JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION

JOURNAL OFTHE AMERICAN DIETETICASSOCIATION

Durham HA, et al, J Am Diet Assoc. 2011; 111 (January).

Comparison of Dietary Intake of Overweight Postpartum

Mothers Practicing Breastfeeding or Formula Feeding

Holiday A. Durham PhD, RD: Louisiana State University

Cheryl A. Lovelady PhD, MPH, RD, FADA: University North Carolina at Greensboro

Rebecca J. N. Brouwer MS: Duke University Medical Center (DUMC)

Katrina M. Krause MS: DUMC

Truls Østbye PhD, MD: DUMC


Durham HA, et al.J Am Diet Assoc. 2011; 111 (January).

Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding

Rates of overweight & obesity in childbearing years

The postpartum period is a critical time for weight-management interventions because weight retention and weight gain in this period are significant predictors of long-term obesity 2,3.

In 2007-2008,

percentage of women

ages 20-39 years who

were overweight or obese 1

1. National Center for Health Statistics. Health, United States, 2008. With Chartbook. Hyattsville, Maryland: 2009. Web site. http://www.cdc.gov/nchs/data/hus/hus08.pdf. Published March 2009. Updated August 2009. Accessed September 1, 2009. 2. Gunderson EP, Abrams B. Epidemiology of gestational weight gain and body weight changes after pregnancy. Epidemiol Rev. 2000;22:261-74.3. Rooney BL, Schauberger CW. Excess pregnancy weight gain and long-term obesity: one decade later. Obstet Gynecol. 2002;100:245-52.


Durham HA, et al. J Am Diet Assoc. 2011; 111 (January).


Objectives

• Compare nutrient, meal and snack intakes, food group servings and prevalence of dieting among fully breastfeeding, mixed breast and formula feeding, and formula feeding, overweight and obese women.

• Compare nutrient intakes and food group servings to the Dietary Reference Intake and MyPyramid recommendations, respectively.

Serum Vitamin C (mg/dl) by Salad Intake



• Infant feeding practices, demographic information, and dietary information were collected on 450 women between six and nine weeks postpartum.

• Two 24-hour dietary recalls were completed by phone, using Nutrition Data Systems for Research1,2.

1. Nutrition Coordinating Center, University of Minnesota. Nutrition Data System (NDS). NDS-R[5.0]. 2004. Minneapolis, MN, University of Minnesota. 2. Nutrition Coordinating Center, University of Minnesota. Nutrition Data System (NDS). NDS-R[2005]. 2005. Minneapolis, MN, University of Minnesota.

Study Design





Comparison of energy intake and supplement use of women fully breastfeeding (FB), mixed feeding

(MF) or formula feeding (FF)FB (n=160) MF (n= 128) FF (n=162)

Percent taking Vitamin/Mineral/Fatty Acid Supplements *

80% 72% 43%

Percent reporting dieting * 5% 13% 21%

Estimated Energy Requirement (kcal) 2407 ± 11 2478 ± 18 2523 ± 18

Energy Intake (kcal)

Total sample

Dieters

Non-Dieters

2107 ± 50 a

2095 ± 363

2110 ± 54

1866 ± 56 b

1468 ± 105

1915 ± 57

1657 ± 50 c

1342 ± 92

1717 ± 59

a, b, c Groups with different letters are significantly different, P ≤ 0.001* Significantly different between groups, Chi-square, P ≤ 0.05.





Percentage of women consuming less than the Estimated Average Requirement (EAR)

Total Vitamin A

Vitamin E

Vitamin C

Total Folate

percentage percentage

percentage percentage


% < EAR is the percentage of group whose intake was below the Estimated Average Requirements.




Percentage of women consuming less than the Adequate Intakes (AI)

Calcium

percentage


% < AI is the percentage of group whose intake was below the Adequate Intake recommendation.




*p= 0.06

* p < 0.01

* p < 0.01

percentage

* Significantly different between groups, Chi-square, P ≤ 0.05.

The majority of women (n=399) reported consuming dinner on both days, with no differences between groups.

Percentage of fully breastfeeding, mixed feeding or formula feeding women

consuming meals and snacks on both days




Recommended food group servings based on MyPyramid1 guidelines for reference participants who represents the average Active Mother’s Postpartum participant (sedentary, 165 cm, 89 kg, 31 years old, with a 2 month old baby, who was either FB, MF, or FF).

Groups with different letters are significantly different, P ≤ 0.001 (when adjusted for group differences in participant characteristics: pre-pregnancy BMI, race, age, education, income, marital status). 1U.S. Department of Agriculture. MyPyramid. 2007. Web site. http://www.MyPyramid.com. Published October 2007. Updated March 2009.

Breastfeeding (BF), mixed feeding (MF) and formula feeding (FF) women did not meet MyPyramid1 recommendations for any food group

Food Groups


b

aa

b

a, b

a

food groups


Durham HA, et al. J Am Diet Assoc. 2011; 111 (January).

Groups with different letters are significantly different, P ≤ 0.001 (when adjusted for group differences in participant characteristics: pre-pregnancy BMI, race, age, education, income, marital status).

food groups

aa

b


Comparison of beverage and dessert intake among fully breastfeeding, mixed

feeding or formula feeding women




Summary


Formula feeding women: • Consumed less energy, servings of grains, and desserts• More likely to diet• Less likely to consume a multivitamin supplement

Breastfeeding women:• Consumed more energy and more refined grains and desserts• Snacked more frequently

All groups were at risk for inadequate intake of vitamins A, C, E, and folate.

In addition, the intakes of vitamin D and calcium were low in all groups.

All groups did not consume the recommended servings of any of the MyPyramidfood groups.




Conclusion

Decrease

• Refined grains

• Regular soda

• Sweetened beverages

• Desserts

To help increase intakes of nutrients that are lacking in the diet and promote postpartum weight loss, dietitians should encourage women to:

Increase• Fruits• Vegetables• Low-fat dairy• Whole grains• Legumes• Healthy types of fat


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