Advertisement

NOTICE: We are experiencing technical issues with Academy members trying to log into the JAND site using Academy member login credentials. We are working to resolve the issue as soon as possible. Alternatively, if you are an Academy member, you can access the JAND site by registering for an Elsevier account and claiming access using the links at the top of the JAND site. Email us at jo[email protected] for assistance. Thanks for your patience!

Associations Among Food Security, Diet Quality, and Dietary Intake During Pregnancy in a Predominantly African American Group of Women from North Carolina

Published:August 31, 2021DOI:https://doi.org/10.1016/j.jand.2021.08.110

      Abstract

      Background

      Low food security during pregnancy can negatively affect women’s physical and mental health. Although many women make a greater effort to eat a healthy diet during pregnancy, the influence of low food security during pregnancy on maternal diet is not well understood.

      Objective

      This study aimed to assess the association between adult food security and maternal diet during pregnancy in a sample from North Carolina.

      Design

      This was a cross-sectional, secondary data analysis of food security (marginal, low, and very low vs high) and maternal diet during pregnancy.

      Participants and setting

      This study included 468 predominantly Black/African American women during pregnancy from the Nurture cohort, enrolled through prenatal clinics in central North Carolina between 2013 and 2016.

      Main outcome measure

      Diet quality was assessed using the Alternate Healthy Eating Index-Pregnancy and the Mediterranean Diet Score. Dietary intake from seven food groups included in the Alternate Healthy Eating Index-Pregnancy and/or Mediterranean Diet Score was assessed as well.

      Statistical analysis performed

      Multiple linear regression models were used to examine the association between food security and diet quality and dietary intake during pregnancy, adjusting for race/ethnicity; participation in the Special Supplemental Nutrition Program for Women, Infants, and Children; education; prepregnancy body mass index; age; parity; and mean daily energy intake.

      Results

      In this study, there was no association between maternal food security status and diet quality during pregnancy. However, researchers observed an association between low and marginal food security and greater intake of red and processed meats (marginal: β = 2.20 [P = 0.03]; low: β = 2.28 [P = 0.04]), as well as an association between very low food security and decreased vegetable consumption (β = –.43; P = 0.03).

      Conclusions

      Very low food security was associated with reduced vegetable intake. In addition, low and marginal food security were associated with greater red and processed meat intake. Future research should focus on nationally representative populations and include longitudinal assessments to allow for the study of the influence of food security on health during pregnancy.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Murthy V.H.
        Food insecurity: a public health issue.
        Public Health Rep. 2016; 131: 655-657
        • US Dept of Agriculture, Economic Research Service
        Key statistics & graphics.
        (Published 2019. Accessed August 26, 2021)
        • US Dept of Agriculture, Economic Research Service
        Definitions of food security.
        (Published 2019. Accessed August 26, 2021)
        • Calloway E.E.
        • Parks C.A.
        • Bowen D.J.
        • Yaroch A.L.
        Environmental, social, and economic factors related to the intersection of food security, dietary quality, and obesity: an introduction to a special issue of the Translational Behavioral Medicine journal.
        Transl Behav Med. 2019; 9: 823-826
        • Hanson K.L.
        • Connor L.M.
        Food insecurity and dietary quality in US adults and children: a systematic review.
        Am J Clin Nutr. 2014; 100: 684-692
        • Landry M.J.
        • van den Berg A.E.
        • Asigbee F.M.
        • Vandyousefi S.
        • Ghaddar R.
        • Davis J.N.
        Child-report of food insecurity is associated with diet quality in children.
        Nutrients. 2019; 11: 1574
        • Guendelman S.
        • Gemmill A.
        • MacDonald L.A.
        Biomechanical and organisational stressors and associations with employment withdrawal among pregnant workers: evidence and implications.
        Ergonomics. 2016; 59: 1613-1624
        • Power M.
        • Uphoff E.
        • Kelly B.
        • Pickett K.E.
        Food insecurity and mental health: an analysis of routine primary care data of pregnant women in the Born in Bradford cohort.
        J Epidemiol Community Health. 2017; 71: 324-328
        • Laraia B.
        • Vinikoor-Imler L.C.
        • Siega-Riz A.M.
        Food insecurity during pregnancy leads to stress, disordered eating, and greater postpartum weight among overweight women.
        Obesity (Silver Spring). 2015; 23: 1303-1311
        • Laraia B.A.
        • Siega-Riz A.M.
        • Gundersen C.
        Household food insecurity is associated with self-reported pregravid weight status, gestational weight gain, and pregnancy complications.
        J Am Diet Assoc. 2010; 110: 692-701
        • US Dept of Agriculture
        About WIC.
        (Accessed August 26, 2021)
        • Whaley S.E.
        • Ritchie L.D.
        • Spector P.
        • Gomez J.
        Revised WIC food package improves diets of WIC families.
        J Nutr Educ Behav. 2012; 44: 204-209
        • Hamad R.
        • Collin D.F.
        • Baer R.J.
        • Jelliffe-Pawlowski L.L.
        Association of Revised WIC Food Package with perinatal and birth outcomes: a quasi-experimental study.
        JAMA Pediatr. 2019; 173: 845-852
        • US Depts of Agriculture and Health and Human Services
        Dietary Guidelines for Americans 2020-2025.
        US Government Printing Office, Washington, DC2020
        • Liese A.D.
        • Krebs-Smith S.M.
        • Subar A.F.
        • et al.
        The Dietary Patterns Methods Project: synthesis of findings across cohorts and relevance to dietary guidance.
        J Nutr. 2015; 145: 393-402
        • 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
        • Chatzi L.
        • Rifas-Shiman S.L.
        • Georgiou V.
        • et al.
        Adherence to the Mediterranean diet during pregnancy and offspring adiposity and cardiometabolic traits in childhood.
        Pediatr Obes. 2017; 12: 47-56
        • Martinez-Gonzalez M.A.
        • Salas-Salvado J.
        • Estruch R.
        • et al.
        Benefits of the Mediterranean Diet: insights From the PREDIMED Study.
        Prog Cardiovasc Dis. 2015; 58: 50-60
        • Fragopoulou E.
        • Panagiotakos D.B.
        • Pitsavos C.
        • et al.
        The association between adherence to the Mediterranean diet and adiponectin levels among healthy adults: the ATTICA study.
        J Nutr Biochem. 2010; 21: 285-289
        • Barbaresko J.
        • Koch M.
        • Schulze M.B.
        • Nöthlings U.
        Dietary pattern analysis and biomarkers of low-grade inflammation: a systematic literature review.
        Nutr Rev. 2013; 71: 511-527
        • Sofi F.
        • Abbate R.
        • Gensini G.F.
        • Casini A.
        Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis.
        Am J Clin Nutr. 2010; 92: 1189-1196
        • Bach-Faig A.
        • Berry E.M.
        • Lairon D.
        • et al.
        Mediterranean diet pyramid today. Science and cultural updates.
        Public Health Nutr. 2011; 14: 2274-2284
        • Trichopoulou A.
        • Costacou T.
        • Bamia C.
        • Trichopoulos D.
        Adherence to a Mediterranean diet and survival in a Greek population.
        N Engl J Med. 2003; 348 (2599-2599)
        • Milà-Villarroel R.
        • Bach-Faig A.
        • Puig J.
        • et al.
        Comparison and evaluation of the reliability of indexes of adherence to the Mediterranean diet.
        Public Health Nutr. 2011; 14: 2338-2345
        • McCullough M.L.
        • Feskanich D.
        • Stampfer M.J.
        • et al.
        Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance.
        Am J Clin Nutr. 2002; 76: 1261-1271
        • Ancira-Moreno M.
        • Vadillo-Ortega F.
        • Rivera-Dommarco J.A.
        • et al.
        Gestational weight gain trajectories over pregnancy and their association with maternal diet quality: results from the PRINCESA cohort.
        Nutrition. 2019; 65: 158-166
        • H Al Wattar B.
        • Dodds J.
        • Placzek A.
        • et al.
        Mediterranean-style diet in pregnant women with metabolic risk factors (ESTEEM): a pragmatic multicentre randomised trial.
        PLoS Med. 2019; 16e1002857
        • Mijatovic-Vukas J.
        • Capling L.
        • Cheng S.
        • et al.
        Associations of diet and physical activity with risk for gestational diabetes mellitus: a systematic review and meta-analysis.
        Nutrients. 2018; 10: 698
        • Gunther J.
        • Hoffmann J.
        • Spies M.
        • et al.
        Associations between the prenatal diet and neonatal outcomes-a secondary analysis of the cluster-randomised GeliS Trial.
        Nutrients. 2019; 11: 1889
        • Gardner B.
        • Croker H.
        • Barr S.
        • et al.
        Psychological predictors of dietary intentions in pregnancy.
        J Hum Nutr Diet. 2012; 25: 345-353
        • Savard C.
        • Plante A.S.
        • Carbonneau E.
        • et al.
        Do pregnant women eat healthier than non-pregnant women of childbearing age?.
        Int J Food Sci Nutr. 2020; : 1-12
        • Parker H.W.
        • Tovar A.
        • McCurdy K.
        • Vadiveloo M.
        Socio-economic and racial prenatal diet quality disparities in a national US sample.
        Public Health Nutr. 2020; 23: 894-903
        • 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
        • Bodnar L.M.
        • Siega-Riz A.M.
        A Diet Quality Index for Pregnancy detects variation in diet and differences by sociodemographic factors.
        Public Health Nutr. 2002; 5: 801-809
        • Park C.Y.
        • Eicher-Miller H.A.
        Iron deficiency is associated with food insecurity in pregnant females in the United States: National Health and Nutrition Examination Survey 1999-2010.
        J Acad Nutr Diet. 2014; 114: 1967-1973
        • Benjamin Neelon S.E.
        • Ostbye T.
        • Bennett G.G.
        • et al.
        Cohort profile for the Nurture Observational Study examining associations of multiple caregivers on infant growth in the Southeastern USA.
        BMJ Open. 2017; 7e013939
        • US Dept of Agriculture, Economic Research Service
        Survey tools.
        • Block G.
        • Hartman A.M.
        • Dresser C.M.
        • Carroll M.D.
        • Gannon J.
        • Gardner L.
        A data-based approach to diet questionnaire design and testing.
        Am J Epidemiol. 1986; 124: 453-469
        • Block G.
        • Woods M.
        • Potosky A.
        • Clifford C.
        Validation of a self-administered diet history questionnaire using multiple diet records.
        J Clin Epidemiol. 1990; 43: 1327-1335
      1. NutritionQuest.
        https://www.nutritionquest.com
        Date accessed: August 27, 2021
      2. Nutrition Data System for Research [computer program]. Version 2013. University of Minnesota, Minneapolis, MN2013
        • US Surgeon General
        A 2005 Message to Women from the U.S. Surgeon General: Advisory on Alcohol Use in Pregnancy.
        US Surgeon General’s Office, Rockville, MD2005
        • Centers for Disease Control and Prevention
        Alcohol use in pregnancy.
        • US Depts of Agriculture and Health and Human Services
        Dietary Guidelines for Americans, 2010.
        7th edition. US Government Printing Office, Washington, DC2010
      3. SAS [computer program]. Version 9.4. Cary, NC SAS Institute, Inc, 2016
        • 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
        • Wilcox S.
        • Sharpe P.A.
        • Liese A.D.
        • Dunn C.G.
        • Hutto B.
        Socioeconomic factors associated with diet quality and meeting dietary guidelines in disadvantaged neighborhoods in the Southeast United States.
        Ethn Health. 2018; : 1-17
        • Sanjeevi N.
        • Freeland-Graves J.
        • Hersh M.
        Food insecurity, diet quality and body mass index of women participating in the Supplemental Nutrition Assistance Program: the role of intrapersonal, home environment, community and social factors.
        Appetite. 2018; 125: 109-117
        • Leung C.W.
        • Tester J.M.
        The association between food insecurity and diet quality varies by race/ethnicity: an analysis of National Health and Nutrition Examination Survey 2011-2014 results.
        J Acad Nutr Diet. 2019; 119: 1676-1686
        • Tomayko E.J.
        • Mosso K.L.
        • Cronin K.A.
        • et al.
        Household food insecurity and dietary patterns in rural and urban American Indian families with young children.
        BMC Public Health. 2017; 17: 611
        • Rouhani M.H.
        • Salehi-Abargouei A.
        • Surkan P.J.
        • Azadbakht L.
        Is there a relationship between red or processed meat intake and obesity? A systematic review and meta-analysis of observational studies.
        Obes Rev. 2014; 15: 740-748
        • Pan A.
        • Sun Q.
        • Bernstein A.M.
        • et al.
        Red meat consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis.
        Am J Clin Nutr. 2011; 94: 1088-1096
        • Zheng Y.
        • Li Y.
        • Satija A.
        • et al.
        Association of changes in red meat consumption with total and cause specific mortality among US women and men: two prospective cohort studies.
        BMJ. 2019; 365: l2110
        • Schoenaker D.A.
        • Mishra G.D.
        • Callaway L.K.
        • Soedamah-Muthu S.S.
        The role of energy, nutrients, foods, and dietary patterns in the development of gestational diabetes mellitus: a systematic review of observational studies.
        Diabetes Care. 2016; 39: 16-23
        • Knudsen V.K.
        • Orozova-Bekkevold I.M.
        • Mikkelsen T.B.
        • Wolff S.
        • Olsen S.F.
        Major dietary patterns in pregnancy and fetal growth.
        Eur J Clin Nutr. 2008; 62: 463-470
        • El Zein A.
        • Mathews A.E.
        • House L.
        • Shelnutt K.P.
        Why are hungry college students not seeking help? Predictors of and barriers to using an on-campus food pantry.
        Nutrients. 2018; 10: 1163
        • Purdam K.
        • Garratt E.A.
        • Esmail A.
        Hungry? Food insecurity, social stigma and embarrassment in the UK.
        Sociology. 2016; 50: 1072-1088
        • Hebert J.R.
        • Clemow L.
        • Pbert L.
        • Ockene I.S.
        • Ockene J.K.
        Social desirability bias in dietary self-report may compromise the validity of dietary intake measures.
        Int J Epidemiol. 1995; 24: 389-398
        • Hiza H.A.
        • Casavale K.O.
        • Guenther P.M.
        • Davis C.A.
        Diet quality of Americans differs by age, sex, race/ethnicity, income, and education level.
        J Acad Nutr Diet. 2013; 113: 297-306
        • Brown A.G.M.
        • Houser R.F.
        • Mattei J.
        • Lichtenstein A.H.
        • Folta S.C.
        Qualitative exploration of cultural factors influencing diet among African-, Caribbean- and US-born Blacks living in the northeast USA.
        J Nutr Sci. 2019; 8: e23
        • Moshfegh A.J.
        • Rhodes D.G.
        • Baer D.J.
        • et al.
        The US Department of Agriculture Automated Multiple-Pass Method Reduces Bias in the Collection of Energy Intakes.
        Am J Clin Nutr. 2008; 88: 324-332
        • Freedman L.S.
        • Commins J.M.
        • Moler J.E.
        • et al.
        Pooled results from 5 validation studies of dietary self-report instruments using recovery biomarkers for energy and protein intake.
        Am J Epidemiol. 2014; 180: 172-188
      4. Hébert JR, Hurley TG, Steck SE, Miller DR, Tabung FK. Considering the value of dietary assessment data in informing nutrition-related health policy 1 , 2. 2014:447-455.

        • Subar A.F.
        • Thompson F.E.
        • Kipnis V.
        • et al.
        Comparative validation of the Block, Willett, and National Cancer Institute food frequency questionnaires: the Eating at America’s Table Study.
        Am J Epidemiol. 2001; 154: 1089-1099

      Biography

      S. Gonzalez-Nahm is an assistant professor, Department of Nutrition, University of Massachusetts Amherst, Amherst, MA.

      Biography

      T. Østbye is a professor, Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC.

      Biography

      C. Hoyo is a professor, Department of Biological Sciences, North Carolina State University, Raleigh, NC.

      Biography

      R. Kravitz is a professor, Department of Pediatrics, Duke University Medical Center, Durham, NC.

      Biography

      S. Benjamin-Neelon is a professor, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.