Assessment of diet quality in pregnant women using the Healthy Eating Index

doi:10.1016/j.jada.2004.11.028

Journal of the American Dietetic Association

Volume 105, Issue 2, February 2005, Pages 240-246

https://doi.org/10.1016/j.jada.2004.11.028 Get rights and content

Abstract

The objectives of this pilot study were to examine the diets of pregnant women and healthy women of childbearing age, to quantify their diets using the US Department of Agriculture Healthy Eating Index (HEI), and to assess the validity of the HEI in pregnancy in terms of macronutrients and micronutrients. Dietary information was prospectively collected from nonpregnant women and pregnant women at 20 to 38 weeks’ gestation using 4-day food records. Diet records were analyzed for nutrient content using computer software and for overall quality using the HEI. Differences between the groups were analyzed statistically using the Student’s t test, descriptive statistics, and χ² analysis. The macronutrient composition of the diets and the number of food group servings were similar in both groups. The HEI scores for control (nonpregnant) and pregnant women were similar, 72.6±1.52 and 75.0±0.99, respectively, of a maximum possible score of 100. Pregnant women did not meet daily recommended intakes of micronutrients of concern in pregnancy (calcium, iron, folate) through dietary means. Dietary counseling and nutritional supplements (particularly iron and folate) may be necessary. The HEI was useful in providing a composite measure of dietary intake, but did not discern the need for vitamin and mineral supplements during pregnancy.

Section snippets

Purpose

The objective of the prospective pilot study was to examine how well the diets of nonpregnant women of childbearing age and of pregnant women compare by applying the existing USDA HEI. The validity was assessed using the existing HEI in pregnancy in terms of macronutrient and micronutrient intake requirements for pregnancy. The results from this study could help direct the development of an HEI for pregnancy.

Materials and methods

Healthy nonpregnant control women and healthy pregnant women at 20 to 38 weeks’ gestation were recruited from the general population through advertisements posted throughout the university, medical clinics, physician’s offices, and community places in Edmonton, Alberta, Canada. Nonpregnant and pregnant women ages 20 to 40 years with good English comprehension and a willingness to keep dietary records were included. Women with a diagnosis of impaired glucose tolerance, diabetes mellitus, or a

Results

Forty-nine healthy control women and 52 healthy pregnant women at 30.1±0.71 weeks’ gestation took part in the study. Previous nutrition counseling/instruction history is unknown. The demographics of the groups are provided in Table 1. The women in the control group were mostly white and were younger than those in the pregnant group (Table 1). More of the control group reached a higher education level, but because some were still students, their income did not reflect this. Only 12% of the

Discussion

The USDA HEI, in pregnant and nonpregnant women, seems to provide a useful tool for comparing the diets against the Food Guide Pyramid, but our detailed analysis of micronutrients of concern in pregnancy shows that the HEI does not discern the need for vitamin and mineral supplements during pregnancy. A Medline search did not reveal any published articles or relevant reports in which the HEI had been used to assess diet quality in pregnant women. The national food guides are designed to meet

Conclusions

We conclude that the existing USDA HEI showed how well the women followed the food guidelines, but in pregnancy, it failed to pick up micronutrient deficiencies. A new HEI for pregnancy would measure diet quality in pregnancy in relation to goals, and would need to factor in a way to assess micronutrients of special concern in pregnancy. Because outcomes of pregnancy vary depending on the mother’s prepregnancy nutritional status (3), it is also important to examine dietary needs in young women

M. E. Pick, M. Edwards, and D. Moreau are research associates, Department of Medicine, Division of Endocrinology and Metabolism

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Dietary risk factors for hypertensive disorders of pregnancy
2024, Pregnancy Hypertension
To assess whether diet quality and specific dietary components are associated with hypertensive disorders of pregnancy (HDP).
Nested case control study in a prospectively collected cohort of 450 participants with singleton pregnancies who completed the National Institutes of Health Diet Health Questionnaire II (DHQ-II) in the third trimester or within 3 months of delivery. Patients with fetal anomalies, conception by in-vitro fertilization, and deliveries at outside hospitals were excluded from the original prospective cohort study. Cases were patients diagnosed with HDP and controls were patients without HDP. Cases and controls were matched by BMI class in a 1:2 ratio. Exposures of interest were HEI-2015 score components and other DHQ-II dietary components including minerals, caffeine, and water. These dietary components were compared between cohorts using univariate analyses.
HEI-2015 total scores representing diet quality, component scores, and objective background data between patients with HDP and patients without HDP.
150 patients with HDP were matched to 300 controls without HDP. Baseline demographics were similar between groups, including BMI. Patients with HDP were less likely to have high quality diets (HEI ≥ 70) than controls (7.3 % v 15.7 %, P = 0.02). HDP were associated with significantly higher dairy, saturated fat, and sodium intake compared to controls. Other components were similar between groups.
Patients with HDP are more likely to have lower diet quality and higher consumption of sodium, dairy, and saturated fats. These results can be used to study antenatal diet modification in patients at high risk of HDP.
Nutritional, antioxidant and dietary potential of some traditional leafy vegetables used in ethnic culinary preparations
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Various ethnic communities in India rely on traditional leafy vegetables (TLVs) for nutritional requirements. They are an important part of ethnic culinary preparations and form the basis of traditional food systems across communities. The TLVs are often collected from the wild and the culinary preparations change seasonally. The ethnic culinary preparations based on TLVs also form the basis of cultures and represent bicultural diversity of a region. In this backdrop, this study was designed to investigate the importance of TLVs for a family of two adults and 2 children using daily required nutrient intake (DRNI). In this study, we analyzed proximate composition, minerals, and antioxidant components of five TLVs namely Alternanthera brasiliana, A. sessilis, Amaranthus dubius, Cyathula prostrata and Euphorbia hirta which are important part of ethnic culinary preparations for the tribes residing in the foothills of Western Ghats, India. The results of this study reported the highest moisture (8.424%), crude fat (4.43%), vitamin C (59.44 AsA and 30.72 DHA mM/g FW), polyphenol (348.84 mg GAE/g DW) and free radical scavenging activity (lowest IC₅₀ value) in E. hirta. The crude fiber was highest in C. prostrata leaves (10.41%) whereas total crude protein and carbohydrate levels in all samples were found in the range of 13–23% and 43–54%, respectively. Elemental quantification using ICP-OES shows that the leaves of A. brasiliana, A. sessilis, A. dubius and C. prostrata are rich in K, Ca, Mg and Mn. A. dubius recorded the highest flavonoid content (10.48 mg QE/g DW). DRNI estimates of the TLVs show positive dietary contribution to a family with 2 adults and 2 children. Therefore, it is concluded that the TLVs that are a part of ethnic cuisines among the tribal communities are an important source of vitamins, proteins, antioxidant components and micronutrients. Identification of nutrient dense locally available TLVs and their supplementation with the staple foods can help reduce the burden of increasing malnutrition and undernutrition among the poorer and tribal communities of India and other developing countries that are facing issues of food security.
Health-Related Preconception Factors: Adherence to Guidelines and Associations with Weight Status
2022, Journal of the Academy of Nutrition and Dietetics
Citation Excerpt :
Women’s diet was evaluated during the year before pregnancy using a food frequency questionnaire from which a diet quality index was adapted and a diet quality score was calculated.40 Other studies in which women’s diet quality in preconception was assessed found a considerable prevalence of low scores, independent from the women’s pregnancy intention.22,41,42 Overall, data suggest that women’s diet quality before pregnancy is suboptimal and needs improvement.
Knowing the percentage of women planning a pregnancy who meet preconception dietary and physical activity (PA) guidelines and which health-related preconception factors are associated with body mass index (BMI) could help improve preconception care.
In a study conducted in women who were planning to conceive, the aims were to describe and compare eating and PA habits to current guidelines, as well as to identify the factors associated with BMI.
This was a cross-sectional study.
From 2017 to 2020, women planning to conceive within the next year (n = 217) were recruited in the province of Québec (Canada) to participate in the Apports Nutritionnels durant la GrossessE – Cohorte Contrôle study. Among them, 184 (84.8%) were included in the analyses.
Women completed three (90.2%) or two (9.8%) Web-based 24-hour dietary recalls and the International Physical Activity Questionnaire. Weight and height as well as the presence/absence of weight/body image concerns were self-reported. Eating and PA habits were compared with dietary reference intakes and Canadian guidelines, respectively.
Descriptive statistics were used to describe the sample, eating and PA habits, as well as adherence to guidelines. A multivariable regression analysis was performed to identify the factors associated with BMI.
On average, women were aged 30.8 ± 4.1 years and identified as White (94.0%). Most of them had weight/body image concerns (58.7%), 54.6% of whom had a normal body weight. Overall, 42.3% engaged in 150 minutes/week or more of moderate-to-vigorous intensity PA and 84.8% consumed <135 g alcoholic beverages per week. Mean dietary intake was below Dietary Reference Intakes for carbohydrates, vitamins D and E, and above Dietary Reference Intakes for total fat and folic acid. Factors associated with a higher BMI were weight/body image concerns (β = 1.83; R² = 13.0%), higher dietary protein intake (β = .05; R² = 4.0%), lower income (β = .85; R² = 2.9%), no folic acid supplementation (β = .83; R² = 2.5%), spending less time in moderate-to-vigorous intensity PA (β = –.006; R² = 2.4%), eating <2 snacks (β = .75; R² = 2.2%), and <3 meals (β = 1.38; R² = 1.5%) daily.
Women planning to conceive do not have optimal eating and PA behaviors. Modifiable factors associated with BMI in preconception were identified.
Strengthening research investigating maternal nutrition and children's neurodevelopment: How can we do it better? Where do we go from here?
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Maternal pregnancy diet, postnatal home environment and executive function and behavior in 3- To 4-y-olds
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Optimal maternal nutrition during pregnancy has been linked to better cognitive and behavioral development in children. However, its influence on the effects of suboptimal postnatal exposures like reduced stimulation and support in the home is not known.
To examine the effect of maternal pregnancy diet on executive function and/or behavioral development in children raised in suboptimal home environments.
Data were provided by 808 mother–infant dyads from the Canadian Maternal-Infant Research on Environmental Chemicals–Child Development study. Maternal pregnancy diet was self-reported using the Healthy Eating Index 2010 questionnaire. Stimulation and support in the home was assessed using the Home Observation for Measurement of the Environment (HOME) when children were 3–4 y old. Child executive function was reported by mothers at this age using the Behavior Rating Inventory of Executive Functioning–Preschool Edition, and child behavior was assessed using the Behavior Assessment System for Children–2nd Edition. We examined the interaction of maternal pregnancy diet and postnatal HOME scores on child executive function and behavior using linear regression adjusted for maternal education, postpartum depression, prepregnancy BMI, and smoking.
Maternal pregnancy diet was associated with an increasingly positive association with child working memory (β: 0.21; 95% CI: 0.82, 3.41; P = 0.001), planning (β: 0.17; 95% CI: 0.38, 2.84; P = 0.007), and adaptability (β: –0.13; 95% CI: –1.72, –0.08; P = 0.032) as levels of postnatal stimulation decreased.
The positive association of maternal pregnancy diet quality and executive function and adaptability in 3- to 4-y-olds appeared to increase with decreasing levels of postnatal stimulation and support. These results suggest that overall maternal pregnancy diet could be linked to better child neurodevelopment in families experiencing barriers to providing stimulation and support to children in their home.
Maternal pregnancy diet quality is directly associated with autonomic nervous system function in 6-month-old offspring
2020, Journal of Nutrition
Many pregnant women are consuming diets of poor overall quality. Although many studies have linked poor prenatal diet quality to an increased risk of specific diseases in offspring, it is not known if exposure to poor prenatal diet affects core neurophysiological regulatory systems in offspring known to lie upstream of multiple diseases.
We aimed to examine the association between prenatal diet quality and autonomic nervous system (ANS) function in infants at 6 mo of age.
Data from 400 women (aged >18 y, with uncomplicated pregnancies) and their infants participating in the Maternal-Infant Research on Environmental Chemicals-Infant Development cohort were used to investigate links between prenatal diet quality and infant ANS function at 6 mo of age. Prenatal diet quality was assessed using the Healthy Eating Index (2010), calculated from a validated FFQ completed by women during the first trimester. Infant ANS function was measured using 2 assessments of heart rate variability (HRV) including root mean square of successive differences (RMSSD) and SD of N-N intervals (SDNN). Associations were analyzed before and after adjustment for socioeconomic status, maternal depression symptoms, maternal cardiometabolic dysfunction, breastfeeding, and prenatal smoking.
Poorer prenatal diet quality was associated with lower infant HRV assessed using RMSSD (B: 0.07; 95% CI: 0.01, 0.13; R² = 0.013) and SDNN (B: 0.18; 95% CI: 0.02, 0.35; R² = 0.011). These associations remained significant after adjustment for confounding variables [RMSSD: B: 0.09; 95% CI: 0.003, 0.18; squared semipartial correlation (sp²) = 0.14 and SDNN B: 0.24; 95% CI: 0.0, 0.49; sp² = 0.13].
In a large cohort study, poorer prenatal diet quality was associated with lower offspring HRV, a marker of decreased capacity of the ANS to respond adaptively to challenge. Therefore, poor prenatal diet may play a significant role in the programming of multiple organ systems and could increase general susceptibility to disease in offspring.

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M. E. Pick, M. Edwards, and D. Moreau are research associates, Department of Medicine, Division of Endocrinology and Metabolism

E. A. Ryan is a professor, Department of Medicine, Perinatal Research Centre, Muttart Diabetes Research and Training Centre, University of Alberta, Edmonton, Alberta, Canada.

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ResearchPerspectives in practiceAssessment of diet quality in pregnant women using the Healthy Eating Index

Abstract

Section snippets

Purpose

Materials and methods

Results

Discussion

Conclusions

J Am Diet Assoc

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Prev Med

J Am Diet Assoc

Medical Hypotheses

Canada’s Food Guide to Healthy Eating

Nutrition and Your HealthDietary Guidelines for Americans

Position of the American Dietetic AssociationNutrition and lifestyle for a healthy pregnancy outcome

J Am Diet Assoc

Research
Perspectives in practice
Assessment of diet quality in pregnant women using the Healthy Eating Index