dietary supplementation in the form of multigrain panjiri for three months while subjects belonging to control group were not supplemented the additional soya multigrain panjiri. Results reveal that after the study period, more percentage of selected tribal women from experimental group had normal haemoglobin levels as compared to their counterpart i.e. tribal women belonging to control group. It was concluded that soya multigrain panjiri when used as dietary supplement, is beneficial in increasing the haemoglobin levels and thereby useful in management of anaemia in tribal women.

Zinc Deficiency among Lactating Mothers from a Peri-Urban Community of the Ecuadorian Andean Region: An Initial Approach to the Need of Zinc Supplementation.

Zinc is an important mineral for biological and physiological processes. Zinc deficiency (ZD) is one of the most common micronutrient deficiencies worldwide and a crucial determinant of pregnancy outcomes and childhood development. Zinc levels and the zinc supplementation rate among lactating women have not been assessed neither in Ecuador nor in the Andean region. We conducted a pilot study including 64 mothers of infants between eight days to seven months old from a primary care center located in Conocoto, a peri-urban community of Quito, Ecuador. The mothers were interviewed and a fasting blood sample was taken to determine plasma zinc levels. The prevalence of ZD was calculated and compared with the prevalence of ZD among Ecuadorian non-pregnant non-lactating women, and the sample was analysed considering zinc supplementation during pregnancy. The prevalence of ZD among the participants was 81.3% (95% CI: 71.7–90.9), higher than the reported among non-pregnant non-lactating women (G2 = 18.2; p < 0.05). Zinc supplementation rate was 31.2%. No significant differences were found comparing the groups considering zinc supplementation. The insights obtained from this study encourage extending studies to document zinc levels and its interactions among breastfeeding women in areas with a high prevalence of ZD in order to determine the need of zinc supplementation.