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

PURPOSE: This study aimed at evaluating the effectiveness of a nutritional counselling intervention based on encouraging the consumption of unprocessed and minimally processed foods, rather than ultra-processed products, and the practice of physical activities to prevent excessive gestational weight gain in overweight pregnant women. METHODS: This was a two-armed, parallel, randomized controlled trial conducted in primary health units of a Brazilian municipality from 2018 to 2021. Overweight, adult pregnant women (n = 350) were randomly assigned to control (CG) or intervention groups (IG). The intervention consisted of three individualized nutritional counselling sessions based on encouraging the consumption of unprocessed and minimally processed foods rather than ultra-processed products, following the NOVA food classification system, and the practice of physical activities. The primary outcome was the proportion of women whose weekly gestational weight gain (GWG) exceeded the Institute of Medicine guidelines. Adjusted logistic regression models were employed. RESULTS: Complete data on weight gain were available for 121 women of the IG and 139 of the CG. In modified intention-to-treat analysis, there was a lower chance of the IG women having excessive GWG [OR 0.56 (95% CI 0.32, 0.98), p = .04], when compared to the CG. No between-group differences were observed for the other maternal outcomes investigated. CONCLUSION: The present study was unprecedented in demonstrating that nutritional counselling based on the NOVA food classification system, together with encouraging the practice of physical activity, is effective in preventing excessive weight gain in overweight pregnant women. TRIAL REGISTRATION: Registered on July 30th 2018 at Brazilian Registry of Clinical Trials (RBR-2w9bhc).

Dietary total antioxidant capacity during pregnancy and birth outcomes.

PURPOSE: To investigate the effect of maternal dietary total antioxidant capacity (DTAC) and main food sources on the risk of preterm birth (PB) and offspring birth size. METHODS: Cohort study that included 733 Brazilian mother-child pairs. Two 24 h dietary recalls were obtained during pregnancy and the usual intake was estimated through the Multiple Source Method. Data of the offspring were extracted from the national live births information system. Adjusted multivariable logistic regression models were used to investigate the relationship that energy-adjusted DTAC and food sources have with the outcomes. RESULTS: In total, 9.7% of the children were PBs, 6.0% were born with low birth weight (LBW), 6.7% with macrosomia, 9.3% were small for gestational age (SGA) and 16.4% large for gestational age (LGA). The mean energy-adjusted DTAC ± SD was 4.7 ± 2.1 mmol. The adjusted OR (95%CI) of PB for each increasing tertile of maternal DTAC were 0.71 (0.41, 1.30) and 0.54 (0.29, 0.98), when compared with the lowest intake. For LBW, these were 0.25 (0.09, 0.65) and 0.63 (0.28, 1.41). A likelihood of lower odds for PB was found for a higher intake of fruits [0.66 (0.39, 1.09)]. Women with a higher consumption of milk were less likely to have a child with LBW [0.48 (0.23, 1.01)], and children whose mothers reported a higher intake of beans had lower odds of being born LGA [0.61 (0.39, 0.93)]. CONCLUSION: The data suggest that a higher intake of foods with antioxidant activity during pregnancy might reduce the chance of adverse birth outcomes.

Study Protocol effectiveness of a nutritional intervention based on encouraging the consumption of unprocessed and minimally processed foods and the practice of physical activities for appropriate weight gain in overweight, adult, pregnant women: a randomized controlled trial.

BACKGROUND: Evidence from observational studies suggests that a greater intake of ultra-processed foods during pregnancy is associated with a higher chance of obesity, increased gestational weight gain, and neonatal adiposity. The aim of the present study is to evaluate the effectiveness of a nutritional intervention based on encouraging the consumption of unprocessed and minimally processed foods and the practice of physical activities for appropriate weight gain in overweight, adult, pregnant women. Additionally, the effect of the intervention on pregnancy outcomes, neonatal adiposity, and the child's weight and height will be investigated. METHODS: This is a two-armed parallel randomized controlled trial that will be conducted at primary health units in Ribeirão Preto, SP, Brazil. Adult pregnant women who are overweight and receiving prenatal care in the public health system will be included. The women will be randomly allocated into control (standard care) or intervention groups. Those enrolled in the intervention group will participate in three individualized nutritional counselling sessions based on encouraging the consumption of unprocessed and minimally processed foods and the practice of physical activities. The recruitment of the participants will be carried out at seven health facilities over 12 months, with a sample of 300 women expected. Maternal anthropometric, sociodemographic, blood pressure, biochemical, and lifestyle data will be obtained at baseline (up to the 16th week of gestation), and during a second assessment (34th to 36th gestational week). The neonate body composition will be estimated after birth, and data on pregnancy outcomes, weight and height of children at 6, 12 and 24 months of age will be further obtained from medical records. DISCUSSION: This will be the first randomized controlled trial to test the effectiveness of a nutritional intervention based on encouraging the consumption of unprocessed and minimally processed foods and the practice of physical activities for appropriate weight gain in adult, overweight, pregnant women. Furthermore, the effect of the intervention on pregnancy outcomes, neonatal adiposity and the child's weight and height will be evaluated. TRIAL REGISTRATION: Registro Brasileiro de Ensaios Clínicos (Rebec) RBR-2w9bhc July 30th 2018 (http://www.ensaiosclinicos.gov.br/rg/?q=RBR-2w9bhc+), and RBR-7yx36h June 4th 2019 (http://www.ensaiosclinicos.gov.br/rg/?q=RBR-7yx36h+0.

Effect of a lifestyle intervention among pregnant women with overweight on neonatal adiposity: A randomized controlled clinical trial.

BACKGROUND: The excess neonatal adiposity is considered a risk factor for the development of childhood obesity and the birth weight is a marker of health throughout life. AIMS: To evaluate the effect of a lifestyle intervention conducted among pregnant women with overweight on neonatal adiposity and birth weight. METHODS: A total of 350 pregnant women were recruited and randomly allocated into the control (CG) and intervention (IG) groups. Pregnant women in the IG were invited to participate in three nutritional counselling sessions based on encouraging the consumption of unprocessed and minimally processed foods, rather than ultra-processed foods, following the NOVA food classification system, which categorizes foods according to the extent and purpose of industrial processing, and the regular practice of physical activity. Neonatal adiposity was estimated using a previously validated anthropometric model. Adjusted linear regression models were used to measure the effect. RESULTS: Adopting the modified intention-to-treat principle, data from 256 neonates were analyzed for birth weight, and data from 163 for body composition estimation. The treatment had no effect on the proportion of fat mass [ß 0.52 (95 % CI -1.03, 2.06); p = .51], fat-free mass [ß -0.50 (95 % CI -2.45, 1.45); p = .61] or birth weight [ß 53.23 (95 % CI -87.19, 193.64); p = .46]. CONCLUSIONS: In the present study, the lifestyle counselling used had no effect on neonatal adiposity or birth weight. Future studies should investigate the effect of more intensive interventions.

Estimate of Dietary Total Antioxidant Capacity of Pregnant Women and Associated Factors.

OBJECTIVE: To investigate the dietary total antioxidant capacity (DTAC) of pregnant women, and associated factors. METHODS: Cross-sectional study conducted with 785 pregnant adult women attended in primary health care centers of Ribeirão Preto, state of São Paulo, Brazil. Two 24-hour dietary recalls were obtained, and the usual intake was estimated through the Multiple Source Method. The DTAC was estimated using the ferric reducing antioxidant power assay. The relationship between the higher DTAC estimate (≥ median of 4.3 mmol/day) and associated factors was investigated using adjusted logistic models with backward selection. RESULTS: In total, 25% of the pregnant women were classified as overweight, and 32% as obese. The median (P25, P75) DTAC was 4.3 (3.3-5.6) mmol/day. Through adjusted logistic regression models with backward selection, a higher chance of DTAC estimates above the median among pregnant women aged ≥ 35 years old (2.01 [1.24-3.27]) was verified when compared with younger pregnant women. Women with prepregnancy overweight (0.63 [0.45-0.89]) and obesity (0.59 [0.40-0.88]) presented a lower chance of DTAC estimates above the median when compared with eutrophic pregnant women. A higher DTAC estimate was positively associated with the use of dietary supplements (1.39 [1.03-1.88]), and negatively associated with total dietary energy (0.59 [0.42-0.85]). CONCLUSION: The DTAC estimate over the median was associated with greater age, adequate body weight, use of dietary supplements, and lower energy intake.

OBJETIVO: Investigar a capacidade antioxidante total da dieta (CATd) de gestantes e os fatores associados. MéTODOS: Estudo transversal conduzido entre 785 gestantes adultas em acompanhamento de pré-natal em Unidades Básicas de Saúde de Ribeirão Preto, São Paulo, Brasil. Para a estimativa da dieta usual, 2 inquéritos recordatórios de 24 horas foram obtidos e ajustados empregando-se o Multiple Source Method. A CATd foi estimada com base no ensaio de potência de redução de ferro. Para investigar a relação entre a maior estimativa de CATd (≥ mediana de 4,3 mmol/dia) e os fatores associados, foram empregados modelos de regressão logística ajustados em função backward. RESULTADOS: No total, 25% das gestantes foram classificadas com sobrepeso e 32% com obesidade. A mediana (P25; P75) da CATd foi de 4,3 (3,3­5,6) mmol/dia. Em modelos de regressão logística ajustados em função backward, verificou-se maior chance da estimativa da CATd acima da mediana entre gestantes com idade ≥ 35 anos (2,01 [1,24­3,27]), quando comparadas às gestantes de menor idade. Mulheres com sobrepeso (0,63 [0,45­0,89]) e obesidade (0,59 [0,40; 0,88]) no período pré-gestacional apresentaram menor chance da estimativa da CATd acima da mediana, quando comparadas às eutróficas. A estimativa da CATd foi positivamente associada ao uso de suplementos dietéticos (1,39 [1,03­1,88]) e negativamente associada à energia total da dieta (0,59 [0,42­0,85]). CONCLUSãO: A estimativa da CATd acima da mediana foi positivamente associada à maior idade, eutrofia, ao uso de suplementos dietéticos e à menor ingestão energética.

Pro-inflammatory diet during pregnancy is associated with large-for-gestational-age infants.

A pro-inflammatory diet in pregnant women is associated with an increased risk of harmful maternal and fetal health outcomes. The present study aimed to investigate the relationship between the maternal energy-adjusted dietary inflammatory index (E-DII) and the classification of birth weight of newborns. We hypothesized that a maternal pro-inflammatory diet would be associated with a higher chance of inadequate birth weight infants. A prospective cohort study was conducted among 600 mother-infant pairs in Brazil. The E-DII was calculated through 24-hour dietary recalls on 2 occassions, using 36 of its 45 components. Secondary data on birth weight, sex of the newborns, and gestational age at birth were obtained. Adjusted logistic regression models were used to investigate the relationship between the maternal E-DII (in tertiles) and birth weight categories. The mothers' mean (standard deviation [SD]) age was 27 (5) years, 32.2% were overweight, and 21.5% had prepregnancy obesity. In total, 62 (10.3%) cases of small-for-gestational-age newborns and 79 (13.2%) of large-for-gestational-age (LGA) newborns were identified. The mean (SD) of the E-DII was 1.6 (1.5), ranging from -2.6 to 6.0. In adjusted logistic regression models, it was found that women classified in the third tertile of the E-DII had higher odds of having LGA infants (odds ratio, 2.07 [95% confidence interval, 1.07-4.02], P =.03), when compared with the women classified in the first tertile. A maternal pro-inflammatory diet was associated with a higher chance of LGA infants, reinforcing the relevance of the consumption of foods naturally rich in antioxidants during pregnancy.

Excessive abdominal adiposity and body fat are associated with lower serum vitamin D levels: A population-based study / Excesso de adiposidade abdominal e de gordura corporal se associa à menor concentração sérica de vitamina D: um estudo de base populacional

ABSTRACT Objective To estimate the prevalence of 25-hydroxyvitamin D deficiency and to analyze factors associated with lower serum vitamin levels in Brazilian adults. Methods A cross-sectional, population-based study consisted of 626 adult individuals of both sexes living in the urban area of Viçosa, Minas Gerais. The dependent variable used was the serum level of 25-hydroxyvitamin D and the independent variables were sociodemographic, anthropometric and body composition variables. The associations among the variables were verified using simple and multiple linear regression models, considering alpha lower than 0.05 for the input in the final model. Results The prevalence of 25-hydroxyvitamin D deficiency was 14.4% and the prevalence was 42.0%. Excess abdominal fat was higher in subjects with 25-hydroxyvitamin D sufficiency. The serum level of 25-hydroxyvitamin D was 30.34±9.85ng/ml. Body adiposity was higher in men with vitamin insufficiency. Negative associations were observed between serum 25-hydroxyvitamin D levels and age, educational level, body adiposity (p=0.028) and abdominal adiposity (p=0.023). Conclusion Our results showed that excess body and abdominal adiposity are strong predictors of alterations in the serum vitamin D levels, thus public policies for prevention and treatment in this population are essential.

RESUMO Objetivo Estimar a prevalência de deficiência de 25 hidroxivitamina D e analisar fatores associados à menor concentração sérica da vitamina em adultos brasileiros. Métodos Estudo transversal, de base populacional, realizado com 626 indivíduos adultos, de ambos os sexos, residentes na área urbana do município de Viçosa, Minas Gerais. A variável dependente utilizada foi a concentração sérica de 25 hidroxivitamina D e as independentes foram variáveis sociodemográficas, antropométricas e de composição corporal. As associações entre as variáveis foram verificadas utilizando-se modelos de regressão linear simples e múltipla, considerando alfa menor que 0,05 para a entrada no modelo final. Resultados A prevalência de deficiência de 25 hidroxivitamina D foi de 14,4% e a insuficiência de 42,0%. O excesso de gordura abdominal foi maior em indivíduos com suficiência de 25 hidroxivitamina D. A concentração sérica de 25 hidroxivitamina D foi de 30,34±9,85 ng/ml. A adiposidade corporal foi maior em homens com insuficiência. Foram verificadas associações negativas entre a concentração sérica de 25 hidroxivitamina D e a idade, a escolaridade, a adiposidade corporal (p=0,028) e a adiposidade abdominal (p=0,023). Conclusão Nossos resultados mostraram que o excesso de adiposidade corporal e abdominal são fortes preditores de alterações na concentração sérica de vitamina D, por isso, é importante que condutas públicas de prevenção e tratamento sejam estabelecidas nesta população.