Study on Nutritional Status and Food Pattern of Pre-Pregnant, Pregnant and Lactating Mothers in Bogor, West Java

Transcription

1 Study on Nutritional Status and Food Pattern of Pre-Pregnant, Pregnant and Lactating Mothers in Bogor, West Java Siti Madanijah, Dodik Briawan, Rimbawan, Zulaikhah, Nuri Andarwulan, Lilis Nuraida & Jacques Bindels Southeast Asian Food & Agricultural Science & Technology (SEAFAST) Center, Bogor Agricultural University PB) OUTLINE Background Objectives Output Methods Results Conclusion 1

2 BACKGROUND The malnutrition problems in Indonesia occur at the every stage of the life cycle DOUBLE BURDEN NUTRITION PROBLEMS Source : Harian Kompas,

3 BACKGROUND BACKGROUND 3

4 OBJECTIVES To obtain data on nutritional status in the pre-pregnant (at child-bearing age), pregnant and lactating mothers; To obtain data on food pattern in the pre-pregnant (at child-bearing age), pregnant and lactating mothers To define recommendation of additional nutrients required by pre-pregnant (at child-bearing age), pregnant and lactating mothers OUTPUTS Information on the prevalence and the severity of nutritional status in pre-pregnant (at child-bearing age), pregnant and lactating mothers Information on food preferences and food pattern including snack foods in pre-pregnant (at child-bearing age), pregnant and lactating mothers Recommendations of additional nutrients required by pre-pregnant (at child-bearing age), pregnant and lactating mothers 4

5 Location : Bogor area 3 groups: - pre pregnant (at childbearing age) women - pregnant women - lactating mother Number of respondent : 200/group; total 600 Criteria of subject: - at quintile 2, 3 and 4 based on HH expenditure; METHODS Methods of data collection SURVEY 2x24 hours Food Recall FFQ BLOOD ANALYSIS Design for Selection of respondents Population 1 st screening : meet the inclusion criteria for each group Interview using screening form Yes Respondent candidate (1) No Stop Respondent candidate (2) Interview using Questionnaire 2 nd screening : meet 2 nd, 3 rd and 4 th Quintile Yes No STOP Blood Analysis BOGOR CITY **) (Rp/cap/month) Q Range Mean Q 5 622,421-6,676,869 1,158,923 Q 4 432, , ,468 Q 3 332, , ,730 Q 2 253, , ,701 Q 1 127, , ,570 ** SUSENAS

6 Inclusion Criteria for each group Inclusion criteria for pre-pregnant women (child-bearing age) : - healthy - married (age years) - preparing for pregnancy Inclusion criteria for pregnant women: - healthy - age : years - at second trimester of pregnancy (>3-6 mo) Inclusion criteria for lactating mother: - healthy - age : years - breastfeeding (age of their babies days) Respondent of the study Quintile Pre-pregnant women Group Pregnant women Lactating mothers Total Q Q Q Total

7 Sub samples for Blood Analysis Group/ Quintile Prepregnant Pregnant Lactating Total Q Q Q Total Data Analysis Food Consumption The Indonesian Food Composition Table (2007 and 2008), ASEAN Food Composition Table (2000), Nutrisurvey, The Composition of Foods, Wfood Composition (FAO) were used to calculate the nutrients intake. The nutrients adequacy was assessed by comparing the actual nutrients intake with the Indonesian RDA s (ID-RDA) / Angka Kecukupan Gizi (WKNPG, 2004) Nutrients CBA (=PP) Pregnant Lactating Energy (kcal/day) Protein (g/day) Iron (mg/day) Calcium (mg/day) Vitamin A (RE/day) Vitamin C (mg/day) Folate (µg/day) Zinc (mg/day)

8 Data Analysis for Food Consumption Cut-off point for nutrients intake Nutrients Category and cut off Source Energy and protein intake Vitamin and mineral intake (Fe, Ca, Vitamin A, Vitamin C, Folate, Zinc) Clear deficit (<70% RDA) Moderate-mild deficit (70-90% RDA Sufficient (>90% RDA) Estimated Average Requirement: 77% RDA Deficient (< 77% RDA) Sufficient ( 77% RDA) Ministry of Health, RI (1996) Gibson (2005) Types of Blood Sample Analysis Blood samples : +15 ml/respondent (135 respondent, 45 respondent/group) No Analysis Prepregnant Pregnant Lactating Method 1. Hb v v v Peroxidation/Colorimetry 2. Ferritin serum v v v 3. Zn v v v AAS 4. Se v v v AAS 5 Vitamin A v v v HPLC 6 Folic acid v - - Chemiluminescent Immunoassay (CMIA) Chemiluminescent Immunoassay (CMIA) 8

9 Data Analysis for Blood Biomarker Cut-off point for blood biomarker Blood biomarker Hemoglobin Pre-pregnant women and lactating mothers Pregnant women Ferritin Pre-pregnant women and lactating mothers Pregnant women Folate (pre-pregnant women) Selenium Zinc Vitamin A (All group) Category and cut-off Deficiency (< 12 g/dl) Deficiency (< 11 g/dl) Deficiency (<15 µg/l) Deficiency (<12 µg/l) Deficiency (<6.7 ng/ml) Deficiency (< 0.75 µmol/l) Deficiency (<65 µmol/l) Deficiency (<20 µg/dl) RESULTS 9

10 Nutritional Status A. BMI based Nutrition status CBA / PP (n=200) Lactating (n=220) Underweight (< 18.5) 28 (14%) 20 (9.1%) Normal ( ) 110 (55%) 113 (51.4%) Overweight ( ) 45 (22.5%) 69 (31.4%) Obese ( 30.0) 17 (8.5%) 16 (8.2%) Mean ± SD 23.2 ± ± 3.2 B. MUAC based Nutrition status CBA /PP (n=200) Pregnant (n=203) Lactating (n=220) CEM (< 23.5 cm) 25 (12.5%) 38 (18.7%) 32 (14.5%) Normal ( 23.5 cm) 175 (87.5) 165 (81.3%) 188 (85.5%) Mean ± SD 27.4 ± ± ± 3.3 Food Consumption (g/cap/day) No Food Category CBA / PP Pregnant Lactating 1 Cereals and cereal products Meat and meat products Poultry and poultry products Fish and fish products Egg and egg products Milk and dairy products Legume and legume products Vegetables and veg. products Fruit and fruit products Beverages Snack foods TOTAL

11 Energy and protein intake during pre-pregnancy pregnancy and lactation Energy intake (kcal/day) Protein intake (g/day) 70 (ID-RDA: 50, 67, 67 g/d) Protein pre pregn pregnancy lactation Energy intake was below Indonesia RDA s (77.6 %, 76.2% and 73.9%, respectively) Protein intake was below Indonesia RDA (93.2%, 72.1% and 86%, respectively) Energy and protein intake during pregnancy according to SEL Energy intake (kcal/day) (ID-RDA (AKG): kcal/d) Protein intake (g/day) 70 (ID-RDA (AKG): 67 g/d) Protein wealth quintiles 0 Q2 Q3 Q4 wealth quintiles Energy and protein intake of total group were below Indonesia RDA s (75.7% and 72.1%, respectively) 11

12 Protein Quality Intake of animal protein sources and vegetable protein Protein intake (g/day) milk+dairy egg fish meat+poultry vegetable 0 quintile 2 quintile 3 quintile 4 Next to the low absolute protein intake in Q2, the poor protein quality (only 31.3% animal protein) increases the level of concern! Average %ID-RDA and percentage of nutrient deficiencies Nutrients CBA / PP Pregnant Lactating %ID-RDA % def %ID-RDA % def %ID-RDA % def Energy Protein Iron Calcium Vitamin A Vitamin C Folate Zinc

13 Percentage of macronutrient deficiencies (cut off: 70% of ID-RDA, 2004) , ,0 39,7 45,9 27,0 34,1 CBA Pregnant Lactating Energy Protein Percentage of individual vitamin and mineral deficiencies (cut off: 77% of ID-RDA, 2004 (~EAR) ,7 88,0 76,8 84,7 90,0 98,0 90, ,0 68,2 68,0 55,7 60,5 62,5 66,5 65, , , Iron Calcium Vit amin A Vitamin C Folate Zinc CBA Pregnant Lactating 13

14 Percentage of multiple micronutrient deficiencies CBA / PP (n=200) Pregnant (n=203) Lactating (n=220) Deficiency n (%) n (%) n (%) 5 micronutrients 34 (17) 62 (30.5) 50 (22.7) 4 micronutrients 66 (33) 77 (37.9) 72 (32.7) 3 micronutrients 64 (32) 46 (22.6) 58 (26.4) 2 micronutrients 30 (15) 13 (6.4) 25 (11.4) 1 micronutrient 5 (2.5) 5 (2.5) 12 (5.5) TOTAL 199 (99.5) 203 (100) 217 (98.6) Micronutrients include Iron, Vitamin A, Vitamin C, Folate, Zinc Deficiencies can be derived from any combinations of those five micronutrients None of pregnant women has sufficient intake of micronutrients Percentage of multiple micronutrient deficiency in combination with protein deficiency Deficiency CBA / PP (n=200) Pregnant (n=203) Lactating (n=220) n (%) n (%) n (%) 5 micronutrients 19 (9.5) 48 (23.7) 30 (13.6) 4 micronutrients 24 (12) 50 (24.6) 33 (15) 3 micronutrients 9 (4.5) 17 (8.4) 10 (4.6) 2 micronutrients 2 (1) 1 (0.5) 2 (0.9) 1 micronutrient - 1 (0.5) - TOTAL 54 (27) 117 (57.6) 75 (34.1) 57.6% of pregnant women who are deficient in protein also deficient in at least one micronutrient 14

15 Food taboos (prohibition against consuming certain foods ) in pre-pregnant, pregnant, and lactating mothers CBA / PP No Type of food % 1 Sour food Spicy food Shrimp Instant noodle Salted fish Pineapple Tuna fish Water spinach Offal Cucumber 2.0 Reason Scare of suffering from: 1. Allergy (8%) 2. Gastritis (7.5%) 3. Hypertension (4.5%) 4. Womb s health (3%) 5. Leucorrhea (1.5%) Pregnant No Type of food % 1 Pineapple Tape (fermented cassava) Durian Salak Spicy food Softdrink Sticky rice Jengkol/petai Sour food Shrimp 2.5 Reason: Scare of suffering from 1. Abortion (8.4%) 2. Heartburn sensation (3.4%) 3. Gastritis (1.5%) 4. Hypertension (1.0%) Lactating No Type of food % 1 Taro Spicy food Banana Sour food Shrimp Salted fish Fish Offal Pumpkin, squash Kangkong leaves 3.6 Reason: Scare of suffering from 1. Baby s health (9.5%) 2. Allergy (7.7%) 3. Parental believe (6.4%) 4. Disease (5.0%) 5. Fishy odor breast milk (4.5%) Micronutrients status determined by blood analysis in a sub-sample (n= 3 x 45) of the population Biomarker CBA / PP Pregnant Lactating Mean±SD % def Mean±SD % def Mean±SD % def Haemoglobin (g/dl) 13.2± ± ± Ferritin (µg/l) 65.2± ± ± Vitamin A (µg/dl) 49.8± ± ± Selenium (µmol/l) 1.5± ± ± Zinc (µmol/l) 74.2± ± ± Folate (ng/ml) 17.6 ±5.2 0 ND - ND - Folate Intake (PP) % RDA :

16 Percentage of respondents who are deficient in blood biomarker 60 55, ,2 42, ,1 22,2 17,8 23,08 27,9 13,3 11,1 6,7 8,9 4,4 28,9 24,4 0 Haemoglobin Ferritin Vitamin A Selenium Zinc CBA Pregnant Lactating Prevalence of pregnant mother is the highest among other groups in anemia, ferritin deficiency, VAD, and zinc deficiency Criteria of Deficiency Group % Deficient Source of Infornmation Anemia Pregnant women (Hb) 41.2 (Ferritin) CED CBA women (Hb) 23.8 (Ferritin) Pregnant women National West Java West Java MOH, 2008 Madanijah et. al, 2011 Madanijah et. al, 2011 MOH,2005 MOH, 2008 (15-45yrs) Madanijah et. al, 2011 Madanijah et. al, 2011 Sanjaya, 2009 Sanjaya, 2009 Madanijah et. al, 2011 Vitamin A Pregnant women Suharno, 1992 Madanijah et. al,

17 CONCLUSIONS 17