Top

Published in:

Open Access 01-12-2016 | Study protocol

Study protocol: Mother and Infant Nutritional Assessment (MINA) cohort study in Qatar and Lebanon

Authors: Farah Naja, Lara Nasreddine, Al Anoud Al Thani, Khaled Yunis, Michael Clinton, Anwar Nassar, Sara Farhat Jarrar, Patricia Moghames, Ghina Ghazeeri, Sajjad Rahman, Walaa Al-Chetachi, Eman Sadoun, Nibal Lubbad, Zelaikha Bashwar, Hiba Bawadi, Nahla Hwalla

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

Abstract

Background

The Middle East and North Africa region harbors significant proportions of stunting and wasting coupled with surging rates of non-communicable diseases (NCDs). Recent evidence identified nutrition during the first 1000 days of life as a common denominator not only for optimal growth but also for curbing the risk of NCDs later in life. The main objective of this manuscript is to describe the protocol of the first cohort in the region to investigate the association of nutrition imbalances early in life with birth outcomes, growth patterns, as well as early determinants of non-communicable diseases. More specifically the cohort aims to1) examine the effects of maternal and early child nutrition and lifestyle characteristics on birth outcomes and growth patterns and 2) develop evidence-based nutrition and lifestyle guidelines for pregnant women and young children.

Methods/design

A multidisciplinary team of researchers was established from governmental and private academic and health sectors in Lebanon and Qatar to launch the Mother and Infant Nutritional Assessment 3-year cohort study. Pregnant women (n = 250 from Beirut, n = 250 from Doha) in their first trimester are recruited from healthcare centers in Beirut, Lebanon and Doha, Qatar. Participants are interviewed three times during pregnancy (once every trimester) and seven times at and after delivery (when the child is 4, 6, 9, 12, 18, and 24 months old). Delivery and birth data is obtained from hospital records. Data collection includes maternal socio-demographic and lifestyle characteristics, dietary intake, anthropometric measurements, and household food security data. For biochemical assessment of various indicators of nutritional status, a blood sample is obtained from women during their first trimester. Breastfeeding and complementary feeding practices, dietary intake, as well as anthropometric measurements of children are also examined. The Delphi technique will be used for the development of the nutrition and lifestyle guidelines.

Discussion

The Mother and Infant Nutritional Assessment study protocol provides a model for collaborations between countries of different socio-economic levels within the same region to improve research efficiency in the field of early nutrition thus potentially leading to healthier pregnancies, mothers, infants, and children.

Available only for authorised users

Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–51. doi:10.1016/S0140-6736(13)60937-X.CrossRefPubMed

Siega-Riz AM, Viswanathan M, Moos MK, Deierlein A, Mumford S, Knaack J, et al. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol. 2009;201(4):339.e1–14. doi:10.1016/j.ajog.2009.07.002.CrossRef

Li N, Liu E, Guo J, Pan L, Li B, Wang P, et al. Maternal prepregnancy body mass index and gestational weight gain on pregnancy outcomes. 2013.

Lau EY, Liu J, Archer E. Maternal weight gain in pregnancy and risk of obesity among offspring: a systematic review. 2014;2014:524939. doi:10.1155/2014/524939.

Gaillard R, Steegers EA, Franco OH, Hofman A, Jaddoe VW. Maternal weight gain in different periods of pregnancy and childhood cardio-metabolic outcomes. The Generation R Study. Int J Obes (Lond). 2015;39(4):677-85. doi:10.1038/ijo.2014.175.

Augustyniak RA, Singh K, Zeldes D, Singh M, Rossi NF. Maternal protein restriction leads to hyperresponsiveness to stress and salt-sensitive hypertension in male offspring. Am J Physiol Regul Integr Comp Physiol. 2010;298(5):R1375–82. doi:10.1152/ajpregu.00848.2009.CrossRefPubMedPubMedCentral

Ramadan WS, Alshiraihi I, Al-karim S. Effect of maternal low protein diet during pregnancy on the fetal liver of rats. Ann Anat. 2013;195(1):68–76. doi:10.1016/j.aanat.2012.05.006.CrossRefPubMed

Khan IY, Dekou V, Douglas G, Jensen R, Hanson MA, Poston L, et al. A high-fat diet during rat pregnancy or suckling induces cardiovascular dysfunction in adult offspring. Am J Physiol Regul Integr Comp Physiol. 2005;288(1):R127–33. doi:10.1152/ajpregu.00354.2004.CrossRefPubMed

Bispham J, Gardner DS, Gnanalingham MG, Stephenson T, Symonds ME, Budge H. Maternal nutritional programming of fetal adipose tissue development: differential effects on messenger ribonucleic acid abundance for uncoupling proteins and peroxisome proliferator-activated and prolactin receptors. Endocrinology. 2005;146(9):3943–9. doi:10.1210/en.2005-0246.CrossRefPubMed

10.

Herrera E, Ortega-Senovilla H. Lipid metabolism during pregnancy and its implications for fetal growth. Curr Pharm Biotechnol. 2014;15(1):24–31.CrossRefPubMed

11.

Maslova E, Rytter D, Bech BH, Henriksen TB, Olsen SF, Halldorsson TI. Maternal intake of fat in pregnancy and offspring metabolic health - A prospective study with 20 years of follow-up. Clin Nutr. 2015. doi:10.1016/j.clnu.2015.03.018.

12.

Ronnenberg AG, Goldman MB, Chen D, Aitken IW, Willett WC, Selhub J, et al. Preconception homocysteine and B vitamin status and birth outcomes in Chinese women. Am J Clin Nutr. 2002;76(6):1385–91.PubMed

13.

de la Calle M, Usandizaga R, Sancha M, Magdaleno F, Herranz A, Cabrillo E. Homocysteine, folic acid and B-group vitamins in obstetrics and gynaecology. Eur J Obstet Gynecol Reprod Biol. 2003;107(2):125–34.CrossRefPubMed

14.

Scholl TO. Iron status during pregnancy: setting the stage for mother and infant. Am J Clin Nutr. 2005;81(5):1218s–22s.PubMed

15.

Furness D, Fenech M, Dekker G, Khong TY, Roberts C, Hague W. Folate, vitamin B12, vitamin B6 and homocysteine: impact on pregnancy outcome. Matern Child Nutr. 2013;9(2):155–66. doi:10.1111/j.1740-8709.2011.00364.x.CrossRefPubMed

16.

Gadgil M, Joshi K, Pandit A, Otiv S, Joshi R, Brenna JT, et al. Imbalance of folic acid and vitamin B12 is associated with birth outcome: an Indian pregnant women study. Eur J Clin Nutr. 2014;68(6):726–9. doi:10.1038/ejcn.2013.289.CrossRefPubMed

17.

Bora R, Sable C, Wolfson J, Boro K, Rao R. Prevalence of anemia in pregnant women and its effect on neonatal outcomes in Northeast India. J Matern Fetal Neonatal Med. 2014;27(9):887–91. doi:10.3109/14767058.2013.845161.CrossRefPubMed

18.

Victora CG, de Onis M, Hallal PC, Blossner M, Shrimpton R. Worldwide timing of growth faltering: revisiting implications for interventions. Pediatrics. 2010;125(3):e473–80. doi:10.1542/peds.2009-1519.CrossRefPubMed

19.

Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, et al. What works? Interventions for maternal and child undernutrition and survival. Lancet (London, England). 2008;371(9610):417–40. doi:10.1016/s0140-6736(07)61693-6.CrossRef

20.

Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet (London, England). 2013;382(9890):452–77. doi:10.1016/s0140-6736(13)60996-4.CrossRef

21.

Horta BL, Victora CG. Long-term effects of breastfeeding-a systematic review. 2013.

22.

Ramakrishnan U, Imhoff-Kunsch B, Martorell R. Maternal nutrition interventions to improve maternal, newborn, and child health outcomes. 2014.CrossRef

23.

Forsdahl A. Are poor living conditions in childhood and adolescence an important risk factor for arteriosclerotic heart disease? Br J Prev Soc Med. 1977;31(2):91–5.PubMedPubMedCentral

24.

Barker DJ, Winter PD, Osmond C, Margetts B, Simmonds SJ. Weight in infancy and death from ischaemic heart disease. Lancet (London, England). 1989;2(8663):577–80.CrossRef

25.

Barker DJ. In utero programming of chronic disease. Clin Sci (Lond). 1998;95(2):115–28.CrossRef

26.

Horton R. Maternal and child undernutrition: an urgent opportunity. Lancet (London, England). 2008;371(9608):179. doi:10.1016/s0140-6736(07)61869-8.CrossRef

27.

Save the Children. Nutrition in the first 1000 days: State of the world’s mothers 2012 Save the Children Fund. 2012. http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/STATEOFTHEWORLDSMOTHERSREPORT2012.PDF. Accessed 26 Jun 2015.

28.

Arenz S, Ruckerl R, Koletzko B, von Kries R. Breast-feeding and childhood obesity--a systematic review. Int J Obes Relat Metab Disord. 2004;28(10):1247–56. doi:10.1038/sj.ijo.0802758.CrossRefPubMed

29.

Horta BL. Evidence on the long-term effects of breastfeeding. WHO Geneva: World Health Organization; 2007.

30.

Oddy W, Li J, Robinson M, Whitehouse A: The Long-Term Effects of Breastfeeding on Development. Shanghai, China: InTech; 2012.

31.

Shields L, Mamun AA, O'Callaghan M, Williams GM, Najman JM. Breastfeeding and obesity at 21 years: a cohort study. J Clin Nurs. 2010;19(11-12):1612–7. doi:10.1111/j.1365-2702.2009.03015.x.CrossRefPubMed

32.

Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess. 2007;153:1–186.

33.

Atladottir H, Thorsdottir I. Energy intake and growth of infants in Iceland-a population with high frequency of breast-feeding and high birth weight. Eur J Clin Nutr. 2000;54(9):695–701.CrossRefPubMed

34.

Spyrides MH, Struchiner CJ, Barbosa MT, Kac G. Effect of predominant breastfeeding duration on infant growth: a prospective study using nonlinear mixed effect models. J Pediatr (Rio J). 2008;84(3):237–43. doi:10.2223/JPED.1797.CrossRef

35.

Singhal A, Lanigan J. Breastfeeding, early growth and later obesity. Obes Rev. 2007;8 Suppl 1:51–4. doi:10.1111/j.1467-789X.2007.00318.x.CrossRefPubMed

36.

Kelishadi R, Farajian S. The protective effects of breastfeeding on chronic non-communicable diseases in adulthood: A review of evidence. Adv Biomed Res. 2014;3:3. doi:10.4103/2277-9175.124629.CrossRefPubMedPubMedCentral

37.

Huh SY, Rifas-Shiman SL, Taveras EM, Oken E, Gillman MW. Timing of solid food introduction and risk of obesity in preschool-aged children. Pediatrics. 2011;127(3):e544–51. doi:10.1542/peds.2010-0740.CrossRefPubMedPubMedCentral

38.

Seach KA, Dharmage SC, Lowe AJ, Dixon JB. Delayed introduction of solid feeding reduces child overweight and obesity at 10 years. Int J Obes (Lond). 2010;34(10):1475–9. doi:10.1038/ijo.2010.101.CrossRef

39.

WHO. Regional Strategy on Nutrition 2010-2019 and Action Plan. World Health Organization Regional Office for the Eastern Mediterranean (WHO-EMRO). World Health Organization. World Health Organization, Cairo, Egypt. 2011. http://www.emro.who.int/nutrition/nutrition-infocus/in-focus.html. Accessed 6 May 2015.

40.

Len-Cava N, Lutter C, Ross J, Martin L. Quantifying the benefits of breastfeeding: a summary of the evidence. Pan American Health Organization, Washington DC. 2002. http://www.ennonline.net/quantifyingbenefitsbreastfeeding2. Accessed 4 May 2015.

41.

de Onis M, Blossner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr. 2010;92(5):1257–64. doi:10.3945/ajcn.2010.29786.CrossRefPubMed

42.

Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England). 2014;384(9945):766–81. doi:10.1016/s0140-6736(14)60460-8.CrossRef

43.

Atinmo T, Mirmiran P, Oyewole OE, Belahsen R, Serra-Majem L. Breaking the poverty/malnutrition cycle in Africa and the Middle East. Nutr Rev. 2009;67 Suppl 1:S40–6. doi:10.1111/j.1753-4887.2009.00158.x.CrossRefPubMed

44.

Musaiger AO, Al-Hazzaa HM. Prevalence and risk factors associated with nutrition-related noncommunicable diseases in the Eastern Mediterranean region. Int J Gen Med. 2012;5:199–217. doi:10.2147/ijgm.s29663.CrossRefPubMedPubMedCentral

45.

El-Kogali S, Krafft C. Expanding Opportunities for the Next Generation: Early Childhood Development in the Middle East and North Africa. World Bank Publications; 2015.

46.

Ng SW, Zaghloul S, Ali HI, Harrison G, Popkin BM. The prevalence and trends of overweight, obesity and nutrition-related non-communicable diseases in the Arabian Gulf States. Obes Rev. 2011;12(1):1–13. doi:10.1111/j.1467-789X.2010.00750.x.CrossRefPubMed

47.

Howard JJ. Medical devices and the Middle East: market, regulation, and reimbursement in Gulf Cooperation Council states. Med Devices (Auckl). 2014;7:385.CrossRef

48.

Sibai A, Hwalla N, Adra N, Rahal B. Prevalence and covariates of obesity in Lebanon: findings from the first epidemiological study. Obes Res. 2003;11(11):1353–61. doi:10.1038/oby.2003.183.CrossRefPubMed

49.

UNICEF, World Bank, WHO. Joint malnutrition dataset on child malnutrition estimates. 2014. http://www.who.int/nutgrowthdb/estimates/en/. Accessed 22 Apr 2015.

50.

WHO. Noncommunicable diseases. Country profiles. World Health Organization. World Health Organization. 2014a. http://www.who.int/nmh/publications/ncd-profiles-2014/en/. Accessed 2 May 2015.

51.

WHO. Global Health Observatory Data Repository: Obesity data by country. World Health Organization. World Health Organization. 2014b. http://www.who.int/gho/ncd/risk_factors/overweight/en/. Accessed 4 June 2015.

52.

Seidell JC. Obesity, insulin resistance and diabetes--a worldwide epidemic. Br J Nutr. 2000;83 Suppl 1:S5–8.PubMed

53.

Nasreddine L, Naja F, Chamieh MC, Adra N, Sibai AM, Hwalla N. Trends in overweight and obesity in Lebanon: evidence from two national cross-sectional surveys (1997 and 2009). BMC Public Health. 2012;12:798. doi:10.1186/1471-2458-12-798.CrossRefPubMedPubMedCentral

54.

Nasreddine L, Hwalla N, Sibai A, Hamze M, Parent-Massin D. Food consumption patterns in an adult urban population in Beirut, Lebanon. Public Health Nutr. 2006;9(2):194–203.CrossRefPubMed

55.

Moshfegh AJ, Rhodes DG, Baer DJ, Murayi T, Clemens JC, Rumpler WV, et al. The US Department of Agriculture Automated Multiple-Pass Method reduces bias in the collection of energy intakes. Am J Clin Nutr. 2008;88(2):324–32.PubMed

56.

Raper N, Perloff B, Ingwersen L, Steinfeldt L, Anand J. An overview of USDA’s dietary intake data system. J Food Composition Anal. 2004;17(3):545–55.CrossRef

57.

Naja F, Hwalla N, Fossian T, Zebian D, Nasreddine L. Validity and reliability of the Arabic version of the Household Food Insecurity Access Scale in rural Lebanon. Public Health Nutr. 2014:1-8. doi:10.1017/s1368980014000317.

58.

WHO. WHO: Indicators for assessing infant and young child feeding practices. Part 1 Definitions. World Health Organization. Geneva: WHO. 2008a. http://www.who.int/maternal_child_adolescent/documents/9789241596664/en/.

59.

Whitney CW, Lind BK, Wahl PW. Quality assurance and quality control in longitudinal studies. Epidemiol Rev. 1998;20(1):71–80.CrossRefPubMed

60.

Cohen J. Statistical power analysis for the behavioral sciences (rev. Lawrence Erlbaum Associates, Inc; 1977.

61.

Gracie SK, Lyon AW, Kehler HL, Pennell CE, Dolan SM, McNeil DA, et al. All Our Babies Cohort Study: recruitment of a cohort to predict women at risk of preterm birth through the examination of gene expression profiles and the environment. BMC Pregnancy Childbirth. 2010;10:87. doi:10.1186/1471-2393-10-87.CrossRefPubMedPubMedCentral

62.

Kristman V, Manno M, Cote P. Loss to follow-up in cohort studies: how much is too much? Eur J Epidemiol. 2004;19(8):751–60.CrossRefPubMed

63.

Jones J, Hunter D. Consensus methods for medical and health services research. BMJ. 1995;311(7001):376.CrossRefPubMedPubMedCentral

64.

Qatar General Secretariat for Development Planning. Qatar’s National Development Strategy 2011-2016. Doha: Qatar General Secretariat for Development Planning; 2011.

65.

NHS. National Health Strategy. Qatar National Nutrition and Physical Activity Plan (2011-2016). National Health Strategy. 2011. https://extranet.who.int/nutrition/gina/sites/default/files/QAT%202011%20National%20Nutrition%20and%20Physical%20Activity%20Action%20Plan.pdf. Accessed 22 May 2015.

66.

MOPH. The MOH Strategic Plan. The Ministry of Public Health, Lebanon. 2007. http://www.moph.gov.lb/media/documents/themohstrategyplanmodified.pdf. 2012. Accessed 26 Jun 2015.

Title: Study protocol: Mother and Infant Nutritional Assessment (MINA) cohort study in Qatar and Lebanon
Authors: Farah Naja
Lara Nasreddine
Al Anoud Al Thani
Khaled Yunis
Michael Clinton
Anwar Nassar
Sara Farhat Jarrar
Patricia Moghames
Ghina Ghazeeri
Sajjad Rahman
Walaa Al-Chetachi
Eman Sadoun
Nibal Lubbad
Zelaikha Bashwar
Hiba Bawadi
Nahla Hwalla
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-016-0864-5

At a glance: The STEP trials

Springer Medicine

Study protocol: Mother and Infant Nutritional Assessment (MINA) cohort study in Qatar and Lebanon

Abstract

Background

Methods/design

Discussion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods/design

Discussion

Please log in to get access to this content

Other articles of this Issue 1/2016

The influence of grandmothers on breastfeeding rates: a systematic review

Erratum to: The influence of travel time on emergency obstetric care seeking behavior in the urban poor of Bangladesh: a GIS study

Psychosocial factors associated with early initiation and frequency of antenatal care (ANC) visits in a rural and urban setting in South Africa: a cross-sectional survey

A cross-sectional survey of policies guiding second stage labor in urban Japanese hospitals, clinics and midwifery birth centers

Determinants of institutional birth among women in rural Nepal: a mixed-methods cross-sectional study

Criteria-based audit to improve quality of care of foetal distress: standardising obstetric care at a national referral hospital in a low resource setting, Tanzania