Browsing by Author "Jorgensen, J.M."
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Item Consumption of multiple micronutrients or small-quantity lipid-based nutrient supplements containing iodine at the recommended dose during pregnancy, compared with iron and folic acid, does not affect women’s urinary iodine concentration in rural Malawi: a secondary outcome analysis of the iLiNS DYAD trial(Public Health Nutrition, 2021) Adu-Afarwuah, S.; Arnold, C.D.; Maleta, K.; Ashorn, P.; Ashorn, U.; Jorgensen, J.M.; Fan, Y.; Nkhoma, M.; Bendabenda, J.; Matchado, A.; Dewey, K.G.Objectives: Inadequate iodine intake during pregnancy increases the risk of neo natal morbidity and mortality. We aimed to evaluate whether prenatal supplements containing iodine affect urinary iodine concentrations (UIC) of pregnant women in Malawi. Design: A randomised controlled trial. Pregnant women (n 1391) were assigned to consume 60 mg/d Fe and 400 μg/d folic acid (IFA) or 18 vitamins and minerals including 250 μg/d iodine (MMN) or 20 g/d small-quantity lipid-based nutrient sup plements (SQ-LNS) with similar nutrient contents as MMN group, plus macronu trients (LNS) until childbirth. In a sub-study (n 317), we evaluated group geometric mean urinary iodine concentration (UIC) (μg/L) at 36 weeks of gestation controlling for baseline UIC and compared median (baseline) and geometric mean (36 weeks) UIC with WHO cut-offs: UIC < 150, 150–249, 250–499 and ≥500 reflect ing insufficient, adequate, above requirements and excessive iodine intakes, respectively. Setting: Mangochi District, Malawi. Participants: Women ≤20 weeks pregnant. Results: Groups had comparable background characteristics. At baseline, overall median (Q1, Q3) UIC (319 (167, 559)) suggested iodine intakes above require ments. At 36 weeks, the geometric mean (95 % CI) UIC of the IFA (197 (171, 226)), MMN (212 (185, 243)) and LNS (220 (192, 253)) groups did not differ (P = 0·53) and reflected adequate intakes. Conclusions: In this setting, provision of supplements containing iodine at the rec ommended dose to pregnant women with relatively high iodine intakes at base line, presumably from iodised salt, has no impact on the women’s UIC. Regular monitoring of the iodine status of pregnant women in such settings is advisable. Clinicaltrials.gov identifier: NCT01239693.Item Prenatal Iron Deficiency and Replete Iron Status Are Associated with Adverse Birth Outcomes, but Associations Differ in Ghana and Malawi(Journal of Nutrition, 2019-03) Oaks, B.M.; Jorgensen, J.M.; Baldiviez, L.M.; Adu-Afarwuah, S.; Maleta, K.; Okronipa, H.; Sadalaki, J.; Lartey, A.; Ashorn, P.; Ashorn, U.; Vosti, S.; Allen, L.H.; Dewey, K.G.Background:Previous literature suggests a U-shaped relation between hemoglobin concentration and adverse birthoutcomes. There is less evidence on associations between iron status and birth outcomes.Objective:Our objective was to determine the associations of maternal hemoglobin concentration and iron status withbirth outcomes.MethodsWe conducted a secondary data analysis of data from 2 cohorts of pregnant women receiving iron-containingnutritional supplements (20–60 mg ferrous sulfate) in Ghana (n=1137) and Malawi (n=1243). Hemoglobin concentrationand 2 markers of iron status [zinc protoporphyrin and soluble transferrin receptor (sTfR)] were measured at≤20 weeksand 36 weeks of gestation. We used linear and Poisson regression models and birth outcomes included preterm birth(PTB), newborn stunting, low birth weight (LBW), and small-for-gestational-age.Results:Prevalence of iron deficiency (sTfR>6.0 mg/L) at enrollment was 9% in Ghana and 20% in Malawi. In earlypregnancy, iron deficiency was associated with PTB (9% compared with 17%, adjusted RR: 1.63; 95% CI: 1.14, 2.33)and stunting (15% compared with 23%, adjusted RR: 1.44; 95% CI: 1.09, 1.94) in Malawi but not Ghana, and was notassociated with LBW in either country; replete iron status (sTfR<10th percentile) was associated with stunting (9%compared with 15%, adjusted RR: 1.71; 95% CI: 1.06, 2.77) in Ghana, but not PTB or LBW, and was not associated withany birth outcomes in Malawi. In late pregnancy, iron deficiency was not related to birth outcomes in either country andiron-replete status was associated with higher risk of LBW (8% compared with 16%, adjusted RR: 1.90; 95% CI: 1.17,3.09) and stunting (6% compared with 13%, adjusted RR: 2.14; 95% CI: 1.21, 3.77) in Ghana, but was not associatedwith birth outcomes in Malawi.Conclusions:The associations of low or replete iron status with birth outcomes are population specific. Research toreplicate and extend these findings would be beneficial. These trials were registered atclinicaltrials.govas NCT00970866(Ghana) and NCT01239693 (Malawi).J Nutr2019;149:513–521.Item Small-Quantity Lipid-Based Nutrient Supplements Do Not Affect Plasma or Milk Retinol Concentrations Among Malawian Mothers, or Plasma Retinol Concentrations among Young Malawian or Ghanaian Children in Two Randomized Trials(The Journal of Nutrition Community and International Nutrition, 2021) Haskell, M.J.; Young, R.; Adu-Afaruwah, S.; Lartey, A.; Okronipa, H.E.T.; Maleta, K.; Ashorn, U.; Jorgensen, J.M.; Fan, Y-M.; Arnold, C.D.; Allen, L.H.; Ashorn, P.; Dewey, K.G.Background: Vitamin A (VA) deficiency is prevalent in preschool-aged children in sub-Saharan Africa. Objectives: We assessed the effect of small-quantity lipid-based nutrient supplements (SQ-LNS) given to women during pregnancy and lactation and their children from 6 to 18 mo of age on women’s plasma and milk retinol concentrations in Malawi, and children’s plasma retinol concentration in Malawi and Ghana. Methods: Pregnant women (≤20 wk of gestation) were randomized to receive daily: 1) iron and folic acid (IFA) during pregnancy only; 2)multiplemicronutrients (MMN; 800 μg retinol equivalent (RE)/capsule), or 3) SQ-LNS (800 μg RE/20g) during pregnancy and the first 6 mo postpartum. Children of mothers in the SQ-LNS group received SQ-LNS (400 μg RE/20 g) from 6 to 18 mo of age; children of mothers in the IFA and MMN groups received no supplement. Plasma retinol was measured in mothers at ≤20 and 36 wk of gestation and 6 mo postpartum, and in children at 6 and 18 mo of age. Milk retinol was measured at 6 mo postpartum. VA status indicators were compared by group. Results: Among Malawian mothers, geometric mean (95% CI) plasma retinol concentrations at 36 wk of gestation and 6 mo postpartum were 0.97 μmol/L (0.94, 1.01 μmol/L) and 1.35 μmol/L (1.31, 1.39 μmol/L), respectively; geometric mean (95% CI) milk retinol concentration at 6 mo postpartum was 1.04 μmol/L (0.97, 1.13 μmol/L); results did not differ by intervention group. Geometric mean (95% CI) plasma retinol concentrations for Malawian children at 6 and 18 mo of age were 0.78 μmol/L (0.75, 0.81 μmol/L) and 0.81 μmol/L (0.78, 0.85 μmol/L), respectively, and for Ghanaian children they were 0.85 μmol/L (0.82, 0.88 μmol/L) and 0.88 μmol/L (0.85, 0.91 μmol/L), respectively; results did not differ by intervention group in either setting. Conclusions: SQ-LNS had no effect on VA status of mothers or children, possibly because of low responsiveness of the VA status indicators. J Nutr 2021;151:1029–1037.