National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×

Nutrition Issues in Developing Countries

Part I: Diarrheal Diseases

Part II: Diet and Activity During Pregnancy and Lactation

Subcommittee on Nutrition and Diarrheal Diseases Control

Subcommittee on Diet, Physical Activity, and Pregnancy Outcome

Committee on International Nutrition Programs

Food and Nutrition Board

Institute of Medicine

NATIONAL ACADEMY PRESS
Washington, D.C.
1992

Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×

National Academy Press
2101 Constitution Avenue, N.W. Washington, D.C. 20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.

This study was supported by the U.S. Agency for International Development under Contract No. DAN-0262-G-SS-7050-00.

Library of Congress Catalog Card No. 91-62280

International Standard Book Number 0-309-04092-2

Additional copies of this report are available from:
National Academy Press
2101 Constitution Avenue, N.W. Washington, DC 20418

S018

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

First Printing, May 1992

Second Printing, March 1993

Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×

SUBCOMMITTEE ON NUTRITION AND DIARRHEAL DISEASES CONTROL

CUTBERTO GARZA (Chair),

Division of Nutritional Sciences, Cornell University, Ithaca, New York

ROBERT E. BLACK,

Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland

KENNETH H. BROWN,

Program in International Nutrition, Department of Nutrition, University of California, Davis, California

RICHARD A. CASH,

Harvard Institute for International Development, Cambridge, Massachusetts

JUDSON M. HARPER,

Colorado State University, Fort Collins, Colorado

GERALD KEUSCH,

Division of Geographic Medicine and Infectious Diseases, Tufts-New England Medical Center, Boston, Massachusetts

GRETEL H. PELTO,

Departments of Nutritional Sciences and of Anthropology, University of Connecticut, Storrs, Connecticut

Staff

ROBERT EARL, Program Officer (from August 1990)

VIRGINIA HIGHT LAUKARAN, Program Officer (until August 1988)

SUSAN BERKOW, Program Officer (August 1988 through December 1989)

JANIE MARSHALL, Senior Secretary

Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×

SUBCOMMITTEE ON DIET, PHYSICAL ACTIVITY, AND PREGNANCY OUTCOME

MYRON WINICK (Chairman),

University of Health Science, Chicago Medical School, North Chicago, Illinois

CUTBERTO GARZA,

Division of Nutritional Sciences, Cornell University, Ithaca, New York

SANDRA L. HUFFMAN,

Center to Prevent Childhood Malnutrition, Bethesda, Maryland

JANET C. KING,

Department of Nutritional Sciences, University of California, Berkeley, California

MICHAEL S. KRAMER,

Department of Pediatrics and of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada

ISABEL NIEVES,

Institute of Nutrition of Central America and Panama, Guatemala, C.A.

JULIAN T. PARER,

Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, California

JOHN W. SPARKS,

University of Texas Health Science Center, Houston, Texas

ZENA A. STEIN,

Department of Epidemiology, School of Public Health, Columbia University, New York, New York

FERNANDO E. VITERI,

Department of Nutritional Sciences, University of California, Berkeley, California

ROBERT WISWELL,

Palo Alto Veterans Administration Hospital, Palo Alto, California

Staff

ROBERT EARL, Program Officer (from August 1990)

VIRGINIA HIGHT LAUKARAN, Program Officer (until August 1988)

SUSAN BERKOW, Program Officer (August 1988 through December 1989)

JANIE MARSHALL, Senior Secretary

Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×

COMMITTEE ON INTERNATIONAL NUTRITION PROGRAMS

MALDEN C. NESHEIM (Chair),

Office of the Provost, Cornell University, Ithaca, New York

REYNALDO MARTORELL (Vice Chair),

Division of Nutritional Sciences, Cornell University, Ithaca, New York

KENNETH H. BROWN,

Program in International Health, Department of Nutrition, University of California, Davis, California

CUTBERTO GARZA,

Division of Nutritional Sciences, Cornell University, Ithaca, New York

GAIL G. HARRISON,

College of Medicine, University of Arizona, Tucson, Arizona

ROBERT HORNIK,

Annenberg School of Communication, University of Pennsylvania, Philadelphia, Pennsylvania

GRETEL PELTO,

Departments of Nutritional Sciences and of Anthropology, University of Connecticut, Storrs, Connecticut

BARRY POPKIN,

Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina

BEATRICE LORGE ROGERS,

School of Nutrition, Tufts University, Medford, Massachusetts

Staff

VIRGINIA HIGHT LAUKARAN, Program Officer (until August 1988)

SUSAN BERKOW, Program Officer (August 1988 through December 1989)

JANIE MARSHALL, Senior Secretary

Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×

FOOD AND NUTRITION BOARD

RICHARD J. HAVEL (Chair),

Cardiovascular Research Institute, University of California School of Medicine, San Francisco, California

HAMISH N. MUNRO (Vice Chair),

Human Nutrition Research Center on Aging, U.S. Department of Agriculture, Tufts University, Boston, Massachusetts

EDWARD J. CALABRESE,

Environmental Health Program, Division of Public Health, University of Massachusetts, Amherst, Massachusetts

DORIS H. CALLOWAY,

Department of Nutritional Sciences, University of California, Berkeley, California

WILLIAM E. CONNOR,

Division of Endocrinology, Metabolism, and Clinical Nutrition, Department of Medicine, Oregon Health Sciences University, Portland, Oregon

DeWITT GOODMAN (deceased),

Institute of Human Nutrition, Columbia University, New York, New York

M.R.C. GREENWOOD,

Office of Graduate Studies, University of California, Davis, California

JOAN D. GUSSOW,

Department of Nutrition Education, Teachers College, Columbia University, New York, New York

JOHN E. KINSELLA,

College of Agriculture, University of California, Davis, California

LAURENCE N. KOLONEL,

Cancer Center of Hawaii, University of Hawaii, Honolulu, Hawaii

BERNARD J. LISKA,

Department of Food Science, Purdue University, West Lafayette, Indiana

REYNALDO MARTORELL,

Division of Nutritional Sciences, Cornell University, Ithaca, New York

DONALD B. McCORMICK,

Department of Biochemistry, Emory University School of Medicine, Atlanta, Georgia

WALTER MERTZ,

Human Nutrition Research Center, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, Maryland

MALDEN C. NESHEIM,

Office of the Provost, Cornell University, Ithaca, New York

Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×

J. MICHAEL McGINNIS (Ex Officio),

Office of Disease Prevention and Health Promotion, Department of Health and Human Services, Washington, D.C.

ARNO G. MOTULSKY (Er Officio),

Center for Inherited Diseases, University of Washington, Seattle, Washington

Staff

CATHERINE E. WOTEKI, Director (beginning April 1990)

ALVIN LAZEN, Acting Director (August 1989 to April 1990)

SUSHMA PALMER, Director (until August 1989)

FRANCES M. PETER, Deputy Director (until June 1990)

SHIRLEY ASH, Financial Specialist (until August 1991)

UTE S. HAYMAN, Administrative Assistant (until March 1991)

MARCIA S. LEWIS, Administrative Assistant (beginning July 1991)

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
This page in the original is blank.
Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×

PART II: DIET AND ACTIVITY DURING PREGNANCY AND LACTATION

 

 

1

 

SUMMARY

 

73

2

 

OVERVIEW OF THE SOCIOECONOMIC AND HEALTH STATUS OF WOMEN IN DEVELOPING COUNTRIES

 

77

   

Economic Situation and Food and Nutrition in Developing Countries

 

77

   

Status of Women: Health and Social Issues

 

78

   

Literacy

 

78

   

Fertility

 

79

   

Access to Health Care

 

79

   

Family planning

 

79

   

Infant and child mortality

 

80

   

Maternal mortality

 

81

   

Nutritional anemia

 

81

   

Low birth weight—Health and nutritional status of the mother

 

82

   

Breastfeeding

 

83

   

Physical Activities of Pregnant Women in Developing Countries

 

83

   

Patterns of energy expenditure and intake and low birth weight

 

86

   

Activity patterns of women in rural areas

 

87

   

Income from agricultural labor

 

90

   

Seasonality

 

92

   

Activity patterns of women in urban areas

 

94

   

Informal sector activity

 

97

3

 

PHYSIOLOGY OF NORMAL PREGNANCY AND THE EFFECTS OF UNDERNUTRITION

 

103

   

Body Weight and Composition

 

103

   

Maternal energy expenditure and energy balance

 

105

   

Potential energy-sparing mechanisms

 

107

   

Blood volume and composition

 

109

   

Undernutrition, blood volume expansion, and placental blood flow in animal models

 

109

   

Gestational Effects on Organ Systems in Pregnant Women

 

110

   

Pregnancy-related changes in maternal metabolism

 

111

   

Metabolic adaptations

 

111

Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
   

Metabolic and Transport Function of the Placenta

 

116

   

Placental transport in malnourished women and animals

 

117

   

Effect on nutrient flux

 

117

   

Fetal Metabolism and Nutrition

 

118

   

Iron status and work performance

 

119

4

 

NUTRIENT METABOLISM AND PHYSICAL ACTIVITY

 

125

   

Energy

 

125

   

Resting or basal energy requirements

 

125

   

Energy requirements for activity

 

127

   

Sources of energy

 

131

   

Protein

 

132

   

Iron

 

132

   

Pregnancy and Oxygen Consumption

 

133

   

Pregnancy, Work, and Substrate Metabolism

 

134

   

Hormonal changes

 

134

   

Temperature

 

134

   

Effect of Maternal Undernutrition or Physical Activity on the Fetus

 

135

   

Effects of Undernutrition on Physical Activity

 

136

   

Productivity

 

137

   

Discretionary physical activity

 

138

   

Physical work capacity

 

138

5

 

EFFECTS OF DIET AND PHYSICAL ACTIVITY IN PREGNANT HUMAN POPULATIONS

 

143

   

Effects of Energy Intake

 

144

   

Background

 

144

   

Gestational duration

 

146

   

Fetal growth

 

146

   

Spontaneous abortion

 

147

   

Congenital anomalies

 

148

   

Maternal mortality

 

148

   

Other pregnancy complications

 

149

   

Effects of Maternal Work and Physical Activity

 

149

   

Background

 

149

   

Gestational duration

 

151

   

Fetal growth

 

155

   

Spontaneous abortion

 

159

   

Congenital anomalies

 

160

   

Maternal mortality

 

161

   

Other pregnancy complications

 

161

Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
This page in the original is blank.
Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×

PART I
DIARRHEAL DISEASES

Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
This page in the original is blank.
Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
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Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
Page R7
Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
Page R8
Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
Page R9
Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
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Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
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Page R11
Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
Page R12
Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
Page R13
Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
Page R14
Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
Page R15
Suggested Citation:"Front Matter." Institute of Medicine. 1992. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases, Part II: Diet and Activity During Pregnancy and Lactation. Washington, DC: The National Academies Press. doi: 10.17226/1979.
×
Page R16
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This book considers two important international nutrition issues, provides a scientific evaluation, and proposes strategies for intervention at the community level.

Part I, Diarrheal Diseases, considers the dietary and nutritional factors that may affect the risk of contracting diarrheal disease and presents programmatic implications of these findings.

Part II, Diet and Activity During Pregnancy and Lactation, examines data on the extent to which women in the developing world are known to reduce or otherwise alter their activities and diets as a result of childbearing.

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