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Biomedical subjects

J M van Raaij

Publications and source records attributed to J M van Raaij.

At least 19 recordsLinked to original sources
PubMed2001

Zinc supplementation during pregnancy and effects on growth and morbidity in low birthweight infants: a randomised placebo controlled trial.

BACKGROUND: Infant malnutrition and mortality rates are high in less-developed countries especially in low-birthweight infants. Zinc deficiency is also widely prevalent in these circumstances. We aimed to assess the effect of daily zinc supplements given to pregnant mothers on their infants' growth and morbidity. METHODS: We did a double-blind, placebo controlled, randomised trial in 199 and 221 Bangladeshi infants whose mothers took 30 mg daily elemental zinc or placebo, respectively, from 12 to 16 weeks' gestation until delivery. Infants were followed up until 6 months of age. We obtained data for morbidity every week by mothers' recall. Infants' anthropometric measurements were done every month, and their serum zinc was assessed at 1 and 6 months of age. FINDINGS: Infants of mothers who received zinc during pregnancy had at age 6 months reduced risks compared with those in the placebo group for acute diarrhoea (risk ratio 0.84; 95% CI 0.72-0.98), dysentery (0.36; 0.25-0.84), and impetigo (0.53; 0.34-0.82). These reductions were seen in low-birthweight infants but not in those with normal birthweight. There were no differences in infant growth or serum zinc concentrations between treatment groups. INTERPRETATION: Maternal zinc supplementation during pregnancy resulted in a reduction of the health risks in Bangladeshi low-birthweight infants, although this intervention did not improve birthweight. Whether zinc should be added to usual antenatal supplements in regions with high rates of low birthweight should be reviewed.

Anthropometry↗
PubMed2001

Impact of iron supplementation and deworming on growth performance in preschool Beninese children.

OBJECTIVE: To assess the effects of iron and deworming on linear growth performance of preschoolers. DESIGN: Three-month randomized, double-blind and placebo-controlled trial. The children were allocated to four treatments: iron (60 mg elemental iron/day) + albendazole (200 mg/day for 3 consecutive days, repeated 1 month later), iron + albendazole-placebo, albendazole + iron-placebo or placebos. The supplementation was supervised. SUBJECTS: A group of 177 children aged 3-5 y was selected from low-income households in a rural area in southern Bénin. A complete data set was analysed for 140 subjects. Many children were stunted (58% had height-for-age Z-score <-2), none were wasted (2% had weight-for-height Z-score < -2) and 76% were anemic (Hb < 110 g/l). MAIN OUTCOME MEASURES: Anthropometric parameters, hemoglobin and eggs per gram feces. RESULTS: No significant difference in changes in anthropometric parameters was observed between study groups, and also not in a sub-sample of stunted and anemic subjects. Changes in hemoglobin were highest in the iron-treated subjects at the end of the 3-month intervention period (P = 0.032). The difference between the iron and the placebo groups remained significant even 7 months later (P = 0.022). The difference was 5 g/l in both periods. Ascaris lumbricoides and hookworm infections decreased significantly in albendazole-treated subjects (P < 0.05). CONCLUSIONS: In addition to recurrent parasitic infection burden, the children may have multiple micronutrient deficiencies. Therefore, it may be interesting to study appetite and food intake of young toddlers in relation to health and linear growth performance in poor environments.

Albendazole↗
PubMed2000

A randomized, placebo-controlled trial of the effect of zinc supplementation during pregnancy on pregnancy outcome in Bangladeshi urban poor.

BACKGROUND: Maternal zinc supplementation has been suggested as a potential intervention to reduce the incidence of low birth weight in developing countries. To date, placebo-controlled trials have all been performed in industrialized countries and the results are inconsistent. OBJECTIVE: The objective of this study was to evaluate whether zinc supplementation in Bangladeshi urban poor during the last 2 trimesters of pregnancy was associated with pregnancy outcome. DESIGN: We conducted a double-blind, placebo-controlled trial in which 559 women from Dhaka slums, stratified by parity between 12 and 16 wk of gestation, were randomly assigned to receive 30 mg elemental Zn/d (n = 269) or placebo (n = 290). Supplementation continued until delivery. Serum zinc was estimated at baseline and at 7 mo of gestation. Dietary intake was assessed at baseline and anthropometric measurements were made monthly. Weight, length, and gestational ages of 410 singleton newborns were measured within 72 h of birth. RESULTS: At 7 mo of gestation, serum zinc concentrations tended to be higher in the zinc-supplemented group than in the placebo group (15.9 +/- 4.4 compared with 15.2 +/- 4.3 micromol/L). No significant effect of treatment was observed on infant birth weight (2513 +/- 390 compared with 2554 +/- 393 g; NS) or on gestational age, infant length, or head, chest, or midupper arm circumference. The incidence and distribution of low birth weight, prematurity, and smallness for gestational age also did not differ significantly after zinc supplementation. CONCLUSIONS: Supplementation with 30 mg elemental Zn during the last 2 trimesters of pregnancy did not improve birth outcome in Bangladeshi urban poor. These results indicate that interventions with zinc supplementation alone are unlikely to reduce the incidence of low birth weight in Bangladesh.

Anthropometry↗
PubMed1997

Low-sodium diet in pregnancy: effects on blood pressure and maternal nutritional status.

In ninety-four Dutch nulliparous women the effects of a low-Na diet in pregnancy on blood pressure, energy and nutrient intake, Ca metabolism, Zn and Mg status and body composition were studied longitudinally. The women were randomly divided into an intervention group (n 41), which used a low-Na diet (mean urinary Na excretion 61 mmol/24 h) from week 14 of pregnancy until delivery and a control group (n 53; mean urinary Na excretion 142 mmol/24 h). No effect of the diet on blood pressure was observed. The use of a low-Na diet resulted in significantly reduced intakes of energy, protein, carbohydrates, fat, Ca, Zn, Mg, Fe and cholesterol. However, the women on the low-Na diet appeared to be able to adapt quite well to the reduced intake since Ca, Zn and Mg homeostasis was maintained. In the case of Ca and Mg this was probably due to the observed reduced urinary excretions of these nutrients. Non-significant reductions in weight gain (1.5 kg) and fat-mass gain (0.9 kg) over pregnancy were found in the women on the low-Na diet. No significant effects of the diet on birth weight or placental weight were observed.

Adult↗
PubMed1995

Energy requirements of pregnancy for healthy Dutch women.

Over the past 15 years we have performed several longitudinal studies with healthy Dutch women, in which components of an energy balance were measured before, during and after pregnancy. The observed small changes in energy intake over pregnancy are insufficient to meet the energy costs of pregnancy. This suggests that substantial savings were made on energy expenditure. We found no evidence for improvement of digestibility, for lower energy costs in ingesting, absorbing, transporting and storing nutrients, or for lower energy costs for performing fixed-paced physical tasks. So, it appears that our Dutch women cannot increase the efficiency of their energy metabolism. However we could clearly demonstrate that our women reduced their daily energy expenditure by decreasing the amount and pace of physical activity. In summary, our studies suggest there is no need for well-nourished western women to increase food intake in pregnancy, provided that the mothers reduce their level of physical activity. However, since the requirements for specific nutrients are increased in pregnancy, special attention should be given to the quality of the diet.

Diet↗
PubMed1995

Resting metabolic rate and thermic effect of a meal in the follicular and luteal phases of the menstrual cycle in well-nourished Indian women.

The resting metabolic rate (RMR) and thermic effect of a standard test meal (TEM) were measured twice each during the follicular and luteal phases (confirmed by plasma concentrations of progesterone and estradiol) of a single menstrual cycle, and once during the follicular phase of the following menstrual cycle, by using indirect calorimetry, in 13 well-nourished Indian women. There was a significant increase in the TEM (P < 0.05) (6.72 +/- 1.57% vs 7.96 +/- 1.48% of the energy content of the test meal for follicular and luteal phases, respectively) of 18.5% during the luteal phase of the menstrual cycle but no significant difference in the RMR or postmeal total energy output (PMTEO). Dietary energy and macronutrient intakes in all subjects in both phases of the menstrual cycle were also similar. The RMR and the PMTEO were also similar when measured in the follicular phase of consecutive menstrual cycles.

Adult↗
PubMed1995

Resting metabolic rate and work efficiency of rural Beninese women: a 2-y longitudinal study.

This study was performed on 34 female farmers in northern Benin during 2 consecutive years. Body composition, energy intake, energy expenditure, resting metabolic rate (RMR), and energy cost of cycling on a bicycle were measured in three periods per year. Energy intake showed seasonal fluctuations of approximately 1.7 MJ/d in 1990 and 0.6 MJ/d in 1991. Body weight fluctuated between periods, with the lowest weight in preharvest periods. Observed changes in body weight were 2.6 +/- 2.3 and 0.9 +/- 1.7 kg in 1990 and 1991, respectively. The same pattern was observed in both fat mass and fat-free mass. RMR, energy cost of cycling, and delta work efficiency did not show any seasonal changes. It is concluded that metabolic adaptation, as a response to a seasonal food shortage up to 15% of average daily intake, will not occur.

Adult↗
PubMed1995

Changes in energy expenditure, anthropometry, and energy intake during the course of pregnancy and lactation in well-nourished Indian women.

Basal metabolic rate (BMR), thermic effect of a meal (TEM), anthropometry, and dietary intakes were measured in 18 control subjects; 18 pregnant women at 12, 24, and 34 wk gestation; and in 17 of these women at 12 and 24 wk postpartum, to uncover any metabolic economy associated with either pregnancy or lactation. Results indicated that the BMR and TEM were not associated with any energy saving either during pregnancy or lactation. Mean weight gain from 12 wk gestation to term was 11.4 +/- 3.7 kg; mean birth weight of the infants was 3.06 +/- 0.41 kg. Estimated gain in adipose tissue and fat mass were 3.1 +/- 3.6 and 2.5 +/- 2.9 kg, respectively. Energy cost of pregnancy was estimated to be 303 +/- 171 MJ. The cumulative increase in energy intake over the last two trimesters of pregnancy was 290 +/- 280 MJ, meeting a large part of the total estimated cost of pregnancy. Weight gained by infants who were exclusively breast-fed from birth to 12 wk of age was used as a proxy indicator of adequate lactational performance. The extra energy required during lactation appeared to have been met largely by increases in energy intake, rather than by any metabolic economy or increase in fat mobilization.

Adult↗
PubMed1994

No substantial reduction of the thermic effect of a meal during pregnancy in well-nourished Dutch women.

To investigate changes in the thermic effect of a meal (TEM) during pregnancy, metabolic rate was measured in the fasting state and during the first 180 min after consumption of a standardized test meal in twenty-seven women before, and in each trimester of pregnancy. Resting metabolic rate (RMR) showed a steady increase over pregnancy: values in weeks 24 and 35 of pregnancy were significantly higher than the prepregnancy baseline (Tukey's studentized range test). The pattern of changes of postprandial metabolic rate (PPMR) was similar to that of RMR. Consequently TEM, calculated as PPMR minus RMR, did not change over pregnancy; mean TEM values (kJ/180 min) before and in weeks 13, 24 and 35 of pregnancy were 117.3 (SD 19.4), 116.4 (SD 23.7), 111.6 (SD 24.4) and 111.5 (SD 26.7) respectively. We consider changes in TEM of less than 15% to be of little importance physiologically. If true changes in TEM over pregnancy are 15% or more we would have had a 90% chance of observing significant changes in TEM in the present study, given the number of subjects and the methods used. Therefore, we conclude that no substantial reduction in TEM occurs during pregnancy.

Adult↗
PubMed1994

Effect of lactation on resting metabolic rate and on diet- and work-induced thermogenesis.

Energy metabolism was measured in 24 women before pregnancy and during lactation (2 mo postpartum). Resting metabolic rate (RMR) increased by 0.17 +/- 0.38 kJ/min and postprandial metabolic rate (PPMR) showed a similar increase (0.17 +/- 0.45 kJ/min). Thus, the thermic effect of the meal (PPMR minus RMR) was not affected by lactation. Between subjects, the lactation-induced increase in RMR appeared to be positively related to body weight. During lactation gross metabolic rates during cycling (CMR) were slightly reduced and net metabolic rates during cycling (CMR minus RMR) tended to decrease by 0.6 kJ/min at all workloads; however, the decrease was statistically significant only at the lowest workload. Changes in metabolic rate during the recovery period after exercise were not significant, but resembled changes in RMR rather than changes in CMR. We conclude that no major changes in metabolic efficiency occurred during lactation.

Adult↗
PubMed1994

Energy balances of healthy Dutch women before and during pregnancy: limited scope for metabolic adaptations in pregnancy.

To investigate changes in energy metabolism during pregnancy, complete 8-d energy balances were measured before pregnancy and at 12, 23, and 34 wk gestation in 12 healthy Dutch women. While for each individual woman experimental diets were kept constant throughout the study with average intakes of 8.76 +/- 0.92 MJ/d (before pregnancy), 8.72 +/- 1.08 MJ/d (week 12), 8.85 +/- 0.93 MJ/d (week 23), and 8.72 +/- 1.12 MJ/d (week 34), neither the digestibility nor the metabolizability of the supplied diets showed significant changes from before pregnancy (92.8% and 88.6%, respectively) throughout pregnancy (92.7% and 88.2%, respectively). Twenty-four-hour energy expenditure (24-h EE) increased significantly from 8.63 +/- 0.80 MJ/d (before pregnancy) to 8.73 +/- 1.15, 9.08 +/- 1.08, and 9.94 +/- 0.94 MJ/d in weeks 12, 23, and 34 of gestation, to the extent predictable from changes in resting metabolic rate so that in an experimental setting with physical activity and energy intake standardized there seems little scope for other adaptive mechanisms.

Adult↗
PubMed1994

No changes during pregnancy in the net cost of cycling exercise.

OBJECTIVE: To investigate whether work efficiency improves during pregnancy. DESIGN: Longitudinal; energy expenditure measurements (ventilated hood system) before the onset of pregnancy and in weeks 13, 24 and 35 of gestation. SUBJECTS: Healthy Dutch women (n = 26), recruited with advertisements in local newspapers and posters displayed in public buildings. MAIN OUTCOME MEASURES: Resting metabolic rate (RMR); metabolic rate during cycling at workloads of 30, 45, 60 and 75 W (CMRgross); post-cycling metabolic rate (PCMRgross); net energy costs of cycling (CMRnet = CMRgross - RMR); net recovery costs after cycling exercise (PCMRnet = PCMRgross - RMR). RESULTS: RMR, CMRgross and PCMRgross increased during pregnancy; under all conditions, metabolic rates were 0.9 kJ/min higher at 35 weeks gestation than before pregnancy (P < 0.05). CMRnet and PCMRnet showed no significant change during gestation. CONCLUSIONS: Changes in metabolic rate during cycling exercise suggest that pregnancy does not induce an improvement of work efficiency.

Adult↗
PubMed1992

Body composition of rural Beninese women in different seasons assessed by skinfold thickness and bioelectrical-impedance measurements and by a deuterium oxide dilution technique.

Body composition of 24 rural Beninese women was assessed in a pre- and a postharvest season by using skinfold-thickness measurements, bioelectrical-impedance analysis (BIA), and deuterium oxide (D2O) dilution. Fat mass assessed by D2O dilution was 12.3 +/- 3.3 kg; by skinfold-thickness measurements, 13.8 +/- 3.3 kg; and by BIA, 14.1 +/- 2.9 kg. Fat mass assessed by D2O was significantly lower (P less than 0.05) than fat mass assessed by the other two methods. Body weight in the postharvest season was 0.8 +/- 1.6 kg higher (P less than 0.05) than during the preharvest season. All three methods demonstrated that there were no significant changes in fat mass but that fat-free mass increased significantly (P less than 0.05) from pre- to postharvest season.

Adult↗
PubMed1992

Energy intake, energy expenditure, and body composition of poor rural Philippine women throughout the first 6 mo of lactation.

Between 6 and 30 wk postpartum, body weight and body-fat mass of 40 healthy, rural, lactating Filipino women decreased by 1.5 (P < 0.05) and 0.7 kg (P < 0.05), respectively. Energy intake decreased slightly (NS) from 8.84 +/- 2.05 MJ/d (2113 +/- 489 kcal/d; mean +/- SD) at 6 wk to 8.67 +/- 2.37 MJ/d (2073 +/- 566 kcal/d) at 30 wk. Basal metabolic rate (BMR) remained unchanged throughout lactation, and physical-activity level increased significantly (P < 0.05) from 1.61 +/- 0.17 x BMR at 6 wk to 1.97 +/- 0.18 x BMR at 30 wk. Energy intakes at 6 and 30 wk of lactation were 1.02 and 0.77 MJ/d (244 and 185 kcal/d) higher (P < 0.05), respectively, than in early pregnancy. At ages 1-6 mo, mean weights and lengths of mainly breast-fed infants had Z scores between 0 and -1. By using the growth patterns of the breast-fed infants as proxy indicators for adequacy of lactational performance, this study suggests that present recommended energy intakes for lactation are too high for healthy Filipino women who show adequate lactational performance.

Adipose Tissue↗
PubMed1991

Energy cost of lactation, and energy balances of well-nourished Dutch lactating women: reappraisal of the extra energy requirements of lactation.

At 9 wk postpartum the difference in energy intake of 40 lactating (2440 +/- 430 kcal/d) and 16 nonlactating women (1680 +/- 400 kcal/d) was 760 kcal/d but decreased to 550 kcal/d when adjusted for habitual intakes and body weight. Energy cost of lactation amounted to 650 kcal/d (breast-milk production, 745 +/- 130 g/d). When compared with nonlactating counterparts, the lactating women mainly achieved energy balance by eating more. Sixteen of the 40 lactating women were also studied at 56 wk. Their cost of lactation at 5-13 wk was 630 kcal/d (breast-milk production, 720 +/- 124 g/d); these women met their energy cost of lactation by eating more (415 kcal/d); by tissue mobilization (35 kcal/d), and by reducing energy expenditure (180 kcal/d). The present study helps in the understanding of how well-nourished women with an adequate lactational performance may cope in everyday life with the energy stress of lactation, and suggests that current recommendations of energy needs during lactation are too high.

Adipose Tissue↗
PubMed1990

Energy cost of walking at a fixed pace and self-paced before, during, and after pregnancy.

Body weight, basal metabolic rate (BMR), and treadmill metabolic rate (TMR) (3.9 km/h, no elevation) were measured in 39 women at 12, 24, and 36 wk gestation and at 9 wk postpartum. Prepregnancy measurements were also made on 15 of the women. TMR at 36 wk (3.65 +/- 0.50 kcal/min) was significantly higher than at 24 wk (3.38 +/- 0.43 kcal/min) or at 9 wk postpartum (3.38 +/- 0.43 kcal/min). Net energy cost (TMR minus BMR) at 36 wk gestation (2.42 +/- 0.40 kcal/min) was not different from prepregnancy or postpartum values but was significantly higher than at 12 wk (2.28 +/- 0.39 kcal/min) and 24 wk (2.28 +/- 0.37 kcal/min) gestation. In eight women the energy cost of self-paced walking on a treadmill was measured. The absolute and net energy cost decreased sharply from 6 to 12 wk gestation (by 8% and 11%, respectively) but remained unchanged afterwards. The data suggest that in the energy requirements for pregnant women no additional allowance need be made for physical activity, even if a woman's activity pattern includes a substantial amount of externally paced work.

Energy Metabolism↗
PubMed1990

Energy metabolism of overweight women 1 mo and 1 y after an 8-wk slimming period.

Twenty-four hour energy expenditure (24EE) and spontaneous physical activity were measured in 13 overweight women before and at the end of an 8-wk slimming period. These measurements were repeated in 10 women 1 mo after the slimming period (1-mo follow-up) and in eight women 1 y after slimming (1-y follow-up). The weight loss achieved after 8 wk of slimming (8.7-9.9 kg) was maintained throughout the follow-up periods; 24EE decreased during slimming from 9572 +/- 703 (means +/- SD) to 8060 +/- 471 kJ/d and increased after refeeding to 8379 +/- 739 kJ/d after 1 mo and to 8285 +/- 454 kJ/d after 1 y. On the basis of body weight, energy requirement (approximately 126 kJ.kg-1.d-1) did not change throughout the slimming and follow-up programs. Spontaneous physical activity, which had been lowered during slimming, tended to increase afterwards. No changes in metabolic efficiency seemed to occur or persist.

Adaptation, Physiological↗