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Correlates of Prenatal Diet Quality in Low-Income Hispanic Women

Published:April 05, 2019DOI:https://doi.org/10.1016/j.jand.2019.02.004

      Abstract

      Background

      Low-income Hispanic women are at-risk of poor prenatal diet quality. Correlates associated with prenatal diet quality in this group of women are understudied.

      Objective

      The objective of this study was to examine the associations between financial, cultural, psychosocial, and lifestyle correlates and prenatal diet quality in low-income Hispanic women.

      Design

      This cross-sectional analysis used data from pregnant women enrolled in the Starting Early Trial, a randomized-controlled trial of a primary-care based child obesity prevention program beginning in pregnancy. The trial enrolled women from clinics affiliated with a large urban medical center in New York City from 2012 to 2014. Financial, cultural, psychosocial, and lifestyle variables were collected using a comprehensive baseline questionnaire. Usual dietary intakes over the past year were assessed using the Block Food Frequency Questionnaire 2005 bilingual version.

      Participants

      The study enrolled low-income Hispanic women between 28 and 32 gestational weeks (N=519).

      Main outcome measures

      Prenatal diet quality was measured by the Healthy Eating Index 2015.

      Statistical analyses performed

      Unadjusted and adjusted multivariable linear regression analyses were performed to determine independent associations between financial, cultural, psychosocial, and lifestyle correlates and Healthy Eating Index 2015 total score.

      Results

      Overall prenatal diet quality was poor (mean Healthy Eating Index 2015 total score=69.0±9.4). Most women did not meet the maximum score for total vegetables (65.3%), whole grains (97.1%), dairy (74.8%), fatty acids (84.4%), refined grains (79.8%), sodium (97.5%), saturated fats (92.9%), and added sugars (66.5%). Women who reported screen time ≤2 hours/day, physical activity before and/or during pregnancy, and being born outside the United States had higher mean Healthy Eating Index 2015 total score than women with screen time >2 hours/day, no physical activity, and those born in the United States.

      Conclusions

      Prenatal diet quality of low-income pregnant Hispanic women was suboptimal. This cross-sectional study revealed associations between cultural and lifestyle factors and prenatal diet quality in low-income Hispanic women. Longitudinal studies are needed to determine long-term influences and specific behaviors to target for effective intervention studies.

      Keywords

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      References

        • Procter S.B.
        • Campbell C.G.
        Position of the Academy of Nutrition and Dietetics: Nutrition and lifestyle for a healthy pregnancy outcome.
        J Acad Nutr Diet. 2014; 114: 1099-1103
        • Ramakrishnan U.
        • Grant F.
        • Goldenberg T.
        • Zongrone A.
        • Martorell R.
        Effect of women's nutrition before and during early pregnancy on maternal and infant outcomes: A systematic review.
        Paediatr Perinat Epidemiol. 2012; 26: 285-301
        • Uusitalo U.
        • Arkkola T.
        • Ovaskainen M.L.
        • et al.
        Unhealthy dietary patterns are associated with weight gain during pregnancy among Finnish women.
        Public Health Nutr. 2009; 12: 2392-2399
        • von Ruesten A.
        • Brantsaeter A.L.
        • Haugen M.
        • et al.
        Adherence of pregnant women to Nordic dietary guidelines in relation to postpartum weight retention: Results from the Norwegian Mother and Child Cohort Study.
        BMC Public Health. 2014; 14: 75
        • Gluckman P.D.
        • Hanson M.A.
        • Cooper C.
        • Thornburg K.L.
        Effect of in utero and early-life conditions on adult health and disease.
        N Engl J Med. 2008; 359: 61-73
        • Crozier S.R.
        • Robinson S.M.
        • Borland S.E.
        • Godfrey K.M.
        • Cooper C.
        • Inskip H.M.
        Do women change their health behaviours in pregnancy? Findings from the Southampton Women's Survey.
        Paediatr Perinat Epidemiol. 2009; 23: 446-453
        • Bodnar L.M.
        • Simhan H.N.
        • Parker C.B.
        • et al.
        Racial or ethnic and socioeconomic inequalities in adherence to national dietary guidance in a large cohort of US pregnant women.
        J Acad Nutr Diet. 2017; 117: 867-877
        • Darmon N.
        • Drewnowski A.
        Does social class predict diet quality?.
        Am J Clin Nutr. 2008; 87: 1107-1117
        • Kirkpatrick S.I.
        • Dodd K.W.
        • Reedy J.
        • Krebs-Smith S.M.
        Income and race/ethnicity are associated with adherence to food-based dietary guidance among US adults and children.
        J Acad Nutr Diet. 2012; 112: 624-635.e626
        • US Census Bureau
        Facts for feature: Hispanic heritage month 2018. Profile America facts for features: CB18-FF.07.
        (Published September 2018. Accessed November 16, 2018)
        • Braveman P.
        • Marchi K.
        • Egerter S.
        • et al.
        Poverty, near-poverty, and hardship around the time of pregnancy.
        Matern Child Health J. 2010; 14: 20-35
        • Coleman-Jensen A.
        • Rabbitt M.P.
        • Gregory C.A.
        • Singh A.
        Household food security in the United States in 2016.
        (Published September 2017. Accessed August 17, 2018)
        • Dammann K.W.
        • Smith C.
        Factors affecting low-income women's food choices and the perceived impact of dietary intake and socioeconomic status on their health and weight.
        J Nutr Educ Behav. 2009; 41: 242-253
        • Black A.P.
        • Brimblecombe J.
        • Eyles H.
        • Morris P.
        • Vally H.
        • K OD
        Food subsidy programs and the health and nutritional status of disadvantaged families in high income countries: A systematic review.
        BMC Public Health. 2012; 12: 1099
        • Baskin R.
        • Hill B.
        • Jacka F.N.
        • O'Neil A.
        • Skouteris H.
        The association between diet quality and mental health during the perinatal period. A systematic review.
        Appetite. 2015; 91: 41-47
        • Fowles E.R.
        • Stang J.
        • Bryant M.
        • Kim S.
        Stress, depression, social support, and eating habits reduce diet quality in the first trimester in low-income women: A pilot study.
        J Acad Nutr Diet. 2012; 112: 1619-1625
        • Evenson K.R.
        • Wen F.
        National trends in self-reported physical activity and sedentary behaviors among pregnant women: NHANES 1999-2006.
        Prev Med. 2010; 50: 123-128
        • Emond J.A.
        • Karagas M.R.
        • Baker E.R.
        • Gilbert-Diamond D.
        Better diet quality during pregnancy is associated with a reduced likelihood of an infant born small for gestational age: An analysis of the prospective New Hampshire Birth Cohort Study.
        J Nutr. 2018; 148: 22-30
        • Thomson J.
        • Tussing-Humphreys L.
        • Goodman M.
        • Olender S.
        Baseline demographic, anthropometric, psychosocial, and behavioral characteristics of rural, Southern women in early pregnancy.
        Matern Child Health J. 2016; 20: 1980-1988
        • Hales C.M.
        • Carroll M.D.
        • Fryar C.D.
        • Ogden C.L.
        Prevalence of obesity among adults and youth: United States, 2015-2016.
        NCHS Data Brief. 2017; 288: 1-8
        • Gross R.S.
        • Mendelsohn A.L.
        • Gross M.B.
        • Scheinmann R.
        • Messito M.J.
        Randomized controlled trial of a primary care-based child obesity prevention intervention on infant feeding practices.
        J Pediatr. 2016; 174: 171-177.e172
        • NutritionQuest
        Questionnaires and screening.
        (Published 2014. Accessed August 1, 2016)
        • Crozier S.R.
        • Robinson S.M.
        • Godfrey K.M.
        • Cooper C.
        • Inskip H.M.
        Women's dietary patterns change little from before to during pregnancy.
        J Nutr. 2009; 139: 1956-1963
        • Rifas-Shiman S.L.
        • Rich-Edwards J.W.
        • Willett W.C.
        • Kleinman K.P.
        • Oken E.
        • Gillman M.W.
        Changes in dietary intake from the first to the second trimester of pregnancy.
        Paediatr Perinat Epidemiol. 2006; 20: 35-42
        • Block G.
        • DiSogra C.
        WIC Dietary Assessment Validation Study, Final Report.
        US Department of Agriculture, Food and Nutrition Service, Alexandria, VA1995
        • Johnson B.A.
        • Herring A.H.
        • Ibrahim J.G.
        • Siega-Riz A.M.
        Structured measurement error in nutritional epidemiology: Applications in the Pregnancy, Infection, and Nutrition (PIN) Study.
        J Am Stat Assoc. 2007; 102: 856-866
        • US Departments of Health and Human Services and Agriculture
        2015-2020 Dietary Guidelines for Americans, 8th ed.
        (Published December 2015. Accessed August 1, 2018)
        • Krebs-Smith S.M.
        • Pannucci T.E.
        • Subar A.F.
        • et al.
        Update of the Healthy Eating Index: HEI-2015.
        J Acad Nutr Diet. 2018; 118: 1591-1602
        • Reedy J.
        • Lerman J.L.
        • Krebs-Smith S.M.
        • et al.
        Evaluation of the Healthy Eating Index-2015.
        J Acad Nutr Diet. 2018; 118: 1622-1633
        • National Cancer Institute
        SAS code. Healthy Eating Index.
        (Revised January 2018. Accessed July 1, 2018)
        • Institute of Medicine, Food and Nutrition Board
        Dietary Reference Intakes: The Essential Guide to Nutrient Requirements.
        The National Academies Press, Washington, DC2006
        • Doyle I.M.
        • Borrmann B.
        • Grosser A.
        • Razum O.
        • Spallek J.
        Determinants of dietary patterns and diet quality during pregnancy: A systematic review with narrative synthesis.
        Public Health Nutr. 2017; 20: 1009-1028
        • Fowles E.R.
        • Bryant M.
        • Kim S.
        • et al.
        Predictors of dietary quality in low-income pregnant women: A path analysis.
        Nurs Res. 2011; 60: 286-294
        • Nash D.M.
        • Gilliland J.A.
        • Evers S.E.
        • Wilk P.
        • Campbell M.K.
        Determinants of diet quality in pregnancy: Sociodemographic, pregnancy-specific, and food environment influences.
        J Nutr Educ Behav. 2013; 45: 627-634
        • Ayala G.X.
        • Baquero B.
        • Klinger S.
        A systematic review of the relationship between acculturation and diet among Latinos in the United States: Implications for future research.
        J Am Diet Assoc. 2008; 108: 1330-1344
        • Bickel G.
        • Nord M.
        • Price C.
        • Hamilton W.
        • Cook J.
        Guide to measuring household food security (Revised 2000).
        (Published September 1997. Revised March 2000. Accessed August 1, 2018)
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The PHQ-9: Validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
      1. A data users guide to the BRFSS physical activity questions. How to assess the 2008 Physical Activity Guidelines for Americans.
        (Published 2011. Accessed August 1, 2018)
        • Rousham E.K.
        • Clarke P.E.
        • Gross H.
        Significant changes in physical activity among pregnant women in the UK as assessed by accelerometry and self-reported activity.
        Eur J Clin Nutr. 2006; 60: 393-400
        • Gaston A.
        • Cramp A.
        Exercise during pregnancy: A review of patterns and determinants.
        J Sci Med Sport. 2011; 14: 299-305
        • Hu F.B.
        • Li T.Y.
        • Colditz G.A.
        • Willett W.C.
        • Manson J.E.
        Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women.
        JAMA. 2003; 289: 1785-1791
        • World Health Organization Consultation on Obesity
        Obesity: Preventing and Managing the Global Epidemic.
        World Health Organization, Geneva, Switzerland2000
      2. STATA Data Analysis and Statistical Software version 15.0. StataCorp, College Station, TX2018
        • Willett W.
        Nutritional Epidemiology.
        Oxford University Press, New York, NY2013
        • Sotos-Prieto M.
        • Bhupathiraju S.N.
        • Mattei J.
        • et al.
        Association of changes in diet quality with total and cause-specific mortality.
        N Engl J Med. 2017; 377: 143-153
        • Hinkle D.E.
        • Wiersma W.
        • Jurs S.G.
        Applied Statistics for the Behavioral Sciences.
        Houghton Mifflin, Boston, MA2003
        • Pardoe I.S.
        • Young D.
        STAT 501 regression methods. 12.4 - Detecting multicollinearity using variance inflation factors.
        (Revised 2018. Accessed August 1, 2018)
        • Cohen J.
        Statistical Power Analysis for the Behavioral Sciences.
        L Erlbaum Associates, Hillsdale, NJ1988
        • Watts V.
        • Rockett H.
        • Baer H.
        • Leppert J.
        • Colditz G.
        Assessing diet quality in a population of low-income pregnant women: A comparison between Native Americans and whites.
        Matern Child Health J. 2007; 11: 127-136
        • Rifas-Shiman S.L.
        • Rich-Edwards J.W.
        • Kleinman K.P.
        • Oken E.
        • Gillman M.W.
        Dietary quality during pregnancy varies by maternal characteristics in Project Viva: A US cohort.
        J Am Diet Assoc. 2009; 109: 1004-1011
        • Champagne C.M.
        • Casey PH
        • Connell C.L.
        • et al.
        Poverty and food intake in rural America: Diet quality is lower in food insecure adults in the Mississippi Delta.
        J Am Diet Assoc. 2007; 107: 1886-1894
        • Leung C.W.
        • Epel E.S.
        • Ritchie L.D.
        • Crawford P.B.
        • Laraia B.A.
        Food insecurity is inversely associated with diet quality of lower-income adults.
        J Acad Nutr Diet. 2014; 114: 1943-1953.e1942
        • Gamba R.
        • Leung C.W.
        • Guendelman S.
        • Lahiff M.
        • Laraia B.A.
        Household food insecurity is not associated with overall diet quality among pregnant women in NHANES 1999-2008.
        Matern Child Health J. 2016; 20: 2348-2356
        • Supplemental Nutrition Assistance Program
        What can SNAP buy?.
        (Published November 2017. Accessed January 15, 2019)
        • Oliveira V.
        • Racine E.
        • Olmsted J.
        • Ghelfi L.
        The WIC program: Background, trends, and issues. Economic Information Bulletin No. 134.
        (Published January 2015. Accessed August 1, 2018)
      3. Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Revisions in the WIC food packages; final rule.
        (Published March 2014. Accessed January 15, 2019)
        • Andreyeva T.
        • Tripp A.S.
        • Schwartz M.B.
        Dietary quality of Americans by Supplemental Nutrition Assistance Program participation status: A systematic review.
        Am J Prev Med. 2015; 49: 594-604
        • Schultz D.J.
        • Byker Shanks C.
        • Houghtaling B.
        The impact of the 2009 Special Supplemental Nutrition Program for Women, Infants, and Children food package revisions on participants: A systematic review.
        J Acad Nutr Diet. 2015; 115: 1832-1846
        • Tester J.M.
        • Leung C.W.
        • Crawford P.B.
        Revised WIC food package and children's diet quality.
        Pediatrics. 2016; 137
        • Duffey K.J.
        • Gordon-Larsen P.
        • Ayala G.X.
        • Popkin B.M.
        Birthplace is associated with more adverse dietary profiles for US-born than for foreign-born Latino adults.
        J Nutr. 2008; 138: 2428-2435
        • Di Noia J.
        • Monica D.
        • Cullen K.W.
        • Perez-Escamilla R.
        • Gray H.L.
        • Sikorskii A.
        Differences in fruit and vegetable intake by race/ethnicity and by Hispanic origin and nativity among women in the Special Supplemental Nutrition Program for Women, Infants, and Children, 2015.
        Prev Chronic Dis. 2016; 13: E115
        • Montez J.K.
        • Eschbach K.
        Country of birth and language are uniquely associated with intakes of fat, fiber, and fruits and vegetables among Mexican-American women in the United States.
        J Am Diet Assoc. 2008; 108: 473-480
        • Yoshida Y.
        • Scribner R.
        • Chen L.
        • Broyles S.
        • Phillippi S.
        • Tseng T.S.
        Role of age and acculturation in diet quality among Mexican Americans - findings from the National Health and Nutrition Examination Survey, 1999-2012.
        Prev Chronic Dis. 2017; 14: E59
        • Perez-Escamilla R.
        Acculturation, nutrition, and health disparities in Latinos.
        Am J Clin Nutr. 2011; 93: 1163s-1167s
        • Harley K.
        • Eskenazi B.
        • Block G.
        The association of time in the US and diet during pregnancy in low-income women of Mexican descent.
        Paediatr Perinat Epidemiol. 2005; 19: 125-134
        • Kieffer E.C.
        • Welmerink D.B.
        • Sinco B.R.
        • et al.
        Dietary outcomes in a Spanish-language randomized controlled diabetes prevention trial with pregnant Latinas.
        Am J Public Health. 2014; 104: 526-533
        • Florez K.R.
        • Dubowitz T.
        • Ghosh-Dastidar M.B.
        • Beckman R.
        • Collins R.L.
        Associations between depressive symptomatology, diet, and body mass index among participants in the Supplemental Nutrition Assistance Program.
        J Acad Nutr Diet. 2015; 115: 1102-1108
        • Flynn A.C.
        • Dalrymple K.
        • Barr S.
        • et al.
        Dietary interventions in overweight and obese pregnant women: A systematic review of the content, delivery, and outcomes of randomized controlled trials.
        Nutr Rev. 2016; 74: 312-328
        • Huffman F.G.
        • Vaccaro J.A.
        • Exebio J.C.
        • Zarini G.G.
        • Katz T.
        • Dixon Z.
        Television watching, diet quality, and physical activity and diabetes among three ethnicities in the United States.
        J Environ Public Health. 2012; 2012: 191465
        • Sisson S.B.
        • Shay C.M.
        • Broyles S.T.
        • Leyva M.
        Television-viewing time and dietary quality among U.S. children and adults.
        Am J Prev Med. 2012; 43: 196-200
        • Woolcott C.G.
        • Dishman R.K.
        • Motl R.W.
        • Matthai C.H.
        • Nigg C.R.
        Physical activity and fruit and vegetable intake: Correlations between and within adults in a longitudinal multiethnic cohort.
        Am J Health Promot. 2013; 28: 71-79
        • Pearson N.
        • Biddle S.J.
        Sedentary behavior and dietary intake in children, adolescents, and adults. A systematic review.
        Am J Prev Med. 2011; 41: 178-188
        • Streuling I.
        • Beyerlein A.
        • Rosenfeld E.
        • Hofmann H.
        • Schulz T.
        • von Kries R.
        Physical activity and gestational weight gain: A meta-analysis of intervention trials.
        BJOG. 2011; 118: 278-284
        • ACOG Committee Opinion No
        650: Physical activity and exercise during pregnancy and the postpartum period.
        Obstet Gynecol. 2015; 126: e135-e142
        • Marquez D.X.
        • Bustamante E.E.
        • Bock B.C.
        • Markenson G.
        • Tovar A.
        • Chasan-Taber L.
        Perspectives of Latina and non-Latina white women on barriers and facilitators to exercise in pregnancy.
        Women Health. 2009; 49: 505-521
        • Lindsay A.C.
        • Wallington S.F.
        • Greaney M.L.
        • Tavares Machado M.M.
        • De Andrade G.P.
        Patient-provider communication and counseling about gestational weight gain and physical activity: A qualitative study of the perceptions and experiences of Latinas pregnant with their first child.
        Int J Environ Res Public Health. 2017; 14
        • Ferrari R.M.
        • Siega-Riz A.M.
        • Evenson K.R.
        • Moos M.K.
        • Carrier K.S.
        A qualitative study of women's perceptions of provider advice about diet and physical activity during pregnancy.
        Patient Educ Couns. 2013; 91: 372-377
        • Lynch K.E.
        • Landsbaugh J.R.
        • Whitcomb B.W.
        • Pekow P.
        • Markenson G.
        • Chasan-Taber L.
        Physical activity of pregnant Hispanic women.
        Am J Prev Med. 2012; 43: 434-439
        • Thompson F.E.
        • Kirkpatrick S.I.
        • Subar A.F.
        • et al.
        The National Cancer Institute's Dietary Assessment Primer: A resource for diet research.
        J Acad Nutr Diet. 2015; 115: 1986-1995

      Biography

      L. Thomas Berube is a doctoral degree candidate, Steinhardt Department of Nutrition and Food Studies, New York University, New York City.

      Biography

      K. Woolf is an associate professor, Steinhardt Department of Nutrition and Food Studies, New York University, New York City.

      Biography

      M. J. Messito is a clinical associate professor, Department of Pediatrics, School of Medicine, New York University, New York City.

      Biography

      R. Gross is an assistant professor, Department of Pediatrics, School of Medicine, New York University, New York City.

      Biography

      A. Deierlein is an assistant professor, Department of Public Health Nutrition, College of Global Public Health, New York University, New York City.