title: Macronutrient and sociodemographic determinants of gestational weight gain among HIV-negative women in Tanzania.
abstract: BACKGROUND
  The effect of dietary macronutrient composition on the rate of gestational weight gain among women in sub-Saharan Africa is unclear.
  
  
  OBJECTIVE
  To examine the effect of macronutrient intake on the rate of gestational weight gain among HIV-negative women in Tanzania.
  
  
  METHODS
  The weights of 8,428 women were measured monthly from 12 weeks of gestation to term. Prenatal dietary intake was estimated as the cumulative average of multiple 24-hour dietary recalls. The association between energy intake and percentage of energy from carbohydrate, protein, and total fat and rate of weight gain (grams per month) was estimated from generalized estimating equation models. Macronutrient effects were adjusted for total energy using the nutrient density model and maternal age, maternal height, maternal mid-upper-arm circumference, parity, marital status, maternal occupation, maternal education, household wealth, season, and treatment regimen assignment. Body mass index (BMI) was considered as a confounder and a potential modifier of the effect of macronutrient intake on gestational weight gain.
  
  
  RESULTS
  A 6 g/month increase in rate of weight gain was associated with every 100-kcal increment in daily total energy intake (95% CI, 1 to 12; p = .03). Analyses substituting 5% of energy from fat by protein showed that weight gain would decrease by 72 g/month (95% CI, 6 to 140; p = .03); substituting 5% of energy from carbohydrate by protein decreased gain by 70 g/month (95% CI, 15 to 124; p = .01). Baseline BMI did not modify these associations.
  
  
  CONCLUSIONS
  Further research on the effects of macronutrient composition on gestational weight gain is needed to inform the design of supplementation programs for women in developing countries.
authors.forename: Freeman T
authors.initials: FT
authors.lastname: Changamire
authors.forename: Ramadhani S
authors.initials: RS
authors.lastname: Mwiru
authors.forename: Gernard I
authors.initials: GI
authors.lastname: Msamanga
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.forename: Willy
authors.initials: W
authors.lastname: Urassa
authors.forename: Ellen
authors.initials: E
authors.lastname: Hertzmark
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
authors.forename: Karen E
authors.initials: KE
authors.lastname: Peterson
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D004032:Diet / Q000379:methods*; D015930:Diet Records; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D004041:Dietary Fats / Q000008:administration & dosage*; D004044:Dietary Proteins / Q000008:administration & dosage*; D004311:Double-Blind Method; D002149:Energy Intake / Q000502:physiology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D012959:Socioeconomic Factors; D013636:Tanzania; D015430:Weight Gain / Q000502:physiology*
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins