Índice inflamatório da dieta em gestantes: influência na saúde materno-infantil e correlação com o índice de qualidade da dieta adaptado para gestantes e ingestão de nutrientes

Abstract

Objective: To review the health outcomes associated with the Dietary Inflammatory Index (DII) in pregnant women, and to evaluate the correlation of this instrument with the Diet Quality Index Adapted for Pregnant Women (IQDAG) and nutrient intake during the second and third gestational trimesters. Methods: This dissertation consists of two articles, a systematic review with meta-analysis and a cross-sectional original article. In the review, we included observational studies up to March/2022, in English, Portuguese or Spanish, which investigated DII during pregnancy associated with: gestational diabetes; gestational age at delivery; type of delivery; anthropometry of pregnant women and children up to ten years of age. A search was conducted in the Virtual Health Library; Cochrane; Embase; PubMed; Scopus and Web of Science. Methodological quality was assessed using the Newcastle-Ottawa Scale and the Joanna Briggs Institute Critical Appraisal Tools for Analytical Cross-Sectional Studies. In the original study, we included 260 women recruited in 2018/2019 in a public reference hospital. Socioeconomic, gestational and food consumption data were collected through the Food Frequency Questionnaire (FFQ) referring to the 2nd and 3rd gestational trimesters, enabling the calculation of the IQDAG, energy-adjusted DII (E-DII) and nutrient intake. Results: In the review, 185 studies were evaluated, 16 were included for narrative synthesis and 9 for meta-analysis. Most studies were longitudinal (87.5%), applied FFQ (68.8%) and had high methodological quality. Higher maternal DII was associated with higher risk of small-for-gestational-age babies - SGA (OR: 1.15; 95% CI: 1.08, 1.21; I2: 29%; p = 0.24), low birth weight - LBW (OR: 1.16; 95% CI: 1.06, 1.26; I2: 56%; p = 0.10), and the association with childhood obesity was suggestive (3 of 4 studies). Regarding the original study, the median of the E-DII was 0.04 (-1.30; 1.90) and for the IQDAG it was 68.82 (18.82; 98.22). There was no relevant difference between E-DII tertiles for sociodemographic, gestational, and anthropometric characteristics. The E-DII and the IQDAG showed agreement (55.7%) and inverse correlation (r=-0.53; p<0.001). Each unit increase in IQDAG, iron, iodine, magnesium, pyridoxine, and vitamin E decreased the E-DII score (p<0.05). An increase of one unit in protein, saturated fatty acids and vitamin C increased the E-DII score (p<0.05). Conclusion: A more pro-inflammatory diet during pregnancy was associated with a higher risk of SGA and LBW babies, in addition to a possible correlation with obesity throughout childhood. The E-DII in pregnant women was inversely associated with the IQDAG and with important nutrients during pregnancy, indicating that a pro-inflammatory diet is also of poor-quality diet. This highlights the importance of adequate nutrition during pregnancy for maternal and child health.