Validação relativa de Questionário de Freqüência Alimentar em gestantes usuárias de serviços do Sistema Único de Saúde em dois municípios no Rio Grande do Sul, Brasil

Increased consumption of ultra-processed foods during pregnancy is associated with sociodemographic, behavioral, and obstetric factors: A cohort study

A diet based on ultra-processed food (UPF) does not meet nutritional needs, especially during pregnancy. The aim of this study is to assess the change in UPF consumption from preconception to pregnancy and associated factors. Our hypothesis is that women tend to adopt a healthier eating pattern during pregnancy, decreasing the intake of UPF and increasing the intake of unprocessed/minimally processed foods. A prospective cohort study with 326 participants was carried out from 2016 to 2019 in 2 health units in Rio de Janeiro, Brazil. Pregestational food consumption assessed using the food frequency questionnaire in the prenatal interview in women up to 20 gestational weeks and gestational consumption in the interview 2 months after delivery. Food items classified according to the NOVA system. For the mean variation from preconception to gestational UPF consumption, we used the generalized estimating equations model with linear distribution. Control of confounding variables was based on the literature on factors associated with UPF consumption, using a 3-level hierarchical model. The proportion of UPF energy consumption was 28.9% in preconception and 33% during pregnancy. Older and more educated women had a lower mean variation in the consumption of UPF during the pregnancy. A higher average consumption of UPF observed among women physically inactive before pregnancy, who smoked during pregnancy, were multiparous, and with had a low pregestational weight. These results reflect similar behavior to that of the general population, aggravated by a significant increase during pregnancy. However, older and more educated women and those with healthy behaviors showed lower UPF intake in pregnancy.

Validation and calibration of the Food Consumption Frequency Questionnaire for pregnant women

BACKGROUND

Few food frequency questionnaires (FFQ) have been validated for pregnant women, particularly those in small- and medium-sized cities in different regions of Brazil.

OBJECTIVES

To validate and calibrate a semiquantitative FFQ for pregnant women.

DESIGN AND SETTING

The study was validated with a sample of 50 pregnant women (≥ 18 years) enrolled in Brazilian prenatal services.

METHODS

An FFQ and a 24-hour recall were used to evaluate dietary intake. Dietary variables were tested for normality and log-converted when asymmetrical. Pearson's Correlation Coefficient was used to validate the questionnaire. Linear regression was applied to extract calibration factors. All variables underlying the consumption analysis were adjusted for energy.

RESULTS

The mean age of the pregnant women was 26 years ± 6.2 years; 58% were in their first trimester, and 30% were identified as overweight/obese. The Pearson correlation analysis results indicated that the FFQ overestimated energy and nutrient intake, whose coefficients ranged from -0.15 (monounsaturated fat) to 0.50 (carbohydrate). Adjusting for energy reduced the mean values of intake coefficients, which now ranged from -0.33 (sodium) to 0.96 (folate). The calibration analysis results indicated variation in the coefficients from -0.23 (sodium) to 1.00 (folate). Calibration produced satisfactory coefficients for the FFQ compared with the reference standard for energy, macronutrients, monounsaturated fat, cholesterol, vitamins B12/C, folate, sodium, iron, and calcium.

CONCLUSIONS

After validating and calibrating tests, we observed that the FFQ was adequately accurate for assessing the food consumption of the pregnant women in this study.

Food frequency questionnaires developed and validated for pregnant women: Systematic review

OBJECTIVES

Assessing food intake by pregnant women is extremely important, because maternal dietary patterns can influence fetal development as well as have either a positive or negative effects on both the mother and fetus. Thus, the aim of the present study was to carry out a systematic review of the literature on food frequency questionnaires developed and validated for pregnant women, in order to assess their methodological quality and validation process.

METHODS

A systematic review of studies focused on validating food frequency questionnaires for pregnant women was carried out in the PubMed, Embase, Scopus, LILACS, and OpenGrey databases. The selected studies were assessed based on their correlation coefficient in validation and reproducibility analyses, whereas their methodological quality was assessed based on the scoring system proposed by the EURopean micronutrient RECommendations Aligned Network of Excellence.

RESULTS

In total, 10 965 articles were identified in these databases; among them, 14 studies, with sample sizes ranging from 46 to 221 participants, and with participants (pregnant women) at a mean age of 28.68 ± 4.34 y, were selected. Most of the included studies used the 24-h food recall as the method for developing the food list (n = 6), with composition ranging from 46 to 255 items. With respect to the methodological assessment of the selected articles, half of the assessed tools were classified as having excellent methodological quality; their validation and reproducibility correlation coefficients were classified as moderate and high (r ≥ 0.40).

CONCLUSIONS

Food frequency questionnaires developed for pregnant women appear to be reliable tools to assess food intake by this group. Overall, they had good methodological quality and adequate correlation coefficients compared with reference methods.

Association between maternal dietary intake classified according to its degree of processing and sex-specific birth weight for gestational age

ABSTRACT Objective To assess the association between the maternal diet, according to the degree of processing of food consumption, and birth weight for gestational age and sex. Methods A cross-sectional study with 300 women was conducted from February 2009 to 2011 from a maternity ward in Mesquita, Rio de Janeiro. The outcome was based on sex-specific birth weight for gestational age: small, adequate, or large. A validated food frequency questionnaire was used to estimate the food consumption during the 2nd and 3rd trimesters of pregnancy. The food intake was classified into three groups according to the degree of processing: 1) unprocessed or minimally processed foods and culinary ingredients (oil, fats, salt, and sugar), 2) processed foods, and 3) ultra-processed foods. Descriptive analyses were made to assess the tertiles of the percentage of energy intake of each food group on the outcome and on maternal and infant characteristics. Multinomial logistic regressions were used to test the association of the tertiles of food according to the degree of processing on the outcome (adequate, small, or large birth weight for gestational age and sex). Results The analysis of the food frequency questionnaire from the 300 women indicated that the mean percentage of kcal consumed from unprocessed and minimally processed food and culinary ingredients was 54.0%, while the percentages of energy from processed foods and ultra-processed foods were 2.0% and 44.0%, respectively. The highest tertile of consumption of unprocessed and minimally processed food and culinary ingredients had a protective effect on the prevalence of newborn large for gestational weight in relation to the lowest (OR: 0.13; 95% IC: 0.02 to 0.89; p=0.04). Conclusion High consumption of unprocessed and minimally processed food and culinary ingredients during the last six months of pregnancy might be a protective factor against having a newborn large for gestational weight when compared to mothers with the lowest consumption.

Vitamin D during pregnancy and its association with birth outcomes: a Brazilian cohort study

BACKGROUND/OBJECTIVES

Evidence is lacking on how variation in vitamin D concentrations during gestation affects perinatal outcomes. Therefore, we evaluated the association between vitamin D serum concentrations during pregnancy and neonatal outcomes.

METHODS

A prospective cohort of 180 healthy Brazilian pregnant women was followed and plasma 25-hydroxyvitamin [25(OH)D, nmol/L] was measured at 5-13 (baseline), 20-26 and 30-36 gestational weeks. Birth weight (BW), birth length (BL), BW z-scores, BL z-scores, first minute Apgar, small for gestational age (SGA), large for gestational age (LGA) and preterm birth were the outcomes. Multiple linear and Poisson regression models were estimated. Best linear unbiased prediction of random coefficients model was used to determine the association between the mean rate of change in vitamin D during pregnancy concentrations and neonatal outcomes.

RESULTS

Mean (SD) BW was 3300 (600) g, BW z-score 0.34 (1.11), BL 49.3 (3.3) cm, BL z-score 0.44 (1.5), and first minute Apgar score 8.2 (1.4). Prevalence of SGA, LGA and preterm birth were 6%, 18% and 13%, respectively. 25(OH)D was directly associated with the risk of preterm birth at all trimesters. Incidence-rate ratios were 1.02, 1.05 and 1.04 for the 1st, 2nd and 3rd trimester, respectively. Mean rate of change during pregnancy in 25(OH)D was directly associated with BW z-score (β: 0.36, 95% CI 0.07; 0.65), LGA risk (IRR: 1.97, 95% CI 1.07; 3.63) and preterm birth (IRR: 7.35, 95% CI 2.99; 18.07).

CONCLUSIONS

Mean 25(OH)D rate of change during pregnancy was directly associated with BW z-scores, and increased LGA and preterm birth risk.

Can the pregnant woman's food intake be influenced by her clinical condition during pregnancy?

Abstract Objectives: to evaluate the association between dietary intake during pregnancy and different gestational clinical conditions (hypertensive, diabetics, smokers, having intrauterine growth restriction and a control group) and associated factors. Methods: cross-sectional study nested in a cohort study from 2011 to 2016 that occurred in three hospitals in Porto Alegre (Brazil). Sociodemographic conditions and prenatal were investigated and maternal feeding practices were analyzed by the Food Frequency Questionnaire. To calculate the caloric percentage from food groups, food items were categorized into:unprocessed or minimally processed, processed and ultra-processed foods. The Kruskal-Wallis test with Dunn's post-hoc compared food consumption between the groups and the Poisson regression evaluated the association between the variables. Results: there was no statistical difference in food intake among 303 mothers of different gestational clinical conditions, but diabetic pregnant women had lower caloric contribution value of ultra-processed foods. In addition, pregnant women from all groups showed adequate consumption in relation to the percentage of caloric contribution of macronutrients in the total energy value. Conclusions: there was no difference in energy consumption according to different gestational clinical conditions.In diabetic, smokers and hypertensive pregnant women, associations between total energy intake and different sociodemographic factors were observed between the groups.

Prepregnancy Dietary Patterns and Their Association with Perinatal Outcomes: A Prospective Cohort Study

BACKGROUND

Dietary intake may be associated with neonatal outcomes, yet little is known about the influence of prepregnancy dietary pattern (DP).

OBJECTIVES

To evaluate the association between prepregnancy DPs and perinatal outcomes.

DESIGN

Prospective cohort study during pregnancy (baseline between 5 and 13 gestational week and three follow-up visits: 20 to 26 gestational weeks, 30 to 36 gestational weeks, and 30 to 40 days postpartum, respectively). Diet was assessed in the first trimester using a food frequency questionnaire and having prepregnancy as the time frame.

PARTICIPANTS/SETTING

Two hundred fifty-three pregnant women met the following eligibility criteria (20 to 40 years of age, 5 to 13 weeks of gestation at baseline, free of chronic [except obesity] or infectious diseases, and with a singleton pregnancy). The final sample was composed of 193 pregnant women attending a public health care center in Rio de Janeiro, Brazil, from 2009 to 2012.

MAIN OUTCOME MEASURES

Type of delivery, large for gestational age (LGA), birth length (BL)>90th percentile, Apgar score<7 at 1 minute, and preterm birth.

STATISTICAL ANALYSES

Reduced rank regression was used to identify prepregnancy DPs that explain the following response variables: fiber density (daily dietary fiber intake in grams, divided by total daily energy intake in kilocalories), dietary energy density, and percent energy from saturated fat. Statistical analyses included multiple logistic regression models. The following covariates were defined as confounders based on a unique Direct Acyclic Graph for each outcome: maternal age, current smoker, alcohol consumption, years of education, and first-trimester leisure physical activity.

RESULTS

The prevalence of normal delivery was 56.7%. LGA occurred in 16%, BL>90th percentile in 24.3%, Apgar score<7 at 1 minute in 14.2%, and preterm birth in 9.5% of the study population. Three DPs were identified: "fast food and candies" was associated with higher odds of LGA (odds ratio [OR]=4.38, 95% CI: 1.32 to 14.48) and BL>90th percentile (OR=4.81, 95% CI: 1.77 to 13.07); "beans, bread, and fat" was inversely associated with Apgar score<7 at 1 minute (OR=0.14, 95% CI: 0.03 to 0.70); and "vegetables and dairy" was inversely associated with preterm birth (OR=0.24, 95% CI: 0.06 to 0.97). There was no association between adherence to DPs and type of delivery.

CONCLUSIONS

Higher adherence to fast food and candies prepregnancy DP increased the odds of LGA birth, while a higher adherence to vegetables and dairy DP decreased the odds of preterm birth.

Factors Associated with Excessive Gestational Weight Gain Among Brazilian Mothers

BACKGROUND

Gestational Weight Gain (GWG) is an important predictor of maternal and child health.

MATERIALS AND METHODS

Cross-sectional study was carried out in a public maternity unit of a hospital in a Brazilian metropolis that aimed to evaluate the factors associated with excessive GWG. Data were collected on food consumption, anthropometry, and on socioeconomic, demographic, and health status. The GWG was obtained by consulting each woman's gestational record. The association between GWG and the other variables was assessed using the chi-square test with the Bonferroni correction, with a significance level of 5%.

RESULTS

We evaluated 98 mothers with a mean age of 25.4 ± 6.8 years and a postpartum time of 2.5 ± 1.2 days. Before pregnancy, 42.9% of this population was overweight. The mean GWG was 12.2 ± 6.5 kg, with 39.8% classified with excessive GWG. A higher prevalence of excessive GWG was observed among mothers who had higher per capita income (p = 0.003), had had cesarean delivery (p = 0.016), lower limbs edema (p = 0.012), and excess weight before pregnancy (p = 0.001). There was no significant association of GWG with eating habits.

CONCLUSIONS

Excessive GWG is associated with socioeconomic and nutritional factors. Nutritional monitoring during prenatal care may favor effective interventions and contribute to positive outcomes for both maternal and child health.

Caffeine Intake During Pregnancy in Different Intrauterine Environments and its Association with Infant Anthropometric Measurements at 3 and 6 Months of Age

Objective To investigate the association between maternal caffeine intake during pregnancy and infant anthropometric measurements at age 3 and 6 months. Methods Longitudinal observational study of mother-child pairs stratified into five groups: diabetic women (DM), hypertensive women (HYP), smoking mothers (SMO), mothers of infants small for gestational age (SGA), and controls (CTL). Pairs were recruited from three public hospitals in Porto Alegre, Brazil, from 2011 to 2015, using a convenience sampling strategy. The Food Frequency Questionnaire (FFQ) was administered on postpartum day 7 to evaluate maternal caffeine intake during pregnancy. The anthropometric measurements of interest (weight, length, and skinfold thickness) were assessed at birth and at age 3 and 6 months. Linear regression was used to analyze the interaction between caffeine intake and skinfold thickness. Results Overall, 272 mother-child pairs were investigated (41 DM, 26 HYP, 68 SMO, 25 SGA, and 112 CTL). There were no differences in anthropometric measurements between infants born to mothers who had and had not consumed caffeine during pregnancy (P > 0.05). Children of mothers in the DM group had the highest adjusted average skinfold thicknesses at 3 months. An interaction between maternal caffeine intake during pregnancy and the sum of skinfolds at age 3 months was found in the DM and CTL groups (P < 0.05). However, significant differences were not observed at 6 months. Conclusions Maternal caffeine intake influenced infants skinfold thickness measurements at 3 months of age. This parameter was reduced in infants born to mothers with DM and increased in those born to healthy control mothers.

[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.

Association between dietary patterns and mental disorders in pregnant women in Southern Brazil

Objective:

To evaluate the association between dietary patterns and mental disorders among pregnant women in southern Brazil.

Methods:

Cross-sectional study with 712 pregnant women recruited from the Study of Food Intake and Eating Behaviors in Pregnancy (ECCAGe). Food intake assessment was performed using the Food Frequency Questionnaire. Dietary patterns were identified by cluster analysis. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was used to evaluate participants’ mental health. Poisson regression models with robust variance were fitted to estimate prevalence ratios (PR).

Results:

In the adjusted models, there was a high prevalence of major depressive disorder among women with low fruit intake (43%, PR 1.43, 95%CI 1.04-1.95) and high sweets and sugars intake (91%, PR 1.91, 95%CI 1.19-3.07). Women with a common-Brazilian dietary pattern had higher prevalence of major depressive disorder compared to those with a varied consumption pattern (PR 1.43, 95%CI 1.01-2.02). Low intake of beans was significantly associated with generalized anxiety disorder (PR 1.40, 95%CI 1.01-1.93).

Conclusions:

Low consumption of fruits and beans and intake of the common-Brazilian dietary pattern during pregnancy were associated with higher prevalence of mental disorders. These results reinforce the importance of an adequate dietary intake to ensure better mental health in pregnancy.

Agreement of dietary fiber and calorie intake values according to the choice of nutrient composition and household measure tables

ABSTRACT Objective: To analyze the variations in the daily intake of dietary fiber and calories according to the different nutrient composition and homemade measure tables. Methods: Five different methods based on different nutrient composition and household measure tables were used to calculate daily calorie and fiber intake, measured using a food frequency questionnaire, of 633 pregnant women receiving care in primary health care units in the Southern region of Brazil; they were selected to participate in a cohort study. The agreement between the five methods was evaluated using the Kappa and weighted Kappa coefficients. The Nutritional Support Table, a Brazilian traditional food composition table and the Brazilian household expenditure survey were used in Method 1. Brazilian Food Composition Table and the Table for the Assessment of Household Measures (Pinheiro) were used in Methods 2 and 3. The average values of all subtypes of food listed in the Brazilian Food Composition Table for each corresponding item in the food frequency questionnaire were calculated in the method 3. The United States Department of Agriculture Food Composition Table and the table complied by Pinheiro were used in Method 4. The Brazilian Food Composition Table and the Brazilian household expenditure survey were used in Method 5. Results: The highest agreement of calorie intake values were found between Methods 2 and 3 (Kappa=0.94; 0.92-0.95), and the lowest agreement was found between Methods 4 and 5 (Kappa=0.46; 0.42-0.50). As for the fiber intake, the highest agreement was found between Methods 2 and 5 (Kappa=0.87; 0.82-0.90), and the lowest agreement was observed between Methods 1 and 4 (Kappa=0.36; 0.3-0.43). Conclusion: Considerable differences were found between the nutritional composition tables. Therefore, the choice of the table can influence the comparability between studies.

Comparison of a short version of the Food Frequency Questionnaire with its long version--a cross-sectional analysis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

CONTEXT AND OBJECTIVE

The food frequency questionnaire (FFQ) is the preferred instrument for obtaining dietary information in epidemiological studies. A short form of the FFQ was compared with the original version that was used in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), and also with three 24-hour dietary recalls.

DESIGN AND SETTING

Cross-sectional study carried out in six Brazilian state capitals.

METHODS

Multiple linear regression was used to reduce the original food and drink list of the FFQ, which had contained 114 food items. The frequency of consumption and nutritional composition of the foods were also taken into consideration. To assess the validity of the shortened FFQ, the energy and nutrients values of the 24-hour dietary recalls were deattenuated and log-transformed.

RESULTS

The list of the FFQ of ELSA-Brasil was reduced to 76 food items. The intraclass correlation coefficients in the validation study ranged from 0.17 (selenium) to 0.66 (calcium).

CONCLUSIONS

The number of items was reduced by 33%, while still maintaining relatively good capacity to measure energy and selected nutrients.

Relação entre a retenção de peso nos primeiros três meses pós-parto com ganho de peso e ingestão alimentar durante a gestação

Objetivos:estudar a retenção de peso em mulheres nos primeiros três meses pós-parto e sua correlação com ganho de peso gestacional (GPG) e consumo alimentar.Métodos:estudo de coorte com 61 mulheres. Aplicou-se: Questionário de Frequência Alimentar (QFA), Questionário Internacional de Atividade Física (IPAQ) e questionário referente à amamentação e dados antropométricos. Realizaram-se avaliações entre 24 e 48 horas pós-parto, 7, 15, 30 e 90 dias. A retenção de peso deu-se pela subtração entre peso aos três meses pós-parto e peso pré-gestacional. Os testes estatísticos usados foram: correlações de Pearson e Spearman, teste t de Student, de comparação múltipla com ajuste de Bonferroni e regressão linear.Resultados:a média de idade foi 28±7,0 anos, com medianas: de consumo alimentar diário na gestação de 3.670,3 kcal, GPG de 12,0 kg e retenção de peso nos primeiros três meses de 3,2 Kg. Observou-se associação significativa entre retenção de peso nos primeiros três meses pós-parto e o GPG (p<0,001) e a paridade (p<0,05). Para cada quilo ganho durante a gestação 0,8 kg foi retido nos primeiros três meses.Conclusões:a retenção de peso três meses pós-parto mostrou-se maior quanto maior o GPG durante a gestação e a paridade.

[Reproducibility, relative validity, and calibration of a food-frequency questionnaire for adults in Greater Metropolitan Porto Alegre, Rio Grande do Sul State, Brazil]

This study tested the relative validity and estimated calibration factors of a food-frequency questionnaire (FFQ) with 120 food items in 128 adults. We applied one FFQ and three 24h recalls. Validity was tested by the Bland-Altman method, intraclass correlation coefficient (ICC), classification in quartile categorization, and weighted kappa. Calibration factors were estimated by linear regression, with 24h recall of food intake as the dependent variable and the FFQ values as the independent variable. FFQ underestimated the nutrient intake when compared to 24h recall. The energy-adjusted and de-attenuated ICC ranged from 0.19 (zinc) to 0.82 (calcium). 37% of subjects were classified in the same quartile, with mean kappa of 0.28 (zinc: 0.08; calcium: 0.49). The highest calibration factors were 0.48 (calcium), 0.47 (potassium), and 0.44 (carbohydrates), and the lowest was 0.10 (retinol). FFQ showed satisfactory relative validity and calibrated energy and nutrient intake values similar to 24h recall.

Healthy eating index for pregnancy: adaptation for use in pregnant women in Brazil

OBJECTIVE

To evaluate dietary quality in a sample of pregnant women based on one simple and objective parameter.

METHODS

Pregnant women (n = 712), between 16 and 36 weeks, attending primary care clinics in Porto Alegre and Bento Gonçalves, Southern Brazil, in 2010 were recruited to take part. The Healthy Eating Index for Brazilian Pregnancy (HEIP-B) was created, derived from the American instrument called Alternate Healthy Eating Index for Pregnancy (AHEI-P). Questionnaires on frequency of consumption and on socio-demographic factors were completed. Focused principal component analysis (ACPF) was used to assess the relationship between the index and nutrients relevant to pregnancy.

RESULTS

The median (interquartile range) of AHEI-P and HEIP-B were 66.6 (57.8-72.4) and 67.4 (60.0-73.4), respectively. The HEIP-B showed a good positive correlation with nutrients which are specifically recommended for pregnancy: folate (r = 0.8; p < 0.001), calcium (r = 0.6; p < 0.001) and iron (r = 0.7; p < 0.001).

CONCLUSIONS

The quality of the diet of the pregnant women in this study was classified as within the "improvements needed" cut off point, which demonstrates the need for more specific education on nutrition for this stage of life. The index showed good correlations and, thus, may be considered an effective tool for assessing the quality of nutrition during pregnancy.

Dietary patterns during pregnancy and the association with sociodemographic characteristics among women attending general practices in southern Brazil: the ECCAGe Study

The assessment of the relationship between food intake and sociodemographic factors is crucial for developing effective public health policies. The present study aimed to examine dietary patterns in pregnant women and the association between these patterns and sociodemographic characteristics. Pregnant women attending general practices in southern Brazil (n = 712) answered a questionnaire and a food-frequency questionnaire with 88 items. Three dietary patterns were identified using cluster analysis. The association between the dietary patterns and sociodemographic variables was analyzed using the chi-square test and adjusted standardized residuals (p < 0,05). The restricted pattern was associated with lower maternal age, not living with a partner and being a non-working student. The varied pattern was associated with older maternal age, living with a partner, being employed and higher levels of education and income. The common-Brazilian dietary pattern included traditional Brazilian food items and was associated with lower levels of education and income, being unemployed and being a non-student.

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.

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.

Fibre intake and evolution of BMI: from pre-pregnancy to postpartum

Objective

To evaluate the effect of fibre intake on the evolution of maternal BMI from pregnancy to postpartum and to identify dietary patterns associated with fibre intake.

Design

Cohort study. Food intake was obtained using an FFQ. Focused principal component analysis was used focusing on the variables: postpartum weight retention and total dietary fibre intake. Poisson regression models with robust variance were built in order to measure the effect of fibre intake during the postpartum period on obesity risk.

Setting

Primary care clinics in southern Brazil.

Subjects

Pregnant women (n370) were followed until the 5th month postpartum.

Results

The highest contribution to fibre intake came from the consumption of beans. Consumption of bread and rice indicated a common Brazilian food pattern along with beans. Participants retained a median of 4·4 (interquartile range 0·6, 7·9) kg of weight gained during pregnancy. Obesity risk, defined as an unfavourable evolution of BMI during pregnancy and postpartum, was present in 189 (55·1 %) women. Individual food items did not have an important effect on weight retention. In Poisson regression adjusting for maternal age, pre-pregnancy BMI and total gestational weight gain, inadequate postpartum fibre intake increased obesity risk by 24 % (relative risk = 1·24; 95 % CI 1·05, 1·47).

Conclusions

Important maternal weight retention occurred in these women. Adequate fibre intake may reduce obesity risk in the period following childbirth.

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.

Impact of Perinatal Different Intrauterine Environments on Child Growth and Development in the First Six Months of Life--IVAPSA Birth Cohort: rationale, design, and methods

Background

In the last twenty years, retrospective studies have shown that perinatal events may impact the individual health in the medium and long term. However, only a few prospective studies were designed to address this phenomenon. This study aims to describe the design and methods of the Impact of Perinatal Environmental Variations in the First Six Months of Life - the IVAPSA Birth Cohort.

Method/Design

This is a clinical study and involves the recruitment of a birth cohort from hospitals in Porto Alegre, Rio Grande do Sul, Brazil. Mothers from different clinical backgrounds (hypertensive, diabetics, smokers, having an intrauterine growth restricted child for idiopathic reasons, and controls) will be invited to join the study twenty-four hours after the birth of their child. Data on economic, social, and maternal health care, feeding practices, anthropometric measures, physical activity, and neuropsychological evaluation will be obtained in interviews at postpartum, 7 and 15 days, 1, 3 and 6 months of life.

Discussion

To our knowledge, this is the first thematic cohort focused on the effects of intrauterine growth restriction to prospectively enroll mothers from different clinical backgrounds. The IVAPSA Birth Cohort is a promising research platform that can contribute to the knowledge on the relationship between perinatal events and their consequences on the children's early life.

Assessment of protein intake during pregnancy using a food frequency questionnaire and the effect on postpartum body weight variation

The aim of this study was to investigate the effect of protein intake during pregnancy on postpartum weight variation. This was a prospective cohort study with 421 women interviewed at 15 days (baseline) and 2, 6, and 9 months postpartum. Data on diet were obtained using the food frequency questionnaire, focusing on the second and third trimesters. Protein intake was considered adequate when women consumed ≥ 1.2g of protein per kg body weight, and inadequate when < 1.2g/kg. The study adopted the mixed effects model for repeated measurements over time. The results showed a mean postpartum weight loss of 0.409kg/month (±0.12) (p < 0.01). Women with adequate protein intake during pregnancy lost an additional 0.094kg/month (±0.04) during postpartum (p = 0.03) when compared to women with inadequate intake. The model was adjusted for energy, % body fat, stature, age, schooling, skin color, and smoking. Recommended protein intake during pregnancy favored postpartum weight reduction.

Nutrition, mental health and violence: from pregnancy to postpartum Cohort of women attending primary care units in Southern Brazil--ECCAGE study

BACKGROUND

Woman's nutritional status, before and during pregnancy, is a strong determinant of health outcomes in the mother and newborn. Gestational weight gain and postpartum weight retention increases risk of overweight or obesity in the future and they depend on the pregestational nutritional status and on food consumption and eating behavior during pregnancy. Eating behavior during pregnancy may be the cause or consequence of mood changes during pregnancy, especially depression, which increases likelihood of postpartum depression. In Brazil, a study carried out in the immediate postpartum period found that one in three women experienced some type of violence during pregnancy. Violence and depression are strongly associated and both exposures during pregnancy are associated with increased maternal stress and subsequent harm to the infant. The main objectives of this study are: to identify food intake and eating behaviors patterns; to estimate the prevalence of common mental disorders and the experience of violence during and after pregnancy; and to estimate the association between these exposures and infant's health and development.

METHODS/DESIGN

This is a cohort study of 780 pregnant women receiving care in 18 primary care units in two cities in Southern Brazil. Pregnant women were first evaluated between the 16th and 36th week of pregnancy at a prenatal visit. Follow-up included immediate postpartum assessment and around the fifth month postpartum. Information was obtained on sociodemographic characteristics, living circumstances, food intake, eating behaviors, mental health and exposure to violence, and on infant's development and anthropometrics measurements.

DISCUSSION

This project will bring relevant information for a better understanding of the relationship between exposures during pregnancy and how they might affect child development, which can be useful for a better planning of health actions aiming to enhance available resources in primary health care.