Maternal and child nutrition in rural Bangladesh: special reference to the effect of dietary fat supplementation on vitamin A status

D.S. Alam

Research output: Thesisinternal PhD, WU

Abstract

The prevalence of maternal and child malnutrition in Bangladesh is one of the highest in the world. It is estimated that 50% of women of childbearing age suffer chronic energy deficiency (BMI<18.5), nearly half of infants are born with a low birth weight (<2.5 kg), and about 60% of preschool children are stunted. Protein energy malnutrition and deficiencies of micronutrient often coexist in pregnant and lactating women, in breastfed infants and in young children.

This thesis reports the effect of daily supplementation with 18 g dietary fat from mid/late pregnancy until six months postpartum on the vitamin A status of mothers and their infants. The validity of a specific dietary assessment method to identify pregnant and lactating women at risk of vitamin A deficiency also has been examined and maternal energy intake during pregnancy and lactation was studied. Growth of infants in relation to breastfeeding practices, exclusive or non-exclusive, was assessed. Finally, the effect of diarrhoeal morbidity on growth of young children was examined. All studies were performed in rural Bangladesh.

Results show that daily supplementation with 18 g of dietary fat has a beneficial effect on maternal vitamin A status during early lactation. Those supplemented with fat had relatively higher serumβ-carotene and lutein concentrations than those not supplemented. Measurement of vitamin A intake by the 24-hour vitamin A-focused recall was shown to be more reliable than the measurement by a food frequency questionnaire in identifying groups, groups not individual pregnant and lactating women at risk of vitamin A deficiency. Maternal energy intake during pregnancy and lactation was found to be low. The women gained insufficient weight during pregnancy and 48% delivered low birth weight infants. Women also lost 1 kg of body weight during the first six months of lactation. All infants were still breastfed at 6 mo, 70% and 37% were exclusively breastfed at 3 and 6 mo, respectively. There were no differences in morbidity and growth between the exclusive and non-exclusively breastfed infants however the growth of the exclusively breastfed infants more closely resembled that of WHO breastfed reference infants. In young children, dysentery (bloody diarrhoea) showed a significant negative association with ponderal and linear growth both in the 3 mo and 1 yr growth periods.

From these findings it can be concluded that dietary fat supplementation may have a significant role in improving the vitamin A status of populations with a low fat intake and who derive their vitamin A mainly from provitamin A carotenoids. Poor maternal energy balance in otherwise poorly nourished women during pregnancy probably contributed to the extremely high prevalence of low birth weight in the community studied. What is lacking, however, is data on energy expenditure and that is required to precisely define the level of energy inadequacy. The similarity in growth pattern between our infants and that of WHO breastfed reference infants suggests that this growth pattern (i.e. the growth rate) might be physiologically optimal in this population, except that they start at a lower level due to low birth weight. This difference in growth, i.e. poorer weight, therefore is mainly attributable to the intrauterine rather than postnatal factors. It is also concluded that Infant and child nutrition can be substantially improved by preventing dysentery in this community.

Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • Wageningen University
Supervisors/Advisors
  • Hautvast, J.G.A.J., Promotor
  • Fuchs, G.J., Promotor, External person
  • van Raaij, J.M.A., Promotor
Award date19 Jun 2001
Place of PublicationS.l.
Print ISBNs9789058084231
Publication statusPublished - 2001

Keywords

  • maternal nutrition
  • child nutrition
  • dietary fat
  • vitamin a deficiency
  • pregnancy
  • women
  • lactating women
  • rural population
  • bangladesh

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