The Effect of Pumpkin Seed Biscuits on Nutritional and Zinc Status: A Randomized Controlled Trial in Pregnant Women

Rosdiana Syakur; Aminuddin Syam; Veni Hadju; Sukri Palutturi; Anto J. Hadi; Ridha Hafid; Musaidah Musaidah

doi:10.3889/oamjms.2022.9937

Authors

Rosdiana Syakur Doctoral Student in Public Health, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Department of Public Health, Faculty of Public Health, Indonesia Timur University, Makassar, Indonesia
Aminuddin Syam Department of Nutrition, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
Veni Hadju Department of Nutrition, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
Sukri Palutturi Department of Public Health, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
Anto J. Hadi Department of Public Health, Faculty of Public Health, Aufa Royhan University, Padang Sidempuan, Indonesia
Ridha Hafid Department of Sport and Health, Gorontalo State University, Gorontalo, Indonesia
Musaidah Musaidah Department of Nursing, STIKES Gunung Sari, Makassar, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2022.9937

Keywords:

Pregnancy, Zinc, Nutritional status, Biscuits, Pumpkin seeds

Abstract

BACKGROUND: In several studies in Indonesia, low birth weight (LBW) is shown as the most dominant risk factor for stunting. Some of the causes of LBW are chronic energy deficiency during pregnancy, anemia during pregnancy, lack of nutrient supply during pregnancy, pregnancy complications, maternal parity, and birth spacing. In this case, women commonly suffer from micronutrient deficiencies including iodine, iron, Vitamin A, zinc, and folate. Related to this, about 80% of pregnant women in the world fulfill normative pregnancy needs due to inadequate zinc intake. One source of micronutrients rich in zinc is pumpkin seeds. The nutritional potential of pumpkin seeds is realized in the form of food products for pregnant women, including amino acids. One example of pumpkin seed fortification has been assessed in biscuit products by trained panelists and consumers, obtaining results that 20% additional pumpkin seed flour to biscuits becomes the best treatment. Meanwhile, in the case of this study, we expect that the pumpkin seed biscuits provided can increase the energy intake in pregnant women because when pumpkin seeds are added, the nutrition contained in the biscuits is also increased, in this case, the nutrition includes the zinc and Fe.

AIM: The purpose this research is to figure out how pumpkin seed biscuits affect pregnant women concerning their nutrition status and serum zinc levels.

METHODS: The method employed was a double-blind and randomized experimental research involving pre- and post-test control groups. The inclusion criteria of the participants involved were pregnant women aged 20–35 years old who were at their first and second trimesters of pregnancy and parity one to three and singleton pregnancy. Meanwhile, the exclusion criteria of the participants were pregnant women suffering from severe complications. There were 89 pregnant women further gathered in this study, but only 66 of them met the criteria and idled into two groups. In this case, one group received the pumpkin seed biscuit intervention, while the other received placebo biscuits. The intervention was conducted for 90 days where the pregnant women were provided with four biscuits for daily consumption.

RESULTS: The nutritional status parameter of pregnant women involved in the current research was assessed, including body weight, mid-upper arm circumference (MUAC), and serum zinc levels. In this case, the average serum zinc level obtained was 48.75 g/dL from 60 pregnant women. Furthermore, a significant increase occurred in nutritional status for each group, marked by body weight gain, and increased MUAC. However, no significant difference emerged between the pumpkin seed biscuit group and the placebo biscuit group with p = 0.914 and p = 0.916, respectively. A significant increase in zinc levels was observed in both groups. In this case, changes in zinc levels between the two groups were significantly different (13.72 ± 1.84 vs. 9.81 ± 11.81, p = 0.007).

CONCLUSION: Giving pumpkin seed biscuits contribute to weight gain and increase the MUAC the pregnant women which, in turn, improves their nutritional status and serum zinc.

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References

Wong KL, Restrepo-Mendez MC, Barros AJ, Victora CG. Socioeconomic inequalities in skilled birth attendance and child stunting in selected low and middle-income countries: Wealth quintiles or deciles? PLoS One. 2017;12(5):1-18. https://doi.org/10.1371/journal.pone.0174823 PMid:28467411 DOI: https://doi.org/10.1371/journal.pone.0174823

Riskesdas Kementerian Kesehatan. Ris Kesehat Dasar: HASIL UTAMA. Indonesia: Riskesdas Kementerian Kesehatan; 2018.

Aryastami NK, Shankar A, Kusumawardani N, Besral B, Jahari AB, Achadi E. Low birth weight was the most dominant predictor associated with stunting among children aged

-23 months in Indonesia. BMC Nutr. 2017;3(1):1-6. https://doi.org/10.1186/s40795-017-0130-x DOI: https://doi.org/10.1186/s40795-017-0130-x

Muthayya S, Rah JH, Sugimoto JD, Roos FF, Kraemer K, Black RE. The global hidden hunger indices and maps: An advocacy tool for action. PLoS One. 2013;8(6):e67860. https://doi.org/10.1371/journal.pone.0067860 PMid:23776712 DOI: https://doi.org/10.1371/journal.pone.0067860

Sorouri ZZ, Sadeghi H, Pourmarzi D. The effect of zinc supplementation on pregnancy outcome: A randomized controlled trial. J Matern Neonatal Med. 2016;29(13):2194-8. https://doi.org/10.3109/14767058.2015.1079615 PMid:26365330 DOI: https://doi.org/10.3109/14767058.2015.1079615

Hutchinson MS, Figenschau Y, Almås B, Njølstad I, Jorde R. A high prevalence of Zinc-but not iron-deficiency among women in rural Malawi: A cross-sectional study. Int J Vitam Nutr Res. 2011;81(5):317-27. DOI: https://doi.org/10.1024/0300-9831/a000079

Wang Y, Cao Z, Peng Z, Xin X, Zhang Y, Yang Y, et al. Folic acid supplementation, preconception body mass index, and preterm delivery: Findings from the preconception cohort data in a Chinese rural population. BMC Pregnancy Childbirth. 2015;15(1):1-9. https://doi.org/10.1186/s12884-015-0766-y PMid:26670558 DOI: https://doi.org/10.1186/s12884-015-0766-y

Karimi A, Bagheri S, Student P, Health R. Zinc deficiency in pregnancy and fetal-neonatal outcomes and impact of the supplements on pregnancy outcomes. Iran J Neonatol. 2012;3(2):77-83.

Nossier SA, Naeim NE, El-Sayed NA, Abu Zeid AA. The effect of zinc supplementation on pregnancy outcomes: A double-blind, randomized controlled trial, Egypt. Br J Nutr. 2015;114(2):274-85. https://doi.org/10.1017/s000711451500166x PMid:26099195 DOI: https://doi.org/10.1017/S000711451500166X

Syakur R, Syam A, Hadju V, Palutturi S. The impact of maternal zinc supplementation on pregnancy outcomes and maternal serum zinc: A systematic review. Nat Volatiles Essent Oils. 2021;8(4):8301-13.

Karamali M, Heidarzadeh Z, Seifati SM, Samimi M, Tabassi Z, Talaee N, et al. Zinc supplementation and the effects on pregnancy outcomes in gestational diabetes: A randomized, doubleblind, placebo-controlled trial. Exp Clin Endocrinol Diabetes. 2015;124(1):28-33. https://doi.org/10.1055/s-0035-1564146 DOI: https://doi.org/10.1055/s-0035-1564146

US Department of Agriculture. Agricultural Research Servi. Washington DC, United States: US Department of Agriculture National Nutrient Database for Standard Reference Release; 2013. p. 21.

Syam A, Zainal Z, Kurniati Y, Hardiyanti H, Ulfasari I, Ishak A, et al. Preference test of biscuit products from pumpkin seeds (Cucurbita sp.). Enferm Clin. 2020;30:375-8. https://doi.org/10.1016/j.enfcli.2019.10.115 DOI: https://doi.org/10.1016/j.enfcli.2019.10.115

Syam A, Sari NP, Thaha AR, Suriah S, Jafar N, Salam A, et al.The effect of pumpkin seed flour (Cucurbita moschata Durch) on zinc serum levels in malnourished Wistar rats. Enferm Clin. 2020;30:337-40. https://doi.org/10.1016/j.enfcli.2019.10.095 DOI: https://doi.org/10.1016/j.enfcli.2019.10.095

Syam A, Kurniati ZY. Akhmar AM, editor. Biji Labu Kuning Yang Menyehatkan. 1st ed. Makassar: Masagena Press; 2019.

Hotz C, Peerson JM, Brown KH. Suggested lower cutoffs of serum zinc concentrations for assessing zinc status: Reanalysis of the second National Health and Nutrition Examination Survey data (1976-1980). Am J Clin Nutr. 2003;78(4):756-64. https://doi.org/10.1093/ajcn/78.4.756 PMid:14522734 DOI: https://doi.org/10.1093/ajcn/78.4.756

Ota E, Haruna M, Suzuki M, Anh DD, Tho LH, Tam NT, et al. Indice maternel de masse corporelle et augmentation du poids en gestation et leur association avec les observations périnatales au Viet Nam. Bull World Health Organ. 2011;89(2):127-36. https://doi.org/10.2471/blt.10.077982 DOI: https://doi.org/10.2471/BLT.10.077982

Institute of Medicine. Committee of Nutritional Status during Pregnancy and Lactation. Food and Nutrition Board: Nutrition during pregnancy. Part I, Weight Gain Part II. Nutrient Supplements. Washington, DC: National Academies Press; 1990. https://doi.org/10.17226/1451 DOI: https://doi.org/10.17226/1451

Goldstein RF, Abell SK, Ranasinha S, Misso M, Boyle JA, Mary, et al. Association of gestational weight gain with maternal and infant outcomes: A systematic review and meta-analysis. JAMA. 2017;317(21):2207-25. https://doi.org/10.1001/jama.2017.3635 PMid:28586887 DOI: https://doi.org/10.1001/jama.2017.3635

Patel A, Prakash AA, Das PK, Gupta S, Pusdekar YV, Hibberd PL. Maternal anemia and underweight as determinants of pregnancy outcomes: Cohort study in eastern rural Maharashtra, India. BMJ Open. 2018;8(8):e021623. DOI: https://doi.org/10.1136/bmjopen-2018-021623

Ververs MT, Antierens A, Sackl A, Staderini N, Captier V. Which Anthropometric Indicators Identify a Pregnant Woman as Acutely Malnourished and Predict Adverse Birth Outcomes in the Humanitarian Context? PLoS Curr. 2013;5:8. https://doi.org/10.1371/currents.dis.54a8b618c1bc031ea140e3f2934599c8 PMid:23787989 DOI: https://doi.org/10.1371/currents.dis.54a8b618c1bc031ea140e3f2934599c8

Kemenkes RI. Pedoman Penanggulangan Kurang Energi kronik (KEK) Pada Ibu Hamil. Direktorat Bina Gizi: Jakarta; Kemenkes RI; 2015. p. 1-52. https://doi.org/10.36419/jki.v12i1.434 DOI: https://doi.org/10.36419/jki.v12i1.434

Bari A, Sultana N, Mehreen S, Sadaqat N, Imran I, Javed R. Patterns of maternal nutritional status based on mid upper arm circumference. Pak J Med Sci. 2020;36(3):382-6. https://doi.org/10.12669/pjms.36.3.1331 PMid:32292438 DOI: https://doi.org/10.12669/pjms.36.3.1331

Kpewou DE, Poirot E, Berger J, Vicheth Som S, Laillou A, Belayneh SN, et al. Maternal mid-upper arm circumference during pregnancy and linear growth among Cambodian infants during the first months of life. Matern Child Nutr. 2020;16(Suppl 2):e12951. https://doi.org/10.1111/mcn.12951 PMid:32835455 DOI: https://doi.org/10.1111/mcn.12951

Vasundhara D, Hemalatha R, Sharma S, Ramalaxmi BA, Bhaskar V, Babu JJ, et al. Maternal MUAC and fetal outcome in an Indian tertiary care hospital: A prospective observational study. Matern Child Nutr. 2020;16(2):e12902. https://doi.org/10.1111/mcn.12902 PMid:31833195 DOI: https://doi.org/10.1111/mcn.12902

Tang AM, Chung M, Dong K, Terrin N, Edmonds A, Assefa N, et al. Determining a global mid-upper arm circumference cut-off to assess malnutrition in pregnant women. Public Health Nutr. 2020;23(17):3104-13. https://doi.org/10.1017/s1368980020000397 PMid:32799964 DOI: https://doi.org/10.1017/S1368980020000397

Araújo CL, Hallal PC, Nader GA, Neutzling MB, Defátima Vieira M, Menezes AM, et al. Effect of birth size and proportionality on BMI and skinfold thickness in early adolescence: Prospective birth cohort study. Eur J Clin Nutr. 2009;63(5):634-9. https://doi.org/10.1038/ejcn.2008.20 PMid:18301436 DOI: https://doi.org/10.1038/ejcn.2008.20

Reynolds D. Severe gestational edema. J Midwifery Womens Health. 2003;48(2):146-8. https://doi.org/10.1016/s1526-9523(02)00419-1 PMid:12686948 DOI: https://doi.org/10.1016/S1526-9523(02)00419-1

Hotz C. Dietary indicators for assessing the adequacy of population zinc intakes. Food Nutr Bull. 2007;28(Suppl 3):S430-53 https://doi.org/10.1177/15648265070283s304 DOI: https://doi.org/10.1177/15648265070283S304

Roohani N, Hurrell R, Kelishadi R, Schulin R. Zinc and its importance for human health: An integrative review. J Res Med Sci. 2013;18(2):144-57. PMid: 23914218

Rohmawati L, Sari DK, Sitepu M, Rusmil K. A randomized, placebo-controlled trial of zinc supplementation during pregnancy for the prevention of stunting: Analysis of maternal serum zinc, cord blood osteocalcin and neonatal birth length. Med Glas (Zenica). 2021;18(2):415-20. https://doi.org/10.17392/1267-21 PMid:33871218

Seriana I, Yusrawati Y, Lubis G. Serum Zinc level at term pregnancy and newborn anthropometry. Indones J Obstet Gynecol. 2016;3:190-5. https://doi.org/10.32771/inajog.v3i4.53 DOI: https://doi.org/10.32771/inajog.v3i4.53

Mekonnen A, Terefe W, Belachew A, Adhanu A, Gezae K. Prevalence and Associated factors of zinc deficiency among pregnant women attending antenatal care at gambella hospital, gambella, ethiopia, 2018. Am J Life Sci. 2019;7(5):91. https://doi.org/10.11648/j.ajls.20190705.12 DOI: https://doi.org/10.11648/j.ajls.20190705.12

Naem NE, El-Sayed NM, Nossier SA, Abu Zeid AA. Zinc status and dietary intake of pregnant women, Alexandria, Egypt. J Egypt Public Health Assoc. 2014;89(1):35-41. https://doi.org/10.1097/01.epx.0000443987.44261.9b DOI: https://doi.org/10.1097/01.EPX.0000443987.44261.9b

Wijaksono AW, Rasyid R, Mariko R. Hubungan kadar zink dan kenaikan berat badan ibu hamil dengan berat badan bayi lahir di RSUD Curup Kabupaten Rejang Lebong Propinsi Bengkulu. Maj Kedokt Andalas. 2019;42(2):56. https://doi.org/10.25077/mka.v42.i2.p56-61.2019 DOI: https://doi.org/10.25077/mka.v42.i2.p56-61.2019

Syam A, Burhan FK, Hadju V, Citrakesumasari C, Akhmar AM. The effect of biscuits made from pumpkin seeds flour on serum zinc levels and weight in malnutrition wistar rats. Open Access Maced J Med Sci. 2020;8(A):428-33. https://doi.org/10.3889/oamjms.2020.4402 DOI: https://doi.org/10.3889/oamjms.2020.4402

Haider, Za B. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2017;4(4):CD004905. PMid:28407219 DOI: https://doi.org/10.1002/14651858.CD004905.pub5

Wang H, Hu YF, Hao JH, Chen YH, Su PY, Wang Y, et al. Maternal zinc deficiency during pregnancy elevates the risks of fetal growth restriction: A population-based birth cohort study. Sci Rep. 2015;5:1-10. https://doi.org/10.1038/srep11262 PMid:26053136 DOI: https://doi.org/10.1038/srep11262

Samimi M, Asemi Z, Taghizadeh M, Azarbad Z, Rahimi-Foroushani A, Sarahroodi S. Concentrations of serum zinc, hemoglobin and ferritin among pregnant women and their effects on birth outcomes in Kashan, Iran. Oman Med J. 2012;27(1):40-5. https://doi.org/10.5001/omj.2012.08 PMid:22359724 DOI: https://doi.org/10.5001/omj.2012.08

Nanbakhsh F, Tabrizi FM. The relationship between cord blood and maternal serum zinc levels and birth weight. Iran J Neonatol. 2017;8(3):6-10.

Iqbal S, Ali I. Effect of maternal zinc supplementation or zinc status on pregnancy complications and perinatal outcomes: An umbrella review of meta-analyses. Heliyon. 2021;7(7):e07540. https://doi.org/10.1016/j.heliyon.2021.e07540 PMid:34368474 DOI: https://doi.org/10.1016/j.heliyon.2021.e07540