Exploring Dietary Intake, Nutrition Literacy, and Gestational Weight Gain among Latinas during Pregnancy

• Main Author: Melo Teruel Biagi Camargo, Juliana
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01.01.2019
• Subjects: Acculturation; Education; Latin American cultural groups; Latin American Studies; Literacy; Minority groups; Nutrition; Obstetrics; Premature birth; Quality of life; Women
• ISBN: 9781088364994; 1088364993

Nutrition literacy has emerged as an area of increasing interest in nutrition research due to its potential impact to promote healthy diets and prevent nutrition-related chronic diseases. Among populations impacted Latinos are an important minority group who disproportionately suffer from diseases that could be prevented through healthy eating. Considering the pandemic of obesity among females and high rates of weight gain faced by Latinas during pregnancy, this research aimed to assess nutrition literacy among Latinas during pregnancy and its relationship with dietary intake, diet quality and gestational weight gain.This ancillary observational study to a randomized controlled phase III clinical trial (Assessment of Docosahexaenoic Acid on Reducing Early preterm birth, ADORE) collected data on Latinas enrolled in the parent trial and consented to the ancillary study. The main outcomes investigated included relationships amongst dietary intake (three 24-hour recalls analyzed by Nutrition Data System for Research), diet quality (Healthy Eating Index-2010 and Healthy Eating Index-2015), nutrition literacy (Nutrition Literacy Assessment Instrument), and gestational weight gain (total and rate gain per week). Food security (Household Food Security USDA), perceived behavioral control, quality of life (CDC), acculturation (General Acculturation Index), age, and education were also collected and considered potential mediators of the hypothesized relationship between nutrition literacy and diet quality.In a sample of 111 women, only achieved the highest Nutrition Literacy cut-off point for “possibility of good nutrition literacy”, whereas a majority performed in the lowest range (n=80). For the different subscales of Nutrition Literacy, women experienced greater difficulty with food label & numeracy, energy sources in food (i.e. macronutrient knowledge) and consumer skills.During pregnancy, Latinas consumed a mean intake of 1.3 g protein per kg of pre-pregnancy weight (kg) and 2086 kcal/day. Of calories consumed during pregnancy, 50.8% were derived from carbohydrates and 32% from total fat. For fat fractions, Latinas reported a mean intake of 10.3% of kcalories from saturated fatty acids, 11.3% of kcalories from monounsaturated fatty acids and 7.2% of kcalories from polyunsaturated fatty acids. For micronutrients, accounting for food and supplement intake, all Latinas achieved the recommendations for vitamin A and vitamin B12. However, recommendations for folate, iron, vitamin D, and calcium were not achieved. Regarding diet quality, during pregnancy, Latinas had a score of 68 out of 100 for Healthy Eating Index-2010, and 70 out of 100 for Healthy Eating Index-2015. Differences between Healthy Eating Index-2010 and Healthy Eating Index-2015 were statistically significant (t=-6.6, p-value <.001), and this difference appears largely due to a change in the allocation of legumes in Healthy Eating Index-2015.Variables that predicted nutrient and diet quality for Latinas during pregnancy were acculturation, age, education, income, nutrition literacy, pre-pregnancy BMI, and social support from family and friends.In this cohort, 73.3% of women started a pregnancy either overweight (33.7%) or obese (39.6%). Women had a total gestational weight gain of 19 lb, and a gestational weight gain per week of 0.7 lb. About 3 in 10 exceeded the total gestational weight gain recommendation (all three trimesters of pregnancy), and 5 in 10 exceeded the gestational weight gain per week recommendation (second and third trimester). When analyzed by pre-pregnancy body mass index ranges, 1 in 4 women who started pregnancy overweight or obese gained more weight during pregnancy than recommended. A similar trend was observed for weight per week during pregnancy, where 1 in 2 women who were overweight and obese gained more than recommended.Total gestational weight gain for Latinas was predicted by pre-pregnancy body mass index and diet quality (r2 = 0.15, F= 7.62, p-value= 0.001). Gestational weight gain per week was predicted only by pre-pregnancy body mass index.From path analysis, we found that age and acculturation presented a direct effect on diet quality during pregnancy. The proposed hypothetical model explained 21% of the variance of diet quality during pregnancy, and beyond, and acculturation included: income, education, perceived behavioral control, food security, and nutrition literacy. Future research efforts will seek to develop interventions to preventing excessive gestational weight gain during pregnancy and manage post-partum weight-loss among Latinas.