Dietary Supplement Use And Iron, Zinc And Folate Intake In Pregnant .
Dietary supplement use and iron, zinc and folate intakein pregnant women in London, OntarioA. Roy, MSc (1,2); S. E. Evers, PhD (3); M. K. Campbell, PhD (1,4,5,6,7)This article has been peer reviewed.AbstractIntroduction: We examined the dietary intake of iron, zinc and folate, estimated fromboth food and supplement sources, in 2019 pregnant women who participated in thePrenatal Health Project (PHP). The PHP recruited pregnant women from ultrasoundclinics in London, Ontario, in the years 2002–2005.Methods: Participants completed a telephone survey, which included a food frequencyquestionnaire and questions on dietary supplement use. Frequencies of use of dietarysupplements were generated. Nutrient intake values were estimated from food andsupplement sources, and summed to calculate total daily intake values.Results: Most women took a multivitamin supplement, and many women took folicacid and iron supplements; however, one-fifth of the sample did not take any supplementsproviding any of the three micronutrients. Despite being of a higher socio-economicstatus overall, significant proportions of the cohort ranked below the recommendeddietary allowance values for iron, zinc, and folate. This suggests there may be otherbarriers that impact dietary practices.Conclusions: Further research is required on how to better promote supplement use anda healthy diet during pregnancy.Keywords: iron, folate, zinc, dietary supplement, diet, nutrition, pregnancyIntroductionAdequate amounts of nutrients duringpregnancy are essential for maternal, fetaland child health. However, few populationbased studies have examined dietary intakeand use of dietary supplements amongpregnant women in Canada. Of particularinterest are iron, zinc and folate. Iron isintegral to the structure and function ofred blood cells, and its deficiency can resultin anemia. Anemia and iron deficiencyduring pregnancy can cause pre-term birthand low birth weight.1 In non-anemicmothers, iron supplementation may offerprotection against low birth weight.2 Ironis also involved in myelination, neuro transmitter function, various cellular andoxidative processes, energy productionand thyroid hormone metabolism.1 Irondeficiency has been implicated inneurological and cognitive disorders inthe mother; these include major depressivedisorder, recognized to have healthconsequences on both the mother andchild.3,4 The 2009 Health Canada guidelinesrecommend a daily supplement of 16 to20 mg of iron during pregnancy to ensureadequate iron intake.5Zinc is integral to DNA synthesis andnecessary for the structure and functionof regulatory, structural and enzymaticproteins as well as cell membranes. Itis involved in neurological function andproper immune function.1,6,7 Various studieshave implicated zinc deficiency in pre-termand low birth weight, although routinesupplementation is not recommendedunless there is an identified deficiency.8Zinc deficiency is also implicated indepressive disorders.1,4 Folate is involved inthe metabolism of nucleic acids and aminoacids and in neurological functioning.While inadequate folate is implicated invarious birth defects and poor pregnancyoutcomes, its role in neural tube defectshas received the most attention. In variouscountries, including Canada, women ofchild-bearing age are advised to takesupplements. Food fortification policies arein effect in response to the strong evidenceof the importance of folic acid intakein the very early stages of pregnancy.9,10Like iron and zinc, folate deficiency isimplicated in depressive disorders.1,4Health Canada has set out a RecommendedDietary Allowance (RDA) for a number ofnutrients. The RDA is defined as the “averagedaily dietary intake level that is sufficientAuthor references1. Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada2. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada3. Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada4. Department of Paediatrics, University of Western Ontario, London, Ontario, Canada5. Department of Obstetrics and Gynecology, University of Western Ontario, London, Ontario, Canada6. Children’s Health Research Institute, London, Ontario, Canada7. Lawson Health Research Institute, London, Ontario, CanadaCorrespondence: Dr. M. Karen Campbell, Department of Epidemiology and Biostatistics, Kresge Building, Room K201A, University of Western Ontario, London, ON N6A 5C1;Tel.: (519) 661-2162; Fax: (519) 661-3766; Email: Karen.Campbell@schulich.uwo.caVol 32, No 2, March 2012 – Chronic Diseases and Injuries in Canada76
to meet the nutrient requirements of nearlyall (97 to 98 percent) healthy individualsin a particular life-stage and gender group.”11For pregnant women, the RDA of ironis 27 mg/day, of zinc is 11 mg/day andof folate, as dietary folate equivalents(DFE), is 600 μg/day.11 In addition to theRDA, the Society of Obstetricians andGynaecologists of Canada recommends adaily folic acid supplement of at least 400 μg(with higher amounts indicated based onrisk status).9In this paper, we examine the reporteddaily dietary intake of iron, zinc and folateestimated from both the food and dietarysupplements of 2019 pregnant women inLondon, Ontario, who participated inthe Prenatal Health Project (PHP). We alsogenerate and examine rates of supplementuse among the 2019 women and investigatethe types of supplements taken among theentire PHP cohort (n 2357). We presentthe results of analyses that explore possiblesociodemographic determinants of dietaryintake.for the name, amount and frequency ofconsumption of all nutrient supplementscurrently used regularly. Nutrient amountscould be quantitatively estimated if theparticipant reported the brand and productname of a prenatal supplement or elsethe exact nutrient amounts. Whenbrand or product information of prenatalsupplements was missing (n 930), wecalculated the nutrient composition fromthe most commonly used prenatalmultivitamin supplement, Centrum Materna.(Of the 643 women of the PHP core cohortwho named a brand, most used CentrumMaterna [n 592], followed by LifeBrand [n 24], the composition of whichis identical to that of Centrum Materna.)To generate average daily values, weassumed the standard dose of one tabletper day; if otherwise specified, we adjustedthe intake values according to the reportedfrequency.The Ethics Review Board for HealthSciences Research Involving HumanSubjects at The University of WesternOntario approved the study.In contrast to prenatal multivitaminproducts, where the similar compositionsjustify assuming nutrient content, regularadult multivitamins on the market varysubstantially. Thus, for those who reportedtaking such a supplement without specifyinga brand name (n 137), nutrient intakefrom supplements was declared missing.For the same reason, single-nutrient dietarysupplements without specific amountsprovided were also declared missing, withthe exception of folic acid. Because there isless variation among folic acid supplements,a dose of 400 μg folic acid per day wasassumed for those who did not specifytheir regular dose of folic acid supplement.This assumption is consistent with otherstudies that have measured folate supplementintake.13 Based on the reported frequencyof consumption, we calculated average dailyintake values. A few respondents claimedto be taking a separate folic acid supplementthat provided more than 1 mg (1000 μg) offolic acid per day; due to the possibilityof inaccurate reporting, these were notquantified but were declared missing.Folate intake from supplement sources wasconverted to dietary folate equivalents (DFE)by multiplying by 1.7.11Trained interviewers collected dietarysupplement intake data as part ofthe structured PHP telephone surveyquestionnaire. They asked respondentsDietary intake from food was assessedwith a food frequency questionnaire (FFQ).This was given to the study participants tocomplete before their scheduled telephoneMethodsData for the Prenatal Health Project (PHP)were collected between 2002 and 2005 frompregnant women recruited at ultrasoundclinics in London, Ontario. The PHPwas designed to assess the psychosocial,nutritional, endocrine and infectiousdeterminants of pre-term birth, and itsmethods have been discussed in moredetail elsewhere.12 Inclusion criteria werebeing aged 16 years or older, living in theGreater London Area, carrying a singletonpregnancy of between 10 and 22 weeksgestation, and speaking English. Womenwho met the inclusion criteria and whosigned the consent form were eligible toparticipate. Those who were carrying apregnancy with a known fetal anomalywere excluded.77interview; they then reported theiranswers during the telephone interview.The FFQ is considered an acceptablemethod of assessing dietary intake in largesurveys, including prenatal studies.14 Themajor advantages of the FFQ, whichmake it more practical than dietary recallsor multiple food records, are the lowrespondent burden and the lower cost ofdata collection since it can be incorporatedeasily into the telephone interview itself.As there was no specific information onthe dietary intake of pregnant Canadianwomen, we based the design of the FFQon dietary data collected through 24-hourdietary recalls from 183 women who werebreastfeeding at three months postpartum.15We compared the FFQ to one developedfor a USA-based study of prenatal health14and subsequently added some more foods(e.g. broth). A pilot test of the FFQ for thePHP was conducted in London, and theinstrument was validated with 3-day foodrecords kept by 22 pregnant women. Thecorrelation coefficients were as follows:folate 0.76 (p .001), zinc 0.46 (p .05)and iron 0.19 (not significant).The FFQ assessed the usual frequency ofconsumption of 106 foods over the monthprior to the interview date. Frequency ofconsumption of each item was categorizedas never, once per day, 2 to 3 times per day,4 or more times per day, once per week,2 to 4 times per week, 5 to 6 times per week,or 1 to 3 times per month. CANDAT NutrientCalculation System software16 was used toconvert responses to metric estimates ofenergy and nutrient intake per day, basedon the 2006 Canadian Nutrient File.17Nutrient intake values from supplementswere added to those from food to yieldtotal daily dietary intakes.Of 3656 women approached at ultrasoundclinics to participate in the PHP, 2747 agreedto participate and 2421 (66%) completed thesurvey. Of these 2421 respondents, 38 wereeliminated from the “core” longitudinalcohort due to perinatal data not beingavailable or not being applicable (for suchreasons as loss to follow-up, miscarriage,abortion or neonatal death). Additionally,26 women had been recruited into thestudy twice, for two different pregnancies;for each of these participants, a single setof data was randomly excluded. ThisVol 32, No 2, March 2012 – Chronic Diseases and Injuries in Canada
yielded 2357 PHP participants in the corelongitudinal cohort, with 2019 included inthe intake analyses reported in this paper.Those included had completed the FFQ,reported an energy consumption amountwithin two standard deviations from thesample mean (as outside that plausiblerange is indicative of possible inaccuratereporting), had plausible FFQ-derivedintake values for the nutrients of interest,and did not have any missing values forthe nutrient supplement intake valuesfor the nutrients of interest.34 years (with mean age of 30 years),were married, had completed college oruniversity and had household incomesof between 30,000 and 79,999. Mostwomen reported taking one or moredietary supplements; however, 29.6% didnot receive any zinc from supplementsources, 28.4% did not receive any ironfrom supplement sources and 20.3% didnot receive any folic acid from supplementsources. Approximately one-fifth of thesample did not take any regular orprenatal multivitamin products or singlenutrient supplements that contained anyzinc, iron or folic acid.Table 2 shows the descriptive analyses ofeach of the three micronutrients. Includedare estimates of mean daily intake fromfood, from dietary supplements and fromboth sources together. Also indicated is theproportion ranking below the RDA, basedon the total dietary intake estimates.Because of the inherent limitations of theTable 1Characteristics of Prenatal Health Project (PHP)dietary intake analysis participants (n 2019)Statistical analysesFor the sample of 2019 eligible studyparticipants, we calculated descriptiveanalyses of the estimated mean dailyintake values of iron, zinc and folate fromfood, from supplements and from totaldietary intake. To explore the contributionof supplement use in this regard, stratumspecific mean intakes for each micronutrientwere also calculated, based on whether asupplement containing the micronutrientwas being taken; Student’s t tests wereconducted to see if the differences betweenstrata of supplement use were statisticallysignificant. A correlation matrix betweenthe total intakes of the three micronutrientswas also generated to see whether intakeswere linked. To assess possible predictors ofdiet, we explored associations between dietand four categorical sociodemographicvariables: age, marital status, education andhousehold income. To this end, we usedANOVA to explore associations betweenthe four categorical sociodemographicvariables and total dietary iron, zinc andfolate intake separately. In addition, weran χ2 tests between each of the socio demographic variables and dichotomizedsupplement use to assess any possibleassociations. Finally, we determined thefrequencies of the types of dietary supplements taken by the full core PHP cohort(n 2357). The statistical package SASversion 9.1 (SAS Institute Inc.)18 was usedto conduct data management and statisticalanalyses.Categorical variablesParticipantsNumber, nPercentage, %Age group, years 2222–3435 854.2157878.235517.6Marital ated/divorced1638.1143171.357528.7 30,00022411.930,000–79,99994150.080,000 pleted college diploma/university degreeOtherHousehold incomea, Using one or more dietary supplement(s)bTaking a supplement containing ironTaking a supplement containing zincTaking a supplement containing folic acidMeasured variablesResultsMean(SD)Age, years30.4(5.0)Energy consumption, kcal/day1982(545)Abbreviation: SD, standard deviation.Table 1 shows the characteristics of theeligible survey participants (n 2019).Most women were aged between 22 andaSample size is less than 2019 due to missing values.bContaining any amount of folic acid, iron or zinc; therefore, those assigned a “no” to this variable were not taking anyof the multivitamin products or single-nutrient products listed in Table 4.Vol 32, No 2, March 2012 – Chronic Diseases and Injuries in Canada78
Table 2Intake from food and dietary supplements of iron, zinc and folate by pregnant women (n 2019)MicronutrientRDA for pregnantwomenEstimated mean daily intake, weight per day (SD)From food aloneFrom dietarysupplements aloneTotalProportion of samplebelow RDA,%Iron (mg/day)2713 (4)19 (12)32 (13)31Zinc (mg/day)1110 (3)5 (3)16 (5)18600473 (155)1338 (763)1811 (772)16Folate (μg/day DFE)aAbbreviations: DFE, Dietary Folate Equivalent; RDA, Recommended Dietary Allowance; SD, standard deviation.aIn addition to the RDA from food, the Society of Obstetricians and Gynaecologists of Canada recommends that pregnant women take a 400 μg folic acid supplement (400 μg folic acid approximately 680 DFE).9FFQ method of dietary assessment, it isnot considered appropriate to use theestimates of nutrient intake to assessnutrient adequacy. However, FFQ estimatesmay be used to rank nutrient intakes ina popu lation based on the RDA.19 In thiscase, a relatively high proportion of thesample fell below the specified RDA for allthree micronutrients: iron (31%), zinc(18%) and folate (16%). A correlationmatrix between the total intakes ofthe three micronutrients showed highcorrelation.Table 3 shows stratum-specific meanestimates of total dietary intake, accordingto whether a supplement containingthe particular micronutrient was beingtaken. The corresponding Student’s ttests indicate statistically significantdifferences in mean intakes for all threemicronutrients. Figure 1 shows histogramsdepicting the distributions of the threemicronutrients. While total zinc intakefollows a reasonably normal distribution,the distributions for total iron intakeand total folate (DFE) intake arebimodal, each showing two distinctpeaks. For both micronutrients, one peakwas below the RDA level while the otherwas above. The peaks correspond tothe stratum-specific mean estimates inTable 3; in other words, the bimodaldistributions are a function of dietarysupplement use.Table 4 shows the types of nutrientsupplement product used; that is, multi vitamin products as well as single-nutrientsupplements featuring iron, zinc or folate.To show the complete range of productsused, the numbers are based on the fullPHP core cohort of 2357 women. Therefore,the table includes entries that could notbe quantified. Of the specified prenatalmultivitamin supplements, the mostcommonly used product was CentrumMaterna (n 592). In the case ofsupplements of specific micronutrients(i.e. single-nutrient supplements, orproducts containing a small complex ofnutrients), the most common were folicacid supplements (n 354), followed byiron supplements (n 98).ANOVA tests were run to examine whetherthere were associations between the fourcategorical sociodemographic variables andeach of total dietary iron, zinc and folateintakes. None was statistically significant.Similarly, of the χ2 tests conducted betweeneach of the sociodemographic variablesand dichotomized dietary supplementuse, none was statistically significant.In other words, age, marital status,education, and household income werenot associated with either total dietaryintake or supplement use in this groupof women.DiscussionLondon is a city in southwestern Ontario.In 2006, its population was just over350 000.20 The reported median familyincome in 2005 was 67,018—only slightlyhigher than the median family incomefor Canada ( 63,866) and only slightlylower than that for Ontario ( 69,156).20The results of this study may thus beinformative for other Canadian cities withsimilar characteristics.Table 3Total dietary iron, zinc and folate intake by pregnant women, stratified by supplement use (n 2019)MicronutrientRDA for pregnant womenIron (mg/day)27Zinc (mg/day)11Folate (μg/day DFE)Estimated mean daily intake, weight per day (SD) [n]Participantsobtaining micronutrientonly from foodParticipants obtainingmicronutrient from bothfood and supplement sources13 (4)40 (6)[n 573][n 1446]11 (3)18 (3)600[n 597][n 1422]482 (157)2148 (422)[n 409][n 1610]Student’s t test* 100.0 44.7 78.4Abbreviations: DFE, Dietary Folate Equivalent; p, p-value; SD, Standard deviation.* p .00179Vol 32, No 2, March 2012 – Chronic Diseases and Injuries in Canada
Figure 1Estimated dietary intake of dietary folate equivalents, iron and zinc from both food and supplement sources (separately and totalled)by Prenatal Health Project (PHP) survey participants (n 2019)Intake of Dietary Folate Equivalents from food equency150FrequencyTotal intake of Dietary Folate Equivalents (from food plus supplement sources)Intake of Dietary Folate Equivalents from supplements 000DFE intake (mcg/day)DFE intake (mcg/day)DFE intake (mcg/day)RDA for pregnant women: 600 mcg/dayRecommendation: 400 mcg folic acid ( 680 mcg DFE) daily supplementRDA for pregnant women: 600 mcg/dayIron intake from food onlyTotal iron intake (from food plus supplement sources)Iron intake from supplements only2004000150020010050100050005101520iron intake 5002040iron intake (mg/day)06020RDA for pregnant women: 27 mg/dayTotal zinc intake (from food plus supplement sources)Zinc intake from supplements Zinc intake from food only50002050001015zinc intake (mg/day)60RDA for pregnant women: 27 mg/day150540iron intake (mg/day)051015zinc intake (mg/day)RDA for pregnant women: 11 mg/day5101520zinc intake (mg/day)2530RDA for pregnant women: 11 mg/dayAbbreviations: DFE, Dietary Folate Equivalent; RDA, Recommended Dietary Allowance.Note: The arrows approximately indicate the RDA for each nutrient.Few Canadian studies have examineddietary intake and supplement useduring pregnancy. Of those that have,most focus on folic acid supplementuse.21-25 In terms of nutrient intake fromfood among Canadian pregnant women,a 2005 paper by Pick et al.26 reportedon the nutrient intake levels of a smallsample of non-pregnant and pregnantwomen in Edmonton, Alberta. Becausethey were reporting findings from a pilotstudy, the sample size was relativelysmall (n 52 pregnant women), whichthey acknowledge as a limitation.26 Incontrast, our study uses a very largesample size and a pre-piloted, validatedinstrument to capture dietary intake.Additionally, Pick et al. did not factor innutrient values from dietary supplements,26while we were able to incorporate nutrientvalues from supplements to generate totalintake estimates. Thus, our study offersa valuable glimpse into the nutritionalstatus of a pregnant Canadian population,thereby contributing meaningfully to theliterature in the area.We found that a significant proportionof women had dietary intakes of iron,zinc and folate that ranked below the RDAvalues. Nutrient intake from food alone wasparticularly low (see Figure 1), supportingother Canadian studies that suggested thatit is difficult for pregnant women to meetrecommendations for key micronutrientsfrom food alone.26,27Vol 32, No 2, March 2012 – Chronic Diseases and Injuries in Canada80Additionally, one-fifth of women did nottake any supplements containing any of thethree micronutrients. Given the importanceof these micronutrients for maternal andfetal health, this is of concern.Clinical practice guidelines emphasize theimportance of folic acid supplementationduring pregnancy9 and recommend ironsupplementation.5 Thus it is not surprisingthat these two micronutrients were themost common among single-micronutrientproducts. The bimodal distributionsassociated with both micronutrients area function of dietary supplement use, asshown in Table 3; women who usedsupplements for these nutrients were wellabove the RDAs for them and constituted
the higher-valued peaks, whereas womenwho did not use dietary supplementsdid not achieve the RDAs for them andconstituted the lower-valued peaks. Thus,dietary supplement use is clearly integralto the attainment of the micronutrientintake levels required during pregnancy.prevents neural tube defects is unknown,it seems that folic acid supplements (ratherthan natural food folates) may be key tothe preventive effect.25 As such, it is ofconcern that 20% of women in this samplewere not taking a dietary supplementcontaining folic acid.Even with folic acid fortification of foodsin Canada and the United States, mostwomen appear to require a separate folicacid supplement in order to achieve thered blood folate concentrations requiredto prevent neural tube defects.25,27 Whilethe exact mechanism by which folic acidAs mentioned in the Results section, theintake values for the three micronutrientswere highly correlated overall. This findingis likely a reflection of the fact that individuals tend to be deficient in multiplemicronutrients due to poor overall dietarypractices; along the same vein, it mayTable 4Self-reported multivitamin supplements and single-nutrient supplementsfeaturing iron, zinc or folate, taken by the full cohort of Prenatal Health Project (PHP)participants (n 2357 women)SourceNumber of self-reported entries,nTotalQuantifiedMissingRegular multivitamin 21eSingle-nutrient zinc supplement220Zinc with selected (few) other micronutrients101eSingle-nutrient folic acid supplement34731532Folic acid in a supplement with a fewselected other micronutrients734Product specifiedaProduct not specifiedPrenatal multivitamin supplementProduct specified: Centrum MaternaProduct specified: othercProduct not specifieddIronSingle-nutrient iron supplementIron in a supplement with one other micronutrientZincFolateNote: This table shows the frequencies of self-reporting of types of supplements. To show the full range of products used, thetable is based on the core PHP cohort, including those participants who were excluded from the other analyses in this paper.Please note that some women may have been taking multiple types of supplements; as such, there may be multiple entries fora single participant. Similarly, as discussed in the paper and displayed in Table 1, a notable proportion of women did not takeany supplements; there are no entries for these participants.aSpecified regular multivitamin brands: Centrum (regular), Centrum Forte, Centrum Protegra, Flintstones (children’smultivitamins), Nutrilite Double X, Life Daily One for Women, Life Spectrum, Life Spectrum Forte, One A Day,One A Day – Women’s.bDeclared missing because, in contrast to prenatal multivitamins, the nutrient composition of regular adult multivitaminsvaries substantially and therefore cannot be inferred from other brands.cSpecified prenatal multivitamin brands (apart from Centrum Materna): Equate, Fem, GNC, Jamieson, Life, NaturalFactors (MultiStart), Orifer F, PregVit, Rexall, Thorne Research, Truly.dAssumed to be identical to Materna since nutrient compositions of different prenatal multivitamin products arevery similar.eDeclared missing because nutrient composition of single-nutrient dietary supplements (aside from folic acid) variessubstantially and therefore cannot be inferred from other brands.81also be a reflection of multivitaminsupplement use, through which individualsreceive the micronutrients together as a“package.”Age, marital status, education andhousehold income were not associated witheither total dietary intake of micronutrientsor supplement use. As part of a separateanalysis involving PHP data, we used multi variable regression to evaluate predictors ofdietary zinc intake more thoroughly. Thosefindings, done in the context of a researchquestion on the predictors of prenataldepression, have been reported in detailelsewhere;28 none of the sociodemographicvariables or psychosocial stress were shownto be predictors of dietary zinc intake inthis cohort.28 The cohort as a whole isof higher socio-economic status thanthe general population of the city ofLondon.20,28 Thus, other factors mayaccount for the variation in dietary intake.Further investigation to uncover these factorswould be pertinent from a public-healthpolicy perspective. Certainly, the linkbetween socio-economic status and dietaryintake is well-established.29-33 In that light,it is somewhat intriguing that notableproportions of a more socially advantagedcohort also show indications of inadequatedietary intake and a lack of supplement use.Such findings may flag the existence ofadditional barriers in Canadian women’slives, not captured by typical socio-economicstatus indicators. It has been suggestedin the folic acid supplement literature, forexample, that there may be barriers at thehealth care provider and public-health policylevels.24,25 There has been increasing focuson the social determinants of populationhealth and on health promotion as afunction of public health;34-36 both of theseframeworks may be useful to understandthe determinants of dietary intake andsupplement use among Canadian womenof childbearing age. Further research andaction is warranted to help effectivelypromote healthy dietary practices acrossall segments of the Canadian population.Study strengths and limitationsThe FFQ method of assessing dietaryintake offers only an estimate of nutrientvalues, and individual-level adequacystatus cannot be determined with certainty.Vol 32, No 2, March 2012 – Chronic Diseases and Injuries in Canada
However, for large survey studies such asthis one, it is an acceptable and usefulmethod, and still offers insight relevantfor the purposes of public health. As notedin the Methods section, the correlationcoefficient for the validation of iron intakeis low (0.19). Since the estimate of ironintake from FFQ data was lower than thatobtained from the 3-day records in the pilottest, our findings are likely conservative.However, this issue is unlikely to accountfor the very stark difference in totaliron intake between those taking and nottaking an iron-containing supplement. Inother words, it likely does not alterthe conclusion that supplement use isimportant in achieving the RDA for ironduring pregnancy.variety of locations in London, where itis routine practice for pregnant women toget ultrasounds. A potential limitation isthe fact that only English-speaking womencould be recruited. However, as less than2% of women in London, Ontario, cannotspeak English,20 the impact is likelynegligible. The PHP cohort is of somewhathigher socio-economic status than thegeneral population of the city of London,Ontario,20 which may indicate selectionbias; however, it also allowed for intriguingfindings to come to light regarding dietaryintake and supplement use in more sociallyadvantaged segments of the population, asdiscussed above.As described in the Methods section, weassumed that unspecified prenatal dietarysupplements were of the same compositionas Centrum Materna. This assumption,however, is reasonable given the similaritiesbetween popular prenatal multivitaminproducts on the market. Additionally, forthose who did not specify the amount oftheir folic
Keywords: iron, folate, zinc, dietary supplement, diet, nutrition, pregnancy Introduction Adequate amounts of nutrients during pregnancy are essential for maternal, fetal and child health. However, few population-based studies have examined dietary intake and use of dietary supplements among pregnant women in Canada. Of particular
What percentage of U.S. adults used any dietary supplement in the past 30 days, and did this vary by sex and age in 2017-2018? During 2017-2018, 57.6% of adults aged 20 and over reported using any dietary supplement in the past 30 days (Figure 1). A higher percentage of women (63.8%) reported dietary supplement use than men (50.8%). For both
The FDA defines a supplement as, "products (other than tobacco) intended to supplement the diet that bear or contain one or more of the following dietary ingredients: a. A vitamin; b. A mineral; c. An herb or other botanical; d. An amino acid; e. A dietary substance for use by man to supplement the diet by increasing the total dietary intake .
The purpose of this study was to (1) describe dietary supplement intake of study participants by age and race; (2) identify the reasons or motivations for dietary supplement intake; and (3) determine if dietary supplement intake impacts diet quality and cardiovascular and nutritional biomarkers. Methods
Iron, zinc plating 2 E3C-S50 (8) E39-L40 Iron, zinc plating 1 Phillips screws M4 25 (with spring and plain washers) Iron, zinc plating 2 E3JK Nuts M4 Iron, zinc plating 2 E39-L41 Iron, zinc plating 2 Phillips screws M3 14 (with spring washers) Iron, zinc plating 4 6 E3C-1 (10) Plain washer M3 Iron, zinc plating 4 E39-L42 Iron, black coating 2
The indication allowed for health supplements are; used as health supplement, dietary supplement, food supplement or nutritional supplement. The indication for pregnant and lactating women would be "vitamin and mineral supplements for pregnant and lactating women". Functional claims acceptable for health supplement products are listed in .
Iron deficiency anemia can be associated with low dietary intake of iron, inadequate iron absorption or excessive blood loss. Women of childbearing age, pregnant women, preterm and low birth weight infants, older infants, toddlers and teenage girls are at greatest risk of developing iron deficiency anemia because they have the greatest iron needs.
On one end the products maintain health while at the other end they are said to be of a medicinal nature. The problem lies in defining dietary supplement as curative or preventive. 2. The Domestic Players and Raw Material Disparity India and China dominate the dietary supplement industry in Asia - Pacific region
A Pre-Revolution Time Line Directions: Using the list in the box, fill in the events and laws that led up to the American Revolution. Write the event or law below each year. You may need to do some online research to complete this exercise. Boston Tea Party, Stamp Act Congress, Intolerable Acts, The French and Indian
