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2 Methods for Dietary Assessment During Pregnancy
Pages 5-26

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From page 5...
... (Anna Maria Siega-Riz) • Micronutrient inadequacies during pregnancy are common despite the high prevalence of the use of dietary supplements.
From page 6...
... Topics included estimating the intake of dietary supplements, perspectives from a nutritional ­phenotyping cohort, a French-Canadian perspective, and analytical methods. CHALLENGES TO ESTIMATING DIET DURING PREGNANCY To set the stage for the speaker presentations, Anna Maria Siega-Riz, dean and professor in the School of Public Health and Health Sciences at the University of Massachusetts Amherst and member of the workshop series planning committee, reviewed pregnancy-specific considerations when assessing diet.
From page 7...
... Siega-Riz turned to discuss a second consideration, which is to determine the number of assessments -- and the timing of their administration -- needed to characterize dietary intake throughout the duration of pregnancy. This time period is shorter than the time periods associated with other diet– disease relationships of high research interest, she pointed out, but multiple assessments conducted at specific time points are important because changes that occur during certain phases of pregnancy influence typical intake of food groups and nutrients.
From page 8...
... ESTIMATING INTAKE OF DIETARY SUPPLEMENTS DURING PREGNANCY Kate Sauder, assistant professor of pediatric nutrition and assistant director for translation research at the Lifecourse Epidemiology of ­Adiposity and Diabetes Center at the University of Colorado, discussed best practices for estimating the intake of dietary supplements during pregnancy. Sauder began by highlighting the importance of considering dietary supplements in pregnancy research, explaining that micronutrient inade­ quacies during this life stage are common.
From page 9...
... Turning to discuss food frequency questionnaires (FFQs) , which she suggested are better suited than 24-hour recalls for accurately capturing episodic dietary supplement use during pregnancy, Sauder explained that interviewers can use an FFQ tool with embedded questions about dietary supplements or an external dietary supplement log.
From page 10...
... Sauder moved on to review limitations that she described as inherent to assessing micronutrient intake from dietary supplements, urging stakeholders to consider these limitations when analyzing, interpreting, and disseminating findings. First, she emphasized that some women are unable or unwilling to accurately report what and how much they consume.
From page 11...
... Widen described the study's methods for assessing weight, body composition, diet, physical activity, and related measures (see Figure 2-1) , emphasizing that participant burden was a key consideration when choosing assessment tools and timing.
From page 12...
... includes both an FFQ and a 24-hour dietary recall, she said, but only the latter is repeated at the second and third study visits in an effort to balance the need to track changes over time with the desire to mitigate participant burden. The study context called for the FFQ to be web based, relatively low in cost, and available in English and Spanish, which led to the choice of the Diet History Questionnaire III (DHQ-III)
From page 13...
... Medications to control nausea are of particular interest, she said, as that information can provide insight into appetite and eating behaviors. The MINT study team also collects general pregnancy information at the third study visit, including information about development of any complications (e.g., gestational diabetes, hypertension, preeclampsia)
From page 14...
... She described a web-based tool to assess dietary intakes, presented information about a study that aimed to validate the tool in pregnant women, shared results from dietary assessments during pregnancy, and offered lessons learned. A self-administered, web-based, 24-hour dietary recall tool for the French-Canadian population (Jacques et al., 2016)
From page 15...
... Its objectives are to validate the web-based, 24-hour dietary recall tool among pregnant women and to assess and measure changes in dietary intakes throughout trimesters and compare intakes with Canadian dietary guidelines. During each trimester of pregnancy, the study used online tools to administer three 24-hour dietary recalls, one 3-day food record, a dietary supplement questionnaire, and other questionnaires to assess nausea, vomiting, and eating behaviors as well as physical activity.
From page 16...
... Similarly, the highest women's intakes of vitamin D and iron from food alone were below the EAR for those micronutrients, but only 20 percent had total intakes below the EAR after adding intakes from dietary supplements. The ANGE investigators also assessed changes in participants' diet quality using the 2007 C-HEI (Savard et al., 2019)
From page 17...
... Beginning with the types of measurement error in self-reported dietary intake (usual intake) , Sotres-Alvarez described random error and systematic error.
From page 18...
... This method estimates distribution for a population or subpopulation, she said, and at least partially corrects bias caused by measurement error in estimated associations between usual dietary intakes and health outcomes. Sotres-Alvarez pointed out a major caveat of the NCI method, which is that it assumes the reference instrument is unbiased of the true usual intake.
From page 19...
... Sotres-Alvarez reviewed methods to account for dietary supplement use in estimates of total usual intake of foods and supplements. No single method exists, she said, explaining that the best method for a given situation is context specific in that it depends on the research question, population characteristics, sample size, and proportion of the population consuming dietary supplements.
From page 20...
... Resources to learn more about these topics include the NCI's measurement error webinar series and dietary assessment primer.3,4 Q & A SESSION Following the four presentations, speakers answered questions from the members of the workshop series planning committee. These questions were about a variety of topics, including dietary supplements when exploring associations between nutrient intakes and outcomes, strategies to address social desirability bias, strength of current reference values for nutritional intake during pregnancy, assessing sugar-sweetened beverage intake during pregnancy, including ethnic- and culture-specific foods and beverages in assessment tools, approaches to account for pregnancy-associated changes in taste preferences, modifying administration of dietary assessment tools based on social factors, using biomarkers and other analytical strategies to improve estimates of usual intake, and choosing complementary assessment tools and combining data.
From page 21...
... Strength of Current Reference Values for Nutritional Intake During Pregnancy Dana Dabelea, professor of epidemiology and pediatrics and director of the Lifecourse Epidemiology of Adiposity and Diabetes Center at the University of Colorado Anschutz Medical Campus, wondered about the strength of current guidelines for intakes of energy, macronutrients, and micronutrients during pregnancy, particularly in light of the ANGE study's results indicating stable intakes of some components. She asked what type of studies would be helpful to support potentially revised recommendations for energy and nutrient needs during pregnancy, including the role that dietary supplements play.
From page 22...
... Morisset noted that her team has not assessed sugar-sweetened beverage intake specifically but could use existing ANGE data to do so in the future. Including Ethnic- and Culture-Specific Foods and Beverages in Assessment Tools Esa Davis, associate professor of medicine and clinical and translational science at the University of Pittsburgh School of Medicine, asked about the diversity of ethnic and cultural foods and beverages in dietary assessment tools.
From page 23...
... Widen reported that her team provides hands-on support and extra assistance to participants with lower levels of education and socioeconomic indicators, but she admitted that the time burden of this approach makes it not feasible to apply to all study participants. Sauder noted that with dietary supplements, participants from all backgrounds can be educated on what constitutes a dietary supplement and encouraged to bring their products to interviews rather than relying on memory.
From page 24...
... Choosing Complementary Assessment Tools and Combining Data Dabelea asked how to approach combining data on the intake of micronutrients from foods and beverages and from dietary supplements when different tools were used to assess those two sources, such as in the context of a large study population. Sotres-Alvarez explained that in addition to the strategy of collecting multiple records for total food and beverage intake, it is ideal to have dietary supplement intake data for the same time period.
From page 25...
... When asked if micronutrients consumed in dietary supplements have the same biological effect if consumed in food, Sauder suggested that most do but emphasized that the amount consumed at one time is an important factor because maximal absorption and storage capability differs among micronutrients. The same attendee also asked how to account for factors that could affect bioavailability, such as interactions between nutrients in a dietary supplement or existence of different chemical compositions for a particular nutrient across supplement brands, particularly in the absence of biomarker data.
From page 26...
... Frequency of Dietary Assessment During Pregnancy With evidence from the ANGE study about stability in intakes over the course of pregnancy, an attendee questioned the necessity of conducting dietary assessment in each trimester. Siega-Riz inferred that if additional evidence indicates that dietary intakes are stable throughout pregnancy, then future studies could reduce participant burden by collecting fewer dietary assessments.


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