(P10-109-24) Examining Energy and Macronutrient Intake Substitution in Home-Based Diets Among Pregnant Women in a Balanced Energy-Protein (BEP) Supplementation Trial in Sarlahi, Nepal

Objectives: To assess whether daily calorie and macronutrient intakes differ between supplemented and control women in their third trimester of pregnancy in a randomized controlled trial of balanced energy protein (BEP) supplementation in rural Nepal.

Methods: The Maternal Infant Nutrition Trial (MINT) is a 2X2 factorial, household randomized efficacy trial to assess the impact of BEP supplementation during pregnancy and lactation on birth outcomes and infant growth in 1550 mother-infant pairs. The BEP intervention consists of a daily multiple micronutrient fortified lipid-based paste containing 400 kcal and 14.5g of protein. 120 women in the BEP and control groups (n=240) were systematically selected to undergo duplicate, non-consecutive 24-hour dietary recalls in their third trimester of pregnancy. Data was captured using the multiple pass method and an electronic data collection app. A photo atlas developed and validated in adjacent districts was used for portion size recall, and standard recipes were sourced from another local dietary assessment study and by project staff. Nutrient intakes were estimated using South Asian food composition tables and participant-level intakes were averaged from the two recalls. BEP consumption was omitted from the intake estimates.

Results: A total of 183 duplicate 24-hour dietary recalls were collected from 88 women in the BEP arm and 95 in the control arm. Energy and macronutrient intakes in the third trimester of pregnancy did not differ between groups. The difference between control and supplement group for calorie intake was 60 kcal (95CI: -139, 258), 1.1g for protein (95CI:-5.3, 7.4) and 17.1g for carbohydrates (95CI: -17.1, 51.3) and -1.7 g for fat (95CI: -8.6, 5.2). The differences between control and supplement groups in percent of calories from fat (-1.4%, 95CI: -3.1, 0.4), protein (+0.2%, 95CI: -0.7, 0.4) and carbohydrates (+1.5%, 95CI: -0.2, 3.2) were minimal. In the control group, 17.7% (95CI: 16.4, 19.0) of calories were from fat, 11.7% (95CI: 11.3, 12.0) were from protein, and 69.8% (95CI: 68.5, 71.0) were from carbohydrates.

Conclusions: BEP supplementation in pregnancy did not result in a replacement of regular macronutrient intakes from home-based diets in the third trimester showing no evidence of substitution related to supplementation.

Funding Sources: BMGF, Thrasher Research Fund, NIH