[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.

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.

Development of a Diet Quality Index Adapted for Pregnant Women / Desenvolvimento de um Índice de Qualidade da Dieta Adaptado para Gestantes

ABSTRACT 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.

RESUMO OBJETIVO: Desenvolver um Índice de Qualidade da Dieta Adaptado para Gestantes (IQDAG) e avaliar sua relação com características de mulheres atendidas pelo Sistema Único de Saúde. MÉTODOS: Os dados de consumo alimentar são provenientes de um estudo transversal conduzido entre 785 gestantes adultas do município de Ribeirão Preto, SP, entre 2011 e 2012. A elaboração do índice foi baseada nas recomendações do Ministério da Saúde, em índices dietéticos nacionais prévios e no novo Guia Alimentar para a População Brasileira. Para descrever a qualidade da dieta segundo as características maternas, foram empregados os testes ANOVA, Kruskal-Wallis e qui-quadrado. RESULTADOS: O IQDAG apresenta nove componentes, sendo representados por três grupos de alimentos (em porções/1.000 kcal); cinco nutrientes; e um componente moderador. Elevada proporção de gestantes atingiu a pontuação máxima para os componentes leguminosas e hortaliças. Porém, poucas mulheres atingiram a pontuação máxima para o consumo de frutas frescas, ingestão de fibras, ômega 3, cálcio, folato, ferro e alimentos ultraprocessados. Verificou-se melhor qualidade da dieta entre gestantes de maior idade, eutróficas, que relataram praticar mais tempo de atividade física e que faziam uso de suplementos dietéticos. A maior pontuação do índice também foi observada entre as mulheres com maior ingestão de carboidratos, proteínas, vitaminas C, E e A, e dos minerais cálcio, folato e ferro, bem como entre aquelas com menor ingestão de gorduras totais e gorduras saturadas. CONCLUSÕES: O presente índice dietético foi inédito ao incorporar a recomendação do novo Guia Alimentar para a População Brasileira quanto à moderação do consumo de alimentos ultraprocessados. Demonstrou-se útil na avaliação da qualidade da dieta de gestantes e uma maior pontuação foi verificada entre mulheres de maior idade, eutróficas e que relataram um estilo de vida saudável. Estratégias de promoção do consumo de frutas frescas, alimentos ricos em fibras, ômega 3, cálcio, folato, ferro e minimamente processados em gestantes são necessárias.