Dietary Diversity is Low and Associated with Nutritional Status of Women in Early Pregnancy in Rural Bangladesh
Rolf Klemm *
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Abu Ahmed Shamim
The JiVitA Project, Johns Hopkins University, Gaibanda, Bangladesh.
Saijuddin Shaikh
The JiVitA Project, Johns Hopkins University, Gaibanda, Bangladesh.
Hasmot Ali
The JiVitA Project, Johns Hopkins University, Gaibanda, Bangladesh.
Kerry Schulze
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Parul Christian
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Alain Labrique
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Keith West
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
*Author to whom correspondence should be addressed.
Abstract
Objectives: To evaluate the association between nutritional status and other risk factors with dietary diversity in the 1st trimester of pregnancy among women in rural Bangladesh.
Methods: A cross-sectional analysis of data among women enrolled during the 1st trimester of pregnancy into the JiVitA-1 weekly vitamin A or beta-carotene supplementation trial in rural Bangladesh from 2001 to 2007. A dietary diversity score (DDS) based on 9-conventionally defined food groups was calculated based on data collected from a 7-day food frequency questionnaire. Mid-upper arm circumference (MUAC) from the main trial (n=67,690), and BMI and serum markers of micronutrient status from a substudy (n=1,869) of women were used as indicators of maternal nutritional status. Other individual, household and seasonality factors were examined for their association with DDS, and as potential confounders in the association between DDS and maternal nutritional status.
Results: Overall mean (sd) DDS was low at 2.1 (1.1) (Max. Score=9). In a multivariate model, selected individual (maternal education, being a wage earner, and selected morbidity symptoms), household (living standard index, smaller household size, food security, and ownership of a fruit grove, home garden or fish pond) factors and seasonality (non-lean season) were positively associated with maternal DDS. Maternal MUAC, BMI and serum levels of lycopene (biomarker for vegetable/fruit intake) were also associated with DDS.
Conclusions: In this rural setting of northern Bangladesh, dietary diversity is low and maternal nutritional status is poor. Dietary diversity, measured by a simple score summed over one week, was positively associated with maternal nutritional status in early pregnancy.