Correlates of Prenatal Diet Quality in Low-Income Hispanic Women.
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.
Project description:BACKGROUND:Fast food and other away from home food sources are linked with poorer diet quality and adverse health outcomes. The diet quality of young adults, major consumers of fast food, is understudied in terms of long-term shifts based on food sources for key subpopulation disparities. METHODS:The study included young adults ages 18-39 (n = 8012) from the Continuing Survey of Food Intakes by Individuals 1989-1991 (n = 4217) and the National Health and Nutrition Examination Survey 2011-2012 and 2013-2014 (n = 3795). We stratified individuals based on their combination of food sources, race/ethnicity, and socioeconomic status. Using 24-h dietary recall data, we measured diet quality with the Healthy Eating Index-2015 (HEI-2015). Differences in diet quality were determined using 95% confidence intervals. RESULTS:Overall, diet quality increased across all food sources between the 1989-1991 and 2011-2014 surveys. The restaurant category overtook the at home category as the healthiest food source, while the fast food category remained the unhealthiest on days it was consumed. Vegetable intake decreased, while added sugar intake increased across all sources. Non-Hispanic whites and non-Hispanic blacks experienced similar increases in HEI-2015 scores across all food sources except restaurants, while Mexican American diet quality remained unchanged. Although all income levels experienced an increase in diet quality, the disparity between low- and high-income groups increased considerably. CONCLUSIONS:US young adults consume healthier foods from all food sources, however, fast food consumers have significantly lower quality in the remainder of their diets. Additionally, Mexican Americans and low-income individuals emerge as high-risk groups for poor diet quality.
Project description:This secondary analysis explored the association between gestational weight gain, pre-pregnancy body mass index (BMI), and prenatal diet quality in a United States national sample. The sample comprised 1322 pregnant women in the longitudinal Infant Feeding Practices Study II with Diet History Questionnaire data. Diet quality in the third trimester was assessed using the Alternative Healthy Eating Index for Pregnancy. Self-reported pre-pregnancy BMI (categorized as underweight<18.5, normal weight 18.5-24.9, overweight 25.0-29.9, and obese?30.0) and total gestational weight gain were used to categorize adherence to the Institute of Medicine's recommendations as inadequate, adequate, or excessive weight gain. Diet quality in pre-pregnancy BMI and gestational weight gain groups were compared using Tukey-adjusted generalized linear models adjusted for sociodemographic factors, Women, Infants, and Children participation, parity, and energy intake. Due to missing gestational weight gain data, sensitivity analyses with multiply imputed data were conducted. Women were on average 28.9 years old and of higher socioeconomic status (40% college graduates) and mostly non-Hispanic White (84%), and the mean Alternative Healthy Eating Index for Pregnancy score was 61.2 (of 130). Both pre-pregnancy BMI and gestational weight gain were inversely associated with diet quality scores (p<0.01). The interaction between pre-pregnancy BMI and gestational weight gain was significant (p = 0.04), therefore gestational weight gain models were stratified by BMI group. In stratified adjusted models, gestational weight gain was differently associated with diet quality scores (p<0.05) among women with underweight, normal weight, overweight, and obesity. The relationship between gestational weight gain and prenatal diet quality depended on pre-pregnancy BMI. For example, within women with normal weight, higher diet quality was observed in the adequate gestational weight gain group. Interventions to broadly improve prenatal diet quality are needed, however, resources can be used to target women with higher pre-pregnancy BMIs and women with inadequate or excessive gestational weight gain.
Project description:OBJECTIVES:The purpose of this study was to examine associations of sociodemographic and lifestyle factors with diet quality in a multiethnic population. METHODS:The analysis included 160?353 African American, Native Hawaiian, Japanese American, Latino, and non-Hispanic white participants aged 45 to 75 y who entered the Multiethnic Cohort study by completing a comprehensive questionnaire in 1993 to 1996 and did not report cancer or heart disease. Diet quality was assessed using four diet quality indexes (DQIs): the Healthy Eating Index 2010, the Alternative Healthy Eating Index 2010, the alternate Mediterranean Diet, and the Dietary Approaches to Stop Hypertension. RESULTS:For three DQIs, the Healthy Eating Index 2010, Alternative Healthy Eating Index 2010, and Dietary Approaches to Stop Hypertension, mean scores were significantly higher in women than men, whereas the mean score of the alternate Mediterranean Diet was significantly higher in men than women. In both men and women, older age, higher education, being physically active, and multivitamin use were associated with scores above the median of DQIs, whereas overweight/obesity, current smoking, and heavy alcohol consumption (?2 drinks/d) were associated with scores less than the median of DQIs. Race/ethnicity had inconsistent associations according to the DQIs. Being widowed, being a previous smoker, and having a low body mass index (<20 kg/m2) were associated with scores less than the median of DQIs in men but not in women. CONCLUSIONS:Diet quality was associated with sociodemographic and lifestyle characteristics in men and women. The associations with several factors, such as marital status, body mass index, and smoking status, differed by sex. These findings may help to identify at-risk populations for nutritional screening and to develop nutritional intervention strategies and educational materials.
Project description:BACKGROUND:A valuable addition to the mobile health (mHealth) space is an exploration of the context of minorities in developed countries. The transition period postmigration, culture, and socioeconomic uniqueness of migratory groups can shed light on the problems with existing prenatal mHealth apps. OBJECTIVE:The objectives of this study were to (1) use the theoretical concept of pregnancy ecology to understand the emotional, physical, information, and social challenges affecting low-income Caribbean immigrant women's prenatal well-being practices and (2) develop a deep understanding of challenges worthy of consideration in mHealth design for these women. METHODS:This qualitative interpretive approach using analytical induction presents the findings of 3 focus group sessions with 12 Caribbean immigrant women living in South Florida in the United States. The study took place from April to September 2015. RESULTS:The participants revealed problematic tiers and support needs within the pregnancy ecology including emotional stressors caused by family separation, physical challenges, information gaps, and longing for social support. CONCLUSIONS:mHealth interventions for low-income Caribbean immigrant women must be designed beyond the conventional way of focusing on the events surrounding the unborn child. It can be tailored to the needs of the expecting mother. Pregnancy information should be customized on the basis of the variability of lifestyle, cultural practices, socioeconomic status, and social ties while still being able to deliver appropriate guidelines and clear cultural misconceptions.
Project description:Home cooking is associated with improved diet quality. Non-Hispanic Blacks, a population with diet-quality related health disparities, report lower home cooking than other racial/ethnic groups. Factors and subsequent dietary outcomes associated with this cooking disparity are relatively unknown. A secondary analysis was performed using demographic and consumer behavior data from the 2007-2010 cycles of the National Health and Nutrition Examination Survey (NHANES) to identify factors associated with household cooking frequency of dinner among Non-Hispanic Blacks. Self-reported dietary data were used to calculate Healthy Eating Index-2010 (HEI-2010) to determine cooking related objective diet quality. Lower income, unemployment, and higher perceived diet quality were significantly associated with higher cooking frequency (p < 0.05). For diet quality, higher vegetable (p = 0.031), lower empty calorie intake (p = 0.002), higher dinner time protein (p = 0.004) and lower dinner time dairy intake (p = 0.003) were associated with cooking. Total HEI scores were associated with higher cooking frequency for middle income (p = 0.007), but not higher or lower income categories (p = 0.306; p = 0.384), respectively. On average, factors associated with cooking frequency were psychosocial, income, and employment related. Objective diet quality as measured by HEI was variable. Future dietary studies among Non-Hispanic Blacks should include cooking, socioeconomic status and perceived diet quality as particularly relevant factors of interest.
Project description:The proportion of women entering pregnancy overweight or obese has been rising and, in turn, is associated with adverse maternal and fetal outcomes. Gestational weight gain (GWG) exceeding Institute of Medicine (IOM) guidelines further increases health risks and has been independently associated with postpartum weight retention. Hispanic women are disproportionately affected by overweight and obesity, but have had limited access to interventions that promote healthy lifestyles due to cultural, socioeconomic, and language barriers. Therefore, the overall goal of this randomized controlled trial is to test the efficacy of a culturally and linguistically modified, individually-tailored lifestyle intervention to reduce excess GWG, increase postpartum weight loss, and improve maternal metabolic status among overweight/obese Hispanic women.Overweight/obese Hispanic women are recruited in early pregnancy and randomly assigned to a Lifestyle Intervention (n = 150) or a Comparison Health and Wellness (control) intervention (n = 150). Multimodal contacts (i.e., in-person, telephone counseling, and mailed print-based materials) are used to deliver the intervention from early pregnancy (12 weeks gestation) to 6 months postpartum, with follow-up to 1 year postpartum. Targets of the intervention are to achieve IOM Guidelines for GWG and postpartum weight loss; American Congress of Obstetrician and Gynecologist guidelines for physical activity; and American Diabetes Association guidelines for diet. The intervention draws from Social Cognitive Theory and the Transtheoretical Model and includes strategies to address the specific social, cultural, and economic challenges faced by low-income Hispanic women. Assessments are conducted at baseline (~10 weeks gestation), mid pregnancy (24-28 weeks gestation), late pregnancy (32-34 weeks gestation) and postpartum at 6-weeks, 6-months, and 12-months by bicultural and bilingual personnel blinded to the intervention arm. Efficacy is assessed via GWG, postpartum weight loss, and biomarkers of glycemic control, insulin resistance, and cardiovascular disease risk factors. Changes in physical activity and diet are measured via 7-day accelerometer data and 24-h dietary recalls at each assessment time period.Hispanic women are the fastest growing minority group in the U.S. and are disproportionately affected by overweight and obesity. This randomised trial uses a high-reach, low-cost strategy that can readily be translated into clinical practice in underserved and minority populations.NCT01868230 May 29, 2013.
Project description:Hispanic women have a higher prevalence of weight associated complications in pregnancy. This ethnic disparity is likely related to behavior patterns, social circumstances, environmental exposures, and access to healthcare, rather than biologic differences. The objective was to determine associations between sociodemographic characteristics, health behaviors, and psychosocial stressors and gestational weight gain (GWG) in low-income Hispanic women. During pregnancy, information on sociodemographic characteristics, health behaviors, and psychosocial stressors were collected. Linear regression estimated mean differences in GWG by selected predictors. Multinomial logistic regression estimated odds of inadequate and excessive GWG by selected predictors. Five-hundred and eight women were included, 38% had inadequate and 28% had excessive GWG; 57% with a normal pre-pregnancy BMI had inadequate GWG. Compared to women with normal BMI, women with overweight or obesity were more likely to have excessive GWG (aRRR = 1.88, 95% CI: 1.04, 3.40 and aRRR = 1.98, 95% CI: 1.08, 3.62, respectively). Mean total GWG was higher among women who were nulliparous (ß = 1.34 kg, 95% CI: 0.38, 2.29) and those who engaged in ?3 h of screen time daily (ß = 0.98 kg, 95% CI: 0.02, 1.94), and lower among women who were physically active during pregnancy (ß = -1.00 kg, 95% CI: -1.99, -0.03). Eating breakfast daily was associated with lower risk of inadequate GWG (aRRR = 0.47, 95% CI: 0.26, 0.83). Depressive symptoms and poor adherence to dietary recommendations were prevalent, but none of the psychosocial or dietary variables were associated with GWG. In this cohort of primarily immigrant, low-income, Hispanic women, there were high rates of poor adherence to diet and physical activity recommendations, and a majority of women did not meet GWG guidelines. Modifiable health behaviors were associated with GWG, and their promotion should be included in prenatal care.
Project description:Background:Inappropriate gestational weight gain (GWG) has been associated with adverse perinatal events. High rates of GWG have been reported among Hispanic women. Observational studies indicate that dietary and physical activity interventions during the prenatal period may improve maternal and infant health, but very few randomized trials have been conducted among high-risk overweight/obese Hispanic women. Accordingly, we conducted a lifestyle intervention among high-risk pregnant women and evaluated its impact on achieving appropriate GWG and on improving birthweight. Methods:Eligible overweight/obese women presenting at the University Hospital in Puerto Rico with a singleton pregnancy before 16 gestational weeks were recruited and randomized to lifestyle intervention (n=15) or control group (n=16). The lifestyle intervention focused on improving physical activity and diet quality and optimizing caloric intake. We evaluated the impact of the lifestyle intervention on achieving appropriate GWG and on infant birthweight. Poisson and linear regression analyses were performed. Results:The primary intent to treat analysis showed no significant effect on achievement of appropriate GWG/week through 36 weeks in the intervention group (4/15 women) when compared with the control group (3/16 women) (adjusted incidence rate ratio =1.14; 95% CI: 0.20, 6.67). Although not statistically significant, women in the intervention group (6/15) were 1.7 times more likely to achieve appropriate weekly GWG until delivery when compared with controls (4/16 women) (adjusted incidence rate ratio = 1.67; 95% CI: 0.40, 6.94). We observed lower adjusted birthweight-for-length z-scores in the intervention compared with the control group among male newborns with z-score difference -1.74 (-3.04, -0.43), but not among females -0.83 (-3.85, 2.19). These analyses were adjusted for age and baseline body mass index. Conclusion:Although larger studies are required to determine whether women with obesity may benefit from prenatal lifestyle interventions targeting GWG, our results are suggestive of the intervention improving adherence to established Institute of Medicine guidelines.
Project description:Diabetes and obesity have reached epidemic proportions in the U.S. with rates consistently higher among Hispanics as compared to non-Hispanic whites. Among Hispanic women diagnosed with gestational diabetes mellitus (GDM), 50% will go on to develop type 2 diabetes within 5 years of the index pregnancy. Although randomised controlled trials among adults with impaired glucose tolerance have shown that diet and physical activity reduce the risk of type 2 diabetes, such programs have not been tested in high-risk postpartum women. The overall goal of this randomised controlled trial is to test the efficacy of a culturally and linguistically modified, individually-tailored lifestyle intervention to reduce risk factors for type 2 diabetes and cardiovascular disease among postpartum Hispanic women with a history of abnormal glucose tolerance during pregnancy.Hispanic pregnant women who screen positive for GDM will be recruited and randomly assigned to a Lifestyle Intervention (n = 150) or a Health & Wellness (control) Intervention (n = 150). Multimodal contacts (i.e., in-person, telephone, and mailed materials) will be used to deliver the intervention from late pregnancy (29 weeks gestation) to 12 months postpartum. Targets of the intervention are to achieve Institute of Medicine Guidelines for postpartum weight loss; American Congress of Obstetrician and Gynecologist guidelines for physical activity; and American Diabetes Association guidelines for diet. The intervention draws from Social Cognitive Theory and the Transtheoretical Model and addresses the specific cultural and environmental challenges faced by low-income Hispanic women. Assessments will be conducted at enrollment, and at 6-weeks, 6-months, and 12-months postpartum by trained bicultural and bilingual personnel blinded to the intervention arm. Efficacy will be assessed via postpartum weight loss and biomarkers of insulin resistance and cardiovascular risk. Changes in physical activity and diet will be measured via 7-day actigraph data and three unannounced 24-hour dietary recalls at each assessment time period.Hispanic women are the fastest growing minority group in the U.S. and have the highest rates of sedentary behavior and postpartum diabetes after a diagnosis of GDM. This randomised trial uses a high-reach, low-cost strategy that can readily be translated into clinical practice in underserved and minority populations.NCT01679210.
Project description:Healthy diet has been linked to better age-related functioning, but evidence on the relationship of diet quality in late midlife and measures of physical capability in later life is limited. Research on potential sex differences in this relationship is scarce. The aim was to investigate the prospective association between overall diet quality, as assessed by the Healthy Eating Index-2015 (HEI-2015) at 60-64 years and measures of walking speed 7 years later, among men and women from the Insight 46, a neuroscience sub-study of the Medical Research Council National Survey of Health and Development. Diet was assessed at 60-64 years using 5-d food diaries, from which total HEI-2015 was calculated. At 69-71 years, walking speed was estimated during four 10-m walks at self-selected pace, using inertial measurement units. Multivariable linear regression models with sex as a modifier, controlling for age, follow-up, lifestyle, health/social variables and physical performance, were used. The final sample consists of 164 women and 167 men (n 331). Women had higher HEI-2015 and slower walking speed than men. A 10-point increase in HEI-2015 was associated with faster walking speed among women (B 0·024, 95 % CI 0·006, 0·043), but not men. The association remained significant in the multivariable model (B 0·021, 95 % CI 0·003, 0·040). In women, higher diet quality in late midlife is associated with faster walking speed. A healthy diet in late midlife is likely to contribute towards better age-related physical capability, and sex differences are likely to affect this relationship.