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Title: Effect of nutritional interventions on micronutrient status in pregnant Malawian women with moderate malnutrition: A randomized, controlled trial

Author
item GLOSZ, CAMBRIA - CALIFORNIA POLYTECHNIC STATE UNIVERSITY
item SCHAFFNER, ANDREW - CALIFORNIA POLYTECHNIC STATE UNIVERSITY
item REAVES, SCOTT - CALIFORNIA POLYTECHNIC STATE UNIVERSITY
item MANARY, MARK - CHILDREN'S NUTRITION RESEARCH CENTER (CNRC)
item PAPATHAKIS, PEGGY - CALIFORNIA POLYTECHNIC STATE UNIVERSITY

Submitted to: Nutrients
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 7/5/2018
Publication Date: 7/7/2018
Citation: Glosz, C.M., Schaffner, A.A., Reaves, S.K., Manary, M.J., Papathakis, P.C. 2018. Effect of nutritional interventions on micronutrient status in pregnant Malawian women with moderate malnutrition: A randomized, controlled trial Nutrients. 10:879. https://doi.org/10.3390/nu10070879.
DOI: https://doi.org/10.3390/nu10070879

Interpretive Summary: Dietary deficiency of vitamins or minerals, know as micronutrient malnutrition, is widespread in sub-Saharan Africa with pregnant women being particularly vulnerable due to the higher nutrient requirements to sustain the mother and baby. This sub-study looked at the differences in micronutrient concentrations in the blood of pregnant women receiving different supplementary foods, either a corn soy blend plus iron and folic acid (CSB+IFA) or a highly fortified nutrient dense peanut paste (RUSF). Although both foods provided above the recommended daily allowance of most micronutrients, the women's nutrient status did not improve in almost all nutrient measurements making it clear that the current standard of care, CSB+IFA, is not enough to improve nutritional statuses of the women.

Technical Abstract: Micronutrient deficiencies during pregnancy are common in Africa and can cause adverse outcomes. The objective was to measure micronutrient status and change in moderately malnourished pregnant Malawian women randomized to one of three nutritional interventions. Serum vitamin B12, 25-hydroxyvitamin D, folate, retinol, ferritin, zinc, albumin and C-reactive protein were measured in pregnant women with MUAC>=20.6 cm and <=23.0 cm at enrollment (n=343) and after 10 weeks (n=229) of receiving: (1) ready-to-use supplementary food (RUSF); (2) fortified corn-soy blend (CSB+) with multiple-micronutrient supplement (CSB+UNIMMAP); or (3) CSB+ with iron and folic acid (CSB+IFA). Each provided 100-300% Recommended Dietary Allowance of most micronutrients and 900 kcal/day. Birth length was measured in 272 infants. Enrollment measurements indicated deficiencies in vitamin B12 (20.9%) and zinc (22.3%), low values of ferritin (25.1%) and albumin (33.7%), and elevated CRP (46.0%). Vitamin B12 is known to decrease in the third trimester; the RUSF group had the smallest decrease from enrollment to week 10 (3%), compared to 20% decrease in the CSB+IFA group and 8% decrease in the CSB+UNIMMAP group (p=0.001). Mean serum 25-hydroxyvitamin D increased most in the RUSF group (+6.4 ng/mL), compared to CSB+IFA (+1.7 ng/mL) and CSB+UNIMMAP (+2.7 ng/mL) (p<0.001). Micronutrient deficiencies and inflammation are common among moderately malnourished pregnant women and had little improvement despite supplementation above the RDA, with the exception of vitamins B12 and D.