Effectiveness of a minimally processed food-based nutritional counselling intervention on weight gain in overweight pregnant women: a randomized controlled trial

Ultra-processed Food Intake During Pregnancy and its Impact on Maternal Diet Quality and Weight Change: A Systematic Review of Observational Studies

PURPOSE OF REVIEW

Adequate and balanced nutrition during pregnancy is essential for both the mother's and fetus's health. The increased dietary intake of ultra-processed foods (UPFs) and their significant share in the diet negatively affects diet quality and gestational weight gain during pregnancy. The aim of this systematic review was to examine the association of UPFs consumption with diet quality and gestational weight change among healthy pregnant women, using data from observational studies (PROSPERO Identifier: CRD42023468269) from the last 10 years.

RECENT FINDINGS

A search was performed in Pubmed, Wiley, Scopus, and Web of Science, and studies published in english language were selected. Study selection and data extraction were made by determining the exclusion and eligible inclusion criterias according to the PECOS framework. Of the 12 studies included, 5 were longitudinal cohort studies and 7 were cross-sectional studies. On average, half of the energy in the participants' daily diets came from UPFs in 3 studies, but the energy share of UPFs was about 20-30% in the remainder studies. UPFs-enriched maternal diet was associated with less dietary intake of legumes, vegetables, fruits and protein sources (seafood and plant protein, total protein) and greater consumption of refined grains compared to those who consume less UPFs. In parallel, UPFs consumption was negatively associated with Healthy Eating Index. UPF intake during pregnancy has a negative impact on diet quality and gestational weight gain. Increasing awareness of UPFs during this period may reduce potential complications during pregnancy and fetal growth.

Relationship between paternal excessive weight and neonatal anthropometry in a clinical trial of nutritional counseling for pregnant women with overweight

BACKGROUND/OBJECTIVES

Human studies suggest that fathers with obesity influence infant growth and development. This study aimed to evaluate the relationship between paternal body mass index (BMI) and waist circumference (WC) with neonatal anthropometry and adiposity.

METHODS

This study is a cohort nested in a randomized controlled clinical trial of nutritional counseling for pregnant women with overweight. In total, 89 partner-pregnant woman-neonate triads were included. Paternal anthropometric measurements were taken at the time of the interview. Secondary data related to birth were obtained through access to the health information systems. Neonatal skinfold thickness was assessed and the adiposity was estimated using a predictive anthropometric model. Pearson's correlation and adjusted multivariate linear regression models were employed to evaluate the relationship between paternal BMI and WC with neonatal anthropometric measurements and adiposity.

RESULTS

In total, 57.0% of the fathers presented a BMI ≥ 25 kg/m² and 14.6% a waist circumference ≥102 cm. The mean ± SD birth weight of the newborns (g) was 3357 ± 538. Paternal BMI and WC were inversely correlated with head circumference at birth [r = -0.31 (p = 0.004), r = -0.23 (p = 0.03), respectively]. Paternal BMI was also inversely correlated with the birth weight standardized by gestational age (z-score) [r = -0.23 (p = 0.03)]. In adjusted multivariate linear regression models, the paternal BMI (kg/m²) was inversely associated with the head circumference at birth (cm) [β = -0.07 (95% CI -0.15; -0.001) p = 0.04].

CONCLUSION

The data suggest that paternal excessive weight have a negative effect on fetal development, as assessed by anthropometric measurements. The inverse association between paternal BMI and the head circumference at birth was independent of confounders. Future studies with larger sample sizes are necessary to confirm or refute such hypotheses.

Effectiveness of nutritional counseling with overweight pregnant women on child growth at 6 months: A randomized controlled trial

OBJECTIVE

Studies that have investigated the effect of nutritional counseling during the prenatal period on the follow-up outcomes of children at 6 mo have produced inconclusive results. The present study aimed to investigate the effect of nutritional counseling, based on the NOVA food classification, encouraging the consumption of fresh and minimally processed foods, with overweight adult pregnant women on infant growth at 6 mo of age.

METHODS

A randomized controlled trial with 195 pairs of pregnant overweight women and their infants at 6 mo of age was conducted in a Brazilian municipality. The pregnant women were allocated to the control group (CG) or intervention group (IG) at the beginning of the pregnancy. The IG received three sessions of nutrition counseling throughout the pregnancy. Linear regression models were used to investigate the effect of the nutritional counseling on infant growth.

RESULTS

One hundred ninety-five mother-infant pairs with complete data were included (96 CG, and 99 IG). The mean ± SD infant weight (g) at 6 mo was 7856.1 ± 1.1, and length (cm) was 67.0 ± 2.9. There were no differences in maternal and newborn characteristics between the groups. In the linear regression models, the counseling had no effect on anthropometric parameters of the infants at 6 mo of age: weight-for-length Z-score (β 0.089 [95% CI -0.250; 0.427], P = 0.61); length-for-age Z-score (β 0.032 [95% CI -0.299; 0.363], P = 0.85); weight-for-age Z-score (β 0.070 [95% CI -0.260; 0.400], P = 0.68); BMI-age Z-score (β 0.072 [95% CI -0.270; 0.414], P = 0.68).

CONCLUSIONS

There was no effect on infant growth at 6 mo of age after the nutritional counseling during pregnancy. Future studies are needed to confirm this hypothesis.

Ultra-processed foods consumption and health-related outcomes: a systematic review of randomized controlled trials

Introduction

The increase in ultra-processed foods (UPFs) intake has raised concerns about its impact on public health. Prospective observational studies have reported significant associations between higher intake of UPFs and adverse health outcomes. The aim of this study is to determine whether these associations could be confirmed in randomized controlled trials (RCTs).

Methods

We conducted a systematic review to analyze the evidence on the effects of UPFs intake on health. A systematic search was conducted in Medline, Embase, Web of Science, Scopus, LILACS, and CENTRAL up to April 22, 2024. RCTs in English, Spanish, and Portuguese evaluating the health effects of interventions to modify UPFs intake were included. The certainty of evidence was determined using the GRADE methodology.

Results

Three educational intervention studies and one controlled feeding trial were included, evaluating the effect of reducing the consumption of UPFs (455 participants, median follow-up, 12 weeks). No significant effects were observed in 30 out of the 42 outcomes evaluated. The controlled feeding trial in adults with stable weight showed a reduction in energy intake, carbohydrates, and fat (low certainty of evidence), as well as in body weight, total cholesterol, and HDL cholesterol (moderate certainty of evidence). In the educational intervention studies, a reduction in body weight and waist circumference was observed (low certainty of evidence) in women with obesity, as well as improvement in some dimensions of quality of life (very low certainty of evidence). No significant changes were observed in children and adolescents with obesity, while in overweight pregnant women, the consumption of UPFs was not reduced, so the observed benefits could be attributed to other components of the intervention.

Conclusion

Interventions aimed at reducing the consumption of UPFs showed benefits on some anthropometric and dietary intake outcomes, although significant effects were not observed for most of the evaluated outcomes. The limited number and significant methodological limitations of the studies prevent definitive conclusions. Further well-designed and conducted RCTs are needed to understand the effects of UPF consumption on health.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023469984.

Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

OBJECTIVE

To evaluate the existing meta-analytic evidence of associations between exposure to ultra-processed foods, as defined by the Nova food classification system, and adverse health outcomes.

DESIGN

Systematic umbrella review of existing meta-analyses.

DATA SOURCES

MEDLINE, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews, as well as manual searches of reference lists from 2009 to June 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Systematic reviews and meta-analyses of cohort, case-control, and/or cross sectional study designs. To evaluate the credibility of evidence, pre-specified evidence classification criteria were applied, graded as convincing ("class I"), highly suggestive ("class II"), suggestive ("class III"), weak ("class IV"), or no evidence ("class V"). The quality of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, categorised as "high," "moderate," "low," or "very low" quality.

RESULTS

The search identified 45 unique pooled analyses, including 13 dose-response associations and 32 non-dose-response associations (n=9 888 373). Overall, direct associations were found between exposure to ultra-processed foods and 32 (71%) health parameters spanning mortality, cancer, and mental, respiratory, cardiovascular, gastrointestinal, and metabolic health outcomes. Based on the pre-specified evidence classification criteria, convincing evidence (class I) supported direct associations between greater ultra-processed food exposure and higher risks of incident cardiovascular disease related mortality (risk ratio 1.50, 95% confidence interval 1.37 to 1.63; GRADE=very low) and type 2 diabetes (dose-response risk ratio 1.12, 1.11 to 1.13; moderate), as well as higher risks of prevalent anxiety outcomes (odds ratio 1.48, 1.37 to 1.59; low) and combined common mental disorder outcomes (odds ratio 1.53, 1.43 to 1.63; low). Highly suggestive (class II) evidence indicated that greater exposure to ultra-processed foods was directly associated with higher risks of incident all cause mortality (risk ratio 1.21, 1.15 to 1.27; low), heart disease related mortality (hazard ratio 1.66, 1.51 to 1.84; low), type 2 diabetes (odds ratio 1.40, 1.23 to 1.59; very low), and depressive outcomes (hazard ratio 1.22, 1.16 to 1.28; low), together with higher risks of prevalent adverse sleep related outcomes (odds ratio 1.41, 1.24 to 1.61; low), wheezing (risk ratio 1.40, 1.27 to 1.55; low), and obesity (odds ratio 1.55, 1.36 to 1.77; low). Of the remaining 34 pooled analyses, 21 were graded as suggestive or weak strength (class III-IV) and 13 were graded as no evidence (class V). Overall, using the GRADE framework, 22 pooled analyses were rated as low quality, with 19 rated as very low quality and four rated as moderate quality.

CONCLUSIONS

Greater exposure to ultra-processed food was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes. These findings provide a rationale to develop and evaluate the effectiveness of using population based and public health measures to target and reduce dietary exposure to ultra-processed foods for improved human health. They also inform and provide support for urgent mechanistic research.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42023412732.

Interventions in preconception and pregnant women at risk of gestational diabetes; a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Women at risk of gestational diabetes mellitus (GDM) need preventative interventions.

OBJECTIVE

To evaluate targeted interventions before and during pregnancy for women identified as being at risk of developing GDM.

METHODS

Systematic review and meta-analysis conducted following PRISMA guidelines. MEDLINE, EMBASE and the Cochrane Library in addition to reference and citation lists were searched to identify eligible randomised controlled trials (RCTs) utilising risk stratification during the preconception period or in the first/early second trimester. Screening and data extraction were carried out by the authors independently. Quality assessment was conducted based on the Cochrane risk-of-bias tool. Random effects meta-analysis and narrative synthesis were performed.

RESULTS

Eighty-four RCTs were included: two during preconception and 82 in pregnancy, with a pooled sample of 22,568 women. Interventions were behavioural (n = 54), dietary supplementation (n = 19) and pharmacological (n = 11). Predictive factors for risk assessment varied; only one study utilised a validated prediction model. Gestational diabetes was reduced in diet and physical activity interventions (risk difference - 0.03, 95% CI 0.06, - 0.01; I2 58.69%), inositol (risk difference - 0.19, 95% CI 0.33, - 0.06; I2 92.19%), and vitamin D supplements (risk difference - 0.16, 95% CI 0.25, - 0.06; I2 32.27%). Subgroup analysis showed that diet and physical activity interventions were beneficial in women with ≥ 2 GDM risk factors (risk difference - 0.16, 95% CI 0.25, - 0.07; I2 11.23%) while inositol supplementation was effective in women with overweight or obesity (risk difference - 0.17, 95% CI 0.22, - 0.11; I2 0.01%). Effectiveness of all other interventions were not statistically significant.

CONCLUSIONS

This review provides evidence that interventions targeted at women at risk of GDM may be an effective strategy for prevention. Further studies using validated prediction tools or multiple risk factors to target high-risk women for intervention before and during pregnancy are warranted.

Greater Ultra-Processed Food Intake during Pregnancy and Postpartum Is Associated with Multiple Aspects of Lower Diet Quality

Low diet quality during pregnancy and postpartum is associated with numerous adverse maternal and infant health outcomes. This study examined relations of ultra-processed food intake with diet quality during pregnancy and postpartum. Using data from 24-h recalls, ultra-processed food intake was operationalized as percent energy intake from NOVA-classified ultra-processed foods; diet quality was measured using Healthy Eating Index 2015 (HEI) total and component scores. Pearson correlations examined associations of ultra-processed food intake with HEI total and component scores, and food group intake was compared across four levels of ultra-processed food intake. On average, ultra-processed food comprised 52.6 ± 15.1% (mean ± SD) of energy intake in pregnancy and 50.6 ± 16.6% in postpartum. Ultra-processed food intake was inversely correlated with HEI total and 8 of 13 component scores. Compared to participants with the highest ultra-processed food intake (≥60% energy), those with the lowest ultra-processed food intake (<40% energy) had a 17.6-point higher HEI total score and consumed 2−3 times more fruit, vegetables, and seafood and plant proteins, and 1½ times more total protein. Additionally, they consumed 2/3 as much refined grains and 1/2 as much added sugar. Greater ultra-processed food intake was associated with lower diet quality across most HEI components. Reducing ultra-processed food intake may broadly improve adherence to dietary guidelines in pregnant and postpartum populations.