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  • aternal N utri'otion

    .III Report to the Ministry of Health

    from

    Patsy Watson Senior Lecturer in Nutrition Department of Biochemistry Massey University Albany Campus Private Bag 102-904 North Shore MSC A UCKLAND

    098979 31 October 1996

    STACK

    wQ 175 [Q] WAT 1996

    MOH Library

    II IIIIUI IIfl I 98979M

    I •

    •/.. SE\r srr

  • ACKNOWLEDGEMENTS

    The statistical advice and assistance with the analysis in this report given by Dr Barry McDonald, Biometrician has been much appreciated.

    In addition the assistance of the following people in data collection, entry, processing and analysis is gratefully acknowledged:

    Mrs Judy Matheson

    Mrs Vicki Cameron

    Ms Marianne Salmon

    Ms Lisa Ward

    Mrs Judi Scheffer

    Ms Alexandria Meier

    Dr Mark von Veh

    Ms Janene McNamara

    Ms Cara Mackle

    Ms Geraldine Wood

    Mr Andrew Trow

    Finally the skills of Mrs Fleur Daniels in presentation and layout are recognized with thanks.

    This study was made possible by grants from the following:

    New Zealand Ministry of Health

    New Zealand Lottery Science Board

    Palmerston North Medical Research Foundation

    Massey University Research Fund

  • SUMMARY 1. Two hundred and fourteen women volunteered for the study, ten miscarried and seven

    withdrew, leaving 197 for whom data collection was complete. Of these subjects 89.8% were of European origin and 6.6% Maori.

    2. The data collection period lasted from the fourth month of pregnancy to 1 year after birth. During this period 16 weighed diet records, 6 minute by minute daily activity records, 35 skinfold measurements, 5 weight measurements plus social, cultural, medical and lifestyle details were collected from all subjects.

    3. More subjects worked in higher socio-economic group occupations. Twenty-one subjects were supported by benefits only.

    4. Mean energy intake of the sample in month 4 and month 7 of pregnancy was 8.9 MJ/day. Twenty-five percent of subjects had energy intakes> 10.4 MJ/day and 20% had intakes < 7.0 MJ/day. There was no significant difference in energy and nutrient intake between the fourth and seventh month of pregnancy. The mean percentage of total energy from protein, fat and carbohydrate was close to Nutrition Task Force recommendations.

    5. Protein intake was below the recommended level of 0.8 g/kg of body mass in 20% of all subjects. Animal protein and cholesterol intake was excessively high in some. Fibre intake was low with 40% of subjects consuming less than 20g a day.

    6. Intake of most nutrients was adequate, however a substantial percentage of subjects had calcium, iron, zinc, selenium and folate intakes less than two-thirds of the Australian RNI for pregnancy. Vitamin A and Vitamin C intakes were very high and in some cases excessive.

    7. The mean weight of food eaten by women on a benefit or in the lower socio-economic groups was significantly less than that eaten by higher socio-economic groups. This resulted in a significantly lower nutrient intake in the former groups, with calcium, zinc, iron, selenium, and total folate intakes substantially below recommended levels. The benefit group had the lowest intake levels. The contribution of fat, carbohydrate and protein to total energy was not different in the lower socio-economic groups. They just ate less. There were some highly significant negative impacts on growth to 1 year of children born to these lower socio-economic group mothers.

    S. The anthropometric measurements indicated that the sample ranged from the extremely lean (borderline malnutrition) to the obese. On average 12 months after birth, the women were still 2.3 kg heavier than before pregnancy. Only 20% of women returned to their pre-pregnancy weight.

    9. Women generally started putting on weight around the 13th week of gestation. Those women who put on weight before the 13th week lost only 20 to 50% of that weight after birth. Activity levels were more important than diet in determining weight loss after pregnancy. The lower the socio-economic group, and the higher the pre-pregnancy BMI, the biceps to costal ratio, the older the women, and the more pregnancies she had had, the greater the weight gain post pregnancy. Of the significant nutrients high fructose intakes (high fruit juice and carbonated bevera ge) and high saturated fatty acid intakes (high fatty meat, dairy product, cake and biscuit intake) were the most important indicators of weight gain.

  • 10. There were many more heavy babies at birth and 1 year (> 97th percentile) than one would expect when compared with the NCHS growth curves.

    11. Highly significant positive influences on birthweight included pre-pregnancy BMI, the number of recent pregnancies, and zinc intake. Highly significant negative influences included the biceps to costal skinfold ratio, the length of time spent sleeping and lying, smoking, high wholegrain and high tea intakes (high manganese) and high animal protein intakes (high S).

    12. Highly significant positive influences on growth in terms of weight for height at one year included; the sex of the baby, its birthweight, weight gain to 6 weeks and monounsaturated fatty acid and Vitamin E intake of the mother during pregnancy. Highly significant negative influences on growth at one year included the length of breastfeeding and polyunsaturated fatty acid and cholesterol intake of the mother during pregnancy. Whether these effects of maternal nutrition intake during pregnancy on growth at one year are a result of some influence of maternal diet on the foetus itself, or an indicator of the type of weaning food fed the infant cannot be determined.

  • CONTENTS

    1. Objectives. 1

    2. Introduction . 1

    3. Methods ................................. ................................................................................. 2 3.1 Pilot Studies Completed...............................................................................2 3.2 Techniques of Data Collection......................................................................3 3.3 Data Collection Programme........................................................................4 3.4 Ethical Approval..........................................................................................4 3 .5 Subjects ................................................................................. ........................ 5

    4. Cultural and Socio-Economic Background of Subjects...................................6 4 . 1 Results........................................................................................................... 6 4.2 Discussion of Results.....................................................................................8

    5. Body Weight and Body Fat Levels of Subjects..................................................9 5.1 Methods of Analysis......................................................................................9 5.2 Results .......................................................................................................... JO 5.3 Discussion of Results .................................................................................... 11

    6. Dietary Intake of Subjects ................................................................................... 16 6.1 Methods of Analysis...................................................................................... 16 6.2 Results..........................................................................................................16 6.3 Discussion of Results ..................................................................................... 23

    7. Effect of Socio-Economic Group on Dietary Intake of the Mother, and Anthropometric Measurements of Mother and Baby..............................25 7.1 Methods of Analysis......................................................................................25 7.2 Results..........................................................................................................26 7.3 Discussion of Results....................................................................................26

    S. Factors that Influence the Loss of Fat Accumulated During Pregnancy 30 8.1 Methods of Analysis ...................................................................................... 30 8.2 Results........................................................................................................... 8.3 Discussion of Results ....................................................................................39

  • 9. Infant Measurements from Birth to One Year 50 9.1 Methods of Analysis......................................................................................50 9.2 Results..........................................................................................................50 9.3 Discussion of Results....................................................................................54

    10. Influences on Babies Birthweight ..................................................................... 55 10.1 Methods of Analysis......................................................................................55 10.2 Results .......................................................................................................... 55 10.3 Discussion of Results....................................................................................60

    11. Influences on Infant Growth at One Year........................................................71 11.1 Methods of Analysis....................................................