Association between the Diet Quality Index Adapted for Pregnant Women (IQDAG) and excess maternal body weight

Crivellenti, Lívia Castro; Zuccolotto, Daniela Cristina Candelas; Sartorelli, Daniela Saes

doi:10.1590/1806-93042019000200002

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 19 (2) • Apr-Jun 2019 • https://doi.org/10.1590/1806-93042019000200002 copy

Association between the Diet Quality Index Adapted for Pregnant Women (IQDAG) and excess maternal body weight

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to investigate the relationship between the Diet Quality Index Adapted for Pregnant Women (IQDAG) and excess maternal body weight.

Methods:

a cross-sectional study was conducted with 754 adult pregnant women, in Ribeirão Preto, São Paulo, between 2011 and 2012. The criteria proposed by Atalah were used to classify the body mass index (BMI). Adjusted multinomial logistic regression models were employed to investigate the relationship between the IQDAG and being overweight and obese, estimating the odds ratio (OR) and the 95% confidence interval (CI95%).

Results:

the mean (SD) age of women was 28 (5) years, 33.4% were overweight and 25.6% obese. The pregnant women with higher scores in the IQDAG were less likely to be overweight [OR= 0.56 (CI95% = 0.37-0.85)] or obese [0.43 (0.26-0.71)]; those with higher scores in the "Fiber" [0.51 (0.33; 0.78)] and "Iron" [0.62 (0.40-0.96)] components were less likely to be overweight. However, women with higher scores in the percentage of energy from ultra-processed foods were more likely to be overweight [1.72 (1.10-2.94)] or obese [5.24 (2.80-9.80)], when compared to women with lower scores.

Conclusions:

poorer quality maternal diets were observed among the women who were overweight and obese during pregnancy.

Key words
Pregnant women; Food consumption; Overweight; Obesity

Component	Score
Component	0	10	20
Vegetables/1,000 kcal (in portions)	0	≥ 1.5
Legumes/1,000 kcal (in portions)	0	≥ 0.5
Fresh fruit/1,000 Kcal (in portions)	0	≥ 1.5
Fiber (g)	0	≥ 28.0
Omega 3^b b Estimate from the diet and use of dietary supplements (mg)	0	≥ 1.4
Calcium^b b Estimate from the diet and use of dietary supplements (mg)	0	≥ 800.0
Folate^b b Estimate from the diet and use of dietary supplements (mg)	0	≥ 520.0
Iron^b b Estimate from the diet and use of dietary supplements (mg)	0	≥ 22.0
Ultra-processed foods^c c percentage of energy from ultra-processed foods.	≥ 45	-	≤ 18

	BMI Classification^a a BMI classification, according to the gestational week, following the criteria of Atalah et al.13 Women classified as underweight (n= 31) according to gestational age were excluded from the analyses						P^b b p value according to ANOVA (continuous variables with normal distribution), Kruskal-Wallis (continuous variables without normal distribution) and chi-square (categorical variables) tests
	Adequate (n=309)		Overweight (n=252)		Obesity (n=193)
	X̄ ± SD		X̄ ± SD		X̄ ± SD
Maternal Characteristics - (X̄ ± SD)
Age (years)	27.1 ± 5.4		27.7 ± 5.4		28.7 ± 5.7		<0.01
Education (years)	9.6 ± 2.6		9.1 ± 2.6		9.0 ± 2.9		0.04
Parity	1.1 ± 1.2		1.2 ± 1.1		1.4 ± 1.4		0.01
	Md (P₂₅-P₇₅)		Md (P₂₅-P₇₅)		Md (P₂₅-P₇₅)
Physical activity (min/week)^c c Minutes per week of walking and exercise -	50.0 (0.0-150.0)		35.0 (0.0-116.3)		50.0 (0.0-120.0)		0.18
Md (P₂₅-P₇₅)
	n	%	n	%	n	%
Self reported skin color - n (%)							0.15
White	143	46.3	111	44.0	88	44.6
Brown	99	32.0	103	40.9	67	34.7
Others	67	21.7	38	15.1	148	20.7
Economic stratum							0.02
A	0	0.0	3	1.2	2	1.0
B	48	15.6	42	16.7	50	25.9
C	214	69.5	176	69.8	119	61.7
D	46	14.9	31	12.3	21	10.9
E	1	3.0	0	0.0	1	0.5
Smoking history							0.69
Never smoked	243	78.6	198	78.6	156	80.8
Ex-smoker	34	11.0	32	12.7	24	12.4
Currently smokes	32	10.4	22	8.7	13	6.7
Use of supplements	215	69.6	148	58.7	115	59.6	0.01
Pre-gestational BMI^d d Classification of pre-gestational BMI according to the Institute of Medicine.22 Pre-gestational BMI value ≤20 kg/m2 was adopted as inclusion criterion							<0.001
Adequate	287	92.9	94	37.3	9	4.7
Overweight	21	6.8	147	58.3	57	29.5
Obese	1	0.3	11	4.4	127	65.8
Self reported hypertension	25	8.1	16	6.3	33	17.1	<0.001
GDM^e e GDM Diagnosis, according to World Health Organization criteria.23	37	12.0	44	17.5	54	28.0	<0.001

	BMI Classification^a a Classification of BMI according to gestational week.13 Women classified as low weight (n = 31) according to gestational age were excluded from the analyses			p ^b b p value ANOVA
	Adequate (n=309)	Overweight (n=252)	Obesity (n=193)	p ^b b p value ANOVA
IQDAG Score	71.6 ± 12.1^c c Difference in the mean of the women with adequate BMI, compared to the women with obesity, after Bonferroni test	69.9 ± 11.6	68.3 ± 11.6	< 0.001
Vegetables/1,000 kcal	2.4 ± 1.5	2.4 ± 1.4	2.2 ± 1.3	0.28
Legumes/1,000 kcal	1.7 ± 1.2	1.5 ± 0.9	1.5 ± 0.9	0.09
Fresh fruits/1,000 kcal	0.9 ± 0,6	0.8 ± 0.6	0.8 ± 0.6	0.43
Fiber (g)	24.4 ± 11.0^c c Difference in the mean of the women with adequate BMI, compared to the women with obesity, after Bonferroni test	22.3 ± 7.6^d d Difference in the mean of the women with adequate BMI, compared to the women who were overweight, after Bonferroni test; BMI = body mass index	22.4 ± 7.4	< 0.001
Omega 3 (mg)	1.0 ± 0.4	1.0 ± 0,3	1.0 ± 0.4	0.20
Calcium (mg)	551.5 ± 244.1	536.4 ± 235.0	531.8 ± 246.4	0.62
Folate (μg)	646.2 ± 1034.7	599.4 ± 1086.3	477.6 ± 422.2	0.06
Iron (mg)	53.1 ± 40.7	47.0 ± 41.0	50.0 ± 43.3	0.23
Ultra-processed foods^e e percentage of energy from ultra-processed foods.	31.9 ± 13.4	31.4 ± 12.3	33.0 ± 13.2	0.43

	Overweight OR (CI95%)^b b Multinomial logistic regression models, considering the first tertile of consumption and eutrophic women as the reference, adjusted for: age (years), education (years of schooling), parity (number of children), physical activity (minutes per week of walking and physical exercises), self-report skin color (white, brown or others), economic stratum (A or B, C, D or E), smoking history (never smoked, ex-smoker, current smoker) total energy ingestion (kcal) and dietary underreporting (yes/no)			Obesity OR (CI95%)^b b Multinomial logistic regression models, considering the first tertile of consumption and eutrophic women as the reference, adjusted for: age (years), education (years of schooling), parity (number of children), physical activity (minutes per week of walking and physical exercises), self-report skin color (white, brown or others), economic stratum (A or B, C, D or E), smoking history (never smoked, ex-smoker, current smoker) total energy ingestion (kcal) and dietary underreporting (yes/no)
	1^st Tertile (n = 77)	2^nd Tertile (n = 80)	3^rd Tertile (n = 95)	1^st Tertile (n = 47)	2^nd Tertile (n = 72)	3^rd Tertile (n = 74)
IQDAG	Ref	0.78 (0.51-1.19)	0.56 (0.37-0.85)	Ref	0.92 (0.57-1.49)	0.43 (0.26-0.71)
Vegetables/1,000 kcal	Ref	1.23 (0.81-1.89)	1.03 (0.67-1.58)	Ref	0.66 (0.40-1.07)	0.72 (0.45-1.17)
Legumes/1,000 kcal	Ref	0.81 (0.53-1.24)	0.75 (0.49-1.15)	Ref	0.55 (0.34-0.90)	0.74 (0.46-1.21)
Fresh fruits/1,000 kcal	Ref	0.93 (0.60-1.42)	0.98 (0.64-1.49)	Ref	0.90 (0.55-1.33)	0.81 (0.50-1.33)
Fiber^c c Adjusted by total dietary calories, using the residual method (g)	Ref	0.86 (0.56-1.30)	0.51 (0.33-0.78)	Ref	0.76 (0.46-1.25)	0.79 (0.49-1.29)
Omega 3^c c Adjusted by total dietary calories, using the residual method (mg)	Ref	0.98 (0.64-1.47)	0.89 (0.58-1.36)	Ref	0.94 (0.57-1.54)	1.16 (0.71-1.88)
Calcium^c c Adjusted by total dietary calories, using the residual method (mg)	Ref	1.11 (0.73-1.68)	1.12 (0.73-1.71)	Ref	1.21 (0.75-1.97)	1.22 (0.74-2.00)
Folate^c c Adjusted by total dietary calories, using the residual method (μg)	Ref	0.85 (0.56-1.30)	0.98 (0.65-1.53)	Ref	0.63 (0.39-1.06)	0.75 (0.46-1.22)
Iron^c c Adjusted by total dietary calories, using the residual method (mg)	Ref	0.57 (0.37-0.87)	0.62 (0.40-0.96)	Ref	0.72 (0.43-1.20)	0.74 (0.45-1.21)
Ultra-processed foods^d d percentage of energy from ultra-processed foods	Ref	2.08 (1.32-3.27)	1.72 (1.10-2.94)	Ref	3.55 (2.08-6.06)	5.24 (2.80-9.80)

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[1] Author's Contribuition

Crivellenti LC, Zuccolotto DCC, Sartorelli DS contributed in the conception and planning of this study. Data collection was performed by Crivellenti LC and Zuccolotto DCC, and data analysis and interpretation were carried out by Sartorelli DS and Crivellenti LC. The manuscript was elaborated and revised by Crivellenti LC. All of the authors approved the final version of the manuscript and took public responsibility on the article's content.