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Relationship between pregestational nutritional status and type of processing of foods consumed by high-risk pregnant women

Abstract

Objectives:

to relate pregestational nutritional status, maternal age and number of pregnancies to the distribution of macronutrients and micronutrients according to the type of processing offoods consumed by high-risk pregnant women.

Methods:

a retrospective cross-sectional study was carried out with data from medical records of 200 pregnant women served by a public outpatient clinic in Rio Grande do Sul from 2014 to 2016.

Results:

the mean percentages of lipids, monounsaturated fatty acids, polyunsaturated fatty acids and sodium intake were higher among ultra-processed foods. There was a significant inverse correlation between maternal age and total calorie intake (p=0.003) and percentage of carbohydrates (p=0.005) and proteins (p=0.037) from ultra-processed foods. There was also a significant association between pregestational nutritional status and total calorie intake (p=0.018) and percentage of carbohydrates (p=0.048) from ultra-processed foods.

Conclusions:

the mean percentages of lipids, monounsaturated fatty acids, polyunsaturated fatty acids and sodium intake were higher among ultra-processed foods. It was observed that the older the maternal age of high-risk pregnant women, the lower the intake of total calories and percentages of carbohydrates and proteins from ultra-processed foods. It was also observed that pregestational nutritional status was significantly associated with the intake of total calories and percentage of carbohydrates from ultra-processed foods.

Key words
Pregnancy high-risk; Maternal health; Feeding behavior

Resumo

Objetivos:

relacionar o estado nutricional pré-gestacional, a idade materna e o número de gestações com a distribuição de macronutrientes e micronutrientes conforme o tipo de processamento dos alimentos consumidos por gestantes de alto risco.

Métodos:

estudo retrospectivo transversal, realizado a partir de dados de prontuários de 200 gestantes atendidas em um ambulatório público do Rio Grande do Sul, no período de 2014 a 2016.

Resultados:

a média de consumo em percentuais de lipídios, ácidos graxos monoinsaturados, poli-insaturados e sódio foi maior entre os alimentos ultraprocessados. Observou-se correlação significativamente inversa entre a idade materna e o consumo de calorias totais (p=0,003), percentuais de carboidratos (p=0,005) e proteínas (p=0,037) provenientes de alimentos ultraprocessados. Verificou-se também associação significativa entre o estado nutricional pré-gestacional e o consumo de calorias totais (p=0,018) e percentual de carboidrato (p=0,048) provenientes de alimentos ultraprocessados.

Conclusões:

a média de consumo em percentuais de lipídios, ácidos graxos monoinsaturados, poli-insaturados e sódio foi maior entre os alimentos ultraprocessados, verificou-se que quanto maior a idade materna da gestante de alto risco, menor é o consumo de calorias totais, percentuais de carboidratos e proteínas, oriundos dos alimentos ultraprocessados e identificou-se também que o estado nutricional pré-gestacional possui associação significativa com o consumo de calorias totais e percentual de carboidrato provenientes de alimentos ultraprocessados.

Palavras-chave
Gravidez de alto risco; Saúde materna; Comportamento alimentar

Introduction

Pregnancy is the period in which nutritional needs are increased due to physiological adjustments in the maternal organism and fetal development. Therefore, adequate nutrient availability and a balanced diet are essential for this phase of life.11 Bueno AAA, Beserra JAS, Weber ML. Características da alimentação no período gestacional. LifeStyle J. 2016; 3 (2): 30-43. During pregnancy, both mother and the fetus may face health risks that can lead this phase to become a risk pregnancy22 Teixeira D, Pestana D, Calhau C, Vicente L, Graça P. Alimentação e Nutrição na Gravidez. Programa Nacional para a Promoção da Alimentação Saudável. Direção-Geral da Saúde (Editor). Lisboa; 2015. Disponível em: https://www.alimentacaosaudavel.dgs.pt/activeapp/wpcontent/files_mf/1444899925Alimentacaoenutricaonagravidez.pdf
https://www.alimentacaosaudavel.dgs.pt/a...
in which the most common consequences are preterm birth, prolonged pregnancy, preeclampsia and eclampsia, hemorrhages, gestational diabetes, cervical insufficiency, and even death of the fetus.33 Brasil. Ministério da Saúde. Gestação de alto risco: manual técnico. 5 ed. Brasília, DF; 2010.

Pregnant women's inadequate dietary habits potentiate risks during pregnancy44 Rodrigues AFC, Farias ER, Gomes FKI, Pureza IROM, Leite JGM, Braga RC, Pereira WD. Perfil nutricional de gestantes de alto risco atendidas numa clínica escola de nutrição de Maceió - AL e incentivo ao aleitamento materno. Entre Aberta Revista de Extensão. 2014; 1 (1): 1-8. Disponível em: revistas.cesmac.edu.br/index.php/entreaberta/article/download/302/221
revistas.cesmac.edu.br/index.php/entreab...
and have a strong impact on obstetric outcomes and clinical characteristics of the newborn.55 Nascimento IB, Sales WB, Fleig R, Silva GD, Silva CS. Excesso de peso e dislipidemia e suas intercorrências no período gestacional: uma revisão sistemática. Rev Bras Saúde Matern Infant. 2016; 16 (2): 103-11. Therefore, the expectant mother needs to be aware of her pregestational nutritional status, her food intake and, above all, the quality of the food sheeats.66 Fazio ES, Nomura RMY, Dias MCG, Zugaib M. Consumo dietético de gestantes e ganho ponderal materno após aconselhamento nutricional. Rev Bras Ginecol Obstet. 2011; 33 (2): 87-92.

The Dietary Guidelines for the Brazilian Population classified food according to the type of processing, with natural foods being those obtained from nature that do not undergo any type of processing. Minimally processed foods are natural foods that undergo some type of processing for cleaning, removal of unwanted parts, grinding, drying and pasteurization, among others. Processed foods are natural or minimally processed foods that contain additives (sugar, salt or some substance used in cooking) to enhance flavor or increase durability. Ultra-processed foods are foods that undergo several types of processing and that are added to industrial formulations.77 Brasil. Ministério da Saúde. Guia alimentar para a população brasileira. 2 ed. Brasília, DF; 2014.

The daily intake of natural and minimally processed foods is related to disease prevention.88 Verly Junior E, Carvalho AM, Fisberg RM, Marchioni DML. Adesão ao guia alimentar para população brasileira. Rev Saúde Pública. 2013; 47 (6): 1021-7. On the other hand, the intake of processed and ultraprocessed foods is related to the onset of chronic diseases given the changes in their nutritional composition. This explains the importance of having pregnant women prioritize natural foods and reduce the intake of processed foods and avoid ultraprocessed foods.99 Louzada MLC, Martins APB, Canella DS, Baraldi LG, Levy RB, Claro RM, Moubarac JC, Cannon G, Monteiro CA. Impacto de alimentos ultraprocessados sobre o teor de micronutrientes da dieta no Brasil. Rev Saúde Pública. 2015; 49: 45.

Healthy habits and choices, in addition to minimizing risks during pregnancy, improve the quality of fetal development and maternal nutritional status.1010 Brasil. Senado Federal. Orientações Nutricionais: da gestação à primeira infância. Brasília: Senado Federal; 2015. Thus, given the scarcity of publications addressing the relationship between pregnant women's nutritional status and the type of processing of the food they eat, this study aimed to relate pregestational nutritional status, maternal age and number of pregnancies to the distribution of macronutrients and micronutrients according to the type of processing of foods consumed by high-risk pregnant women.

Methods

This is a quantitative retrospective cross-sectional study of data from medical records of 300 high-risk pregnant women. The study included high-risk pregnant women aged 15 to 45 years who were referred from 2014 to 2016 for the treatment of comorbidities such as hypertension, diabetes mellitus, hypothyroidism, toxoplasmosis and obesity in a public outpatient clinic located in the countryside of Rio Grande do Sul. The study excluded 100 medical records that did not present complete data on a 24-hour dietary recall of a single day and information on pregestational nutritional status, age, and number of pregnancies. Thus, 200 medical records were selected for analysis. The present study was approved by a Research Ethics Committee under Approval Nº. 1.591.097 and CAAE No. 55981216.3.0000.5310.

The pregestational nutritional status was determined using the body mass index (BMI) and its classification was based on the 1998 World Health Organization (WHO) standards, namely: malnutrition (<18.5 kg/m2), normal weight (≥18.5 and ≤24.9 kg/m2), overweight (≥ 25.0 and ≤ 29.9 kg/m2), class I obesity (≥30.0 and ≤34.9 kg/m2), class II obesity (≥35.0 and ≤39.9 kg/m2) and class III obesity (≥40.0 kg/m2).1111 Associação Brasileira para o Estudo da Obesidade e da Síndrome Metabólica. Diretrizes Brasileiras de Obesidade. 3 ed. São Paulo: Ac Farmacêutica; 2009.

The 24-hour dietary recalls of the pregnant women were analyzed using the 2008 DietWin® software and total calories and intake of carbohydrates, proteins, lipids, sodium, and monounsaturated, polyunsaturated and saturated fats from all the foods consumed were measured. After that, the calories and percentages of each macronutrient and each micronutrient mentioned above were calculated according to the classification of each food described in the Dietary Guidelines for the Brazilian Population, which categorizes foods into: natural, minimally processed, processed and ultra-processed.77 Brasil. Ministério da Saúde. Guia alimentar para a população brasileira. 2 ed. Brasília, DF; 2014.

Statistical analysis was performed using the Kruskal-Wallis test and Pearson's correlation analysis. Results were considered significant at a maximum significance threshold of 5%. The software used for the analyses was the SPSS (Statistical Package for the Social Sciences) version 22.0.

Results

The mean age of the pregnant women was 29.64 ± 6.82, the mean number of children was 1.92 ± 1.04, and the mean number of pregnancies was 2.49 ± 1.5. With regard to the percentages of total calories from the different types of processing of the foods consumed by high-risk pregnant women, 47.21% were from natural/minimally processed foods, 38.07% were from ultra-processed foods, and 14.72% were from processed foods.

According to Table 1, there were higher means of total calories and percentages of carbohydrates, proteins and saturated fats from natural/minimally processed foods followed by ultra-processed and processed foods. The mean percentages of lipids and monounsaturated and polyunsaturated fats were higher among ultra-processed foods, followed by natural/minimally processed foods and processed foods. In regard to the percentage of sodium, there was a higher mean among ultra-processed foods, followed by processed foods and natural/minimally processed foods.

Table 1
Characterization of total calorie intake and percentage of carbohydrates, protein, lipids, monounsaturated fatty acids, polyunsaturated fatty acids, saturated fatty acids and sodium from natural/minimally processed, processed and ultraprocessed foods among high-risk pregnant women.

There was a direct correlation (Table 2) between age and percentage of carbohydrates from natural/minimally processed foods (p=0.013). There was also a significant inverse relationship between age and intake of total calories (p=0.003) and percentages of carbohydrates (p=0.005) and proteins (p=0.037) from ultra-processed foods.

Table 2
Association of number of pregnancies, age and pregestational nutritional status with total calorie intake and percentage of carbohydrates, protein, lipids, monounsaturated fatty acids, polyunsaturated fatty acids, saturated fatty acids and sodium from natural/minimally processed, processed and ultra-processed foods among high-risk pregnant women.

There was also a correlation between pregestational nutritional status and percentage of protein from natural/minimally processed foods (p=0.021). The percentage of intake of protein from natural/minimally processed foods in Class III obese pregnant women was significantly lower when compared with overweight and class I and II obese pregnant women. There was also an association of pregestational nutritional status with total calorie intake (p=0.018) and percentage of carbohydrates (p=0.048) from ultra-processed foods. Total calorie intake and percentage of carbohydrates from ultraprocessed foods were significantly higher among high-risk pregnant women with class III obesity and normal weight when compared with overweight and class II obese pregnant women. Additionally, overweight and class II obese high-risk pregnant women exhibited lowers percentages of protein from ultraprocessed foods (p=0.024) when compared with those with normal weight or class I and III obesity (Table 3).

Table 3
Association of pregestational nutritional status with total calorie intake and percentage of carbohydrates and protein from natural/minimally processed, processed and ultra-processed foods among high-risk pregnant women.

Class III obese pregnant women presented lower percentages of intake of monounsaturated (p=0.040) and saturated (p=0.034) fats from natural/minimally processed foods when compared with class II obese pregnant women (Table 4).

Table 4
Association of pregestational nutritional status with percentage of intake of lipids, monounsaturated fatty acids, polyunsaturated fatty acids and saturated fatty acids from natural/minimally processed, processed and ultra-processed foods among high-risk pregnant women.

There was an association between pregestational nutritional status and percentage of sodium from natural/minimally processed foods (p=0.050). Class III obese pregnant women presented significantly lower percentages of intake of sodium from natural/minimally processed foods when compared with overweight or class I and II obese pregnant women (Table 5).

Table 5
Association of pregestational nutritional status with percentage of intake of sodium from natural/minimally processed, processed and ultra-processed foods among high-risk pregnant women.

Discussion

The consumption of ultra-processed foods in the present study represented 38.07% of the total calories consumed by high-risk pregnant women. This percentage is lower than that found in a study carried out with young adults in the city of Pelotas, Rio Grande do Sul, which showed a consumption of 51.20%,1212 Bielemann RM, Motta JVS, Minten GC, Horta BL, Gigante DP. Consumo de alimentos ultraprocessados e impacto na dieta de adultos jovens. Rev Saúde Pública. 2015; 49: 28. and higher than that found in a study carried out with individuals from the 2008 and 2009 Family Budget Surveys in São Paulo, which demonstrated a consumption of 21.5% of total calories.1313 Louzada MLC, Martins APB, Canella DS, Baraldi LG, Levy RB, Claro RM, Moubarac JC, Cannon G, Monteiro CA. Alimentos ultraprocessados e perfil nutricional da dieta no Brasil. Rev Saúde Pública. 2015; 49: 38. This finding shows the increasing influence of ultraprocessed products on Brazilian food1414 Martins APB, Levy RB, Claro RM, Moubarac JC, Monteiro CA. Participação crescente de produtos ultraprocessados na dieta brasileira (1987-2009). Rev Saúde Pública. 2013; 47 (4): 656-65. and hence the need to develop strategies to encourage the consumption by the entire population, including pregnant women, of natural/minimally processed foods.1515 Crivellenti LC, Zuccolotto DCC, Sartorelli DS. Desenvolvimento de um Índice de Qualidade da Dieta Adaptado para Gestantes. Rev Saúde Pública. 2018; 52: 59.

The present study demonstrated that the older the maternal age of high-risk pregnant women, the lower the intake of total calories and the percentages of carbohydrates and proteins from ultra-processed foods. This finding agrees with other studies that have shown that older pregnant women tend to eat less unhealthy snacks and fast food,1616 Hutchinson AD, Charters M, Prichard I, Fletcher C, Wilson C. Understanding maternal dietary choices during pregnancy: The role of social norms and mindful eating. Appetite. 2017; 112: 227-34.,1717 Teixeira JA, Castro TG, Grant CC, Wall CR, Castro ALDS, Francisco RPV, Vieira SE, Saldiva SRDM, Marchioni DM. Dietary patterns are influenced by socio-demographic conditions of women in childbearing age: a cohort study of pregnant women. BMC Public Health. 2018; 18: 301. which are meals known to increase overweight and obesity1818 Oexle N, Barnes TL, Blake CE, Bell BA, Liese AD. Neighborhood fast food availability and fast food consumption. Appetite. 2015; 92: 227-32. as they contain a large amount of sugar, fat and sodium.1919 Favoretto CM, Wiernetz PL. Alimentação sustentável e alimentos de fast food: o que a química e o meio ambiente têm a ver com isso? In: Secretaria de Educação do Governo do Estado de Paraná. Os desafios da escola pública Paranaense na perspectiva do professor PDE: Artigos. Paraná: Programa de Desenvolvimento Educacional; 2013. p. 1-15.

In the present study, class III obese high-risk pregnant women presented lower percentages of intake of protein from natural/minimally processed foods when compared with overweight or class I and II obese pregnant women. The consumption of ultraprocessed foods was responsible for the second highest mean rate of total calories and percentages of carbohydrates, proteins and saturated fats consumed. Consumption of ultra-processed foods during pregnancy results in unfavorable consequences for both mother and the fetus, including the woman's excessive weight gain during pregnancy and an increase in the newborn's body fat. It is important to emphasize that the permanence of such excess weight may contribute to the development of associated comorbidities, such as type II diabetes, cardiovascular disease, mental health problems and cancer.2020 Rohatgi KW, Tinius RA, Cade WT, Steele EM, Cahill AG, Parra DC. Relationships between consumption of ultraprocessed foods, gestational weight gain and neonatal outcomes in a sample of US pregnant women. PeerJ. 2017; 5: 1-17.

Maternal food consumption during pregnancy is responsible for promoting the neurodevelopment of children, which reinforces the importance of having a healthy lifestyle before pregnancy even begins.2121 Freitas - Vilela AA, Pearson RM, Emmett P, Heron J, Smith ADAC, Emond A, Hibbeln JR, Castro MBT, Kac G. Maternal dietary patterns during pregnancy and intelligence quotients in the offspring at 8 years of age: Findings from the ALSPAC cohort. Matern Child Nutr. 2017; 14 (1): 1-11. Thus, prenatal care is of fundamental importance to encourage, guide and motivate pregnant women by promoting healthy eating habits2222 Brasil. Ministério da Saúde. Atenção ao pré-natal de baixo risco. Brasília, DF; 2012. and by monitoring the health of the mother and the fetus.2121 Freitas - Vilela AA, Pearson RM, Emmett P, Heron J, Smith ADAC, Emond A, Hibbeln JR, Castro MBT, Kac G. Maternal dietary patterns during pregnancy and intelligence quotients in the offspring at 8 years of age: Findings from the ALSPAC cohort. Matern Child Nutr. 2017; 14 (1): 1-11. In a study on the healthy eating index of Brazilian pregnant women, the overall dietary intake of pregnant women was assessed based on three food groups(vegetables, fruits and beans and other protein-rich vegetables), two ratios (red/white meat and polyunsaturated/saturated fat) and five nutrients (fiber, trans fat, calcium, folate and iron) and it was found that most of them lacked dietary intake improvements, thus showing the need to deliver food education at this stage of life.2323 Melere C, Hoffmann JF, Nunes MAA, Drehmer M, Buss C, Ozcariz SGI, Soares RM, Manzolli PP, Duncan BB, Camey SA. Índice de alimentação saudável para gestantes: adaptação para uso em gestantes brasileiras. Rev Saúde Pública. 2013; 47 (1): 20-8.

In the present study, class III obese and normal weight high-risk pregnant women presented a higher intake of total calories and higher percentages of carbohydrates from ultra-processed foods when compared with overweight and class II obese pregnant women, that is, the consumption of ultraprocessed foods may not be related only to the nutritional status of pregnant women. Social mobility improvement, lifestyle and high levels of education are some of the factors that suggest a greater access to ultra-processed foods; in addition, these same factors can influence individuals' physical inactivity.1212 Bielemann RM, Motta JVS, Minten GC, Horta BL, Gigante DP. Consumo de alimentos ultraprocessados e impacto na dieta de adultos jovens. Rev Saúde Pública. 2015; 49: 28.

Overweight and class II obese high-risk pregnant women consumed significantly lower percentages of protein from ultra-processed foods compared with normal weight and class I and III obese pregnant women. According to results found in the present study, this relationship occurred because overweight and class II obese high-risk pregnant women consumed higher percentages of protein from natural/minimally processed foods.

It was also observed that class III obese pregnant women consumed significantly lower percentages of monounsaturated and saturated fatty acids from in natura/minimally processed foods compared with-class II obese pregnant women. This finding indicates that class III obese pregnant women consumed higher percentages of saturated and monounsaturated fatty acids from ultra-processed foods. Therefore, interventions and actions should be carried out during prenatal care in order to promote and encourage the consumption of natural foods, as well as reinforce the importance of healthy habits2424 Gomes CB, Malta MB, Martiniano ACA, Di Bonifácio LP, Carvalhaes MABL. Práticas alimentares de gestantes e mulheres não grávidas: há diferenças? Rev Bras Ginecol Obstet. 2015; 37 (7): 325-32. and, mainly, inform pregnant women about how much their nutritional status influences the baby's health. Pregnant women who have a BMI that suggests obesity tend to have greater complications during childbirth and maternal complications such as gestational diabetes and hypertensive syndrome and are more likely to experience perinatal complications such as macrosomia and low Apgar score in the first minute.2525 Silva JC, Amaral AR, Ferreira BS, Petry JF, Silva MR, Krelling PC. Obesidade durante a gravidez: resultados adversos da gestação e do parto. Rev Bras Ginecol Obstet. 2014; 36 (11): 509-13.

The present study demonstrated that class III obese pregnant women exhibited a significantly lower percentage of sodium intake from natural/minimally processed foods when compared with overweight and class I and II obese pregnant women, i.e., class III obese pregnant women consumed higher percentages of sodium from ultraprocessed foods. It was also possible to identify that the overall mean percentages of lipids, monounsaturated fatty acids, polyunsaturated fatty acids and sodium were higher among ultra-processed foods, which may be related to the strong influence of marketing on the eating habits of the population1414 Martins APB, Levy RB, Claro RM, Moubarac JC, Monteiro CA. Participação crescente de produtos ultraprocessados na dieta brasileira (1987-2009). Rev Saúde Pública. 2013; 47 (4): 656-65. and to the fact that these foods are well accepted due to their taste, have a long shelf life and are practical, as they can be consumed at any time and place.2626 Monteiro CA, Cannon G, Moubarac JC, Levy RB. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutrition. 2017; 21 (1): 5-17. Therefore, nutritional follow-up is essential for the definition of a diet that meets nutritional demands.22 Teixeira D, Pestana D, Calhau C, Vicente L, Graça P. Alimentação e Nutrição na Gravidez. Programa Nacional para a Promoção da Alimentação Saudável. Direção-Geral da Saúde (Editor). Lisboa; 2015. Disponível em: https://www.alimentacaosaudavel.dgs.pt/activeapp/wpcontent/files_mf/1444899925Alimentacaoenutricaonagravidez.pdf
https://www.alimentacaosaudavel.dgs.pt/a...

During pregnancy, there is a greater predisposition to positive changes in maternal food choices, which are driven by the desire for a healthy outcome in the baby's life.2727 O' Brien OA, Lindsay KL, McCarthy M, McGloin AF, Kennelly M, Scully HA, McAuliffe FM. Influences on the food choices and physical activity behaviours of overweight and obese pregnant women: A qualitative study. Midwifery. 2017; 47: 28-35. A cohort study in Rio de Janeiro analyzed the type of food processing and changes in food consumption before and during pregnancy and concluded that the consumption of ultra-processed foods decreased and the consumption of natural/minimally processed foods increased from the period before pregnancy and throughout pregnancy, thus emphasizing the importance of nutritional follow-up during pregnancy.2828 Santos NHA, Eshriqui I, Sena ABF, Cocate PG, Vilela AAF, Benaim C, Vaz JS, Castro MB, Kac G. Dietary intake variations from pre-conception to gestational period according to the degree of industrial processing: A Brazilian cohort. Appetite. 2016; 105: 164-71. Despite that, the vast majority of women continue to consume foods rich in sugar, saturated fat and sodium during pregnancy.1919 Favoretto CM, Wiernetz PL. Alimentação sustentável e alimentos de fast food: o que a química e o meio ambiente têm a ver com isso? In: Secretaria de Educação do Governo do Estado de Paraná. Os desafios da escola pública Paranaense na perspectiva do professor PDE: Artigos. Paraná: Programa de Desenvolvimento Educacional; 2013. p. 1-15. Such habits may be related to the increase in overweight and obesity55 Nascimento IB, Sales WB, Fleig R, Silva GD, Silva CS. Excesso de peso e dislipidemia e suas intercorrências no período gestacional: uma revisão sistemática. Rev Bras Saúde Matern Infant. 2016; 16 (2): 103-11. as well as heighten the predisposition of chronic diseases2929 Baraldi LG. Consumo de alimentos ultraprocessados e qualidade nutricional da dieta na população americana [tese]. São Paulo: Programa de Pós-graduação em Nutrição em Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo; 2016. such as diabetes mellitus, which is associated with high rates of perinatal morbidity and mortality.33 Brasil. Ministério da Saúde. Gestação de alto risco: manual técnico. 5 ed. Brasília, DF; 2010.

A simple way to reduce the chances of developing chronic diseases and improve maternal and neonatal health in the short and long term is - in addition to getting prenatal care - to reduce the consumption of ultra-processed foods.1919 Favoretto CM, Wiernetz PL. Alimentação sustentável e alimentos de fast food: o que a química e o meio ambiente têm a ver com isso? In: Secretaria de Educação do Governo do Estado de Paraná. Os desafios da escola pública Paranaense na perspectiva do professor PDE: Artigos. Paraná: Programa de Desenvolvimento Educacional; 2013. p. 1-15. The consumption of this kind of food should be reduced because they are rich in saturated fat, trans fat and free sugar and poor in fiber and protein when compared with natural/minimally processed foods.99 Louzada MLC, Martins APB, Canella DS, Baraldi LG, Levy RB, Claro RM, Moubarac JC, Cannon G, Monteiro CA. Impacto de alimentos ultraprocessados sobre o teor de micronutrientes da dieta no Brasil. Rev Saúde Pública. 2015; 49: 45.,3030 Monteiro CA, Levy RB, Claro RM, Castro IRR, Cannon G. A new classification of foods based on the extent and purpose of their processing. Cad Saúde Pública. 2010; 26 (11): 2039-49. A diet based on natural and minimally processed foods may even prevent diseases.88 Verly Junior E, Carvalho AM, Fisberg RM, Marchioni DML. Adesão ao guia alimentar para população brasileira. Rev Saúde Pública. 2013; 47 (6): 1021-7.

One of the limitations of this study may have been the use of a single dietary recall from each high-risk pregnant woman. In addition, the dietary recall was based on secondary data and hence there may have been underestimation or overestimation of habitual consumption. This study is expected to contribute to the improvement of the care of pregnant women and to the evolution of scientific knowledge, thus improving health education and strengthening current public policies in the field of maternal and child health.

In the present study, the mean percentages of intake of lipids, monounsaturated fatty acids, polyunsaturated fatty acids and sodium were higher among ultra-processed foods. It was also observed that the older the maternal age of high-risk pregnant women, the lower the intake of total calories and the percentages of carbohydrates and proteins from ultra-processed foods. Finally, it was observed that pregestational nutritional status is significantly associated with the intake of total calories and percentage of carbohydrates from ultra-processed foods.

Thus, the study confirmed that the consumption of ultra-processed foods is present among high-risk pregnant women, which makes it necessary to develop nutrition education actions and strengthen existing public policies in the field of maternal and child health in order to raise women's awareness of how much their food consumption and habits may affect their children's lives in the short and long term.

References

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    Bueno AAA, Beserra JAS, Weber ML. Características da alimentação no período gestacional. LifeStyle J. 2016; 3 (2): 30-43.
  • 2
    Teixeira D, Pestana D, Calhau C, Vicente L, Graça P. Alimentação e Nutrição na Gravidez. Programa Nacional para a Promoção da Alimentação Saudável. Direção-Geral da Saúde (Editor). Lisboa; 2015. Disponível em: https://www.alimentacaosaudavel.dgs.pt/activeapp/wpcontent/files_mf/1444899925Alimentacaoenutricaonagravidez.pdf
    » https://www.alimentacaosaudavel.dgs.pt/activeapp/wpcontent/files_mf/1444899925Alimentacaoenutricaonagravidez.pdf
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    Brasil. Ministério da Saúde. Gestação de alto risco: manual técnico. 5 ed. Brasília, DF; 2010.
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    Rodrigues AFC, Farias ER, Gomes FKI, Pureza IROM, Leite JGM, Braga RC, Pereira WD. Perfil nutricional de gestantes de alto risco atendidas numa clínica escola de nutrição de Maceió - AL e incentivo ao aleitamento materno. Entre Aberta Revista de Extensão. 2014; 1 (1): 1-8. Disponível em: revistas.cesmac.edu.br/index.php/entreaberta/article/download/302/221
    » revistas.cesmac.edu.br/index.php/entreaberta/article/download/302/221
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    Nascimento IB, Sales WB, Fleig R, Silva GD, Silva CS. Excesso de peso e dislipidemia e suas intercorrências no período gestacional: uma revisão sistemática. Rev Bras Saúde Matern Infant. 2016; 16 (2): 103-11.
  • 6
    Fazio ES, Nomura RMY, Dias MCG, Zugaib M. Consumo dietético de gestantes e ganho ponderal materno após aconselhamento nutricional. Rev Bras Ginecol Obstet. 2011; 33 (2): 87-92.
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    Louzada MLC, Martins APB, Canella DS, Baraldi LG, Levy RB, Claro RM, Moubarac JC, Cannon G, Monteiro CA. Impacto de alimentos ultraprocessados sobre o teor de micronutrientes da dieta no Brasil. Rev Saúde Pública. 2015; 49: 45.
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Publication Dates

  • Publication in this collection
    22 July 2019
  • Date of issue
    Apr-Jun 2019

History

  • Received
    10 July 2018
  • Reviewed
    25 Jan 2019
  • Accepted
    01 Feb 2019
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