Journal Articles
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Item Food Group Consumption and Nutrient Intake by Breastfeeding Women: Comparison to Current Dietary Guidelines and Nutrient Recommendations.(MDPI (Basel, Switzerland), 2025-01-21) Jin Y; Coad J; Brough L; Billeaud C; Asher OBACKGROUND/OBJECTIVES: Optimal nutrition is essential for the health of breastfeeding women and their infants. This study aimed to assess food and nutrient intake and alignment with nutrition guidelines for breastfeeding women living in New Zealand. METHODS: Seventy-six breastfeeding women were enrolled in the longitudinal Mother and Infant Nutrition Investigation study and completed a weighed four-day diet diary including supplement use at three months postpartum. The number of servings consumed for each food group were calculated based on the 2020 Eating and Activity Guidelines for New Zealand Adults. Nutrient intakes were compared to the nutrient reference values for Australia and New Zealand. RESULTS: Overall, the percentages of women who met the recommended number of servings for fruits, vegetables, grain foods, meats and milk/milk products were 25%, 0%, 5%, 34%, and 13%, respectively. None of women met the current recommendations for all food groups. Many participants had intakes below the estimated average requirement or adequate intake and were at risk of nutrient inadequacy for vitamin E (55%), vitamin D (53%), manganese (61%), and selenium (55%). CONCLUSIONS: Breastfeeding women had a low alignment with the current dietary guidelines and were at risk of an inadequate intake of vitamin E, D, manganese, and selenium. Research to investigate the barriers and enablers of healthy food choices is needed.Item Portable X-ray fluorescence of zinc and selenium with nail clippings-Mother and Infant Nutrition Investigation (MINI).(PLOS, 2024-10-23) Fleming DEB; Madani N; Kaiser MG; Kim JS; Keltie E; Drage N; Jin Y; Coad J; Brough L; Specht AZinc and selenium are essential minerals for human nutrition. Reliable biomarkers of zinc status and selenium status in humans are therefore important. This work investigates a novel portable X-ray fluorescence (XRF) method with the ability to rapidly assess zinc and selenium in nail clippings. This approach used a mono-energetic X-ray beam to excite characteristic X-rays from the clippings. Nail clippings were obtained from the Mother and Infant Nutrition Investigation (MINI), a study designed to assess nutrition in a population of women and their breastfed children in New Zealand. Twenty mother-infant pairings were selected to provide nail clippings at two time points (visit 1 at 3 months postpartum; visit 2 at 6 months postpartum). Nail clippings from each mother-infant pairing were divided into three groupings of clippings prior to analysis: those obtained from a big toe of the mother, those from the other toes of the mother, and those from the toes and fingers of the infant. Clippings were prepared and mounted prior to XRF measurement, providing four distinct fragments from each clipping grouping. These fragments were assessed by XRF using a measurement time of either 300 s (visit 1) or 180 s (visit 2). XRF results were determined through both an automated system output and an analysis of the X-ray energy spectrum. Following this assessment of zinc and selenium with the non-destructive XRF method, clippings were measured for zinc and selenium concentration using a "gold standard" technique of inductively coupled plasma mass spectrometry (ICP-MS). Mean ICP-MS concentrations ranged from 122 μg/g to 127 μg/g for zinc, and from 0.646 μg/g to 0.659 μg/g for selenium. Precision, assessed by a relative standard deviation of measurement, was superior for ICP-MS relative to XRF. For both zinc and selenium, XRF results were compared with ICP-MS concentrations. Linear equations of best fit were determined for each comparison between XRF and ICP-MS results. Coefficients of determination (r2) were stronger for zinc (from 0.74 to 0.95) than selenium (from 0.53 to 0.70). A decrease in XRF measurement time from 300 s to 180 s did not appear to adversely affect the correlation between XRF and ICP-MS results. Using the mono-energetic portable XRF method, the correlation of XRF zinc results with ICP-MS zinc concentrations was improved over previous findings, and selenium measurement was reported for the first time. The method may prove useful for future applications to trace element analysis using nail clippings as a biomarker.Item Predictors for achieving adequate antenatal care visits during pregnancy: a cross-sectional study in rural Northwest Rwanda(BioMed Central Ltd, 2023-01-26) Dusingizimana T; Ramilan T; Weber JL; Iversen PO; Mugabowindekwe M; Ahishakiye J; Brough LBACKGROUND: Inadequate antenatal care (ANC) in low-income countries has been identified as a risk factor for poor pregnancy outcome. While many countries, including Rwanda, have near universal ANC coverage, a significant proportion of pregnant women do not achieve the recommended regimen of four ANC visits. The present study aimed to explore the factors associated with achieving the recommendation, with an emphasis on the distance from household to health facilities. METHODS: A geo-referenced cross-sectional study was conducted in Rutsiro district, Western province of Rwanda with 360 randomly selected women. Multiple logistic regression analysis including adjusted odd ratio (aOR) were performed to identify factors associated with achieving the recommended four ANC visits. RESULTS: The majority (65.3%) of women had less than four ANC visits during pregnancy. We found a significant and negative association between distance from household to health facility and achieving the recommended four ANC visits. As the distance increased by 1 km, the odds of achieving the four ANC visits decreased by 19% (aOR = 0.81, P = 0.024). The odds of achieving the recommended four ANC visits were nearly two times higher among mothers with secondary education compared with mothers with primary education or less (aOR = 1.90, P = 0.038). In addition, mothers who responded that their household members always seek health care when necessary had 1.7 times higher odds of achieving four ANC visits compared with those who responded as unable to seek health care (aOR = 1.7, P = 0.041). Furthermore, mothers from poor households had 2.1 times lower odds of achieving four ANC visits than mothers from slightly better-off households (aOR = 2.1, P = 0.028). CONCLUSIONS: Findings from the present study suggest that, in Rutsiro district, travel distance to health facility, coupled with socio-economic constraints, including low education and poverty can make it difficult for pregnant women to achieve the recommended ANC regimen. Innovative strategies are needed to decrease distance by bringing ANC services closer to pregnant women and to enhance ANC seeking behaviour. Interventions should also focus on supporting women to attain at least secondary education level as well as to improve the household socioeconomic status of pregnant women, with a particular focus on women from poor households.Item Saccharomyces cerevisiae Yeast-Based Supplementation as a Galactagogue in Breastfeeding Women? A Review of Evidence from Animal and Human Studies(MDPI (Basel, Switzerland), 2021-03) Jia LL; Brough L; Weber JL; Demmelmair HPerceived insufficient milk production (PIM) adversely affects breastfeeding duration. Women sometimes use galactagogues with the intent to increase breast milk production and support lactation. Saccharomyces cerevisiae yeast-based supplement (SCYS) is an inactive form of Saccharomyces cerevisiae yeast (SCY) either obtained from the fermentation process or grown on molasses. Anecdotal evidence suggests SCYS is a galactagogue. SCYS is promoted on the internet as a galactagogue in various forms and doses. Dietary supplementation with SCYS during gestation and lactation significantly increases milk yield in ruminants. No human study has evaluated efficacy of SCYS as a galactagogue. SCYS is rich in B vitamins, beta-glucan, mannan oligosaccharides and bioavailable chromium; these may impact breast milk production or composition, thus may alleviate PIM. The safety of taking SCYS during lactation is not well studied. Studies have reported contamination of SCYS with ochratoxin A (OTA) as well as minor side effects from SCYS. Studies are needed to evaluate the efficacy of SCYS on breast milk production and composition and to assess the safety of taking SCYS during lactation in humans.Item A Mixed-Methods Study of Factors Influencing Access to and Use of Micronutrient Powders in Rwanda(Johns Hopkins Center for Communication Programs, 2021-06-30) Dusingizimana T; Weber JL; Ramilan T; Iversen PO; Brough LThe World Health Organization recommends point-of-use fortification with multiple micronutrients powder (MNP) for foods consumed by children aged 6-23 months in populations where anemia prevalence among children under 2 years or under 5 years of age is 20% or higher. In Rwanda, anemia affects 37% of children under 5 years. The MNP program was implemented to address anemia, but research on factors affecting the implementation of the MNP program is limited. We conducted a mixed-methods study to examine the factors influencing access to and use of MNP among mothers (N=379) in Rutsiro district, northwest Rwanda. Inductive content analysis was used for qualitative data. Logistic regression analysis was used to determine factors associated with the use of MNP. Qualitative results indicated that the unavailability of MNP supplies and distribution issues were major barriers to accessing MNP. Factors influencing the use of MNP included mothers' perceptions of side effects and health benefits of MNP, as well as inappropriate complementary feeding practices. Mothers of older children (aged 12-23 months) were more likely to use MNP than those of younger children (aged 6-11 months) (adjusted odds ratio [aOR]=3.63, P<.001). Mothers whose children participated in the supplementary food program were nearly 3 times more likely to use MNP than those whose children had never participated in the program (aOR=2.84, P=.001). Increasing household hunger score was significantly associated with lower odds of using MNP (aOR=0.80, P=.038). Mechanisms to monitor MNP supply and program implementation need to be strengthened to ensure mothers have access to the product. MNP program implementers should address gaps in complementary feeding practices and ensure mothers have access to adequate complementary foods. L'Organisation Mondiale de la Santé recommande l'enrichissement de l'alimentation à domicile (enrichissement sur le point d'utilisation) à l'aide des poudres de micronutriments multiples (PMN) pour les aliments consommés par les enfants âgés de 6 à 23 mois dans les populations où la prévalence de l'anémie chez les enfants de moins de 2 ans ou 5 ans est de 20% ou plus. Au Rwanda, l'anémie touche 37% des enfants de moins de 5 ans et le programme de PMN a été mis en œuvre pour lutter contre l'anémie. Cependant, la recherche sur les facteurs qui affectent la mise en œuvre du programme de PMN est limitée. Nous avons mené une étude par méthodes mixtes pour examiner les facteurs qui influencent l'accès des mères (n=379) à la PMN et son utilisation dans le district de Rutsiro, au nord-ouest du Rwanda. L'analyse du contenu inductif a été utilisée pour les données qualitatives. Pour déterminer les facteurs associés à l'utilisation des PMN, une régression logistique a été utilisée. Les résultats qualitatifs ont indiqué que l'indisponibilité des approvisionnements en PMN et les problèmes de distribution constituaient des obstacles majeurs à l'accès à la PMN. Les facteurs qui influencent l'utilisation des PMN comprenaient les perceptions, chez les mères, des effets secondaires et des avantages des PMN pour la santé, ainsi que des pratiques d'alimentation complémentaire inappropriées. Les mères d'enfants plus âgés (12 à 23 mois) étaient plus susceptibles d'utiliser la PMN que celles d'enfants plus jeunes (6 à 11 mois) (odds ratio ajusté [ORA]=3,63, P<0,001). Les mères des enfants qui avaient participé au programme d'alimentation complémentaire étaient près de 3 fois plus susceptibles d'utiliser la PMN que celles des enfants qui n'avaient jamais participé au programme (ORA=2,84, P=0,001). L'augmentation du score de faim dans les ménages était significativement associée à des chances plus faibles d'utiliser la PMN (ORA=0,80, P=0,038). Les mécanismes de suivi de l'approvisionnement en PMN et de la mise en œuvre du programme doivent être renforcés pour s'assurer que les mères ont accès au produit. Les responsables de la mise en œuvre du programme de PMN devraient combler les lacunes au niveau des pratiques d'alimentation complémentaire et veiller à ce que les mères aient accès à des aliments complémentaires adéquats.Item Do Micronutrient and Omega-3 Fatty Acid Supplements Affect Human Maternal Immunity during Pregnancy? A Scoping Review(MDPI (Basel, Switzerland), 2022-01-15) Rees G; Brough L; Orsatti GM; Lodge A; Walker S; Pérez-Cano FJMaternal dietary micronutrients and omega-3 fatty acids support development of the fetal and neonatal immune system. Whether supplementation is similarly beneficial for the mother during gestation has received limited attention. A scoping review of human trials was conducted looking for evidence of biochemical, genomic, and clinical effects of supplementation on the maternal immune system. The authors explored the literature on PubMed, Cochrane Library, and Web of Science databases from 2010 to the present day using PRISMA-ScR methodology. Full-length human trials in English were searched for using general terms and vitamin A, B12, C, D, and E; choline; iodine; iron; selenium; zinc; and docosahexaenoic/eicosapentaenoic acid. Of 1391 unique articles, 36 were eligible for inclusion. Diverse biochemical and epigenomic effects of supplementation were identified that may influence innate and adaptive immunity. Possible clinical benefits were encountered in malaria, HIV infections, anemia, Type 1 diabetes mellitus, and preventing preterm delivery. Only limited publications were identified that directly explored maternal immunity in pregnancy and the effects of micronutrients. None provided a holistic perspective. It is concluded that supplementation may influence biochemical aspects of the maternal immune response and some clinical outcomes, but the evidence from this review is not sufficient to justify changes to current guidelines.