Consumo alimentar durante a gestação e desfechos de saúde materno-infantil
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Data
2020-02-18
Autores
Gomes, Caroline de Barros
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Universidade Estadual Paulista (Unesp)
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Introdução: A avaliação do índice glicêmico (IG) e da carga glicêmica (CG) da dieta, o percentual energético advindo de alimentos ultraprocessados (%UPP) e identificação de padrões alimentares (PA) são três das mais recentes formas de avaliação do consumo alimentar, permitindo uma avaliação global da dieta. Estas formas de avaliação, quando aplicadas a gestantes, podem contribuir para avançar no entendimento da influência da alimentação sobre desfechos de saúde materno-infantil. Objetivo: Avaliar a associação da alimentação durante gestação e o ganho de peso gestacional (GPG) e o peso ao nascer dos bebês investigando o consumo alimentar de três diferentes maneiras: 1. IG e CG; 2. %UPP e 3. PA. Métodos: Tratam-se de estudos observacionais, longitudinais, com dados advindos de um projeto matriz, no qual foram acompanhadas duas coortes de gestantes de risco obstétrico habitual de Botucatu-SP. Foram convidadas a participar todas as gestantes inscritas entre novembro de 2012 a junho de 2013 (n=353) na rede de atenção primária à saúde do município. Em cada trimestre gestacional, aplicaram-se dois inquéritos do tipo recordatório alimentar de 24 horas, um por entrevista presencial e outro por telefone, referentes a dia de semana e final de semana; os dados foram processados no software Nutrition Data System for Research (NDSR). O IG e a CG da dieta foram obtidos no próprio software; o %UPP foi calculado segundo a classificação NOVA; para identificação dos PA, realizou-se análise de componentes principais. O peso ao nascer em gramas foi obtido no Sistema de Informações sobre Nascidos Vivos, com cálculo do escore-z segundo sexo e idade gestacional ao nascimento, de acordo com as diretrizes do International Fetal and Newborn Consortium for the 21st Century (INTERGROWTH-21st). O ganho ponderal gestacional no segundo e terceiro trimestre foi estimado com base nos dados registrados nos prontuários adotando-se as recomendações e classificações do Institute of Medicine. Ao final do seguimento, 267 gestantes foram acompanhadas. A associação entre exposições e desfechos foi realizada com modelos de regressão linear ou logística, conforme natureza da variável de desfecho, corrigidos por coorte e pelas variáveis potencialmente confundidoras. As análises foram realizadas no software STATA versão 14.2, considerando p<0,05 como estatisticamente significante. Resultados: O aumento de um ponto no IG significou diminuição de, em média, 12 gramas no GPG semanal. O aumento de um ponto no %UPP expressou, em média, 2g a mais no GPG semanal no segundo e terceiro trimestres. O aumento de um ponto no escore de adesão ao padrão Integral, Frutas, Legumes e Leite com baixo teor de gordura e Derivados do Leite no segundo trimestre gestacional representou um aumento 26,7 gramas no GPG semanal, mas não se manteve com o ajuste da energia. Conclusões: Diferentes avaliações do consumo alimentar durante a gestação revelaram associações com o ganho de peso gestacional, seja de maneira positiva ou negativa, contudo associações estatisticamente significativas com o peso ao nascer dos bebês não foram observadas. A importância da alimentação durante a gestação confirmou seu papel no desfecho do GPG, mas não encerra as investigações no campo, pelo contrário, amplia sua necessidade.
Introduction: Evaluation of glycemic index (GI) and glycemic load (GL), energy percentage provided from ultra-processed foods (% UPF) and identification of dietary patterns (DP) are three of the most recent ways of assessing food consumption, allowing an overall assessment of the diet. These forms of assessment, when applied to pregnant women, may contribute to advance the understanding of the influence of feeding on maternal and child health outcomes. Objective: To assess the association of food consumption during pregnancy and gestational weight gain (GWG) and birth weight by investigating. Food consumption in three different ways: 1. GI and GL; 2.% UPF; 3. DP. Methods: These are observational, longitudinal studies, with data from a matrix project, in which two cohorts of pregnant women at habitual obstetric risk from Botucatu-SP, Brazil were followed. All pregnant women enrolled between November 2012 and June 2013 (n = 353) in the primary health care network of the municipality were invited to participate. In each gestational trimester, two 24-hour dietary recalls were applied, one by face-to-face interview and the other by telephone, regarding weekday and weekend. The data were processed in the Nutrition Data System for Research (NDSR) software. Dietary GI and GL were obtained in the software itself; % UPF was calculated according to the NOVA classification; To identify the DP, a principal component analysis was performed. Birth weight in grams was obtained from the Sistema de Informações sobre Nascidos Vivos by calculating the z-score according to sex and gestational age at birth according to the International Fetal and Newborn Consortium for the 21st Century (INTERGROWTH-21st) guidelines. The gestational weight gain in the second and third trimester was estimated based on the data recorded in the medical records, adopting the recommendations and classifications of the Institute of Medicine. At the end of follow-up, 267 pregnant women were followed. The association between exposures and outcomes was performed with linear or logistic regression models, depending on the nature of the outcome variable, corrected by cohort and potentially confounding variables. Analyzes were performed using STATA software version 14.2, considering p<0.05 as statistically significant. Results: A one-point increase in GI meant an average of 12 grams decrease in weekly gestational weight gain. The one-point increase in % UPF expressed, on average, 2g more in weekly gestational weight gain in the second and third trimesters. The one-point increase in the adherence score to the Whole Fat, Low-Fat Fruits, Vegetables and Dairy DP in the second gestational trimester represented an increase of 26.7 grams in the weekly GWG, but was not maintained with the energy. Conclusions: Different assessments of food consumption during pregnancy revealed associations with gestational weight gain, either positively or negatively, however associations with birth weight were not observed. The importance of feeding during pregnancy has confirmed its role in the outcome of GWG, but does not end investigations in the field, on the opposite, expands its need.
Introduction: Evaluation of glycemic index (GI) and glycemic load (GL), energy percentage provided from ultra-processed foods (% UPF) and identification of dietary patterns (DP) are three of the most recent ways of assessing food consumption, allowing an overall assessment of the diet. These forms of assessment, when applied to pregnant women, may contribute to advance the understanding of the influence of feeding on maternal and child health outcomes. Objective: To assess the association of food consumption during pregnancy and gestational weight gain (GWG) and birth weight by investigating. Food consumption in three different ways: 1. GI and GL; 2.% UPF; 3. DP. Methods: These are observational, longitudinal studies, with data from a matrix project, in which two cohorts of pregnant women at habitual obstetric risk from Botucatu-SP, Brazil were followed. All pregnant women enrolled between November 2012 and June 2013 (n = 353) in the primary health care network of the municipality were invited to participate. In each gestational trimester, two 24-hour dietary recalls were applied, one by face-to-face interview and the other by telephone, regarding weekday and weekend. The data were processed in the Nutrition Data System for Research (NDSR) software. Dietary GI and GL were obtained in the software itself; % UPF was calculated according to the NOVA classification; To identify the DP, a principal component analysis was performed. Birth weight in grams was obtained from the Sistema de Informações sobre Nascidos Vivos by calculating the z-score according to sex and gestational age at birth according to the International Fetal and Newborn Consortium for the 21st Century (INTERGROWTH-21st) guidelines. The gestational weight gain in the second and third trimester was estimated based on the data recorded in the medical records, adopting the recommendations and classifications of the Institute of Medicine. At the end of follow-up, 267 pregnant women were followed. The association between exposures and outcomes was performed with linear or logistic regression models, depending on the nature of the outcome variable, corrected by cohort and potentially confounding variables. Analyzes were performed using STATA software version 14.2, considering p<0.05 as statistically significant. Results: A one-point increase in GI meant an average of 12 grams decrease in weekly gestational weight gain. The one-point increase in % UPF expressed, on average, 2g more in weekly gestational weight gain in the second and third trimesters. The one-point increase in the adherence score to the Whole Fat, Low-Fat Fruits, Vegetables and Dairy DP in the second gestational trimester represented an increase of 26.7 grams in the weekly GWG, but was not maintained with the energy. Conclusions: Different assessments of food consumption during pregnancy revealed associations with gestational weight gain, either positively or negatively, however associations with birth weight were not observed. The importance of feeding during pregnancy has confirmed its role in the outcome of GWG, but does not end investigations in the field, on the opposite, expands its need.
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Palavras-chave
Nutrição na gravidez, Índice glicêmico, Carga glicêmica, Padrões alimentares, Alimentos ultraprocessados, Peso ao nascer, Gestação, Nutrition during pregnancy, Glycemic index, Glycemic load, Dietary patterns, Ultra-processed foods, Birth weight, Pregnancy