Postpartum iron status in nonlactating participants and nonparticipants in the special supplemental nutrition program for women, infants, and children.

BACKGROUND: Iron deficiency, a pervasive problem among low-income women of childbearing age, threatens maternal health and pregnancy outcomes. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was designed to alleviate health problems and provides supplemental nutritious foods, nutrition education, and health care referrals. OBJECTIVES: The aim of this study was to examine the benefits associated with participation in WIC in terms of biochemical tests of postpartum iron status in nonlactating women. DESIGN: WIC participants (n = 57) and eligible nonparticipants (n = 53), matched by race and age, were followed bimonthly over 6 mo postpartum. Finger stick blood samples (500 microL) were collected for measurement of plasma ferritin, transferrin receptor (TfR), and hemoglobin (Hb). RESULTS: The mean (+/-SE) Hb concentration of participants exceeded that of nonparticipants from months 2 through 6. At 6 mo, the mean Hb concentration of participants was significantly higher than that of nonparticipants (8.01+/-0.12 and 7.63+/-0.12 mmol/L, respectively; P< 0.05) and the prevalence of anemia was significantly lower (17% and 51%, respectively; P<0.05). TfR and ferritin concentrations (consistently within the reference ranges) and dietary iron intakes did not differ significantly between participants and nonparticipants and were not correlated with Hb concentrations. CONCLUSIONS: Our results suggest that WIC participants were significantly less likely to become anemic if uninterrupted postpartum participation lasted for 6 mo. The lack of correlation among iron status indicators suggests that the lower mean Hb concentration in nonparticipants at 6 mo may not have been related to improved iron status in participants but to other nutrient deficiencies or differences in access to health care and health and nutrition education.

Dietary folate equivalents: interpretation and application.

The 1998 Dietary Reference Intakes express the new Recommended Dietary Allowances for folate in dietary folate equivalents ("DFEs"), which account for differences in the absorption of naturally occurring food folate and the more bioavailable synthetic folic acid. The quantity of dietary folate equivalents occurring naturally in food equals the micrograms of folate as reported, and the dietary folate equivalents provided by fortified foods equal the micrograms of food folate plus 1.7 times the micrograms of added folic acid. Currently, the use of dietary folate equivalents is recommended for planning and evaluating the adequacy of people's folate intake. As a result of new US Food and Drug Administration regulations, folic acid has been added to enriched cereal grains and thus affects hundreds of food products. To help dietetics professionals plan and evaluate diets that include enriched cereal grain products, we estimated the dietary folate equivalent content of a selection of foods using data supplied by the US Department of Agriculture and grouped the foods by dietary folate equivalent content.

Validity of a food frequency questionnaire in assessing nutrient intakes of low-income pregnant women.

OBJECTIVE: In 1989, a validation study of eight nutrients was performed on a modified food frequency questionnaire (FFQ) specifically designed for low-income pregnant women. The purpose of this study was to broaden the scope of the previous study by assessing the validity of the FFQ for 17 additional nutrients. METHODS: The Pregnancy Food Frequency Questionnaire (PFFQ) was administered to a sample of 295 low-income, pregnant women aged 14-43 years living in Massachusetts. A randomly selected subsample of 101 women who provided at least one diet recall and reported intake of less than 4,500 calories were included in this analysis. RESULTS: Mean intake of 25 nutrients as assessed by one administration of the PFFQ and up to three diet recalls collected over 1 month were similar. Unadjusted correlation coefficients between nutrient intake measured by diet recalls and the questionnaire ranged from .28 (carotene) to .61 (folate). After adjusting for energy intake the correlations ranged from .03 (B12) to .46 (folate). The correlations corrected for day-to-day variation were higher, ranging from .07 (B12) to .90 (zinc). The mean correlation was .47 and there were 54% over .40. CONCLUSIONS: A food frequency questionnaire for English-speaking, low-income, pregnant women can provide maternal and child health practitioners and researchers a valid estimate of diet across a wide range of nutrients.

Dietary Reference Intakes: the new basis for recommendations for calcium and related nutrients, B vitamins, and choline.

Dietary Reference Intakes (DRIs) represent the new approach adopted by the Food and Nutrition Board to providing quantitative estimates of nutrient intakes for use in a variety of settings, replacing and expanding on the past 50 years of periodic updates and revisions of the Recommended Dietary Allowances (RDAs). The DRI activity is a comprehensive effort undertaken to include current concepts about the role of nutrients and food components in long-term health, going beyond deficiency diseases. The DRIs consist of 4 reference intakes: the RDA, which is to be used as a goal for the individual; the Tolerable Upper Intake Level (UL), which is given to assist in advising individuals what levels of intake may result in adverse effects if habitually exceeded; the Estimated Average Requirement (EAR), the intake level at which the data indicate that the needs for 50% of those consuming it will not be met; and the Adequate Intake (AI), a level judged by the experts developing the reference intakes to meet the needs of all individuals in a group, but which is based on much less data and substantially more judgment than that used in establishing an EAR and subsequently the RDA. When an RDA cannot be set, an AI is given. Both are to be used as goals for an individual. Two reports have been issued providing DRIs for nutrients and food components reviewed to date: these include calcium and its related nutrients: phosphorus, magnesium, vitamin D, and fluoride; and most recently, folate, the B vitamins, and choline. The approaches used to determine the DRIs, the reference values themselves, and the plans for future nutrients and food components are discussed.

Nutritional assessment of the pregnant woman.

Physicians are encouraged to implement standard procedures to incorporate nutritional assessment into routine prenatal care. Simple questionnaires can produce a useful starting point that guides subsequent questions. Data obtained from the history and medical records, anthropometric measurements, laboratory values, and clinical evaluation of the patient all help to identify women who need emphasis on healthful diet, assistance with obtaining adequate intake, or special nutrition services.

Characteristics of diet among a culturally diverse group of low-income pregnant women.

This study reports on diet quality and variety in food selection among a culturally diverse group of 335 low-income pregnant Massachusetts women. The Index for Nutritional Quality (INQ), which is the observed nutrient density divided by the recommended nutrient density, was estimated for seven nutrients from data reported on food frequency questionnaires and diet recalls. Mean INQs for protein and vitamin C were above the recommended level of 1.0, whereas INQ for iron was 0.6 or less. Mean INQ for calcium was 1.2 for whites and between 0.9 and 1.0 for non-whites. When comparisons were made among ethnic groups by site of prenatal care, significant differences in INQ were found for all nutrients except iron and vitamin B-6. WIC participants had higher diet quality for protein, calcium, iron, and vitamin B-6 than did non-participants. Employed women had higher protein and zinc INQs than did unemployed women, and non-smokers had higher iron and vitamin B-6 INQs than did smokers. Variety was not significantly correlated with diet quality but differed (p less than .001) among site-specific ethnic groups. We conclude that there is a need for investigation of factors influencing dietary practices that are associated with sites of prenatal care.

Supplement use among a culturally diverse group of low-income pregnant women.

Among a culturally diverse group of 344 low-income pregnant women, self-reported rates of supplement use prior to confirmation of pregnancy were much lower than those reported for young women in national surveys (16% vs. up to 40%, respectively). Prenatal vitamins, prescribed routinely for all patients, were reportedly taken at least four times a week by 86% of the subjects and two to three times a day by 5%. About 5% of the sample reported consuming highly fortified cereal at least once daily. There is a possibility of higher than recommended use of supplemental vitamins among these women resulting from misunderstanding of the number of pills to be taken and/or high consumption of highly fortified cereals.

Caveat emptor: assessing needs, evaluating computer options.

A variety of services and microcomputer programs are available for providing the dietitian with a mechanized diet-analysis system for calculating nutrients from food records or recipes. They differ widely in the content of their data bases, cost, ease of use, reporting of results, flexibility, and other features. The characteristics of seven programs available by mail order from diet-analysis service vendors and five microcomputer programs were compared. The results of analysis of a one-day food record using various systems and coding by three different operators were compared. Differences by both system and operator were apparent. Nutritionists need to recognize that for some programs the reliability and the validity of data are uncertain. When making purchasing decisions for nonresearch applications, the nutritionist is advised to compare systems and services and to consider carefully whether mechanized diet analysis is of sufficient benefit in the delivery of high-quality nutrition care to offset its cost. The dietitian who chooses to use computerized diet analysis has a responsibility for making sure that reported results are reasonable and for interpreting results to other health professionals and to patients.

Planning high-carbohydrate, high-fiber diets with a microcomputer.

Current research suggests that a diet high in carbohydrate and fiber (HCF) may be useful in the management of diabetes mellitus, hypercholesterolemia, and hypertriglyceridemia. To meet the needs of our clinic population, a microcomputer program has been developed that allows for individualization of HCF menu patterns that satisfy both the diet prescription and the patient's preferences. Educational materials were prepared to guide and augment the HCF diet instruction. It is hoped that this comprehensive approach to diet planning and teaching can be applied in similar settings to facilitate the delivery of quality patient care.