Prepregnancy adherence to plant-based diet indices and exploratory dietary patterns in relation to fecundability

Background Modest associations have been reported between specific food groups or nutrients and fecundability [measured by time to pregnancy (TTP)]. Examining overall diets provides a more holistic approach towards understanding their associations with fecundability. It is not known whether plant-based diets indices or exploratory dietary patterns are associated with fecundability. Objectives We examine the associations between adherence to 1) plant-based diet indices; and 2) exploratory dietary patterns and fecundability among women planning pregnancy. Methods Data were analyzed from the Singapore Preconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO) study. Prepregnancy diet was assessed using a semi-quantitative FFQ from which the overall, healthful, and unhealthful plant-based diet indices (oPDI, hPDI, and uPDI, respectively) were calculated. Exploratory dietary patterns were derived using factor analysis based on 44 predefined food groups. Participants were categorized into quintiles based on their dietary pattern scores. TTP (expressed in menstrual cycles) was ascertained within a year from the prepregnancy dietary assessment. Discrete-time proportional hazard models, adjusted for confounders, were used to estimate fecundability ratios (FRs) and 95% CIs, with FR > 1 indicating a shorter TTP. Results Among 805 women, 383 pregnancies were confirmed by ultrasound scans. Compared with women in the lowest quintile, those in the highest quintile of the uPDI had reduced fecundability (FR of Q5 compared with Q1, 0.65; 95% CI, 0.46-0.91; P trend, 0.009). Conversely, greater adherence to the hPDI was associated with increased fecundability (1.46; 95% CI, 1.02-2.07; P trend, 0.036). The oPDI was not associated with fecundability. Among the 3 exploratory dietary patterns, only greater adherence to the Fast Food and Sweetened Beverages (FFSB) pattern was associated with reduced fecundability (0.61; 95% CI, 0.40-0.91; P trend, 0.018). Conclusions Greater adherence to the uPDI or the FFSB dietary pattern was associated with reduced fecundability among Asian women. Greater adherence to the hPDI may be beneficial for fecundability, though this requires confirmation by future studies.Peer reviewe

Modifiable Risk Factor Score and Fecundability in a Preconception Cohort in Singapore

Importance: Although multiple modifiable risk factors have been identified for reduced fecundability (defined as lower probability of conception within a menstrual cycle), no scoring system has been established to systematically evaluate fecundability among females who are attempting to conceive. Objective: To examine the association of a risk score based on 6 modifiable factors with fecundability, and to estimate the percentage reduction in incidence of nonconception if all study participants achieved a minimal risk score level. Design, Setting, and Participants: This population-based cohort study obtained data from the S-PRESTO (Singapore Preconception Study of Long-Term Maternal and Child Outcomes) prospective cohort study. Females of reproductive age who were trying to conceive were enrolled from February 2015 to October 2017 and followed for 1 year, ending in November 2018. Data were analyzed from March to May 2022. Exposures: A reduced fecundability risk score was derived by giving participants 1 point for each of the following factors: unhealthy body mass index, unhealthy diet, smoking, alcohol intake, folic acid supplement nonuser, and older maternal age. Total scores ranged from 0 to 6 and were classified into 5 levels: level 1 (score of 0 or 1), level 2 (score of 2), level 3 (score of 3), level 4 (score of 4), and level 5 (score of 5 or 6). Main Outcomes and Measures: Fecundability, measured by time to conception in cycles, was analyzed using discrete-time proportional hazards models with confounder adjustment. Results: A total of 937 females (mean [SD] age, 30.8 [3.8] years) were included, among whom 401 (42.8%) spontaneously conceived within 1 year of attempting conception; the median (IQR) number of cycles before conception was 4 (2-7). Compared with participants with a level 1 risk score, those with level 2, 3, 4, and 5 risk scores had reductions in fecundability of 31% (adjusted fecundability ratio [FR], 0.69; 95% CI, 0.54-0.88), 41% (FR, 0.59; 95% CI, 0.45-0.78), 54% (FR, 0.46; 95% CI, 0.31-0.69) and 77% (FR, 0.23; 95% CI, 0.07-0.73), respectively. Assessment of the population attributable fraction showed that all participants achieving a minimal (level 1) risk level would be associated with a reduction of 34% (95% CI, 30%-39%) in nonconception within a year. Conclusions and Relevance: Results of this study revealed the co-occurrence of multiple modifiable risk factors for lowered fecundability and a substantially higher conception rate among participants with no or minimal risk factors. The risk assessment scoring system proposed is a simple and potentially useful public health tool for mitigating risks and guiding those who are trying to conceive.publishedVersionPeer reviewe

Changes in Diet Quality from Pregnancy to 6 Years Postpregnancy and Associations with Cardiometabolic Risk Markers

Adopting a healthy diet during and after pregnancy is important for women’s cardiometabolic health. We related changes in diet quality from pregnancy to 6 years postpregnancy to cardiometabolic markers 8 years postpregnancy. In 652 women from the GUSTO cohort, we assessed dietary intakes at 26–28 weeks’ gestation and 6 years postpregnancy using 24 h recall and a food frequency questionnaire, respectively; diet quality was scored using a modified Healthy Eating Index for Singaporean women. Diet quality quartiles were derived; stable, large/small improvement/decline in diet quality as no change, >1 or 1 quartile increase/decrease. Fasting triglyceride (TG), total-, high- and low-density-lipoprotein cholesterol (TC, HDL- and LDL-C), glucose and insulin were measured 8 years postpregnancy; homeostatic model assessment for insulin resistance (HOMA-IR) and TG: HDL-C ratio were derived. Linear regressions examined changes in diet quality quartiles and cardiometabolic markers. Compared to a stable diet quality, a large improvement was associated with lower postpregnancy TG [−0.17 (−0.32, −0.01) mmol/L], TG: HDL-C ratio [−0.21 (−0.35, −0.07) mmol/L], and HOMA-IR [−0.47 (−0.90, −0.03)]; a large decline was associated with higher postpregnancy TC and LDL-C [0.25 (0.02, 0.49); 0.20 (0.004, 0.40) mmol/L]. Improving or preventing a decline in diet quality postpregnancy may improve lipid profile and insulin resistance

Evaluation of paper-based and web-based food frequency questionnaires for 7-year-old children in Singapore

Advances in technology enabled the development of a web-based, pictorial food frequency questionnaire (FFQ) to collect parent-report dietary intakes of 7-year-old children in the GUSTO study. This study aimed to compare intakes estimated from a paper-FFQ and a web-FFQ, and examine the relative validity of both FFQs against 3-day diet records (3DDR). Ninety-two mothers reported food intakes of their 7-year-old child on a paper-FFQ, a web-FFQ and a 3DDR. A usability questionnaire collected participants' feedback on the web-FFQ. Correlations and agreement in energy, nutrients and food groups intakes between the dietary assessments were evaluated using Pearson's correlation, Lin's concordance, Bland-Altman plots, Cohen's kappa and tertile classification. The paper- and web-FFQ had good correlations (≥0.50) and acceptable-good agreement (Lin's concordance ≥0.30; Cohen's kappa ≥0.41; ≥50% correct and ≤10% mis-classification into same or extreme tertiles). Compared to 3DDR, both FFQs showed poor agreement (&lt;0.30) in assessing absolute intakes except micronutrients (web-FFQ had acceptable-good agreement); but showed acceptable-good ability to classify children into tertiles (κ≥0.21; ≥40% and ≤15% correct or misclassification). Bland-Altman plots suggest good agreement between web-FFQ and 3DDR in assessing micronutrients and several food groups. The web-FFQ was well-received (e.g. &gt;89% found it user-friendly), and majority (81%) preferred the web-FFQ over the paper-FFQ. The newly developed web-FFQ produced intake estimates comparable to the paper-FFQ, has acceptable-good agreement with 3DDR in assessing absolute micronutrients intakes, and acceptable-good ability to classify children according to categories of intakes. The positive acceptance of the web-FFQ makes it a feasible tool for future dietary data collection. </p

Evaluation of preconception dietary patterns among women enrolled in a multi-site study

Background: diet indices are widely used in nutritional research across communities but do not “capture” the full extent of diet variability across multiple countries. Empirically-derived dietary patterns can provide additional information as they reflect combinations of foods potentially associated with health outcomes. Limited studies have evaluated preconception dietary patterns among heterogeneous populations.Objectives: in the multi-site NiPPeR study, secondary aims included: (1) derive pooled and site-specific preconception dietary patterns, and (2) evaluate these patterns using anthropometric measures and metabolic biomarkers.Methods: women planning pregnancy (n = 1720) in the United Kingdom, Singapore and New Zealand completed interviewer-administered harmonized food-frequency and lifestyle questionnaires at recruitment. Across-cohort (“pooled”) and site-specific dietary patterns were derived, and associations between dietary pattern scores and BMI, waist to hip ratio, plasma lipids and glycemia assessed using multivariable linear regression, expressing results as standard deviation change in outcome per standard deviation change in dietary pattern score.Results: the pooled analysis identified three dietary patterns: ‘Vegetables/Fruits/Nuts’ (‘Healthy’), ‘Fried potatoes/Processed meat/Sweetened beverages’ (‘Less Healthy’) and ‘Fish/Poultry/Noodles/Rice’ (‘Mixed’). The ‘Healthy’ and ‘Less Healthy’ pooled pattern scores were highly correlated with their corresponding site-specific dietary pattern scores (‘Healthy’: ρ = 0.87–0.93, ‘Less Healthy’: ρ = 0.65–0.88). Women with higher scores for the ‘Healthy’ pooled pattern had a lower waist to hip ratio [Standardized beta (95% CI): -0.10 (-0.18, -0.01)]; those with higher scores for the ‘Less Healthy’ pooled pattern had a higher BMI [0.17 (0.09, 0.24)], higher LDL cholesterol [0.10 (0.01, 0.19)] and less optimal glucose profiles. However, we noted higher adherence to the ‘Healthy’ pooled pattern with higher BMI.Conclusions: the ‘Healthy’ and ‘Less Healthy’ pooled patterns were comparable to the corresponding site-specific patterns. While the associations between these patterns and objective anthropometric/metabolic measures were largely in the expected directions, future studies are required to confirm these findings

Changes in diet quality from pregnancy to 6 years post-pregnancy and associations with cardio-metabolic risk markers

Adopting a healthy diet during and after pregnancy is important for women’s cardiometabolic health. We related changes in diet quality from pregnancy to 6 years postpregnancy to cardiometabolic markers 8 years postpregnancy. In 652 women from the GUSTO cohort, we assessed dietary intakes at 26–28 weeks’ gestation and 6 years postpregnancy using 24 h recall and a food frequency questionnaire, respectively; diet quality was scored using a modified Healthy Eating Index for Singaporean women. Diet quality quartiles were derived; stable, large/small improvement/decline in diet quality as no change, &gt;1 or 1 quartile increase/decrease. Fasting triglyceride (TG), total-, high- and low-density-lipoprotein cholesterol (TC, HDL- and LDL-C), glucose and insulin were measured 8 years postpregnancy; homeostatic model assessment for insulin resistance (HOMA-IR) and TG: HDL-C ratio were derived. Linear regressions examined changes in diet quality quartiles and cardiometabolic markers. Compared to a stable diet quality, a large improvement was associated with lower postpregnancy TG [−0.17 (−0.32, −0.01) mmol/L], TG: HDL-C ratio [−0.21 (−0.35, −0.07) mmol/L], and HOMA-IR [−0.47 (−0.90, −0.03)]; a large decline was associated with higher postpregnancy TC and LDL-C [0.25 (0.02, 0.49); 0.20 (0.004, 0.40) mmol/L]. Improving or preventing a decline in diet quality postpregnancy may improve lipid profile and insulin resistance

Macronutrient composition and food groups associated with gestational weight gain: the GUSTO study

Purpose:To examine the associations of energy, macronutrient and food intakes with GWG on 960 pregnant women from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) mother-offspring cohort.Methods:Dietary intake was assessed at 26–28 weeks’ gestation with a 24-hour recall and 3-day food diary. GWG z-scores were calculated from first (4–13 weeks’ gestation) and last (30–40 weeks gestation) measured weights; inadequate and excessive GWG were defined using the Institute of Medicine recommendations based on weights between 15 and 35 weeks’ gestation. Associations were examined using substitution models for macronutrient composition, with linear or multinomial logistic regressions.Results:Mean ± SD daily energy intake was 1868 ± 598 kcal, and percentage energy intakes were 51.8 ± 8.9% from carbohydrate, 15.7 ± 3.9% from protein and 32.6 ± 7.7% from fat. Higher energy intake (per 500 kcal increment) was associated with 0.18 SD higher GWG. In isocaloric diets, higher-carbohydrate and lower-fat intakes (at 5% energy substitution) were associated with 0.07 SD higher GWG, and 14% higher likelihood of excessive GWG. Concordantly, the highest tertile of carbohydrate-rich foods intake was associated with 0.20 SD higher GWG, but the highest tertile of fruit and vegetable intake was independently associated with 60% lower likelihood of inadequate GWG. Additionally, the highest tertile of dairy intake was associated with 0.18 SD lower GWG; and the highest tertile of plant-based protein foods intake was associated with 60% and 34% lower likelihood of inadequate and excessive GWG.Conclusions:Balancing the proportions of carbohydrates and fat, and a higher intake of plant-based protein foods may be beneficial for achieving optimal GWG

Dietary patterns of five-year-old children and their correlates: findings from a multi-ethnic Asian cohort

There is limited data on the dietary patterns of 5-year-old children in Asia. The study examined childhood dietary patterns and their maternal and child correlates in a multi-ethnic Asian cohort. Based on caregiver-reported one-month quantitative food frequency questionnaires of 777 children from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort, cluster analysis identified two mutually exclusive clusters. Children in the “Unhealthy” cluster (43.9%) consumed more fries, processed meat, biscuits and ice cream, and less fish, fruits and vegetables compared to those in the “Healthy” cluster (56.1%). Children with mothers of lower educational attainment had twice the odds of being assigned to the “Unhealthy” cluster (adjusted OR (95% CI) = 2.19 (1.49-3.24)). Children of Malay and Indian ethnicities had higher odds of being assigned to the “Unhealthy” cluster (adjusted OR = 25.46 (15.40-42.10) and 4.03 (2.68-6.06)) respectively, relative to Chinese ethnicity. In conclusion, this study identified two dietary patterns in children, labelled as the “Unhealthy” and “Healthy” clusters. Mothers’ educational attainment and ethnicity were two correlates that were associated with the children’s assignments to the clusters. These findings can assist in informing health promotion programmes targeted at Asian children

Maternal night-time eating and sleep duration in relation to length of gestation and preterm birth

Background &amp; aims Maternal metabolic disturbance arising from inappropriate meal timing or sleep deprivation may disrupt circadian rhythm, potentially inducing pregnancy complications. We examined the associations of maternal night-time eating and sleep duration during pregnancy with gestation length and preterm birth. Methods We studied 673 pregnant women from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Maternal energy intake by time of day and nightly sleep duration were assessed at 26–28 weeks' gestation. Based on 24-h dietary recall, night-eating was defined as consuming &gt;50% of total energy intake from 1900 to 0659 h. Short sleep duration was defined as &lt;6 h night sleep. Night-eating and short sleep were simultaneously analyzed to examine for associations with a) gestation length using multiple linear regression, and b) preterm birth (&lt;37 weeks' gestation) using logistic regression. Results Overall, 15.6% women engaged in night-eating, 12.3% had short sleep and 6.8% delivered preterm. Adjusting for confounding factors, night-eating was associated with 0.45 weeks shortening of gestation length (95% CI −0.75, −0.16) and 2.19-fold higher odds of delivering preterm (1.01, 4.72). Short sleep was associated with 0.33 weeks shortening of gestation length (−0.66, −0.01), but its association with preterm birth did not reach statistical significance (1.81; 0.76, 4.30). Conclusions During pregnancy, women with higher energy consumption at night than during the day had shorter gestation and greater likelihood of delivering preterm. Misalignment of eating time with day–night cycles may be a contributing factor to preterm birth. This points to a potential target for intervention to reduce the risk of preterm birth. Observations for nightly sleep deprivation in relation to gestation length and PTB warrant further confirmation

Associations of circadian eating pattern and diet quality with substantial postpartum weight retention

Besides food quantity and quality, food timing and frequency may contribute to weight regulation. It is unclear if these factors during pregnancy can influence maternal weight retention after childbirth. We thus aimed to examine the associations of maternal circadian eating pattern and diet quality in pregnancy with substantial postpartum weight retention (PPWR) at 18 months in an Asian cohort. We assessed circadian eating pattern and diet quality of 687 women using 24-h dietary recalls at 26–28 weeks’ gestation. We calculated PPWR by subtracting maternal weight in the first trimester from weight at 18-month postpartum and defined substantial PPWR as ≥5 kg weight retention. Multivariable binary logistic regression was performed. Overall, 16% of women had substantial PPWR. After the confounders adjustment, night eating, defined by greater night-time caloric intake (odds ratio 1.95; 95% confidence interval 1.05, 3.62), and lower diet quality, classified by median score of the Healthy Eating Index (1.91; 1.17, 3.10), were independently associated with higher odds of substantial PPWR. No associations with substantial PPWR were observed for night fasting duration and number of eating episodes. In conclusion, alignment of eating time with day–night cycles and diet quality during pregnancy may play a role in PPWR, with possible implications for long-term obesity ris