Nutritional Analysis of a Cohort of Women Who are

currently trying to fall pregnant

Journal of Australian Nutrition

Edith Cowan University

Tutor: Marc Sim

Final Word Count: 2434

Contents
Abstract.................................................................................................................................................3

Introduction...........................................................................................................................................3

Results...................................................................................................................................................3

Tables....................................................................................................................................................5

Table 1.1 Average baseline demographic and anthropometric analysis for 45 female participants.. .5

Table 1.2 Analysis of Energy and macronutrient intake from 3-day recall........................................6

Table 1.3 Data analysis of vitamin and mineral intake compared to nutrient reference value...........7

Discussion.............................................................................................................................................7

Conclusion.............................................................................................................................................9

Reflection..............................................................................................................................................9

References...........................................................................................................................................10

Infographic..........................................................................................................................................12
Abstract
Aim: determine the nutritional status and potential health implications of young to middle-aged
premenopausal women, who are trying to fall pregnant using anthropometric and dietary intake data.
Population: Young to middle-aged pre-menopausal Caucasian women (n=45) with a mean age of 32 ± 4.75
years (25-40 years), being in a middle socio-economic status, located in the north metropolitan region of Perth,
Western Australia. Results: The cohort was classified as usual (body mass index 24.16 ± 4.38 kg/m2) with body
fat in the unhealthy (too high) rang (35.44 ± 9.22%). The mean waist to hip ratio of 0.77 ± 0.0.5 and waist
circumference of 77.65 ± 10.04 cm placed the cohort at a near borderline increased risk of chronic disease.
Dietary data was likely affected by under-reporting but showed that the cohort did not meet the Acceptable
Macronutrient Distribution Range for carbohydrates (43.83%) and exceeded requirements for saturated fats and
alcohol. The cohort did not meet the Nutrient Reference Values for polyunsaturated fats, fibre, calcium, folate,
iron, magnesium, retinol, vitamin E and potassium and exceeded the suggested dietary target for sodium.
Conclusion: The cohort is near at risk of chronic disease based on the anthropometric measurement of waist-to-
hip ratio and an unhealthy body fat percentage and dietary intake data. A dietary intervention has shown to be
successful with women struggling to conceive.

Word Count: 220

Introduction
Preconception health for women is as healthy as possible, leading towards conception by boosting the
chances of falling pregnant. The World Health Organization (WHO) explains that preconception care has a
positive impact on pregnancy and child health outcomes (Preconception care: Maximizing the gains for
maternal and child health, n.d.). The mother’s body composition and dietary intake including macro and
micronutrients can increase the risk of chronic disease of the fetus, and It is reported that maternal nutrition and
iron-deficiency anemia increases the risk of maternal death (Preconception care: Maximizing the gains for
maternal and child health, n.d.).
Weak maternal body composition, could be either being underweight or overweight are associated with
adverse pregnancy outcomes such as maternal hypertension, pre-eclampsia, gestational diabetes and stillbirths,
thus having a balanced diet is essential through all stages of pregnancy (Cedergren, 2004). The western diet is
considered to have high dietary intakes of saturated fats, sucrose and a low intake of dietary fibre which
contributes to a growing health risk concern for metabolic diseases such as diabetes and obesity (Statovci,
Aguilera, MacSharry & Melgar, 2017).
The quality of carbohydrates has been linked with polycystic ovary syndrome and insulin resistance in
women (Chavarro, Rich-Edwards, Rosner & Willett, 2007). Dietary fat intake is vital during pregnancy,
especially docosahexaenoic acid (DHA) which is an Omega-3 polyunsaturated fatty acid (PUFA) as it reduces
the risk of preeclampsia by 33% and severe preeclampsia by 54% (Arvizu et al., 2018). Alcohol consumption
has shown to harm fertilization, embryo quality and implantation and can also lead to several short terms and
some long term such as fetal alcohol syndrome (Nakhoul, Seif, Haddad & Haddad, 2017).
Nutrition among young to middle-aged women of reproductive age within a middle socio-economic
status has several dietary deficiencies such as iron, folate, vitamin A, iodine, zinc, and calcium. A typical diet
contains a high intake of red meats, refined grains, refined sugars, and high-fat dairy (Stephenson et al., 2018).
Folate protects against neural tube defects (Gardiner et al., 2008). Calcium is essential during pregnancy as the
growing fetus receives it is nourishment from the mother, if the bone was not built before pregnancy and was
not part of a regular diet, the bone can be broken down to provide the necessary calcium (Gardiner et al., 2008).
Women who are in their reproductive age are most at risk of iron deficiency due to blood loss from menstruation
and poor diet (Gardiner et al., 2008). This report aims to determine the nutritional status and potential health
implications of young to middle-aged premenopausal women, who are trying to fall pregnant using
anthropometric and dietary intake data.

Results

Demographic and anthropometric data

The demographic and anthropometric data for the cohort is presented in Table 1. The mean age of the
participating women was 32 years. The cohort ranged from 17.96 to 37.03kg/m2 with an average body mass
index (BMI) of 24.16kg/m2 classifying the group within the normal range (Lee & Nieman, 2013). The range for
body fat (BF) percentage was 21.11% to 60.39% with a mean of 35.44%, which classifies as unhealthy (too
high). The waist circumference ranged from 60.75cm to 107.5cm with a mean of 77.65cm, indicating the cohort
is at the borderline of the recommended 80cm cut off for women to be at higher risk for chronic disease (Lee &
Nieman, 2013). The hip circumference range is 83cm to 125.05cm with an average of 100.29cm. The waist to
hip (WTH) ratio range is between 0.69cm and 0.90, with a mean of 0.77, which is also slightly below the
recommended cut off for increased chronic disease risk (Lee & Nieman, 2013). The average triceps skinfold,
mid-upper arm circumference 27.65mm and 307.78mm respectively. The mid-arm muscle circumference
(MAMC) of 220.95mm was 103.18% of the median value and sat between the 50th and 75th percentile (Stewart,
2015).

Dietary Data – Energy and Macronutrients

Dietary Intake

The collected data of the daily energy intake of the cohort is found in table 1.2. As the cohort had two
separate female age brackets 18-29yr and 30-51 and therefore (Nutrient Reference Values for Australia and New
Zealand Executive Summary, 2006), the basal metabolic rate (BMR) ranges for 18-29yr ranges from 4664.80
kJ/day to 7876.40 kJ/day and the estimated energy requirement (EER) range for 18-29yr was 6530.72Kj/day to
11026.96Kj/day, with a mean of 8559.17Kj/day. The BMR range for 30-51yr was 5068 kJ/day to 6662.60
kJ/day with a mean of 5731.43 kJ/day and the EER range for the 30-51yr age group was 7095.20Kj/day to
9327.64Kj/day.
 The three-day macronutrient intake of the cohort is found in table 1.2. The protein (CHON) and fat
intake are within the acceptable macronutrient distribution range (AMDR) which have been laid out by the
National Health and Medical Research Council (NHMRC). The protein range is between 16.4g and 135.75g
with a mean of 81.09g, making up 19.12% of the cohorts daily kilojoule intake. The total fat, including
polyunsaturated, monounsaturated and saturated fat range ranges between 14.82g and 123.96g per day with a
mean of 69.35g per day. The cohort is within the total fat distribution range. However, the participants have
exceeded the less than 10% of total kilojoules recommended by the NHMRC of saturated fat, with a range from
5.79g/day to 63.84g/day with a mean of 14.34% of total daily kilojoules (NHMRC, 2006a). The participant's
carbohydrates intake has provided a mean of 184.25g per day, providing 43.83% of daily intake, which falls
below the AMDR recommendation of 45-65%. Fibre intake ranges between 9.78g and 39.49g per day, with a
mean of 18.67g per day, falling below the NRVs recommendation for women to consume 25g per day ("Dietary
Fibre | Nutrient Reference Values", 2019). Alcohol consumption ranged from 0 and 34.63mL per day, with an
average of 6.01mL. The recent studies on alcohol consumption have shown it to lead to short term and long term
problems such as fetal alcohol syndrome and other effects on fertilization, embryo quality and implantation.
Alcohol consumption can lead short term as well as a long term such as fetal alcohol syndrome (Nakhoul, Seif,
Haddad & Haddad, 2017). Due to the women in the cohort trying their best to conceive, the recommendation for
alcohol consumption should be zero ("Alcohol | NHMRC", n.d.).

The three-day vitamin and mineral intake for the cohort is found in table 1.3. The cohort either met or
exceeded the NRV’s recommended dietary intake (RDI) for the following micronutrients: Beta Carotine
(however below the 5000 μg/day for SDT), Riboflavin, Retinol, Vitamin C, Phosphorus, and Zinc. Niacin
equivalent had a range of 8.09mg/day to 53.82mg/day, with a mean of 35.49mg which is above the upper limit
(UL) of 35mg/day. The cohort showed sodium having a range of 599.24mg/day to 4601.69mg/day, with a mean
of 2420.61mg/day which exceeds the suggested dietary target of 2000mg/day ("Nutrients | Nutrient Reference
Values", 2017) further investigation is required but a high salt diet can lead to renal and cardiovascular diseases
in fetal origins (Mao et al., 2013). The cohort did not meet the recommended daily intake requirements set by
the NRV for the following: Calcium, Folate, Iron, Magnesium, Vitamin E, and Potassium. The cohort has a
mean calcium intake is 851.02mg/day, and the RDI is 1000mg/day. Folate has a mean intake of 240.90mg/day,
and the RDI is 400mg/day. The average iron intake is 11.57mg/day, and the RDI is 18mg/day. The mean
magnesium is 251.17mg/day, and the RDI is 320mg/day. The mean Vitamin E is 5.39mg/day, and the RDI is
7mg/day. The mean potassium is 2461.31mg/day, and the RDI is 2800mg/day.
Tables
Table 1.1 Average baseline demographic and anthropometric analysis for 45 female
participants.
Measurement Mean Standard Minimum Maximu Range Classification
Deviation ± m
Age (years) 32.64 4.57 25 40 15
Height (cm) 163.73 6.12 150.60 175.5 24.9
Weight (kg) 64.88 12.30 42.40 34.20 8.2
BMI (kg/m2) 24.16 4.38 17.96 37.03 19.07 18.5 – 24.99 =
Normal Range
< 18.5 =
underweight
18.5-24.9 = normal
25-29.9 =
overweight
30-34.9 = obesity I
35-39.9 = obesity II
≥ 40 = extreme
obesity1
Fat Mass (kg) 23.95 10.88 9.50 55.50 46
Lean Mass (kg) 40.98 4.35 31.30 53.40 22.10
Waist 77.65 10.04 60.75 107.50 46.75 <80 = Lower risk
circumference (cm) <80cm = no risk
80-88cm = increased
chronic disease risk
≥ 88cm = high
chronic
disease risk1
Hip circumference 100.29 9.38 83 125.05 42.05
(cm)
Waist-to-hip ratio 0.77 0.05 0.69 0.90 0.21 <0.8 = Borderline
increased risk
> 0.8 = increased
chronic disease risk1
Body Fat (%) 35.44 9.22 21.11 60.39 39.28 >=32% Unhealthy
(too high)
≤ 8% = unhealthy
low
9-23% = acceptable
range (low end)
24-31% = acceptable
range (high end)
≥ 32% = unhealthy
high1
Total Body Water 29.99 3.18 22.90 39.10 16.2
Bone Mineral 0.93 0.13 0.70 1.14 0.44
Density (Neck
Femur)
Triceps skinfold 27.65 8.41 10.10 40 29.9 50-75th Percentile
(mm) 117% of median1
Mid upper arm 307.78 33.32 221 399 178
circumference (mm)
Mid arm muscle 220.95 28.90 168.08 277.11 109.03 50-75th Percentile
circumference (mm) 103.18% of
combined median2
1
Lee and Nieman (2013).
2
Stewart (2015).
Table 1.2 Analysis of Energy and macronutrient intake from 3-day recall.
Macronutrient Mean SD Min Max Range AMDR/SDT % of Intake
1

BMR 18-29yr 6113.69 958.93 4664.80 7876.40 3211.60

BMR 30-51yr 5731.43 374.89 5068 6662.60 1594.60
EER 18-29yr 8559.17 1342.51 6530.72 11026.96 4496.24
EER 30-51yr 8024 524.84 7095.20 9327.64 2232.44
Total Energy Intake 7220.75 1999.44 1940.94 10727.19 8786.25
Fats 69.35 24.84 14.82 123.96 109.14 20-35% 34.83%
Saturated Fats 28.65 11.62 5.79 63.84 58.05 < 10% 14.34%
Polyunsaturated Fats 10.10 4.48 2.01 18.51 16.5 5.05%
Monounsaturated Fats 24.50 8.91 5.34 43 37.66 12.33%
Protein 81.09 24.30 16.40 135.75 119.35 15-25% 19.12%
Carbohydrates 184.25 55.29 65.43 316.44 251.01 45-65% 43.83%
Fibre 18.67 6.51 9.78 39.49 29.71 25g (AI) 74.70%
28g (SDT)
Alcohol 6.01 8.46 0 34.63 34.63 0 2.62%
1
("Nutrients | Nutrient Reference Values", 2017)

Table 1.3 Data analysis of vitamin and mineral intake compared to nutrient reference value
Micronutrien Mean SD Min Max Range RDI1 % of EAR1 AI1 UL1 SDT1 Classification
t RDI

Beta Carotine 2386.6 1323.6 532.62 6626.7 6094.0 700 47.73% 500 5000 Adequate
(μg/day) 3 3 0 8 RDI, Below
SDT

Calcium 851.02 306.90 204.84 1628.3 1423.5 1000 85.10% 840 Below RDI
(mg/day) 4 1

Niacin Equiv. 35.49 11.05 8.09 53.82 45.74 14 253.52 11 35 Above UL

(mg/day) %

Folate 240.90 94.52 101.06 486.72 385.66 400 60.22% 320 Below RDI
(μg/day)

Iron (mg/day) 11.57 4.58 2.91 25.03 22.12 18 64.26% 8 Below RDI

Magnesium 251.17 77.43 73.84 488.23 414.39 320 78.49% 265 Below RDI
(mg/day)

Thiamin 1.51 0.64 0.36 3.54 3.18 1.10 137.42 0.9 Non Adequate
(mg/day) % e

Riboflavin 2.27 0.83 0.34 4.86 4.52 1.10 206.42 0.9 Non Adequate
(mg/day) % e

Retinol 745.22 273.62 200.91 1267.2 1066.3 700 106.46 500 3000 Adequate
Equiv. 7 6 %
(μg/day)

Vitamin C 102.51 52.75 27.96 288.76 260.8 45 227.80 30 1000 Adequate

(mg/day) %
Vitamin E 5.39 1.88 2.57 10.06 7.49 7 77.06% 300 Below RDI
(mg/day)

Sodium 2420.6 831.44 599.24 4601.6 4002.4 2000 121.03 400- 2000 Above SDT
(mg/day) 1 9 5 % 920

Potassium 2461.3 605.31 1063.3 3449.9 2386.6 2800 87.90% 2800 Non Below RDI
(mg/day) 1 5 9 4 e

Phosphorus 1381.0 418.53 308.28 2263.9 1955.6 1000 138.11 580 4000 Adequate
(mg/day) 7 5 7 %

Zinc (mg/day) 10.40 3.17 2.37 17.84 15.47 8 130.04 6.5 40 Adequate
 %
1
("Nutrients | Nutrient Reference Values", 2017)
Discussion

Anthropometric measures and chronic disease risk

The anthropometric analysis of the cohort has indicated that the participants are considered a normal
range, at a borderline of increased risk of chronic diseases and had a median body fat percentage at an unhealthy
(too high) level. Higher levels of BMI are associated with increased risk of cardiovascular disease, diabetes,
hypertension, malignancies and overall death rates (Nuttall, 2015), increases miscarriage and still-birth
(Meldrum, 2017) anovulation, subfertility and infertility (Talmor & Dunphy, 2015). According to Ian Janssen et
al. the waist circumference with the body mass index can predict a more significant variance in chronic disease
risk than just BMI (Janssen, Katzmarzyk & Ross, 2004). Waist circumference above 80cm for women indicates
an increased risk ("Waist Circumference", 2018). The mean waist circumference for the cohort was 77.65cm,
indicated that they are near the borderline cut-off for at-risk (Lee & Nieman, 2013).

Dietary Intake

According to the Schofield equation, the estimated energy requirement to achieve a BMI of 22kg/m2
resulting in reduced morbidity for this cohort is 7,700kJ/day for women aged 19-30, a height of 1.6m and a
physical activity level (PAL) of 1.4 ("Dietary Energy | Nutrient Reference Values", 2017) . The EER for
women aged 31-50 with a height of 1.6m and a PAL of 1.4 is 7,600kJ/day ("Dietary Energy | Nutrient Reference
Values", 2017). The mean recommended EER using the Schofield equation in table 1.2 for 19-30yr was
8559.17kJ/day and the EER for 30-50yr 8024kJ/day. According to the dataset provided, the mean total energy
intake was 7220.75kJ/day, which could mean that the participants have a recall bias, relying on memory to
construct their 3-day total recall and possibly under-recording ("Food-Based Assessment of Dietary Intake",
2002).

The daily intake of macronutrient protein and fat intake are within the acceptable macronutrient
distribution range (AMDR) which have been laid out by the National Health and Medical Research Council
(NHMRC). Fat provided 34.83% of total daily kilojoules which is reaching the upper limit of 35%, and the
upper limit was set in relation to obesity and cardiovascular disease risk ("Summary | Nutrient Reference
Values", 2017). Saturated fat provided 14.34% of energy intake with a mean of 28.65g per day exceeding the
NRVs recommendation of consuming less than 10% per day to reduce the risk of chronic diseases such as heart
disease ("Summary | Nutrient Reference Values", 2017). The cohorts average carbohydrate intake was
184.25g/day, resulting in an average 43.83% of total daily intake, just under the lower AMDR recommendation
of 45% ("Summary | Nutrient Reference Values", 2017). A diet high in quality carbohydrates may play an
important role in ovulation and fertility in healthy women (Chavarro, Rich-Edwards, Rosner & Willett, 2007).
Adequate dietary fibre has been linked to risk reduction for chronic diseases such as diabetes and heart disease.
The mean intake of dietary fibre was 18.67g/day, and the NRV recommends an adequate intake (AI) of 25g/day
and a suggested dietary intake (SDT) of 28g/day, the cohort does not reach either of the recommendations
("Dietary Fibre | Nutrient Reference Values", 2019).
 The cohort either met or exceeded the NRV's recommended dietary intake (RDI) for the following
micronutrients: Beta Carotine, Riboflavin, Retinol, Vitamin C, Phosphorus, and Zinc. Adequate Vitamin A is
essential for fetal growth & reproduction. However, very high levels of retinol acid can cause miscarriage and
congenital disabilities (Gardiner et al., 2008). However, the cohort did not meet the recommended daily intake
requirements set by the NRV for the following: Calcium, Folate, Iron, Magnesium, Vitamin E, and Potassium.
Deficiencies in micronutrient can lead to pre-eclampsia, pre-term deliveries, neural tube defects of the brain or
spinal cord (Vitamin B12 plays a role in folate circulation (Yang et al., 2017)) in pregnant women (Schaefer &
Nock, 2019). Women trying to conceive generally have lower than the recommended levels of micronutrients,
especially folate, vitamin B12, vitamin D, calcium, iodine, iron, and selenium (Schaefer & Nock, 2019). The
cohort’s average folate is 240.90mg/day, which is below the NRVs RDI of 400mg/day. There is clear evidence
that folate protects against neural tube defects (Gardiner et al., 2008). The average calcium intake is
851.02mg/day, which is below the NRVs RDI of 1000mg/day. Calcium is vital during pregnancy as the growing
fetus receives it is nourishment from the mother, if the bone was not built before pregnancy and was not part of
a regular diet, the bone can be broken down to provide the necessary calcium (Gardiner et al., 2008). The
average iron is 11.57mg/day, which is also below the NRVs RDI of 18mg/day. Women who are in their
reproductive age are most at risk of iron deficiency due to blood loss from menstruation and poor diet (Gardiner
et al., 2008).

Conclusion

The nutritional status of a cohort of 45 pre-menopausal Caucasian Australian women aged between 25-
40 years who are currently trying to fall pregnant. The participants were assessed using anthropometric
measures and a 3-day weighted food recall to record dietary intake. The cohort was found to be of normal body
mass, with an unhealthy (too high) body fat percentage and a waist circumference under the ‘at risk' of chronic
disease level. The food intake was most likely under-reported due to recall bias but showed excess intakes of
saturated fat and inadequate consumption of carbohydrates, calcium, folate, iron, magnesium, vitamin E, and
potassium. With the inadequate intakes, it could put the participants at an increased risk of diet-related chronic
disease and affect their ability to conceive. By increasing fresh fruit, green vegetables, whole-grains and dairy
products would help meet the recommended NRVs. A weight-loss intervention would benefit the participants by
reducing body fat percentage and therefore reduce their chronic disease risk and increase the rate of conception.

Reflection

This is my first nutritional journal article report I have written. I have read several journal articles and
understood the basic layout of the report, but once it came to writing my own, it was a lot more time consuming
than I had initially thought. I found that trying to write shorter and concise information to stay within the word
count was more challenging than I was using unnecessary long-winded paragraphs in the past.
The part of this assessment I found most challenging was the introduction because an introduction is
the first impression the reader gets when picking up your paper and therefore it needs to be concise and
engaging and prepares the reading for what the report will entail. The second challenge I had was using the ideal
formula to calculate BMR/EER as there are multiple calculations you could use. I am quite skilled at using
Microsoft Excel and found using the equation calculation easy to understand to produce the results. Thirdly I
found the infographic difficult as I don’t have much creativity or computer graphic skills.
I found the cohort and associated risk factors interesting, I do have basic knowledge of the macro and
micronutrients, but I have learnt a lot more about the NRVs and how they can affect women trying to conceive.
As I am studying nutrition bioscience, I believe this assessment has provided me with valuable information and
new skills for my future as a nutritionist.
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Infographic