Effects of dietary counseling on vitamin and mineral intakes of pregnant women in Finland
Liu, Yangbo (2019)
Liu, Yangbo
2019
Master's Degree Programme in Public and Global Health
Yhteiskuntatieteiden tiedekunta - Faculty of Social Sciences
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Hyväksymispäivämäärä
2019-11-26
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:tuni-201911045684
https://urn.fi/URN:NBN:fi:tuni-201911045684
Tiivistelmä
Background: Micronutrient status during pregnancy is considered to be critical to maternal health, fetal health, and childbirth outcomes; it also related to the risk of chronic diseases in offspring. Even with the improving recognition of gestational nutritional needs, micronutrient malnutrition still is a public health challenge for pregnant women even in Finland. With adequate dietary counseling and intervention, the gestational micronutrient intake could possibly be optimized effectively
Aim of the study: The main aim of this study is to examine the effects of the dietary counseling on the changes in vitamin and mineral intake from 8 to 12 weeks’ gestation to 36 to 37 weeks’ gestation among women at increased risk for gestational diabetes mellitus (GDM) in Finland. Another aim of this study is to compare the percentage of women who fulfill the Nordic Nutrition Recommendations 2012 for these nutrients in the intervention and the usual care groups at 36 to 37 weeks’ gestation.
Methods: The data for this study was drawn from the cluster-randomized controlled trial NELLI, which is conducted in primary health care maternity clinics of 14 municipalities southern in Finland in 2007–2009. NELLI study aimed to prevent GDM by counseling on diet, physical activity, and gestational weight gain during pregnancy among pregnant women with a high risk of GDM. The general objective of the dietary intervention was to help participants achieve a healthy diet based on Finnish dietary recommendations. The clinic nurses used counseling cards to standardize counseling; the participants used the followed-up notebooks to keep a record of the dietary plan and the adherence. A validated 181-item food frequency questionnaire (FFQ) was used for evaluating participants’ dietary habits.
Statistical analyses for descriptive information of different variables and the percentage comparison were performed in SPSS software. STATA statistical software was used in calculating the energy-adjusted micronutrient intake variables and analyzing differences in changes of intakes of vitamin and mineral’s outcomes from baseline to 36–37 weeks gestation between the intervention group and usual care group. The between-group difference in changes was examined using multilevel mixed-effects linear regression models, enabling correction of the results for between-municipality, between-clinic, and between-nurse variation. In each model, the changes were used as the outcome variables and the model of each energy-adjusted intake variable was adjusted first for baseline level of that variable, then second adding the adjustments for maternal age, BMI (both continuous), parity, education, smoking status and working status (all categorical). Percentage comparison of fulfillment in Nordic Nutrition Recommendations 2012 at 36–37 weeks gestation was made between intervention and usual care groups.
Results: The women in the intervention group were more likely to be nulliparous, highly educated, normal weight, non-smokers, and working fulltime than women in the usual care group.
Regarding vitamins, in the fully adjusted model, the between-group difference in change in the intake of betacaroten equivalent was not statistically significant anymore. The between-group difference in change in the intake of niacin equivalent decreased statistically significantly less by 0.33 mg/1000kcal (95%CI -.004 to 1.015, P = 0.04) in the intervention group compared with the usual care group from baseline to 37-37 weeks’ gestation. The between-group difference in change in the intake of folate (95%CI 1.45 to 12.09, P = 0.01), vitamin D (95%CI 0.02 to 0.42, P = 0.01) and vitamin E (95%CI 0.26 to 0.67, P<0.001) were all statistically significantly decreased less in the intervention group compared with the usual care group from baseline to 37-37 weeks’ gestation.
For the minerals, in the fully adjusted model, the mean energy-adjusted intake of magnesium decreased statistically significantly less by 3.56 mg/1000kcal (95%CI 0.20 to 9.96, P = 0.03) in the intervention group compared with the usual care group from baseline to 37-37 weeks’ gestation. The mean energy-adjusted intake of potassium increased statistically significantly more by 38.06 mg/1000kcal (95%CI -3.17 to 124.50, P = 0.05) in the intervention group compared with the usual care group from baseline to 37-37 weeks’ gestation. For other micronutrients, the between-group differences in changes were not statistically significant in the fully adjusted model.
The number (%) of participants fulfilling the recommended intake of vitamin D was 14.4% in the intervention group and 6.5% in the usual care group at 36-37 weeks gestation (P=0.02). Except for folate, magnesium, and selenium, the percentage of women fulfilling the recommendations was slightly higher in the intervention than in the usual care group for most of the nutrients, but the differences were not statistically significant.
Conclusion: This study shows that dietary counseling plays a decisive role in vitamin and mineral intake of pregnant women. The intake of potentially essential micronutrients had increased more or decreased less through dietary counseling during pregnancy using fully adjustment analyze model. After the dietary counseling, for most micronutrients, there were larger numbers (%) of pregnant women at 36–37 weeks gestation fulfilling the NNR in the intervention group compared to the usual care group discovered without statistical significance.
Aim of the study: The main aim of this study is to examine the effects of the dietary counseling on the changes in vitamin and mineral intake from 8 to 12 weeks’ gestation to 36 to 37 weeks’ gestation among women at increased risk for gestational diabetes mellitus (GDM) in Finland. Another aim of this study is to compare the percentage of women who fulfill the Nordic Nutrition Recommendations 2012 for these nutrients in the intervention and the usual care groups at 36 to 37 weeks’ gestation.
Methods: The data for this study was drawn from the cluster-randomized controlled trial NELLI, which is conducted in primary health care maternity clinics of 14 municipalities southern in Finland in 2007–2009. NELLI study aimed to prevent GDM by counseling on diet, physical activity, and gestational weight gain during pregnancy among pregnant women with a high risk of GDM. The general objective of the dietary intervention was to help participants achieve a healthy diet based on Finnish dietary recommendations. The clinic nurses used counseling cards to standardize counseling; the participants used the followed-up notebooks to keep a record of the dietary plan and the adherence. A validated 181-item food frequency questionnaire (FFQ) was used for evaluating participants’ dietary habits.
Statistical analyses for descriptive information of different variables and the percentage comparison were performed in SPSS software. STATA statistical software was used in calculating the energy-adjusted micronutrient intake variables and analyzing differences in changes of intakes of vitamin and mineral’s outcomes from baseline to 36–37 weeks gestation between the intervention group and usual care group. The between-group difference in changes was examined using multilevel mixed-effects linear regression models, enabling correction of the results for between-municipality, between-clinic, and between-nurse variation. In each model, the changes were used as the outcome variables and the model of each energy-adjusted intake variable was adjusted first for baseline level of that variable, then second adding the adjustments for maternal age, BMI (both continuous), parity, education, smoking status and working status (all categorical). Percentage comparison of fulfillment in Nordic Nutrition Recommendations 2012 at 36–37 weeks gestation was made between intervention and usual care groups.
Results: The women in the intervention group were more likely to be nulliparous, highly educated, normal weight, non-smokers, and working fulltime than women in the usual care group.
Regarding vitamins, in the fully adjusted model, the between-group difference in change in the intake of betacaroten equivalent was not statistically significant anymore. The between-group difference in change in the intake of niacin equivalent decreased statistically significantly less by 0.33 mg/1000kcal (95%CI -.004 to 1.015, P = 0.04) in the intervention group compared with the usual care group from baseline to 37-37 weeks’ gestation. The between-group difference in change in the intake of folate (95%CI 1.45 to 12.09, P = 0.01), vitamin D (95%CI 0.02 to 0.42, P = 0.01) and vitamin E (95%CI 0.26 to 0.67, P<0.001) were all statistically significantly decreased less in the intervention group compared with the usual care group from baseline to 37-37 weeks’ gestation.
For the minerals, in the fully adjusted model, the mean energy-adjusted intake of magnesium decreased statistically significantly less by 3.56 mg/1000kcal (95%CI 0.20 to 9.96, P = 0.03) in the intervention group compared with the usual care group from baseline to 37-37 weeks’ gestation. The mean energy-adjusted intake of potassium increased statistically significantly more by 38.06 mg/1000kcal (95%CI -3.17 to 124.50, P = 0.05) in the intervention group compared with the usual care group from baseline to 37-37 weeks’ gestation. For other micronutrients, the between-group differences in changes were not statistically significant in the fully adjusted model.
The number (%) of participants fulfilling the recommended intake of vitamin D was 14.4% in the intervention group and 6.5% in the usual care group at 36-37 weeks gestation (P=0.02). Except for folate, magnesium, and selenium, the percentage of women fulfilling the recommendations was slightly higher in the intervention than in the usual care group for most of the nutrients, but the differences were not statistically significant.
Conclusion: This study shows that dietary counseling plays a decisive role in vitamin and mineral intake of pregnant women. The intake of potentially essential micronutrients had increased more or decreased less through dietary counseling during pregnancy using fully adjustment analyze model. After the dietary counseling, for most micronutrients, there were larger numbers (%) of pregnant women at 36–37 weeks gestation fulfilling the NNR in the intervention group compared to the usual care group discovered without statistical significance.