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ORIGINAL ARTICLE
Year : 2019  |  Volume : 8  |  Issue : 12  |  Page : 3832-3839  

The relationship between weight gain in exclusively breastfed babies and maternal diet


Department of Family Medicine, Aster MIMS, Kozhikode, Kerala, India

Date of Submission03-Aug-2019
Date of Decision20-Aug-2019
Date of Acceptance10-Sep-2019
Date of Web Publication10-Dec-2019

Correspondence Address:
Dr. Mumina Razack
Meeqath, 14/322B, Vattampoyil, P.O. Kallai, Kozhikode, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_613_19

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  Abstract 


Objectives: To determine the relationship between maternal nutrition and their breastfed infants' anthropometric measures during the first 14 weeks after delivery. Methods: A prospective, observational study, comprising 200 mothers and their infants. The weight, length, and head circumference of the infants and the weight and dietary intake of the mothers were recorded at 6, 10, and 14 weeks. Results: The relationship between weight gain in babies and calorie intake at 6, 10, and 14 weeks were significant (P value < 0.05). The relationship between weight gain in babies and protein intake at 6 and 10 weeks was not significant (P value at 6 weeks = 0.896, P value at 10 weeks = 0.127) but was significant at 14 weeks (<0.05). Mothers' weight gain during 14 weeks was significant (P value < 0.05). When mothers were distributed into four groups according to their calorie and protein intake for comparison (median value: calorie-2034 kilocalorie, protein- 78.7 grams), the weight, length and head circumference gain in infants and mothers' weight were significantly higher in Group I and Group II compared to Group III and Group IV with P value < 0.05 at 6, 10, and 14 weeks. Conclusions: Calorie intake was low in mothers when compared to RDA recommendations. Infants showed lower weight, length, and head circumference gain than WHO Child Growth Standards. There is a direct relationship between the maternal diet and anthropometric measures of their infants. During postnatal period, mothers showed an increase in weight, rather than the decrease that is usually expected.

Keywords: Lactating mothers, maternal diet, weight gain in infants


How to cite this article:
Razack M, Parambath VA, Rajanbabu B. The relationship between weight gain in exclusively breastfed babies and maternal diet. J Family Med Prim Care 2019;8:3832-9

How to cite this URL:
Razack M, Parambath VA, Rajanbabu B. The relationship between weight gain in exclusively breastfed babies and maternal diet. J Family Med Prim Care [serial online] 2019 [cited 2020 Aug 10];8:3832-9. Available from: http://www.jfmpc.com/text.asp?2019/8/12/3832/272470




  Introduction Top


Nutritional requirement among lactating mothers is high as compared to nonlactating women. A regular consumption of nutrient-rich diet after lactation may help to replenish body reserves of nutrients utilized during pregnancy and lactation.[1],[2] Any taboos that exist about foods which are actually nutritionally healthy must be discussed.[3] In India, various dietary nutritional supplements are given to lactating women. The present study aims to discuss the nutritional intake of lactating women in the Northern part of Kerala (Malabar) and its influence on the physical growth parameters of their infants during the first 14 weeks after delivery.


  Subjects Top


Inclusion criteria

  1. Women who delivered after completing 37 weeks of gestation (normal delivery/LSCS) with no pregnancy-related complications (Pregnancy-induced hypertension, gestational diabetes mellitus, gestational thrombocytopenia)
  2. Women with no systemic illnesses (e.g. systemic lupus erythematous, immune thrombocytopenic purpura, asthma, seizure disorder etc.)
  3. Babies of term gestational age (completed 37 weeks) and who were exclusively breast fed
  4. Babies without intrauterine growth restriction, congenital anomalies, large for gestational age, and without any significant postnatal problems (neonatal jaundice, birth asphyxia, etc.)



  Methods Top


After obtaining written informed consent for the study, histories were elicited from the mothers. The birth weight, length and head circumference of the babies at birth were noted. The mothers' weight on the third day after delivery were noted. When the mothers and their babies came for the postnatal checkup and immunization at 6, 10, and 14 weeks, 24-hour recall diet of the mothers were noted and their body weight were measured. The anthropometric measures (weight, length, and head circumference) of the babies were also recorded by trained staff at the immunization clinic. The mothers were divided into four groups depending on the median values of calorie and protein intake. The infants' weight, length, and head circumference were compared to the weights of the mothers. Ethics committee approval was obtained. Date of approval – 17/10/2016.

Anthropometric measures

The weight of the babies were measured in kilograms using an electronic weighing scale, with the baby wearing no clothes or diapers. Their lengths were recorded in centimeters, which was measured in the supine position using an infantometer. Their head circumferences (occipitofrontal circumference) were measured using a nonstretchable fiberglass tape and recorded in centimeters. The average weights at birth, 6th, 10th, and 14th weeks, both in male and female babies, were compared with the WHO Child growth standards (50th percentile).[4] In India, WHO Child Growth Standards have been adopted since 2009 for monitoring and promoting child growth and development. This was implemented through the National Rural Health Mission (NRHM) and ICDS.

Dietary assessment

Dietary surveys were done by the 24-hour recall method. Information on the total amount of each preparation was noted in terms of standardized cups. The calorific and nutritive values of different foods consumed by the mothers were estimated using the tables of nutritive value of Indian food and compared with the Recommended Daily Allowance (RDA) for the Indians by the Indian Council of Medical Research 2010 (ICMR).[5]


  Results Top


Of the 200 mother–child pairs included in the study, 82 mothers belonged to the age group of 26–30 years. 140 of the mothers underwent LSCS.

The majority of mothers were from Kozhikode district (177) and 100 of them were Muslims. A total of 91 babies were male.

Difference in weight during 6, 10, and 14 weeks

Weight in males:

[Table 1] shows that the mean birth weight in males is 3.067 kg (SD = 0.299). The weights at birth, 6, 10, and 14 weeks were significantly lower when compared to the WHO Child Growth Standards (50th Percentile) for males, P value (<0.05) [Figure 1].
Table 1: Weight in males

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Figure 1: Comparison of weight in male babies with WHO Child Growth Standards (50th percentile)

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Weight in females:

[Table 2] shows that the mean birth weight of female babies was 3.024 kg (SD = 0.355). The weights at birth, 6 weeks and 10 weeks were significantly lower when compared to the WHO Child Growth percentile (50th percentile) with P value < 0.05. The weight at 14 weeks was higher when compared to the WHO Child Growth standards, but was not statistically significant (P = 0.064) [Figure 2].
Table 2: Weight in females

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Figure 2: Comparison of weight in female babies with WHO Child Growth Standards (50th percentile)

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Difference in lengths at 6, 10, and 14 weeks

Length in males: The lengths at 6 weeks and 10 weeks were significantly lower when compared to WHO growth standards (50th percentile) and was statistically significant (P value < 0.05). The average length at birth and at 14 weeks were lower when compared to WHO child growth standards, but not statistically significant (P value > 0.05) [Figure 3], [Table 3].
Figure 3: Comparison of length in male babies with WHO Child growth standards (50th percentile)

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Table 3: Length in males

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Length in females: The average length at birth was less than the WHO standards (50th percentile), but was not statistically significant (P value > 0.05). The average length at 6 weeks and 10 weeks was lower when compared to WHO standards (50th percentile) with a P value < 0.05. At 14 weeks, the length was found to be more than WHO growth standards, but was not statistically significant [Figure 4], [Table 4].
Figure 4: Comparison of length in females with WHO Child Growth standards (50th percentile)

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Table 4: Length in Females

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Difference in head circumference during 14 weeks

Head circumference in males: The head circumference at birth, 6 weeks, and 10 weeks were lower when compared to the WHO child growth standards which were statistically significant with P value < 0.05. At 14 weeks, the head circumference was lower than WHO growth standards but was not statistically significant (P value > 0.327) [Table 5], [Figure 5].
Table 5: Head circumference in males

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Figure 5: Comparison of head circumference of male babies with WHO Child Growth standards (50th percentile)

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Head circumference in females: The average head circumference in females was significantly lower at birth, 6 weeks, and 10 weeks when compared to the WHO standards (50th percentile; P value < 0.05). At 14 weeks, the head circumference was significantly higher than the WHO child growth standards; P value < 0.05 [Table 6], [Figure 6].
Table 6: Head circumference in female babies

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Figure 6: Comparison of head circumference of female babies with WHO Child Growth standard (50th percentile)

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Difference in the weight of mothers during 14 weeks

All the P values are less than the significance level 0.05; the difference in weight of mother during the first 14 weeks after delivery is significant. That is, the weights of the mothers significantly increased during 14 weeks after delivery as compared to their weight mother measured 3 days after delivery. [Table 7], [Figure 7]
Table 7: Weight in mother

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Figure 7: Weight gain in mothers during 14 weeks period after delivery

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Calorie and protein intake in mothers

[Table 8] shows that the average intake of calorie in all the mothers was 2040 kcal, which was less than the RDA. The average protein intake in all mothers was 77 grams, which was more than the RDA.
Table 8: Comparison between average intake of calorie and protein with recommended daily allowance

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[Figure 8] shows that among the 200 mothers, 34 consumed between 2250–2500 kcal/day, 88 consumed 2250–2000 kcal/day, 70 consumed 1750–2000 kcal/day, and 8 consumed 1500–1750 kcal/day.
Figure 8: Calorie intake in mothers

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[Figure 9] shows the protein intake among the mothers. 79 of them took 80–90 grams/day, 95 of them took 70–80 grams/day, 24 took 60–70 grams, and 2 of them took 50–60 grams/day of protein.
Figure 9: Protein intake in mothers

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Relationship between weight gain in infants and maternal diet at 6 weeks

[Table 9] shows that the beta value corresponding to calories was significant as the corresponding P value was less than the significant level (<0.05). The corresponding P value of 0.896 for protein intake, which is greater than the significance level, indicates that protein intake is not related to weight gain.
Table 9: Relationship between weight gain in infants and nutrient intake at 6 Weeks

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Relationship between weight gain in infants and maternal diet at 10 weeks

[Table 10] shows that the beta value corresponding to calorie intake was found to be significant as the corresponding P value (<0.05) was less than the significant level. Since, the corresponding P value (0.127) is greater than the significance level 0.05, protein intake is not related to weight gain.
Table 10: Relationship between weight gain in infants and maternal diet at 10 weeks

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Relationship between weight gain in infants and maternal diet intake at 14 weeks

[Table 11] shows that the beta values corresponding to calorie and protein intake are found to be significant as the corresponding P values are less than the significant level of 0.05.
Table 11: Relationship between weight gain in infants and maternal dietary intake at 14 Weeks

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Distribution of mothers into groups

Mothers were classified into four groups according to their calorie and protein intakes for comparison. Groups were formed according to the median value calorie and protein intake, which was 2034 kilocalorie and 78.7 grams, respectively [Table 12].
Table 12: Distribution of mothers into groups

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[Figure 10] shows that 37.0% (n = 74) of the mothers belonged to Group I and 13.0% (n = 26) of the mothers belonged to Group II. Around 11.5% (n = 23) of the mothers belonged to Group III and 38.5% (n = 77) of the mothers belonged to Group IV.
Figure 10: Distribution of mothers into groups

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Difference in weight gain in infants between groups

Weight at 6, 10, and 14 weeks: The intergroup difference in weight gain at 6, 10, and 14 weeks was significant (P value < 0.05). The weight gain is significantly higher in Group I and Group II compared to Group III and Group IV [Table 13]; [Figure 11].
Table 13: Difference in weight gain in infants between groups

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Figure 11: Comparison of gain in weight at 6, 10, and 14 weeks between groups

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Difference in length gain in infants between groups

Length at 6, 10, and 14 Weeks: The intergroup difference in length gain at 6, 10, and 14 weeks was significant. The length gain is significantly higher in Group I and Group II compared to Group III and Group IV [Table 14]; [Figure 12].
Table 14: Difference in length gain in infants between groups

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Figure 12: Comparison in Length gain at 6, 10, and 14 weeks between groups

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Difference in head circumference gain between groups

Head Circumference at 6, 10, and 14 Weeks: The intergroup difference in gain in head circumference at 6, 10, and 14 weeks was significant. The head circumference gain was significantly higher in Group II and Group III compared to Group I and Group IV [Table 15]; [Figure 13].
Table 15: Difference in head circumference gain between groups

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Figure 13: Comparison of head circumference gain at 6, 10, and 14 weeks between groups

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Difference in the weight of mother between groups

Weight of Mothers at 6, 10, and 14 Weeks: The intergroup difference in weights at 6, 10, and 14 weeks was significant. That is, there was significant difference in weight across groups. The table shows that the difference in weight was significantly higher in Group II and Group I compared to Group III and Group IV [Table 16] [Figure 14].
Table 16: Difference in weight of mother between groups

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Figure 14: Comparison of weight of mothers at 6, 10, and 14 weeks between groups

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  Discussion Top


Most of the mothers in this study (41%) belonged to the age group of 26–30 years. Among the infants, most of them were first born (58%). 88.5% of the mothers hailed from Kozhikode. Out of the 200 infants, 54.5% were female babies and 45.5% were males.

All the babies included in the study were term (37 weeks-40 weeks) and adequate for gestational age according to the WHO growth chart. The average birth weight of the babies was 3.044 kg. This is similar to the findings reported by Krishnan, Avabratha, et al.,[6] in South India, which also showed an average birth weight of 3.07 kg.

When the average weight, length, and head circumference at birth, 6 weeks, 10 weeks, and 14 weeks of males and female babies in our study were compared to WHO growth standards, they were found to be lower.

In Kerala, particularly in Malabar region, postpartum care includes special diets, high in carbohydrates, proteins, and fats. Most of the mothers in the study group were nonvegetarians and their average daily intake was 2040 kilocalorie and 77 grams proteins. The calorie intake was found to be lower than the recommended daily allowance, which is 2,500 kcal. Some studies done in lactating women in Kolkata and Haryana also reported lower intake of calories, similar to our study.[7],[8] In one of the recent studies done by Ryan Wessells et al., they found that pregnant and lactating women had difficulty in meeting the nutrient recommendations.[9]

The nutritional status of women in our study, if considered as per calorie intake alone, was directly related to weight gain in their babies during the first 14 weeks. But intake of proteins, though higher in our study population than RDA, did not show any relation to the weight gain in babies during 6th and 10th weeks. However, for reasons that are not clear, the intake of protein had an influence on weight gain at 14 weeks. Protein in mother is needed for body building, repair and maintenance of body tissues, and improving cellular immunity. But as per our findings, whether it influences the weight gain in their babies is not clear.

When the mothers were grouped according to the nutrient intake, it was observed that the babies of mothers who consumed more calories had more weight gain when compared to those who consumed lesser calories, irrespective of the protein intake. These babies had also gained more in length and head circumference. These findings are similar to those reported by Kajale, Khadilkar, et al., which showed that weight gain in infants was higher among the women taking traditional food supplements, which had higher calories and fat, even though those diets were protein deficient.[10] These findings emphasize the need for postnatal counseling to improve nutrient intake in mothers. The counseling can be tailored to individual woman, based on risk factors for poor nutrition such as extremes of maternal age, restrictive dietary practices (e.g. vegetarian), excessive weight gain during pregnancy, and deviations from ideal body weight and multiple gestations.

In the present study, overall, the weight of mothers showed a significant increase after delivery. The increase in weight was more among mothers having higher calorie intake. During postpartum period, in addition to the loss of about 5 to 6 kg due to uterine evacuation and normal blood loss, there is usually a further decrease of 2 to 3 kg through diuresis.[11] A study done by Butte, Garza et al.[12]also showed decreasing trend in the weight of lactating mother during first 4 months postpartum. But in North Malabar region, it is common for almost all postpartum women to keep traditional “dais” during the postpartum period for 40 days. The “dais” cook food, assist in bathing, and take care of the babies; the mothers usually do very little physical activity. This lack of physical activity may be an additional reason for the increase in the body weight in mothers, contrary to other studies.[11],[12]

In our study, the follow up was done only till 14 weeks post delivery when the mothers came for immunization of their babies, unlike the study conducted by Samano, Martinez et al. where the study duration was for 1 year and weight loss was noted in mothers.[13] It is hence recommended that in our region, mothers and their carers should be educated accordingly in the prenatal and immediate postnatal period, and exercises may be initiated gradually after delivery if medically safe, depending on the mode of delivery, vaginal or cesarean, and the presence or absence of medical or surgical risks or complications.[14]

Thus, it can be concluded that the dietary intake in lactating women has an effect on weight gain in their babies. The study by Van der Pligt et al.[15]in Australia, showed that counseling regarding healthy eating and physical activity is far less during the postpartum period, compared to the advice provided during pregnancy. This may be true in several other parts of the world and seems to be so for lactating women in the North Malabar region of Kerala also. Hence, postpartum women should be counselled about a personalized, balanced diet, including a variety foods such as meat, fish, oils, nuts, seeds, cereals, beans, vegetables, and milk. A specific strategy needs to be established to promote women's diet and physical activity during the months following childbirth to enable women to achieve optimal diet and physical activity habits for the sake of their own and their infants' health.


  Conclusion Top


  • The calorie intake is low in all mothers when compared to RDA recommendations.
  • Infants showed lower weight, length, and head circumference gain than WHO Child Growth Standards.
  • There is a direct relationship between the maternal diet and weight gain of their infants.
  • During postnatal period mothers showed an increase in weight, rather than the decrease that is usually expected.


Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Institute of Medicine (US). Committee on Nutritional Status During Pregnancy and Lactation. Meeting Maternal Nutrient Needs During Lactation. Nutrition During Lactation. Washington (DC): National Academies Press (US); 1991. p. 213-33.  Back to cited text no. 1
    
2.
Procter SB, Campbell CG. Position of the academy of nutrition and dietetics: Nutrition and lifestyle for a healthy pregnancy outcome. J Acad Nutr Diet 2014;114:1099-103.  Back to cited text no. 2
    
3.
Department of Making Pregnancy Safer. World Health Organization. Counselling for Maternal and Newborn Health Care: A Handbook for Building Skills. Geneva: World Health Organization; 2010. p. 122-8.  Back to cited text no. 3
    
4.
WHO Child Growth Standards [Internet]. World Health Organization[cited 2018 Jun 23]. Available from: www.who.int/childgrowth/en/.  Back to cited text no. 4
    
5.
Gopalan C, Rama Sastri BV, Balasubramanian SC. Food Composition Table. Nutritive Value of Indian Foods. Hyderabad: National institute of Nutrition. Indian Council of Medical Research; 1989. p. 47-58.  Back to cited text no. 5
    
6.
Krishnan KD, Avabratha KS, D'Souza AJ. Estimation of average birth weight in term newborns: A hospital-based study in coastal Karnataka. Int J Contemp Pediatr 2014;1:156-9.  Back to cited text no. 6
    
7.
Malhotra P, Chaturvedi S, Pruthi R, Malhotra N, Malhotra V, Chaturvedi A, et al. Nutritional awareness among lactating Indian women. Adv Res Gastroenterol Hepatol 2016;1(3).  Back to cited text no. 7
    
8.
Mallik S, Choudhury K, Majumdar S. A study on nutritional status of lactating mothers attending the immunization clinic of a Medical College Hospital of Kolkata, West Bengal. IOSR J Dent Med Sci 2017;16:30-4.  Back to cited text no. 8
    
9.
Wesells KR, Young RR, Ferguson EL, Quedrago CT, Faye MT, Hess SY. Assessment of dietary intake and nutritional gaps, and development of food based recommendations among pregnant and lactating women in Zinder, Niger: An optifood linear programming analysis. Nutrients 2019;11:72.  Back to cited text no. 9
    
10.
Kajale N, Khadilkar A, Chiponkar S, Unni J, Mansukhani N. Effect of traditional food supplements on nutritional status of lactating mothers and growth of their infants. Nutrition 2014;30:1360-5.  Back to cited text no. 10
    
11.
Cunningham GC, Leveno KJ, Hauth JC, Bloom SL, Gilstrap L, Wenstrom KD. The Puerperium. Williams Obstetrics. 22 ed. New York: The McGraw-Hill Companies; 2007. p. 667-75.  Back to cited text no. 11
    
12.
Butte NF, Garza C, Stuff JE, Smith EO, Nichols BL. Effect of maternal diet and body composition on lactational performance. Am J Clin Nutr 1984;39:296-306.  Back to cited text no. 12
    
13.
Sámano R, Martínez-Rojano H, Martínez EG, Jiménez BS, Rodríguez GP, Zamora JP, et al. Effects of breastfeeding on weight loss and recovery of pregestational weight in adolescent and adult mothers. Food Nutr Bull 2013;34:123-30.  Back to cited text no. 13
    
14.
American College of Obstetricians and Gynecologists. Physical activity and exercise during pregnancy and the postpartum period. Committee Opinion No. 650. Obstet Gynecol 2015;126:e135-42.  Back to cited text no. 14
    
15.
Van der Pligt P, Olander EK, Ball K, Crawford D, Hesketh KD, Teychenne M, et al. Maternal dietary intake and physical activity habits during the postpartum period: Associations with clinician advice in a sample of Australian first time mothers. BMC Pregnancy Childbirth 2016;16:27.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15], [Table 16]



 

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