A healthy eating index to measure diet quality in pregnant women in Singapore: a cross-sectional study

Abstract

Background: 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. Methods: 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. Results: 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). Conclusions: 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. Clinical Trial Registry: NCT01174875

Harmonization of Food-Frequency Questionnaires and Dietary Pattern Analysis in 4 Ethnically Diverse Birth Cohorts

“…Our external validation against the mAHEI(46), which has been used previously to assess 319 diet quality in pregnant women (55), found that mAHEI score was associated with greater 320 adherence to the plant-based and health-conscious diet patterns and lower adherence to the 321 Western diet, which confirms alignment of our dietary patterns with external methods for 322 assessing diet quality. 323…”

“…To 48 overcome the limitations of single-nutrient or single-food studies, the empirical derivation of 49 dietary patterns Ñ defined as Òthe quantities, proportions, variety or combinations of different 50 foods and beverages in diets, and the frequency with which they are habitually consumedÓ (13), 51 has been proposed as a method to characterize diet that more accurately reflects how we 52 consume foods or nutrients, and these patterns can be assessed for their associations with health 53 and disease. (14-18) 54 Canada is an ethnically diverse nation (19) which introduces challenges for healthcare 55 providers tasked with providing evidence-based dietary advice, because much of what we know 56 about diet and disease is rooted in studies of white European populations. Dietary choice is 57 closely tied to ethnicity (e.g., foods, cooking methods, and eating habits) (20) and the degree to 58 which an individual or community consumes ethnically-traditional foods can be influenced by 59 immigration and residency in a host country.…”

Adherence to a healthy eating index for pregnant women is associated with lower neonatal adiposity in a multiethnic Asian cohort: the Growing Up in Singapore Towards healthy Outcomes (GUSTO) Study

“…), and the results may not be applicable to other populations of pregnant women (18). The intake of sweetened beverages was accounted for in the DASH diet (21) but less emphasized in other diet quality indexes (13,15,16,19,30). Earlier studies have shown that the intake of sweetened beverages during pregnancy is associated with an increased risk of preterm birth (47)(48)(49).…”

“…The HEI-SGP has been validated to examine diet quality of pregnant women in Singapore (30) and, to date, has been associated with health outcomes such as maternal retinal microvasculature abnormalities (31) and gestational diabetes (in preparation). In brief, the HEI-SGP has 11 components with a maximum possible raw score of 90.…”

“…Diet quality was measured by the Healthy Eating Index for pregnant women in Singapore (HEI-SGP) (30). The HEI-SGP has been validated to examine diet quality of pregnant women in Singapore (30) and, to date, has been associated with health outcomes such as maternal retinal microvasculature abnormalities (31) and gestational diabetes (in preparation).…”