1. Nutrition around Conception and the Prevention of Low Birthweight
2. Maternal nutrient intake and birthweight
3. The Association between Maternal Diet and Birth Dimensions
4. The Need for Nutritional Assessment in the Treatment of the Infertile Patient
5. The Menstral Cycle as Indicator in Prepregnancy Care
6. Nutrition of Women in Anticipation of Pregnancy
7. Nutritional Counselling and Supplementation in the Second and Third Trimester of Pregnancy,
8. The Association of Maternal Social Class with Maternal Diet and the Dimensions of Babies in a Population of London Women
9. Fortification of Grain Products with Folate: Should Britain Follow the American Example?
10. Protein in the Diet of Children: A Discussion of Current Recommenations
11. The Problem of Low Birthweight, the Cost and Possibilities of Prevention
12. New Nutrient Intake Recommendations are Needed for Childbearing
13. Low Birthweight in Electoral Wards: A Useful Health and Social Indicator at the Local Level
14. Reducing Waiting Lists for Hospital Admission: Community Nutrition Services Reduce the Need for Hospital Beds
15. New Evidence on the Nutrition of British School Children and Conclusions for School Meals
1. Nutrition around Conception and the Prevention of Low Birthweight
About 80 per cent of perinatal deaths are associated with low birthweight. Mothers' prepregnancy weight for height is correlated with birthweight, but this is only a crude indication of the close connection between low birthweight and maternal consumption of energy, protein and a range of other nutrients before and around the time of conception. Diet influences follicular growth before ovulation and thus affects ovulatory maturation and the number and quality of ova produced. Immediately after fertilisation diet affects the rate at which ova proceed to first and subsequent cleavages and therefore the size of the subsequent fetus. Diet acts not only directly on follicular and embryonic growth but indirectly by affecting gonadotropin secretion. The endocrine system is sensitive to blood concentrations of amino acids and some vitamins and minerals. Gonadotropin secretion is also depressed by smoking, and by some drugs, poisons and diseases, which may as a result also affect birthweight.
Margaret Wynn
Mangement Committee
Maternity Alliance
Arthur Wynn
Executive Committee
McCarrison Society
Nutrition and Health, 1988, Vol 6, no 1, pp 37-52
2. Maternal nutrient intake and birthweight
The relation between diet towards the end of the first trimester of gestation and subsequent birth-weights was examined in 419 singleton pregnancies. The mothers of babies of low birth-weight were found to be consuming a diet significantly lower in energy and in some essential nutrients than the mothers of larger babies. Associations were also found between nutrient intakes, length of gestation and pre-pregnancy maternal weight.
Wendy Doyle, M. A. Crawford, A. H. A. Wynn and S. W. Wynn
Nuffield Laboratories of Comparative Medicine,
Institute of Zoology
Regent's Park
London NW1 4RY
Journal of Human Nutrition and Dietetics 1989, 2, 415-422
3. The Association between Maternal Diet and Birth Dimensions
Nutrient intakes of 513 women during one week towards the end of the first trimester of pregnancy were recorded and analysed. Correlations between maternal nutrient intake and birthweight, newhorn head circumference and newborn length were significant for many nutrients. These associations were found to be greatest for the babies below median weight. Maternal intake of the B vitamins notably thiamin and niacin, and minerals, notably magnesium and iron, were significantly correlated with birth weight, head circumference and length. Vitamin and mineral supplementation of the mothers during the last two trimesters of pregnancy had no significant effect on birth dimensions. It is concluded that the principal associations of maternal diet and birth dimension probably had their origin during ovulatory maturation and early embryonic development.
W. DOYLE,M. A. CRAWFORD PHD, A. H. A. WYNN MA, S. W. WYNN MA MSc
Nuffield Laboratories of Comparative Medicine,
Institute of Zoologogy,
Regent's Park,
London NWJ 4RY.
Journal of Nutritional Medicine 1990, 1, 9-17
4. The Need for Nutritional Assessment in the Treatment of the Infertile Patient
Low body weight is a risk factor for amenorrhoea and for infertility. A Body Mass Index (BMI) around 23 or 24 kg/m2 is satisfactory both for general health, fertility and for infant birth weight. Low body weight and poor maternal nutrition are also risk factors for low birth weight and associated childhood handicap, the use of drugs to promote ovulation increases the risk of low birth weight if nutrition is not corrected. While body weight and BMI are valuable risk indicators the effects ofcomnposition of the diet override the effects of body weight, the hypothalamus being more sensitive to blood composition resulting from nutrients in the diet. Recovery of menstruation and fertility on a good diet occurs more quickly than recovery of normal reproduction. It is wise to defer all attempts at conception for at least 3 or 4 months on a good diet following recovery from amenorrhoea.
ARTHUR WYNN MA AND MARGARET WYNN BA
9 View Road,
Highgate,
London N6 4DJ.
Journal of Nutritional Medicine 1990, 1, 315-324
5. The Menstral Cycle as Indicator in Prepregnancy Care
Menstrual cycles are an important biological marker in reproductive toxicology but the effects are frequently not distinguishable from the effects of inadequate nutrition which are synergistic. The delay in ovulation and slow-down of the menstrua1 cycle are the main effects associated with an increased risk of subsequent miscarriage, low birth-weight and congenital malformations. Irregularity of cycle length is also a biological effect marker. There is an enhanced risk during recovery from amenorrhoea of continued long cycles and recovery should be monitored by recording cycle length at least. Amenorrhoea or slow-down of the menstrual cycles are non-invasive markers of depressed levels of steroid hormones which can result in poor pregnancy outcome and which can be damaging to bone maintenance in the longer term.
Margaret and Arthur Wynn
Nutrition and Health 1991, Vol. 2. pp. 387-398
6. NUTRITION OF WOMEN IN ANTICIPATION OF PREGNANCY
A causal connection between maternal nutrient intake and birth outcome is not universally accepted. In this paper further empirical support is provided, particularly in relation to the impact of maternal nutrition around the time of conception or very early in pregnancy. It is argued that the hypothesis that maternal nutrition has no connection with birthweight is very easily refuted.
It is suggested that there should be a new category of recommended dietary allowances; "women in anticipation of pregnancy". The diet of 513 pregnant London women were recorded for 7 days during the first trimester of their pregnancy. Birthweight and nutrient intakes were found to be significantly correlated but only over the lower half of the birthweight range. The optimum birthweight range with the lowest perinatal and infant mortalities is 3,500-4,500 g and it is suggested that the nutrient intake of the 165 women who had babies in this optimum weight range provide tentative values for nutrient intake recommendations in anticipation of pregnancy, but are not claimed to be representative. The need for adjustments of recommendations for the individual, for example for a low body mass index, is discussed. A body mass index of 24 kg/m2 is recommended based on the median of the 165 women.
A.H.A. WYNN, M.A. CRAWFORD, WENDY DOYLE and S.W. WYNN
Institute of Brain Chemistry and Human Nutrition,
Hackney Hospital,
Homerton High Street,
London E9 6BE
Nutrtion and Health 1991, 7, pp 69-88
7. Nutritional Counselling and Supplementation in the Second and Third Trimester of Pregnancy,
633 London women who were given nutritional counselling in the last two trimesters of pregnancy had babies who were on average 78 g heavier than 266 controls who were not counselled. The birth head circumference and birth length of the babies of the counselled women were not significantly different to the controls. Of the 633 counselled women, 211 received a vitamin-mineral supplement and 205 also received a supplement to provide additional linoleic acid. Neither supplemented group had babies with dimensions significantly different to the babies of 217 women who received counselling only with no supplemenets. Earlier papers showed very significant correlations between maternal nutrient intakes during the first trimester and birth dimensions, these strong associations contrast with the very modest effects of dietary supplementation in the second and third trimesters of pregnancy and emphasize the overriding importance of maternal nutrition around the time of 0conception. It is concluded that the variations in newborn size are mainly determined before the end of the first trimester.
W. DOYLE BA SRD, A. H. A. WYNN MA, M. A. CRAWFORD FIBIoL AND S. W. WYNN MA MSc
Institute of Brain Chemistry and Human Nutrition,
Hackney Hospital,
Homerton High St.
London E9 6BE
JourNAL OF NutritionAL Medicine 1992, Vol. 3, pp. 249-256
Records of the diets of 513 London mothers towards the end of the first trimester of pregnancy have been reported previously to show the maternal nutritional intakes associated with birthweight in the optimum range, which may be assumed to approximate to basic maternal needs for reproduction. The diets associated with low birthweight and small head size were also recorded and were found to be inferior.
The present paper shows social class gradients for baby size and 35 essential dietary components, providing an indication of which basic maternal nutritional needs were not always met. There was no social class gradient for intake of total energy, or the energy carriers carbohydrate and fat. There were, however, statistically highly significant social class gradients for intake of protein, seven minerals and six B-vitamins, all of which were also highly significantly correlated with birthweight.
Maternal intake of these 14 components of diet fell progressively as birthweight fell, but only for the mothers of smaller babies below 3270g, the median for the study. Further increase of maternal intakes of any nutrient by mothers whose babies were above median did not apparently further increase birthweight.
The social and medical problem presented by maternal nutrition is that of a minority of women who enter pregnancy with qualitatively inadequate nutritional status. This minority is found in all social classes but increases from social class I to V, and further still among single mothers. The women comprising this minority eat foods not meeting basic maternal needs for a ange of nutrients characteristic of whole grains, vegetables and fruit and dairy
S.W. WYNN, A.H.A. WYNN, W. DOYLE and M.A. CRAWFORD
Institute of Brain Chemistry and Human Nutrition,
Queen Elizabeth Hospital for Children,
Hackney,
London E2 8PS, UK
Nutrition and Health 1994, 9, pp 303-315
9. Fortification of Grain Products with Folate: Should Britain Follow the American Example?
The fortification of all grain products with folate is mandatory in the USA from lst January 1999. The decision has been prompted by research indicating that the risk of heart disease, cancer, stroke, nervous system disorders, including Alzheimer's disease, and neural tube defects may be reduced by daily intake of folate higher than is currently normal in the American population. There is a debate on the adequacy of the level of folate mandated and on the limiting of fortification to grain products. Furthermore, there have been representations to the US Food and Drug Administration to include B12 in the fortification requirement. Would British health also benefit from such fortification?
Margaret and Arthur Wynn,
Nutrition and Health, 1998, Vol 12, pp 147-161
10. Protein in the Diet of Children: A Discussion of Current Recommenations
The British National Diet and Nutrition Survey has described the diet of a representative sample of children aged 1 1/2 to 4 1/2 years. The first results of the latest American survey NHANES III have also been published. These results are compared with the British reference nutrient intakes (RNIs). The median British and American preschool child is shown to eat between two and three times the RNI for protein. It is shown that a reduction of the average child's protein intake to the level of the RNIs would be likely to inhibit the immune system reducing resistance to infectious disease, to depress levels of growth hormones and reduce rates of growth, and that children's protein consumption lower than present levels has been associated both historically and geographically with worse health. It is suggested that any advice recommending or accepting a change in children's diets should be justified by observation and experiment with particular reference to children's growth and the immune response and other effects on health. The new survey should be used to provide standards for catering and collective purposes, subject to any validated modifications in the interests of health.
Margaret Wynn and Arthur Wynn Journal of Nutrition and Environmental Medicine, 1996, Vol 6, pp 161-177
11. The Problem of Low Birthweight, the Cost and Possibilities Prevention
Low birthweight is costly to sufferers and to society. Primary prevention gives benefits exceeding costs, but many plans to prevent low birthweight, for example improvement in antenatal care, have failed because the intervention is too late. Preconception care is generally necessary. Poor maternal nutrition and infection are the major causes of low birthweight.
Margaret Wynn and Arthur Wynn,
Nutrition and Health, 1997, Vol II, pp 159-184
12. New Nutrient Intake Recommendations are Needed for Childbearing
British recommendations (DRVs and RNIs) include hardly any increments for pregnancy. British recommendations for protein are likely to cause unsatisfactory birthweight. What is the normal nutrient intake in pregnancy of healthy women? What evidence is there of special requirements for folate, iron, magnesium or iodine? New recommendations for nutrient intakes in pregnancy should be the responsibility of the Food Standards Agency and a survey of the diets of pregnant women is needed.
Margaret and Arthur Wynn,
Nutrition and Health, 2000, Vol 13, pp 199-211
13. Low Birthweight in Electoral Wards: A Useful Health ans Social Indicator at the Local Level
Greater use of electoral ward data is recommended for the guidance of allocation of resources to reduce low birthweight rates and for the monitoring of the health of communities. Ward data on low birthweight can be used for correlation studies to show the many associations of social, economic and health factors with low birthweight and with each other. A recent government report shows a substantial increase in the prevalence of disability since 1985 which is partly a consequence of an increase in low birthweight and of a deterioration in the nutritional status of an important minority of poor families who are concentrated in inner city wards.
Margaret Wynn and Arthur Wynn
Nutrition and Health 2000; 14: 77-87.
The number of hospital beds needed is greatly increased by the malnutrition of patients before admission and after discharge. Malnourished patients spend longer in hospital and are more likely to die following surgery or other treatment. Extensive studies show that low blood serum albumin, indicating protein deficiency, is a major risk factor for morbidity and mortality among hospital patients. Community food and nutrition services are extending throughout the developed world as part of public health policies. Such services can reduce costs by reducing the need for hospital beds, can reduce waiting lists and save the lives of many hospital patients. Preventive nutrition services can give financial benefits much exceeding costs.
Margaret and Arthur Wynn
Nutrition and Health, 2001, Vol 15, pp 3-16
15. New Evidence on the Nutrition of British School Children and Conclusions for School Meals
The National Diet and Nutrition Survey: Young people aged 4 to 18 years published in 2000 was based on the actual diets and intake of nutrients in 1997 of a representative sample of 2,000 British children.1 One stated purpose of the Survey was to assist in the development of "dietary guidelines for food provided by schools." It was necessary to "monitor the extent of the deviation of the children's diet from that recommended as optimum for health." The Survey uses the Reference Nutrient Intakes (RNIs) set out in Dietary Reference Values for Food Energy and Nutrients for the United Kingdom published in 1991 by the Department of Health.2 The Survey covers energy, protein, carbohydrates, fat and fatty acids, vitamins and minerals. Table 1 shows the percentage of children aged 4 to 18 years in four age brackets who failed to reach RNI levels for 8 vitamins and Table 2 shows those who failed to reach the level for 7 minerals. More than 10 years have passed since the RNI values were published and there are now many reasons for believing that they are out-of-date and in need of revision.
Margaret and Arthur Wynn
Nutrition and Health, 2002, Vol 16, pp 55-71