Food and nutrient intake and adherence to dietary recommendations during pregnancy: a Nordic mother–child population-based cohort
Background: A woman’s food intake during pregnancy has important implications not only for herself but also for the future health and well-being of her child. Suboptimal dietary quality has been consistently reported in many high-income countries, reflecting poor adherence to dietary guidelines.
Objective: This study aimed to explore the intake of food and nutrients in a cohort of pregnant women in Norway and their adherence to Nordic Nutrition Recommendations (NNR) and Norwegian food-based guidelines (NFG).
Design: We investigated the dietary intake in 1,674 pregnant women from the mother–child birth cohort, PreventADALL, recruited at approximately 18-week gestational age. Dietary intake was assessed by an electronic validated food frequency questionnaire (PrevFFQ) in the first half of pregnancy.
Results: Total fat intake was within the recommended intake (RI) range in most women; however, the contribution of saturated fatty acids to the total energy intake was above RI in the majority (85.2%) of women. Carbohydrate intake was below RI in 43.9% of the women, and 69.5% exceeded the RI of salt. Intakes of fiber, vegetables, and fish were high in a large part of the population. Many women had a high probability of inadequate intakes of the following key micronutrients during pregnancy: folate (54.4%), iron (49.6%), calcium (36.2%), vitamin D (28.7%), iodine (24.4%), and selenium (41.3%). A total of 22.8% women reported an alcohol intake of >1 g/day, and 4.4% reported an alcohol intake of >10 g/day. Women with higher educational levels showed a tendency towards healthier eating habits, except for higher intakes of alcohol and coffee, compared to women with lower educational level.
Discussion: Excessive saturated fat intake and limited intake of many important micronutrients during pregnancy were common, potentially increasing the risk for adverse pregnancy and birth outcomes.
Conclusions: This study highlights the need for improved nutritional guidance to pregnant women across all educational levels.
- GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. 2019. doi: 10.1016/S0140-6736(19)30041-8.
- World Health Organization. Global strategy on diet, physical activity and health (diet) 2016. Available from: http://www.who.int/dietphysicalactivity/diet-overview/en/ [cited 6 September 2019].
- Food and Agriculture Organization of the United Nations. Food-based dietary guidelines 2018. Available from: http://www.fao.org/nutrition/education/food-dietary-guidelines/regions/europe/en/ [cited 4 September 2019].
- World Health Organization. Healthy diet 2018 [updated 23 October 2018]. Available from: http://www.who.int/news-room/fact-sheets/detail/healthy-diet [cited 6 September 2019].
- The Norwegian Directorate of Health. Nutrition recommendations from the Norwegian Directorate of Health 2016 [updated 24 October 2016]. Available from: https://helsedirektoratet.no/folkehelse/kosthold-og-ernering/kostrad-fra-helsedirektoratet [cited 3 April 2019].
- The Norwegian Directorate of Health. Kostråd for å fremme folkehelsen og forebygge kroniske sykdommer; Metodologi og vitenskapelig kunnskapsgrunnlag. Oslo, Norway: The Norwegian Directorate of Health; 2011.
- Nordic Nutrition Recommendations 2012. Integrating nutrition and physical activity: Nordic Council of Ministers; 2014. Available from: https://norden.diva-portal.org/smash/get/diva2:704251/FULLTEXT01.pdf [cited 1 September 2019].
- Johansson L. NORKOST 1993-94 Landsomfattende kostholdsundersøkelse blant menn og kvinner i alderen 16-79 år (National dietary survey among men and women aged 16–79 years). Oslo: National Nutrition Council; 1997.
- Johansson L, Solvoll K. Norkost 1997. Landsomfattende kostholdsundersøkelse blant menn og kvinner i alderen 16-79 år (National dietary survey among males and females, 16–79 years). Oslo: National nutrition and physical education council; 1999; Publication No 2.
- Totland TH, Melnæs BK, Lundberg-Hallén N, Helland-Kigen KM, Lund-Blix NA, Myhre JB, et al. Norkost 3 En landsomfattende kostholdsundersøkelse blant menn og kvinner i Norge i alderen 18-70 år, 2010–11. Oslo, Norway Helsedirektoratet; 2012.
- The Institute for Health Metrics and Evaluation (IHME). Diet 2017. Available from: http://www.healthdata.org/diet [cited 15 February 2019].
- World Health Organization E. Nutrition 2019. Available from: http://www.euro.who.int/en/health-topics/disease-prevention/nutrition [cited 4 March 2019].
- Statistics Norway (SSB). Population 2019 [updated 20 August 2019]. Available from: https://www.ssb.no/en/befolkning/statistikker/folkemengde/aar-per-1-januar [cited 23 October 2019].
- Statistics Norway (SSB). Educational attainment of the population 2019 [updated 20 June 2019]. Available from: https://www.ssb.no/en/utdanning/statistikker/utniv/aar [cited 23 October 2019].
- Jacobsen BK, Eggen AE, Mathiesen EB, Wilsgaard T, Njølstad I. Cohort profile: the Tromsø Study. Int J Epidemiol 2011; 41: 961–7. doi: 10.1093/ije/dyr049.
- Tromsøundersøkelsen. Om Tromsøundersøkelsen 2017 [updated 29 August 2017]. Available from: https://uit.no/forskning/forskningsgrupper/sub?p_document_id=367276&sub_id=377965 [cited 20 September 2017].
- Carlsen MH, Lillegaard IT, Karlsen A, Blomhoff R, Drevon CA, Andersen LF. Evaluation of energy and dietary intake estimates from a food frequency questionnaire using independent energy expenditure measurement and weighed food records. Nutr J 2010; 9(1): 37. doi: 10.1186/1475-2891-9-37.
- Carlsen MH, Blomhoff R, Andersen LF. Intakes of culinary herbs and spices from a food frequency questionnaire evaluated against 28-days estimated records. Nutr J 2011; 10(1): 50. doi: 10.1186/1475-2891-10-50.
- Carlsen MH, Karlsen A, Lillegaard IT, Gran JM, Drevon CA, Blomhoff R, et al. Relative validity of fruit and vegetable intake estimated from an FFQ, using carotenoid and flavonoid biomarkers and the method of triads. Br J Nutr 2011; 105(10): 1530–8. doi: 10.1017/S0007114510005246.
- Matportalen. Old tables – The Norwegian Food Compostion Table 2015. Matportalen no. 2015. Available from: https://www.matportalen.no/verktoy/the_norwegian_food_composition_table/old_tables [cited 13 October 2019].
- UiT The Arctic University of Norway. EUTRO - Forskningsdata i system 2017. Available from: https://uit.no/forskning/forskningsgrupper/gruppe?p_document_id=525017 [cited 5 April 2019].
- Grimby G, Börjesson M, Jonsdottir I, Schnohr P, Thelle D, Saltin B. The ‘Saltin–Grimby Physical Activity Level Scale’ and its application to health research. Scand J Med Sci Spor 2015; 25(S4): 119–25. doi: 10.1111/sms.12611.
- The Norwegian Directorate of Health. Nutrient recommendations 2016 [updated 8 November 2016]. Available from: https://helsedirektoratet.no/folkehelse/kosthold-og-ernering/neringsstoffanbefalinger [cited 20 September 2019].
- Black AE. Critical evaluation of energy intake using the Goldberg cut-off for energy intake: basal metabolic rate. A practical guide to its calculation, use and limitations. Int J Obesity 2000; 24(9): 1119–30. doi: 10.1038/sj.ijo.0801376.
- Freedman LS, Commins JM, Moler JE, Arab L, Baer DJ, Kipnis V, et al. Pooled results from 5 validation studies of dietary self-report instruments using recovery biomarkers for energy and protein intake. Am J Epidemiol 2014; 180(2): 172–88. doi: 10.1093/aje/kwu116.
- Brouns F. Overweight and diabetes prevention: is a low-carbohydrate–high-fat diet recommendable? Eur J Nutr 2018; 57(4): 1301–12. doi: 10.1007/s00394-018-1636-y.
- Johansson I, Nilsson LM, Stegmayr B, Boman K, Hallmans G, Winkvist A. Associations among 25-year trends in diet, cholesterol and BMI from 140,000 observations in men and women in Northern Sweden. Nutr J 2012; 11(1): 40. doi: 10.1186/1475-2891-11-40.
- Ewers B, Trolle E, Jacobsen SS, Vististen D, Almdal TP, Vilsboll T, et al. Dietary habits and adherence to dietary recommendations in patients with type 1 and type 2 diabetes compared with the general population in Denmark. Nutrition 2019; 61: 49–55. doi: 10.1016/j.nut.2018.10.021.
- Jonsdottir SE, Brader L, Gunnarsdottir I, Kally Magnusdottir O, Schwab U, Kolehmainen M, et al. Adherence to the Nordic Nutrition Recommendations in a Nordic population with metabolic syndrome: high salt consumption and low dietary fibre intake (The SYSDIET study). Food Nutr Res 2013; 57:1, 21391. doi: 10.3402/fnr.v57i0.21391.
- Rippin HL, Hutchinson J, Jewell J, Breda JJ, Cade JE. Adult Nutrient Intakes from Current National Dietary Surveys of European Populations. Nutrients 2017; 9(12):1288. doi: 10.3390/nu9121288.
- Fondell E, Christensen SE, Balter O, Balter K. Adherence to the Nordic Nutrition Recommendations as a measure of a healthy diet and upper respiratory tract infection. Public Health Nutr 2011; 14(5): 860–9. Available from: https://dx.doi.org/10.1017/S136898001000265X.
- Vinas BR, Barba LR, Ngo J, Gurinovic M, Novakovic R, Cavelaars A, et al. Projected prevalence of onadequate nutrient intakes in Europe. Ann Nutr Metab 2011; 59(2–4): 84–95. doi: 10.1159/000332762.
- Nasjonalt råd for ernæring: Meyer H, Brunvand L, Brustad M, Holvik K, Johansson L, Paulsen J. Tiltak for å sikre en god vitamin D-status i befolkningen (Proposals to secure a good vitamin D-status in the population), Rapport IS-1408. Norwegian Nutrition Council Oslo; Norway: Norwegian Nutrition Council; 2006.
- ter Borg S, Verlaan S, Hemsworth J, Mijnarends DM, Schols JM, Luiking YC, et al. Micronutrient intakes and potential inadequacies of community-dwelling older adults: a systematic review. Br J Nutr 2015; 113(8): 1195–206. doi: 10.1017/S0007114515000203.
- Stea TH, Lillegaard ITL, Frøyland L, Haugen M, Henjum S, Løvik M, et al. Assessment of dietary intake of nicotinic acid and nicotinamide in relation to tolerable upper intake levels. Opinion of the Panel on Nutrition, Dietetic Products, Novel Food and Allergy of the Norwegian Scientific Committee for Food Safety. VKM Report 2017: 27. Oslo, Norway: Norwegian Scientific Committee for Food Safety; 2017. Report No.: 8282592846.
- Blomhoff R, Beckman-Sundh U, Brot C, Solvoll K, Steingrimsdóttir L, Carlsen MH. Health risks related to high intake of preformed retinol (vitamin A) in the Nordic countries. Copenhagen: Nordic Council of Minsters; 2003.
- Jacobsen BK, Thelle DS. The Tromsø Heart Study: responders and non-responders to a health questionnaire, do they differ? Scand J Soc Med 1988; 16(2): 101–4. doi: 10.1177/140349488801600207.
- Knudsen AK, Hotopf M, Skogen JC, Overland S, Mykletun A. The health status of nonparticipants in a population-based health study: the Hordaland Health Study. Am J Epidemiol 2010; 172(11): 1306–14. doi: 10.1093/aje/kwq257
- Langhammer A, Krokstad S, Romundstad P, Heggland J, Holmen J. The HUNT study: participation is associated with survival and depends on socioeconomic status, diseases and symptoms. BMC Med Res Methodol 2012; 12(1): 143. doi: 10.1186/1471-2288-12-143.
Authors retain copyright of their work, with first publication rights granted to SNF Swedish Nutrition Foundation. Read the full Copyright- and Licensing Statement.