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

Maternal⁺	PEI-UPF Quartiles				p
Maternal⁺	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
%G1^a	51.5±14.0	42.8±17.5	36.2±11.8	28.4±13	<0.01
%G2^a	6.5±6.8	5.8±7.8	4.9±5.5	3.6±4.7	0.04
%G3^a	13.1±12.2	10.7±9.7	9.4±9.6	6.9±5.8	0.03
%G4^a	28.8±14.8	40.7±14.0	49.6±13.3	61.2±16.5	<0.01
Total kcals^a	1875.9±926.2	1863.6±1222.7	1953±886.8	1921.8±807.5	0.78
HEI 0-100^a	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

[i] ^a = one-way ANOVA, ^b= chi square

*Statistically significant mean difference between quartiles: p<0.05

⁺Maternal Quartiles (mean week 14 and 35) (n=156) (mean, min-max range): Q1 =28.8 (12.8-36.09%), Q2=40.7 (36.10-45.23%), Q3=49.6 (45.24-54.73%), Q4=61.2 (54.74-75.25%);

⁺⁺Neonatal Quartiles (n=126) (mean week 14 and 25, min-max range): Q1=31 (13.5-36.4%, Q2=32(36.6-45.96%), Q3=32(45.97-54.78%), Q4=31(54.79-75.25%)

G1 = unprocessed foods, G2= minimally processed culinary ingredients, G3= processed foods, G4= ultra-processed foods;

%= contribution to total energy intake; kcals=kilocalorie; HEI=Healthy Eating Index

Table 2

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
Parity^b	-0.15	-0.06	0.12	0.03	-0.05	0.14
Race^c	-0.24	0.12	0.02	0.07	0.17	-0.14
Income^c	0.03	0.04	-0.12	-0.02	0.006	-0.13
College^c	0.17	-0.08	-0.20	-0.14	-0.07	-0.24
Group^c	-0.21	0.19	0.06	-0.16	-0.12	-0.08
Offspring⁺⁺
Length^a (cm)	--	0.79	0.57	0.76	0.81	0.44
Age^a (years)	--	-0.03	-0.07	-0.01	0.02	-0.09
Sex^c	--	-0.32	-0.32	-0.36	-0.32	0.24

[i] ^a=Pearson correlation; ^b=partial correlation ^c=biserial correlation

Bold type: Statistically significant correlation =p<0.05

BMI: body mass index; HEI: Healthy Eating Index, Parity: 1, 2, 3+; Race: white or nonwhite Income: <$75,000, >$75,000; College: yes, no;

Group: lifestyle intervention or usual care; Obesity: with overweight but no obesity, obesity; Sex: male or female

Table 3

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
Adjusted^a2	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
Adjusted^a3	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
Adjusted^a4	.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
Adjusted^a5	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
Adjusted^a6	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
Adjusted^a7	.350	.29	.41	.340	.28	.40	.351	.29	.41	.327	.26	.39	0.482

[i] ^a Model marginal means and confidence intervals presented with Bonferroni correction

¹Maternal Quartiles (n=156) (mean, min-max range) 45.1% (12.8-75.25): Q1 =39 (12.8-36.09%), Q2=39 (36.10-45.23%), Q3=39 (45.24-54.73%), Q4=39 (54.74-75.25%); Neonatal Quartiles (n=126) (mean, min-max range): Q1=31 (13.5-36.4%, Q2=32(36.6-45.96%), Q3=32(45.97-54.78%), Q4=31(54.79-75.25%)

²Gestational Weight Gain (GWG) adjusted for group assignment (reference is Usual Care) and obesity (reference is with overweight but not obesity)

³Lean Mass adjusted for sex (reference is male), length (cm) and group (reference is Usual Care)

⁴Fat Mass (QMR) adjusted for college (reference is no) length (cm) and sex (reference is male)

⁵Total Body Water (TBW) adjusted for length (cm) and sex (reference is male)

⁶Fat Free Mass (FFM) adjusted for length (cm) and sex (reference is male)

⁷Fat Mass (ADP) adjusted for college (reference is no) length (cm) sex (reference is male

Supplementary Table 1

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	-0.616^a	0.539
Gestational Age at Randomisation (weeks)	14.41 ± .753	14.43 ± .795	0.144^a	0.886
Height (cm)	164.58± 5.43	163.80 ± 6.78	-0.973^a	0.431
Weight (kg)	80.88 ± 12.14	83.24 ± 15.86	1.049^a	0.296
Mean BMI Categories (kg/m²)	29.86 ± 3.88	31.0 ± 5.4	1.551^a	0.117
>24.9	54 (65.1%)	41 (55.4%)	1.783^c	0.182
>29.9	29 (34.9%)	33 (44.6%)
Parity			3.042^c	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			1.208^c	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			1.967^d	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			1.416^c	0.291
No	17 (20.7%)	10 (13.5%)
Yes	65 (79.3%)	64 (86.5%)

[i] No between group differences existed at baseline in parent study¹⁸

a = t statistic reported, b = 2xc chi square reported, c = rx2 chi square reported, d = rx2 Fischers reported

Supplementary Table 2

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	2.658^a	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	1.865^a	271.8±148.4	0.069
Healthy Eating Index (HEI) 2010 Score (0-100)	56.69 ±14.31	56.09 ±16.32	-0.245^a	-0.60±2.45	0.807
Total Fruit (0-5)^c	3.47±1.88	3.39±1.98	2999^b	-0.78±0.31	0.896
Whole Fruit (0-5)^c	3.47±2.13	3.12±2.19	3289^b	-0.35±0.35	0.318
Solid Fats, Alcohol, Added Sugars (SOFAAS) (0-10)^d	14.06±5.07	13.51±6.01	2511^b	-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	0.227^a	37.3±164.3	0.837
HEI 2010 Score	62±16	55.8±15.5	-2.465^a	-6.23±2.52	0.015*
Total Fruit^c	3.83±1.69	3.05±1.96	3735^b	-0.83±0.29	0.009*
Whole Fruit^c	3.87±2	3.00±2.24	3764^b	-0.79±0.34	0.004*
SOFAAS^d	14.53±5.67	12.8±5.67	3624^b	-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

[i] a = t statistic reported, b =Mann Whitney u distribution reported, c= scored in context of adequacy where the relationship to the HEI total score is positive d= scored in context of moderation where the relationship to HEI total score is negative

Supplementary Table 3

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

[i] FM: Fat mass; FFM: Fat-free mass;

LM: Lean mass

TBW: Total body water

Supplementary Table 4

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

Maternal⁺	GWG N=156		Mean Difference ±SE	p
Maternal⁺	<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

G1 = unprocessed foods, G2= minimally processed culinary ingredients, G3= processed foods, G4= ultra-processed foods;

%= contribution to total energy intake;

Supplementary Table 5

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

	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

[i] G1 = unprocessed foods, G2= minimally processed culinary ingredients, G3= processed foods, G4= ultra-processed foods;

^a Maternal Quartiles (mean week 14 and 35) (n=156) (mean, min-max range): Q1 =28.8 (12.8-36.09%), Q2=40.7 (36.10-45.23%), Q3=49.6 (45.24-54.73%), Q4=61.2 (54.74-75.25%);

%= contribution to total energy intake; Kcal=kilocalorie; HEI=healthy eating index;

*Statistically significant mean difference between week 14 and 35: p<0.05 (t-test)

References

Authors

Metrics

Articles in this issue

DOI: https://doi.org/10.34763/jmotherandchild.20212504.d-21-00025 | Journal eISSN: 2719-535X | Journal ISSN: 2719-6488

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Language: English

Page range: 244 - 259

Submitted on: Oct 25, 2021

Accepted on: Jan 5, 2022

Published on: Mar 23, 2022

Published by: Institute of Mother and Child

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

neonatal body composition,

quantitative magnetic resonance,

ultra-processed food,

gestational weight gain

Related subjects:

Medicine,

Clinical medicine,

Pediatrics and juvenile medicine,

Paediatric haematology and oncology,

Public health

© 2022 Kathryn Whyte, Isobel Contento, Randi Wolf, Laura Guerra, Euridice Martinez, Xavier Pi-Sunyer, Dympna Gallagher, published by Institute of Mother and Child
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 25 (2021): Issue 4 (December 2021)

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

Figures & Tables

Figure 1

Table 1