Anna Maria Siega-Riz

The Diet Quality Index Revised: A Measurement Instrument for Populations

OBJECTIVEnTo evaluate a revision of the Diet Quality Index called the Diet Quality Index Revised (DQI-R).nnnDESIGNnThe original Diet Quality Index was revised to reflect current dietary guidance, to incorporate improved methods of estimating food servings, and to develop and incorporate measures of dietary variety and moderation. The scoring of the original scale was reversed in direction and expanded to a 100-point scale to improve interpretability.nnnMETHODS/SUBJECTSnData from the 1994 Continuing Survey of Food Intakes by Individuals were used. A sample of 3,202 adults aged 18 and older contributed 2 days of dietary intake data based on 24-hour recalls for the development and revision of various components of the DQI-R.nnnSTATISTICAL ANALYSESnPearson correlation analyses, ordinary least squares regression analyses, and a nonparametric test to determine trends across ordered groups were used.nnnRESULTSnThe mean DQI-R score for the 1994 sample was 63.4 of a possible 100-point score. Sample respondents were more likely to have met dietary guidance in the areas of dietary cholesterol (66.9% met goal) and iron intakes (59.6% met goal) relative to the Recommended Dietary Allowances but less likely to have met goals related to fruit servings (19.6% met goal), grain servings (23.1% met goal), and calcium intakes (16.6% met goal) relative to the Recommended Dietary Allowance. There is a statistically significant quantitative and qualitative improvement in all components of the DQI-R as one moves from the lowest grouping of scores to the highest. For example, persons with DQI-R scores less than 40 consumed 43.9% of energy from fat, 72% of the Adequate Intake for calcium, and 6.7% of the recommended servings of fruit per day. In contrast, those with DQI-R scores greater than 80 consumed 24.2% of energy from fat, 101% of the Adequate Intake for calcium, and 137% of the recommended servings of fruit per day.nnnAPPLICATIONSnThe DQI-R reflects the dietary guidance principles of macronutrient distribution, moderation, variety, and proportionality. Although the index was designed to monitor dietary changes in populations rather than individuals, each index component reflects an aspect of national dietary guidance. Calculation of DQI-R scores for an individual should provide an estimate of diet quality relative to national guidelines, and differences in scores over time should suggest improvement or decline in overall diet quality.

Effect of Body Image on Pregnancy Weight Gain

The majority of women gain more weight during pregnancy than what is recommended. Since gestational weight gain is related to short and long-term maternal health outcomes, it is important to identify women at greater risk of not adhering to guidelines. The objective of this study was to examine the relationship between body image and gestational weight gain. The Body Image Assessment for Obesity tool was used to measure ideal and current body sizes in 1,192 women participating in the Pregnancy, Infection and Nutrition Study. Descriptive and multivariable techniques were used to assess the effects of ideal body size and discrepancy score (current—ideal body sizes), which reflected the level of body dissatisfaction, on gestational weight gain. Women who preferred to be thinner had increased risk of excessive gain if they started the pregnancy at a BMI ≤26xa0kg/m2 but a decreased risk if they were overweight or obese. Comparing those who preferred thin body silhouettes to those who preferred average size silhouettes, low income women had increased risk of inadequate weight gain [RRxa0=xa01.76 (1.08, 2.88)] while those with lower education were at risk of excessive gain [RRxa0=xa01.11 (1.00, 1.22)]. Our results revealed that body image was associated with gestational weight gain but the relationship is complex. Identifying factors that affect whether certain women are at greater risk of gaining outside of guidelines may improve our ability to decrease pregnancy-related health problems.

Dietary Restraint and Gestational Weight Gain

OBJECTIVEnTo determine whether a history of preconceptional dieting and restrained eating was related to higher weight gains in pregnancy.nnnDESIGNnDieting practices were assessed among a prospective cohort of pregnant women using the Revised Restraint Scale. Women were classified on three separate subscales as restrained eaters, dieters, and weight cyclers.nnnSUBJECTSnParticipants included 1,223 women in the Pregnancy, Infection, and Nutrition Study.nnnMAIN OUTCOME MEASURESnTotal gestational weight gain and adequacy of weight gain (ratio of observed/expected weight gain based on Institute of Medicine recommendations).nnnSTATISTICAL ANALYSES PERFORMEDnMultiple linear regression was used to model the two weight-gain outcomes, while controlling for potential confounders including physical activity and weight-gain attitudes.nnnRESULTSnThere was a positive association between each subscale and total weight gain, as well as adequacy of weight gain. Women classified as cyclers gained an average of 2 kg more than noncyclers and showed higher observed/expected ratios by 0.2 units. Among restrained eaters and dieters, there was a differential effect by body mass index. With the exception of underweight women, all other weight status women with a history of dieting or restrained eating gained more weight during pregnancy and had higher adequacy of weight gain ratios. In contrast, underweight women with a history of restrained eating behaviors gained less weight compared to underweight women without those behaviors.nnnCONCLUSIONSnRestrained eating behaviors were associated with weight gains above the Institute of Medicines recommendations for normal, overweight, and obese women, and weight gains below the recommendations for underweight women. Excessive gestational weight gain is of concern because of its association with postpartum weight retention. The dietary restraint tool is useful for identifying women who would benefit from nutritional counseling prior to or during pregnancy with regard to achieving targeted weight-gain recommendations.

Prenatal nutrition: A practical guide for assessment and counseling

Adequate nutrition during the periconceptional and prenatal periods is important for healthy pregnancy outcomes. By enhancing maternal nutritional status, health care providers can help pregnant women lower their risk of certain pregnancy complications and decrease their childrens risk of adverse birth outcomes and later chronic disease. Use of evidence-based tools and recommendations will assist in the assessment of pregnant womens diets and streamline the counseling session to optimize their nutritional status. This article contains a review of the literature related to nutrition intervention studies during pregnancy that were designed to improve habits or achieve target weight gains and nutrition recommendations specific for the pregnancy state, as well as tools/resources for the health care provider for implementation of these recommendations into their busy practices.