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.

[Maternal factors associated with habitual consumption of ultra-processed foods during pregnancy]. / Fatores maternos associados ao consumo usual de alimentos ultraprocessados na gestação.

The scope of the study was to investigate the relationship between maternal sociodemographic, obstetric and lifestyle characteristics and the habitual consumption of ultra-processed foods. It included a cross-sectional study of n = 784 pregnant women attended by the Unified Health System. Diet was estimated using two 24-hour recall surveys, using the multiple-pass method. Ultra-processed foods were classified using the UN NOVA food classification and their habitual consumption was expressed as the contribution to the total energy percentage. Adjusted linear regression models were used to investigate the relationship between maternal characteristics and the percentage of energy (%E) derived from ultra-processed foods. The %E of ultra-processed foods in the diet was 32.1%. Maternal age (-0.45[-0.62; -0.29] p < 0.001), economic bracket D+E in relation to A+B (-2.95[-5.59; -0.32] p = 0.03) and energy underreporting (-6.95[-8.86; -5.04] p < 0.001) were inversely associated with the %E of ultra-processed foods, whereas the pre-pregnancy Body Mass Index (BMI) (0.41[0.22; 0.60] p < 0.001) was directly associated. This would suggest that maternal age, economic status, energy underreporting and pre-gestational anthropometric status are associated with the consumption of ultra-processed foods during pregnancy.

O objetivo do estudo foi investigar a relação entre as características sociodemográficas, obstétricas e de estilo de vida maternas e o consumo usual de alimentos ultraprocessados. Estudo transversal, n = 784 gestantes, assistidas pelo Sistema Único de Saúde. A dieta foi estimada utilizando dois inquéritos recordatórios de 24 horas, pelo método de passagens múltiplas. Os alimentos ultraprocessados foram classificados empregando-se a classificação NOVA e seu consumo usual foi expresso como a contribuição no percentual energético total. Modelos de regressão linear ajustados foram empregados para investigar a relação entre as características maternas e o percentual energético proveniente (%E) de ultraprocessados. O %E de ultraprocessados na dieta foi de 32,1%. A idade materna (-0,45 [-0,62; -0,29] p < 0,001), estrato econômico D+E em relação a A+B (-2,95 [-5,59; -0,32] p = 0,03) e sub-relato energético (-6,95 [-8,86; -5,04] p < 0,001) foram inversamente associados ao %E de ultraprocessados, enquanto o índice de massa corporal (IMC) pré-gestacional (0,41 [0,22; 0,60] p < 0,001) foi diretamente associado. Sugere-se que a idade materna, o estrato econômico, a subnotificação energética e o estado antropométrico pré-gestacional estejam associados ao consumo de alimentos ultraprocessados durante a gestação.

Dietary Patterns and Factors Associated with Food Affinity in Pregnant Women from Quito, Ecuador.

Nutrition during pregnancy influences perinatal outcomes and predispositions to chronic diseases. A prospective cohort study was carried out with the objectives of describing the dietary patterns in the pregnant population in the city of Quito, Ecuador and analysing the sociodemographic and lifestyle factors that influence the adherence to each dietary pattern. The body mass index was calculated for each patient, and the patients were classified according to the Atalah criteria. The Global Physical Activity Questionnaire was also applied. The dietary patterns were assessed using a dietary survey with a 24 h recall on two occasions. A total of 535 pregnant women were included. A positive association was found between the pattern "dairy, salads and sweet snacks/dressings" and foreign nationality (ß = 0.82 (0.43;1.21)). The "refined carbohydrates" pattern was negatively associated with education equal to or less than 7 years and an income of up to one basic salary (ß = -0.59 (-1.05; -0.14)). The "traditional Ecuadorian" pattern showed a positive association with being born in the coastal region of Ecuador (ß = 0.62 (0.22; 1.01)). This study identified three dietary patterns in pregnant women and their possible associations with certain sociodemographic factors. More studies are needed to better understand these patterns as well as to analyse their nutritional and caloric properties.

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.

The Association between Dietary Pattern, Obesity, and Glycemic Control of Children and Adolescents with Type 1 Diabetes Mellitus.

AIMS: To evaluate the association between dietary patterns, obesity, and glycemic control in children and adolescents with type 1 diabetes mellitus (T1DM). METHODS: A cross-sectional study was carried out in 2015 at a diabetes reference center in Rio de Janeiro. Sociodemographic data and those related to outpatient follow-ups were obtained from the medical records. The assessment of food consumption was performed using a 24 h food recall. Obesity was defined as body mass index-for-age (BMI-for-age) ≥ +1 z-score. Glycemic control was assessed using glycated hemoglobin (HbA1c). Dietary patterns were generated by factorial analysis, and each individual's adherence to these dietary patterns was determined by the factor loadings and then classified into terciles. RESULTS: The study population included 120 children and adolescents, among whom 5 dietary patterns were identified. The prevalence of obesity was 31.7% (n = 38), and 64.2% (n = 77) of the participants had inadequate glycemic control. We observed that individuals with higher adherence to dietary pattern five, characterized by a greater consumption of ultra-processed foods, had higher odds of having higher HbA1c levels (OR = 3.49; 95% CI = 1.18-11.16). CONCLUSIONS: Higher consumption of ultra-processed foods can be detrimental to glycemic control in children and adolescents. Thus, food intake monitoring is of paramount importance as part of the multidisciplinary care of patients with T1DM.

Relationship between diet quality and biochemical profile in Brazilian overweight pregnant women.

OBJECTIVE: The aim of this study was to evaluate the relationship between the Adapted Diet Quality Index for Pregnant Women (IQDAG) and the biochemical profile of overweight pregnant adult women. METHODS: This was a cross-sectional study, using baseline data from a randomized controlled clinical trial conducted with 239 pregnant women in Brazil. The usual diet was obtained through two dietary recalls and the Multiple Source Method. Diet quality was assessed using the IQDAG, which has nine components: eight for adequacy and one for moderation. Fasting blood glucose, insulin, total cholesterol, low-density lipoprotein, high-density lipoprotein, triacylglycerols, and C-reactive protein were measured to evaluate the biochemical profile. Adjusted linear regression models were used to evaluate the association between the score of the IQDAG (and its components) and the biochemical profile. The significance level considered was P ≤ 0.05. RESULTS: The mean index score was 75.4 points. An inverse association was observed between the consumption of legumes and total cholesterol level (ß = -4.76; 95% confidence interval [CI], -9.16 to -0.35; P = 0.03) and low-density lipoprotein (ß = -4.13; 95% CI, -7.56 to -0.69; P = 0.02), and a direct association between calcium intake and total cholesterol (ß = 0.02; 95% CI, 0.002-0.41; P = 0.03). No other associations were observed between the investigated variables. CONCLUSIONS: The data from the present study suggest that higher consumption of legumes is associated with lower levels of total cholesterol and low-density lipoprotein. A higher intake of calcium was directly associated with total cholesterol . Further research is required to fully understand how diet quality affects pregnant women's biochemical profiles and what that means for the health of the mother and the fetus.

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.

Relationship between the quality of the pregnant woman's diet and birth weight: a prospective cohort study.

BACKGROUND: Birth weight is a relevant predictor of childhood health outcomes. Studies investigating the association between modifiable risk factors, as the maternal diet quality, and birth weight are needed. We aimed to investigate the association between the Diet Quality Index Adapted for Pregnant Women (IQDAG) score and birth weight. METHODS: This is a prospective cohort that includes 547 Brazilian mother-child pairs. Dietary recalls and a food frequency questionnaire were obtained during pregnancy. Information on birth weight, sex, and gestation duration were obtained from the Live Birth Information System (SINASC). RESULTS: On total, 3.8% of the newborns were classified as low birth weight (LBW), 6.0% with macrosomia, 10.2% small for gestational age (SGA), and 11.2% large for gestational age (LGA). The mean (SD) IQDAG score was 70.1 (11.8). Adjusted logistic regression models showed that women in the third tertile of the IQDAG score presented a lower risk of having LGA babies [OR 0.44 (95% CI 0.22, 0.90), p-trend = 0.02] compared to the first tertile. Women in the third tertile of omega-3 intake presented a lower risk of giving birth to LGA infants [OR 0.33 (95% CI 0.15, 0.69), p-trend = 0.00] and LBW infants [OR 0.18 (95% CI 0.04, 0.83), p-trend = 0.02] when compared to the first tertile. There was also a lower SGA trend among the children of women in the third tertile of omega-3 intake [OR 0.43 (95% CI 0.17, 1.07), p-trend = 0.03] compared to the first tertile. CONCLUSION: A better diet quality and higher omega-3 intake are protective factors for LGA babies, and increased maternal omega-3 intake reduce the risk of LBW and LGA, and may be a protective factor against the birth of SGA infants.

A better quality of maternal dietary fat reduces the chance of large-for-gestational-age infants: A prospective cohort study.

OBJECTIVES: We sought to investigate the relationship between the usual intake of fatty acids and indices of dietary fat quality in pregnant women and the birth-weight categories of their newborns. METHODS: This prospective cohort study was conducted with 734 mother-infant pairs in Brazil. Dietary intake was estimated through 24-h dietary recalls. Secondary data on birth weight, sex of the newborn, and pregnancy duration were obtained. The relationship of fatty acids and indices with birth-weight categories were investigated using logistic regression models adjusted for confounding factors. We considered P values < 0.05 significant. RESULTS: The median (interquartile range) maternal age was 27 (23-31) y; 46.2% of the pregnant women had pregestational body mass index ≥ 25 kg/m2, 18.1% had gestational diabetes mellitus, and 11.2% had hypertension. Regarding the newborns, 68 (9.3%) were classified as small for gestational age, 545 (74.2%) as appropriate size for gestational age, and 121 (16.5%) as large for gestational age. In adjusted logistic regression models, a lower chance of being large for gestational age was observed among the children of women classified in the third tertile (versus the first tertile) for intake of polyunsaturated fatty acids (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.31-0.89; P = 0.02), ω-3 fatty acids (OR, 0.48; 95% CI, 0.28-0.80; P = 0.005), and ω-6 fatty acids (OR, 0.56; 95% CI, 0.33-0.96; P = 0.04) and for ratios of polyunsaturated to saturated fatty acids (OR, 0.54; 95% CI, 0.32-0.92; P = 0.03) and hypocholesterolemic to hypercholesterolemic fatty acids (OR, 0.51; 95% CI, 0.30-0.87; P = 0.01). CONCLUSIONS: The data suggest that better-quality fat in the maternal diet can reduce the chance of a large-for-gestational-age newborn.

Nutritional intervention programme among a Japanese-Brazilian community: procedures and results according to gender.

OBJECTIVE: To describe the results of a nutritional intervention programme among Japanese-Brazilians according to gender. DESIGN: A non-controlled experimental study. SETTING: The research included three points of clinical, nutritional and physical activity evaluation: at baseline (in 2005), after the first year and at the end of the second year (in 2007). The paired Student t test and multiple linear regression analysis were used to evaluate changes in the subjects' profile (clinical, nutritional and physical activity variables). SUBJECTS: Japanese-Brazilians (n 575) of both genders, aged over 30 years. RESULTS: We verified statistically significant reductions in body weight (0.9 kg), waist circumference (2.9 cm), blood pressure, fasting blood glucose (>3 mg/dl) and total cholesterol (>20 mg/dl) and its fractions, in both genders. We also found reductions in intake of energy (among men), protein (among women) and fat (both genders) and increases in intake of total fibre (among women) and carbohydrate (among men). CONCLUSIONS: The intervention programme indicated meaningful benefits for the intervention subjects, with changes in their habits that led to a 'healthier' lifestyle positively impacting their nutritional and metabolic profile.

Recognition of taste in patients during antineoplastic therapy with platinum drugs.

Taste changes caused by the use of platinum drugs have been described. However, few studies qualify the impaired tastes and whether these changes are derived exclusively from chemotherapy (QTx). AIMS: Evaluation of changes in sweet, sour, salty, bitter, and umami tastes in patients receiving QTx with platinum drugs was the aim of this study. METHODS: A total of 43 subjects, 21 from the study group and 22 from the control, were studied in two time periods, one before the start of QTx (T0) and another after two cycles of QTx (T1). The usual dietary intake, body mass index (BMI), handgrip strength and fatigue (through the fatigue pictogram) were evaluated to characterize the group studied. Taste Strips tests were performed for all 4 tastes and umami was studied by comparing Likert's scale using monosodium glutamate (GMS) food. Statistical analysis was performed using repeated measures (ANOVA), mixed model, with significance level p≤0.05. RESULTS: Salty and sour were the most affected tastes in the study group (p = 0.001 and 0.05); as well as the ionotropic receptors (p = 0.02) responsible for identifying these tastes. There was a difference between the times for BMI, dynamometry and impact in daily activities, by the fatigue pictogram (p = 0.008, 0.009 and 0.006 respectively). CONCLUSION: These findings suggest an important role in altering taste recognition, mainly in salty and sour tastes, identified by ionotropic receptors, which seems to be related to dietary changes. QTx has demonstrated a contribution to impairment of functionality and fatigue.

Relationship between minimally and ultra-processed food intake during pregnancy with obesity and gestational diabetes mellitus.

This study aimed to investigate the relationship between food intake (considering the nature, extent, and purpose of food processing) during pregnancy and overweight, obesity, and gestational diabetes mellitus conditions. This is a cross-sectional study conducted among 785 adult women in singleton pregnancies (between 24th and 39th weeks of gestation) in Brazil. Usual food intake was estimated by the Multiple Source Method, using two 24-hour dietary recalls. The food groups of interest in this study were the unprocessed or minimally processed foods and ultra-processed foods. The World Health Organization criteria for the diagnosis of gestational diabetes mellitus and the Atalah criteria for excess weight were used. Adjusted multinomial logistic regression models were used to assess the relationship between energy contribution (%E) from foods with overweight and obesity conditions and, adjusted logistic regression models for gestational diabetes mellitus. In total, 32.1% participants were overweight, 24.6% were obese, and 17.7% of women were diagnosed with gestational diabetes mellitus . After adjustments, an inverse association between the highest tertile of %E from the intake of unprocessed or minimally processed foods and obesity was found [0.49 (0.30-0.79)]. Moreover, a positive association between the highest tertile of %E from ultra-processed food intake [3.06 (1.27-3.37)] and obesity was observed. No association between food intake (considering the nature, extent, and purpose of food processing) during pregnancy and overweight or gestational diabetes mellitus was found. The findings suggest a role of food processing in obesity but not in gestational diabetes mellitus. Further research is warranted to provide robust evidence on the relationship between the role of processed foods in obesity and gestational diabetes mellitus.

Dietary patterns during pregnancy derived by reduced-rank regression and their association with gestational diabetes mellitus.

OBJECTIVE: Evidence for the combined association of the quality of dietary carbohydrates and fats during pregnancy with gestational diabetes mellitus (GDM) is scarce. The aim of this study was to identify dietary patterns during pregnancy, derived by the reduced-rank regression (RRR) model, associated with fiber density (g/1000 kcal) and the Thrombogenicity Index (TI) and to investigate their relationship with GDM. METHODS: This was a cross-sectional study conducted with 785 pregnant women at gestational weeks 24 to 39. The diagnosis of GDM was based on the World Health Organization criteria. One 24-h dietary recall was obtained from all women and a second measurement from 73% of the sample, with the multiple source method used to estimate the usual diet. The patterns were determined by RRR, and the relationship with GDM was investigated using adjusted logistic regression models. RESULTS: The mean (standard deviation) age of the women was 28 y and 17.7% had GDM. Dietary pattern 1 (high rice, beans, and vegetables, with low full-fat dairy products, biscuits, and sweets) correlated positively with fiber density and negatively with TI and was inversely associated with GDM after multiple adjustments (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.36-0.95; P = 0.03). Dietary pattern 2 (high red meats, full-fat dairy products, chocolate powder and fruits, with low chicken and margarine) correlated positively with both TI and fiber density, with no association with GDM found (OR, 1.48; 95% CI, 0.91-2.40; P = 0.11). CONCLUSION: These data highlight the joint importance of the quality of dietary carbohydrates and fats in the dietary patterns of pregnant women in relation to the risk for developing GDM.

Dietary patterns of pregnant women, maternal excessive body weight and gestational diabetes.

OBJECTIVE: To investigate the relationship between the dietary patterns of pregnant women with maternal excessive body weight and gestational diabetes mellitus. METHODS: A cross-sectional study conducted with a convenience sample of 785 adult pregnant women attended by the Unified Health System of Ribeirão Preto, state of São Paulo, between 2011 and 2012. Two 24-hour dietary recalls, corrected by the multiple source method, were employed . For the classification of the body mass index and the diagnosis of gestational diabetes mellitus, the criteria by Atalah and the World Health Organization were used, respectively. Dietary patterns were obtained by principal component analysis using the Varimax rotation method. The relationship between adherence to patterns, overweight and obesity was analyzed by multinomial logistic regression models and the relationship with gestational diabetes mellitus by adjusted unconditional logistic regression models. RESULTS: We identified four dietary patterns: "traditional Brazilian"; "snacks"; "coffee" and "healthy". Women with a higher adherence to the "Healthy" (OR = 0.52; 95%CI 0.33-0.83) and "Brazilian Traditional" patterns (OR = 0.61; 95%CI 0.38-0.96) presented a lower chance of obesity, when compared to women with lower adherence, regardless of confounding factors. After adjustment for maternal excessive body weight, there was no association between dietary patterns and gestational diabetes mellitus. CONCLUSIONS: Among the pregnant women, greater adherence to "traditional Brazilian" and "healthy" patterns was inversely associated with obesity, but no relationship was identified with gestational diabetes mellitus after adjusting for excessive body weight. Prospective studies are recommended to investigate the relationship between dietary patterns, overweight and gestational diabetes mellitus, reducing the chance of reverse causality.

The role of food processing in the inflammatory potential of diet during pregnancy.

The aim was to investigate the relationship between the energy contribution (E%) of foods according to the degree of industrial processing and the energy-adjusted dietary inflammatory index (E-DII) in pregnancy. Two 24-hour dietary recalls were obtained from each of the 784 pregnant women. Adjusted linear regression models allowed observing an inverse association between E-DII scores and E% from minimally processed foods ß = -0.049 (95%CI -0.055- -0.042) and a direct association with the E% of ultra-processed foods ß = 0.052 (95%CI 0.045-0.058), indicating a relationship between the dietary inflammatory potential and the degree of industrial processing of foods.