Micronutrient intake and the probability of nutrient adequacy among children 9-24 months of age: results from the MAL-ED birth cohort study.

OBJECTIVE: To estimate the total energy and micronutrient intakes of children 9-24 months of age and evaluate the probability of adequacy (PA) of the diet in seven MAL-ED sites. DESIGN: Cohort study. Food intake was registered monthly using 24-h recalls beginning at 9 months. We estimated PA for thirteen nutrients and overall mean PA (MPA) by site and 3-month periods considering estimated breast milk intake. SETTING: Seven sites in Asia, Africa and Latin America. PARTICIPANTS: 1669 children followed from birth to 24 months of age. RESULTS: Median estimated %energy from breast milk ranged from 4 to 70 % at 9-12 months, and declined to 0-39 % at 21-24 months. Iron bioavailability was low for all sites, but many diets were of moderate bioavailability for zinc. PA was optimal for most nutrients in Brazil and South Africa, except for iron and vitamin E (both), calcium and zinc (South Africa). PA for zinc increased only for children consuming a diet with moderate bioavailability. MPA increased 12-24 months as the quantity of complementary foods increased; however, PA for vitamin A remained low in Bangladesh and Tanzania. PA for vitamins D and E and iron was low for most sites and age groups. CONCLUSIONS: MPA increased from 12 to 24 months as children consumed higher quantities of food, while nutrient density remained constant for most nutrients. Ways to increase the consumption of foods containing vitamins D, E and A, and calcium are needed, as are ways to increase the bioavailability of iron and zinc.

Dietary intake from complementary feeding is associated with intestinal barrier function and environmental enteropathy in Brazilian children from the MAL-ED cohort study.

A child's diet contains nutrients and other substances that influence intestinal health. The present study aimed to evaluate the relations between complementary feeding, intestinal barrier function and environmental enteropathy (EE) in infants. Data from 233 children were obtained from the Brazilian site of the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project cohort study. Habitual dietary intake from complementary feeding was estimated using seven 24-h dietary recalls, from 9 to 15 months of age. Intestinal barrier function was assessed using the lactulose-mannitol test (L-M), and EE was determined as a composite measure using faecal biomarkers concentrations - α-1-antitrypsin, myeloperoxidase (MPO) and neopterin (NEO) at 15 months of age. The nutrient adequacies explored the associations between dietary intake and the intestinal biomarkers. Children showed adequate nutrient intakes (with the exception of fibre), impaired intestinal barrier function and intestinal inflammation. There was a negative correlation between energy adequacy and L-M (ρ = -0·19, P < 0·05) and between folate adequacy and NEO concentrations (ρ = -0·21, P < 0·01). In addition, there was a positive correlation between thiamine adequacy and MPO concentration (ρ = 0·22, P < 0·01) and between Ca adequacy and NEO concentration (ρ = 0·23; P < 0·01). Multiple linear regression models showed that energy intakes were inversely associated with intestinal barrier function (ß = -0·19, P = 0·02), and fibre intake was inversely associated with the EE scores (ß = -0·20, P = 0·04). Findings suggest that dietary intake from complementary feeding is associated with decreased intestinal barrier function and EE in children.

Infant feeding practices and determinant variables for early complementary feeding in the first 8 months of life: results from the Brazilian MAL-ED cohort site.

OBJECTIVE: The present study aimed to describe breast-feeding, complementary feeding and determining factors for early complementary feeding from birth to 8 months of age in a typical Brazilian low-income urban community. DESIGN: A birth cohort was conducted (n 233), with data collection twice weekly, allowing close observation of breast-feeding, complementary feeding introduction and description of the WHO core indicators on infant and young child feeding. Infant feeding practices were related to socio-economic status (SES), assessed by Water/sanitation, wealth measured by a set of eight Assets, Maternal education and monthly household Income (WAMI index). Two logistic regression models were constructed to evaluate risk factors associated with early complementary feeding. RESULTS: Based on twice weekly follow-up, 65 % of the children received exclusive breast-feeding in the first month of life and 5 % in the sixth month. Complementary feeding was offered in the first month: 29 % of the children received water, 15 % infant formulas, 13 % other milks and 9·4 % grain-derived foods. At 6 months, dietary diversity and minimum acceptable diet were both 47 % and these increased to 69 % at 8 months. No breast-feeding within the first hour of birth was a risk factor for the early introduction of water (adjusted OR=4·68; 95 % CI 1·33, 16·47) and low WAMI index a risk factor for the early introduction of other milks (adjusted OR=0·00; 95 % CI 0·00, 0·02). CONCLUSIONS: Data suggest local policies should promote: (i) early breast-feeding initiation; (ii) SES, considering maternal education, income and household conditions; (iii) timely introduction of complementary feeding; and (iv) dietary diversity.

Delivery practices of traditional birth attendants in Dhaka slums, Bangladesh.

This paper describes associations among delivery-location, training of birth attendants, birthing practices, and early postpartum morbidity in women in slum areas of Dhaka, Bangladesh. During November 1993-May 1995, data on delivery-location, training of birth attendants, birthing practices, delivery-related complications, and postpartum morbidity were collected through interviews with 1,506 women, 489 home-based birth attendants, and audits in 20 facilities where the women from this study gave birth. Associations among maternal characteristics, birth practices, delivery-location, and early postpartum morbidity were specifically explored. Self-reported postpartum morbidity was associated with maternal characteristics, delivery-related complications, and some birthing practices. Dais with more experience were more likely to use potentially-harmful birthing practices which increased the risk of postpartum morbidity among women with births at home. Postpartum morbidity did not differ by birth-location. Safe motherhood programmes must develop effective strategies to discourage potentially-harmful home-based delivery practices demonstrated to contribute to morbidity.

Effect of maternal zinc supplementation on the cardiometabolic profile of Peruvian children: results from a randomized clinical trial.

Zinc is an essential micronutrient for the development of the fetal renal, cardiovascular and metabolic systems; however, there is limited evidence of its effects on the postnatal cardiometabolic function. In this study, we evaluated the effect of maternal zinc supplementation during pregnancy on the cardiometabolic profile of the offspring in childhood. A total of 242 pregnant women were randomly assigned to receive a daily supplement containing iron+folic acid with or without zinc. A follow-up study was conducted when children of participating mothers were 4.5 years of age to evaluate their cardiometabolic profile, including anthropometric measures of body size and composition, blood pressure, lipid profile and insulin resistance. No difference in measures of child cardiometabolic risk depending on whether mothers received supplemental zinc during pregnancy. Our results do not support the hypothesis that maternal zinc supplementation reduces the risk of offspring cardiometabolic disease.

Environmental enteropathy is associated with cardiometabolic risk factors in Peruvian children.

Environmental enteropathy (EE) is a syndrome of altered small intestine structure and function hypothesized to be common among individuals lacking access to improved water and sanitation. There are plausible biological mechanisms, both inflammatory and non-inflammatory, by which EE may alter the cardiometabolic profile. Here, we test the hypothesis that EE is associated with the cardiometabolic profile among young children living in an environment of intense enteropathogen exposure. In total, 156 children participating in the Peruvian cohort of a multicenter study on childhood infectious diseases, growth and development were contacted at 3-5 years of age. The urinary lactulose:mannitol ratio, and plasma antibody to endotoxin core were determined in order to assess intestinal permeability and bacterial translocation. Blood pressure, anthropometry, fasting plasma glucose, insulin, and cholesterol and apolipoprotein profiles were also assessed. Extant cohort data were also used to relate biomarkers of EE during the first 18 months of life to early child cardiometabolic profile. Lower intestinal surface area, as assessed by percent mannitol excretion, was associated with lower apolipoprotein-AI and lower high-density lipoprotein concentrations. Lower intestinal surface area was also associated with greater blood pressure. Inflammation at 7 months of age was associated with higher blood pressure in later childhood. This study supports the potential for a relationship between EE and the cardiometabolic profile.

Measurement of blood loss at childbirth and postpartum.

OBJECTIVE: To accurately measure blood loss during childbirth in a developing country. METHOD: The alkaline hematin technique was used to quantify blood lost during delivery and 24 h postpartum in 158 women in Pemba Island, Zanzibar. RESULT: Women were found to lose less blood during childbirth and 24 h postpartum than previously reported. Compared with laboratory values, nurse-midwives approximated blood loss accurately (mean difference, i.e., mean underestimation by nurse-midwives, 4.90 mL); however, their imprecision was greater for higher laboratory values. CONCLUSION: This study may prompt further investigation, as no comparable data exist for developing countries where maternal mortality is high and severe anemia prevalent.

Delivery-related complications and early postpartum morbidity in Dhaka, Bangladesh.

OBJECTIVE: To describe delivery-related complications and postpartum morbidity of women living in slum areas of Dhaka, Bangladesh. METHOD: From November 1993 to May 1995, 1506 women were interviewed regarding delivery-related complications and postpartum morbidities. Operational definitions were applied to maternal reports to categorize serious delivery-related complications and postpartum morbidity. Corroborating information was identified from medical records for facility-based deliveries and physical examinations by female physicians 14 to 22 days postpartum. RESULT: Thirty-six percent of women described serious delivery-related complications and 75% of women reported postpartum morbidity. There were two maternal deaths among 1471 live births. When maternal reports were related to corroborating information, the proportion of women's reports of serious complications and morbidity appears reasonably accurate for some conditions. CONCLUSION: A large proportion of urban slum women in Dhaka experience serious delivery-related complications and/or postpartum morbidity. Information on delivery practices that contribute to morbidity and factors that influence appropriate care seeking is needed.

The epidemiology of diabetes in pregnant Native Canadians. A risk profile.

OBJECTIVE: The purpose of this study was to determine the prevalence of diabetes in pregnancy (gestational diabetes mellitus [GDM] and NIDDM) and to identify risk factors in the development of GDM in a native population in northwestern Ontario, Canada. RESEARCH DESIGN AND METHODS: A retrospective analysis of 1,305 singleton deliveries among Ojibwa-Cree women from northwestern Ontario, Canada, was conducted from 1990 to 1993 inclusive. GDM was diagnosed using a 3-h oral glucose tolerance test (OGTT) and defined according to standard guidelines. RESULTS: The overall prevalence of diabetes in pregnancy (NIDDM and GDM) was 11.6% (152 of 1,305) with a GDM prevalence of 8.4% (110 of 1,305). Among 741 women with complete data, prevalence rates increased with age, peaking at 46.9% in the age-group > or = 35 years. Significant risk factors for GDM included older maternal age, multiparity, prepregnancy obesity, a family history of diabetes, and a history of GDM in previous pregnancies. CONCLUSIONS: Diabetes in pregnancy among Ojibwa-Cree reported here represent the highest rates reported to date in a Canadian population. The high rates of maternal obesity and relative young age of this population further highlight the urgent need for diabetes screening and prevention in this population.

Changes in iron status during pregnancy in peruvian women receiving prenatal iron and folic acid supplements with or without zinc.

BACKGROUND: Iron deficiency anemia is the most prevalent nutrient deficiency during pregnancy, yet there are few data on the effect of prenatal iron supplementation in women in developing countries. OBJECTIVE: Our objective was to describe the effect of iron supplementation on hematologic changes during pregnancy, and the effect on those changes of adding zinc to the supplements. DESIGN: Pregnant women were enrolled in a randomized, double-masked study conducted at a hospital in a shantytown in Lima, Peru. Women were supplemented daily from 10-24 wk gestation to 4 wk postpartum with 60 mg Fe and 250 microg folic acid with or without 15 mg Zn. Hemoglobin and ferritin concentrations were measured in 645 and 613 women, respectively, at enrollment, at 28-30 and 37-38 wk gestation, and in the cord blood of 545 neonates. RESULTS: No differences in iron status were detected by supplement type, but hematologic changes were related to initial hemoglobin status. Women with anemia (hemoglobin <110 g/L) showed steady increases in hemoglobin concentration throughout pregnancy whereas women with relatively higher initial hemoglobin concentrations had declining values during mid pregnancy, then rising values by 37-38 wk gestation. Women with an initial hemoglobin concentration >95 g/L showed increases in serum ferritin by the end of the pregnancy. Despite supplementation, women with poorer hematologic status; who were younger, single, and multiparous; and who consumed fewer supplements were more likely to have anemia at the end of pregnancy. CONCLUSIONS: These hematologic changes are congruent with the effects of iron supplementation reported in placebo-controlled trials and the addition of zinc did not significantly affect them.

Adding zinc to prenatal iron and folate supplements improves maternal and neonatal zinc status in a Peruvian population.

BACKGROUND: Maternal zinc deficiency during pregnancy may be widespread among women in developing countries, but few data are available on whether prenatal zinc supplementation improves maternal and neonatal zinc status. OBJECTIVE: We studied whether maternal zinc supplementation improved the zinc status of mothers and neonates participating in a supplementation trial in a shantytown in Lima, Peru. DESIGN: Beginning at gestation week 10-24, 1295 mothers were randomly assigned to receive prenatal supplements containing 60 mg Fe and 250 microg folate, with or without 15 mg Zn. Venous blood and urine samples were collected at enrollment, at gestation week 28-30, and at gestation week 37-38. At birth, a sample of cord vein blood was collected. We measured serum zinc concentrations in 538 women, urinary zinc concentrations in 521 women, and cord zinc concentrations in 252 neonates. RESULTS: At 28-30 and 37-38 wk, mothers receiving zinc supplements had higher serum zinc concentrations than mothers who did not receive zinc (8.8 +/- 1.9 compared with 8.4 +/- 1.5 micromol/L and 8.6 +/- 1.5 compared with 8.3 +/- 1.4 micromol/L, respectively). Urinary zinc concentrations were also higher in mothers who received supplemental zinc (P < 0.05). After adjustment for covariates and confounding factors, neonates of mothers receiving zinc supplements had higher cord zinc concentrations than neonates of mothers who did not receive zinc (12.7 +/- 2.3 compared with 12.1 +/- 2.1 micromol/L). Despite supplementation, maternal and neonatal zinc concentrations remained lower than values reported for well-nourished populations. CONCLUSION: Adding zinc to prenatal iron and folate tablets improved maternal and neonatal zinc status, but higher doses of zinc are likely needed to further improve maternal and neonatal zinc status in this population.

Potential contribution of maternal zinc supplementation during pregnancy to maternal and child survival.

Mild-to-moderate zinc deficiency may be relatively common worldwide, but the public health importance of this degree of zinc deficiency is not well defined. The purpose of this review was to provide a conceptual framework for evaluating the public health importance of maternal zinc deficiency as it relates to fetal growth and development, complications of pregnancy, labor and delivery, and maternal and infant health. The mechanisms through which zinc deficiency could influence health outcomes are well described. The results of experimental studies conducted in animal models have motivated concern about the potential health effects of mild-to-moderate maternal zinc deficiency. Observational studies in human populations have produced strong associations between poor maternal zinc status and various indicators of poor pregnancy outcome, but supplementation trials have not produced strong, or even consistent results. Supplementation trials are needed to define the public health importance of maternal zinc deficiency worldwide.

Anthropometric status and cataract: the Salisbury Eye Evaluation project.

BACKGROUND: Weight or body mass index (BMI; in kg/m2) is frequently identified as a risk factor for cataract, but the nature of the association is unclear. OBJECTIVE: We aimed to characterize the relation between BMI and stature and risk of different types of cataract. DESIGN: We analyzed data from participants in the Salisbury Eye Evaluation (SEE), a cross-sectional survey of visual status and demographic, nutritional, and environmental factors conducted between 1993 and 1995 in a representative sample of community-dwelling older persons in Salisbury, MD. Multiple logistic regression techniques were used to compare risk factors between individuals with nuclear, cortical, or posterior subcapsular (PSC) opacities and individuals with no cataract. RESULTS: Risk of nuclear opacification was greater in participants with lower BMIs [adjusted odds ratio of 1.13 (95% CI: 1.02, 1.27) with a BMI of 22.5 compared with 28.0] and of taller stature [1.12 (95% CI: 1.01, 1.25) with a stature of 170.5 cm compared with 164]. In contrast, risk of cortical opacification was greater in participants with higher BMIs and of taller stature, but the relation for stature diminished in magnitude and was not significant after adjustment for other risk factors. BMI was not related to risk of PSC opacities, but there was some evidence that taller stature is a risk factor for PSC opacification (P = 0.06) after adjustment for other risk factors. CONCLUSIONS: Both BMI and stature are independent risk factors for cataracts in the SEE population, with the nature of the risk dependent on cataract type.

Vitamin C status and mortality in US adults.

BACKGROUND: Low vitamin C status may increase the risk of mortality from cancer and cardiovascular disease. OBJECTIVE: The objective was to test whether an association existed between serum ascorbate concentrations and mortality and whether the association was modified by cigarette smoking status or sex. DESIGN: Serum ascorbate concentrations were measured in adults as part of the second National Health and Nutrition Examination Survey (1976-1980). Vital status was ascertained 12-16 y later. RESULTS: The relative risk (RR) of death, adjusted for potential confounders, was estimated by using Cox proportional hazards models. Men in the lowest (<28.4 micromol/L) compared with the highest (>/=73.8 micromol/L) serum ascorbate quartile had a 57% higher risk of dying from any cause (RR: 1.57; 95% CI: 1.21, 2.03) and a 62% higher risk of dying from cancer (RR: 1.62; 95% CI: 1.01, 2.59). In contrast, there was no increased risk among men in the middle 2 quartiles for these outcomes and no increased risk of cardiovascular disease mortality in any quartile. There was no association between serum ascorbate quartile and mortality among women. These findings were consistent when analyses were limited to nonsmokers or further to adults who never smoked, suggesting that the observed relations were not due to cigarette smoking. CONCLUSIONS: These data suggest that men with low serum ascorbate concentrations may have an increased risk of mortality, probably because of an increased risk of dying from cancer. In contrast, serum ascorbate concentrations were not related to mortality among women.

Influence of prenatal iron and zinc supplements on supplemental iron absorption, red blood cell iron incorporation, and iron status in pregnant Peruvian women.

BACKGROUND: It is estimated that 60% of pregnant women worldwide are anemic. OBJECTIVE: We aimed to examine the influence of iron status on iron absorption during pregnancy by measuring supplemental iron absorption, red blood cell iron incorporation, and iron status in pregnant women. DESIGN: Subjects were 45 pregnant Peruvian women (33+/-1 wk gestation), of whom 28 received daily prenatal supplements containing 60 mg Fe and 250 microg folate without (Fe group, n = 14) or with (Fe+Zn group, n = 14) 15 mg Zn, which were were consumed from week 10 to 24 of gestation until delivery. The remaining 17 women (control) received no prenatal supplementation. Iron status indicators and isotopes were measured in maternal blood collected 2 wk postdosing with oral (57Fe) and intravenous (58Fe) stable iron isotopes. RESULTS: Maternal serum ferritin and folate concentrations were significantly influenced by supplementation (P < 0.05). Serum iron was also significantly higher in the Fe than in the Fe+Zn (P < 0.03) or control (P < 0.001) groups. However, the supplemented groups had significantly lower serum zinc concentrations than the control group (8.4+/-2.3 and 10.9+/-1.8 micromol/L, respectively, P < 0.01). Although percentage iron absorption was inversely related to maternal serum ferritin concentrations (P = 0.036), this effect was limited and percentage iron absorption did not differ significantly between groups. CONCLUSIONS: Because absorption of nonheme iron was not substantially greater in pregnant women with depleted iron reserves, prenatal iron supplementation is important for meeting iron requirements during pregnancy.

PIP: The influence of iron status on iron absorption during pregnancy was examined among pregnant Peruvian women. This was done by measuring supplemental iron absorption, red blood cell iron incorporation and iron status. The subjects were 45 pregnant Peruvian women (33 +or- 1 week gestation) who were divided into 2 groups. The first group of 28 pregnant women received daily prenatal supplements containing 60 mg of iron and 250 mcg of folate with or without 15 mg of zinc, from week 10 to 24 of gestation until delivery. The second group of 17 women served as the control group. The control group was not given prenatal supplementation. The iron status indicators and isotopes were measured in maternal blood collected 2 weeks postdosing with oral iron-57 and intravenous iron-58 stable isotopes. The results showed that supplementation significantly influenced the maternal serum ferritin and folate concentrations (P 0.05). The serum iron of the iron group was significantly higher than that of the iron + zinc group (P 0.03) or control group (P 0.001). However, the serum zinc concentrations were lower in the supplemented group than in the control group. Even though the percentage of iron absorption was inversely related to maternal serum ferritin concentration, the effect was limited and the percentage of iron absorption did not differ significantly between the two groups. Considering that the absorption of nonheme iron was not substantially greater in pregnant women with depleted iron reserves, it was concluded that prenatal iron supplementation is essential for meeting iron requirements, especially during pregnancy.

Infant growth patterns in the slums of Dhaka in relation to birth weight, intrauterine growth retardation, and prematurity.

BACKGROUND: Relations between size and maturity at birth and infant growth have been studied inadequately in Bangladesh, where the incidence of low birth weight is high and most infants are breast-fed. OBJECTIVE: This study was conducted to describe infant growth patterns and their relations to birth weight, intrauterine growth retardation, and prematurity. DESIGN: A total of 1654 infants born in selected low-socioeconomic areas of Dhaka, Bangladesh, were enrolled at birth. Weight and length were measured at birth and at 1, 3, 6, 9, and 12 mo of age. RESULTS: The infants' mean birth weight was 2516 g, with 46.4% weighing <2500 g; 70% were small for gestational age (SGA) and 17% were premature. Among the SGA infants, 63% had adequate ponderal indexes. The mean weight of the study infants closely tracked the -2 SD curve of the World Health Organization pooled breast-fed sample. Weight differences by birth weight, SGA, or preterm categories were retained throughout infancy. Mean z scores based on the pooled breast-fed sample were -2.38, -1. 72, and -2.34 at birth, 3 mo, and 12 mo. Correlation analysis showed greater plasticity of growth in the first 3 mo of life than later in the first year. CONCLUSIONS: Infant growth rates were similar to those observed among breast-fed infants in developed countries. Most study infants experienced chronic intrauterine undernourishment. Catch-up growth was limited and weight at 12 mo was largely a function of weight at birth. Improvement of birth weight is likely to lead to significant gains in infant nutritional status in this population, although interventions in the first 3 mo are also likely to be beneficial.

Is prolonged breastfeeding associated with malnutrition? Evidence from nineteen demographic and health surveys.

BACKGROUND: A growing body of literature suggests that prolonged breastfeeding (typically defined as beyond the first year of life) may be a risk factor for malnutrition. METHODS: To examine the extent to which continued breastfeeding is a risk factor for malnutrition, we used multiple regression techniques to relate current breastfeeding status to weight and stature in children < 36 months old whose mothers participated in one of 19 Demographic and Health Surveys (DHS) conducted between 1987 and 1989. RESULTS: The data from 9 of 11 countries outside sub-Saharan Africa (SSA) indicated that among older children, those still breastfed are shorter and lighter than those no longer breastfed. These differences, which reached statistical significance in five countries, become apparent at 12-18 months of age. In contrast, in five of eight SSA countries, younger still breastfed children are significantly shorter and lighter than those no longer breastfed, but, the differences are largely diminished among older children. These basic patterns were not altered by adjustment for family sociodemographic characteristics, health care utilization, and recent child illness. CONCLUSIONS: Important differences in nutritional status associated with continued breastfeeding are observed throughout the developing world, and are not likely due to confounding by family sociodemographic characteristics, health care utilization or recent child illness. A unifying interpretation of the observed relationships is that child size is somehow related to the decision to wean, and that whereas in SSA, the biggest children are weaned first, in non-SSA countries, the smallest children are weaned last.

PIP: A growing body of literature suggests that prolonged breast feeding, typically defined as breast feeding beyond age one year, may be a risk factor for malnutrition. The authors therefore investigated the extent to which prolonged breast feeding is a risk factor for malnutrition. Findings are based upon the use of multiple regression to relate current breast feeding status to weight and stature in children younger than age 36 months whose mothers participated in one of 19 Demographic and Health Surveys (DHS) conducted during 1987-89. The data from 9 of 11 countries outside of sub-Saharan Africa (SSA) indicate that among older children, those still breastfed are shorter and lighter than those no longer breastfed. These differences, which reached statistical significance in five countries, become apparent at age 12-18 months. In five of eight SSA countries, younger still breastfed children are significantly shorter and lighter than those no longer breastfed, but the differences are largely diminished among older children. These basic patterns did not change once adjustments were made for family sociodemographic characteristics, health care use, and recent child illness.

Determinants of gestational weight gain outside the recommended ranges among black and white women.

OBJECTIVES: To identify factors influencing risk of gaining outside the Institute of Medicine recommendations for pregnancy weight gain, and to determine whether these factors differ by race. METHODS: Multivariate methods were used to identify risk factors for under- and over-gain among 2617 black and 1253 white women delivering at the Johns Hopkins Hospital during 1987-1989. RESULTS: Only 28.2% of black women and 32.5% of white women gained the recommended amounts of weight during pregnancy. Maternal pre-pregnancy body mass index (BMI), height, parity, education, smoking, hypertension, duration of pregnancy, and fetal sex influenced risk for under-gain or over-gain. Black women were 1.51 (95% confidence interval [CI] 1.23-1.85) times more likely to under-gain, but 0.89 (95% CI 0.74-1.08) times less likely to over-gain than white women. No interactions were found between any factor examined and BMI or race. CONCLUSION: Only about one-third of women are gaining the recommended amounts of weight during pregnancy. Black women are at increased risk for gaining less weight than recommended, and selected maternal characteristics associated with race do not explain this difference. Further, risk factors for under-or over-gain do not differ between black and white women.

Influence of maternal anthropometric status and birth weight on the risk of cesarean delivery.

OBJECTIVE: To determine whether greater weight gain during pregnancy is associated with an increased risk of cesarean delivery, and, if so, whether this effect is explained by the positive influence of weight gain on birth weight and if there is a threshold of pregnancy weight gain above which the risk of cesarean delivery is increased differentially. METHODS: We analyzed live births at Johns Hopkins Hospital for the period 1987-1989. A multiple logistic regression model was used to evaluate the risk of cesarean delivery, recorded in the hospital's perinatal data base. RESULTS: The study sample contained 4346 patients, 1086 of whom delivered by cesarean. Associated independently with an increased risk of cesarean delivery were the following: 1) greater weight gain during pregnancy, 2) older maternal age, 3) greater maternal prepregnant body mass index, 4) maternal height of 1.57 m or less, 5) the diagnosis of preeclampsia during current pregnancy, and 6) carrying a fetus weighing more than 3591 g at birth. An additional risk factor for cesarean delivery was a fetus less than 2847 g at birth, with the risk more marked the lower the gestational age. Maternal height of 1.73 m or more and a history of at least one previous viable pregnancy were associated independently with a decreased risk of cesarean delivery. CONCLUSION: The risk of cesarean delivery increases linearly with pregnancy weight gain, independent of birth weight. No specific threshold of weight gain can be determined above which the cesarean risk climbs more rapidly.

Nutrient intakes and adequacy among an older population on the eastern shore of Maryland: the Salisbury Eye Evaluation.

OBJECTIVE: To describe the reported usual dietary intakes of the participants in the Salisbury Eye Evaluation (SEE) project and to estimate the prevalence of inadequate nutrient intakes using the probability approach. SUBJECTS/SETTING: A representative sample of elderly residents (aged 65 to 85 years) of Salisbury, Md. DESIGN: Cross-sectional survey, using a food frequency questionnaire to obtain nutrient intakes. We estimated energy and protein; percent of energy intake from carbohydrates, fat, and protein; as well as usual intakes of cholesterol, vitamin A, carotenoids, vitamin C, thiamin, riboflavin, vitamin B-6, vitamin E, niacin, iron, calcium, zinc, and folate. Estimates of prevalence of inadequate nutrient intakes were calculated using the probability approach among the 2,655 participants with complete nutrient intake information. STATISTICAL ANALYSES PERFORMED: The chi 2 test for independence and analysis of variance. A P < .05 was considered significant in a 2-sided test. RESULT: On average, white participants of both genders reported higher mean energy and nutrient intakes than did black participants. Zinc had the highest estimated prevalences of inadequacy across all gender and race categories, followed by calcium, vitamin E, and vitamin B-6. Vitamin C, with estimated prevalences of inadequacy lower than 13%, and folate, with prevalences lower than 17%, had the lowest estimated prevalences of inadequacy across all gender, race, and age categories. CONCLUSIONS: In this population, there are race differences in estimated prevalences of inadequate nutrient intake. According to the current nutrient requirements for adults aged 51 years and older, many elderly persons have inadequate dietary intakes of key nutrients.