Association of dietary patterns and degree of food processing with feelings of depression in pregnancy

Badanai, Nayla de Lourenço; Zuccolotto, Daniela Cristina Candelas; Crivellenti, Lívia Castro; Sartorelli, Daniela Saes

doi:10.1590/1806-93042019000300006

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 19 (3) • Jul-Sep 2019 • https://doi.org/10.1590/1806-93042019000300006 copy

Association of dietary patterns and degree of food processing with feelings of depression in pregnancy

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to investigate the relationship of dietary patterns and degree of food processing with feelings of depression in pregnancy.

Methods:

cross-sectional study conducted with 784 adult pregnant women in Ribeirão Preto, SP, between 2011 and 2012. Feelings of depression were obtained through a structured questionnaire. Two 24-hour dietary recalls were obtained (24th-39th weeks of gestation) and adjusted through the Multiple Source Method. Four dietary patterns were determined: “Brazilian traditional”,“snacks”, “coffee”, and “healthy”. Adjusted logistic regression models were used to assess the relationship ofthe tertiles of dietary patterns and energy contribution (% E) of foods according to the degree of industrial processing with feelings of depression (always/most of the time vs. sometimes/never).

Results:

12% of the women reported feelings of depression during the pregnancy. Women with greater adherence to “Brazilian traditional”[OR= 0.54 (CI95%= 0.30-0.97)] and “healthy” patterns [0.53 (0.30-0.94)] and with higher % E from minimally processed foods [0.51 (0.28-0.93)] presented a lower chance of feelings of depression. A higher % E from ultra-processed foods [2.39 (1.29-4.41)] was directly associated with the outcome. No associations with the other patterns were found.

Conclusions:

greater adherence to the“Brazilian traditional” and “healthy” dietary patterns was inversely associated with feelings of depression during pregnancy, possibly mediated by the degree of industrial processing of the foods.

Key words
Pregnant women; Dietary habits; Industrialized foods; Depression

Maternal characteristics	Self report of feelings of depression or sadness			p ^* * p value according to Student's t-test for continuous variables with normal distribution, Mann-Whitney U test for continuous variables without normal distribution or Chi-square test for categorical variables.
	All (n = 784)	Yes (n = 94)	No (n = 690)
		Mean (SD)
Age (years)	28 (5)	29 (6)	27 (5)	0.002
Education (years of study)	9 (3)	9 (3)	9 (3)	0.470
Pre-gestational BMI (kg/m²)	26 (5)	26 (5)	26 (5)	0.290
Gestational week at interview	28 (3)	28 (3)	28 (3)	0.590
		n (%)
Marital status
Married/with partner	615 (78.4)	65 (69.1)	550 (79.7)	0.001
Single	143 (18.2)	20 (21.3)	123 (17.8)
Separated/widowed	26 (3.3)	9 (9.6)	17 (2.5)
Economic stratum
A+B	154 (19.6)	20 (21.3)	134 (19.4)	0.880
C	526 (67.1)	61 (64.9)	465 (67.4)
D+E	104 (13.3)	13 (13.8)	91 (13.2)
Self-report of skin color
White	349 (44.5)	45 (47.9)	304 (44.1)	0.230
Non-white	435 (55.5)	49 (52.1)	386 (55.9)
Amount of sleep (hours/day)
< 7	125 (15.9)	25 (26.6)	100 (14.5)	0.003
7\|-9	326 (41.6)	41 (43.6)	285 (41.3)
≥ 9	333 (42.5)	28 (29.8)	305 (44.2)
Alcohol consumption during pregnancy	197 (25.0)	29 (31.0)	168 (24.0)	0.110
Smoking status
Never smoked	623 (79.5)	68 (72.3)	555 (80.4)	0.005
Currently smokes	71 (9.1)	17 (18.1)	54 (7.8)
Ex-smoker	90 (11.5)	9 (9.6)	81(11.8)
		Median (P₂₅, P₇₅)
Physical activity (minutes/week)	40 (0.136)	60 (0.150)	40 (0.120)	0.180

	Self report of feelings of depression or sadness						p ^* * Chi-square test.
	All (n = 784)		Yes (n = 94)		No (n = 690)
	n	%	n	%	n	%
Eating patterns (Tertiles) Traditional Brazilian
1^st	260	33.2	38	40.4	222	32.2	0.07
2^nd	262	33.4	34	36.2	228	33.0
3^rd	262	33.4	22	23.4	240	34.8
Snacks
1^st	260	33.2	28	29.8	232	33.6	0.13
2^nd	262	33.4	40	42.6	222	32.2
3^rd	262	33.4	26	27.6	236	34.2
Coffee
1^st	261	33.3	27	28.8	234	33.9	0.55
2^nd	262	33.4	32	34.0	230	33.3
3^rd	261	33.3	35	37.2	226	32.8
Healthy
1^st	260	33.2	38	40.4	223	32.3	0.22
2^nd	262	33.4	31	33.0	231	33.5
3^rd	262	33.4	25	26.6	236	34.2
Food consumption by degree of industrial processing (Tertiles) Minimally processed
1^st	261	33.3	38	40.0	223	32.4	0.12
2^nd	261	33.3	33	35.1	228	33.0
3^rd	262	33.4	23	24.5	239	34.7
Processed
1^st	261	33.3	29	30.9	232	33.6	0.86
2^nd	261	33.3	32	34.0	229	33.2
3^rd	262	33.4	33	35.1	229	33.2
Ultra Processed
1^st	261	33.3	21	22.3	240	34.8	0.04
2^nd	261	33.3	33	35.1	228	33.0
3^rd	262	33.4	40	42.6	222	32.2

Eating patterns	1^st Tertile	2^nd Tertile	3^rd Tertile	p
"Brazilian Traditional"pattern
Crude model	1.00	0.87 (0.53, 1.43)	0.54 (0.31, 0.93)	0.03
Adjusted model^ Models adjusted for: age (years), education (years of schooling), marital status (single, married/with partner/widowed), smoking (never smoked, former smoker, smoker), alcohol consumption (yes/no), physical activity (minutes per week of walking or exercise), pre-gestational BMI (kg/m2), amount of sleep (<7; 7\|-9; ≥9 hours per day), gestational week at the time of interview (weeks) and total dietary energy (kcal).	1.00	0.92 (0.55, 1.54)	0.54 (0.30, 0.97)	0.04
"Snacks" pattern
Crude model	1.00	1.49 (0.89, 2.50)	0.91 (0.52, 1.60)	0.76
Adjusted model^ Models adjusted for: age (years), education (years of schooling), marital status (single, married/with partner/widowed), smoking (never smoked, former smoker, smoker), alcohol consumption (yes/no), physical activity (minutes per week of walking or exercise), pre-gestational BMI (kg/m2), amount of sleep (<7; 7\|-9; ≥9 hours per day), gestational week at the time of interview (weeks) and total dietary energy (kcal).	1.00	1.54 (0.89, 2.66)	0.91 (0.49, 1.67)	0.76
"Coffee" pattern
Crude model	1.00	1.21 (0.70, 2.08)	1.34 (0.79, 2.29)	0.28
Adjusted model^ Models adjusted for: age (years), education (years of schooling), marital status (single, married/with partner/widowed), smoking (never smoked, former smoker, smoker), alcohol consumption (yes/no), physical activity (minutes per week of walking or exercise), pre-gestational BMI (kg/m2), amount of sleep (<7; 7\|-9; ≥9 hours per day), gestational week at the time of interview (weeks) and total dietary energy (kcal).	1.00	1.28 (0.64, 1.98)	1.13 (0.65, 1.97)	0.67
"Healthy" pattern
Crude model	1.00	0.79 (0.47, 1.31)	0.62 (0.36, 1.06)	0.08
Adjusted model^ Models adjusted for: age (years), education (years of schooling), marital status (single, married/with partner/widowed), smoking (never smoked, former smoker, smoker), alcohol consumption (yes/no), physical activity (minutes per week of walking or exercise), pre-gestational BMI (kg/m2), amount of sleep (<7; 7\|-9; ≥9 hours per day), gestational week at the time of interview (weeks) and total dietary energy (kcal).	1.00	0.73 (0.43, 1.23)	0.53 (0.30, 0.94)	0.03

Food consumption (%E)	1^st Tertile	2^nd Tertile	3^rd Tertile	p
Minimally processed
Crude model	1.00	0.85 (0.51 - 1.40)	0.57 (0.33 - 0.98)	0.04
Adjusted model^ Models adjusted for: age (years), education (years of schooling), marital status (single, married/with partner/widowed), smoking (never smoked, former smoker, smoker), alcohol consumption (yes/no), physical activity (minutes per week of walking or exercise), pre-gestational BMI (kg/m2), amount of sleep (<7; 7\|-9; ≥9 hours per day), gestational week at the time of interview (weeks) and total dietary energy (kcal). TCV = Total caloric value.	1.00	0.87 (0.51 - 1.47)	0.51 (0.28 - 0.93)	0.03
Processed
Crude model	1.00	1.12 (0.66 - 1.91)	1.15 (0.68 - 1.96)	0.60
Adjusted model^ Models adjusted for: age (years), education (years of schooling), marital status (single, married/with partner/widowed), smoking (never smoked, former smoker, smoker), alcohol consumption (yes/no), physical activity (minutes per week of walking or exercise), pre-gestational BMI (kg/m2), amount of sleep (<7; 7\|-9; ≥9 hours per day), gestational week at the time of interview (weeks) and total dietary energy (kcal). TCV = Total caloric value.	1.00	1.06 (0.61 - 1.83)	1.15 (0.66 - 1.98)	0.62
Ultra-processed
Crude model	1.00	1.65 (0.93 - 2.94)	2.06 (1.18 - 3.60)	0.01
Adjusted model^ Models adjusted for: age (years), education (years of schooling), marital status (single, married/with partner/widowed), smoking (never smoked, former smoker, smoker), alcohol consumption (yes/no), physical activity (minutes per week of walking or exercise), pre-gestational BMI (kg/m2), amount of sleep (<7; 7\|-9; ≥9 hours per day), gestational week at the time of interview (weeks) and total dietary energy (kcal). TCV = Total caloric value.	1.00	1.87 (1.01 - 3.43)	2.39 (1.29 - 4.41)	0.01

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[1] Authors' contribution

NLB and DSS were responsible for the study design, data analysis, interpretation and writing of the manuscript. LCC and DCCZ contributed to the data collection, analysis and interpretation, and reviewed the manuscript. All the authors approved the final version of the manuscript.