Improving women's diet quality preconceptionally and during gestation: effects on birth weight and prevalence of low birth weight--a randomized controlled efficacy trial in India (Mumbai Maternal Nutrition Project).

BACKGROUND: Low birth weight (LBW) is an important public health problem in undernourished populations. OBJECTIVE: We tested whether improving women's dietary micronutrient quality before conception and throughout pregnancy increases birth weight in a high-risk Indian population. DESIGN: The study was a nonblinded, individually randomized controlled trial. The intervention was a daily snack made from green leafy vegetables, fruit, and milk (treatment group) or low-micronutrient vegetables (potato and onion) (control group) from ≥ 90 d before pregnancy until delivery in addition to the usual diet. Treatment snacks contained 0.69 MJ of energy (controls: 0.37 MJ) and 10-23% of WHO Reference Nutrient Intakes of ß-carotene, riboflavin, folate, vitamin B-12, calcium, and iron (controls: 0-7%). The primary outcome was birth weight. RESULTS: Of 6513 women randomly assigned, 2291 women became pregnant, 1962 women delivered live singleton newborns, and 1360 newborns were measured. In an intention-to-treat analysis, there was no overall increase in birth weight in the treatment group (+26 g; 95% CI: -15, 68 g; P = 0.22). There was an interaction (P < 0.001) between the allocation group and maternal prepregnant body mass index (BMI; in kg/m(2)) [birth-weight effect: -23, +34, and +96 g in lowest (<18.6), middle (18.6-21.8), and highest (>21.8) thirds of BMI, respectively]. In 1094 newborns whose mothers started supplementation ≥ 90 d before pregnancy (per-protocol analysis), birth weight was higher in the treatment group (+48 g; 95% CI: 1, 96 g; P = 0.046). Again, the effect increased with maternal BMI (-8, +79, and +113 g; P-interaction = 0.001). There were similar results for LBW (intention-to-treat OR: 0.83; 95% CI: 0.66, 1.05; P = 0.10; per-protocol OR = 0.76; 95% CI: 0.59, 0.98; P = 0.03) but no effect on gestational age in either analysis. CONCLUSIONS: A daily snack providing additional green leafy vegetables, fruit, and milk before conception and throughout pregnancy had no overall effect on birth weight. Per-protocol and subgroup analyses indicated a possible increase in birth weight if the mother was supplemented ≥ 3 mo before conception and was not underweight. This trial was registered at www.controlled-trials.com/isrctn/ as ISRCTN62811278.

Dietary Habits of Female Urban Slum-dwellers in Mumbai.

RESEARCH QUESTION: Intakes of micronutrient-rich foods are low among women of child-bearing age living in slums. We investigated relationships between consumption of these foods and socio-demographic variables. METHODOLOGY: A 91-item Food Frequency Questionnaire was administered to women (n=1651) aged 16-40 yrs living in a Mumbai slum. We identified associations between categorical demographic variables and consumption frequency of these foods using chi-square tests. Associations with age and body mass index were investigated using one-way ANOVAs. RESULTS: A quarter of women ate fruit and green leafy vegetables < 3 times per week, Apart from in tea, median consumption of milk and milk products was < twice a week, 16% never consumed non-vegetarian foods. Median consumption of non-vegetarian foods was 4.5 times per week. Women employed in unskilled jobs and those whose husbands had skilled occupations ate green leafy vegetables more frequently. Participants educated to tertiary level consumed fruit and milk most frequently (p<0.05).

Influence of fluoride containing toothpaste on serum and urine fluoride levels in children.

This study was undertaken to investigate the effect of fluoridated toothpaste on serum and urine fluoride levels in two groups of children with supervised brushing. As part of the study dietary intakes of fluoride were calculated from a 24 hour diet record and eight samples of water from different families were also analysed for their fluoride content.

Feeding of colostrum in urban and rural areas.

The practice of colostrum feeding and factors influencing the same were studied by interviewing 2158 mothers belonging to low socio-economic group from urban slums and rural areas of Maharashtra and Gujarat. Statistically significant (p less than 0.001) difference was found between rural and urban areas with regard to the practice of feeding colostrum. Though the percentage feeding colostrum was very poor, the discard of colostrum was very less among rural mothers. Developmental programmes such as ICDS and others also showed significantly beneficial effects on colostrum feeding practice in both urban and rural (p less than 0.001) areas. Socio-economic factors such as better income (p less than 0.001) and hospital delivery were noted to have positive influence on colostrum feeding. Religion did not seem to affect the practice of colostrum feeding.