Assessment of Nutritional Status and Related Factors of Lactating Women in the Urban and Rural Areas of Southwestern Iran: A Population-Based Cross-Sectional Study Abstract

Document Type: Original Article


1 Nutritional Health Research Center, Health and Nutrition Department, Lorestan University of Medical Sciences, Khorramabad, Iran;

2 Department of Biostatistics and Epidemiology, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran;

3 Department of Medicinal Chemistry, School of Pharmacy, Jundishapur University of Medical Sciences, Ahvaz, Iran;

4 Razi Herbal Medicines Research Center, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran


Background: During the lactation period, mothers are at an increased risk of nutritional deficiencies due to improper dietary patterns, physiological changes, and various socio-demographic factors. The present study aimed to examine the nutritional status, dietary intake, and related factors among lactating women in the urban and rural areas of Khorramabad, Lorestan province in the southwest of Iran.
Methods: The present population-based cross-sectional study was conducted in Khorramabad (Iran) during April-July 2012. The study population included 708 lactating mothers who were referred to the health centers in Khorramabad (10 urban health centers and 30 rural health/community centers). A multi-stage sampling method was used to recruit the participants. The nutritional status and food intake of the participants were assessed over three days using the 24-hour dietary recall (24HDR) and dietary record (DR) questionnaires. The data were analyzed using SPSS software (version 16.0) with the Chi-square test, Fisher’s exact test, paired t test, independent t test, and Pearson correlation coefficient. PResults: The mean age and body mass index (BMI) of the mothers were 29.78±6.24 years and 26.11±3.70 kg/m2, respectively. There was a significant difference in calorie intake between the different categories of age, BMI, education level, job status (P<0.001) and lactation stage (P=0.034). The energy and nutrient intakes, except iron and phosphor, were statistically lower (P<0.05) than the prescribed Recommended Dietary Allowances (RDA). The intake of vitamins K, B1, B2, B3, and C; protein, magnesium, phosphor, zinc, copper, and iodine by mothers in the rural areas was significantly higher (P<0.05) than those in the rural areas. Higher intakes of energy and macronutrients by the lactating mothers had a significant negative correlation with an increase in age and had a significant positive correlation with a higher BMI (P<0.001).
Conclusion: Lactating women in the urban and rural areas of Khorramabad (Iran) had a poor nutritional status. Nutrition education and a modified dietary pattern during the lactation period are recommended.


  1. Nakhaie Mr, Palizvan Mr. The Evaluation Of The Relationship Between Dietary Fat Intake And Colostrum Beta-Carotene Of Lactating Mothers Referring To Hospitals In Tabriz. Scientific Journal Of Kurdistan University Of Medical Sciences. 2012;17:15-20. [In Persian]
  2. Das*Graças*Tavares*Do*Carmo M, Granhen*Tavares*Colares L, Sandre-Pereira G, De*Abreu*Soares E. Nutritional Status Of Brazilian Lactating Women. Nutrition & Food Science. 2001;31:194-200.
  3. Gay J. The Health Of Women: A Global Perspective. New York (Us): Routledge; 2018.
  4. Valentine CJ, Wagner CL. Nutritional Management of the Breastfeeding Dyad. Pediatric Clinics of North America. 2013;60:261-74.
  5. Kong X. Influencing Factors from Lactating Mother Without Diseases On Breast Milk Quality And Quantity. International Journal of Pediatrics. 2016;43:445-8
  6. Alemayehu M, Argaw A, Mariam AG. Factors Associated With Malnutrition Among Lactating Women In Subsistence Farming Households From Dedo And Seqa-Chekorsa Districts, Jimma Zone, 2014. Developing Country Studies. 2015;5:114-22.
  7. George GC, Hanss-Nuss H, Milani TJ, Freeland-Graves JH. Food Choices Of Low-Income Women During Pregnancy And Postpartum. Journal of the American Dietetic Association. 2005;105:899-907.
  8. Ayatollahi SM. Nutritional Assessment Of Lactating Women In Shiraz In Relation To Recommended Dietary Allowances. Eastern Mediterranean Health Journal. 2004;10:822-7.
  9. Abedini Z, Ahmari*Tehran H, Khorrami*Rad A. Calorie Intake And The Related Factors In Lactating Mothers Referring To Health Centers. Journal Of Mazandaran University Of Medical Sciences. 2012;21:271-8. [In Persian]
  10. Hormozi M, Khaghani Sh. Diet Status In Lactating Mothers Referring To Khoramabad Health And Treatment Centers. Yafteh. 2002;4:49-54. [In Persian]
  11. Mahdavi R, Nikniaz L, Arefhosseini S. Energy, Fluids Intake And Beverages Consumption Pattern Among Lactating Women In Tabriz, Iran. Pakistan Journal Of Nutrition. 2009;8:69-73.
  12. Nazeri P, Zarghani NH, Mirmiran P, Et AL. Iodine Status In Pregnant Women, Lactating Mothers, And Newborns In An Area With More Than Two Decades Of Successful Iodine Nutrition. Biological Trace Element Research. 2016;172:79-85.
  13. Moghasemi S, Ajh N, Estaki T, Mirmiran P. The Status, Policies And Programs Of Nutrition Among In Nursing Mothers: A Review Article. Jorjani Biomedicine Journal. 2014;2:1-10. [In Persian]
  14. Wang Z, Dang S, Xing Y, Et AL. Dietary Patterns And Their Associations With Energy, Nutrient Intake And Socioeconomic Factors In Rural Lactating Mothers In Tibet. Asia Pacific Journal Of Clinical Nutrition. 2017;26:450-6.
  15. Sanusi Ra, Falana Oa. The Nutritional Status Of Mothers Practicing Breast Feeding In Ibadan, Nigeria. African Journal Of Biomedical Research. 2009;12:107-12.
  16. Hazaveheei MM, Pirzadeh A, Entezari MH, Et AL. Investigating The Knowledge, Attitude And Nutritional Practice Of Female Middle School Second Graders In Isfahan In 2008. Knowledge & Health. 2009;4:24-7. [In Persian]
  17. Ghaffarpour M, Houshiar-Rad A, Kianfar H. The Manual For Household Measures, Cooking Yields Factors And Edible Portion Of Foods. Tehran: Keshavarzi Press; 1999. [In Persian]
  18. Azar M, Sarkisian E. Food Composition Table Of Iran: National Nutrition And Food Research Institute. Tehran: Shahid Beheshti University Press; 1980. [In Persian]
  19. Mohammadhossini S, Hosseini N, Moghimi M, Fouladi M. Knowledge And Practice Of Mothers, Regarding The Supplementary Nutrition Of Breast-Fed Infants, Yasuj, Iran. Iranian Journal Of Neonatology. 2014;4:28-33.
  20. Veghari G, Mansourian A, Abdollahi A. Breastfeeding Status And Some Related Factors In Northern Iran. Oman Medical Journal. 2011;26:342-8.
  21. Kulkarni B, Shatrugna V, Nagalla B, Rani KU. Regional Body Composition Changes During Lactation In Indian Women From The Low-Income Group And Their Relationship To The Growth Of Their Infants. Journal Of The American College Of Nutrition. 2011;30:57-62.
  22. Caire-Juvera G, Ortega MI, Casanueva E, Et AL. Food Components And Dietary Patterns Of Two Different Groups Of Mexican Lactating Women. Journal Of The American College Of Nutrition. 2007;26:156-62.
  23. Gunderson EP. Childbearing And Obesity In Women: Weight Before, During, And After Pregnancy. Obstetrics And Gynecology Clinics Of North America. 2009;36:317-32.
  24. Østbye T, Peterson BL, Krause KM, Et AL. Predictors Of Postpartum Weight Change Among Overweight And Obese Women: Results From The Active Mothers Postpartum Study. Journal Of Women’s Health. 2012;21:215-22.
  25. Kac G, D’aquino*Benicio MH, Valente JG, Velásquez-Meléndez G. Postpartum Weight Retention Among Women In Rio De Janeiro: A Follow-Up Study. Cadernos De Saude Publica. 2003;19:S149-61.
  26. Chandra-Mouli V, Camacho AV, Michaud PA. Who Guidelines On Preventing Early Pregnancy And Poor Reproductive Outcomes Among Adolescents In Developing Countries. Journal Of Adolescent Health. 2013;52:517-22.
  27. Pope JF. Pregnant And Postpartum Adolescents’ Appetite Compulsions, Food Preferences, And Reasons For Dietary Change. [Thesis]. Tennessee (Us): University Of Tennessee; 1991.
  28. Lovelady CA, Stephenson KG, Kuppler KM, Williams JP. The Effects Of Dieting On Food And Nutrient Intake Of Lactating Women. Journal Of The American Dietetic Association. 2006;106:908-12.
  29. Piperata BA, Dufour DL. Diet, Energy Expenditure, And Body Composition Of Lactating Ribeirinha Women In The Brazilian Amazon. American Journal Of Human Biology. 2007;19:722-34.
  30. Kominiarek MA, Rajan P. Nutrition Recommendations In Pregnancy And Lactation. The Medical Clinics Of North America. 2016;100:1199-215.
  31. Alam DS, Van*Raaij JM, Hautvast J, Et AL. Energy Stress During Pregnancy And Lactation: Consequences For Maternal Nutrition In Rural Bangladesh. European Journal Of Clinical Nutrition. 2003;57:151-6.
  32. Da*Cunha J, Macedo*Da*Costa TH, Ito MK. Influences Of Maternal Dietary Intake And Suckling On Breast Milk Lipid And Fatty Acid Composition In Low-Income Women From Brasilia, Brazil. Early Human Development. 2005;81:303-11.
  33. Esmaillzadeh A, Samareh S, Azadbakht L. Dietary Patterns Among Pregnant Women In The West-North Of Iran. Pakistan Journal Of Biological Sciences. 2008;11:793-6.
  34. Geissler C, Calloway DH, Margen S. Lactation And Pregnancy In Iran. Ii. Diet And Nutritional Status. The American Journal Of Clinical Nutrition. 1978;31:341-54.
  35. Müller O, Krawinkel M. Malnutrition And Health In Developing Countries. Canadian Medical Association Journal. 2005;173:279-86.
  36. Ahadi Z, Heshmat R, Sanaei M, Et AL. Knowledge, Attitude And Practice Of Urban And Rural Households Towards Principles Of Nutrition In Iran: Results Of Nutrikap Survey. Journal Of Diabetes & Metabolic Disorders. 2014;13:100.
  37. National Research Council. Diet And Health: Implications For Reducing Chronic Disease Risk: Washington, Dc (Us): The National Academies Press; 1989.
  38. Wakimoto P, Block G. Dietary Intake, Dietary Patterns, And Changes With Age: An Epidemiological Perspective. The Journals Of Gerontology Series A: Biological Sciences And Medical Sciences. 2001;56:65-80.
  39. Lee CL*Jr, Norimah AK, Ismail MN. Association Of Energy Intake And Macronutrient Composition With Overweight And Obesity In Malay Women From Klang Valley. Malaysian Journal Of Nutrition. 2010;16:251-60.
  40. Shim JS, Oh K, Kim HC. Dietary Assessment Methods In Epidemiologic Studies. Epidemiology And Health. 2014;36:E2014009.