Background: Nervous tubing defects ( NTDs ) and Down syndrome ( DS ) are two of the commonest birth defects prevalent in India. Though the etiologies of these defects are multifactorial, it has long been speculated that maternal nutrition is a lending hazard factor.
Aim: To pull an apprehension between the association of birth defects and sufficiency and quality of maternal nutritionary consumption in an Indian cohort.
Design: Analysis of a 24 hr dietetic callback and nutrient frequence questionnaire was used to quantify single nutrient ingestion in footings of entire Calories, saccharides, proteins, fats and vitamins in a survey group consisting of 75 NTD female parents, 102 DS female parents and 104 matched controls. Dietary information was compared to ICMR and USDA nutritionary guidelines for adult females.
Consequences: 25 – 100 % adult females were found to be devouring lower than recommended steps of different nutrient groups with regard to the ICMR guidelines and 5 – 99 % adult females were defaulters as per the USDA guidelines. Merely vitamin B12 consumption was significantly low in DS female parents compared to control-mothers ( 0.46±0.04 µg / twenty-four hours and 1.3±0.14 µg / twenty-four hours severally, p = 0.023 ) .
Decisions: There was an overall lack given the up to 2000 Calories bound for sedentary adult females. Folic acid and vitamin B12 estimations were low compared to the more recent USDA guidelines. Neither folic acid nor vitamin B6 was found to be significantly associated with the hazard of NTD or DS, low vitamin B12 may be a hazard factor for DS.
Keywords: Maternal nutrition, dietetic appraisal, nervous tubing defects, Down syndrome
The maternal diet and health, both before the oncoming and during gestation are important to the chances of the progeny ‘s. Every anticipant adult female needs a good assorted diet that provides both equal Calories and nutrition since the growing of the developing foetus is about wholly dependent on the proviso of nutrition via maternal blood supply. Fetal development involves uninterrupted cell proliferation, distinction and the formation of tissues and variety meats. All mode of cellular activities proceed via extended reproduction of DNA alongside dynamic alterations in forms of look of a big figure of developmentally regulated cistrons. The precise ordinance of cistron look, the environing placental environment ; including the maternal nutrition province are of import subscribers to the completion of normal morphogenesis. When any of these procedures goes amiss – because of disease or intervention in normal patterned advance of development – the effects can be black.
Abundant experimental and epidemiological informations under the auspices of nutritionary genomics efforts to show how nutrition influences homeostasis and the influence of dietetic foods on the genome ; such as the association of inborn anomalousnesss with maternal nutrition and familial factors. Vitamins and micronutrients are now good acknowledged as important cofactors in metabolic tracts that regulate nucleic acids synthesis and / or fix systems every bit good as the look of genes3. Folic acid, vitamin B6 and B12 are three such critical micronutrients ; lacks of which have been speculated to ensue in unnatural embryogenesis chiefly via break of genomic unity and impacting cistron look through change in DNA methylation: a major epigenetic characteristic of Deoxyribonucleic acid that regulates cistron transcription4. Folic acid is an of import precursor of the one – C metamorphosis or the homocysteine remethylation tract. Vitamin B6 is a cofactor of cystathionine & A ; szlig ; synthase ( EC… ) and vitamin B12 is a cofactor of methionine synthase ( EC… ) in the same tract. The ability of these micronutrients along with equal quality nutrition to modulate the hazard of birth defects is presently capable of much research globally. On similar lines we examined the association of maternal nutrition with two unrelated inborn birth defects, viz. , NTDs and DS in the Indian population.
NTDs are really a scope of inborn deformities associated with the failure of the nervous tubing to shut decently during early embryologic development that can take to terrible disablement or even decease. NTDs are physiological abnormalcies with no individual or attributable implicit in familial beginning. The defect really occurs at about the terminal of the first month after construct, at a clip when most adult females do non even recognize they are pregnant! It is hypothesized that the consequence of restrictive emphasiss can be more profound during early gestation and the development of the babe ‘s encephalon and neurological system is at hazard during the vulnerable period76. The etiology of NTDs is multifactorial and the exact mechanisms of their happening are non known. Even as embryologists and geneticists try to clarify the footing of neurulation, most of our apprehension of NTDs comes from surveies in mouse and amphibious theoretical accounts, for obvious grounds! [ Frequency ]
DS is another inborn upset ; a chromosomal abnormalcy characterized with presence of a 3rd transcript of chromosome 21 seen in the affected person. DS is the most common cause of mental deceleration [ Sheth, 2003 ] . The chromosomal abnormalcy is frequently associated with changing types and grades of physiological complications whose cumulative apprehension is far from complete. However, unnatural chromosomal segregation during miosis at oocyte ripening upon the induction of ovulation in the sexually mature female taking to disomic maternal gametes has been proposed to be the primary cause of Down syndrome in more than 90 % of the instances [ ref ] . [ Frequency ]
NTD and DS in the same household…
With the position of advancing good wellness in the general population normally with particular accent on adult females of child – bearing age, authorities bureaus issue directives or guidelines targeted to steering both medical practicians and the public alike. The kernel of these guidelines is to confer the ability of keeping good nutrition coupled to healthy life styles aboard cut downing the load of disease. With adult females these guidelines aim at the optimisation of maternal wellness cut downing the hazard and incidence of birth defects and the happening of chronic complaints by accomplishing optimum fetal growing and development. The Recommendations of the Indian Council of Medical Research ( ICMR ) Nutrition Expert Group ( 1968 ) and the United States Department of Agriculture ‘s ( USDA ) Dietary Guidelines for Americans ( 2005 ) are two such guidelines that we have referred to in the current survey.
Materials and Methods
The survey group comprised of Indian adult females holding a history of offspring with NTD or DS ( instance group ) , and age – and geographical beginning – matched adult females with healthy offspring ( command group ) . History of / or attendant major unwellness viz. malignant neoplastic disease, nephritic or liver disease, or engagement in another clinical test within a month of registration in the present survey, or refusal to give written informed consent for engagement in the survey comprised the exclusion standards.
Seventy five adult females who gave birth to kids with NTDs ( 74 female parents holding kids with NTDs, and 1 female parent holding a kid with both a NTD and DS ) and 102 adult females who gave birth to kids with DS were enrolled along with 104 control female parents. Registration of adult females in the survey involved the completion of an thorough CRF incorporating registration information, demographic informations, medical and obstetric history, and diet appraisals.
A individual 24 hr dietetic callback coupled to a nutrient frequence questionnaire formed the footing of dietetic appraisal. The premier aim of the dietetic callback interviews was to gauge entire consumption of nutrient energy ( Calories ) , foods and micronutrients from nutrients and drinks that were consumed during the 24 hr period prior to the interview. Diet penchant ( vegetarian / mixed diet ) was documented. During the dietetic callback, participants reported inside informations of the old twenty-four hours ‘s repast from early forenoon until bedtime along with vitamin supplementation. Standard mensurating cups were used to help participants in the dietetic callback. The nutrient frequence questionnaire examined information refering to the figure of times nutrient points such as fruits, salads, green leafy veggies, dark veggies, meat, fried nutrients, bites, pizzas, Burgers and aerated drinks etc. were consumed. Information sing the sum of comestible oils ( and type ) , ghee, butter, hydrogenated fats and cheese consumed was used to cipher the mean per capita ingestion.
The survey was approved by Institutional Ethics Committee. Enrolment of adult females in the survey was capable to their supplying written informed consent after being explained about the undertaking. For the easiness of participants the Informed Consent Form were prepared in English, Hindi and Marathi. If the participant was illiterate, consent was obtained by taking a thumb feeling on the ICF after punctually explicating the undertaking in the presence of a household member and a physician or a paramedic.
All informations obtained from the CRFs was entered into computing machine databases which were used for selective retrieval to ease statistical analysis. Microsoft Excel 2007 ( Microsoft, WA, USA ) and SPSS v15 ( Chicago, IL, USA ) were used for statistical analyses of informations.
The dietetic callback informations was analyzed for saccharide, protein, fats, vitamins B6 and B12, folic acid and entire Calories consumed utilizing published exchange values. Micronutrient consumption of instance – and command – female parents was analyzed by t – trial.
Dietary information was carefully divided into seven groups, viz. : fruits, veggies, grains, meat ( and beans ) , milk, oils ( and fats ) and discretional Calorie allowances as per the USDA and ICMR Food Guides for sedentary grownup adult females detailed in Table 1.
Mothers in the instances and control groups were matched for part of beginning and consisted of Maharashtrians, Gujaratis, North Indians, and South Indians.
The average maternal age ( ± criterion divergence ) of control female parents was 38 ± 8 old ages ( n = 104 ) that of NTD female parents was 34 ± 8 old ages ( n = 72 ) and of DS female parents was 38 ± 9 old ages ( n=102 ) .
More Numberss of control female parents were alumnuss and station – alumnuss compared to the instance female parents who were largely school dropouts and matriculate. Annual income of control female parents was higher than that of instance female parents. Most instance female parents belonged to the poorer strata, or were from the lower in-between category whereas most control female parents were from the upper in-between category. More Numberss of the control female parents were employed while more instance female parents were homemakers.
46 % of control female parents, 27 % of NTD female parents and 40 % of DS female parents were vegetarians while the remainder preferred a assorted diet. The BMIs were comparable across groups ( 25 ± 4 kilograms / M2, 25 ± 5 kilogram / M2 and 24 ± 5 kilograms / M2 for control, NTD and DS female parents severally ) . Diabetes and Hypertension were reasonably uncommon and most of those affected took prescribed medicine, this along with ingestion of different types of addendums has been summarized in Table 4.
When dietetic informations of the survey female parents was compared to those given in the dietetic guidelines, 25 – 100 % adult females were found to be devouring lower than recommended steps of different nutrient groups with regard to the ICMR guidelines and 5 – 99 % adult females were defaulters as per the USDA guidelines, the inside informations of which are reflected in Graphs 1 and 2.
The average maternal ages across groups were comparable. It was observed that control female parents were more educated compared to instance female parents.
Although dietetic appraisals of female parents were made at the clip of registration which in most instances was after a significant period since kid birth, this may however reflect the female parent ‘s diet around child birth peculiarly in footings of diet penchant and method of nutrient readying that do non alter drastically over clip.
Meanss of BMI were comparable between both survey groups. Calorific consumption throughout the cohort was lower than the 2000 Calories / twenty-four hours recommendation of both the ICMR and USDA.
From the dietetic consumption computations, it was found that the consumption of folic acid in the cohort was sufficient as per ICMR guidelines ( 100 µg / twenty-four hours ) although low as compared with the US Recommended Daily Allowance ( RDA ) of 400 µg / twenty-four hours harmonizing to Institute of Medicine ( IOM ) of the United States National Academy of Science. This could be attributed to the deficient ingestion of veggies and meat across groups farther complexed by population diverseness and the prevalence of stiff socio – economic systems. There is besides the broad prevalence of regional culinary arts, the tradition of milling grains at little local Millss sans munition, high temperature cookery and the pattern of mostly devouring place cooked repasts that affect the sufficiency and bioavailability of vitamin Bcs from nutrient.
Vitamin B12 consumption of control and NTD female parents was equal harmonizing to Indian RDA of 1 µg / twenty-four hours, though it was significantly low in DS female parents. However vitamin B12 consumption was lower throughout the cohort compared to the US DRI of 2.4 µg / twenty-four hours. Other surveies have besides reported such rampant lack in the Indian population [ ref paper2.docx pg 12 and Yajnik et al. , 2005 ] . Given that all demand of vitamin B12 comes from nutrient of animate being beginning, the exclusive factor that could be attributed to this endemic is the antediluvian vegetarianism of the major ball of the population due to religion chiefly and socio – economic grounds to a smaller extent. Growth deceleration, delayed psychomotor development and sometimes lasting effects on the kid ‘s developing encephalon have been linked with even a mild maternal vitamin B12 lack [ Schneede et al. , 1994 ] . Besides, low dietetic consumption of vitamin B12 or mal-absorption has been implicated as high hazard factor for NTDs [ Allen et al. , 1995 ; Botto et al. , 1999 ] . Low vitamin B12 position has besides been associated with high plasma entire homocysteine concentrations in Indians [ Refsum et al. , 2001 ] . Methionine synthase ( MTR ) remethylates homocysteine to methionine utilizing vitamin B12 as cofactor. Reduced homocysteine remethylation and accordingly less SAM coevals due to cut down MTR activity because of unequal vitamin B12 could be the cause of the reported high homocysteine. Lower SAM coevals is so likely to ensue in DNA hypo-methylation. DNA hypo-methylation has been linked to abnormal chromosomal segregation [ Rosenblatt, 1999 ] , and thereby ; the increased likeliness of DS in the babe.
Vitamin B6 consumption was equal harmonizing to both the Indian RDA ( 2 milligrams / twenty-four hours ) and US RDA ( 1.3 milligrams / twenty-four hours ) [ ref ] .
More figure of control female parents consumed addendums ( Iron, Calcium and multi- vitamin ) compared to instance groups. There is some grounds of socio-economic position and instruction holding an impact on the consciousness in adult females on the ingestion of addendums.
A 24 hr dietetic callback coupled to nutrient frequence questionnaire serves as a sensible step of gauging an person ‘s alimentary consumption ; nevertheless these are non free of restrictions that might happen due to the retrospective nature of the survey and mistakes due to remember prejudice.
Low vitamin B12 may be a conducive factor to the aetiology of DS, underpinning its important function in cellular development. Neither folic acid nor vitamin B6 was found to be significantly associated with the hazard of NTD or DS. Attempts to increase consciousness in adult females of kid bearing age, about use of micronutrient and the inability of rigorous vegetarian diets in supplying these should however be intensified. Given the tendency of hapless ingestion of addendums and their low palatableness in seemingly healthy adult females, the chief focal point of such awareness programmes should be the publicity of accomplishing ideal nutrition via diet with cut downing dependence on addendums.