Associação do índice inflamatório da dieta materna com o estado nutricional do binômio mãe-bebê e composição de ácidos graxos no leite humano nos primeiros seis meses pós-parto: um estudo de coorte

Abstract

Introduction: The impact of inflammatory foods consumption, during pregnancy and lactation, on child growth is still poorly studied. However, in recent years, the ability to modulate inflammation through the diet has gained notoriety with the use of the Energy-Adjusted Diet Inflammatory Index (E-DII®), which is an important research tool. Objective: To evaluate the possible associations of E-DII® with food consumption during the gestational period and the evolution of the nutritional status of the mother-infant dyad and the lipid profile of human milk (HM) in the first six months postpartum. Methods: Cohort study with 260 postpartum women (19-43 years old) and their babies, recruited from June/2018 to June/2019 in a reference maternity hospital in Minas Gerais, Brazil. Sociodemographic, gestational and anthropometric data of the dyad were obtained in the immediate postpartum period and in six consecutive monthly meetings. A food frequency questionnaire was applied at baseline and used to calculate the E-DII® score, considering 27 food parameters. Mature HM was collected, analyzed by gas chromatography coupled with mass spectrometry and the Rose Gottlib method. Kruskal-Wallis, Mann-Whitney, T-student, chi-square, binary and multinomial logistic regression models and generalized estimation equations were applied. Results: At baseline, the highest quartile of the E-DII® was associated with a greater chance of high consumption of ultra-processed foods (odds ratio [OR] 1.15; 95% confidence interval [CI] 1.10-1, 20) and processed products (OR 1.07; 95%CI 1.02-1.13), after adjustments for age, marital status, family income, weight gain adequacy and prenatal consultations. In the cohort, women with the highest median E-DII® had lower adherence to physical activity during pregnancy (p=0.027), higher frequency of cesarean delivery (p=0.024) and higher body mass index over time (p< 0.001). At the end of the 6th month, 35 women with their babies remained in the study. Regarding HM, 151 analyzes were performed, detecting in the 3rd meeting a higher percentage of fat among those with the highest median of E-DII® (4.27±1.98 vs 3.75 ±2.48; p=0.003). No associations were identified between maternal E-DII® and the evolution of child nutritional status. Conclusion: The consumption of a food with greater inflammatory potential during pregnancy was associated with a greater chance of consuming ultra-processed and processed foods and changes in the evolution of maternal nutritional status and in the stability of the HM lipid profile. Guidelines based on unprocessed, minimally processed and with good sources of fatty acids, are necessary in order to contribute to the inflammatory modulation of the diet and enable better outcomes in maternal and child health.