Anthropometry and body composition in infants of malnourished Bangladeshi women supplemented or not supplemented during pregnancy

摘要

Background: In 2005, 32% of mothers of under-5 children in Bangladesh were underweight (BMI < 18.5 kg/m~2 ), whilst 36% of newborns in the country were Low Birth Weight (LBW) in 2003. Between 1995 and 2010, the National Nutrition Programme supplemented pregnant women with BMI < 17 kg/m~2 (low BMI) in increasing numbers, covering at its peak one quarter of the country. The objectives of the NNP were to increase mean pregnancy weight gain to ≥9 kg in 50% of these mothers and to reduce LBW incidence to 20% by 2010. In an initial assessment of the NNP, it was found that four months of maternal supplementation were associated with an 118g increase in birth weight. Our study investigated whether supplementation primarily affected infant lean or fat tissue. Methods: Between April 2010 and September 2011, a total of 90 pregnant women were recruited early in the 2~nd trimester in three groups: 31 low BMI women from intervention areas; 29 low BMI women from control areas; 30 normal BMI (18.5-22.9 kg/m~2 ) women, in equal proportions from control and interventions areas. The daily supervised supplement for low BMI women in intervention areas comprised a mixture of roasted lentils, roasted rice, molasses and soya bean oil, providing 600kcal/day from the 1~st trimester to the end of pregnancy. Socioeconomic status, anthropometry and health related information was collected at recruitment. After delivery, anthropometry was done on both mother and offspring (birth and 14-27 days), along with assessment of body composition by bio-impedance analysis (BIA) in mothers and stable isotope ( ~18O-labelled water) in the infants at 14-27 days. Results: The intervention promoted subcutaneous adiposity in low BMI mothers, but not lean mass estimated by BIA. Contrary to expectations, the main effect of the intervention on the neonate was a significant deficit in length (Δ = -1.6 cm, 95% CI -2.5, -0.7) but no difference in weight or BMI compared to the unsupplemented group. Offspring of supplemented mothers did however grow faster in length between birth and 14-27 days of age. At this follow-up time, infants of supplemented mothers still had shorter length (Δ = -0.89 cm, 95% CI-1.8, 0.02), slightly lower lean mass (Δ = -0.17kg, 95%CI -0.47, 0.12), and higher skinfolds (triceps: Δ = 2.5 mm, 95% CI 1.7, 3.2; subscapular: Δ = 0.8 mm, 95%CI 0.2, 1.5) compared to those of unsupplemented mothers. The offspring of supplemented malnourished mothers were also shorter than those of normal BMI mothers (neonate: -1.2 cm, 95%CI -2.2, -0.3; infant: -1.0 cm, 95%CI -1.2, 0.1), whereas those of unsupplemented malnourished mothers were similar to those of normal BMI mothers (neonate: 0.3 cm, 95%CI -0.7, 1.3; infant: -0.1 cm, 95%CI -1.1, 1.0) Conclusions: The only potential benefit of the intervention was that infants of supplemented malnourished mothers had faster gain in length after birth. They therefore made good some, but not all, of their birth length deficit, and such catchup might continue subsequently. Overall, the increased energy from supplementation primarily benefitted mothers rather than their offspring, while their offspring were also fatter.