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Maternal Energy Depletion Is Buffered among Malnourished Women in Punjab, Pakistan^1,2,

Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853-6301 ^* Department of Social and Preventive Paediatrics, King Edward Medical College, Lahore, Pakistan

Women's nutritional status is believed to deteriorate with increasing reproductive stress (so-called maternal depletion). To evaluate this phenomenon, a new theoretical framework has been suggested that incorporates the concepts of a full reproductive cycle, relative lengths of potential depletion and repletion phases, and initial plane of nutrition. We developed the corresponding statistical model and tested predictions provided by the framework about the effect of reproductive pattern on maternal overall weight change (W) during one reproductive cycle. Seventy-six Pakistani women were classified as well-nourished, marginally nourished or malnourished. The relationship between W and length of all phases of the reproductive cycle, each of which is characterized by varying degrees of reproductive stress, was evaluated with multiple regression analysis. Across the reproductive cycle, well-nourished women had a slight weight increase. Surprisingly, malnourished women gained weight in contrast to marginally nourished women. Also surprisingly, for the latter two groups, periods of moderate reproductive stress were associated with weight loss but periods of high reproductive stress were associated with weight gain. Mechanisms such as efficiency and nutrient partitioning are discussed.

KEY WORDS: • maternal depletion • reproductive cycle • Pakistan • weight change • humans

¹ Data collection was supported by a grant from SAREC (Swedish Agency for Research Cooperation with Developing Countries). Data analysis was supported by CISER (Cornell Institute for Social and Economic Research).

² The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 USC section 1734 solely to indicate this fact.

³ To whom correspondence should be addressed at the current address: Department of Epidemiology and Public Health, Umeå University, S-901 85 Umeå, Sweden.

Manuscript received 29 November 1993. Revision accepted 24 May 1994.