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      Nutrient Intake during Pregnancy and Adherence to Dietary Recommendations: The Mediterranean PHIME Cohort

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          Abstract

          Few studies provide a detailed description of dietary habits during pregnancy, despite the central role of nutrition for the health of the mother and offspring. This paper describes the dietary habits, energy and nutrient intake in pregnant women from four countries belonging to the Mediterranean PHIME cohort (Croatia, Greece, Italy and Slovenia) and evaluates their adherence to the European Food Safety Authority (EFSA) recommendations. A total of 1436 women were included in the present analysis. Maternal diet was assessed using a food frequency questionnaire (FFQ). The mean macro and micronutrient intakes were estimated and compared with the dietary reference values (DRVs). The percentage distribution of the 16 food groups in the total intake of each macronutrient was estimated. All women shared a similar diet during pregnancy; almost all the women in the four countries exceeded the DRV for sugars, and the total fat intake was above the DRV in most women in all the countries, as was the contribution of saturated fatty acids (SFAs) to the total energy intake. In all four countries, we observed an increased risk of micronutrient deficiency for iron, folate and vitamin D. Shared guidelines, implemented at both the national and European level, are essential to improve the maternal nutritional status during pregnancy.

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          Preconceptional and maternal obesity: epidemiology and health consequences.

          Obesity in women of reproductive age is increasing in prevelance worldwide. Obesity reduces fertility and increases time taken to conceive, and obesity-related comorbidities (such as type 2 diabetes and chronic hypertension) heighten the risk of adverse outcomes for mother and child if the woman becomes pregnant. Pregnant women who are obese are more likely to have early pregnancy loss, and have increased risk of congenital fetal malformations, delivery of large for gestational age infants, shoulder dystocia, spontaneous and medically indicated premature birth, and stillbirth. Late pregnancy complications include gestational diabetes and pre-eclampsia, both of which are associated with long-term morbidities post partum. Women with obesity can also experience difficulties during labour and delivery, and are more at risk of post-partum haemorrhage. Long-term health risks are associated with weight retention after delivery, and inherent complications for the next pregnancy. The wellbeing of the next generation is also compromised. All these health issues could be avoided by prevention of obesity among women of reproductive age, which should be viewed as a global public health priority. For women who are already obese, renewed efforts should be made towards improved management during pregnancy, especially of blood glucose, and increased attention to post-partum weight management. Effective interventions, tailored to ethnicity and culture, are needed at each of these stages to improve the health of women and their children in the context of the global obesity epidemic.
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            Addressing Current Criticism Regarding the Value of Self-Report Dietary Data.

            Recent reports have asserted that, because of energy underreporting, dietary self-report data suffer from measurement error so great that findings that rely on them are of no value. This commentary considers the amassed evidence that shows that self-report dietary intake data can successfully be used to inform dietary guidance and public health policy. Topics discussed include what is known and what can be done about the measurement error inherent in data collected by using self-report dietary assessment instruments and the extent and magnitude of underreporting energy compared with other nutrients and food groups. Also discussed is the overall impact of energy underreporting on dietary surveillance and nutritional epidemiology. In conclusion, 7 specific recommendations for collecting, analyzing, and interpreting self-report dietary data are provided: (1) continue to collect self-report dietary intake data because they contain valuable, rich, and critical information about foods and beverages consumed by populations that can be used to inform nutrition policy and assess diet-disease associations; (2) do not use self-reported energy intake as a measure of true energy intake; (3) do use self-reported energy intake for energy adjustment of other self-reported dietary constituents to improve risk estimation in studies of diet-health associations; (4) acknowledge the limitations of self-report dietary data and analyze and interpret them appropriately; (5) design studies and conduct analyses that allow adjustment for measurement error; (6) design new epidemiologic studies to collect dietary data from both short-term (recalls or food records) and long-term (food-frequency questionnaires) instruments on the entire study population to allow for maximizing the strengths of each instrument; and (7) continue to develop, evaluate, and further expand methods of dietary assessment, including dietary biomarkers and methods using new technologies.
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              Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes

              Both low and high gestational weight gain have been associated with adverse maternal and infant outcomes, but optimal gestational weight gain remains uncertain and not well defined for all prepregnancy weight ranges.
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                Author and article information

                Contributors
                Role: Academic Editor
                Role: Academic Editor
                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                24 April 2021
                May 2021
                : 13
                : 5
                : 1434
                Affiliations
                [1 ]Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health–IRCCS ‘Burlo Garofolo’, via dell’Istria 65/1, 34137 Trieste, Italy; federica.concina@ 123456burlo.trieste.it (F.C.); paola.pani@ 123456burlo.trieste.it (P.P.); claudiaveronica.carletti@ 123456burlo.trieste.it (C.C.); alessandra.knowles@ 123456burlo.trieste.it (A.K.); luca.ronfani@ 123456burlo.trieste.it (L.R.)
                [2 ]Department of Medical Area–DAME, University of Udine, via Colugna 50, 33100 Udine, Italy; maria.parpinel@ 123456uniud.it (M.P.); marika.mariuz@ 123456uniud.it (M.M.); fabio.barbone@ 123456uniud.it (F.B.)
                [3 ]Scientific Direction, Institute for Maternal and Child Health–IRCCS ‘Burlo Garofolo’, via dell’Istria 65/1, 34137 Trieste, Italy; liza.vecchibrumatti@ 123456burlo.trieste.it
                [4 ]Institute of Hygiene and Clinical Epidemiology, Friuli Centrale Healthcare and University Trust, via Colugna 50, 33100 Udine, Italy; francesca.valent@ 123456asufc.sanita.fvg.it
                [5 ]Medical Director’s Office, Azienda Sanitaria Friuli Occidentale, via Piave 54, 33170 Pordenone, Italy; dana.little@ 123456asfo.sanita.fvg.it
                [6 ]Department of Pediatrics, University Hospital Centre Rijeka, Krešimirova 42, 51000 Rijeka, Croatia; oleg@ 123456kbc-rijeka.hr (O.P.); igor.prpic@ 123456medri.uniri.hr (I.P.)
                [7 ]Green Infrastructure Ltd., Fallerovo Setaliste 22, 10000 Zagreb, Croatia; zdravko_spiric@ 123456hotmail.com
                [8 ]Institute of Child Health, “Aghia Sophia” Children’s Hospital, Thivon & Papadiamantopoulou, Goudi, 115 27 Athens, Greece; katsofkat@ 123456hotmail.com
                [9 ]Jozef Stefan Institute, Jamova 39, SI-1000 Ljubljana, Slovenia; darja.mazej@ 123456ijs.si (D.M.); janja.tratnik@ 123456ijs.si (J.S.T.); milena.horvat@ 123456ijs.si (M.H.)
                Author notes
                [* ]Correspondence: valentina.rosolen@ 123456burlo.trieste.it ; Tel.: +39-040-378-5401
                Author information
                https://orcid.org/0000-0002-6777-2924
                https://orcid.org/0000-0003-1292-5564
                https://orcid.org/0000-0003-1309-4467
                https://orcid.org/0000-0001-5710-3914
                https://orcid.org/0000-0001-9000-7684
                https://orcid.org/0000-0002-5483-8955
                https://orcid.org/0000-0001-5897-5271
                Article
                nutrients-13-01434
                10.3390/nu13051434
                8146946
                33923157
                7268524a-da15-4bdd-a64c-695ff4e4b1fa
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 26 February 2021
                : 21 April 2021
                Categories
                Article

                Nutrition & Dietetics
                prospective cohort study,pregnant women,nutrient intake,dietary reference values,food groups,phime

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