title: Maternal Dietary Diversity Decreases with Household Food Insecurity in Rural Bangladesh: A Longitudinal Analysis.
abstract: BACKGROUND
  Household food insecurity (HFI) can lead to a poor diet and malnutrition. Yet, little is known about the extent to which maternal diet covaries with food insecurity during pregnancy and lactation.
  
  
  OBJECTIVE
  Longitudinal associations between HFI and maternal dietary diversity from early pregnancy to 3 mo postpartum were examined in rural Bangladesh.
  
  
  METHODS
  We repeatedly assessed dietary intake by using a 7-d food-frequency questionnaire in the first and third trimesters of pregnancy and at 3 mo postpartum among 14,600 women enrolled into an antenatal micronutrient supplementation trial. Maternal dietary diversity score (DDS) was constructed as the sum of 10 food groups reportedly consumed at each assessment. Households were classified at 6 mo postpartum as being food secure or having mild, moderate, or severe HFI on the basis of a 9-item standard scale. Generalized estimating equations were used to estimate the longitudinal relation between HFI status and DDS and the likelihood of individual food-group consumption, adjusting for confounders at the maternal and household levels.
  
  
  RESULTS
  The DDS decreased with progressively worse HFI, an association best explained by a derived household wealth index. Compared with women from food-secure households, women of mild, moderate, and severe HFI were less likely, in a dose-response fashion, to have consumed dairy products [adjusted ORs (95% CIs): 0.73 (0.69, 0.78), 0.62 (0.58, 0.66), and 0.52 (0.48, 0.55), respectively], eggs [0.81 (0.76, 0.85), 0.73 (0.68, 0.77), and 0.61 (0.57, 0.65)], meat [0.83 (0.79, 0.88), 0.73 (0.69, 0.78), and 0.60 (0.56, 0.64)], fish [0.87 (0.80, 0.94), 0.76 (0.70, 0.83), and 0.59 (0.54, 0.65)], legumes and nuts [0.88 (0.83, 0.93), 0.81 (0.76, 0.87), and 0.79 (0.74, 0.85)], and yellow and orange fruit and vegetables [0.85 (0.80, 0.91), 0.78 (0.73, 0.84), and 0.72 (0.67, 0.78)]. Neither intakes of dark-green leafy vegetables nor of vegetable oil were associated with HFI status.
  
  
  CONCLUSIONS
  Antenatal and postnatal maternal dietary diversity, especially intakes of animal-source foods, fruit, and vegetables, declined with worsening food insecurity in rural Bangladesh.
authors: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Muzi
authors: http://orcid.org/0000-0002-8844-0646
authors: M
authors: Na
authors: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Sucheta
authors: http://orcid.org/0000-0002-7374-2238
authors: S
authors: Mehra
authors: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Parul
authors: P
authors: Christian
authors: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; JiVitA Project of Johns Hopkins University, Gaibandha, Bangladesh; and.
authors: Hasmot
authors: H
authors: Ali
authors: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; JiVitA Project of Johns Hopkins University, Gaibandha, Bangladesh; and.
authors: Saijuddin
authors: http://orcid.org/0000-0001-5095-1478
authors: S
authors: Shaikh
authors: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; JiVitA Project of Johns Hopkins University, Gaibandha, Bangladesh; and.
authors: Abu Ahmed
authors: AA
authors: Shamim
authors: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Alain B
authors: http://orcid.org/0000-0003-2502-7819
authors: AB
authors: Labrique
authors: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Helen Keller International, Washington, DC.
authors: Rolf Dw
authors: RD
authors: Klemm
authors: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Lee Sf
authors: LS
authors: Wu
authors: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; kwest1@jhu.edu.
authors: Keith P
authors: http://orcid.org/0000-0001-9458-362X
authors: KP
authors: West
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D016000:Cluster Analysis; D015331:Cohort Studies; D004032:Diet; D019587:Dietary Supplements; D002149:Energy Intake; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D005523:Food Supply; D006801:Humans; D019266:Iron, Dietary / Q000008:administration & dosage; D007774:Lactation; D008137:Longitudinal Studies; D039382:Maternal Nutritional Physiological Phenomena; D018977:Micronutrients / Q000008:administration & dosage; D011247:Pregnancy; D012424:Rural Population; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D019266:Iron, Dietary; D018977:Micronutrients; D005492:Folic Acid
keywords: Bangladesh; South Asia; dietary diversity; food insecurity; pregnancy and lactation