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A secondary analysis of maternal ultra-processed food intake in women with overweight or obesity and associations with gestational weight gain and neonatal body composition outcomes

Kathryn Whyte
Kathryn Whyte
, 
Isobel Contento
Isobel Contento
, 
Randi Wolf
Randi Wolf
, 
Laura Guerra
Laura Guerra
, 
Euridice Martinez
Euridice Martinez
, 
Xavier Pi-Sunyer
Xavier Pi-Sunyer
 y 
Dympna Gallagher
Dympna Gallagher
   | 23 mar 2022
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Article Category: Original Research
Publicado en línea: 23 mar 2022
Páginas: 244 - 259
Recibido: 25 oct 2021
Aceptado: 05 ene 2022
DOI: https://doi.org/10.34763/jmotherandchild.20212504.d-21-00025
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© 2021 Kathryn Whyte et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Enrollment and Analysis
Enrollment and Analysis

NOVA group energy contribution and diet quality differences between week 14 and 35 according to PEI-UPF quartilesa

Q1 (0-36.09%) N=39 (Mean±SD) Q2 (36.10-45.23%) N=39 (Mean±SD) Q3 (45.24-54.73%) N=39 (Mean±SD) Q4 (54.74-75.25%) N=39 (Mean±SD) Total N=156 Mean±SD
Mean Week 14 Mean Week 35 Mean Week 14 Mean Week 35 Mean Week 14 Mean Week 35 Mean Week 14 Mean Week 35 Mean Week 14 Mean Week 35
G1 % 48.5±14.9 54.6±13.2 41.1±17.4 44.6±17.8 37.5±13.0 34.8±10.4 25.9±12.4 30.8±13.2 38.2 ±16.6 41.2±16.6
G2 % 5.6±6.2 7.5±7.2 7.3±9.9 4.1±4.4* 5.1±6.4 4.6±4.4 2.6±3.2 4.6±5.8* 5.1±7.0 5.2±5.7
G3 % 14.8±14.1 11.4±9.9 9.4±8.5 12.1±10.6 10.8±9.8 7.9±9.3 6.9±6.4 6.8±5.3 10.5±10.4 9.5±9.2
G4 % 31.1±14.2 26.6±15.3 42.2±14.2 39.2±13.7 46.5±12.9 52.7±13.1 64.6±15.6 57.7±16.8 46.1±18.6 44.0±19.0
Total 2004.7± 1747.1± 1881.4± 1845.9± 2042.1± 1863.9± 1856.2± 1987.4± 1946 ± 1861 ±1
Kcals 927.2 918.9 975.9 1440.9 962.9 806.2 811.7 808.4 916 021
HEI (0-100) 62.1±13.4 63.2±17.1 58.3±18.4 60.2±18.6 55.9±10.9 56.3±12.7 49.3±15.0 56.4±14.7* 56.4±15.3 59.0±16.0

Maternal and offspring descriptive analysis by quartiles of percentage of energy intake of ultra-processed foods (PEI-UPF).

Maternal+ PEI-UPF Quartiles p
Q1 (0-36.09%) N=39 Mean+SD Q2 (36.10-45.23%) N=39 Mean+SD Q3 (45.24-54.73%) N=39 Mean+SD Q4 (54.74-75.25%) N=39 Mean+SD
%G1a 51.5±14.0 42.8±17.5 36.2±11.8 28.4±13 <0.01
%G2a 6.5±6.8 5.8±7.8 4.9±5.5 3.6±4.7 0.04
%G3a 13.1±12.2 10.7±9.7 9.4±9.6 6.9±5.8 0.03
%G4a 28.8±14.8 40.7±14.0 49.6±13.3 61.2±16.5 <0.01
Total kcalsa 1875.9±926.2 1863.6±1222.7 1953±886.8 1921.8±807.5 0.78
HEI 0-100a 62.7±12 59.2±15.4 56.1±8.3 52.9±11.9 <0.01
Gestational Age (week)a 14.5±0.72 14.6±0.59 14.4±0.80 14.2±0.84 0.17
Maternal Age (years)a 34.1±3.9 33.7±4.5 33.5±3.2 32.5±4.8 0.35
Baseline BMI (kg/m2)a 29.8±4.0 30.2±4.0 31.2±5.8 30.3±4.9 0.33
Parity (%)b 0.45
1 25.6 43.6 30.8 33.3
2 33.3 30.8 25.6 38.5
3+ 41.1 25.6 43.6 28.2
Race (%)b 0.68
White 38.5 51.3 40.0 46.2
Non-white 61.5 48.7 60.0 53.8
Income (%)b 0.96
≤$75,000 33.3 33.3 35.9 38.5
>$75,000 66.7 66.7 64.1 61.4
College (%)b 0.12
No 23.1 12.8 25.6 7.7
Yes 76.9 87.2 74.4 92.3
Group (%)b 0.77
Usual Care 40.0 51.3 46.2 51.3
Lifestyle Intervention 60.0 48.7 53.8 48.7
Offspring++ Q1 N=32 Q2 N=31 Q3 N=32 Q4 N=31 p
Length (cm) (mean±SD)a 49.8±1.9 49.85±2.0 50.08±1.8 49.55±2.3 0.79
Age (days) (mean±SD)a 2.75±2.1 2.62±2.0 2.16±1.8 2.45±1.9 0.65
Sex (%)b 0.04
Female 15 (46.9) 21 (67.7) 12 (37.5) 11 (35.5)
Male 17 (53.1) 10 (32.3) 20 (62.5) 20 (64.5)
Race (%)b 0.76
White 59.4 51.6 62.5 51.6
Non-white 40.6 49.4 37.5 49.4

Maternal covariates and neonatal birth characteristics by gestational weight gain (above or below the mode)

Maternal+ GWG N=156 Mean Difference ±SE p
<7.4kg (n=61) >7.4kg (n=95)
Gestational Age (week) (mean)a 14.5±0.70 14.35±0.80 0.194±.13 0.06
Maternal (years) (mean)Age a 33.6±4.5 33.3±4.0 0.257±.68 0.35
HEI Avg (0-100) 54.3.1±10.4 59.9±13.5 5.63+2.0 <0.01*
Parity (%)b 1.56 0.46
1 28 37
2 33 32
3+ 39 31
Race (%)b 10.87 0.001*
White 28 55
Non-white 78 45
Income (%)b 0.03 0.865
≤$75,000 36 35
>$75,000 64 65
College (%) 3.71 0.05*
No 25 13
Yes 75 87
Group (%)b 5.19 0.02*
UC 36 55
LI 64 45
NOVA PEI
G1 39.7±15 42.3±.17 2.4±3.0 0.37
G2 5.3±5.7 5.1±6.0 0.1±.0.09 0.43
G3 8.0±8.0 10.0±10.0 2.4±1.0 0.06
G4 46.9±17.6 42.2±19.8 4.7±3.1 0.07
GWG 4.87±1.9 11.44±3.1 6.57±0.44 0.001**
Obesity baseline) (at (%)b 29.5 0.000*
BMI <29.9 kg/m2 34 78
BMI >29.9 kg/m2 66 22

Maternal and offspring correlational analysis of gestational weight gain and neonatal body composition outcome variables with potential covariates.

Maternal+ Gestational Weight Gain Lean Mass (QMR) Fat Mass (QMR) Total Body Water (QMR) Fat Free Mass (ADP) Fat Mass (ADP)
Total Kcals 0.05 -0.01 0.03 0.03 0.02 0.03
HEI Average Score 0-100 a 0.14 -0.03 -0.03 -0.06 -0.11 0.02
Gestational Age (week)a -0.004 -0.10 -0.03 -0.07 -0.07 0.02
Maternal Age (years)a -0.06 -0.16 -0.12 -0.20 -0.16 -0.17
Baseline BMI (kg/m2)a -0.31 0.11 0.17 0.12 0.10 0.22
Parityb -0.15 -0.06 0.12 0.03 -0.05 0.14
Racec -0.24 0.12 0.02 0.07 0.17 -0.14
Incomec 0.03 0.04 -0.12 -0.02 0.006 -0.13
Collegec 0.17 -0.08 -0.20 -0.14 -0.07 -0.24
Groupc -0.21 0.19 0.06 -0.16 -0.12 -0.08
Offspring++
Lengtha (cm) -- 0.79 0.57 0.76 0.81 0.44
Agea (years) -- -0.03 -0.07 -0.01 0.02 -0.09
Sexc -- -0.32 -0.32 -0.36 -0.32 0.24

Maternal characteristics at baseline and GWG by intervention/control group

Intervention (n=82) Usual Care (n=74) Test statistic P
Maternal Age (years) 33.62± 3.96 33.21 ± 4.37 -0.616a 0.539
Gestational Age at Randomisation (weeks) 14.41 ± .753 14.43 ± .795 0.144a 0.886
Height (cm) 164.58± 5.43 163.80 ± 6.78 -0.973a 0.431
Weight (kg) 80.88 ± 12.14 83.24 ± 15.86 1.049a 0.296
Mean BMI Categories (kg/m2) 29.86 ± 3.88 31.0 ± 5.4 1.551a 0.117
>24.9 54 (65.1%) 41 (55.4%) 1.783c 0.182
>29.9 29 (34.9%) 33 (44.6%)
Parity 3.042c 0.804
0 26 (31.7%) 26 (35.1%)
1 25 (30.5%) 25 (33.8%)
>2 31 (37.8%) 23 (31.1%)
Race/Ethnicity 1.208c 0.751
Hispanic 25 (30.5%) 17 (23.0%)
Non-Hispanic African 16 (19.5%) 16 (21.6%)
American 35 (42.7%) 34 (45.9%)
Non-Hispanic White 6 (7.3%) 7 (9.5%)
More than one race
Household Income 1.967d 0.579
<$24,999 4 (4.9%) 5 (6.8%)
$25,000-$74,9999 26 (31.7%) 20 (27.0%)
>$75,000 52 (63.4%) 49 (66.2%)
College Degree 1.416c 0.291
No 17 (20.7%) 10 (13.5%)
Yes 65 (79.3%) 64 (86.5%)

Gestational weight gain and maternal ASA-24 by intervention/control group

Intervention (n=82) Usual Care (n=74) Test statistic Mean Difference P
Mean±SD Mean±SD Mean±SE
Gestational Weight Gain (kg) 8.04±3.85 9.8±4.4 2.658a 1.76±0.66 0.009*
Gestational Weight Gain: adherence to Institute of Medicine guidelines
Gained Adequately 51 (62.2%) 33 (44.6%) --- ---
Gained Excessively 31 (37.8%) 41 (55.4%) --- ---
Gestational Weight Gain:defined by median (7.4kg)
Gained Adequately 39(47.6%) 22(29.7%) --- ---
Gained Excessively 43(52.4%) 52(70.3%) --- ---
Pre-Intervention: Automated Self-Administered 24 Food Recall Week 14 N=82 N=74
Total Calories (Kcal) 1817.16±737.4 2088.97 ± 1067.4 1.865a 271.8±148.4 0.069
Healthy Eating Index (HEI) 2010 Score (0-100) 56.69 ±14.31 56.09 ±16.32 -0.245a -0.60±2.45 0.807
Total Fruit (0-5)c 3.47±1.88 3.39±1.98 2999b -0.78±0.31 0.896
Whole Fruit (0-5)c 3.47±2.13 3.12±2.19 3289b -0.35±0.35 0.318
Solid Fats, Alcohol, Added Sugars (SOFAAS) (0-10)d 14.06±5.07 13.51±6.01 2511b -0.55±0.89 0.060
Post-Intervention Automated Self-Administered 24 Food Recall Week 35 N=82 N=74
Total calories 1843.4±979.5 1880.7±1072 0.227a 37.3±164.3 0.837
HEI 2010 Score 62±16 55.8±15.5 -2.465a -6.23±2.52 0.015*
Total Fruitc 3.83±1.69 3.05±1.96 3735b -0.83±0.29 0.009*
Whole Fruitc 3.87±2 3.00±2.24 3764b -0.79±0.34 0.004*
SOFAASd 14.53±5.67 12.8±5.67 3624b -1.87±0.90 0.036*
Pre-Intervention NOVA Scores:
Group 1 40.0±16.3 36.3±16.7 -1.374 a -0.036±0.03 0.171
Group 2 4.9±5.5 5.8±8.4 0.551 a 0.006±0.01 0.582
Group 3 10.6±8.9 10.4±11.9 -0.121 a -0.002±0.02 0.904
Group 4 44.6±18.7 47.8±18.4 1.080 a 0.03±0.03 0.282
Post-Intervention NOVA Scores:
Group 1 40.5±15.8 42.0±17.5 0.569 a 0.151±0.03 0.570
Group 2 5.2±5.9 5.1±5.3 -0.025 a -0.003±0.01 0.980
Group 3 9.4±8.4 9.7±10.0 0.156 a 0.002±0.01 0.876
Group 4 44.9±18.2 43.1±20.1 -0.562 a -0.017±0.03 0.575

Marginal means from ordinary least squares regressions of gestational weight gain (n=156) and neonatal body composition variables (n=126) according to quartiles of percentage of energy intake of ultra-processed foods (PEI-UPF)

PEI-UPF1 Q1 PEI-UPF1 Q2 PEI-UPF1 Q3 PEI-UPF1 Q4 Ptrend
Marginal Means 95% CI Marginal Means 95% CI Marginal Means 95% CI Marginal Means 95% CI
Maternal
GWG (kg)
Unadjusted 8.84 7.5 10.2 10.05 8.7 11.4 8.26 6.9 9.6 8.34 7.0 9.7 0.213
Adjusteda2 8.82 7.2 10.4 10.09 8.5 11.7 8.33 6.7 9.9 8.26 6.7 9.8 0.215
Neonatal
Lean Mass (g)
Unadjusted 2.30 2.2 2.4 2.28 2.2 2.4 2.38 2.3 2.5 2.29 2.2 2.4 0.414
Adjusteda3 2.30 2.2 2.4 2.30 2.2 2.4 2.34 2.3 2.4 2.32 2.3 2.4 0.423
Fat Mass(g)
Unadjusted .558 .50 .62 .559 .50 .62 .568 .51 .62 .503 .44 .56 0.224
Adjusteda4 .554 .48 .63 .544 .47 .62 .569 .50 .64 .521 .45 .60 0.816
TBW(g)
Unadjusted 2.42 2.3 2.5 2.39 2.3 2.5 2.52 2.4 2.6 2.41 2.3 2.5 0.457
Adjusteda5 2.42 2.3 2.5 2.41 2.3 2.5 2.49 2.4 2.6 2.43 2.3 2.5 0.573
FFM(g)
Unadjusted 2.89 2.8 3.0 2.81 2.7 2.9 2.96 2.8 3.1 2.85 2.7 3.0 0.568
Adjusteda6 2.90 2.8 3.0 2.82 2.7 2.9 2.92 2.8 3.0 2.88 2.8 3.0 0.835
Fat Mass (g)
Unadjusted .353 .30 .41 .366 .31 .42 .357 .30 .41 .294 .24 .35 0.119
Adjusteda7 .350 .29 .41 .340 .28 .40 .351 .29 .41 .327 .26 .39 0.482

Neonatal birth characteristics and body composition by intervention/control group

Intervention (n = 68) Usual Care (n = 61) T-Test Statistic p
Birth weight (g) 3280±421 3160 ±468 -1.465 0.146
Birth length (cm) 49.84±1.983 49.8±2.034 -0.325 0.746
Age at measurement 2.54 ±2.1 2.34±1.8 -0.589 0.557
(days)
Weight for length z score -0.22±0.7 -0.43±0.8 -1.57 0.119
PEAPOD
FM (g) 352.5 ±172 329 ±155 -0.806 0.422
FFM (g) 2920±335 2830 ±383 -1.433 0.151
QMR
FM (g) 555±171 535± 164 -0.676 0.500
LM (g) 2360± 262 2260±293 -2.149 0.034*
TBW (g) 2480 ± 282 2390 ± 308 -1.827 0.070
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