Maria Beatriz Trindade de Castro

Aderência às recomendações dietéticas do Institute of Medicine (Estados Unidos) e o seu efeito no peso durante a gestação

O objetivo do trabalho foi estimar o efeito que a aderencia as recomendacoes do Institute of Medicine (IOM) dos Estados Unidos acerca da ingestao de energia e/ou da composicao dos macronutrientes da dieta exercem no peso durante a gestacao. Trata-se de estudo prospectivo com tres pontos de observacao que incluiu 255 gestantes. A variavel dependente foi o peso aferido ao longo da gestacao e a independente a adequacao dietetica segundo as recomendacoes do IOM para ingestao de energia e macronutrientes, categorizada em ingestao adequada ou excessiva. As analises estatisticas foram realizadas com modelos de efeitos mistos para medidas repetidas. As gestantes com ingestao excessiva eram 3,59kg (EP = 0,92kg) mais leves na linha de base (p < 0,01). Em media, o peso das gestantes variou 1,83kg (EP = 0,40kg) por trimestre, mas as gestantes com ingestao excessiva apresentaram um aumento de peso superior de 1,70kg (EP = 0,43kg), no mesmo periodo quando comparadas as com ingestao adequada (p < 0,01). Mulheres que aderiram as recomendacoes de ingestao dietetica segundo o IOM aumentaram menos de peso durante a gestacao.The studys objective was to estimate the effect of adherence to dietary recommendations by the Institute of Medicine (IOM) concerning energy intake and/or macronutrient composition of diet on weight during pregnancy. This was a prospective study with observations at three time points, with a sample of 255 pregnant women. The dependent variable was gestational weight, and the independent variable was dietary adequacy according to IOM recommendations for energy and macronutrient intake, categorized as adequate versus excessive intake. Statistical analyses were performed using mixed effects models for repeated measures. Pregnant women with excessive intake were 3.59kg lighter at baseline (SE = 0.92kg; p < 0.01). On average, gestational weight varied by 1.83kg (SE = 0.40kg) per trimester, but pregnant women with excessive intake showed a higher weight increase of 1.70kg (SE = 0.43kg) during the same period as compared to women with adequate intake (p < 0.01). Women who adhered to IOM dietary recommendations gained less weight during pregnancy.

Gestational dietary patterns are not associated with blood pressure changes during pregnancy and early postpartum in a Brazilian prospective cohort

AbstractPurposenTo identify gestational dietary patterns and evaluate the association between these patterns and the blood pressure (BP) rate of change during pregnancy and the postpartum.MethodsProspective cohort study composed of 191 healthy pregnant women. Systolic BP (SBP) and diastolic BP (DBP) were obtained at the 5th–13th, 20th–26th, 30th–36th gestational weeks, and with 30–45xa0days postpartum. A food frequency questionnaire administered at the 30th–36th gestational week was used to measure dietary intake during pregnancy. Principal component analysis was performed to identify the dietary patterns. A longitudinal linear mixed-effects regression model was used to evaluate the association between the dietary patterns and BP (adjusted for time elapsed after conception and the women’s age, education, parity, body mass index and total energy intake).ResultsThree gestational dietary patterns were identified: healthy, common-Brazilian and processed. SBP/DBP mean values (SD) were 110.1 (9.0)/66.9 (7.5), 108.7 (9.0)/64.9 (6.7), 111.3 (9.2)/67.0 (6.9) and 115.0 (10.7)/73.7 (8.6)xa0mmHg at the first, second and third gestational trimesters and postpartum, respectively. Women with higher/lower adherence to the processed pattern presented SBP of 117.9 and 113.0xa0mmHg (Pxa0=xa00.037), respectively, during postpartum. No association was found between any of the three dietary patterns and SBP in the multiple longitudinal linear regression models, whereas 1 SD increase in the common-Brazilian pattern was associated with a small change of DBP (βxa0=xa00.0006; 95xa0% CI 4.66e-06, 0.001; Pxa0=xa00.048).ConclusionThe three dietary patterns identified revealed no association with changes of SBP and DBP levels during pregnancy and at early postpartum in this sample of healthy Brazilian women.

Association between sociodemographics factors and dietary patterns during pregnancy

OBJECTIVE:To investigate the association between socio-demographic factors and dietary patterns in pregnancy.METHODS:Cross-sectional study with baseline data from a cohort of 421 postpartum women aged 18 and 45 years resident in Rio de Janeiro,Brazil. Dietary intake was evaluated with a validated food frequency questionnaire at 15 days following delivery, having as time frame the second and third pregnancy trimesters. Dietary patterns were identified using factor analysis for principal components analysis. The association between socio-demographic factors and the identified dietary patterns was assessed with multiple linear regression analysis.RESULTS:Two dietary patterns were identified: i) healthy: fruits; green vegetables; vegetables; fish; roots, corn and potato; milk and dairy and herbal tea mate, and negatively loadings for alcohol and coffee and ii) mixed: rice; bean; flour and pasta; breads; cake and cookies; soda and juice; sugar and sweets; fatty foods; meats; chicken; and eggs. The linear regression showed that the income (β=0.0002; 95%CI: 0.0002-0.0004) and schooling (β=0.0491; 95%CI: 0.0264-0.0718) were positively associated with healthy pattern, and parity (β=-0.1044; 95%CI: -0.1665- -0.0423) and skin color (β=-0.3102; 95%CI: -0.5256- -0.0947) were negatively associated. Skin color (β=0.1647; 95%CI: 0.0378- 0.2916) and marital status (β=0.1065; 95%CI: 0.0062- 0.2067) were positively associated with mixed pattern and income (β=-0.0001; 95%CI:-0.0002- -0.0001) and schooling (β=-0.0281; 95%CI: -0.0417- -0.0146) were negatively associated.CONCLUSION:Socio-demographic factors such as income, schooling, skin color, marital status and parity were associated with dietary patterns in this sample of postpartum women residents in Rio de Janeiro.

Mixed dietary pattern is associated with a slower decline of body weight change during postpartum in a cohort of Brazilian women.

OBJECTIVEnThe aim was to assess the effect of dietary patterns on postpartum body weight change (BWC).nnnMETHODSnA Food Frequency Questionnaire (FFQ) with 81 items was applied in 278 women having the first six months after delivery as the time frame. Body weight (BW) was measured at 15 days (baseline) and at 2.6 and 9 months postpartum. Principal components analysis was used to extract the dietary patterns. Linear mixed models were performed having BWC as the outcome and the dietary patterns as independent variables.nnnRESULTSnTwo major dietary patterns were identified: healthy and mixed. Energy intake was 2,838 kcal (DP = 624) and 2,233 kcal (DP = 455), for women classified in the highest quartiles of mixed and healthy dietary patterns, respectively. Mean BWC declined -0.151 kg/ month (SE = 0.02) independently of the dietary pattern. Predicted values of BWC among women that have adhered to mixed dietary pattern indicated a lower BWC of 0.830 kg/month (SE = 0.24; p < 0.001) at 6 months and 0.938 kg/month (SE = 0.24; p < 0.001) at 9 months postpartum.nnnCONCLUSIONnThe mixed dietary pattern was associated with a slower rate of BWC during postpartum, compared the healthy dietary pattern.

High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil.

The association between the quality of maternal dietary fat intake during pregnancy and the infants birthweight (BW) remains controversial. Our goal was to investigate the association between maternal dietary fat intake during pregnancy and the rate of large for gestational age (LGA) newborns. This study employed a cross-sectional analysis of 297 pairs of mothers/children attending a public maternity at Rio de Janeiro, Brazil. BW for gestational age according to the Intergrowth 21st was defined as follows: adequate for gestational age (AGAu2009≤u200990th percentile) and LGA (>90th percentile). The statistical analysis was a Poisson regression with robust estimations of the standard errors. Maternal dietary fat intake variables comprised lipids (% total energy); saturated (mg/1000u2009kcal), monounsaturated (mg/1000u2009kcal) and polyunsaturated (mg/1000u2009kcal) fats; and cholesterol (mg/1000u2009kcal), all of which were obtained with a Food Frequency Questionnaire. The mean BW was 3338u2009g (SDu2009=u2009446.9), and the rate of LGA newborns was 13.1%. The mean maternal total energy intake was 2880u2009kcal (SDu2009=u20091074), cholesterol was 154.3u2009mg/1000u2009kcal (SDu2009=u200968.1) and monounsaturated fat was 6.9u2009mg/1000u2009kcal (SDu2009=u20092). Mothers of LGA newborns reported higher cholesterol dietary intake (195.8 vs. 148u2009mg/1000u2009kcal; Pu2009<u20090.001), pre-pregnancy body mass index (25.1 vs. 23.5u2009kg/m2 ; Pu2009=u20090.026) when compared with mothers of AGA newborns. Women with cholesterol intake within the fourth quartile were 2.48 (95% confidence interval: 1.31-4.66) times more likely to have an LGA infant compared with those in the 1-3 quartiles. Dietary intake of cholesterol during pregnancy influences LGA even after adjusting for other confounders.

Assessment of protein intake during pregnancy using a food frequency questionnaire and the effect on postpartum body weight variation

The aim of this study was to investigate the effect of protein intake during pregnancy on postpartum weight variation. This was a prospective cohort study with 421 women interviewed at 15 days (baseline) and 2, 6, and 9 months postpartum. Data on diet were obtained using the food frequency questionnaire, focusing on the second and third trimesters. Protein intake was considered adequate when women consumed ≥ 1.2g of protein per kg body weight, and inadequate when < 1.2g/kg. The study adopted the mixed effects model for repeated measurements over time. The results showed a mean postpartum weight loss of 0.409kg/month (±0.12) (p < 0.01). Women with adequate protein intake during pregnancy lost an additional 0.094kg/month (±0.04) during postpartum (p = 0.03) when compared to women with inadequate intake. The model was adjusted for energy, % body fat, stature, age, schooling, skin color, and smoking. Recommended protein intake during pregnancy favored postpartum weight reduction.

Protein intake and weight gain among low-income pregnant women from Mesquita County, Rio de Janeiro, Brazil

1 Universidade do Porto, Instituto de Saúde Pública, Departamento de Epidemiologia. Porto, Portugal. 2 Universidade do Estado do Rio de Janeiro, Instituto de Medicina Social, Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil. 3 Universidade Federal do Rio de Janeiro, Instituto de Nutrição Josué Castro, Departamento de Nutrição Social e Aplicada. Av. Carlos Chagas Filho 367, Cidade Universitária, Ilha do Fundão, 21941-590, Rio de Janeiro, RJ, Brasil. Correspondência para/ Correspondence to: MBT CASTRO. E-mail: . Support: Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ/SESDEC/MS/CNPq – 18/2009 – E-26/110.766/2010).

Parental dietary patterns and social determinants of children's dietary patterns

Objective To identify dietary patterns in children up to thirty months of age and verify whether they are associated with parental dietary patterns, and socioeconomic and demographic characteristics. Methods This is a cross-sectional study with baseline data from a population-based study composed of 1,085 households from a representative sample of a metropolitan region in Rio de Janeiro, Brazil. The childrens food intake was evaluated by two 24-hour recalls, and the dietary patterns were identified by principal component analysis stratified into two groups according to the childrens age: 6 to 17 months; and 18 to 30 months. The explanatory variables collected by a structured questionnaire were socioeconomic and demographic characteristics, age at introduction of complementary foods, and parental dietary pattern. A Food Frequency Questionnaire was administered to assess parental dietary pattern, which was determined by principal component analysis. Multivariate linear regression estimated the effect of each explanatory variable on the childrens dietary patterns. Results Three dietary patterns were identified in children aged 6-17 months (basic-mixed; mixed-plus; and milk-flours) and two dietary patterns were identified in children aged 18-30 months: basic-mixed and mixed-plus. Multivariate linear regression showed that complementary feeding (b=0.108; p=0.004) was positively associated with the basic-mixed dietary pattern, and family income (b=0.002; p£0.01), with the mixed-plus dietary pattern. A negative association was found between the traditional parental dietary pattern and childrens mixed-plus pattern in children aged 6-17 months (b=0.152; p=0.006) and in children aged 18-30 months (b=0.152; p=0.016). In children aged up to 18 months, parental education level (b=0.368; p£0.01) was positively associated with the mixed-plus dietary pattern. Conclusion Family income, parental education level, and parental dietary patterns are associated with childrens dietary patterns.

Adherence to dietary recommendations by the Institute of Medicine and the effect on body weight during pregnancy

O objetivo do trabalho foi estimar o efeito que a aderencia as recomendacoes do Institute of Medicine (IOM) dos Estados Unidos acerca da ingestao de energia e/ou da composicao dos macronutrientes da dieta exercem no peso durante a gestacao. Trata-se de estudo prospectivo com tres pontos de observacao que incluiu 255 gestantes. A variavel dependente foi o peso aferido ao longo da gestacao e a independente a adequacao dietetica segundo as recomendacoes do IOM para ingestao de energia e macronutrientes, categorizada em ingestao adequada ou excessiva. As analises estatisticas foram realizadas com modelos de efeitos mistos para medidas repetidas. As gestantes com ingestao excessiva eram 3,59kg (EP = 0,92kg) mais leves na linha de base (p < 0,01). Em media, o peso das gestantes variou 1,83kg (EP = 0,40kg) por trimestre, mas as gestantes com ingestao excessiva apresentaram um aumento de peso superior de 1,70kg (EP = 0,43kg), no mesmo periodo quando comparadas as com ingestao adequada (p < 0,01). Mulheres que aderiram as recomendacoes de ingestao dietetica segundo o IOM aumentaram menos de peso durante a gestacao.The studys objective was to estimate the effect of adherence to dietary recommendations by the Institute of Medicine (IOM) concerning energy intake and/or macronutrient composition of diet on weight during pregnancy. This was a prospective study with observations at three time points, with a sample of 255 pregnant women. The dependent variable was gestational weight, and the independent variable was dietary adequacy according to IOM recommendations for energy and macronutrient intake, categorized as adequate versus excessive intake. Statistical analyses were performed using mixed effects models for repeated measures. Pregnant women with excessive intake were 3.59kg lighter at baseline (SE = 0.92kg; p < 0.01). On average, gestational weight varied by 1.83kg (SE = 0.40kg) per trimester, but pregnant women with excessive intake showed a higher weight increase of 1.70kg (SE = 0.43kg) during the same period as compared to women with adequate intake (p < 0.01). Women who adhered to IOM dietary recommendations gained less weight during pregnancy.

Adhesión a las recomendaciones dietéticas del Institute of Medicine (Estados Unidos) y su efecto en el peso durante la gestación

O objetivo do trabalho foi estimar o efeito que a aderencia as recomendacoes do Institute of Medicine (IOM) dos Estados Unidos acerca da ingestao de energia e/ou da composicao dos macronutrientes da dieta exercem no peso durante a gestacao. Trata-se de estudo prospectivo com tres pontos de observacao que incluiu 255 gestantes. A variavel dependente foi o peso aferido ao longo da gestacao e a independente a adequacao dietetica segundo as recomendacoes do IOM para ingestao de energia e macronutrientes, categorizada em ingestao adequada ou excessiva. As analises estatisticas foram realizadas com modelos de efeitos mistos para medidas repetidas. As gestantes com ingestao excessiva eram 3,59kg (EP = 0,92kg) mais leves na linha de base (p < 0,01). Em media, o peso das gestantes variou 1,83kg (EP = 0,40kg) por trimestre, mas as gestantes com ingestao excessiva apresentaram um aumento de peso superior de 1,70kg (EP = 0,43kg), no mesmo periodo quando comparadas as com ingestao adequada (p < 0,01). Mulheres que aderiram as recomendacoes de ingestao dietetica segundo o IOM aumentaram menos de peso durante a gestacao.The studys objective was to estimate the effect of adherence to dietary recommendations by the Institute of Medicine (IOM) concerning energy intake and/or macronutrient composition of diet on weight during pregnancy. This was a prospective study with observations at three time points, with a sample of 255 pregnant women. The dependent variable was gestational weight, and the independent variable was dietary adequacy according to IOM recommendations for energy and macronutrient intake, categorized as adequate versus excessive intake. Statistical analyses were performed using mixed effects models for repeated measures. Pregnant women with excessive intake were 3.59kg lighter at baseline (SE = 0.92kg; p < 0.01). On average, gestational weight varied by 1.83kg (SE = 0.40kg) per trimester, but pregnant women with excessive intake showed a higher weight increase of 1.70kg (SE = 0.43kg) during the same period as compared to women with adequate intake (p < 0.01). Women who adhered to IOM dietary recommendations gained less weight during pregnancy.