Eating patterns during pregnancy and postpartum and their association with diet quality and energy intake

This study investigates the relationship between meal-specific eating patterns during pregnancy and postpartum with maternal diet quality and energy intake. Participants in a prospective cohort study completed 24-h dietary recalls three times throughout both pregnancy and 1 year postpartum (n = 420). Linear regressions estimated the associations of eating frequency (number of daily main meals and eating occasions), meal and energy regularity (meal skipping and variation of daily energy intake), and intake timing patterns (distribution of energy intake throughout the day, derived using principal component analysis) with daily energy intake and diet quality (Healthy Eating Index-2015, calculated daily and overall, across both pregnancy and postpartum). Eating frequency was positively associated with energy intake and daily diet quality. Irregular meals were associated with lower energy intake in pregnancy but not postpartum and with lower pregnancy and postpartum diet quality. Energy irregularity was not associated with energy intake or diet quality. Higher postpartum diet quality was associated with a morning energy intake pattern (versus late morning/early afternoon or evening). Differences in these associations between pregnancy and postpartum suggest that efforts to support optimal energy intake and diet quality by modifying eating patterns may require specific strategies for pregnancy and postpartum

Associations of ultra-processed food intake with maternal weight change and cardiometabolic health and infant growth

BACKGROUND: Excessive intake of ultra-processed foods, formulated from substances extracted from foods or derived from food constituents, may be a modifiable behavioral risk factor for adverse maternal and infant health outcomes. Prior work has predominately examined health correlates of maternal ultra-processed food intake in populations with substantially lower ultra-processed food intake compared to the US population. This longitudinal study investigated relations of ultra-processed food intake with maternal weight change and cardiometabolic health and infant growth in a US cohort. METHODS: Mothers in the Pregnancy Eating Attributes Study were enrolled at ≤12 weeks gestation and completed multiple 24-Hour Dietary Recalls within six visit windows through one-year postpartum (458 mothers enrolled, 321 retained at one-year postpartum). The NOVA (not an acronym) system categorized food and underlying ingredient codes based on processing level. Maternal anthropometrics were measured throughout pregnancy and postpartum, and infant anthropometrics were measured at birth and ages 2 months, 6 months, and 1 year. Maternal cardiometabolic markers were analyzed from blood samples obtained during the second and third trimesters. RESULTS: Holding covariates and total energy intake constant, a 1-SD greater percent energy intake from ultra-processed foods during pregnancy was associated with 31% higher odds of excessive gestational weight gain (p = .045, 95% CI [1.01, 1.70]), 0.68±0.29 mg/L higher c-reactive protein during pregnancy (p = .021, 95% CI [0.10, 1.26]), 6.7±3.4% greater gestational weight gain retained (p = .049, 95% CI [0.03, 13.30]), and 1.09±0.36 kg greater postpartum weight retention (p = .003, 95% CI [0.38, 1.80]). No other significant associations emerged. CONCLUSIONS: Ultra-processed food intake during pregnancy may be a modifiable behavioral risk factor for adverse maternal weight outcomes and inflammation. Randomized controlled trials are needed to test whether targeting ultra-processed food intake during pregnancy may support optimal maternal health. TRIAL REGISTRATION: Clinicaltrials.gov. Registration ID - NCT02217462. Date of registration - August 13, 2014

Impact of the external school food environment on the associations of internal school food environment with high schoolers’ diet and BMI

OBJECTIVE: To examine associations of school food availability with student intake frequency and BMI, and whether the number of neighbourhood food outlets modifies these associations. DESIGN: Baseline assessment of a nationally representative cohort study of US 10th graders. Students reported intake frequency of fruits and vegetables (FV), snacks and soda. BMI was calculated from measured height and weight. Administrators of seventy-two high schools reported the frequency of school availability of FV, snacks and soda. The number of food outlets within 1 km and 5 km were linked with geocoded school addresses. Data were analysed using adjusted linear and logistic mixed models with multiple imputation for missing data. SETTING: US 2009-2010. PARTICIPANTS: Totally, 2263 US 10th graders from the Next Generation Health Study (NEXT). RESULTS: Greater school FV availability was positively associated with student FV intake. Food outlets within 5 km of schools (but not 1 km) attenuated the association of school FV availability with student intake; this was no longer significant at schools with > 58 food outlets within 5 km. School food availability was not associated with student BMI or student snack or soda intake. CONCLUSIONS: School food availability was associated with student intake of FV, but not with snacks, soda or BMI. Attenuation of the observed associations by the school neighbourhood food environment indicates a need to find ways to support healthy student eating behaviours in neighbourhoods with higher food outlet density