The whole grain of truth for mothers-to-be

Whole grains supply key nutrients such as B vitamins, which are essential for foetal development.
Whole grains supply key nutrients such as B vitamins, which are essential for foetal development.PHOTO: ISTOCK PHOTO

Many S'pore mothers' whole grain intake falls far below the ideal amount: A*Star study

It is well known that pregnant women should have a healthy diet as they need nutrients for the development of their unborn child.

However, a new study of nearly 1,000 expectant mothers in Singapore found that they are not consuming enough whole grains.

The study, by scientists from the Agency for Science, Technology and Research (A*Star) in collaboration with Nestle Research Centre, asked women to recall their previous day's food intake.

Only 30 per cent reported consuming any whole grain food and, among them, the median intake was 23.6g a day.

This is far below the ideal amount of 60-95g of whole grain food that pregnant women should eat a day.

The Singapore consumption lags behind that of European countries such as Denmark, where the median daily whole grain intake among women of fertile age is 48g.

The study revealed that only30per cent consumed any whole grain food and, among them, the median intakewas23.6g a day. This is far below the ideal amount of 60-95gof whole grain food that pregnant women should eat a day

The findings, which represent the first comprehensive report of whole grain intake in an Asian population and pregnant women, was published last September in the Asia Pacific Journal Of Clinical Nutrition.

Principal investigator Mary Chong of the Clinical Nutrition Research Centre at the Singapore Institute for Clinical Sciences, under A*Star, said the low consumption rates are of concern, given that whole grains supply key nutrients such as B vitamins, which are essential for foetal development.

QUALITY CONSUMPTION

One way for pregnant women to obtain enough nutrients without gaining excessive weight is to improve the quality of their diet by substituting food items with more nutrient-dense products, such as whole grains.

DR MARY CHONG, of the Clinical Nutrition Research Centre at the Singapore Institute for Clinical Sciences.

Despite their benefits, whole grain consumption in Singapore is generally low. In 2010, only 27 per cent of adult residents here ate at least one serving of whole grain products a day, according to the National Nutrition Survey 2010.

The Health Promotion Board (HPB) recommends that for adults, at least one serving of rice and alternatives should be made up of whole grain food. Pregnant women are advised to eat at least three servings of whole grain food every day, according to HPB's Healthy Start For Your Pregnancy guide.

Dr Han Wee Meng, head and senior principal dietitian at the nutrition and dietetics department at KK Women's and Children's Hospital, said the higher fibre content in whole grain food is good for the digestive system.

It increases one's feeling of fullness - which is important towards the final trimester of pregnancy, when increased appetite and constipation are common.

Said Dr Chong: "While the findings were not surprising, considering the low average intake of whole grains among adults here, we were hoping that expectant mothers would be more conscious of a healthy diet and have higher intakes. This is obviously not the case."

POOR AWARENESS OF BENEFITS

  • Guide to whole grains in one's diet

  • How do you identify whole grain products?

    •Look for the Healthier Choice Symbol endorsed by the Health Promotion Board that reads "Higher in Whole-Grains" or the "Whole Grain" stamp by the Whole Grain Council in the US.

    •Check the description on the packaging for these terms: Whole grain, whole wheat, sprouted whole grain wheat flour, wholemeal, brown rice, oats or oatmeal (including instant oatmeal). All of these are whole grain products as they contain all parts of the grain.

    What are terms that may be confused with whole grains?

    •Enriched flour, bran, wheat germ and high-fibre do not describe whole grain foods.

    •Multigrain can be several whole grains or several refined grains, or a mix of both. So, multigrain products may not always have whole grains.

    •These terms may not refer to whole grains either: Wheat, wheat flour, durum wheat, organic flour, semolina and stoneground.

    As whole grains help in weight control, can we eat them without restriction?

    Whole grains are not free from or low in carbohydrates. While they help to boost the feeling of fullness, whole grains do contain similar energy values as their refined counterparts. They should, therefore, be included as part of your overall meal plan.

    Is it advisable for very young children to eat whole grains?

    There are concerns about feeding whole grains to children below two years old. This is because the amount of phytates, a compound found in whole grains, can bind to minerals before they are absorbed. It is also harder for the body to digest food with phytates.

    The high-fibre content in whole grains also increases the feeling of fullness, which may affect the appetite of young children who need to obtain sufficient nutrients for growth.

    However, for an overweight child, eating whole grains may help to control food intake.

    Ways to integrate whole grains into your diet:

    •Opt for different types of whole grain bread each week.

    •Eat whole grain cereal with milk or yogurt, or mix it with other breakfast cereals.

    •Add brown rice or oats to white rice when cooking at home.

    •If you don't like brown rice, try red, black and purple rice. There are many varieties on the shelves today.

    •Cook with whole grain noodles or pasta instead of refined varieties. The taste is generally similar, though these may have a nutty flavour.

    •When baking, replace half of white or plain flour with whole wheat flour in your recipes for cupcakes and cookies.

    SOURCES: Dr Mary Chong, principal investigator at the Singapore Institute for Clinical Sciences; Dr Han Wee Meng, head of nutrition and dietetics at KK Women's and Children's Hospital

The study results suggest that there is poor awareness of why whole grain foods are important for pregnant women, she said.

Women may not know that such foods can improve the quality of their diet without their having to consume extra calories, she said.

For instance, one can replace half of one's usual rice intake with brown rice. That way, no extra calories are consumed.

This is important, given that pregnant women have to balance between getting enough nutrients and not eating too much.

Women in their second trimester need 20 to 25 per cent more calories than if they are not pregnant.

This is roughly equivalent to an extra glass of milk and a slice of bread every day. Yet, they should be taking much more nutrients - for instance, 50 per cent more folate, which guards against brain and spinal cord birth defects, and is found in whole grain foods.

"One way for pregnant women to obtain enough nutrients without gaining excessive weight is to improve the quality of their diet by substituting food items with more nutrient-dense products, such as whole grains," explained Dr Chong, who specialises in maternal and infant nutrition.

Dr Han added that, especially for women with gestational diabetes, whole grain foods can help keep blood sugar levels down.

At KKH, the consultation with the doctor usually focuses on checks on mother and baby, and advice based on the mother's healthcare needs.

Those who raise specific questions or express an interest in dietary needs will be referred to a dietitian, said Associate Professor Tan Thiam Chye, who heads inpatient services at KKH's division of obstetrics and gynaecology.

Pregnant women with diabetes, renal diseases or obesity are also referred to dietitians.

Prof Tan said: "There are many critical issues to discuss during a consultation. Diet may take precedence if the obstetrician notes poor weight gain, poor foetal growth or uncontrolled blood sugar level in expectant mothers with diabetes."

While not every mother sees a dietitian at the hospital, all of them are given pregnancy-related materials, including information on diet.

The hospital has also published books and created mobile apps to address concerns about pregnancy.

For instance, a cookbook titled Good Eats For Mums-To-Be that is sold at the hospital includes recommendations on whole grain intake.

ETHNIC DIFFERENCES

A closer look at the study participants revealed that women of Indian ethnicity ate whole grain foods most frequently. This is likely due to the greater use of whole grain in Indian cuisine.

Overall, wholemeal bread was the most commonly eaten whole grain food among the women in the study, followed by oat products, "ethnic" breads such as Indian flatbread and whole grain breakfast cereal.

Corn-based products were commonly consumed too. Brown rice, on the other hand, was eaten by only 4.3 per cent of the mothers.

Dr Han pointed out that people may have mistaken ideas about what whole grain products are.

Some may believe that anything with wheat is considered whole grain. But this is not true - it has to have whole wheat, she said.

Others may think that whole grain foods simply provide fibre, which can also be obtained by eating more fruit and vegetables.

But these two food groups are not interchangeable, said Dr Chong, as fruit and vegetables do not provide the same nutrients and energy as whole grains. And supplements, while helpful, may not be absorbed by the body as well as nutrients from natural food, she added.

A version of this article appeared in the print edition of The Straits Times on April 05, 2016, with the headline 'The whole grain of truth for mothers-to-be'. Print Edition | Subscribe