Public Health Nutrition: 11(4), 379–386 DOI: 10.1017/S1368980007000389 Inadequate intakes of dietary zinc among pregnant women from subsistence households in Sidama, Southern Ethiopia Yewelsew Abebe 1 , Alemtsehay Bogale 1 , K Michael Hambidge 2 , Barbara J Stoecker 3 , Isabel Arbide 4 , Akilu Teshome 4 , Nancy F Krebs 2 , Jamie E Westcott 2 , Karl B Bailey 5 and Rosalind S Gibson 5, * 1 College of Agriculture, Hawassa University, Awassa, Ethiopia: 2 Section of Nutrition, Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO, USA: 3 Department of Nutrition, Oklahoma State University, Stillwater, OK, USA: 4 Bushulo Health Center, Awassa, Ethiopia: 5 Department of Human Nutrition, University of Otago, Dunedin, New Zealand Submitted 10 August 2006: Accepted 17 April 2007: First published online 5 July 2007 Abstract Objective: To assess the prevalence of zinc inadequacy based on dietary intakes and plasma zinc concentrations and, simultaneously, the prevalence of inade- quate intakes of energy, protein, calcium and iron. Design: A cross-sectional study of a convenience sample of subsistence farming households in Sidama, Southern Ethiopia. Subjects: Dietary intakes were calculated from 1-day weighed food records and 40 repeats from 99 pregnant women in the third trimester using analysed values of major staple foods for zinc, iron, calcium and phytate. The distribution of observed intakes was adjusted for usual intakes and the prevalence of inadequacy estimated using the estimated average requirement (EAR) cutpoint method. Prevalence of inadequacy for zinc, protein and iron intakes were compared with those based on biochemical measures. Results: Prevalence of zinc inadequacy was very high: 99% for US FNB EAR and 100% for IZiNCG EAR compared to 72% based on low plasma zinc concentra- tions. Corresponding prevalence estimates for iron were much lower: 4% for inadequate intakes based on US FNB EAR vs. 8.7% for iron deficiency anaemia (haemoglobin , 110 g l 21 ; ferritin , 12 mgl 21 ) and 32.3% for low storage iron. Prevalence of inadequacy for protein was 100% for adjusted intakes and 91% for serum albumin , 32 g l 21 . For calcium, 74% were at risk for inadequate intakes. Conclusion: The high prevalence of inadequate intakes of zinc and protein was reasonably consistent with those based on biochemical measures. Such dietary deficits could be overcome by regular consumption of cellular animal protein. In contrast, both dietary and biochemical measures of iron inadequacy were low. Keywords Zinc intake Phytate Pregnancy Southern Ethiopia Inadequacy Inadequate intakes of dietary zinc have been identified as a major factor in the aetiology of zinc deficiency in devel- oping countries 1 . Such inadequacies may arise from low intakes of zinc per se and/or poor bioavailability of dietary zinc. However, quantitative data on zinc intakes of popu- lation groups in developing countries at risk to zinc defi- ciency are limited, in part because of the paucity of data on the zinc content of indigenous staple foods. Substitution of zinc values for staple foods grown in Western countries is not advisable because the zinc content of plant-based foods tends to reflect local soil zinc levels 2,3 . Poor bioavailability of dietary zinc is associated with plant-based diets high in phytate, a potent inhibitor of zinc absorption 4 . Phytate forms insoluble complexes in the gastrointestinal tract with zinc; these complexes cannot be digested or absorbed because of the absence of intestinal phytase enzyme in humans 5 . Indeed, the relative bio- availability of zinc depends mainly on the phytate : zn ratio of the diet 1 . Certain household food preparation and processing practices (e.g. fermentation, germination and soaking) can reduce the phytate content of plant foods 6 , and thus may lead to some improvement in the bioavailability of zinc from plant-based diets. This reduction may be important in diets consumed in Southern Ethiopia, where two of the major dietary staples consumed – starchy foods based on enset (Enset ventricosum) and enjera prepared from teff (Eragrotis teff) – are fermented. During pregnancy, zinc requirements are especially high because zinc is essential for growth and development of *Corresponding author: Email Rosalind.Gibson@stonebow.otago.ac.nz r The Authors 2007 https://doi.org/10.1017/S1368980007000389 Published online by Cambridge University Press