Try out PMC Labs and tell us what you think. Learn More. Weight gain in the postpartum period is a risk factor for long-term obesity. Investigations of dietary intake among lactating and non-lactating, overweight women may identify nutritional concerns specific to this population.
To compare nutrient, meal and snack intakes, food group servings and prevalence of dieting among fully breastfeeding BF mixed breast and formula feeding MFand formula feeding FFoverweight and obese women. The second aim was to compare nutrient intakes and food group servings to the Dietary Reference Intake DRI and MyPyramid recommendations, respectively. Infant feeding practices and dietary information were collected on women between six and nine weeks postpartum.
Two hour dietary recalls were completed by phone, using Nutrition Data Systems for Research. Analysis of covariance was used to compare infant feeding groups in dietary quality nutrient intake per kcal and food group servings, controlling for pre-pregnancy body mass index, race, age, education, income, and marital status.
Chi-squared X 2 analysis was performed to determine differences in meal and snack intake and dieting among infant feeding groups.
Adjusted nutrient intake did not differ between groups. All groups were at risk for inadequate intakes of vitamins A, E, C, and folate and did not meet recommended servings of all food groups.
BF women consumed lunch and snacks more frequently, were less likely to diet and reported higher intakes of grains and desserts than MF and FF women. To help increase intakes of nutrients lacking in the diet and prevent postpartum weight gain, overweight women should be encouraged to increase fruits, vegetables, low-fat dairy, whole grains, legumes, and healthy types of fat, while decreasing refined grains, regular soda, sweetened beverages, and desserts.
The National Center for Health Statistics reports The postpartum period is a critical time for weight-management interventions because weight retention and weight gain in this period are ificant predictors of long-term obesity 23. However, there are few published studies on the dietary intake of overweight and obese women who have recently delivered babies. George et al. During the late postpartum period total energy, saturated fat and sugar were above the national average, while women failed to meet dietary recommendations of grains, vegetables, fruits and dairy.
In contrast, Fowles and Walker 5 reported predominantly white postpartum women consumed adequate dairy servings, but vegetable intake was not sufficient.
Two studies have reported a higher consumption of fruits and vegetables and a lower fat intake among lactating women as compared to formula feeding women 67. The few studies of nutrient intake during lactation report calcium, zinc, folate, and vitamins E, D, and B-6 intakes are often lower than recommended 89. Investigations of dietary intake in the postpartum dating among lactating and non-lactating, overweight and obese women may help to identify nutritional concerns specific to this population. Therefore, the overall purpose of this study was to assess nutrient intake, food group servings, meals and snack intake, and the prevalence of dieting among a large, diverse sample of overweight and obese postpartum women with two-month old infants.
Since nutrient needs of postpartum women are determined by lactation status, the sample was divided into three groups: 1 those fully breastfeeding BF2 those combining breast milk and formula mixed feeding, MF and 3 woman formula feeding FF their infants. The primary aim was to compare nutrient intake and food group servings among these three groups. The second aim was to evaluate dietary quality by comparing nutrient intakes and food group servings to the Dietary Reference Intake DRI and MyPyramid recommendations, respectively. The from these analyses may be used in dietary interventions deed to promote postpartum weight loss among overweight and obese women.
This paper reports the baseline dietary intake of overweight and obese postpartum women enrolled in a randomized controlled behavioral intervention study, Active Mothers Postpartum AMP. The overall aim of AMP was to evaluate the effect of a nine month intervention to increase physical activity and decrease energy intake on weight loss among postpartum women who were overweight or obese prior to Greensboro It was fat on the theory that the postpartum period may be a teachable moment to promote weight loss and healthy weight maintenance by making weight-related lifestyle changes. Participants were recruited from obstetric clinics and through posters in public areas.
After baseline measurements were completed, participants were randomized to intervention or control groups.
Only the baseline measurements are reported in this paper. The overall study is described in detail elsewhere All participants were measured in light clothing and without shoes. Within three weeks, participants were contacted by phone and completed a survey of demographic information, including age, race, education, income, marital status and parity, pre-pregnancy height and weight, and gestational weight gain. During this interview women were also asked how many times per week they ate from a fast food restaurant like Burger King, Chick-Fil-A, or Pizza Hut.
A trained research assistant collected two hour dietary recalls from each participant via phone within a two week period, using the Nutrition Data System for Research NDSR, version 5. NDSR is a multiple pass approach that details daily food consumption in a phone interview format.
The multiple pass approach has proven to be an effective strategy to accurately record hour recalls among women 13 Prior to the initial recall, participants were mailed a two-dimensional food portion guide to use in estimating the portion sizes of what they consumed. The participant was asked during each recall if the intake represented usual daily consumption; if it did not, the participant was called back at a different time.
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Because of participant availability and time constraints during this early postpartum period, it was not always feasible to obtain one intake on a weekend day. Consistent with Barr et al. Dietary data were analyzed for nutrient composition, food group servings, and meal and snack intakes using NDSR. To compare dietary quality between groups, nutrient intakes were adjusted per 1, calories to control for variation in total energy intake among women.
Estimated energy requirements were calculated for each participant, using the DRI equation for women and adding kcal for full breastfeeding and kcal for mixed feeding. The requirement for protein was calculated for each participant, using 1.
Food groups were consolidated into the following: fruits, vegetables, grains, dairy, meat, fish, poultry, eggs, nuts, seeds, meat alternatives, fats, beverages, miscellaneous foods e. MyPyramid for Moms is a web based program which individualizes recommendations for women based on the Dietary Guidelines for Americans This resulted in reference women who were sedentary; cm tall, weighed 89 kg, were 31 years old, had a two month old baby, and were either fully breastfeeding, mixed feeding or formula feeding.
Means and standard errors SE were calculated for all continuous variables. Categorical variables were summarized as frequencies and percentages. Covariates were pre-pregnancy BMI, race, age, education, income, and marital status. studies have reported relationships between these variables and dietary intake among postpartum women 47 The Bonferroni correction was used to avoid Type 1 error that is often associated with multiple comparisons. Chi-squared X 2 analysis was performed to determine differences in meal and snack intake among infant feeding groups.
Food intakes were collected from all of the women enrolled in the study. Twenty-two participants completed only one, not two days of dietary recalls, due to time constraints or unavailability. However, their data was included in the analysis because it represented typical dietary intake and did not ificantly alter findings.
Participant demographic and anthropometric characteristics are shown in Table 1. FF women were ificantly younger and more likely to have a higher pre-pregnancy and baseline BMI, be black, single, less educated, earning less than BF and MF women. Gestational weight gain and percentages of primiparous and multiparous women were similar among groups. Demographic and anthropometric characteristics of fully breastfeeding, mixed feeding and formula feeding groups in the Active Moms Postpartum Study.
They were also less likely to report consuming a vitamin, mineral, and or fish oil supplement than BF and MF women. MF women were more apt than BF and FF women to report taking an herbal supplement, primarily to increase milk production example Fenugreek. The energy intake of women reporting dieting versus those not dieting was ificantly lower in the MF and FF groups.
The effects of dieting on food and nutrient intake of lactating women.
Additionally, MF women were also at risk for inadequate zinc intake. After adjusting for energy and covariates, reported nutrient intakes were not ificantly different between groups. Comparison of dietary intake of mothers fully breastfeeding, mixed feeding or formula feeding: Active Moms Postpartum Study. Average food group servings are presented in Table 3. As compared to the reference participant i.
Consumption of alcohol was minimal; while the average intake of sweetened beverages and soft drinks was approximately one and a half servings per day.
After adjusting for covariates, servings of grains, refined grains, and desserts were ificantly different among BF, MF and FF women. There was not a ificant difference in fast food intake between groups Table 3. Average of food group servings of fully breastfeeding, mixed feeding and formula feeding groups in the Active Moms Postpartum Study compared to MyPyramid recommendations. Recommended food group servings based on MyPyramid guidelines for reference participants who represents the average AMP participant sedentary, cm, 89 kg, 31 years old, with a 2month old baby, who was either FB, MF, or FF Less than six percent of the participants reported no breakfast on either day of the recalls.
This is the first study to compare nutrient intake, diet quality, and meal patterns of a relatively large and diverse cohort of overweight and obese breastfeeding, mixed feeding, and formula feeding women.