Women selected in present study for dietary intervention are involved in farm activities. For their physical activity, when adequate energy is not consumed for prolonged period along with essential nutrients, leads to undernourishment resulting in low body weight. Hence, in the present study an attempt has been made to increase the daily energy intake of farm women by incorporating an energy dense product with substantial level of other nutrients and to test its efficacy in improving body weight and BMI of women. The findings of the study are presented and discussed below.
Nutrient composition of energy dense laddu : The nutrient composition of energy dense laddu is presented in Table1. It was found that, the product contained 516 kcal of energy per 100 gm. Other proximate composition was 9.80, 31.60, 0.84 and 3.90 of protein, fat, ash and total dietary fiber respectively per 100 g of the product. Micro nutrient content of the product was 159.60, 2.47 and 1.29 mg for calcium, iron and zinc per 100 gm respectively. It was observed that the developed laddu was rich source of energy, protein and fat along with good amount of micro nutrients. The dietary intervention was aimed to incorporate one third (1/3rd ) energy need of the farm women along with regular diet. Accordingly the product formulated was found to be energy dense, mainly due to the ingredients such as, soy flour, sugar powder and ghee. The protein, fat and energy content of laddu prepared from rice, foxtail and barnyard samples was ranged between, 3.04- 5.00 g, 24.64-25.63 g and 68.40-503 kcal per 100 g (Verma et al., 2015). These findings are in supportive to present research findings for energy content, but protein content was also high in present research due to incorporation of ingredients such as soy flour, puffed bengal gram flour, cashew, sesame seeds and ground nut along with popped finger millet. It was observed that, the selected ingredients contributed to the nutritional composition of the developed food product (laddu) to make it nutritionally dense (especially in terms of protein, fat and energy) suitable for dietary intervention of underweight women.
Table 1: Nutrient composition of the energy dense laddu
Nutrients
|
Amount per 100 gm
|
Moisture (g)
|
4.02
|
Protein (g)
|
9.80
|
Fat (g)
|
31.60
|
Ash (g)
|
0.84
|
Total dietary fiber (g)
|
3.90
|
Carbohydrate (g)
|
42.40
|
Energy (kcal)
|
516.0
|
Calcium (mg)
|
159.60
|
Iron (mg)
|
2.47
|
Zinc (mg)
|
1.29
|
Socio-economic profile of subjects: Information on socio-economic status of selected subjects both in control and experimental group was collected and presented in Table 2. It was observed that, in experimental group majority of the women belonged to below 30 years group (46.66%) whereas in control group they belonged to above 40-50 years (56.66%) age group. Collectively women were mainly in the age group of 30-50 years. Almost all the subjects in the study were married irrespective of study group. Nuclear family type was predominant both among control (80.0%) and experimental group (83.33%). In control group most of them were illiterates (50.0%) followed by studied up to middle school (20.0%). Similar trend was observed for experimental group also, where per cent of illiterates and subjects studied up to middle school was same (33.33%).
Table 2: Socio-economic profile of selected subjects
Parameter
|
Control group (N=30)
|
Per cent (%)
|
Experimental
group (N=30)
|
Per cent (%)
|
Age
|
<30
|
02
|
6.66
|
14
|
46.66
|
30-39
|
11
|
36.66
|
06
|
20.00
|
40-50
|
17
|
56.66
|
10
|
33.33
|
Marital status
|
Married
|
30
|
100.00
|
29
|
96.66
|
Unmarried
|
00
|
00
|
01
|
3.33
|
Type of family
|
Joint
|
06
|
20.00
|
05
|
16.66
|
Nuclear
|
24
|
80.00
|
25
|
83.33
|
Educational qualification
|
Illiterate
|
15
|
50.00
|
10
|
33.33
|
Primary
|
02
|
6.66
|
02
|
6.66
|
Middle
|
06
|
20.00
|
10
|
33.33
|
High school
|
03
|
10.00
|
04
|
13.33
|
PUC
|
04
|
13.33
|
03
|
10.00
|
Graduation
|
00
|
0.00
|
01
|
3.33
|
Post Graduate
|
00
|
00
|
00
|
00
|
Land holding
|
Landless
|
08
|
26.66
|
07
|
23.33
|
Marginal (<2 hec)
|
18
|
60.00
|
17
|
56.66
|
Small (3-5 hec)
|
04
|
13.33
|
05
|
16.66
|
Large (> 5 hec)
|
00
|
00
|
01
|
3.33
|
Family Monthly Income (Rs.)
|
Lower < 2640
|
00
|
00
|
00
|
00
|
Upper lower
2641-7886
|
05
|
16.66
|
08
|
26.66
|
Lower middle
7887-19758
|
14
|
46.66
|
19
|
63.33
|
Upper middle
19756-26354
|
09
|
30.00
|
02
|
6.66
|
Upper
>26356-52733
|
02
|
6.66
|
01
|
3.33
|
Higher
>52734
|
00
|
00
|
00
|
00
|
Majority of the subjects had marginal land holding in control (60.0%) and in experimental group (56.66%). Most of the subjects belonged to lower middle income group with average monthly income ranged from Rs. 7887-19758 per month, however distribution to this group was slightly higher in experimental group (63.33%) compared to control (46.66).
Food Habits: Data on meal pattern and food habit of the subjects is as presented in Fig 2. Findings indicated that, though majority of them consumed three meals per day both in control (76.66%) and experimental (96.66%) group, 23.33 per cent subjects in control group consumed two meals per day. It was observed that non vegetarian food habit was predominant both in control (60.0%) and experimental group (80.0%). In rural areas the habit of consuming two meals per day was more prevalent but changing food consumption pattern due to various reasons has influenced rural farm women in consuming three main meals per day. But the prevalence of underweight among these selected farm women reveals insufficient intake of food both in terms of quality and quantity leading under nutrition. Though subjects were non vegetarians the frequency of consumption of non vegetarians foods is twice or thrice in a month, as revealed during personal interview.
Effect of dietary intervention on anthropometric measurement: The pre and post interventional anthropometric findings are presented in Table 3. Findings indicated, the average body weight of rural farm women increased from 40.67±3.29 to 43.29±4.51 kg. Corresponding increase in BMI was also observed from 17.43±0.49 to 18.75±1.26 (kg/ m2) during intervention. These increases in parameters were observed to be statistically significant. Whereas no change was observed in control group. In experimental group, waist circumference was slightly increased from 67.17±5.93 to 69.83±5.44 cm after intervention. Also, small shift in WHR was observed post intervention (0.78±0.05 to 0.80±0.05). However, these impacts were statistically non significant. But in control group these positive changes were unseen.
Nutritional anthropometry is measurement of human body at various ages and levels of nutritional status. Comparison of pre and post evaluation of the anthropometric assessment indicates the significant influence of the dietary intervention on subjects under study. In the present study it was observed that, the dietary intervention with additional calories and protein along with regular diet has contributed towards increasing body weight of the selected farm women. This is clearly indicated by BMI assessment, as the experimental subjects shifted from underweight category to normal after the interventional period. There are limited studies available to compare effect of dietary intervention on underweight women. Prentice et al., in 1987 reported that, energy dense prenatal dietary supplement (430 kcal/day) decreased the proportion of low-birth weight babies (less than 2501 g) from 23.7–7.5 per cent, emphasizes the importance of selective targeting of interventions to truly at-risk groups. Benefit of nutritional supplementation in free living, frail, undernourished elderly people was studied by Payette et al., in 2002 and reported that, nutrition intervention is feasible in free-living, frail undernourished elderly people and results in significant improvement of nutritional status with respect to energy and nutrient intake and weight gain. These findings supports the present research work, that dietary intervention with adequate energy dense food supplements contribute to improvement in undernourished subjects.
Table 3: Pre and post mean anthropometric measurements and indices of under nourished subjects
Anthropometric indices
|
Experimental
|
Control
|
Pre
|
Post
|
t-value
|
Pre
|
Post
|
t- value
|
Weight (Kg)
|
40.67±3.29
|
43.29±4.51
|
2.63**
|
38.30±4.29
|
38.40±4.27
|
0.09ns
|
Height (m)
|
1.53±0.06
|
1.53±0.06
|
|
1.52±0.07
|
1.52±0.07
|
|
BMI (kg/ m2)
|
17.43±0.49
|
18.75±1.26
|
5.36**
|
16.59±1.14
|
16.63±1.18
|
0.13ns
|
Waist Circumference (cm)
|
67.17±5.93
|
69.83±5.44
|
3.55ns
|
63.50±4.59
|
63.77±4.33
|
2.050ns
|
Hip Circumference (cm)
|
86.0±4.02
|
87.83±4.02
|
1.69ns
|
83.4±4.38
|
83.37±4.7
|
1.69ns
|
WHR
|
0.78±0.05
|
0.80±0.05
|
1.73ns
|
0.76±0.05
|
0.77±0.05
|
1.73ns
|
**: Significant at 0.01 level; *: significant at 0.05 level and ns: non-significant
Note: WC: Waist circumference; HC: Hip circumference; WHR: Waist Hip Ratio
Effect of dietary intervention on nutrient intake: Pre and post dietary interventional comparison of nutrient intake is presented in Table 4. Results of nutrient intake indicated that, the protein, fat and energy intake in experimental group was 31.99±3.01 g, 19.46±4.52 g and 1288 kcal respectively and increased to 39.73±3.90 g, 38.02±4.49 g and 1740±122 kcal after
Table4: Pre and post nutrient intake of undernourished subjects
Nutrients intake
|
RDA
|
Experimental
|
Control
|
Nutrient intake
|
% adequacy
|
Nutrient intake
|
% adequacy
|
‘t’
test
|
Nutrient intake
|
% adequacy
|
Nutrient intake
|
% adequacy
|
‘t’ test
|
Nutrients
|
|
Pre
|
Post
|
|
Pre
|
Post
|
|
Protein (g)
|
55
|
31.99±3.01
|
58
|
39.73±3.90
|
72
|
24.68**
|
31.06±3.17
|
56
|
30.93±3.10
|
56
|
0.64ns
|
Fat (g)
|
25
|
19.46±4.52
|
76
|
38.02±4.49
|
152
|
46.67**
|
21.46±4.23
|
86
|
21.22±4.23
|
85
|
1.24ns
|
CHO(g)
|
|
198.42±19.07
|
|
257.54±24.1
|
|
17.00**
|
198.96±18.35
|
|
200.97±16.92
|
|
1.72ns
|
Energy(K cal)
|
2230
|
1288±68.15
|
58
|
1740±122
|
78
|
26.02**
|
1267±63.18
|
57
|
1271±51
|
57
|
0.87ns
|
Mineral (g)
|
|
6.66±0.99
|
|
9.07±1.28
|
|
28.17**
|
6.65±0.86
|
|
6.73±0.94
|
|
0.85ns
|
Calcium(mg)
|
600
|
486.53±103.47
|
81
|
639.46±97.4
|
80
|
60.07**
|
495±72.09
|
83
|
503±80.23
|
84
|
1.17ns
|
Iron (mg)
|
21
|
9.06±1.61
|
43
|
14.48±2.02
|
69
|
40.72**
|
8.92±1.40
|
42
|
9.04±1.33
|
43
|
1.06ns
|
Zinc (mg)
|
10
|
5.23±0.44
|
52
|
5.52±0.69
|
55
|
3.97*
|
5.29±0.54
|
53
|
5.34±0.52
|
53
|
0.90ns
|
Dietary Fiber (g)
|
25-40
|
14.31±2.74
|
36
|
32.41±3.18
|
81
|
42.88**
|
13.78±2.86
|
34
|
13.72±2.65
|
34
|
0.26ns
|
*Significant at @ 5 per cent **Significant @1% ns: Non significant
intervention. However, in control group the intake of these proximate was remained unchanged. It was also found that, post interventional increase in intake of micronutrients (Calcium, iron and zinc) among experimental group. Dietary fiber intake was increased from 36 to 81 per cent adequacy in experimental group. It was noticed that, dietary intervention in experimental group significantly increased the intake of all the essential nutrients with improved adequacy of the nutrients. Whereas in control group no difference was observed. Bhandari et al., in 2016 studied, dietary intake patterns and nutritional status of women of reproductive age in Nepal and reported that, the dietary intake patterns to combat against nutritional deficiencies are not appropriate and nutritional status of women of reproductive age is still poor, indicates the need for dietary intervention among women. Payette et al., (2002) reported that nutritional supplementation in elderly people has significantly improved the energy and protein intake. These findings are in supportive to present study. The food product developed for dietary intervention was not only rich in energy, it also contained all the essential nutrients in optimum level, which is reflected in the increased nutrient intake among farm women. Increase in nutrient intake helps in improving the nutritional status of the women under study.