Department of Nutrition and Dietetics
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Item Late-pregnancy salivary cortisol concentrations of Ghanaian women participating in a randomized controlled trial of prenatal lipid-based nutrient supplements(American Society for Nutrition, 2016) Oaks, B.M.; Laugero, K.D.; Stewart, C.P.; Adu-Afarwuah, S.; Lartey, A.; Ashorn, P.; Vosti, S.A.; Dewey, K.G.Background: High circulating cortisol is associated with miscarriage, preterm birth, and low birth weight. Research in nonpregnant individuals suggests that improved nutrition may lower cortisol concentrations. It is unknown whether nutritional supplementation during pregnancy lowers cortisol. Objective: Our objective was to determine whether women receiving a lipid-based nutrient supplement (LNS) throughout pregnancy would have lower salivary cortisol at 36 wk gestation compared with women receiving other nutrient supplements. Methods: We conducted a randomized controlled trial in 1320 pregnant Ghanaian women at ≤20 wk gestation who were assigned to receive daily throughout pregnancy: 1) 60 mg iron + 400 mg folic acid (IFA), 2) multiple micronutrients (MMNs), or 3) 20 g LNS (containing 118 kcal, 22 micronutrients, and protein). Morning salivary cortisol was collected from a subsample at baseline and at 28 and 36 wk gestation. Results: A total of 758 women had cortisol measurements at 28 or 36 wk gestation. Salivary cortisol at 36 wk gestation did not differ between groups and was (mean ± SE) 7.97 ± 0.199 in the IFA group, 7.84 ± 0.191 in theMMN group, and 7.77 ± 0.199 nmol/L in the LNS group, when adjusted for baseline cortisol, time of waking, and time between waking and saliva collection (P = 0.67). Therewas an interaction between supplementation group andwomen's age (continuous variable, P-interaction = 0.03); and when agewas dichotomized by themedian, significant differences in salivary cortisol concentrations between groups were seen in women≤26 y of age (IFA = 8.23 ± 0.284 nmol/L, MMN= 8.20 ± 0.274 nmol/L, and LNS = 7.44 ± 0.284 nmol/L; P = 0.03) but not in women > 26 y old (IFA = 7.71 ± 0.281 nmol/L, MMN = 7.50 ± 0.274 nmol/L, and LNS = 8.08 ± 0.281 nmol/L; P = 0.13). Conclusions: We conclude that supplementation with LNSs or MMNs during pregnancy did not affect the cortisol concentration in the study population as a whole, in comparison with IFA, but that LNS consumption among younger women may lead to lower cortisol at 36 wk gestation. This trial was registered at clinicaltrials.gov as NCT00970866. © 2016 American Society for Nutrition.Item Breakfast habits among school children in selected communities in the eastern region of Ghana(Ghana medical journal, 2014-06) Intiful, F.D.; Lartey, A.Breakfast is considered the most important meal of the day, yet many people skip breakfast. Studies indicate that school age children who regularly skip breakfast are not likely to concentrate in class, thus affecting school performance. This study determined the breakfast habits and nutrient contributions of the breakfast meal to the days' nutrient intake. A cross sectional study was conducted among school children (n=359) between the ages of 6-19 years in Manya Krobo in the Eastern Region of Ghana. Questionnaires were used to collect information on background characteristics and breakfast consumption habits. The 24-hour dietary recall method was used to obtain information on the children's food intake. T-test was used to compare differences between means of variables of breakfast consumers and skippers. About 85.5% of the children had breakfast on the day of interview. More boys (87.8%) consumed breakfast compared to the girls (83.1%). For those who skipped breakfast, lack of food at home or lack of no money (36.5%) was the main reason. Breakfast consumers had significantly higher energy and nutrient intakes than those who skipped breakfast (energy 2259 verses 1360 kcal, p-0.039; vitamin A 1534 verses 662 ug/RE, p=0.001; iron 22.9 verses 13.9 mg, p=0.017, zinc 9.9 verses 5.6 mg, p=0.034). The breakfast meal contributed between 32-41% of the day's energy intake, and between 30-47% of micronutrient intake. Encouraging breakfast consumption among school children is a way to ensure that they meet their daily nutrient and energy intakes.Item A mixed method study exploring adherence to and acceptability of small quantity lipid-based nutrient supplements (SQ-LNS) among pregnant and lactating women in Ghana and Malawi(BioMed Central Ltd., 2016) Klevor, M.K.; Adu-Afarwuah, S.; Ashorn, P.; Arimond, M.; Dewey, K.G.; Lartey, A.; Maleta, K.; Phiri, N.; Pyykkö, J.; Zeilani, M.; Ashorn, U.Background: Supplementing pregnant and lactating mothers with small quantity lipid-based nutrient supplements (SQ-LNS) has resulted in improvements in birth outcomes in some low-income settings. In order to be effective, SQ-LNS must be consumed regularly over sustained periods. Methods: The objective was to assess and compare acceptability of and adherence to SQ-LNS consumption among pregnant and lactating women in Ghana and Malawi throughout 12 months of supplementation. We enrolled women before 20 gestation weeks into randomized trials in Ghana (n=1320) and Malawi (n=869). In the SQ-LNS group participants received a 20 g sachet of supplement per day during pregnancy and the first 6 months of lactation. In the control groups participants received multiple micronutrients (MMN) during pregnancy and lactation or iron and folic acid (IFA) during pregnancy and calcium during lactation. We used questionnaires to collect data on self-reported adherence to daily use of supplements and conducted in-depth interviews with women in the SQ-LNS group to examine acceptability. Results: The mean self-reported adherence during the supplementation period was lower in Ghana (79.9 %) than in Malawi (91.7 %) for all supplements (difference 11.8 %, P<0.001). Over time, adherence increased in Malawi but decreased in Ghana. In both countries, adherence in the SQ-LNS group was non-inferior to that in the control groups. Participants typically reported consuming SQ-LNS as instructed but when interviewers queried about experiences, most of the women described incidents of non-adherence. A usual reason for not consuming SQ-LNS was nausea and vomiting during pregnancy. Especially in Malawi, women reported sharing SQ-LNS with families and friends. Sustained use of SQ-LNS was attributed to expected health benefits and favorable sensory attributes. Often women compared their pregnancy to previous ones, and were of the view that SQ-LNS made a positive difference. Conclusion: Self-reported sustained adherence to consume SQ-LNS daily was high in both sites but lower in Ghana than in Malawi. In Ghana, adherence decreased over time whereas in Malawi adherence increased. Acceptability and adherence appeared interlinked, complex and context-related. Sustained consumption of SQ-LNS may require tailoring interventions by context. Trial registration: The Ghana trial was registered at clinicaltrials.gov as NCT00970866, and the Malawi trial as NCT01239693.Item Appetitive and dietary effects of consuming an energy-dense food (peanuts) with or between meals by snackers and non-snackers.(Hindawi Publishing Corporation, 2011) Devitt, A.A.; Kuevi, A.; Coelho, S.B.; Lartey, A.; Lokko, P.; Costa, N.; Bressan, J.; Mattes, R.D.Background. Energy-dense foods are inconsistently implicated in elevated energy intake (EI). This may stem from other food properties and/or differences in dietary incorporation, that is, as snacks or with meals. Objective. Assess intake pattern and food properties on acute appetitive ratings (AR) and EI. Design. 201 normal and overweight adults consuming a standard lunch. Test loads of 1255.2 kJ (300 kcal) were added to the lunch or provided as snack. Loads (peanuts, snack mix, and snack mix with peanuts) were energy, macronutrient, and volumetrically matched with a lunch portion as control. Participants completed meal and snack sessions of their randomly assigned load. Results. No differences were observed in daily EI or AR for meal versus snack or treatment versus control. Consumption of peanuts as a snack tended to strengthen dietary compensation compared to peanuts or other loads with a meal. Conclusions. Inclusion of an energy-dense food as a snack or meal component had comparable influence on AR and EI. Peanuts tended to elicit stronger dietary compensation when consumed as a snack versus with a meal. If substantiated, this latter observation suggests that properties other than those controlled here (energy, macronutrient content, and volume) modify AR and EI.