[show abstract][hide abstract] ABSTRACT: OBJECTIVE: To evaluate dietary quality in a sample of pregnant women based on one simple and objective parameter. METHODS: Pregnant women (n = 712), between 16 and 36 weeks, attending primary care clinics in Porto Alegre and Bento Gonçalves, Southern Brazil, in 2010 were recruited to take part. The Healthy Eating Index for Brazilian Pregnancy (HEIP-B) was created, derived from the American instrument called Alternate Healthy Eating Index for Pregnancy (AHEI-P). Questionnaires on frequency of consumption and on socio-demographic factors were completed. Focused principal component analysis (ACPF) was used to assess the relationship between the index and nutrients relevant to pregnancy. RESULTS: The median (interquartile range) of AHEI-P and HEIP-B were 66.6 (57.8-72.4) and 67.4 (60.0-73.4), respectively. The HEIP-B showed a good positive correlation with nutrients which are specifically recommended for pregnancy: folate (r = 0.8; p < 0.001), calcium (r = 0.6; p < 0.001) and iron (r = 0.7; p < 0.001). CONCLUSIONS: The quality of the diet of the pregnant women in this study was classified as within the "improvements needed" cut off point, which demonstrates the need for more specific education on nutrition for this stage of life. The index showed good correlations and, thus, may be considered an effective tool for assessing the quality of nutrition during pregnancy.
Revista de saude publica 02/2013; 47(1):20-28. · 1.01 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study evaluated the reproducibility and relative validity of the Food Frequency Questionnaire (FFQ) used in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Participants (n = 281) completed the FFQ and three food records on two occasions during a 12-month period. Energy and nutrient values from food records were disattenuated and log-transformed. Reproducibility and validity were assessed by the intra-class correlation coefficient (ICC). Agreement between the two methods was evaluated by classification in tertiles. In the evaluation of reproducibility, ICC estimated ranged from 0.55 to 0.83 for protein and vitamin E, respectively. On relative validity, ICC ranged from 0.20 to 0.72 for selenium and calcium, respectively. Exact and adjacent agreement between methods varied from 82.9% for vitamin E to 89% for lipids and calcium (mean 86%). Average disagreement was 13.6%. In conclusion, this FFQ showed satisfactory reliability for all nutrients and reasonable validity, especially for energy, macronutrients, calcium, potassium, and vitamins E and C.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 02/2013; 29(2):379-89. · 0.83 Impact Factor
[show abstract][hide abstract] ABSTRACT: To investigate the association between weekly weight gain, during the second and third trimesters, classified according to the 2009 Institute of Medicine (IOM/NRC) recommendations, and maternal and fetal outcomes.
Gestational weight gain was evaluated in 2,244 pregnant women of the Brazilian Study of Gestational Diabetes (Estudo Brasileiro do Diabetes Gestacional - EBDG). Outcomes were cesarean delivery, preterm birth and small or large for gestational age birth (SGA, LGA). Associations between inadequate weight gain and outcomes were estimated using robust Poisson regression adjusting for pre-pregnancy body mass index, trimester-specific weight gain, age, height, skin color, parity, education, smoking, alcohol consumption, gestational diabetes and hypertensive disorders in pregnancy.
In fully adjusted models, in the second trimester, insufficient weight gain was associated with SGA (relative risk [RR] 1.72, 95% confidence interval [CI] 1.26-2.33), and excessive weight gain with LGA (RR 1.64, 95% CI 1.16-2.31); in third trimester, excessive weight gain with preterm birth (RR 1.70, 95% CI 1.08-2.70) and cesarean delivery (RR 1.21, 95% CI 1.03-1.44). Women with less than recommended gestational weight gain in the 2(nd) trimester had a lesser risk of cesarean deliveries (RR 0.82, 95% CI 0.71-0.96) than women with adequate gestational weight gain in this trimester.
Though insufficient weight gain in the 3(rd) trimester was not associated with adverse outcomes, other deviations from recommended weight gain during second and third trimester were associated with adverse pregnancy outcomes. These findings support, in part, the 2009 IOM/NRC recommendations for nutritional monitoring during pregnancy.
PLoS ONE 01/2013; 8(1):e54704. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: OBJECTIVE: To evaluate the effect of fibre intake on the evolution of maternal BMI from pregnancy to postpartum and to identify dietary patterns associated with fibre intake. DESIGN: Cohort study. Food intake was obtained using an FFQ. Focused principal component analysis was used focusing on the variables: postpartum weight retention and total dietary fibre intake. Poisson regression models with robust variance were built in order to measure the effect of fibre intake during the postpartum period on obesity risk. SETTING: Primary care clinics in southern Brazil. SUBJECTS: Pregnant women (n 370) were followed until the 5th month postpartum. RESULTS: The highest contribution to fibre intake came from the consumption of beans. Consumption of bread and rice indicated a common Brazilian food pattern along with beans. Participants retained a median of 4·4 (interquartile range 0·6, 7·9) kg of weight gained during pregnancy. Obesity risk, defined as an unfavourable evolution of BMI during pregnancy and postpartum, was present in 189 (55·1 %) women. Individual food items did not have an important effect on weight retention. In Poisson regression adjusting for maternal age, pre-pregnancy BMI and total gestational weight gain, inadequate postpartum fibre intake increased obesity risk by 24 % (relative risk = 1·24; 95 % CI 1·05, 1·47). CONCLUSIONS: Important maternal weight retention occurred in these women. Adequate fibre intake may reduce obesity risk in the period following childbirth.
Public Health Nutrition 08/2012; · 2.25 Impact Factor
[show abstract][hide abstract] ABSTRACT: OBJECTIVE: To evaluate whether anthropometric and dietary intake indicators are predictors of pulmonary function in cystic fibrosis (CF) patients. METHODS: This was a cross-sectional study involving 69 patients (age range, 5.4-16.5 years) diagnosed with CF under follow-up at the Hospital de Clínicas de Porto Alegre, located in the city of Porto Alegre, Brazil. Anthropometric assessment was based on body mass index (BMI), mid-arm muscle circumference (MAMC), and triceps skinfold thickness (TST). Dietary intake was assessed by using recall data, which were compared with the recommended dietary allowances. Pulmonary function was assessed by ventilatory capacity, expressed as FEV1. Prevalence ratios for the outcome studied (FEV1 < 80% of predicted) were calculated by indicator. RESULTS: In patients with MAMC and TST below the 25th percentile, the prevalence of FEV1 < 80% of predicted was significantly higher than in those with higher MAMC and TST (p < 0.001 and p = 0.011, respectively). In comparison with other patients, those with a BMI below the 50th percentile showed a 4.43 times higher prevalence of FEV1 < 80% of predicted (95% CI: 1.58-12.41), and that prevalence was 2.54 times higher in those colonized with methicillin-resistant Staphylococcus aureus (MRSA) than in those not so colonized (95% CI: 1.43-4.53). The association between dietary intake and the prevalence of FEV1 < 80% of predicted was of only borderline significance (95% CI: 0.95-3.45). CONCLUSIONS: Not being colonized with MRSA and having a BMI above the 50th percentile appear to preserve pulmonary function in CF patients.
Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 08/2012; 38(4):470-476.
[show abstract][hide abstract] ABSTRACT: In order to describe adequacy of weight gain during pregnancy and its association with pre-pregnancy nutritional status and other factors, a cohort study of pregnant women enrolled at 16-36 weeks of gestation and followed up until delivery was carried out in prenatal care in primary care services in Rio Grande do Sul State, Brazil. Maternal weight was recorded at each prenatal care visit. Weight gain was classified as "adequate," "insufficient" or "excessive" (Institute of Medicine). Poisson regression was used to measure the associations. The sample was comprised of 667 women, and insufficient and excessive weight gain incidences were 25.8% and 44.8%, respectively. Overweight and obese before pregnancy had a significant increased risk of excessive weight gain in pregnancy (RR: 1.75; 95%CI: 1.48-2.07, RR: 1.55; 95%CI: 1.23-1.96, respectively). Women with fewer than six prenatal visits had a 52% increased risk for weight gain below recommended values. Although insufficient weight gain may still be a public health problem, excessive gain is becoming a concern that needs immediate attention in prenatal care.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 05/2010; 26(5):1024-34. · 0.83 Impact Factor
[show abstract][hide abstract] ABSTRACT: Woman's nutritional status, before and during pregnancy, is a strong determinant of health outcomes in the mother and newborn. Gestational weight gain and postpartum weight retention increases risk of overweight or obesity in the future and they depend on the pregestational nutritional status and on food consumption and eating behavior during pregnancy. Eating behavior during pregnancy may be the cause or consequence of mood changes during pregnancy, especially depression, which increases likelihood of postpartum depression. In Brazil, a study carried out in the immediate postpartum period found that one in three women experienced some type of violence during pregnancy. Violence and depression are strongly associated and both exposures during pregnancy are associated with increased maternal stress and subsequent harm to the infant. The main objectives of this study are: to identify food intake and eating behaviors patterns; to estimate the prevalence of common mental disorders and the experience of violence during and after pregnancy; and to estimate the association between these exposures and infant's health and development.
This is a cohort study of 780 pregnant women receiving care in 18 primary care units in two cities in Southern Brazil. Pregnant women were first evaluated between the 16th and 36th week of pregnancy at a prenatal visit. Follow-up included immediate postpartum assessment and around the fifth month postpartum. Information was obtained on sociodemographic characteristics, living circumstances, food intake, eating behaviors, mental health and exposure to violence, and on infant's development and anthropometrics measurements.
This project will bring relevant information for a better understanding of the relationship between exposures during pregnancy and how they might affect child development, which can be useful for a better planning of health actions aiming to enhance available resources in primary health care.
[show abstract][hide abstract] ABSTRACT: To determine the relationship between nutritional status and dietary intake in patients with cystic fibrosis.
Cross-sectional study involving 85 cystic fibrosis patients between 6 and 18 years of age. Dietary intake was evaluated by the 3-day diet record (weighing the food consumed). The outcome measures were the following nutritional status indicators: weight/height (W/H%) percentage, body mass index (BMI) percentiles, Z score for weight/age (W/A), Z score for height/age (H/A) and percentage of dietary intake compared with the Recommended Dietary Allowance (RDA).
The prevalence of well-nourished patients was 77.7%, using BMI above the 25th percentile as the cut-off value, and the W/H% was above 90% in 83.5%. The mean dietary intake, evaluated in 82 patients, was 124.5% of the RDA. In the univariate logistic regression analyses, we found a significant association between the independent variable calorie intake and the Z score for W/A. The multivariate analysis, based on the Z score for H/A and adjusted for FEV1, methicillin-resistant Staphylococcus aureus colonization and number of hospitalizations, demonstrated that a 1% increase in the calorie intake decreases the chance of having short stature by 2% (OR: 0.98; 95% CI: 0.96-1.00). Maternal level of education showed a borderline association (p = 0.054).
The prevalence of malnutrition was low in this sample of patients. The study model demonstrated an association between dietary intake and nutritional status. Dietary intake was a predictive factor of statural growth in patients with cystic fibrosis.
Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 10/2009; 35(10):966-72.
[show abstract][hide abstract] ABSTRACT: Increase in fibre intake during pregnancy may reduce weight gain, glucose intolerance, dyslipidaemia, pre-eclampsia and constipation. Few studies have evaluated adequacy of fibre intake during pregnancy.
To assess, through an FFQ, the dietary fibre intake of pregnant women receiving prenatal care from general public practices and compare it with current guidelines.
Cross-sectional analyses of a pregnancy cohort study (ECCAGE-Study of Food Intake and Eating Behaviour in Pregnancy) conducted in eighteen general practices in southern Brazil, from June 2006 to April 2007.
Five hundred and seventy-eight pregnant women with mean (SD) age of 24.9 (6.5) years and mean gestational age of 24.5 (5.8) weeks.
The mean energy intake was 11 615 kJ/d (2776 kcal/d). The mean total fibre intake (30.2 g/d) was slightly above the recommended value of 28 g/d (P < 0.001), yet 50% (95% CI 46, 54) of the women failed to meet the recommendation. Whole-grain fibre constituted only 1% of total fibre intake in the cereal group. In adjusted Poisson regression analyses, not meeting the recommendation for fibre intake was associated with alcohol intake (prevalence ratio 1.29; 95% CI 1.11, 1.50) and absence of nutritional guidance (prevalence ratio 1.22; 95% CI 1.05, 1.42) during pregnancy.
About half of the pregnant women failed to meet the recommended fibre intake, especially those not reporting nutritional guidance during pregnancy. For most women, whole-grain cereal intake was absent or trivial. Taken together, our data indicate the need, at least in this setting, for greater nutritional education in prenatal care.
Public Health Nutrition 01/2009; 12(9):1392-8. · 2.25 Impact Factor
[show abstract][hide abstract] ABSTRACT: Objective: To determine the relationship between nutritional status and dietary intake in patients with cystic fibrosis. Methods: Cross-sectional study involving 85 cystic fibrosis patients between 6 and 18 years of age. Dietary intake was evaluated by the 3-day diet record (weighing the food consumed). The outcome measures were the following nutritional status indicators: weight/height (W/H%) percentage, body mass index (BMI) percentiles, Z score for weight/age (W/A), Z score for height/age (H/A) and percentage of dietary intake compared with the Recommended Dietary Allowance (RDA). Results: The prevalence of well-nourished patients was 77.7%, using BMI above the 25th percentile as the cut-off value, and the W/H% was above 90% in 83.5%. The mean dietary intake, evaluated in 82 patients, was 124.5% of the RDA. In the univariate logistic regression analyses, we found a significant association between the independent variable calorie intake and the Z score for W/A. The multivariate analysis, based on the Z score for H/A and adjusted for FEV1, methicillin-resistant Staphylococcus aureus colonization and number of hospitalizations, demonstrated that a 1% increase in the calorie intake decreases the chance of having short stature by 2% (OR: 0.98; 95% CI: 0.96-1.00). Maternal level of education showed a borderline association (p = 0.054). Conclusions: The prevalence of malnutrition was low in this sample of patients. The study model demonstrated an association between dietary intake and nutritional status. Dietary intake was a predictive factor of statural growth in patients with cystic fibrosis.
Jornal Brasileiro De Pneumologia - J BRAS PNEUMOL. 01/2009; 35(10).
[show abstract][hide abstract] ABSTRACT: To examine the prevalence of inappropriate eating behaviors and associated factors among pregnant women in primary care.
The Eating Disorder Examination Questionnaire was used to assess eating disorders and the Primary Care Evaluation of Mental Disorders was used to examine anxiety and depressive symptoms. Body mass index (BMI) and pregestational weight were also assessed.
Prevalence of binge eating during pregnancy was 17.3% [95% confidence interval (CI) 14.5-20.0], followed by excessive shape (5.6%; 95% CI 4-8) and weight concerns (5.5%; 95% CI 4-8). Binge eating during pregnancy was significantly associated with binge eating before pregnancy [prevalence ratio (PR) = 3.1; 95% CI 2.2-4.3], current anxiety symptoms (PR = 1.8; 95% CI 1.3-2.4), and prepregnancy BMI < 19.8 kg/m(2) (PR = 1.6; 95% CI 1.1-2.5). The prevalence of eating disorders was 0.6% (95% CI 0.01-1.11).
Eating disorder symptoms should be routinely assessed and treated during prenatal care, along with other comorbid psychiatric symptoms such as anxiety.
International Journal of Eating Disorders 01/2009; 42(5):387-93. · 2.88 Impact Factor
[show abstract][hide abstract] ABSTRACT: AimTo estimate the prevalence of violence, depressive symptoms, and associated factors during pregnancy in women attending antenatal
care in Brazil.
MethodsViolence was assessed using a modified version of the abuse assessment screen (ASS), and depressive symptoms were evaluated
using the primary care evaluation of mental disorders (PRIME-MD). Participants were pregnant women attending 18 primary care
units in Rio Grande do Sul, Brazil, between June 2006 and April 2007. A total of 712 pregnant women participated, but only
627 of them responded the ASS.
ResultsExperience of any lifetime violence was reported by 273 (43.4%) women and 114 (18.2%) reported violence during the current
pregnancy. One-third of them (n=211) reported lifetime domestic violence and 100 (15.9%) women reported this type of violence during the current pregnancy.
Experience of domestic violence during pregnancy was more common in unemployed women, among those with two or more children,
with a higher consumption of alcohol, and who had not planned their current pregnancy. Of the total of sample (n=712), 198 (27.8%) women reported six or more depressive symptoms. The presence of depressive symptoms during pregnancy
was associated with low educational levels, living in a household with five or more people, and with higher consumption of
alcohol during pregnancy.
ConclusionPregnant women attending primary care are exposed to high rates of domestic violence, and many have clinically relevant depressive
symptoms. Appropriate interventions to avoid or minimize the effects of violence and mental disorders to the well-being of
the mothers and their babies are urgently required. Primary care services play an important role in identifying and supporting
women at risk.
KeywordsPregnancy-Depressive symptoms-Domestic violence-Primary care
Social Psychiatry and Psychiatric Epidemiology 45(10):983-988. · 2.86 Impact Factor