Abstract
There are limited tools to assess diet quality in pregnant women in an Asian population. A healthy eating index for pregnant women in Singapore (HEI-SGP) was developed and its association with maternal characteristics examined. The HEI-SGP was adapted from the Healthy Eating Indices (HEI) and Alternate Healthy Eating Index for Pregnancy (AHEI-P) and modified accordingly to recommendations from the Singapore dietary guidelines for pregnant women. It included eight components to reflect the dietary adequacy and quality of food groups and two nutrient-based components to reflect nutrients to be taken in moderation. Total scores range from 0 to 100. Study participants were from a mother-offspring cohort study – Growing Up in Singapore Towards healthy Outcomes (GUSTO), selected using criterion based sampling. Dietary intakes of these women were ascertained at 26–28 weeks of gestation using 24-hour recalls and 3-day food diaries. The HEI-SGP differentiated the diets qualitatively in the cohort of 955 women. The scores had a wide range of 12.6 - 94.3, with mean score of 52.4 (standard deviation 13.8) and were categorised by tertiles. Using one way ANOVA and chi-square tests, participants in the high tertile, compared to those in the middle and low tertiles, were more likely to meet recommendations for intakes of total fruits, whole fruits, total vegetables, dark green leafy and orange vegetables and dairy food groups (p < 0.001 for all). Those in the low tertile had significantly higher percentage of energy from total fat (p < 0.001) and saturated fat (p < 0.001), and lower percentage of energy from protein (p < 0.001) compared to participants from the two higher tertiles. From adjusted multinomial logistic regression analyses, women with poorer diet quality tended to be younger (odds ratio (OR) = 0.94; 95 % confidence interval (CI): 0.90-0.97), belonged to the Malay ethnic group (OR = 2.54; 95 % CI: 1.55-4.16), had lower household incomes (OR = 2.00, 95%CI: 1.03-3.87), were less educated (OR = 1.96, 95%CI: 1.19-3.25), single or had previous pregnancies (OR: 1.51; 95%CI 1.02, 2.24). The HEI-SGP has shown to be useful for differentiating diet quality and may be used to identify women ‘at risk’ of poor diets during pregnancy and whom require early intervention. NCT01174875
Highlights
There are limited tools to assess diet quality in pregnant women in an Asian population
Our study developed a tool (HEI-SGP) for measuring diet quality in pregnant women in Singapore based on data from a 24-hour dietary recall categorised according to adherence to current local dietary guidelines and recommendations
Examining diet quality using Healthy Eating Indices (HEI)-SGP scores by tertiles We found that the mean percentages of recommended servings of each food group met by participants were significantly different across tertiles, demonstrating that the HEI-SGP was not dependent on a single or a few components of the diet and that the weightings used in deriving the score gave a broad representation of adherence to recommendations
Summary
There are limited tools to assess diet quality in pregnant women in an Asian population. Diet quality indices were first developed to monitor a population’s pattern of consumption and/or used to promote public health and education [1, 2] In recent years, these indices have been increasingly used to examine the relationships between the quality of diets and risk of various diseases [3, 4] and population groups, including pregnant women [5, 6]. To optimise the health of both mother and her offspring, many countries have dietary guidelines and recommendations developed for pregnant women [8,9,10,11] Adherence to these dietary guidelines has been used as a marker of diet quality. A study found that diet quality scores were negatively correlated to pre-conception and gestational BMI [6] while another found that diet quality declined significantly between study entry and 28 weeks gestation in overweight and obese pregnant women, and was maintained for 4 months post-partum [12]
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