Fermented soyabean and vitamin C-rich fruit: a possibility to circumvent the further decrease of iron status among iron-deficient pregnant women in Indonesia

Abstract

Objective: Increasing the consumption of Fe-rich foods and thus improving Fe bioavailability without significantly increasing diet cost is the most sustainable intervention for improving Fe intake. We assessed the effect of supplementary food consisting of fermented soyabean (tempeh) and vitamin C-rich fruit consumed during pregnancy on maternal iron deficiency (ID). Design: Pregnant women were randomly allocated by village into optimized diet and control groups. Supplementary food was given 6 d/week at home. The average weekly food provided comprised 600 g of tempeh, 30 g of meat, 350 g of guava, 300 g of papaya and 100 g of orange. Hb, ferritin and transferrin receptor (TfR) concentrations were measured at 12-20 and at 32-36 weeks of gestation. Setting: Thirty-nine villages in Indonesia. Subjects: Pregnant women (12-20 weeks of gestation, n 252). Results: At baseline, mean Hb, ferritin and TfR concentrations and body Fe concentration were within the normal range and did not differ between groups. At near term, mean Hb, ferritin and body Fe decreased, whereas mean TfR increased significantly in both groups. The mean changes in Fe status were similar in both groups. In Fe-deficient women, consumption of an optimized diet was associated with smaller decreases in Hb (1?02 (95 % CI 0?98, 1?07) g/l; P 5 0?058), ferritin (1?42 (95 % CI 1?16, 1?75) mg/l; P 5 0?046) and body Fe (2?57 (95 % CI 1?71, 3?43) mg/kg; P 5 0?073) concentrations, compared with a state of no intervention. Fe-deficient women at baseline benefited more from supplementary food compared with Fe-replete women. Conclusions: Daily supplementary food containing tempeh and vitamin C-rich fruits during pregnancy might have positive effects on maternal ID.

Factors affecting maternal nutrition and health: A qualitative study in a matrilineal community in Indonesia

“…Those who have money can eat a healthy diet, but the problem is for the women who can't afford it. (voluntary community worker 14) This shows that affordability is a real concern for people because it has a severe impact on the nutritional wellbeing of pregnant women, particularly in households with a low family income. However, except for these financial issues, other challenges regarding access to food such as transport, the non-availability of local grocery shops or the quality of food were not discussed.…”

“…There have been several studies which have investigated the association between economic factors and this situation: local food consumption patterns, food supplementation interventions, women empowerment strategies and maternal nutritional status and health [13,14,15,16]. However, the literature on relationships between health, nutrition and matrilineality as a unique social organisation which places women in a distinctive position within the society, is limited.…”

A food synergy approach in a national program to improve the micronutrient status of preschoolers: a randomized control trial protocol

“…Additionally, we considered an intercluster correlation of 0.01 ( n = 10 in each AWC), 95% confidence interval, 80% power, and 20% attrition to achieve the required sample size. Earlier studies reported a change in hemoglobin (Hb) by 0.4–1.0 g/dL with a sample size ranging from n = 89 to 95. In the present study, a subsample of 80 per group was computed for assessing the impact of the intervention on iron biomarkers based on changes in hemoglobin (Hb) of 0.8 g/dL and a standard deviation of 1.5 g/dL.…”

“…Vitamin C reduces dietary ferric iron (Fe 3+ ) to ferrous (Fe 2+ ), which enhances absorption of nonheme iron . Other studies have shown mixed results when used for improving iron status . Increasing nonheme iron absorption by increasing intake of vitamin C–containing food is called a food‐based approach to ameliorating iron deficiency.…”

Effectiveness of Short Message Service Reminders and Leaflets in Complying With Iron Supplementation in Pregnant Women in Depok City, Indonesia

“…The World Health Organization data estimates that the number of pregnant women around the world who have anemia is 41.8%, and at least half of these cases are caused by iron deficiency [5]. In 2013, the percentage of pregnant women in Indonesia with anemia was 37.1% [6,7]. The government has launched a program to distribute iron supplements to pregnant women to be taken daily during pregnancy (or distributing a minimum of 90 tablets) [8].…”