Desenvolvimento de um Questionário Quantitativo de Freqüência Alimentar (QQFA) para gestantes usuárias de Unidades Básicas de Saúde de Ribeirão Preto, São Paulo, Brasil

The contribution of prenatal care in the dietary patterns of high-risk pregnant women

Abstract Objectives: investigate whether prenatal characteristics were associated with dietary pattern of pregnant women. Methods: we studied 200 high-risk pregnant women in Fortaleza, Ceará. The identification of dietary patterns was performed through principal component analysis with the orthogonal Varimax rotation. Poisson regression was used to estimate prevalence ratios (PR) and respective confidence intervals (CI95%). Results: three major dietary patterns were identified: ‘common Brazilian’, ‘healthy’ and ‘energy-dense’. After adjustments conducted with multivariate analysis, pregnant women who had not received dietary guidance in prenatal consultations (34%) were less likely to adhere to the ‘healthy’ pattern (PR = 0,81; CI95%= 0,67-0,95). Pregnant women who attended an appropriate number of consultations (≥ 6 consultations) (41%) showed greater adherence to the ‘healthy’ pattern (PR = 1,15; CI95%= 1,01-1,32) and lower adherence to the ‘energy-dense’ pattern (PR = 0,85; CI95%= 0,74-0,99). Conclusion: it was observed that the high-risk pregnant women who attended an adequate number of consultations during the prenatal care had a higher chance to adhere to the ‘healthy’ pattern and a lower chance to adhere to the ‘energy-dense’ pattern. Not receiving guidelines on prenatal nutrition was inversely associated with the healthy pattern. Thus, the importance of high-risk pregnant women undergoing an appropriate prenatal care is reinforced.

Development of a Diet Quality Index Adapted for Pregnant Women

OBJECTIVE:

To develop a Diet Quality Index Adapted for Pregnant Women (IQDAG) and to evaluate its relation with the characteristics of women treated at the Brazilian Unified Health System.

METHODS:

The data on food intake come from a cross-sectional study carried out with 785 adult pregnant women in the city of Ribeirão Preto, state of São Paulo, Brazil, between 2011 and 2012. The index was based on the recommendations of the Brazilian Ministry of Health, previous national dietary indexes, and the new Dietary Guidelines for the Brazilian Population. We used the ANOVA, Kruskal-Wallis, and chi-square tests to describe the quality of the diet according to the characteristics of the mother.

RESULTS:

The IQDAG has nine components, and it is represented by three food groups (in servings/1,000 kcal), five nutrients, and a moderator component. A high proportion of pregnant women reached the maximum score for the components of legumes and vegetables. However, few women reached the maximum score for consumption of fresh fruits, fiber, omega-3, calcium, folate, iron, and ultra-processed foods. We verified a better quality of diet among older and eutrophic pregnant women who reported practicing more physical activity and taking dietary supplements. We also observed the highest index score among women with higher intake of carbohydrates, proteins, vitamins C, E, and A, and minerals calcium, folate, and iron, as well as among those with lower intake of total fats and saturated fats.

CONCLUSIONS:

This dietary index is unprecedented in incorporating the recommendation of the new Dietary Guidelines for the Brazilian Population regarding the moderation of the consumption of ultra-processed foods. It was useful in evaluating the quality of the diet of pregnant women and we verified a higher score among older and eutrophic women who reported a healthy lifestyle. Strategies are needed to promote a higher consumption of fresh fruits, foods high in fiber, omega-3, calcium, folate, iron, and minimally processed foods in pregnant women.

[Food Frequency Questionnaire developed and validated for the Brazilian population: a review of the literature]

Assessing food intake is a challenge for researchers given the inherent complexity of the issue. One of the methods used in epidemiological studies is the Food Frequency Questionnaire (FFQ). The scope of this paper was to identify studies that developed and/or validated the FFQ in Brazil, analyzing the methods used and the main results of the validation. The PubMed, LILACS and SciELO databases were researched for studies published prior to 2013 on the development and validation of the FFQ in Brazil. These studies were analyzed according to: i) the main methodological characteristics of the elaboration/validation process of the questionnaires; ii) the key results related to validation. Forty-one studies were assessed: 6 on the development of the FFQ; 18 on the development and validation of the FFQ; 17 on the validation of the FFQ. There were inter-regional differences in the publications and methodological differences in the elaboration and validation of the FFQ. Adults and adolescents were the groups most covered for the validation of the FFQ, though specific studies for children < 5 years of age were not found. The methodological rigor and statistical results guarantee the suitability of the validation of the FFQ for the target populations, with high correlations for energy, carbohydrates, fibers, calcium and vitamin C.

Dietary patterns and significance of nutrition for women with low-risk pregnancy

ABSTRACT Objective: To evaluate dietary patterns and significance of diet for pregnant women. Methods: Cross-sectional study carried out in eight health units in Fortaleza, Ceará, Brazil, with 201 pregnant women. The following instruments were used: a socio-economic and health questionnaire, the Free-Word Association Test, and a Food Frequency Questionnaire. Dietary patterns were identified using principal components and factor analysis. Poisson regression with 5% significance level was used. Results: Three dietary patterns were identified: current Brazilian pattern (beans, rice, processed meats, fats, refined grains, pasta and pastries, soft drink, sugar and sweets, cookies and crackers); healthy pattern (fruits and fruit juices, vegetables, whole grains, seafood, dairy products); and energy-rich pattern (salty deep-fried snacks, popcorn, packaged snacks, instant noodles, tubers, and chicken). Women who did not receive nutrition guidance during prenatal care showed less chance of adherence to the current Brazilian dietary pattern (PR=0.87), and therefore their level of consumption of foods commonly present in Brazilian diets was low. For most women, the significance of diet was reported as important and healthy, but it was not associated with any of the diet patterns identified. However, the women who did not consider that during pregnancy diet should be healthy showed greater chance of adherence to the energy-rich pattern (PR=1.18). This finding deserves special attention since excessive weight gain can have a negative effect on pregnancy. Conclusion: Nutrition guidance during prenatal care and the way pregnant women perceive their eating habits can influence their food choices during pregnancy.

Development and validation of a food frequency questionnaire for consumption of polyphenol-rich foods in pregnant women

Previous studies have shown that maternal consumption of polyphenol-rich foods after the third trimester of pregnancy may interfere with the anatomical and functional activity of the fetal heart as, to our knowledge, there are no validated instruments to quantify total polyphenols in pregnant women. The aim of this study was evaluate the reproducibility and validity of a food frequency questionnaire (FFQ), with 52 items, to assess the intake of polyphenol-rich foods in pregnant women in Brazil. This cross-sectional study included 120 pregnant women who participated in nutritional interviews in two moments. The intake of polyphenols estimated by the developed FFQ was compared with the average of two 24-h recalls (24HR), with the average intake measured by a 3-day food diary (D3days) and with the urinary excretion of total polyphenols. The triangular method was applied to calculate Pearson's correlation coefficients, intraclass correlation and Bland-Altman plots for the FFQ, using an independent biochemical marker, in addition to classification by quarters of consumption. The questionnaires were log transformed, adjusted for body mass index and gestational age. The adjustment for energy was applied only of 24HR and D3days. Analysis of the reproducibility between the FFQ showed a very high correlation (r = 0.72; P < 0.05). A low but significant association was observed between the FFQ and urinary excretion (0.23; P = 0.01). The association between the dietary survey methods was moderate to very high (r = 0.36 to r = 0.72; P < 0.001). In conclusion, this questionnaire showed reproducibility and validity for the quantification of consumption of total polyphenols in pregnant women.

Fried food intake estimated by the multiple source method is associated with gestational weight gain

This present study aimed to test the association between fried food intake estimated by a semiquantitative food frequency questionnaire (FFQ), multiple 24-hour dietary recalls (24hRs), and the application of the multiple source method (MSM) in relation to gestational weight gain at the second and third trimesters and weight gain ratio (observed weight gain/expected weight gain). We hypothesized that distinct relationships with weight gain would be found given the measurement errors of self-reported dietary approaches. A prospective study was conducted with 88 adult pregnant women. Fried food intake during pregnancy was assessed using a validated 85-item FFQ, two to six 24hRs per woman, and the MSM with and without frequency of food intake as covariate. Linear regression models were used to evaluate the relationship between fried food estimated by the methods and weight gain. For every 100-g increment of fried food intake, the β (95% confidence interval) for weight gain was β 1.87 (0.34, 3.40) and β 2.00 0.55, 3.45) for estimates using MSM with and without the frequency of intake as covariate, respectively, after multiple adjustments. We found that fried food intake estimated by the FFQ and 24hRs β 0.40 (-0.68, 1.48) and β 0.49 (-0.53, 1.52), respectively, was unrelated to weight gain. In relation to weight gain ratio, a positive association was found for estimates using the MSM with [β 0.29 (0.03, 0.54)] and without the frequency of intake as covariate [β 0.31 (0.07, 0.55)]; and no associations were found for estimates by the FFQ or 24hRs. The data showed that fried food intake estimated the MSM, but not by the FFQ and 24hRs, is associated with excessive weight gain during pregnancy.

Validation of a food frequency questionnaire to assess food group intake by pregnant women

BACKGROUND

Previous studies conducted among pregnant women to test the accuracy of food frequency questionnaires (FFQ) for estimating food group intake were restricted to one specific trimester of pregnancy. The present study aimed to validate a FFQ for assessing the intake of food groups throughout pregnancy.

METHODS

In total, 75 adult pregnant Brazilian women were evaluated. Dietary intake was assessed by the FFQ (completed at the third trimester of pregnancy) and by three 24-h dietary recalls; one in each trimester of pregnancy.

RESULTS

The food items were classified into 20 groups. Adequate deatenuatted Pearson correlation coefficients (>0.4) were observed for the intake of bread/cake, butter/margarine; milk/dairy products; soft drinks/artificial juices; coffee/tea; and pastries/sandwiches. The FFQ served poorly for estimating fruit and vegetable intake. A high percentage (>70%) of women were classified into the same or adjacent quartiles for estimates of cookies/crackers, butter/margarine, milk/dairy products, fruit juices, soft drinks/artificial juices, coffee/tea, roots, rice, beans, meat/chicken/sausages, fried foods, fish, eggs, sweets/sugars, and pastries/sandwiches. Nevertheless, the agreement of joint classification between the dietary methods was mostly into adjacent quartiles, rather than in the same quartile, and low values of kappa were found.

CONCLUSIONS

The data reported in the present study suggest that the FFQ might not be an appropriate dietary method for evaluating food group intake throughout pregnancy. The joint classification between methods by categories of intake of food groups was mostly into adjacent quartiles, which could lead to attenuated associations when investigating diet-disease relationships during pregnancy.

A influência da escolaridade na reprodutibilidade de um questionário quantitativo de frequência alimentar para gestantes

OBJETIVOS: avaliar a influência da escolaridade sobre a reprodutibilidade de um questionário de frequência alimentar (QQFA), previamente desenvolvido para gestantes, na estimativa de nutrientes durante a gestação. MÉTODOS: o QQFA foi aplicado em duplicata (entre 15 e 45 dias) em uma amostra de 95 gestantes. Análises de coeficiente de correlação intraclasse (CCI) e classificação das gestantes em quartis de estimativa de nutrientes, estratificadas por 8 anos de estudo, foram empregadas. RESULTADOS: após ajuste pela energia, o CCI médio foi de 0,66 (variando de 0,33 para ácido graxo linoléico e 0,88 para potássio e folato) e 0,72 (variando entre 0,44 para ácido graxo araquidônico e 0,84 para potássio) entre as aplicações do QQFA para gestantes com menor e maior escolaridade, respectivamente. Em média, 78% e 84% das gestantes foram classificadas no mesmo quartil ou quartil adjacente entre as aplicações do QQFA para gestantes com menor e maior escolaridade, respectivamente. CONCLUSÕES: o questionário apresentou boa precisão na estimativa de nutrientes durante a gestação, exceto para alguns ácidos graxos. Verificou-se maior precisão do QQFA na estimativa de nutrientes entre mulheres com escolaridade correspondente a mais de 8 anos de estudo.

Supplementation with the omega-3 docosahexaenoic acid: influence on the lipid composition and fatty acid profile of human milk

OBJECTIVE: This study assessed the impact of supplementing the diet of women during pregnancy and lactation with fish oil containing the omega-3 fatty acid docosahexaenoic acid, and its influence on the composition of human milk. METHODS: The sample comprised 60 women aged 18 to 38 years with appropriate dietary pattern, all of them healthy and nonsmokers. The intervention consisted of a daily supplementation with fish oil capsules that corresponded to a daily intake of 315mg of docosahexaenoic acid and 80mg of eicosapentaenoic acid during the third trimester of pregnancy and the first three months postpartum. The total fat content and fatty acid profile of their milk were determined by creamatocrit and gas chromatography. Descriptive statistics were used for data analysis and the significance level was set at p<0.05. RESULTS: There was no statistical difference between the fat contents of the study (fish oil capsules) and control (capsules containing corn starch as filler) groups. However, the milk of women taking fish oil contained higher docosahexaenoic and eicosapentaenoic acid levels 30 and 60 days after delivery. These results demonstrate that high omega-3 intake can influence its concentration in human milk. CONCLUSIONS: Given the importance of docosahexaenoic acid in the neonatal period, it is appropriate for pregnant and breastfeeding women to supplement on long-chain polyunsaturated fatty acids, which may be done by adding fish oil to the regular diet.

Relative validation of a quantitative FFQ for use in Brazilian pregnant women

OBJECTIVE

To evaluate the ability of an FFQ, designed for use in Brazilian pregnant women, to estimate nutrient intakes during pregnancy.

DESIGN

A prospective study was conducted among 103 pregnant women attended by the Brazilian national health-care service. Food intake during pregnancy was evaluated by three 24 h dietary recalls (24hR), one per trimester of pregnancy, and also by two FFQ. The FFQ with eighty-five food items included questions about frequency of intake and portion sizes during two periods: the first 24 weeks of pregnancy and the pregnancy period as a whole. Deattenuated Pearson’s correlation coefficients and joint classification into quartiles of nutrient intake were applied.

SETTING

Ribeira˜o Preto, Sa˜o Paulo State, Brazil.

SUBJECTS

One hundred and three pregnant women, aged 18–35 years.

RESULTS

Acceptable correlation coefficients (r > 0.35) were found for Ca, K, Zn, Mg, fibre, vitamin C, niacin and folic acid for intake for the first 24 weeks; and for energy, lipids, protein, carbohydrate, Fe, K, Zn, fibre, vitamin B6, riboflavin and niacin for the gestational period as a whole. A high proportion of study participants (≥ 70 %) were categorized into the same or adjacent quartiles for estimated energy, carbohydrate, Ca, K, fibre, Zn, cholesterol, vitamin A, riboflavin, niacin, vitamin C, vitamin E and folic acid. Gross misclassification ranged from 2.3% (dietary fibre) to 12.5% (vitamin A, thiamin and SFA).

CONCLUSIONS

The FFQ is a useful tool for assessing categories of nutrient intake during pregnancy, since a high proportion of women were classified into the same or adjacent quartiles.