Abstract
Maternal undernutrition is a leading cause of maternal and infant mortality worldwide. Gender inequality, cultural traditions and socio-economic status strongly influence nutritional status in women living in countries such as India. There is currently little information on the nutritional status of pregnant tribal women in India. The aim of this study was to investigate the macronutrient and micronutrient intakes of pregnant tribal women living in Maharashtra, Central India.
An observational, longitudinal study was conducted in Ramtek, outside Nagpur city, Maharashtra, in which 219 pregnant tribal women from the Gond tribe were recruited from three underpriviledged primary health centres that serviced 107 tribal villages. The dietary intake of the pregnant tribal women was determined by a one-day interactive 24-hour recall. Questionnaires, anthropometry, and the 24-hour recall were administered to pregnant women recruited in the second trimester (i.e. visit 1; n=219) and then visited a second time in the third trimester (i.e. visit 2; n=182). A random selection of 60 women from the first visit underwent a repeat recall within 2 weeks of the first 24-hour recall. For most foods and nutrients, the Indian food composition tables were used to convert food intakes into nutrient intakes, however, other food composition tables were employed to obtain any missing food or nutrient values. Folate, beta-carotene, iron and zinc were adjusted for nutrient losses during cooking. The Estimated Average Requirement (EAR) cut-point method was used to determine the prevalence of inadequate nutrient intakes.
The mean gestation age of women at visit 1 was 17.5 wks and at visit 2 was 35 wks. Socio-demographic data indicated that the women lived in poverty, subsisting on a mean annual household income of $890 US dollars. At visit 1, the mean weight of the study population was 44.8kg and over one third had a BMI<18.5, indicating chronic energy deficiency. Over half (51%) of the women had attained <8years of education and 18% were still breastfeeding a previous child.
Mean energy intakes were 6401kJ and 6544kJ at visit 1 and visit 2, respectively, 4000kJ less than the recommended energy intake of 10,853kJ/day for pregnant women. Daily mean protein intakes were 36g and 38g at visit 1 and 2, respectively, less than half the recommendation of 82g. The % energy from fat and carbohydrate at visit 1 was 17% and 71%, respectively, and at visit 2 was 18% and 70%, respectively. Regarding micronutrient intakes at visit 1, the mean daily intakes of iron, calcium, zinc, folate, vitamin A and vitamin B12 was 10.5mg, 314mg, 101μg, 6.4mg, 0.4μg and 352 retinol equivalents, respectively. There were no differences in the macro and micronutrient intakes between visit 1 and visit 2. Almost all the women had intakes below the EAR for every measured nutrient.
The only socio-demographic variable to influence energy intake was household income (p=0.027) at the first visit. Univariate analysis found that women who were currently breastfeeding a child had a BMI that was 0.65 kg/m2 lower than women who were not breastfeeding (p=0.052). Multivariate regression showed that women with <8 years of education had a BMI that was 0.59 kg/m2 lower than women who had ≥8 years of education, confirming the association between educational attainment and maternal undernutrition. Multivariate regression found energy intake to be highly associated with calcium, folate, iron, zinc and vitamin A (as retinol equivalents) intakes, such that for every 1MJ (i.e. 1000kJ) increase in energy, the intakes of each of these micronutrients rose by 16-23% as well, indicating that increasing the energy intakes of these women will also improve their micronutrient intakes. The low energy, protein and micronutrient intakes of these pregnant tribal women place them at high risk of multiple nutrient deficiencies which can adversely impact on the health of both the mother, baby, and pregnancy outcomes.