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Dietary pattern and nutritional status among lactating women in North Karnataka

Women from low-income settings are considered as nutritionally vulnerable. This risk is augmented during pregnancy and lactation as food nutrient requirement increases. Lactating mothers are subjected to nutritional stresses which are further exaggerated by frequent pregnancies resulting in high maternal mortality and health risk for children. As per the World Health Organization, the nutritional status of women of reproductive age is important, as effects of undernutrition are propagated to future generations. More than one-third of Indian women in the reproductive age group are in a state of chronic nutritional deficiency during the preconception period leading to poor health and likely resulting in low birth weight babies. Attainment of millennium development goals (MDG) by our country is largely dependent on the health of mothers and children, which in turn is influenced by diet. Finally, a women’s health affects the household economic well-being, and as a woman with poor health will be less productive in the labor force. While malnutrition is prevalent among all ABSTRACT


INTRODUCTION
Women from low-income settings are considered as nutritionally vulnerable. 1 This risk is augmented during pregnancy and lactation as food nutrient requirement increases. Lactating mothers are subjected to nutritional stresses which are further exaggerated by frequent pregnancies resulting in high maternal mortality and health risk for children. As per the World Health Organization, the nutritional status of women of reproductive age is important, as effects of undernutrition are propagated to future generations. More than one-third of Indian women in the reproductive age group are in a state of chronic nutritional deficiency during the preconception period leading to poor health and likely resulting in low birth weight babies. 2 Attainment of millennium development goals (MDG) by our country is largely dependent on the health of mothers and children, which in turn is influenced by diet. Finally, a women's health affects the household economic well-being, and as a woman with poor health will be less productive in the labor force. While malnutrition is prevalent among all segments of the population, poor nutrition among women begins infancy and continues throughout their lifetime. 3 It is reported that a lactating woman should produce about 700 to 800 ml of milk per day and this requires an extra energy need of about 500 calories per day. Women who are Severely malnourished have reduced lactation performance, thus, the quantity of milk produced depends a lot on the mother's diet. 4 The diet consumed by the mother will not only fulfill her own nutritional needs but will also enable her to produce enough milk for her infant. 5 Energy or calorie needs during lactation are based upon the women's basal metabolic rate, age, activity, how much breast milk is being produced, and other factor. While calorie is needed for milk production, the mother does not need to eat substantially more than she did in her pre-pregnancy state to sustain milk production. 6

Objectives
The objective of the study was to assess the nutritional status and associated factors of lactating women and to assess diet pattern of lactating women.

Study design:
Population based cross sectional study.

Study setting
Urban field practice area of SDM College of Medical Sciences and Hospital Dharwad, Karnataka, India.

Study participants
Lactating mothers (15-49 years) who gives consent for participating in the study, Urban field practice area of SDM College of Medical Sciences and Hospital Dharwad, Karnataka, India.

Data collection
House to house visit in the urban field practice area of SDMCMSH, Dharwad, using pre tested, semi structured questionnaire. Lactating women were examined for anthropometric measurement included recording of weight and height, and dietary pattern using 24 hours recall method in which respondent was asked to name approximate amounts the foods eaten during the previous day at each meal and between meals. The questionnaire covered demographic characteristics of the subjects. These are namely age, sex, occupation, education religious type of family and marital status.

Sample size
Taking prevalence of malnutrition among lactating mothers (15-49 years) as 50, sample size was calculated to be 100 using n=4pq/d×d. Total line list of lactating mothers in the urban field practice area was collected from ICDS teachers, out of total 400 lactating mother line list 100 were selected using systematic sampling method every 4 th lactating mothers were selected.

Study duration
Three-month July 2014 to September2014.

Data analysis
The data was entered using Epi data, version 3.1 and analyzed using the statistical package for social sciences (SPSS), version 20.
Descriptive statistics like percentages and proportions were applied. Chi-square test was applied to find out the association between two or more attributes. The one sample t-test is used to test the statistical difference between a sample mean and a known or hypothesized value of the mean in the population. A p value of <0.05 was considered to be the criteria for statistical significance SPSS 20.0. Table 2 shows the age wise distribution of study subjects, it was found that majority of study subjects were in the age group of 20-25 years 63%. Figure 1 shows in present study majority of study subject were in the BMI of <18.5 and 18.5-22.99. Figure 2 shows diet pattern of lactating women shows that more calories intake was seen during dinner when compare to breakfast.      Table 3 shows that when compare socio-demographic variables (occupation) with the nutritional status (BMI) was found to be statistically significant with (p=0.005).  6 In present study (BMI <18.5 kg/m 2 ) among the lactating mothers was 43%. Similar study conducted in Andhra Pradesh shows 60% and similar study conducted in Kashmir shows 45.5% and Similar study conducted in Ethiopia shows 25%. 1,9,10 Average calorie intake of lactating mother was 1896.09 kcal, study done by Malhotra et al shows average calorie intake of lactating women was 1986.8 kcal which was below the RDA i.e. 2425 kcal because they were not consuming proper food.6. Energy intakes of the lactating women in the study area (mean=1896.09 kcal/day) were less than the recommended nutrient (2500 kcal) Kashmir study shows 41.3% deficient caloric intakes 10 and Ethiopia study shows less than the recommended nutrient intakes. 1 Diet pattern of lactating women shows that more calories intake was seen during dinner when compare to breakfast.

RESULTS
When compare socio-demographic variables (occupation) with the nutritional status (BMI) of lactating mother was found to be statistically significant with (p=0.005). A study done by Veghari et al, shows that no correlation was observed between father's job and maternal BMI. 11 When compare with sample mean (1896.09 kcal) of lactating mother with recommended daily allowances of calorie intake i.e. 2500 kcal shows significant association with p value <0.001.
Limitations of this study were 24-hour recall method is used. Since it is a short-term retrospective method it is more prone to errors. No investigations or interventions used to find nutritional status of lactating mother. Protein micro and macro nutrients are not assessed

CONCLUSION
In present study majority of study subject were in the BMI of <18.5 and 18. 5-22.99. In this study average kcal intake of lactating mother 1896.09 kcal which was below the RDA i.e. 2500 kcal, using one sample t test when compare with sample mean (1896.09 kcal) with recommended daily allowances i.e. 2500 kcal significant association with p value <0.001 and comparing sociodemographic variables (occupation) with the nutritional status (BMI) was found to be statistically significant with (p=0.005). Diet pattern of lactating women shows that more calories intake was seen during dinner when compare to breakfast. Furthermore, research are required to determine protein, micro and macro nutrients deficiency.

Recommendations
• Effective nutritional education of families and communities is recommended to improve dietary practices and nutrition. • Furthermore, research is required to determine the factors impeding the transfer of health and nutrition education in to action research is required to determine protein, micro and macro nutrients deficiency. • As well as to assess the dietary adequacy of the lactating mothers in the study area.