Tracking of dietary patterns between pregnancy and 6 years post-pregnancy in a multiethnic Asian cohort: the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study

Higher Diet Quality Observed in Pregnant Women Compared to Women Living with and without Children in the US: NHANES 2011-2016

BACKGROUND

Women of reproductive age are a critical part of the population because their dietary habits and nutritional status impact the nutritional trajectory of future generations. Various studies have assessed the diet quality among women of reproductive age, but few studies have compared the diet quality of these women across the different life stages.

OBJECTIVE

To compare the diet quality among pregnant women, women living with children and women living without children in the United States of America (USA) using the Healthy Eating Index (HEI).

METHODS

This cross-sectional study was a secondary data analysis of the National Health and Nutrition Survey (NHANES), 2011-2016. Study participants comprised a total of 7120 women, ages 20-44 years in one of three life stage categories, pregnant women, women living in households with and without children less than 18 years. The HEI 2015 was used to assess the overall diet quality score as well as 13 dietary component scores-whole fruit, total fruit, greens and beans, whole grains, total vegetables, total protein foods, fatty acids, seafood and plant proteins, dairy, saturated fat, sodium, refined grains, and added sugars. The differences in HEI scores by life stage was assessed using linear regression models, adjusting for marital status, age, race and ethnicity, poverty index ratio, and educational status.

RESULTS

The mean overall HEI score of participants was 52.0 out of 100 points. The overall HEI scores of pregnant women was significantly higher than women living with and without children respectively (β = 4.6 ± 1.42, p = 0.002; β = 3.7 ± 1.34, p = 0.009). Also, pregnant women had significantly higher scores for whole fruit (β = 0.99 ± 0.18, p < 0.001; β = 0.98 ± 0.17, p < 0.001), dairy (β = 0.63 ± 0.27, p = 0.02; β = 0.68 ± 0.29, p = 0.02) and whole grains (β = 1.05 ± 0.40, p = 0.01; β = 0.97 ± 0.39, p = 0.02) than women living with and without children respectively. On the other hand, women living without children had significantly higher scores for total vegetables (β = 0.18 ± 2.04, p = 0.002), refined grains (β = 0.22 ± 0.10, p = 0.03) and added sugars (β = 0.35 ± 0.16, p = 0.04) than women living with children.

CONCLUSION

Pregnant women had the highest diet quality while women living in households with children had the lowest diet quality among the studied population.

Association between Dietary Patterns during Pregnancy and Children's Neurodevelopment: A Birth Cohort Study

BACKGROUND

Research studies have showed that maternal diet may influence fetal neurodevelopment, but most studies have only assessed single nutrients or food groups.

OBJECTIVE

To investigate the impact of maternal prenatal dietary patterns during pregnancy on child neurodevelopment.

METHODS

Study participants were obtained from the China National Birth Cohort. The Ages and Stages Questionnaire, Third Edition, was used to assess children's neurodevelopment at 36 months old. Maternal antenatal dietary data were collected over three trimesters using food frequency questionnaires. Five distinct maternal dietary patterns throughout pregnancy were identified by principal component analysis, namely protein- and micronutrient-rich dietary patterns, low-iron dietary patterns, pasta as the staple food dietary patterns, iron-rich dietary patterns, tubers, fruits, and baked food dietary patterns. Group-based trajectory modeling was performed for dietary patterns present in all three periods. Multiple linear regression models were used for statistical analysis.

RESULTS

Children of mothers who followed a high protein- and micronutrient-rich dietary pattern trajectory during pregnancy presented better neurodevelopment, including higher gross motor and problem-solving scores. Furthermore, it was observed that children born of women with low-iron dietary patterns had poorer neurodevelopment. In detail, children born to mothers with a low-iron dietary pattern during the first trimester had lower problem-solving scores, while to those who were exposed to a low-iron dietary pattern in the second and third trimesters had lower gross motor scores. Additionally, children with mothers who had a low-iron dietary pattern in the third trimester had lower communication scores.

CONCLUSIONS

A nutrition-balanced protein- and micronutrient-rich dietary pattern and adequate iron dietary pattern for mothers throughout pregnancy may be beneficial to children's neurodevelopment.

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.

Longitudinal dietary trajectories from pregnancy to 3 years post delivery in women with obesity: relationships with adiposity

OBJECTIVE

The study aim was to examine the relationships between longitudinal dietary trajectories from early pregnancy to 3 years post delivery and adiposity measures in women with obesity.

METHODS

The diets of 1208 women with obesity in the UPBEAT (UK Pregnancy Better Eating and Activity Trial) study were assessed using a food frequency questionnaire (FFQ) at 15+0 to 18+6 weeks' gestation (baseline), 27+0 to 28+6 weeks' gestation, and 34+0 to 36+0 weeks' gestation, as well as 6 months and 3 years post delivery. Using factor analysis of the baseline FFQ data, four dietary patterns were identified: fruit & vegetable, African/Caribbean, processed, and snacking. The baseline scoring system was applied to the FFQ data at the four subsequent time points. Group-based trajectory modeling was used to extract longitudinal dietary pattern trajectories. Using adjusted regression, associations between dietary trajectories and log-transformed/standardized adiposity measures (BMI and waist and mid-upper arm circumferences) at 3 years post delivery were examined.

RESULTS

Two trajectories were found to best describe the data for the four individual dietary patterns; these were characterized as high and low adherence. A high adherence to the processed pattern was associated with a higher BMI (β = 0.38 [95% CI: 0.06-0.69]) and higher waist (β = 0.35 [0.03-0.67]) and mid-upper arm circumferences (β = 0.36 [0.04-0.67]) at 3 years post delivery.

CONCLUSIONS

In women with obesity, a processed dietary pattern across pregnancy and 3 years post delivery is associated with higher adiposity.

Dietary trajectories through the life course: opportunities and challenges

Studying the dynamic patterns of dietary changes or stability (otherwise known as dietary trajectories) across the life course can provide important information about when and in whom to intervene with nutritional interventions. This article reviews evidence from longitudinal studies that describe dietary trajectories through the different life stages, covering early life, adolescence to young adulthood and from mid to late adulthood. Current findings suggest that the establishment of diet patterns likely occurs before 3 years of age and allude to other potential ‘windows of change’ in the life course such as the period of 7–9 years of age and during the period of adolescence and early adulthood. Examining diets using various diet parameters appears to be valuable in elucidating different aspects of the diet that can be changed to potentially alter trajectories. In adults, examining long-term diet trends at a population level can reveal shifts in eating patterns as countries undergo epidemiological and nutrition transitions and elucidate the longer-term impact of adherence to particular diets on the development of chronic diseases. While challenges such as the availability of adequate diet data points, consistency in the dietary assessment tools used and the limitations of statistical methods for trajectory modelling remain, integrating diet data with other lifestyle behaviours, high-dimensional biomarkers and genetics data into pattern analyses and examining them from a longitudinal approach, open up potential opportunities to gain deeper insights into diet–disease relationships and support the development of more holistic lifestyle disease prevention recommendations stratified for population groups.