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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2020

01-12-2020 | Malnutrition | Research article

Healthy pregnancies and essential fats: focus group discussions with Zambian women on dietary need and acceptability of a novel RUSF containing fish oil DHA

Authors: Catherine Chunda-Liyoka, Mwansa Ketty Lubeya, Mercy Imakando, Sophia Kisling, Sonoor Majid, Mary S. Willis, Charles Wood, Chipepo Kankasa, Concetta C. DiRusso

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

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Abstract

Background

Nut butter-based Ready to Use Supplemental Foods (RUSF) are an effective way to add nutrients and calories to diets of malnourished and food insecure populations. The RUSF formulations have been further modified to add micronutrients including iron and folic acid needed during pregnancy and lactation. Because docosahexaenoic acid (DHA, C22:6 n-3) enhances fetal development and birth outcomes, it has been suggested that perhaps RUSF formulations for pregnancy should also include this Omega 3 fatty acid. The goal of the present study was to gain an understanding of Zambian women’s knowledge of nutritional needs in pregnancy through structured focus group discussions, and to formulate and determine the acceptability of a RUSF with DHA.

Methods

Structured focus group sessions were conducted among women attending an antenatal clinic at the University Teaching Hospitals in Lusaka, Zambia. Dietary and nutrition knowledge was surveyed through structured dialogue that was recorded by audio and transcribed verbatim. An RUSF containing 400 mg DHA from fish oil in 50 g RUSF was designed and assessed for fatty acid content and product stability. Participants then sampled the RUSF-DHA, provided feedback on taste, and were surveyed about willingness to consume the novel formula using a standardized hedonic instrument.

Results

The participants’ knowledge of foods recommended for use in pregnancy included fruits, vegetables, meat, and fish. Most women reported eating fish at least once per week, although the specific type of fish varied. Most did not have prior knowledge of the importance of consuming fish during pregnancy or that some fish types were more nutritional than others as they included omega 3 fatty acids. The participants were uniformly accepting of the RUSF-DHA for the purpose of enhancing birth and developmental outcomes, but were critical of the aroma in hedonic testing.

Conclusions

Women were committed to consuming a healthy diet that would impact the outcome of pregnancy, and were receptive to advice on the importance of consuming foods such as fish as a source of DHA. The RUSF-DHA formulation was acceptable due to the potential benefits for the developing infant, however, the fishy odor may be limiting for long-term daily use.
Appendix
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Literature
1.
Central Statistical Office (CSO) [Zambia], Ministry of Health (MOH) [Zambia], and ICF International. Zambia Demographic and Health Survey 2013-14. Rockville: Central Statistical Office, Ministry of Health, and ICF International. 2014.
2.
Banda-Nyirenda D, Hüsken SMC, Kaunda W. Impact of nutrition and fish supplementation on the response to Anti Retroviral Therapy, Zambia. A literature review. Regional Programme Fisheries and HIV/AIDS in Africa: Investing in Sustainable Solutions. The WorldFish Center. Project Report 1985. 2009.
3.
Kelly P, Saloojee H, Chen JY, Chung RT. Noncommunicable diseases in HIV infection in low- and middle-income countries: gastrointestinal, hepatic, and nutritional aspects. J Acquir Immune Defic Syndr. 2014;67(Suppl 1):S79–86.PubMedPubMedCentralCrossRef
4.
5.
Marinda PA, Genschick S, Khayeka-Wandabwa C, Kiwanuka-Lubinda R, Thilsted SH. Dietary diversity determinants and contribution of fish to maternal and under-five nutritional status in Zambia. PLoS One. 2018;13(9):e0204009.PubMedPubMedCentralCrossRef
6.
Gitau R, Makasa M, Kasonka L, Sinkala M, Chintu C, Tomkins A, Filteau S. Maternal micronutrient status and decreased growth of Zambian infants born during and after the maize price increases resulting from the southern African drought of 2001-2002. Public Health Nutr. 2005;8(7):837–43.PubMedCrossRef
7.
Steiner-Asiedu M, Lied E, Lie Ø, Nilsen R, Julshamn K. The nutritive value of sun-dried pelagic fish from the rift valley in Africa. J Sci Food Agric. 1993;63(4):439–43.CrossRef
8.
Schoonees A, Lombard M, Musekiwa A, Nel E, Volmink J. Ready-to-use therapeutic food for home-based treatment of severe acute malnutrition in children from six months to five years of age. Cochrane Database Syst Rev. 2013;(6):Cd009000.
9.
de Pee S, Bloem MW. Current and potential role of specially formulated foods and food supplements for preventing malnutrition among 6- to 23-month-old children and for treating moderate malnutrition among 6- to 59-month-old children. Food Nutr Bull. 2009;30(3 Suppl):S434–63.PubMedCrossRef
10.
Chaparro CM, Dewey KG. Use of lipid-based nutrient supplements (LNS) to improve the nutrient adequacy of general food distribution rations for vulnerable sub-groups in emergency settings. Matern Child Nutr. 2010;6(Suppl 1):1–69.PubMedCrossRef
11.
12.
Lazzerini M, Rubert L, Pani P. Specially formulated foods for treating children with moderate acute malnutrition in low- and middle-income countries. Cochrane Database Syst Rev. 2013;6:CD009584.
13.
Arterburn LM, Hall EB, Oken H. Distribution, interconversion, and dose response of n-3 fatty acids in humans. Am J Clin Nutr. 2006;83(6 Suppl):1467S–76S.PubMedCrossRef
14.
Brenna JT, Carlson SE. Docosahexaenoic acid and human brain development: evidence that a dietary supply is needed for optimal development. J Hum Evol. 2014;77:99–106.PubMedCrossRef
15.
Innis SM. Impact of maternal diet on human milk composition and neurological development of infants. Am J Clin Nutr. 2014;99(3):734S–41S.PubMedCrossRef
16.
Mulder KA, King DJ, Innis SM. Omega-3 fatty acid deficiency in infants before birth identified using a randomized trial of maternal DHA supplementation in pregnancy. PLoS One. 2014;9(1):e83764.PubMedPubMedCentralCrossRef
17.
Bazzano AN, Potts KS, Bazzano LA, Mason JB. The life course implications of ready to use therapeutic food for children in low-income countries. Int J Environ Res Public Health. 2017;14(403):1–19.
18.
Brenna JT, Akomo P, Bahwere P, Berkley JA, Calder PC, Jones KD, Liu L, Manary M, Trehan I, Briend A. Balancing omega-6 and omega-3 fatty acids in ready-to-use therapeutic foods (RUTF). BMC Med. 2015;13:117.PubMedPubMedCentralCrossRef
19.
Halcomb EJ, Gholizadeh L, DiGiacomo M, Phillips J, Davidson PM. Literature review: considerations in undertaking focus group research with culturally and linguistically diverse groups. J Clin Nurs. 2007;16(6):1000–11.PubMedCrossRef
20.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.PubMedCrossRef
21.
Arimond M, Zeilani M, Jungjohann S, Brown KH, Ashorn P, Allen LH, Dewey KG. Considerations in developing lipid-based nutrient supplements for prevention of undernutrition: experience from the international lipid-based nutrient supplements (iLiNS) project. Matern Child Nutr. 2015;11(Suppl 4):31–61.PubMedCrossRef
22.
Carlson SE, Colombo J, Gajewski BJ, Gustafson KM, Mundy D, Yeast J, Georgieff MK, Markley LA, Kerling EH, Shaddy DJ. DHA supplementation and pregnancy outcomes. Am J Clin Nutr. 2013;97(4):808–15.PubMedPubMedCentralCrossRef
23.
Sealls W, Gonzalez M, Brosnan MJ, Black PN, DiRusso CC. Dietary polyunsaturated fatty acids (C18:2 omega6 and C18:3 omega3) do not suppress hepatic lipogenesis. Biochim Biophys Acta. 2008;1781(8):406–14.PubMedCrossRef
24.
Adu-Afarwuah S, Lartey A, Dewey KG. Meeting nutritional needs in the first 1000 days: a place for small-quantity lipid-based nutrient supplements. Ann N Y Acad Sci. 2017;1392(1):18–29.PubMedCrossRef
25.
Gundacker C, Kutalek R, Glaunach R, Deweis C, Hengstschlager M, Prinz A. Geophagy during pregnancy: is there a health risk for infants? Environ Res. 2017;156:145–7.PubMedCrossRef
26.
Abu BAZ, van den Berg VL, Raubenheimer JE, Louw VJ. Pica practices among apparently healthy women and their young children in Ghana. Physiol Behav. 2017;177:297–304.PubMedCrossRef
27.
28.
Robert A, Mfilinge P, Limbu SM, Mwita CJ. Fatty acid composition and levels of selected polyunsaturated fatty acids in four commercial important freshwater fish species from Lake Victoria, Tanzania. J Lipids. 2014;2014:712134.PubMedPubMedCentralCrossRef
29.
Maleta K, Amadi B. Community-based management of acute malnutrition (CMAM) in sub-Saharan Africa: case studies from Ghana, Malawi, and Zambia. Food Nutr Bull. 2014;35(2 Suppl):S34–8.PubMedCrossRef
30.
31.
Robinson DT, Caplan M, Carlson SE, Yoder R, Murthy K, Frost B. Early docosahexaenoic and arachidonic acid supplementation in extremely-low-birth-weight infants. Pediatr Res. 2016;80(4):505–10.PubMedCrossRef
32.
Foiles AM, Kerling EH, Wick JA, Scalabrin DM, Colombo J, Carlson SE. Formula with long-chain polyunsaturated fatty acids reduces incidence of allergy in early childhood. Pediatr Allergy Immunol. 2016;27(2):156–61.PubMedPubMedCentralCrossRef
33.
Currie LM, Tolley EA, Thodosoff JM, Kerling EH, Sullivan DK, Colombo J, Carlson SE. Long chain polyunsaturated fatty acid supplementation in infancy increases length- and weight-for-age but not BMI to 6 years when controlling for effects of maternal smoking. Prostaglandins Leukot Essent Fatty Acids. 2015;98:1–6.PubMedPubMedCentralCrossRef
34.
Tam EW, Chau V, Barkovich AJ, Ferriero DM, Miller SP, Rogers EE, Grunau RE, Synnes AR, Xu D, Foong J, et al. Early postnatal docosahexaenoic acid levels and improved preterm brain development. Pediatr Res. 2016;79(5):723–30.PubMedPubMedCentralCrossRef
35.
36.
Yelland LN, Gajewski BJ, Colombo J, Gibson RA, Makrides M, Carlson SE. Predicting the effect of maternal docosahexaenoic acid (DHA) supplementation to reduce early preterm birth in Australia and the United States using results of within country randomized controlled trials. Prostaglandins Leukot Essent Fatty Acids. 2016;112:44–9.PubMedPubMedCentralCrossRef
37.
Meher A, Randhir K, Mehendale S, Wagh G, Joshi S. Maternal fatty acids and their association with birth outcome: a prospective study. PLoS One. 2016;11(1):e0147359.PubMedPubMedCentralCrossRef
38.
Vidakovic AJ, Gishti O, Steenweg-de Graaff J, Williams MA, Duijts L, Felix JF, Hofman A, Tiemeier H, Jaddoe VW, Gaillard R. Higher maternal plasma n-3 PUFA and lower n-6 PUFA concentrations in pregnancy are associated with lower childhood systolic blood pressure. J Nutr. 2015;145(10):2362–8.PubMedCrossRef
39.
Adu-Afarwuah S, Lartey A, Okronipa H, Ashorn P, Ashorn U, Zeilani M, Arimond M, Vosti SA, Dewey KG. Maternal supplementation with small-quantity lipid-based nutrient supplements compared with multiple micronutrients, but not with Iron and folic acid, reduces the prevalence of low gestational weight gain in semi-urban Ghana: a randomized controlled trial. J Nutr. 2017;147(4):697–705.PubMedPubMedCentralCrossRef
40.
Adams KP, Ayifah E, Phiri TE, Mridha MK, Adu-Afarwuah S, Arimond M, Arnold CD, Cummins J, Hussain S, Kumwenda C, et al. Maternal and child supplementation with lipid-based nutrient supplements, but not child supplementation alone, decreases self-reported household food insecurity in some settings. J Nutr. 2017;147(12):2309–18.PubMedPubMedCentralCrossRef
41.
Adu-Afarwuah S, Lartey A, Okronipa H, Ashorn P, Zeilani M, Peerson JM, Arimond M, Vosti S, Dewey KG. Lipid-based nutrient supplement increases the birth size of infants of primiparous women in Ghana. Am J Clin Nutr. 2015;101(4):835–46.PubMedCrossRef
42.
Adu-Afarwuah S, Lartey A, Okronipa H, Ashorn P, Peerson JM, Arimond M, Ashorn U, Zeilani M, Vosti S, Dewey KG. Small-quantity, lipid-based nutrient supplements provided to women during pregnancy and 6 mo postpartum and to their infants from 6 mo of age increase the mean attained length of 18-mo-old children in semi-urban Ghana: a randomized controlled trial. Am J Clin Nutr. 2016;104(3):797–808.PubMedPubMedCentralCrossRef
43.
Moramarco S, Amerio G, Ciarlantini C, Chipoma JK, Simpungwe MK, Nielsen-Saines K, Palombi L, Buonomo E. Community-based Management of Child Malnutrition in Zambia: HIV/AIDS infection and other risk factors on child survival. Int J Environ Res Public Health. 2016;13(7):666.PubMedCentralCrossRef
44.
Craddock JC, Neale EP, Probst YC, Peoples GE. Algal supplementation of vegetarian eating patterns improves plasma and serum docosahexaenoic acid concentrations and omega-3 indices: a systematic literature review. J Hum Nutr Diet. 2017;30(6):693–9.PubMedCrossRef
45.
46.
Marine Oils. In: Drugs and Lactation Database (LactMed). edn. Bethesda (MD): National Library of Medicine (US); 2006.
47.
Morse NL. Benefits of docosahexaenoic acid, folic acid, vitamin D and iodine on foetal and infant brain development and function following maternal supplementation during pregnancy and lactation. Nutrients. 2012;4(7):799–840.PubMedPubMedCentralCrossRef
48.
Jones KD, Ali R, Khasira MA, Odera D, West AL, Koster G, Akomo P, Talbert AW, Goss VM, Ngari M, et al. Ready-to-use therapeutic food with elevated n-3 polyunsaturated fatty acid content, with or without fish oil, to treat severe acute malnutrition: a randomized controlled trial. BMC Med. 2015;13:93.PubMedPubMedCentralCrossRef
49.
Jimenez EY, Mangani C, Ashorn P, Harris WS, Maleta K, Dewey KG. Breast milk from women living near Lake Malawi is high in docosahexaenoic acid and arachidonic acid. Prostaglandins Leukot Essent Fatty Acids. 2015;95:71–8.PubMedCrossRef
Metadata
Title
Healthy pregnancies and essential fats: focus group discussions with Zambian women on dietary need and acceptability of a novel RUSF containing fish oil DHA
Authors
Catherine Chunda-Liyoka
Mwansa Ketty Lubeya
Mercy Imakando
Sophia Kisling
Sonoor Majid
Mary S. Willis
Charles Wood
Chipepo Kankasa
Concetta C. DiRusso
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Malnutrition
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-2783-8

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