Quality of the diet and factors associated with the food consumption of pregnant women attended in the nutritional care project for the maternal and child (PROAMI)

A avaliação dietética e do estado nutricional durante a gestação são de extrema importância ao fornecer informações para o estabelecimento de intervenções de prevenção e controle de agravos à saúde para a mãe e seu filho. O objetivo foi avaliar a qualidade da dieta e fatores associados ao consumo alimentar de gestantes acompanhadas no projeto de atendimento nutricional materno-infantil (PROAMI), Viçosa/MG. Métodos: Estudo transversal com 111 gestantes cujos dados foram coletados nos prontuários de atendimento do PROAMI. O consumo alimentar foi avaliado por meio de um recordatório da dieta habitual, o valor nutricional foi determinado utilizando o Programa DietPro® versão 6.1. Para avaliar a adequação do consumo dos nutrientes e da água utilizou-se as Ingestões Dietéticas de Referência (DRIs). As gestantes foram classificadas em quatro grupos de acordo com a mediana do horário da primeira e última refeição (cedo-cedo, cedo-tarde, tarde-cedo, tarde- tarde). A qualidade da dieta foi avaliada utilizando o Índice de Qualidade da Dieta Adaptado para Gestantes Brasileiras (IQDAG). O estado nutricional foi avaliado utilizando as curvas de Atalah. A análise dos dados foi realizada utilizando o STATA, versão 13.0 e o SPSS versão 20.0. O estudo foi aprovado pelo Comitê de Ética em Pesquisa com Seres Humanos da Universidade Federal de Viçosa (Nº 4.098.560). Resultados: A média de idade foi 34,3 anos (±5,5). Do total, 74,7% eram primíparas, 46% tinham ensino superior e 67,6% tinham companheiro. Quanto ao estado nutricional, 20,7% estavam com baixo peso e 32,4% com excesso de peso na gestação. A média da pontuação total do IQDAG foi de 61,3 (±26,1). As gestantes do 3º tercil de IQDAG apresentaram maior ingestão de vitamina A (OR 1,04; IC95% 1,02- 1,07), B2 (OR 4,34; IC95% 1,70-11,06) e ferro (OR 1,26; IC95% 1,09-1,45), independentemente da idade, escolaridade e do nível de atividade física. Quanto ao horário das refeições, as gestantes que fizeram a primeira refeição do dia mais tarde e a última cedo tiveram maior inadequação de vitamina B12 (RP 2,55; IC 95% 1,41-4,63). E uma maior inadequação no número de refeições (<3/dia) foi observada naquelas que fizeram a primeira refeição tarde e a última cedo (RP:4,74; IC95% 1,50-15,04), e naquelas que fizeram a primeira e a última refeição tarde (RP:4,31; IC95% 1,37; 13,58). As gestantes com excesso de peso tiveram maior consumo de proteínas (p=0,04), gorduras totais (p=0,02) e gorduras saturadas (p=0,03), e menor de frutas frescas (p=0,01) e leguminosas (p=0,01). As gestantes multíparas tiveram maior consumo de leguminosas (p=0,03), hortaliças (p=0,01), energia (p=0,01), potássio (p=0,02) e cobre (p=0,03), e menor de vitamina B6 (p=0,04) comparado as primíparas. Conclusão: A maioria das gestantes apresentou consumo alimentar inadequado e uma moderada qualidade da dieta. Aquelas com excesso de peso e que faziam suas refeições mais tarde apresentaram alimentação com caraterística menos saudável. Houve diferença no consumo alimentar também de acordo com a paridade, o que indica ser um aspecto a ser considerado na atenção nutricional a este grupo. Palavras-chave: Gestação. Consumo alimentar. Horário das refeições. Qualidade da dieta. Estado nutricional. Paridade.Dietary assessment and nutritional status during pregnancy are extremely important when providing information for the establishment of interventions for the prevention and control of health problems for the mother and her child.The objective was to evaluate the quality of the diet and factors associated with the food consumption of pregnant women attended in a nutritional care project for the maternal and child group (PROAMI), Viçosa / MG. Methods: Cross-sectional study with 111 pregnant women whose data were collected from PROAMI's medical records. Food consumption was assessed using a recall of the usual diet, the nutritional value was determined using the DietPro® Program version 6.1. To assess the adequacy of nutrient and water consumption, Reference Dietary Intakes (DRIs) were used. The pregnant women were classified into four groups according to the median time of the first and last meal (early- early, early-late, late-early, late-afternoon). The quality of the diet was assessed using the Adapted Diet Quality Index for Brazilian Pregnant Women (IQDAG). The nutritional status was assessed using Atalah curves. Data analysis was performed using STATA, version 13.0 and SPSS, version 20.0. The study was approved by the Human Research Ethics Committee of Universidade Federal de Viçosa (No. 4,098,560). Results: The mean age was 34.3 years (± 5.5). Of the total, 74.7% were primiparous, 46% had higher education and 67.6% had a partner. As for nutritional status, 20.7% were underweight and 32.4% were overweight during pregnancy. The average total IQDAG score was 61.3 (± 26.1). The pregnant women in the third tertile of IQDAG had a higher intake of vitamin A (OR 1.04; 95% CI 1.02-1.07), B2 (OR 4.34; 95% CI 1.70- 11.06) and iron (OR 1.26; 95% CI 1, 09-1.45), regardless of age, education and physical activity level. As for meal times, pregnant women who ate the first meal of the day later and the last one early had a greater inadequacy of vitamin B12 (PR 2.55; 95% CI 1.41-4.63). And a greater inadequacy in the number of meals (<3 / day) was observed in those who ate the first meal late and the last one early (PR: 4.74; 95% CI 1.50-15.04), and in those who ate first and last meal late (PR: 4.31; 95% CI 1.37; 13.58). Overweight pregnant women had a higher consumption of proteins (p = 0.04), total fats (p = 0.02) and saturated fats (p = 0.03), and less of fresh fruits (p = 0.01) and legumes (p = 0.01). Multiparous pregnant women had a higher consumption of legumes (p = 0.03), vegetables (p = 0.01), energy (p = 0.01), potassium (p = 0.02) and copper (p = 0.03) and lower vitamin B6 (p = 0.04) compared to primiparous women. Conclusion: Most of the pregnant women had inadequate food consumption and a moderate quality of the diet. Those who were overweight and who ate their meals later had a less healthy diet. There was a difference in food consumption also according to parity, which indicates that it is an aspect to be considered in nutritional care for this group. Keywords: Gestation. Food consumption. Meal times. Quality of the diet. Nutritional status. Parity.Coordenação de Aperfeiçoamento de Pessoal de Nível Superio

Association between food consumption and the Quality of Diet Index Adapted for pregnant women

Abstract Objectives: to investigate the association between the Índice de Qualidade da Dieta Adaptado para Gestantes (IQDAG) (Quality of Diet Index Adapted for Pregnant Women) with food consumption, lifestyle and health information. Methods: cross-sectional study with 110 pregnant women assisted at a public health service. Sociodemographic, nutritional and health data were collected from medical records. Food consumption was investigated through the usual intake, for a nutritional analysis, DietPro® program version 6.1 was used. Quality ofdiet was assessed using the IQDAG. Multinomial logistic regression was used to investigate an association between food consumption and IQDAG. Results: the average total score of the IQDAG was 61.3 (±26.1), this is the best quality of the diet. After adjusting for age, schooling and physical activity, the highest consumption of vitamin A (OR=1.04; CI95% = 1.02-1.07) and B2 (OR=2.63; CI95% = 1.19-5.70) was associated with a greater chance of having a better quality of diet (3rdtertile of the IQDAG). Conclusions: pregnant women with better quality of diet had higher intakes of vitamins A and B2. However, other population-based studies are suggested to more broadly in verify its association with food consumption and its ability to identify adherence to nutritional recommendations

Association between food environments and fetal growth in pregnant Brazilian women

Abstract Introduction Birth weight is described as one of the main determinants of newborns’ chances of survival. Among the associated causes, or risk factors, the mother’s nutritional status strongly influences fetal growth and birth weight outcomes of the concept. This study evaluates the association between food deserts, small for gestational age (SGA), large for gestational age (LGA) and low birth weight (LBW) newborns. Design This is a cross-sectional population study, resulting from individual data from the Live Birth Information System (SINASC), and commune data from mapping food deserts (CAISAN) in Brazil. The newborn’s size was defined as follows: appropriate for gestational age (between 10 and 90th percentile), SGA ( 90th percentile), and low birth weight < 2,500 g. To characterize food environments, we used tertiles of the density of establishments which sell in natura and ultra-processed foods. Logistic regression modeling was conducted to investigate the associations of interest. Results We analyzed 2,632,314 live births in Brazil in 2016, after appropriate adjustments, women living in municipalities with limited availability of fresh foods had a higher chance of having newborns with SGA [OR2nd tertile: 1.06 (1.05–1.07)] and LBW [OR2nd tertile: 1.11 (1.09–1.12)]. Conversely, municipalities with greater availability of ultra-processed foods had a higher chance of having newborns with SGA [OR3rd tertile: 1.04 (1.02–1.06)] and LBW [OR2nd tertile: 1.13 (1.11–1.16)]. Stratification by race showed that Black and Mixed/Brown women had a higher chance of having newborns with SGA [OR3rd tertile: 1.09 (1.01–1.18)] and [OR3rd tertile: 1.06 (1.04–1.09)], respectively, while Mixed-race women also had a higher chance of having newborns with LBW [OR3rd tertile: 1.17 (1.14–1.20)]. Indigenous women were associated with LGA [OR3rd tertile: 1.20 (1.01–1.45)]. Conclusion The study found that living in areas with limited access to healthy foods was associated with an increased risk of SGA and low birth weight among newborns, particularly among Black and Mixed/Brown women. Therefore, urgent initiatives aimed at reducing social inequalities and mitigating the impact of poor food environments are needed in Brazil