Ultra-Processed Foods and Schooling Are Independently Associated with Lower Iron and Folate Consumption by Pregnant Women Followed in Primary Health Care
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Inclusion and Exclusion Criteria
2.3. Data Collect
2.4. Data Analysis
2.5. Ethical Aspects
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | n | % | 95% CI |
---|---|---|---|
Age | |||
20 to 24 years | 71 | 32.7 | 26.77; 39.27 |
25 to 29 years | 55 | 25.3 | 19.97; 31.59 |
30 to 34 years | 53 | 24.4 | 19.13; 30.61 |
≥35 years | 38 | 17.5 | 12.98; 23.18 |
Gestational Period | |||
1st Trimester | 33 | 15.3 | 11.10; 20.84 |
2nd Trimester | 87 | 40.0 | 33.62; 46.72 |
3rd Trimester | 97 | 44.7 | 38.10; 51.39 |
Access to social welfare program | |||
No | 188 | 88.3 | 83.17; 91.96 |
Yes | 25 | 11.7 | 8.03; 16.82 |
Schooling | |||
Elementary School | 33 | 15.4 | 11.15; 20.93 |
High school | 113 | 52.8 | 46.06; 59.43 |
University education | 68 | 31.8 | 25.85; 38.35 |
Self-reported skin color | |||
White | 44 | 20.7 | 15.71; 26.65 |
black/brown | 161 | 75.6 | 69.33; 80.91 |
Asian | 8 | 3.7 | 1.81; 7.35 |
Household Income (USD) | |||
Up to 94.00 | 12 | 5.6 | 3.21; 9.68 |
From 94.00 to 188.00 | 17 | 8.0 | 5.00; 12.49 |
From 188.00 to 566.00 | 96 | 45.1 | 38.47; 51.83 |
Over 566.00 | 59 | 27.7 | 22.07; 34.12 |
Not reported | 29 | 13.6 | 9.60; 18.94 |
Ferrous sulfate supplementation | |||
No | 115 | 54.0 | 31.27; 44.28 |
Yes | 98 | 46.0 | 55.71; 68.72 |
Folic acid supplementation | |||
No | 115 | 54.0 | 47.22; 60.61 |
Yes | 98 | 46.0 | 39.38; 52.77 |
Use of multivitamins | |||
No | 180 | 85.3 | 79.82; 89.49 |
Yes | 31 | 14.7 | 10.50; 20.17 |
Home-made meal frequency | |||
Less than 3 days | 28 | 13.1 | 9.21; 18.41 |
Greater than or equal to 3 days | 185 | 86.9 | 8.15; 9.07 |
Pre-gestational BMI 1 | |||
Underweight | 98 | 49.8 | 42.77; 56.73 |
Eutrophy | 8 | 4.1 | 2.03; 7.94 |
Overweight | 58 | 29.4 | 23.46; 36.22 |
Obesity | 33 | 16.7 | 12.13; 22.66 |
Previous Pregnancy | |||
Primiparous | 72 | 33.8 | 27.73; 40.45 |
Multiparous | 141 | 66.2 | 59.54; 72.26 |
Planned Pregnancy | |||
No | 135 | 62.8 | 56.09; 69.02 |
Yes | 80 | 37.2 | 30.97; 43.90 |
Explanatory Variables | Mean Iron Consumption (mg/1000 kcal/day) | CI 95% | Non-Standard β | CI 95% | R-Squared | p-Value |
---|---|---|---|---|---|---|
Age | 0.0184 | |||||
20 to 24 years | 5.30 | 5.00; 5.60 | (reference) | |||
25 to 29 years | 5.07 | 4.68; 5.46 | −0.23 | −0.74; 0.28 | 0.374 | |
30 to 34 years | 5.59 | 5.08; 6.10 | 0.29 | −0.23; 0.81 | 0.277 | |
≥35 years | 5.14 | 4.79; 5.49 | −0.16 | −0.74; 0.41 | 0.576 | |
Gestational Period | 0.0050 | |||||
1st Trimester | 5.43 | 4.70; 6.16 | (reference) | |||
2nd Trimester | 5.35 | 5.06; 5.63 | −0.84 | −0.68; 0.51 | 0.782 | |
3rd Trimester | 5.17 | 4.90; 5.44 | −0.26 | −0.85; 0.33 | 0.388 | |
Access to social welfare program | 0.0303 | |||||
No | 5.37 | 5.16; 5.58 | (reference) | |||
Yes | 4.58 | 3.97; 5.19 | −0.79 | −1.40; −0.17 | 0.012 * | |
Schooling | 0.0319 | |||||
Elementary School | 4.67 | 4.19; 5.15 | (reference) | |||
High school | 5.40 | 5.15; 5.65 | 0.73 | 0.16; 1.30 | 0.012 * | |
University education | 5.37 | 4.97; 5.77 | 0.69 | 0.08; 1.31 | 0.026 * | |
Self-reported skin color | 0.0026 | |||||
White | 5.34 | 4.91; 5.77 | (reference) | |||
black/brown | 5.28 | 5.05; 5.52 | −0.60 | −0.56; 0.44 | 0.813 | |
Asian | 4.93 | 4.31;5.55 | −0.41 | −1.52; 0.69 | 0.465 | |
Ferrous sulfate supplementation | 0.0046 | |||||
No | 5.41 | 5.04; 5,77 | (reference) | |||
Yes | 5.20 | 4.97; 5.43 | −0.20 | −0.61; 0.20 | 0.329 | |
Use of multivitamin | 0.0250 | |||||
No | 5.17 | 4.98; 5.36 | (reference) | |||
Yes | 5.81 | 5.03; 6.58 | 0.63 | 0.08; 1.19 | 0.023 * | |
Home-made meal frequency | 0.0007 | |||||
Less than 3 days | 5.18 | 4.68; 5.68 | (reference) | |||
Greater than or equal to 3 days | 5.29 | 5.07; 5.51 | 0.11 | −0.47; 0.69 | 0.38 | |
Pre-gestational BMI 1 | 0.0094 | |||||
Eutrophy | 5.38 | 5.04; 5.71 | (reference) | |||
Low weight | 5.03 | 4.22; 5.83 | −0.35 | −1.41; 0.71 | 0.516 | |
overweight | 5.07 | 4.76; 5.39 | −0.30 | −0.79; 0.17 | 0.214 | |
Obesity | 5.30 | 4.83; 5.76 | −0.08 | −0.66; 0.50 | 0.784 | |
Previous Pregnancy | 0.0056 | |||||
Primiparous | 5.41 | 5.12; 5.71 | (reference) | |||
Multiparous | 5.18 | 4.92; 5.44 | −0.22 | −0.64; 0.18 | 0.281 | |
Planned Pregnancy | 0.0151 | |||||
No | 5.14 | 4.92; 5.37 | (reference) | |||
Yes | 5.51 | 5.15; 5.87 | 0.36 | −0.03; 0.77 | 0.075 * | |
Energy intake by quintiles of UPF 2 (% of total energy intake) | 0.1316 | |||||
Q1 | 5.57 | 5.00; 6.14 | (reference) | |||
Q2 | 5.97 | 5.59; 6.35 | 0.39 | −0.17; 0.97 | 0.173 | |
Q3 | 5.13 | 4.79; 5.47 | −0.44 | −1.01; 0.13 | 0.132 | |
Q4 | 5.31 | 4.95; 5.67 | −0.26 | −0.84; 0.31 | 0.373 | |
Q5 | 4.40 | 4.06; 4.73 | −1.17 | −1.75; −0.59 | <0.001 ** |
Explanatory Variables | Mean Folate Consumption (mg/1000 kcal/day) | CI 95% | Non-Standard β | CI 95% | R-Squared | p-Value |
---|---|---|---|---|---|---|
Age | 0.0087 | |||||
20 to 24 years | 184.58 | 164.78; 204.38 | (reference) | |||
25 to 29 years | 196.84 | 171.67; 222.02 | 12.26 | −17.46; 41.98 | 0.417 | |
30 to 34 years | 204.48 | 181.93; 227.04 | 19.90 | −10.64; 50.44 | 0.200 | |
≥35 years | 189.45 | 167.58; 211.32 | 4.86 | −28.66; 38.39 | 0.775 | |
Gestational Period | 0.0171 | |||||
1st Trimester | 169.13 | 139.65; 198;60 | (reference) | |||
2nd Trimester | 202.29 | 183.71; 220.87 | 33.16 | −1.30; 67.62 | 0.059 | |
3rd Trimester | 192.72 | 176.46; 208.97 | 23.59 | −10.42; 57.60 | 0.173 | |
Access to social welfare program | 0.0064 | |||||
No | 195.69 | 183.96; 207.42 | (reference) | |||
Yes | 174.69 | 132.18; 217.2 | −20.99 | −56.88; 14.88 | 0.250 | |
Schooling | 0.0185 | |||||
Elementary School | 168.57 | 139.71; 197.43 | (reference) | |||
High school | 201.22 | 184.81; 217.64 | 32.65 | −0.28; 65.59 | 0.052 | |
University education | 190.69 | 172.48; 208.89 | 22.11 | −13.49; 57.73 | 0.222 * | |
Self-reported skin color | 0.0081 | |||||
White | 189.32 | 164.04; 214.60 | (reference) | |||
black/brown | 195.43 | 182.05; 208.82 | 6.11 | −22.63; 34.86 | 34.86 | |
Asian | 157.01 | 120.86; 193.15 | −32.31 | −96.18; 31.56 | 31.56 | |
Folic acid supplementation | 0.0123 | |||||
No | 184.65 | 170.01; 199.29 | (reference) | |||
Yes | 203.30 | 185.39; 221.21 | 18.64 | −4.27; 41.57 | 0.110 | |
Use of multivitamin | 0.0005 | |||||
No | 193.91 | 181.14; 206.68 | (reference) | |||
Yes | 188.43 | 161.04; 215.82 | −5.48 | −37.95; 26.98 | 0.739 | |
Home-made meal frequency | 0.0114 | |||||
Less than 3 days | 170.25 | 144.78; 195.73 | (reference) | |||
Greater than or equal to 3 days | 196.51 | 183.90; 209.126 | 26.25 | −7.27; 59.79 | 0.124 | |
Pre-gestational BMI 1 | 0.0103 | |||||
Eutrophy | 197.38 | 180.72; 214.05 | (reference) | |||
Low weight | 158.55 | 110.78; 206.23 | −38.83 | −99.42; 21.75 | 0.208 | |
overweight | 187.42 | 164.68; 210.15 | −9.96 | −37.69; 17.75 | 0.479 | |
Obesity | 197.12 | 168.07; 226.18 | −0.26 | −33.51; 32.99 | 0.988 | |
Previous Pregnancy | 0.0000 | |||||
No | 193.86 | 175.78; 211;94 | (reference) | |||
Yes | 192.91 | 178.14; 207.69 | −0.94 | −25.14; 23.25 | 0.939 | |
Planned Pregnancy | 0.0186 | |||||
No | 184.27 | 170.58; 197.96 | (reference) | |||
Yes | 207.73 | 188.104; 227.44 | 23.50 | 0.17; 46.82 | 0.048 * | |
Energy intake by quintiles of UPF 2 (% of total energy intake) | 0.0788 | |||||
Q1 | 210.99 | 184.64; 237.35 | (reference) | |||
Q2 | 217.47 | 189.69; 245.24 | 6.47 | −27.56; 40.50 | 0.708 | |
Q3 | 201.20 | 179.19; 223.22 | −9.79 | −44.02; 24.43 | 0.573 | |
Q4 | 183.10 | 158.54; 207.66 | −27.89 | −62.33; 6.53 | 0.112 | |
Q5 | 152.57 | 133.37; 171.78 | −58.42 | −92.85; −23.98 | 0.001 * |
Explanatory Variables | Non-Standard β | CI 95% | Standardized β | p-Value |
---|---|---|---|---|
Schooling | ||||
Elementary School | (reference) | |||
High school | 0.74 | 0.20; 1.28 | 0.25 | 0.007 * |
University education | 0.40 | −0.20; 1.02 | 0.12 | 0.191 |
Energy intake by quintiles of UPF (% of total energy intake) | ||||
Q1 | (reference) | |||
Q2 | 0.37 | −0.20; 0.95 | 0.10 | 0.203 |
Q3 | −0.30 | −0.89; 0.28 | −0.08 | 0.314 |
Q4 | −0.22 | −0.81; 0.37 | −0.06 | 0.461 |
Q5 | −1.15 | −1.74; 0.55 | −0.31 | <0.001 ** |
Explanatory Variables | Non-Standard β | CI 95% | Standardized β | p-Value |
---|---|---|---|---|
Schooling | ||||
Elementary School | (reference) | |||
High school | 38.95 | 6.96; 70.95 | 0.23 | 0.017 * |
University education | 24.88 | −11.48; 61.26 | 0.13 | 0.179 |
Gestational Period | ||||
1st Trimester | (reference) | |||
2nd Trimester | 39.44 | 5.58; 73.30 | 0.22 | 0.023 * |
3rd Trimester | 24.87 | −8.47; 58.23 | 0.14 | 0.143 |
Planned Pregnancy | ||||
No | (reference) | |||
Yes | 26.88 | 3.58; 50.18 | 0.15 | 0.024 * |
Energy intake by quintiles of UPF (% of total energy intake) | ||||
Q1 | (reference) | |||
Q2 | 4.32 | −30.19; 38.85 | 0.02 | 0.805 |
Q3 | −13.45 | −48.85; 21.94 | −0.06 | 0.454 |
Q4 | −37.69 | −72.91; −2.47 | −0.17 | 0.036 * |
Q5 | −63.23 | −98.32; −28.15 | −0.29 | <0.001 ** |
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Biete, A.; Gonçalves, V.S.S.; Crispim, S.P.; Franceschini, S.C.C.; Carmo, A.S.; Pizato, N. Ultra-Processed Foods and Schooling Are Independently Associated with Lower Iron and Folate Consumption by Pregnant Women Followed in Primary Health Care. Int. J. Environ. Res. Public Health 2023, 20, 6063. https://doi.org/10.3390/ijerph20126063
Biete A, Gonçalves VSS, Crispim SP, Franceschini SCC, Carmo AS, Pizato N. Ultra-Processed Foods and Schooling Are Independently Associated with Lower Iron and Folate Consumption by Pregnant Women Followed in Primary Health Care. International Journal of Environmental Research and Public Health. 2023; 20(12):6063. https://doi.org/10.3390/ijerph20126063
Chicago/Turabian StyleBiete, Amanda, Vivian S. S. Gonçalves, Sandra P. Crispim, Sylvia C. C. Franceschini, Ariene S. Carmo, and Nathalia Pizato. 2023. "Ultra-Processed Foods and Schooling Are Independently Associated with Lower Iron and Folate Consumption by Pregnant Women Followed in Primary Health Care" International Journal of Environmental Research and Public Health 20, no. 12: 6063. https://doi.org/10.3390/ijerph20126063